Browsing by Author "de Silva, S.T."

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Adverse events following COVISHIELD (ChAdOx1nCoV-19) vaccination among health care workers in Sri Lanka; a multi-centre cross sectional survey
(Sri Lanka College of Internal Medicine, 2022) Manilgama, S.R.; Hettiarachchi, N.M.; Jayasinghe, I.K.; de Silva, S.T.; Jayalath, T.; Wanigaratne, T.; Bandusiri, R.P.; Suganthan, N.; Sudarshan, P.; Pathirage, M.; Rajaratnam, N.; Senaratne, G.; Rajapaksha, V.; Wickramasinghe, A.; Ranaweera, S.P.A.L.; Thilakarathna, H.M.A.; Kulaweera, M.T.D.
Introduction: A community vaccination programme is the best approach to combat the COVID-19 pandemic. Post-vaccine surveillance is important to identify adverse events (AE) following COVID-19 vaccination in the population. Methods: A multicentre cross-sectional survey was conducted in six provinces to estimate the prevalence of AE following the first dose of COVISHIELD (ChAdOx1nCoV-19) among all categories of health care workers (HCWs). A self-administered questionnaire was used to gather demographic data and AE. Results: Of 5140 participants 67.8% were females. The mean (SD) age was 40.69 (±9.85) years. At least one comorbidity was reported in 15.4%. At least one AE was reported in 86.6% and 49.3% had local AE. Fever (67.2%), headaches (57.3%), body aches (54.4%), chills (51.2%), fatigue (37.5%) and arthralgia (36%) were the most reported systemic AE. The majority of AE lasted less than 24 hours. Pain and redness at the site were the most reported local AE. Mean duration of onset of fever and pain at injection site from the time of the vaccination was 6.65 and 9.67 hours respectively. When participants were divided into two groups by mean age (≤40 and >40 years) and parameters were compared, most systemic (fever, nausea, fatigue, itching) and all local AE were significantly more prevalent in the ≤40 age group. Two percent had reactions within the first 20 minutes. Anaphylaxis developed in 12 participants. Past history of anaphylaxis, drug or food allergy were reported in 0.6%, 2.8% and 6.7% respectively. However, previous history of allergy was not significantly related to immediate reactions or anaphylaxis following vaccination. Despite having minor AE, 71.1% attended routine work while 0.2% required hospitalisation. Conclusions: While 86.6% reported minor AE, only a few serious AE were reported. Overall, the first dose of the vaccine was well-tolerated by HCWs.
Alcohol use and alcoholic fatty liver disease: a prospective, communitybased study among adults in an urban community in Sri Lanka
(The Sri Lanka Medical Association, 2022) Niriella, M.A.; Kasturiratne, A.; Beddage, T.; de Silva, S.T.; Dassanayake, A.S.; Pathmeswaran, A.; Wickremasinghe, A.R.; Kato, N.; de Silva, H.J.
Background: Data on alcoholic fatty liver (AFL) is limited. Therefore, we investigated alcohol use and AFL in a cohort of adults in an urban community in Sri Lanka. Methods: The study population (selected by age-stratified random sampling) was screened in 2007 (35-64 years) and re-evaluated in 2014. They were assessed by structured interviews, anthropometric measurements, liver-ultrasound, and biochemical and serological tests. AFL was diagnosed on ultrasound criteria, ‘unsafe’ alcohol consumption (Asian standards: males>14 units, females >7 units per week) and absence of hepatitis B/C markers. Controls were unsafe alcohol consumers who had no fatty liver on ultrasound. Results: 2985/3012 (99%) had complete data for analysis. 272/2985 (9.1%) were unsafe-drinkers in 2007 [males-270; mean-age-51.9, SD-8.0 years]. 86/272 (31.6%) had AFL [males-85; mean-age-50.2, SD-8.6 years]. Male gender [p<0.001], increased waist circumference (WC) [OR 4.9, p<0.01], BMI>23kg/m2 [OR 3.5, p<0.01] and raised alanine aminotransferase (ALT) [OR 2.8, p<0.01] were independently associated with AFL. 173/272 (63.6%) unsafe alcohol consumers from 2007 were re-evaluated in 2014. 134/173 had either had AFL or had changed to ‘safe’ or no alcohol consumption. 21/39 (53.8%) [males-21 (100%), meanage- 57.9, SD-7.9 years] who remained ‘unsafe’ alcohol users who had no fatty liver in 2007 developed AFL after 7-years (annual incidence 7.7%). On bivariate analysis, only male gender was associated with new-onset AFL. Of the 42 who had AFL at baseline but changed their drinking status from unsafe to safe or no alcohol, 6 had resolution of fatty liver in 2014. Conclusion: In this community-based study among adults from an urban community, unsafe alcohol use was found in 9.1%. Among unsafe alcohol users, the prevalence of AFL was 31.6% and the annual incidence of AFL was 7.7%. New-onset AFL was independently associated with male gender.
Anthropometric correlates of total body fat, visceral adiposity and cardio-metabolic health risk: a community cohort study of urban, adult Sri Lankans
(Sri Lanka Medical Association, 2016) Niriella, M.A.; de Silva, S.T.; Kasturiratne, A.; Kottachchi, D.; Ranawaka, U.K.; Dassanayake, A.S.; de Silva, A.P.; Pathmeswaran, A.; de Silva, H.J.
INTRODUCTION: Anthropometric measurements (AM) are used as proxies for more direct measurements of body fat (BF) and its distribution. Several studies have examined the association between AM, BF and health outcomes such as cardiovascular risk (CVR). However, correlation of such simple AM and advanced measures of BF and the ability of these to predict CVR has not been studied in community follow up studies. OBJECTIVES: To examine the relationship between simple and advanced anthropometric measurements and their ability to predict cardiovascular risk factors in an urban adult Sri Lankan population. METHOD: The data was collected from a community cohort of adults (aged 42-71 years) selected by age-stratified random sampling from electoral lists of the Medical Officer of Health area, Ragama. Individual simple measurements [body weight, height, waist circumference (WC), hip circumference (HC)], advanced measurements [total body fat (TBF), visceral fat percentage (VFP) by Omron® body fat monitor] and cardiovascular risk factors [blood pressure, HbA1c, triglycerides, low-density (LDL-C), high-density-lipoprotein cholesterol (HDL-C) level, cardio-metabloic risk (CMR) (2 or more risk factors)] were assessed and their relationships were examined. RESULTS: 2155 individuals [1244 (57.7%) women, mean age 59.2 years (SD, 7.7)] participated. Complete data were available for 2000 (92.8%) [1147 (57.4%) women, mean age 59.2 years (SD, 7.7)]. Mean (SD) for anthropometric measurements were: males WC-85.9 (10.8) cm, HC-93.4 (8.0) cm, WHpR (waist-to-hip ratio) -0.92 (0.06), WhtR (waist-to-height ratio) -0.52 (0.06), BMI (body mass index) -23.5 (3.8) kg/m2, TBF -27.0 (5.7)%, VFP -10.7 (5.2)%; females WC -84.8 (10.7) cm, HC-97.2 (9.5) cm, WHpR-0.87(0.08), WhtR-0.52 (0.07), BMI -25.4 (4.4) kg/m2, TBF -38.2 (4.2)%, VFP-9.6 (4.9)%. BMI and WC correlated well with VFP (Pearson’s r for males: 0.94 and 0.85, females: 0.96 and 0.78, respectively). In both sexes, increasing BMI, WC, WHtR, TBF and VFP, were significantly associated with higher risks of hypertension, diabetes, dyslipidemia and combined CMR (ROC area under the curve>0.6). CONCLUSIONS: In this cohort of urban, adult Sri Lanka, simple anthropometric measurements correlated strongly with VFP, and were equally good in predicting cardiovascular risk factors.
Assessing motivation to lose weight: the psychometric properties of the Sinhala version of University of Rhode Island Change Assessment (URICA) scale
(Sri Lanka Medical Association, 2023) Niriella, M.A.; de Silva, S.T.; Hapangama, A.; Baminiwatta, A.; Fernando, R.; Ediriweera, D.
INTRODUCTION: Weight reduction through lifestyle modifications is an important component in the management of various chronic diseases. The degree of motivation to change has been shown to predict outcomes in weight reduction interventions. Thus, the availability of a validated self-report tool assessing the degree of motivation for weight management would be useful for both clinical and research purposes in Sri Lanka. OBJECTIVES: To examine the structural validity and internal consistency of the URICA for weight management in a sample of Sri Lankan adults with chronic medical conditions. METHODS: Standard procedures for cross-cultural adaptation of a questionnaire were followed in translating the 32-item URICA into Sinhala. The Sinhala version was administered to 208 patients aged 18-60 years attending outpatient clinical services for non-disabling chronic medical diseases. Psychometric testing included confirmatory factor analysis and the assessment of internal consistency (Cronbach α). RESULTS: The commonly accepted four-factor structure of URICA reflecting Prochaska and Di Clemente’s transtheoretical model (pre-contemplation, contemplation, action and maintenance) showed good model fit, after the removal of four items from the pre-contemplation subscale due to inadequate factor loadings (<0.4). In line with theory, factor correlations indicated that the pre-contemplation factor was inversely correlated with the other three factors, while the other three factors were positively correlated with one another. All four subscales showed good internal consistency (Cronbach α ranging from 0.73 to 0.89). CONCLUSIONS: The Sinhala version of a modified 28-item URICA was found to have sound psychometric properties as a measure of motivation for weight management among Sinhala-speaking adult patient.
Attitudes of nurses in palliative care – A Sri Lankan study
(Sri Lanka Medical Association, 2016) Silva, F.H.D.S.; Luke, N.; Piyarathne, S.P.M.L.R.; de Silva, S.T.
INTRODUCTION AND OBJECTIVES: Care of terminally ill patients and their families by health care workers (HCW) is variable from person to person. The quality of care is influenced by attitudes that the provider holds towards the concept of palliation. There is no formal education or training of HCW in Sri Lanka. This study aimed to determine the attitudes of nurses towards the dying process of a patient in the context of palliative care. METHOD: Nurses working in general medical and surgical wards and critical care units at the Colombo North Teaching Hospital, Ragama were assessed with the Frommelt Attitudes Towards Care of the Dying (FATCOD) scale (a 30 item, 5 point Likert Scale) using a self administered questionnaire. A total of 105 volunteers (general ward – 53, critical care- 52) participated in this study. RESULTS: The total FATCOD score for nurses in general wards was 107.51 (+/- 12.3) while it was 110.64 (+/-15.4) for critical care nurses (range 30-150). The mean FATCOD score for nurses in general wards was 3.58 (+/- 0.49) while nurses in critical care units achieved 3.68 (+/- 0.52). There were no significant differences of the mean scores with regards to nursing grade or duration of service (p<0.05). Scores related to communication between nurses and patients/carers were observed to be low along with the score on family interference in patient care. CONCLUSIONS: The results of this study demonstrate lower scores in all questions when compared to studies done in developed countries. The importance of developing strategies to improve delivery of palliative care services is paramount.
Burnout among Intern Medical Officers in selected Teaching Hospitals: a cross-sectional descriptive study
(Sri Lanka Medical Association, 2016) de Silva, S.T.; Dahanayaka, N.; Ralapanawa, U.; Nishad, A.A.N.; Silva, F.H.D.S.; Shyamali, N.L.A.; Wanigasuriya, K.
INTRODUCTION: Burnout is characterized by emotional exhaustion, depersonalization and reduced personal accomplishment, occurring due to chronic emotional and interpersonal stressors. Burnout is well recognized among medical doctors. Identifying and, where possible, treating burnout is critical, as it has a major impact on the quality of life of doctors, patient safety and health outcomes. OBJECTIVES: Research on burnout in the medical community of Sri Lanka is scarce. Our objective was to determine the prevalence and risk factors for burnout among intern medical officers (IMOs), who are likely to be at high risk. METHOD: Consenting IMOs in Medical, Surgical, Paediatrics and Obstetric and Gynaecology Units of Teaching Hospitals in Colombo South, Colombo North, Peradeniya, Kandy and Karapitiya were administered three standard, validated, self-administered questionnaires on burnout. RESULTS: 124 IMOs participated; 79(62.9%) were females. Mean age was 27.4 years. Oldenburg Burnout Inventory: 75/124(60.5%) suffered from disengagement, and 77/124(62%) from exhaustion. Abbreviated Maslach Inventory: 47/124(38%) suffered from emotional exhaustion, 20/124(16.1%) from depersonalization, and 6/124(5%) from poor personal accomplishment. Work and lifestyle-related causes (ie heavy and monotonous work-load, lack of control over work-load, chaotic work environment, inadequate rest and sleep, lack of help, and absence of a supportive relationship) were significantly associated with higher burnout scores. CONCLUSIONS: Burnout appears to affect approximately 1 in 3 IMOs in our sample. Most work and lifestyle related risk factors for burnout are modifiable. Further studies are needed to identify causes of burnout among IMOs. A system to detect and treat burnout, particularly among IMOs, is an urgent
The clinical utility of accurate NAFLD ultrasound grading: Results from a community-based, prospective cohort study
(Elsevier Science Ireland Ltd, 2021) Niriella, M.A.; Ediriweera, D.S.; Kasturiratne, A.; Gunasekara, D.; de Silva, S.T.; Dassanayake, A.S.; de Silva, A.P.; Kato, N.; Pathmeswaran, A.; Wickremasinghe, A.R.; de Silva, H.J.
OBJECTIVES: Despite its widespread use there is no consensus on ultrasound criteria to diagnose fatty liver. METHOD: In an ongoing, cohort-study, participants were initially screened in 2007 and reassessed in 2014 by interview, anthropometric measurements, liver ultrasonography, and blood tests. We evaluated utility of increased hepatic echogenicity alone (intermediate) compared to using additional criteria which included signal attenuation and/or vascular blunting along with increase of hepatic echogenicity (moderate-severe), to diagnose fatty liver in NAFLD. We made a comparison of the two radiologically defined groups, in order to choose a classification method for NAFLD, which may better predict baseline adverse metabolic traits (MT), and adverse metabolic and cardiovascular events (CVE) after 7-year of follow-up. RESULTS: Of 2985 recruited in 2007, 940 (31.5 %) had moderate-severe NAFLD, 595 (19.9 %) intermediate NAFLD, and 957 (32.1 %) were controls (no fatty liver). 2148 (71.9 %) attended follow-up in 2014; they included 708 who had moderate-severe NAFLD, 446 intermediate NAFLD and 674 controls, at baseline (in 2007). At baseline, adverse anthropometric indices and MTs were significantly higher in both moderate-severe NAFLD and intermediate NAFLD compared to controls, except for low HDL. They were commoner in moderate-severe NAFLD than in intermediate NAFLD. After seven years, the odds of developing new-onset metabolic traits and CVEs were significantly higher compared to controls only in moderate-severe NAFLD. CONCLUSIONS: Only moderate-severe NAFLD predicted risk of incident adverse MTs and CVEs. However, both moderate-severe and intermediate NAFLD were associated with higher prevalence of adverse anthropometric and metabolic traits, thereby identifying individuals who need medical intervention even among those with milder degrees of fatty liver. We therefore recommend using increased hepatic echogenicity, and not only the more stringent criteria (which include signal attenuation and/or vascular blunting), for the diagnosis of fatty liver in individuals with NAFLD. KEYWORDS: Cardiovascular events; Fatty liver; NAFLD; Outcomes; Ultrasonography; Ultrasound criteria.
Comparison of cryptogenic and hepatitis B related hepatocellular carcinoma
(Sri Lanka Medical Association, 2016) Siriwardana, R.C.; Niriella, M.A.; Dassanayake, A.S.; de Silva, A.P.; Gunetilleke, B.; Chok, K.S.H.; Lo, C.M.; Chan, S.C.; Fan, S.T.; de Silva, S.T.
INTRODUCTION AND OBJECTIVES: Viral hepatitis is the leading cause for hepatocellular carcinoma (HCC) globally. Cryptogenic or non-alcoholic fatty liver related HCC is increasing and is predominant in Sri Lanka (SL). Few studies have compared cryptogenic (cHCC) and hepatitis B (bHCC) HCC. Objective of the study was to compare cryptogenic and hepatitis B related hepatocellular carcinoma. METHOD: Patients with HCC were screened at two centres, in Hong Kong (HK) and SL, from 2012-2014. HCC was diagnosed on typical CT/MRI appearance. Biopsy was performed when uncertain. Those with safe alcohol intake, no hepatotoxic exposure, and not having viral, autoimmune or inherited aetiology were considered cHCC. Demography, baseline liver status, tumour characteristics and treatment were compared between groups. A p<0.05 was considered significant. RESULTS: There were 891 patients (350-SL,541-HK). All HK patients were HBsAg positive. Two HBsAg positive SL patients, and 363 with unsafe alcohol intake were excluded. There were no hepatitis C patients. cHCC=234 and bHCC=292 were compared. There was no difference in gender, presenting age, symptoms, transaminases, platelet counts, median tumour diameter, morphology and tumour stage at presentation between groups. Significantly more cHCC had diabetes [133 vs. 67], while more bHCC were cirrhotics [269 vs.175]. At presentation, serum bilirubin was significantly higher in bHCC (1.2 vs. 0.7), while INR (1.23vs1.1) and AFP (51u/lvs.26u/l) were significantly higher in cHCC. bHCC had significantly more surgical candidates [113 vs. 50], while significantly more cHCC were transarterial- chemo-embolization (TACE) candidates [74 vs. 53]. More cHCC were unsuitable for active treatment despite similar tumour stage at presentation. CONCLUSIONS: More cHCC had diabetes and occurred in non-cirrhotic livers. Compared to bHCC, fewer cHCC were candidates for surgery or active treatment at presentation.
Double-trouble: A rare case of co-infection with melioidosis and leptospirosis from Sri Lanka
(Sage, 2023) Gunasena, J.B.; de Silva, S.T.
Melioidosis and leptospirosis are two emerging tropical infections that share somewhat similar clinical manifestations but require different methods of management. A 59-year-old farmer presented to a tertiary care hospital with an acute febrile illness associated with arthralgia, myalgia and jaundice, complicated by oliguric acute kidney injury and pulmonary haemorrhage. Treatment was initiated for complicated leptospirosis but with poor response. Blood culture was positive for Burkholderia pseudomallei and microscopic agglutination test (MAT) for leptospirosis was positive at the highest titres of 1:2560, confirming a co-infection of leptospirosis and melioidosis. The patient made a complete recovery with therapeutic plasma exchange (TPE), intermittent haemodialysis and intravenous (IV) antibiotics. Similar environmental conditions harbour melioidosis and leptospirosis, making co-infection a very real possibility. Co-infection should be suspected in patients from endemic areas with water and soil exposure. Using two antibiotics to cover both pathogens effectively is prudent. IV penicillin with IV ceftazidime is one such effective combination.
Effect of single dose methyl prednisolone in severe illness associated with dengue fever
(Sri Lanka Medical Association, 2010) Premaratna, R.; Jayasinghe, K.G.N.U.; Liyanaarachchi, E.W.; Weerasinghe, O.M.S.; Pathmeswaran, A.; Williams, H.S.A.; de Silva, S.T.; de Silva, A.P.; de Silva, H.J.
INTRODUCTION AND OBJECTIVES: Role of steroids in the management of severe illness associated with dengue fever (SIDF) remains controversial. However, steroids are widely used in severe dengue. METHODS: Patients admitted to Professorial Medical Unit, CNTH, with SIDF during the recent dengue fever outbreak, a single dose intravenous methylprednisolone (MP) was administered as a rescue measure. Clinical and management data of 18 such patients (6 males) who were treated with MP (Group A) are presented here. [Definition of SIDF: fever >100F persisting after the fourth day of illness, without evidence of secondary bacterial infection together with a systolic BP <100mmHg and a postural drop of >20mmHg and the presence of or rapidly developing ascites or pleural effusions]. Fresh frozen plasma (FFP) rather than crystalloids were used to prevent worsening of third space fluid loss and pulmonary oedema on recovery. RESULTS: The mean(SD) age [yrs] 29 (11), and clinical parameters when SIDF was detected; duration of illness[days]: 5.6(1.9), fever[F]; 102(1) , systolic BP[mmHgj; 91(12), Hb[g/dl]: 14.2(3.1), PCVjTTJ: 42(7.2), platelets[xlOy/L]: 25(13), and resuscitation parameters; crystalloids [L/Kg]: 0.32(0.1), FFP[u]: 2(1.1). deaths: 0/18, time to defervasence[days); 1(2)], time to haemodynamic stability[Hrs]: 5.8(5.8), number needing ICU care 5/18. CONCLUSIONS: These preliminary observations appear to suggest beneficial effects of timely given single dose MP in the management of SIDF.
Epidemiology of chronic kidney disease in two tertiary referral centres in Sri Lanka
(Journal of the Ceylon College of Physicians, 2019) Herath, H.M.N.J.; Perera, H.S.S; Karunathilaka, M.A.I.B.B.; Perera, U.M.S.; Bandara, D.M.P.; Samarasinghe, S.M.S.N.; de Silva, S.T.
INTRODUCTION AND OBJECTIVES: Chronic kidney disease (CKD) has become a major public health problem in Sri Lanka. The worldwide leading underlying causes for CKD are diabetes, hypertension and glomerulonephritis. There is regional variation in CKD prevalence in Sri Lanka due to the presence of a CKD of uncertain aetiology (CKDu). The objectives of our study were to identify aetiology, clinical stage and associated co-morbid diseases in patients with CKD referred to the Nephrology Service. METHODOLOGY: This cross-sectional descriptive study was carried out over one-year at Colombo North Teaching Hospital (CNTH), Ragama and District General Hospital, Negombo, from May 2018. All data was obtained from CNTH Renal Registry. RESULTS: Data of 1147 patients were studied. Mean age was 61.8 (SD 13.6) years, 683 (59.8%) were male and the majority [969 (84.5%)] were from Gampaha District. The primary renal disease was diabetes in 645 (56.2%), hypertension in 251 (22%) and glomerulonephritis in 40 (3.5%). There were only 16 (1.4%) patients with CKD-u and none were from Gampaha district. 539 (47%) were in CKD stage III, 329 (28.7%) in stage IV and 147 (12.8%) in stage V; there was no significant difference in the mean age of patients in each CKD stage. The commonest co-morbidity was hypertension, present in 180 (15.7%) patients. CONCLUSION: The commonest causes of CKD in Gampaha district were diabetes and hypertension, with no cases of CKDu. Screening patients with diabetes and hypertension for CKD is mandatory. More research is needed in to CKD due to identifiable causes in the non-CKDu regions of the country, since this appears to be an emerging and under-appreciated problem.
Follow up of metabolic syndrome in the Ragama Health Study
(Faculty of Medicine, University of Kelaniya, Sri Lanka, 2016) de Silva, S.T.
Although previous population based studies have looked at the prevalence of Metabolic Syndrome (MS) in different groups, studies on the incidence of MS are few and lacking from the South Asian region. This is mainly because long-term cohort studies are difficult to sustain. The Ragama Health Study (RHS) follow up in 2014 looked at the incidence of MS in an urban adult Sri Lankan population that was originally recruited in 2007. Traditional and novel risk factors associated with the development of incident MS were identified. We also looked at the outcome of those identified with MS and its components in 2007.
Frequency, pattern and outcome of renal dysfunction in patients with cirrhosis: a prospective study using the proposed ADQI-IAC criteria
(Sri Lanka Medical Association, 2013) de Silva, S.T.; Perera, K.R.P.; Niriella, M.A.; Pathmeswaran, A.; de Silva, H.J.
INTRODUCTION AND OBJECTIVES: Current criteria fail to detect milder degrees of renal dysfunction in cirrhosis, and exclude hepatorenal syndrome (HRS1 and 2) in patients who have structural kidney disease. Definitions addressing these issues have been proposed by a working party from the Acute Dialysis Quality Initiative and International Ascites Club (ADQI-IAC). METHODS: We studied the frequency, pattern and outcome of renal dysfunction in patients with cirrhosis using ADQI-IAC definitions. Consecutive patients attending outpatient clinics in Colombo North Teaching Hospital, Ragama, were prospectively recruited and followed up.RESULTS: Of 277 patients with cirrhosis and stable serum creatinine, 27 (9.7%) had serum creatinine >1.5mg/dl (current cut-off), and 23/27 (85%) fulfilled criteria for HRS2. 65/277 (23.5%) had eGFR<60ml/min [ADQI-IAC cut-off for chronic kidney disease (CKD)], but 42/65 (64.6%) did not fulfill criteria for HRS2. Compared to cirrhotics without CKD, the CKD group were older (61.4 vs 53.7 years; pO.OOOl), more likely to be female (50.8% vs 19.3%; p0.000l), had cryptogenic cirrhosis (67.7% vs 41%; pO.OOOl), and were Child-Pugh class B or C (95.4% vs 74%; p0.00l). As expected, they had higher MELD scores (16.6 vs 13.5; p<0.0001). 48/277 (17.3%) died during follow-up [mean 6.5 months (SD 2.2)]; an eGFR<60ml/min independently increased risk of death (HR 2.7; Nagelkerke R Square test). CONCLUSIONS: Compared to HRS criteria, the ADQI-IAC definition detects more than twice the number of cirrhoric patients with CKD. As CKD is associated with increased mortality, further study is needed to determine whether prognosis can be improved by treating acute deterioration of CKD with available treatments for HRS 1.
Frequency, pattern and short-term outcome of chronic renal dysfunction in patients with cirrhosis
(Wiley Blackwell Scientific Publications, 2013) Perera, K.R.P.; de Silva, S.T.; Niriella, M.A.; Pathmeswaran, A.; de Silva, H.J.
OBJECTIVE: Current criteria fail to detect milder degrees of renal dysfunction in cirrhosis, and exclude hepatorenal syndrome (HRS1, HRS2) in patients with structural kidney disease. Definitions addressing this have been proposed by Working Party of the Acute Dialysis Quality Initiative and International Ascites Club (ADQI-IAC). We studied the frequency, pattern and outcome of renal dysfunction in patients with cirrhosis using ADQI-IAC definitions. METHODS: Consecutive patients attending outpatient clinics in Colombo North Teaching Hospital, Ragama, were prospectively recruited and followed up. RESULTS: Of 277 patients with cirrhosis and stable serum creatinine, 27 (9.7%) had serum creatinine >1.5 mg/dl (current cut-off), and 23/27 (85%) fulfilled criteria for HRS2. 65/277 (23.5%) had eGFR <60 ml/min [ADQI-IAC cut-off for chronic kidney disease (CKD)], but 42/65 (64.6%) did not fulfil criteria for HRS2. Compared to cirrhotics without CKD, the CKD group were older (61.4 vs 53.7 years; p < 0.0001), more likely to be female (50.8% vs 19.3%; p < 0.0001), more likely to have cryptogenic cirrhosis (67.7% vs 41%; p < 0.0001), and Child-Pugh class B or C (95.4% vs 74%; p < 0.001). As expected, they had higher MELD scores (16.6 vs 13.5; p < 0.0001). 58/277 (20.9%) died during follow-up [mean 9.8 months (SD 4.5)]. After adjusting for other variables, CKD independently increased risk of death 3.3-fold (Nagelkerke R Square test). CONCLUSION: Compared to HRS criteria, the ADQI-IAC definition detects more than twice the number of cirrhotic patients with CKD. As the presence of CKD is associated with increased mortality, further studies are needed to determine whether prognosis can be improved in such patients by treating acute deterioration of CKD with available treatments for HRS1.
Frequency, pattern and short-term outcome of chronic renal dysfunction in patients with cirrhosis: a prospective study employing HRS and ADOJ-IAC criteria
(Sri Lanka Medical Association, 2014) de Silva, S.T.; Perera, K.R.P.; Niriella, M.A.; Pathmeswaran, A.; de Silva, H.J.
INTRODUCTION AND OBJECTIVES: Diagnostic criteria of hepatorenal syndrome type 2 (HRS2) fail to detect milder degrees of chronic renal dysfunction (CRD) in cirrhosis, and exclude patients with pre-existing kidney disease. Definitions addressing this have been proposed by Working Party of the Acute Dialysis Quality Initiative and International Ascites Club (ADOJ-IAC), we studied the frequency, pattern and short-term outcome of CRD in patients with cirrhosis, using both HRS2 and ADQJ-IAC criteria. METHODS: Consecutive patients with cirrhosis and stable serum creatinine (SCr) for 3 months or more attending outpatient clinics in Colombo North Teaching Hospital, Ragama, were prospectivefy recruited and followed up. RESULTS: Of 277 patients with cirrhosis and stable SCr, 23 (8.3%) fulfilled criteria for HRS2. 65/277 (23.5%) had eGFR<60ml/min/1.73m2 [ADOJ-IAC definition of chronic kidney disease (CKD)]. This included the 23 patients with HRS2, and an additional 42/65 (64.6%) who did not fulfil diagnostic criteria for HRS2 (non-HRS2 CKD). 58/277 (20.9%) died during follow-up [mean 9.8 months (SD 4.5)]. This included 12/23 (52.2%) with HRS2 and 14/42 (33.3%} with Non-HRS2 CKD. Based on a multiple regression model Child-Turcotte:Pugh (CTP) class and CRD were significantly associated with death. After correcting for CTP class, both HRS2 (OR 4.56, 95%CI 1.79-11.53) and Non-HRS2 CKD (OR 2.19, 95%CI 1.02-4.68) were independently associated with death. CONCLUSIONS: Compared to HRS2 criteria, eGFR<60mI/min/1.73m2 detected almost twice the number of cirrhotics with CRD. Patients with eGFR<60ml/min/1.73m2 who did not fulfil criteria for HRS2 also had significant short-term mortality. ADQI-IAC criteria thus appear to be a more useful definition of CRD in cirrhotics.
Frequency, pattern and short-term outcome of chronic renal dysfunction in patients with cirrhosis: a prospective study using HRS and ADQI-IAC criteria
(Lippincott Williams And Wilkins, 2014) de Silva, S.T.; Perera, R.P.; Niriella, M.A.; Pathmeswaran, A.; de Silva, H.J.
BACKGROUND: Diagnostic criteria of hepatorenal syndrome type 2 (HRS2) fail to detect milder degrees of chronic renal dysfunction (CRD) in cirrhosis and exclude patients with pre-existing kidney disease. Definitions addressing this have been proposed by Working Party of the Acute Dialysis Quality Initiative and International Ascites Club (ADQI-IAC). AIMS: We studied the frequency, pattern and short-term outcome of CRD in patients with cirrhosis, using both HRS2 and ADQI-IAC criteria. PATIENTS AND METHODS: Consecutive patients with cirrhosis and stable serum creatinine for 3 months or more attending outpatient clinics in Colombo North Teaching Hospital (Ragama, Sri Lanka) were prospectively recruited and followed up. RESULTS: Of 277 patients with cirrhosis and stable serum creatinine, 23 (8.3%) fulfilled criteria for HRS2, and 65/277 (23.5%) had estimated glomerular filtration rate (eGFR) less than 60 ml/min/1.73 m [ADQI-IAC definition of chronic kidney disease (CKD)]. This included the 23 patients with HRS2 and an additional 42/65 (64.6%) who did not fulfil diagnostic criteria for HRS2 (non-HRS2 CKD). In all, 58/277 (20.9%) died during follow-up [mean 9.8 months (SD 4.5)]. This included 12/23 (52.2%) with HRS2 and 14/42 (33.3%) with non-HRS2 CKD. On the basis of multiple regression model, Child-Turcotte-Pugh class and CRD were significantly associated with death. After correcting for Child-Turcotte-Pugh class, both HRS2 (odds ratio 4.56, 95% confidence interval 1.79-11.53) and non-HRS2 CKD (odds ratio 2.19, 95% confidence interval 1.02-4.68) were independently associated with death. CONCLUSION: Compared with HRS2 criteria, eGFR less than 60 ml/min/1.73 m detected almost twice the number of cirrhotics with CRD. Patients with eGFR less than 60 ml/min/1.73 m who did not fulfil criteria for HRS2 also had significant short-term mortality. ADQI-IAC criteria thus appear to be a more useful definition of CRD in cirrhotics.
Gender based differences in acute coronary syndrome
(Sri Lanka Medical Association, 2011) Danansuriya, D.S.T.; Alexander, M.A.F.; Harshanie, R.L.P.; Gammulla, S.P.K.H.M.A.T.; Pemarwansa, G.; Thirumavalan, K.; Samarakoon, S.M.S.B.; de Silva, A.P.; de Silva, S.T.; Ranawaka, U.K.
INTRODUCTION AND OBJECTIVES: To describe gender based differences in demographics, risk factors, management and early outcome in Sri Lankan patients with acute coronary syndromes (ACS). Methods: All adults admitted with ACS to medical units of Colombo North Teaching Hospital are enrolled in a prospective Registry. We studied data obtained from patients admitted over a period of 11/2 years. RESULTS: 765 patients were studied (56.9% males). Females were likely to be older [mean age years (SD) - male 59.5(11.4), female 62.9(11.4), pO.OOl]. Women were more likely to have unstable angina (female -56.4%, male- 40,0%)7 while men were more likely to have ST elevated myocardial infarction (M-36.6%? 19.4%) (pO.OOl). Several risk factors were commoner in women (p<0.001): hypertension-female- 70%, male- 49.6%; diabetes - female- 49.7%, male- 35.6%; hyperlipidaemia - female-73.6%, male-56.6%; high waist circumference- female 65.8%, male-29.8%. Smoking and alcohol use were almost exclusively seen in men (75.9% and 84.6% respectively vs. 1.2% and 1.5%; /K0.001). 32.4% of women and 37.6% of men had previous IHD (p=0.079). Women were more likely to be on pre-admission antiplatelet, statin, beta blocker and ACE inhibitor therapy (/7<0.005). Five patients died. There were no differences in care given and early outcome. CONCLUSIONS: There are important gender-related differences in the pattern of ACS in Sri Lankan patients. Several modifiable cardiovascular risk factors were commoner in women, highlighting the need for targeted preventive strategies. Acknowledgements: Japan International Cooperation Agency
Hepatitis B and Hepatitis C virus infections among patients with chronic kidney disease from two presumed high-risk centers
(Sri Lanka Medical Association, 2018) de Silva, S.T.; Perera, P.S.; Anuruddhika, H.W.D.; Dassanayake, R.; Niriella, M.A.
INTRODUCTION AND OBJECTIVES: Community prevalence ofhepatitis-C (HCV) and hepatitis-B (HBV) infection is low in Sri Lanka. Patients with chronic kidney disease (CKD) are at high-risk for HBV and HCV infections. We determined the prevalence and risk factors for HBV and HCV among CKD patients in two Teaching Hospitals. METHODS: This cross-sectional, descriptive study was carried out among CKD patients at Nephrology Units in Polonnaruwa and Ragama Teaching Hospitals. CKD was defined as estimated glomerular filtration rate <60ml/min/1.73m2. Consecutive, consenting adult CKD patients with at least one blood transfusion during the past five years were included. All participants were tested for HBsAg and HCV antibodies by ELISA. Those found to be positive for either underwent confirmatory PCR testing. RESULTS: 232 patients were included [Mean-age: 55.83 years; 156 (59.75%) males]. Diabetes mellitus and/or hypertension were the causes of CKD in 137/232 (59.1%). 82/232 (35.3%) had CKD of uncertain aetiology.153/232 (65.9%) were on hemodialysis and 6/232 (2.6%) had received a kidney transplant. One was an intravenous drug user, 3 had tattoos and 86/232 (37.1%) had practiced unsafe sex previously. 145/232(62.5%) had previously received HBV vaccination and 67/232 (28.9%) had received 3 doses of the vaccine before first blood transfusion, hemodialysis or transplant. Sero-conversion testing was not done in 178/232 (76.7%). Six were previously HBsAg positive. On re-testing 4 were positive for HBsAg While none had HCV antibody positivity. All were negative for HBV-DNA on PCR testing. CONCLUSION: Active HBV,HCV infections were not detected in this cohort of CKD patients. Traditional risk factors were uncommon. Complete HBV vaccination was suboptimal and checking for seroconversion was low.
Hypoglycaemia among patients with type II diabetes mellitus: A retrospective study
(Sri Lanka Medical Association, 2013) Perera, U.D.C.A.; Silva, F.H.D.S.; de Silva, S.T.
INTRODUCTION AND OBJECTIVES; Although there is emphasis on strict glucose control in type II diabetes mellitus (T2DM), information about problems that occur due to hypoglycaemia, especially in resource-poor settings, is lacking. We aimed to determine the prevalence of symptomatic hypoglycaemia, awareness of hypoglycaemia and knowledge about avoiding, detecting and treating hypoglycaemia, in a cohort of patients with T2DM. Methods: A descriptive, retrospective study of patients with T2DM attending general medical clinics of the University Medical Unit, Teaching Hospital, Ragama was carried out for 7 months from May 2012 using an interviewer administered questionnaire. RESULTS: Three hundred patients were recruited. One hundred and two (34%) had experienced at least one hypoglycaemic episode, and more than 2 episodes were experienced by 88 (86.3%). Commonest symptoms were sweating (65.7%) and palpitations (54%). Neuroglycopaenic symptoms were experienced by 54 (52.9%) and 18 (17.6%) had "become unconscious. Thirty (29.4%) had required hospital admission. Sixty nine (67.6%) were on sulphonylurea alone or in combination with metfonnin. Sixty nine (67.6%) were unaware of hypoglycaemia. Main reasons for hypoglycaemia were missed meals 49 (48%) and associated illness 49 (23.5%). Two hundred and thirty eight (79.3%) knew how to treat hypoglycaemia and 151 (50.3%) had received information on hypoglycaemia from medical officers. Two hundred and sixty one (87%) were not using a glucometer and 223 (74%) were unaware of such a device, although 249 (83%) said they could afford one. CONCLUSIONS: Hypoglycaemia is a common but under-recognised symptom among T2DM patients. Severe or recurrent hypoglycaemia is associated with a high cost to the individual and to the health service. Raising awareness by health education, with emphasis on self-monitoring where possible, should receive priority.
Impact of COVID-19 Pandemic on Medical Education: Insights and Recommendations
(South East Asia Regional Association for Medical Education (SEARAME), 2020) Niriella, M.A.; Chandratilake, M.; de Silva, S.T.; de Silva, A.P.
ABSTRACT: Disruptions in medical education are inevitable as healthcare systems across the world are set to be further stretched with the increasing burden of COVID-19 pandemic. Given the risks of nosocomial infection and other unique, similar challenges, there is difficulty in adapting required changes in medical education, particularly for the medical students and training junior doctors. This paper discusses the different elements affecting and the widespread impact of COVID-19 pandemic on medical education. It concludes with strategies to minimize the impact of these factors and a call to action for the medical education system to adapt so it can meet the needs of healthcare learners during this pandemic and beyond. These include online learning, telemedicine and simulations that may help in both teaching/learning and assessment in basic and clinical education. The adaptation of these approaches, however, should be based on the intended learning outcomes and availability of resources. Teaching/learning strategies to develop reasoning skill and increasing the focus on formative assessments appears to be a fundamental requirement in the current context. The programme should adopt flexibility and collaboration as the guiding principles to mitigate the ill-effects of the pandemic on medical education. KEYWORDS: COVID-19, Pandemic, Medical education, Undergraduate, Postgraduate, Continuing, Impact