Conference Papers
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This collection contains abstracts of conference papers, presented at local and international conferences by the staff of the Faculty of Medicine
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Item Development of a model for a resource limited setting, to predict the presence of oesophageal varices among newly diagnosed patients with cirrhosis.(Sri Lanka Medical Association., 2019) Perera, K.; Kodisinghe, S.K.; Ediriweera, D.; Moratuwagama, H.M.D.; Williams, S.; Pathmeswaran, A.; Niriella, M.A.; de Silva, H.J.INTRODUCTION & OBJECTIVES: In cirrhosis upper-gastrointestinal-endoscopy (UGIE) identifies oesophageal varices (OV). UGIE is unavailable in most resource-limited settings. Therefore, we assessed prediction of presence OV using hematological parameters (HP) and Child-Turcott-Pugh (CTP) class. METHODS: A prospective study was carried out on consecutive, consenting, newly-diagnosed patients with cirrhosis, in the University Medical Unit, Colombo North Teaching Hospital, Ragama, from April 20 I 4-April 2016. All patients had UGIE to evaluate presence and degree of OV, prior to appropriate therapy. HP (FBC with indices using automated analyzer and peripheral blood smear using Leishmann stain) and CTP class were assessed. Linear logistic regression model was developed to predict OV using HP and CTP class. RESULTS: 54-patients with cirrhosis were included [14(26%), 24(44%) and 16(30%) belonged to CTP class A, B and C respectively]. 37 had varices [CTP-A 4/14(26.6%), CTP-B 19/24(79.2%), CTP-C 14/16(87.5%)] on UGIE. Generalized linear model fitting showed decreasing percentage of small platelets (%SP) (P=0.002), CTP-B (P=0.003) and CTP-C (P=0.003) compared to CTP-A had higher probability of having OV. The model predicts the log odds for having OV = - 0.189 - (0.046*%SP) + 2.9 [if CTP-B] + 3.7 [if CTP-C]. Based on ROC analysis, a model value >-0.19 was selected as the cutoff point to predict OV with 89%-sensitivity, 76%-specificity, 89% positive predictive value and 76%-negative predictive value. CONCLUSION: We constructed a model using %SP on peripheral blood smear and CTP class. This model can be used to predict the presence of OV, in newly diagnosed patients with cirrhosis, with high sensitivity and specificity, avoiding the need for initial UGIE.Item Development and validation of sinhala version of the Chronic Liver Disease Questionnaire (CLDQ) for assessment of quality of life among cirrhotics(Sri Lanka Medical Association, 2012) Ranawaka, C.K.; Pathmeswaran, A.; de Alwis, W.R.S.; Mufeena, M.N.F.; Wijewantha, H.S.; Senanayake, S.M.; Niriella, M.A.; Dassanayake, A.S.; de Silva, A.P.; de Silva, H.J.INTRODUCTION: Chronic liver disease (CLD) has a negative impact on patient quality of life (QOL). The Chronic Liver Disease Questionnaire (CLDQ) is a validated tool which measures the Health Related Quality of Life (HRQL) among cirrhotics. CLDQ is easy to administer, measures six domains of QOL; abdominal symptoms, fatigue, systemic symptoms, activity, emotional functions and worry. It shows good correlation with severity of CLD. Aims: To develop and validate a Sinhala version of the CLDQ (sCLDQ). METHODS: A standard method of forward and back-translation by bilingual translators was used to develop the sCLDQ. Pilot testing were done with relevant adaptations, considering differences in culture and language. The final version was self-administered to stable CLD patients without significant co-morbidities, together with the WHO BREF Sinhala version (validated for patients of any disease), for comparison. sCLDQ was re-administered 4 weeks later to study its internal consistency and reliability. The sCLDQ validation was assessed by Cronabach's alpha, intraclass correlation coefficient (ICC) and Pearson's correlation coefficient RESULTS: Forty eight patients participated in the validation process. The item total correlations of sCLDQ varied from 0.30 to 0.82 (except one item number 0.15). Overall Cronabach's alpha was 0.92. Re-administration of sCLDQ to 15 patients yielded an ICC of 0.54 (p = 0.02). There was a significant correlation (Pearson's r = 0.34; p = 0.03) between sCLDQ and WHO BREF. CONCLUSIONS: sCLDQ was reliable and valid and would be a useful tool to assess QOL of cirrhotic patients in Sri Lanka.Item Profile of gastric varices among Sri Lankan cirrhotics(Wiley Blackwell Scientific Publications, 2012) Ranawaka, C.K.; Mettananda, K.C.D.; de Alwis, R.; Miththinda, J.K.N.D.; Wijewantha, H.S.; Niriella, M.A.; Dassanayake, A.S.; de Silva, A.P.; de Silva, H.J.BACKGROUND AND AIMS: Gastric varices (GV) can result in life threatening bleeding with a higher mortality than esophageal varices. There have been no studies on the characteristics of GV among Sri Lankan cirrhotics. Aim of this study was to perform a descriptive analysis of GV among a cohort of Sri Lankan cirrhotic population. METHODS: We analyzed medical records of all upper gastrointestinal endoscopies performed on cirrhotics, at the University Endoscopy Unit, Colombo North Teaching Hospital, Ragama, Sri Lanka from 2006 to 2011. Characteristics of GV, demographics, indications and fi ndings at endoscopy were analyzed and they were compared among patients with Oesophageal varices (EV). RESULTS: Out of 641 cirrhotics screened, 628 had a complete data set for analysis. GV was detected in 70 (11%) patients; male:female 8.7:1.3; mean age 55 (SD = ± 10.7) years. From these 48/70 had EV (Gastro Oesophageal Varices GOV1 – 18/48, GOV2 – 30/48) in addition to GV. Only 22/70 had Isolated GV (IGV1–10, IGV2–12). Among patients with GV 38 (54%) had portal hypertensive gastropathy and 3 (4%) had gastric antral vascular ectasia. Nineteen (27%) of GV were detected on presentations with UGIB (6 with IGV, 13 with GOV), whereas 51 (73%) were detected on routine screening. EV was detected in 288 (46%) of cirrhotics (Isolated EV 240, GOV 48). Seventy seven (32%) of EV were detected on presentations with UGIB, whereas 163 (68%) were detected on routine screening. There was no statistically significant difference on presentation with UGIB between isolated EV (77/240) vs. IGV (6/22) patients (p = 0.64; χ2 = 0.2). CONCLUSION: The profi le of GV among our cirrhotics is comparable to previous reports from other centres. Findings suggest that in cirrhotic patients presenting with UGIB, a careful search for the presence of GV is as important as identifying EV, even among patients who have EV.Item Development and validation of sinhala version of the chronic liver disease questionnaire (CLDQ) for assessment of quality of life among cirrhotics(Wiley Blackwell Scientific Publications, 2012) Ranawaka, C.K.; Pathmeswaran, A.; Senanayake, S.M.; de Alwis, R.; Mufeena, M.N.F.; Niriella, M.A.; Dassanayake, A.S.; de Silva, A.P.; de Silva, H.J.BACKGROUND AND AIM: Chronic liver disease (CLD) has a negative impact on patient quality of life (QOL). The Chronic Liver Disease Questionnaire (CLDQ) is a validated tool which measures the Health Related Quality of Life (HRQL) among cirrhotics. CLDQ is easy to administer and measures six domains of QOL; abdominal symptoms, fatigue, systemic symptoms, activity, emotional functions and worry. It shows good correlation with severity of CLD. No tool had been developed previously to asses QOL among CLD patients in Sri Lanka. Aim of this study was to develop and validate a Sinhala version of the CLDQ (sCLDQ). METHODS: A standard method of forward and back-translation by bilingual translators was employed to develop the sCLDQ. Pilot testing was done with relevant linguistic and cultural adaptations. The final version was self-administered to stable CLD patients without significant comorbidities, together with the WHO BREF Sinhala version (a validated QOL assessment tool for any disease), for comparison. sCLDQ was re-administered 4 weeks later to study its internal consistency and reliability. The sCLDQ validation was assessed by Cronabach’s alpha, intraclass correlation coeffi cient (ICC) and Pearson’s correlation coeffi cient. RESULTS AND DISCUSSION: Forty eight patients participated in the validation process. The item total correlations of sCLDQ varied from 0.30 to 0.82 (except one item, 0.15). Overall Cronabach’s alpha was 0.92. Re-administration of sCLDQ to 15 patients yielded an ICC of 0.54 (p = 0.02). There was a signifi cant correlation (Pearson’s r = 0.34; p = 0.03) between sCLDQ and WHO BREF. Conclusion: sCLDQ was reliable and valid and would be a useful tool to assess QOL among cirrhotic patients in Sri Lanka.Item Association between road accidents and minimal hepatic encephalopathy in a cohort of Sri Lankan cirrhotic drivers(Wiley Blackwell Scientific Publications, 2014) Subasinghe, S.K.C.E.; Nandamuni, Y.; Ranasinghe, S.; Kodisinghe, K.; Niriella, M.A.; de Silva, A.P.; de Silva, H.J.OBJECTIVE: Minimal hepatic encephalopathy (MHE) has no recognizable clinical symptoms of hepatic encephalopathy (HE) but has mild cognitive and psychomotor deficits which can interfere with executive decision making and psychomotor speed. It affects driving ability and previous studies in Western countries have demonstrated an association between MHE and increased road accidents. Our objective was to investigate this association in a cohort of Sri Lankan cirrhotic drivers. METHODS: A prospective, case controlled study ongoing study has been conducted in the Gastroenterology Clinic, University Medical Unit, North Colombo Teaching Hospital, Ragama, from August 2013. Patients with cirrhosis of any aetiology, without overt HE, who had been driving any vehicle during the past one month were subjected to 5 standard pencil-paper based psychometric tests used to detect MHE. Road accidents were recorded for both cirrhotic drivers with MHE and controls. Accidents were categorized as major when they resulted in hospitalization of the involved person/s, and minor when there were no serious injuries. RESULTS: Among 55 cirrhotic drivers with MHE [males, median age 53 years (range 30-60)], 7 (12.7%) reported any type of accident compared to 6 (10.9%) among 55 controls [males; median age 51 years (range 30-60)]. 2/55 (3.6%) cases and 2/55 (3.6%) controls reported minor accidents. There were no major accidents in either group. CONCLUSION: Preliminary results of this ongoing study do not indicate an increased frequency of road accidents in a cohort of Sri Lankan cirrhotic drivers with MHEItem 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.Item Development and validation of Sinhala version of the chronic liver disease questionnaire (CLDQ)(Wiley Blackwell Scientific Publications, 2013) Miththinda, J.K.N.D.; Ranawaka, C.; Pathmeswaran, A.; Dassanayake, A.S.; de Alwis, W.R.S.; Mufeena, M.N.F.; Senanayake, S.M.; Niriella, M.A.; de Silva, A.P.; de Silva, H.J.OBJECTIVE: The Chronic Liver Disease Questionnaire (CLDQ) is a validated tool measuring the Health Related Quality of Life among cirrhotics. Aim of this study was to develop and validate a Sinhala version of the CLDQ (sCLDQ) and to test its correlation with the degree of liver dysfunction in a cohort of Sri Lankan patients with cirrhosis. METHODS: A standard translation method was used to develop the sCLDQ. Pilot testing was done with relevant cultural and language adaptations. The final version was self-administered to stable CLD patients, together with the WHO Quality of Life-BREF (WHOQOL-BREF) validated Sinhala version, for comparison. sCLDQ was re administered 4 weeks later to test internal consistency and reliability. The validation was assessed by Cronabach’s alpha, intraclass correlation coefficient (ICC) and Pearson’s correlation coefficient. ANOVA and Pearson’s correlation were used to test correlation with the degree of liver dysfunction. RESULTS: Validation was done with 214 subjects, mean age 55.6 (SD 10.4) years; male 77.6%. Overall Cronabach’s alpha was 0.926. Itra-class correlations varied from 0.431 to 0.912 and all were significant (p 0.000). Retesting was done on a sub-sample of 18 subjects. Test-retest correlation was 0.695 (p 0.008). WHO-BREF was applied on a sub-sample of 48 subjects. There was a significant correlation (Pearson’s r = 0.391; p = 0.004) between sCLDQ and WHOQOL BREF. sCLDQ was significantly associated with MELD (r = −0.13; p = 0.038), MELD Sodium (r = −0.223; p = 0.002), Bilirubin (r = −0.124; p = 0.036), Serum Sodium (r = 0.172; p = 0.009), Serum Albumin (r = 0.201; p = 0.003) and Child grade (f = 3.687; p = 0.027). CONCLUSION: sCLDQ is a reliable and valid tool to assess QoL of Sri Lankan cirrhotics and correlates well with known indices of disease severity.