Medicine
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This repository contains the published and unpublished research of the Faculty of Medicine by the staff members of the faculty
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Item Challenges faced in establishing a pediatric liver transplant program in a lower‐middle‐income country with free healthcare service(Wiley, 2024) Fernando, M.; Tillakaratne, S.; Gunetilleke, B.; Liyanage, C.; Appuhamy, C.; Weerasuriya, A.; Uragoda, B.; Welikala, N.; Ranaweera, L.; Ganewatte, E.; Dissanayake, J.; Mudalige, A.; Siriwardana, R.ABSTRACT: BACKGROUND: Liver transplant is the cure for children with liver failure. Sri Lanka is a lower-middle-income country with a predominant free, state health system. Pediatric liver transplant program in Sri Lanka is still in the budding state where the initial experience of the program is yet to be documented. METHODS: A retrospective review was performed including the clinical characteristics of all pediatric liver transplant recipients of Colombo North Centre for Liver Diseases since the inception of the program from June 2020 to May 2023. RESULTS: There were 14 PLT performed in 3 years. The median recipient age and weight were 8 years (6 months–15 years) and 23.3 kg (6.4–49.2), respectively. The majority were boys (64%). All were from low-income backgrounds. Indications for LT were acute liver failure (5/14), decompensated chronic liver disease (5/14), and acute on chronic liver failure (4/14). Underlying liver diseases were Wilson disease (6/14), autoimmune liver disease (3/14), biliary atresia (2/14) and progressive familial intrahepatic cholestasis type 3 (1/14), and unknown etiology (2/14). The majority were living donor liver transplants (86%). Of the living donors, 42% (5/12) were Buddhist priests. There were three immediate deaths and two late deaths. The 3-month survival was 78%, and overall survival was 64%. Living donor transplants carried a higher success rate (92%) compared to diseased donor transplants (0%; 2/2). CONCLUSIONS: Initial experience of pediatric liver transplant program of Sri Lanka is promising despite being established in a free healthcare system amidst the crisis circumstances.Item Hilar cholangiocarcinomas - from nihilism to aggressive treatment(The College of Surgeons of Sri Lanka, 2012) Liyanage, C.; Nawaratne, M.; Pathirana, A.; Gunasekara, D.; Pranahewa, L.; Prasad, R.; Wijeratne, T.; Bogammana, M.; Wijesooriya, R.; Siriwardhana, R.INTRODUCTION: Hllar-Cholangio-carcinomas (HCC) are aggressive tumours with a dismal prognosis. The general tendency amongst all specialities is to palliate them. As response to adjuvant therapy is marginal we have embarked on aggressive management of these patients with the available surgical and endoscopic expertise. METHODS: Patients presenting to the North Colombo Teaching hospital· and the Gastrointerology unit of the National hospital in 2011 were included . All had Tri phasic CT , MRCP or ERCP prior to be discussed at MDT with all the above authors regarding further management. Patients with Bismuth 1 v lesions and unfit for surgery underwent Combination ERCP/doublestenting/RFA of lesion/Rendezvous procedure/Percutaneous, stenting or PTC. RESULTS: 32 patients were treated .5/32 had radical surgical resections (2 extended right hepatectomy with bile duct resecton and lymphadenectomy (BDR+LA), 2 extended left hepatectomy +BDR+LA, and 1 extended heft hepatectomy with BDR+LA+Reconstruction of Right hepatic artery and right portal vein. I underwent segment iii bypass. 7 patients underwent ERCP and serial RFA with stenting. 3/5 patients are alive and disease free at 6-12 months. CONCLUSIONS: Where possible HCC patients should be offered a curative resection. RFA gives longer and better palliation compared to standard stenting. These patients should be managed by a specialized team as aggressive management may improve their survival.Item Duodenal diverticuli: do they predispose for Common Bile Duct (CBD) pathology?(The College of Surgeons of Sri Lanka, 2012) Liyanage, C.; Keragala, T.; Femandopulle, N.; Nawaratne, N. M. M.INTRODUCTION: Periampullary duodenal diverticuli (PDD) are extra luminal mucosal out pouching of duodenum arising adjacent to or containing the ampulla of Vater or intraluminal portion of CBD . Juxta-papillary duodenal diverticuli (JPDD) are defined as diverticuli located with in radius of 2 cm of major papilla but not involving them. We note that patients with 'DD have a higher tendency for stone formation and biliary complications. METHODS: 100 consecutive patients who underwent ERCP at the National Hospital Sri lanka in 2011 were included in this study. The incidence of DD, position , associated pathology ,difficulty index, special procedures, outcome and complications were noted. RESULTS: 26 patients had DD. 18 had PDD and 6 JPDD. 12/18 of PDD and 4/6 JPDD had common bile duct stones. 1/26 an ERCP could not be. performed and had open CBD exploration. In 6/18 with PDD a hurricane balloon dilatation of the papilla was done instead of sphincterotomy. There · was one hilarcholangio cancer and 2 pancreatic cancers and 4 pancreatitis patients. Patients with stone disease were managed with total endoscopic procedures in 23/24. CONCLUSIONS: Patients with PDD and JPDD have a high incidence of CBD stones disease. .A papillary manometry study could be undertaken to ascertain the biliary sphincter pressures in patients with PDD.Item Retrospective study on the foeto–maternal status of teenage pregnancies in the Dimbulagala MOH area(Sri Lanka Medical Association, 2017) Liyanage, C.; Abeysena, H.T.C.S.; Ariyarathne, A.M.N.; Liyanage, J.; Senavirathnea, D.P.M.A.; Thilak Udayasiri, A.A.INTRODUCTION & OBJECTIVES: A pregnancy occurring in a young woman who has not reached her 20th birthday is considered as a teenage pregnancy. The impact of consequences of teenage pregnancies in Sri Lanka is not well described. The objective of the study was to assess the foetal and maternal status of teenage pregnancies in the Dimbulagala MOH area. METHODS: A community based retrospective cohort study was carried out in the Dimbulagala MOH area. A sample of 160 teenage mothers was selected. An interviewer-administered pre–tested questionnaire was used to collect the data during the study period. Data was analyzed using SPSS 17 version. RESULTS: Of this sample of teenage mothers, 75.0% (n=120) were aged between 17 and 19 years and their highest educational level was up to grades 6-11. Out of the total sample, 75% had attained puberty before 13 years of age. From this sample, 30% had ante-natal complications in early pregnancy like anaemia, ante-partum complications and PIH. Low birth weight (less than 2.5kg) was seen in 42.1% (n=67). Only 4.4% (n=7) was admitted to the PBU due to foetal complications. CONCLUSION: Though we had an idea that teenagers encounter several problems in foetal and maternal life, this study showed those parameters were not above the national average. Further studies should be conducted to evaluate the foeto-maternal status in the future.Item Comparison of performance of Sri Lankan and US children on cognitive and motor scales of the Bayley scales of infant development(Biomed Central, 2014) Godamunne, P.; Liyanage, C.; Wimaladharmasooriya, N.; Pathmeswaran, A.; Wickremasinghe, A.R.; Patterson, C.; Sathiakumar, N.BACKGROUND: There is no validated scale to assess neurodevelopment of infants and children in Sri Lanka. The Bayley III scales have used widely globally but it has not been validated for Sri Lankan children. We administered the Cognitive and Motor Scales of the Bayley III to 150 full-term children aged 6, 12 and 24 months from the Gampaha District of Sri Lanka. We compared the performance of Sri Lankan children 6, 12 and 24 months of age on the cognitive and motor scales of the Bayley III with that of US children. RESULTS: Compared to the US norms, at 12 months, Sri Lankan children had significantly higher cognitive scores and lower gross motor scores, and at 24 months significantly lower cognitive scores. The test had a high test-retest reliability among Sri Lankan children. CONCLUSIONS: There were small differences in the cognitive and motors scores between Sri Lankan and US children. It is feasible to use Bayley III scales to assess neurodevelopment of Sri Lankan children. However, we recommend that the tool be validated using a larger representative sample of all population groups.Item A Rare presentation of submucous colonic lipoma(The Royal College of Surgeons of Edinburgh, 2008) Naga, M.; Chakravorty, A.; Liyanage, C.; Grabham, J.A.No Abstract AvailableItem The Efficacy of micronutrient supplementation in reducing the prevalence of anaemia and deficiencies of zinc and iron among adolescents in Sri Lanka(Nature Publishing Group, 2008) Hettiarachchi, M.; Liyanage, C.; Wickremasinghe, R.; Hilmers, D.C.; Abrams, S.A.Item Prevalence and severity of micronutrient deficiency: a cross-sectional study among adolescents in Sri Lanka(HEC Press, Australia, 2006) Hettiarachchi, M.; Liyanage, C.; Wickremasinghe, R.; Hilmers, D.C.; Abrams, S.A.In order to determine the prevalence of micronutrient deficiencies (iron, zinc and folate) in Sri Lankan adolescent school children and the extent to which multiple micronutrient deficiencies exist in this population, a cross-sectional survey (2003) in the Galle district of the micronutrient and anthropometric status of 945 school children of ages 12-16 years was performed. The prevalence of anemia (Hb < 120.0 g/L) was 49.5% in males and 58.1% in females (overall 54.8%, gender difference, P = 0.004). In anemic children 30.2% of males and 47.8% of females were iron deficient (serum ferritin < 30.0 microg/L). Folate deficiency (<6.80 nmol/L) was found in 54.6% and 52.5% of boys and girls respectively whereas zinc deficiency(<9.95 micromol/L) occurred in 51.5% and 58.3%. Anemic boys had a 1.5 (95% confidence interval (CI) 0.9-2.6) and 1.6-fold (CI; 1.1-2.6) greater risk of being stunted and underweight, whereas the risk among anemic girls was 1.7 (CI; 1.1-2.7) and 1.0 (CI; 0.7-1.5) for being stunted and underweight. The relative risks of having at least two deficiencies in iron, zinc and folate among anemic children were 1.6 (CI; 0.6-4.2) among boys and 0.8 (CI; 0.5-1.5) among girls. Iron deficient subjects had a significantly increased risk of 1.8 (CI, 1.1-3.0) of being deficient in folate and 1.7 (CI, 1.2-2.6) of being deficient in zinc. Zinc deficient subjects had a risk of 1.3 (CI, 1.0-1.8) being iron deficient and 1.2 (CI, 0.9-1.7) of being folate deficient. Multiple micronutrient deficiencies are prevalent in Sri Lankan adolescents.Item Nutrient intake and growth of adolescents in southern Sri Lanka(Sri Lanka Medical Association, 2006) Hettiarachchi, M.; Liyanage, C.; Wickremasinghe, R.; Hilmers, D.; Abrams, S.A.OBJECTIVE: Growth and dietary intake data are essential for formulation of nutritional policies and interventions for children. DESIGN: 945 school children (11-16 years) were subjected to growth assessment and their nutrient intake was determined using the 24-hour dietary recall method on three consecutive days. RESULTS: 21.3% of boys and 21.1% of girls were stunted (-2SD below the median height-for-age). 141 (14.9%) children were both stunted and wasted (-2 SD below the median weight-for-age). Mean body mass index of girls was significantly higher (p < 0.001) than boys at all ages. The mean daily dietary intake of energy was 3.2 (+/- 2.4) MJ, protein 29.1 (+/- 2.1) g, fat 4.5 (+/- 1.1) g, iron 11.5 (+/- 1.0) mg, and zinc 0.8 (+/- 0.7) mg among boys. Among girls, energy intake was 4.2 (+/- 1.8) MJ, protein 29.0 (+/- 2.3) g, fat 4.4 (+/- 1.0) g, iron 11.4 (+/- 1.0) mg, and zinc 0.5 (+/- 0.6) mg. Fat comprised about 4.0% of the daily energy intake. CONCLUSIONS: High rate of growth deficiency and under nutrition among adolescents mandates innovative nutritional intervention strategies. The observed mean intakes of nutrients in the sample showed a worrisome deviation from the recommendations of the dietary guidelines for Sri Lanka.Item Iron absorption from a traditio nal Sri Lankan weaning food and the enhancing effect of ascorbic acid in adult male volunteers(Sri Lanka Medical Association, 1996) Liyanage, C.; Goonaratna, C.; Thabrew, I.OBJECTIVE:To study absorption of iron from Centella gruel and the enhancing effect of ascorbic acid in young adult males.DESIGN: An in vivo absorption study. SETTING: Faculty of Medicine, Galle. METHODS: The percentage of iron absorbed from the Centella gruel was measured using a double isotope technique with 55Fe and 59Fe on 10 healthy male volunteers. OUTCOME MEASURE: Percentage of iron absorption from the gruel with and without ascorbic acid. RESULTS: The mean iron absorption from each meal of Centella gruel was 2.2% (SEM 0.8). This increased to 5% (SEM 1.6) by addition of 50 mg ascorbic acid. When ingested with ascorbic acid, the bioavailable nutrient density (BND) of the weaning food was increased from 0.23 to 0.53 mg iron/1,000 kcal. To satisfy the daily physiological requirements of iron in infants and toddlers, it was calculated that apart from ascorbic acid supplementation, the total iron content also needs to be increased from 2.05 mg to 4.0 mg/meal. CONCLUSION: Centella gruel cannot provide the amount of iron to meet the BND for iron required by infants and toddlers, unless supplemented with an enhancer of iron absorption such as ascorbic acid and its total iron content is increased.