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This repository contains the published and unpublished research of the Faculty of Medicine by the staff members of the faculty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 The treatment of ulcerative colitis: from cure to a new disease(Ceylon Medical Association, 1994) de Silva, H.J.No abstract availableItem Coagulopathy and fibrinolysis following the bite of a hump-nosed viper (Hypnale hypnale)(Oxford University Press, 1996) Premawardena, A.P.; Seneviratne, S.L.; Jayanthi, S.; Gunatilake, S.B.; de Silva, H.J.No abstract availableItem Hepatocellular carcinoma in Sri Lanka: Where do we stand?(Sri Lanka Medical Association, 2013) Siriwardana, R.C.; Liyanage, C.A.H.L.; Jayatunge, D.S.P.; Dassanayaka, A.; Gunetileke, M.G.; Niriella, M.A.; Sirigampola, C.; Upasena, A.; de Silva, H.J.INTRODUCTION AND OBJECTIVES:Hepato-cellular carcinoma (HCC) is the sixth commonest cancer worldwide. We studied 105 consecutive patients with HCC in a single tertiary care centre. METHODS: North Colombo Liver Unit maintains a prospective database of HCC since September 2011. There were 105 entries by February 2013. Decision on the best form of treatment was taken at a multidisciplinary meeting. RESULTS: The median age at presentation was 63 years (range 12-79). Patients were predominantly male 93 (87%). Alcohol consumption above the safe limit was reported in 47 (45%). Hepatitis B surface antigen or C antibody was not detected in any of the patients. Background liver cirrhosis was evident in 59 (79%). Forty two (46%) patients had single nodular tumours while in 20 (21%) it was diffusely infiltrating. Portal vein invasion was seen in 22 (20 %). Median alpha-feto protein (AFP) level was 57.25 mg/ml (1.16- 94120 ng/ml; n=72). Twenty four (33%) patients had AFP level > 400u/l. Surgery was performed in 20 (19%), liver transplant in 2 (1.9%), radio frequency ablation or alcohol ablation in 8 (7.6%), trans arterial chemo embolization (TACE) in 44 (41.9%) and sorafmib was prescribed in four patients. Overall mean survival was 15 months. In the ‘no treatment’ group, mean survival was 4 months. Surgery group had a mean survival of 20 months. CONCLUSION: Hepatitis B is not a risk factor for HCC in Sri Lankans. Median survival without treatment is 4 months.Item Gastroenterology Update(Gastroenterological and Digestive Endoscopy Society Sri Lanka Colombo, Sri Lanka, 1993) Goonaratna, C.; de Silva, H.J.No abstract availableItem Side effects of drugs annual(Elsevier, 2001) de Silva, H.J.This chapter presents an overview and discusses the effects of various antiemetics. These drugs include cisapride, clebopride, domperidone, and 5-HT3 receptor antagonists. Clebopride can cause extrapyramidal syndromes, ranging from transient dyskinesia to persistent parkinsonism and tardive dykinesia. The efficacy and adverse effects of domperidone and metoclopramide have been compared in a double-blind, multicenter, randomized trial in 93 insulin-dependent diabetics with symptomatic gastroparesis. The safety and efficacy of the selective 5-HT3 receptor antagonist alosetron in the treatment of irritable bowel syndrome is reviewed. In patients with irritable bowel syndrome, alosetron increases colonic transit time and colonic compliance. Constipation is the most common adverse effect. Several histamine H2 receptor antagonists, such as like cimetidine, and ranitidine are discussed. The drug interactions associated with cimetidine are explained. Cimetidine can interact with other drugs by inhibiting hepatic cytochrome P450.Item Side effects of drugs annual(Elsevier, 1999) de Silva, H.J.This chapter describes the adverse effects of gastrointestinal drugs. The adverse effects of cisapride include abdominal cramps, diarrhea, headache, dystonic reactions, convulsions, and hypersensitivity. Cisapride cardiotoxicity in association with erythromycin is described in the chapter. Cisapride should be used with caution in patients with severe cardiac disease or other risk factors for developing dysrhythmias, particularly hypokalemia and hypomagnesemia. It should not be given to patients with intestinal obstruction, perforation, or hemorrhage. In adults, metoclopramide has been reported to cause gynecomastia and galactorrhea due to hyperprolactinemia secondary to its dopamine antagonist action. Adverse effects attributable to antiemetic therapy include facial rash, constipation, headache, and weakness. The increased risk of acute liver injury with cimetidine is seen mainly in the first two months of use. In a study discussed in the chapter, gynecomastia and a lobular carcinoma of the breast were reported in a patient with chronic gastric ulcer. The hematological adverse effects of ranitidine include leukopenia, thrombocytopenia, aplastic anemia, hemolytic anemia, and pancytopenia.Item Side effects of drugs annual(Elsevier, 2000) de Silva, H.J.This chapter provides an overview of gastrointestinal drugs. Some of the drug classes discussed include antacids, antiemetics, ulcer healing drugs, and cholelitholytic agents—bile acids. The chapter describes the clinical use of cisapride and its risk:benefit ratio in children. The most common adverse effects are diarrhea, abdominal cramps, borborygmi, and colic. Serious adverse events are rare and include isolated cases of extrapyramidal reactions, seizures in epileptic patients, cholestasis, and ventricular dysrhythmias, anorexia, and enuresis. Coadministration of anticholinergic drugs may compromise the beneficial effects of cisapride. Several treatments are available for promoting the healing of gastric and duodenal ulcers associated with the use of non-steroidal anti-inflammatory drugs (NSAIDs). They include histamine receptor antagonists, proton pump inhibitors, and prostaglandin analogues. Proton pump inhibitors can interact with other drugs by increasing gastric pH, inhibiting hepatic cytochrome P450, or inducing specific isoforms of this enzyme system. However, drug interactions involving these isoenzymes and omeprazole or lansoprazole are uncommon and generally appear to be clinically unimportant.Item Factors affecting Post- Embolization fever and liver failure after Trans- Arterial Chemo-Embolization in a cohort without background infective hepatitis- A prospective analysis.(College of Surgeons of Sri Lanka, 2015) Bandara, L.M.P.M.; Siriwardana, R.C.; Niriella, M.A.; Dassanayake, A.S.; Liyanage, C.A.H.; Sirigampala, C.; Upasena, A.; de Silva, H.J.INTRODUCTION: Transarterial-chemo-embolization (TACE) is used for palliation of unresectable hepatocellular carcinoma (HCC). We studied the tolerability of TACE in a cohort of patients with NASH and alcoholic cirrhosis related HCC. MATERIAL AND METHODS: Of 290 patients with HCC(July 2011 - December 2014), 84 underwent TACE. They were monitored for post-TACE complications: post embolization fever(PEF), nausea and vomiting (NV), abdominal pain, infection, acute hepatic decompensation (AHD) and acute kidney injury (AKI). RESULTS: 84 patients [90.5% males, 89.2% cirrhotics, 89.2% nodular HCC, median age 63(34-84) years] underwent 111 TACE sessions. All were Child class A [69.4% sessions(n=77)] or B; ascites and portal vein invasion was present in 18(16.2%) and 15(13.6%), respectively. 42 (38.2%) TACE procedures resulted in complications [PEF 28(25.2 %), NV 4(3.6%), abdominal pain 9(8.1%), infection 7(6.3%), AHD 13(11.7%), AKI 3(2.7%)]. There were no immediate post-TACE deaths. On univariate analysis elevated serum bilirubin (p=0.046) and low serum albumin (p=0.035) predicted PEF while low serum albumin (p=0.021) and low platelet counts (p=0.041) predicted AHD. In the multivariate model, factors with p 5 cm (p=0.049,OR=2.410)and elevated serum bilirubin (p=0.036,OR=1.517) predicted AHD. CONCLUSIONS: In NASH and alcoholic cirrhosis related HCC patients pre- procedure serum bilirubin, ascites, tumour size and female gender predicted PEF post-TACE. Tumours larger 5cm with elevated bilirubin predicted AHD post-TACE.Item Predictors of mortality in a cohort of adult Sri Lankans(Sri Lanka Medical Association., 2019) Kasturiratne, A.; Beddage, T.; de Silva, S.T.; Niriella, M.A.; Pathmeswaran, A.; Kato, N.; Wickremasinghe, A.R.; de Silva, H.J.INTRODUCTION & OBJECTIVES: There is limited knowledge on early predictors of mortality among Sri Lankans. We investigated predictors of mortality in the Ragama Health Study cohort 10 years after recruitment. METHODS: The study population (35-64-year-olds selected by age-stratified random sampling from the Ragama Medical Officer of Health area) was initially screened in 2007 for socio-demographic, lifestyle, anthropometric and clinical risk factors with informed written consent. Their vital status was assessed in 2017 and the causes of death of the deceased were retrieved from death certificates available with the next-of-kin or declaration of death records from the hospital where the death occurred. RESULTS: Of the 2986 enrolled in 2007, 169 [Males: 107 (63.3%)] had died over the 10-year period, giving an overall mortality rate of 5.7% (95% CI: 5.0 % - 6.4%). The number of deaths due to cardiovascular and cancer related causes were 73/169 and 31/169, respectively. On multivariate analysis using Cox's proportional hazards model, advancing age, male sex, lower educational level, unsafe alcohol consumption and the presence of metabolic syndrome at baseline were independent predictors of all-cause mortality. Advancing age, male sex, unsafe alcohol consumption and the presence of metabolic syndrome at baseline were independent predictors of cardiovascular mortality, while advancing age and unsafe alcohol consumption were the only independent predictors of cancer-related mortality. CONCLUSION: Unsafe alcohol consumption and the presence of metabolic syndrome were important modifiable risks for mortality in this population. Addressing these risks in early adulthood will help to improve longevity.Item Best practices on immunomodulators and biological agents for ulcerative colitis and Crohn's disease in Asia.(Taehan Chang Yŏn'gu Hakhoe, 2019) Ooi, C.J.; Hilmi, I.; Banerjee, R.; Chuah, S.W.; Ng, S.C.; Wei, S.C.; Makharia, G.K.; Pisespongsa, P.; Chen, M.H.; Ran, Z.H.; Ye, B.D.; Park, D.I.; Ling, K.L.; Ong, D.; Ahuja, V.; Goh, K.L.; Sollano, J.; K.Lim, W.C.; Leung, W.; Raja Ali, R.A.; Wu, D.C.; Ong, E.; Mustaffa, N.; Limsrivilai, J.; Hisamatsu, T.; Yang, S.K.; Ouyang, Q.; Geary, R.; de Silva, H.J.; Rerknimitr, R.; Simadibrata, M.; Abdullah, M.; Leong, R.W.L.; Asia Pacific Association of Gastroenterology (APAGE) Working Group on Inflammatory Bowel Disease and Asian Organization for Crohn's and ColitisABSTRACT: The Asia-Pacific Working Group on inflammatory bowel disease (IBD) was established in Cebu, Philippines, under the auspices of the Asian Pacific Association of Gastroenterology with the goal of improving IBD care in Asia. This consensus is carried out in collaboration with Asian Organization for Crohn's and Colitis. With biologic agents and biosimilars becoming more established, it is necessary to conduct a review on existing literature and establish a consensus on when and how to introduce biologic agents and biosimilars in the conjunction with conventional treatments for ulcerative colitis (UC) and Crohn's disease (CD) in Asia. These statements also address how pharmacogenetics influence the treatments of UC and CD and provide guidance on response monitoring and strategies to restore loss of response. Finally, the review includes statements on how to manage treatment alongside possible hepatitis B and tuberculosis infections, both common in Asia. These statements have been prepared and voted upon by members of IBD workgroup employing the modified Delphi process. These statements do not intend to be all-encompassing and future revisions are likely as new data continue to emerge.