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This repository contains the published and unpublished research of the Faculty of Medicine by the staff members of the faculty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 Asia-Pacific association for study of liver guidelines on management of ascites in liver disease(Springer, 2023) Singh, V.; De, A.; Mehtani, R.; Angeli, P.; Maiwall, R.; Satapathy, S.; Singal, A.K.; Saraya, A.; Sharma, B.C.; Eapen, C.E.; Rao, P.N.; Shukla, A.; Shalimar; Choudhary, N.S.; Alcantara-Payawal, D.; Arora, V.; Aithal, G.; Kulkarni, A.; Roy, A.; Shrestha, A.; Mamun, A.M.; Niriella, M.A.; Siam, T.S.; Zhang, C.Q.; Huei, L.G.; Yu, M.L.; Roberts, S.K.; Peng, C.Y.; Chen, T.; George, J.; Wong, V.; Yilmaz, Y.; Treeprasertsuk, S.; Kurniawan, J.; Kim, S.U.; Younossi, Z.M.; Sarin, S.K.No abstract availableItem Wilson's disease and Hyperornithinemia-hyperammonemia-homocitrullinuria Syndrome in a child: A case report with lessons learned!(Jaypee Brothers Medical Publishers, Mumbai, 2021) Fernando, M.; Vijay, S.; Santra, S.; Preece, M.A.; Brown, R.; Rodrigues, A.; Gupte, G.L.Background: Wilson's disease (WD) is a rare disorder of copper toxicosis. Hyperornithinemia-hyperammonemia-homocitrullinuria (HHH) syndrome is even rarer. The coexistence of these two disorders and their clinical implications are not yet reported. We report on a child who succumbed to death due to liver disease caused by both disorders, documenting their disease-causing mutations and highlighting the lessons learnt out of this case. Case description: A child who was diagnosed to have WD soon after birth due to known parental heterozygosity was later found to have developmental delay, seizures, and hyperammonemia. Subsequent evaluation confirmed hyperornithinemia-hyperammonamia-homocitrullinuria (HHH) syndrome as a comorbidity. Though this child was commenced on medical treatment for both the metabolic diseases since early life, his liver disease was rapidly progressive requiring a liver transplant (LTx) at 6-years. He died in the posttransplant period possibly due to sepsis and hidden metabolic consequences. Conclusion: This case highlights that co-occurrence of WD and HHH syndrome would cause progressive liver disease despite medical treatment. Hence, the close clinical follow-up and early LTx would be warranted.Item On the proposed definition of metabolic-associated fatty liver disease [Letter to the Editor](Elsevier, 2022) Niriella, M.A.; de Silva, A.P.; de Silva, H.J.No abstract available, Comment on Wai-Sun Wong V, et al, Clinical Gastroenterology and Hepatology. 2021;19(5):865-870. [Epub 2021 Jan 13.]Item Association of serum ferritin with diabetes and alcohol in patients with non-viral liver disease-related hepatocellular carcinoma(S. Karger, 2017) Siriwardana, R.C.; Niriella, M.A.; Dassanayake, A.S.; Ediriweera, D.; Gunetilleke, B.; Sivasundaram, T.; de Silva, H.J.INTRODUCTION: Non-alcoholic fatty liver disease is a leading cause for hepatocellular carcinoma (HCC) in Sri Lanka. Diabetes mellitus, alcohol abuse, and liver inflammation are known to increase the risk of HCC. The present study evaluates serum ferritin levels in a cohort of patients with non-viral HCC (nvHCC). METHODOLOGY: Consecutive patients with nvHCC presenting to the Colombo North Liver transplant Service, Ragama, from January 2012 to July 2013 were investigated. All were negative for hepatitis B and C. At registration, 5 mL of serum was separated into plain tubes, stored at -80°C and analysed for ferritin using an enzyme-linked immunosorbent assay. Correlation between the serum ferritin and patient risk factors, liver status, and tumour characteristics were analysed. RESULTS: There were 93 patients with nvHCC (median age 65 [12-82] years; 82 [88.2%] males). The median ferritin level was 246.2 μg/L, and 38 (40.86%) patients had elevated ferritin. Non-diabetics (median 363.5 mg/L, p = 0.003) and alcohol abusers (median 261.2 mg/L, p = 0.018) had higher ferritin levels. On multiple-variable analysis, being non-diabetic (p = 0.013) and alcoholic (p = 0.046) was significantly associated with high serum ferritin. No association was found with body mass index, tumour stage, size, macrovascular invasion, number of nodules, alpha-fetoprotein, bilirubin, international normalized ratio, and survival. CONCLUSION: In patients with nvHCC, serum ferritin levels are higher in non-diabetics and alcoholics.