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This repository contains the published and unpublished research of the Faculty of Medicine by the staff members of the faculty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 Autoimmune hepatitis in a patient with cryoglobulinemic vasculitis: A rare association(Springer Nature Group, 2023) Jeyapraniya, A.; de Silva, S.When a patient with cryoglobulinemic vasculitis develops a concurrent liver disease, it is typically associated with hepatitis C. Here, we report the case of a patient with cryoglobulinemic vasculitis and autoimmune hepatitis. A 54-year-old previously healthy woman presented with chronic urticaria. A skin biopsy revealed leukocytoclastic vasculitis and elevated serum cryoglobulins, leading to a diagnosis of cryoglobulinemic vasculitis. She also had abnormal liver functions, high IgG levels, positive antinuclear antibodies, and anti-smooth muscle antibodies. Liver biopsy revealed interface hepatitis confirming the diagnosis of autoimmune hepatitis. This case represents the rare occurrence of autoimmune hepatitis in a patient with cryoglobulinemic vasculitis.Item Tropical liver disease.(Elsevier, 2023) Beeching, N.; Dassanayake, A.The liver is frequently involved in infections that are prevalent in different regions of the tropics, and chronic liver disease, sometimes with multiple aetiological explanations, is an important cause of early morbidity and mortality. This article describes some hepatic and biliary problems that are seen in the tropics or can be imported from resource-poor settings. The epidemiology of hepatitis A is changing in many areas and hepatitis E is now recognized in a wide range of tropical and non-tropical settings. Vaccines have been developed against hepatitis E. Hepatitis B and C continue to cause chronic liver disease, cirrhosis and hepatocellular carcinoma, but these can be eclipsed in epidemiological importance by the sequelae of the emerging epidemic of non-alcoholic fatty liver disease in many parts of the tropics. The pathophysiology of acute and chronic liver disease caused by aflatoxins is better understood, as is the relationship of veno-occlusive disease of the liver to pyrrolizidine alkaloids. Self-poisoning with hepatotoxins is common in many countries. The diagnosis and management of cystic hydatid disease of the liver has been rationalized, based on a systematic approach to the classification of imaging findings.Item 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.Item Item Hepatitis B and C virus markers among new entrant medical students(Sri Lanka Medical Association, 1999) Premawardhena, A.P.; Premaratna, R.; Jayaweera, G.; Costa, S.; Chandrasena, L.G.; de Silva, H.J.AIM: To investigate the presence of hepatitis B and C virus markers in new entrant medical students at the Faculty of Medicine, University of Kelaniya. METHOD: 456 students (mean age 24 years, SD 3.5, 257 men) were investigated before they were exposed to clinical work, using a questionnaire to assess sociodemographic factors and possible risk factors for contracting hepatitis B or C. Blood samples were tested for HBs Ag and anti HBs (n = 456), and anti-HCV (n = 162 randomly selected samples) with a third generation sandwich radioimmunoassay technique. RESULTS: The students were from 20 of the 25 districts in the country, although their distribution was not inform. A past history of hepatitis or jaundice was obtained from 24 (5.3 percent ) and 6 (1.3 percent ) students respectively. None of them had been vaccinated against hepatitis B. At least one risk factor for hepatitis B or C was present in 32 (7 percent ) of them. None of the samples were positive for HBsAg or anti-HCV, and only two (0.44 percent ) were positive for anti-HBs. CONCLUSION: Our results support the view that exposure to hepatitis B and C seems to be uncommon in this country, at least up to young adulthood. As most new entrant medical students are not immune to these infections there is a strong case to vaccinate them against hepatitis B before they are exposed to clinical work.