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This repository contains the published and unpublished research of the Faculty of Medicine by the staff members of the faculty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 Asian Pacific association for the study of liver (APASL) guidelines: hepatitis B virus in pregnancy(Springer,New York, 2022) Kumar, M.; Abbas, Z.; Azami, M.; Belopolskaya, M.; Dokmeci, A.K.; Ghazinyan, H.; Jia, J.; Jindal, A.; Lee, H.C.; Lei, W.; Lim, S.G.; Liu, C.J.; Li, Q.; Mahtab, M.A.; Muljono, D.H.; Niriella, M.A.; Omata, M.; Payawal, D.A.; Sarin, S.K.; Ségéral, O.; Tanwandee, T.; Trehanpati, N.; Visvanathan, K.; Yang, J.M.; Yuen, M.F.; Zheng, Y.; Zhou, Y.H.Hepatitis B virus (HBV) infection still remains a major public health issue in the Asia-Pacific region. Most of the burden of HBV-related disease results from infections acquired in infancy through perinatal or early childhood exposure to HBV in Asia-Pacific. Hepatitis B during pregnancy presents unique management issues for both the mother and fetus. These APASL guidelines provide a comprehensive review and recommendations based on available evidence in the literature, for the management of females with HBV infection through every stage of pregnancy and postpartum. These also address the concerns, management challenges, and required follow-up of children born to hepatitis B-positive mothers.Item Comparison of cryptogenic and hepatitis B related hepatocellular carcinoma(Sri Lanka Medical Association, 2016) Siriwardana, R.C.; Niriella, M.A.; Dassanayake, A.S.; de Silva, A.P.; Gunetilleke, B.; Chok, K.S.H.; Lo, C.M.; Chan, S.C.; Fan, S.T.; de Silva, S.T.INTRODUCTION AND OBJECTIVES: Viral hepatitis is the leading cause for hepatocellular carcinoma (HCC) globally. Cryptogenic or non-alcoholic fatty liver related HCC is increasing and is predominant in Sri Lanka (SL). Few studies have compared cryptogenic (cHCC) and hepatitis B (bHCC) HCC. Objective of the study was to compare cryptogenic and hepatitis B related hepatocellular carcinoma. METHOD: Patients with HCC were screened at two centres, in Hong Kong (HK) and SL, from 2012-2014. HCC was diagnosed on typical CT/MRI appearance. Biopsy was performed when uncertain. Those with safe alcohol intake, no hepatotoxic exposure, and not having viral, autoimmune or inherited aetiology were considered cHCC. Demography, baseline liver status, tumour characteristics and treatment were compared between groups. A p<0.05 was considered significant. RESULTS: There were 891 patients (350-SL,541-HK). All HK patients were HBsAg positive. Two HBsAg positive SL patients, and 363 with unsafe alcohol intake were excluded. There were no hepatitis C patients. cHCC=234 and bHCC=292 were compared. There was no difference in gender, presenting age, symptoms, transaminases, platelet counts, median tumour diameter, morphology and tumour stage at presentation between groups. Significantly more cHCC had diabetes [133 vs. 67], while more bHCC were cirrhotics [269 vs.175]. At presentation, serum bilirubin was significantly higher in bHCC (1.2 vs. 0.7), while INR (1.23vs1.1) and AFP (51u/lvs.26u/l) were significantly higher in cHCC. bHCC had significantly more surgical candidates [113 vs. 50], while significantly more cHCC were transarterial- chemo-embolization (TACE) candidates [74 vs. 53]. More cHCC were unsuitable for active treatment despite similar tumour stage at presentation. CONCLUSIONS: More cHCC had diabetes and occurred in non-cirrhotic livers. Compared to bHCC, fewer cHCC were candidates for surgery or active treatment at presentation.Item Hepatitis B virus markers in primary hepatocellular carcinoma(Faculty of Medicine, University of Peradeniya, Sri lanka, 1994) de Silva, H.J.; Ratnatunga, N.; Ramadasa, S.Based on serological studies, Sri Lanka has a relatively low Hepatitis B virus (HB V) [hepatitis B surface antigen (HBsAg)] carrier rate of 0.9% and a low prevalence of HBV (5-10%) among patients with primary hepatocellular carcinoma (PHC). To investigate this further we looked for HBV markers in PHC using more sensitive immunoliistochemical methods. Formalin fixed paraffin embedded tissue obtained from 18 PHCs were studied. Only 7 of the specimens contained non-tumour liver tis¬sue around the PHC, and evidence of cirrhosis was seen in 5 of them. Four micron thick sections of tissue were stained, with polyclonai antibod¬ies directed against HBsAg and hepatitis B core antigen (HBcAg) using a three stage immunoperoxidase technique (peroxidase-anti peroxidase). Positive control liver tissue was used in all experiments. HBsAg was detected in6(33.3%)of the 18 specimens (in the tumour tissue only in 3 speci¬mens, tumour tissue and surrounding cirrhotic liver tissue in 1. and surrounding cirrhotic liver tissue only and not in tumour tissue in 2 speci¬mens). The staining was cytoplasrnic. HBcAg was not detected in any of the tissue specimens tested. Nodatareg;irding serum alphafetoprotein levels were available from the patients medical records. From the preliminary results of this on going study, HBsAg markers appear to be more frequently associated with PHC than serological studies from Sri Lanka have indicated. HBV may, therefore, have arnore important aetiologi-cal role in PHC in this country than was previ¬ously believed.Item Lamivudine for hepatitis B infection in post-renal transplant patients: 36 month follow-up(Wiley Blackwell Scientific Publications, 2004) de Silva, H.J.; Herath, C.A.; Sheriff, M.H.R.INTRODUCTION: Therapy with interferon-alpha is inappropriate for post-renal transplant Hepatitis B infection, as it may result in graft rejection. We assessed the efficacy of lamivudine in HBV infection among post-renal transplant patients after 36 months of treatment. METHODS: From April 1999, post-renal transplant patients with chronic HBV infection were offered treatment with lamivudine 100 mg/day. Their liver function and HBV serology were assessed 3 monthly, and HBV-DNA annually or when otherwise indicated. Post-transplant immunosuppressive therapy was not altered. RESULTS: Lamivudine treatment was started in 43 patients [M:F = 28:15; median age 41 yrs (range 28–76)]. At recruitment, all were HBsAg (+), HBV-DNA (+) and anti-Hbe (-); 35 were HBeAg (+). Serum ALT was 24–768 IU/L (median 113). 6 had hepatic decompensation and 4 died (3 from renal causes) within one month of starting lamivudine. After 12 months of treatment HBV-DNA became undetectable and ALT normalised in 30/39 (76.9%). 16/30 discontinued treatment, but all 16 became HBV-DNA (+) 3 months later; lamivudine was restarted. 32 patients completed 36 months of treatment (7 lost to follow-up). All were HBsAg (+); 23 were HBVDNA (+) - 18/23 had earlier become DNA (-) with treatment but had breakthrough HBV-DNA (+), 5/23 were HBV-DNA(+) throughout follow-up; 4 patients were HBV-DNA (-), HBeAg (-), anti-Hbe (+); and 5 were HBV-DNA (-), HBeAg (-), anti-Hbe (-). There were no side-effects attributable to lamivudine. CONCLUSIONS: Lamivudine therapy suppressed HBV-DNA in postrenal transplant patients with HBV infection on immunosuppressive therapy, but suppression was dependant on continued therapy. After 36 months of treatment few patients showed HBe seroconversion, but not eradication of infection. Breakthrough HBV-DNA (+) occurred in a significant proportion during continued treatmentItem Study on immunity against Hepatitis B in children after vaccination during infancy(Sri lanka Medical Association, 2015) Perera, K.P.J.; Hapugoda, M.; Fernando, K.M.D.; Dimal, D.A.INTRODUCTION AND OBJECTIVES: Hepatitis B vaccine is given in Sri Lanka to all infants at 2, 4,6 months. As a low prevalent country the risk of acquiring Hepatitis B is more likely during adolescence and later. It is important to know whether immunity produced by vaccination during infancy last up to this stage, or a booster dose is needed to augment the immune response. METHOD: With informed written consent and assent from children, 150 ten year old school children with evidence of Hepatitis B vaccination during infancy, were tested for Hepatitis B antibody status using ELISA. Children who had an antibody titre less lOmlU/mL were offered a free booster dose. Antibody levels were retested one month after the booster. RESULTS: 128 (67%) had an antibody titre above 10m ID/ml. All children with a titre <10mlU/ml, accepted the booster dose. All children who received the booster had an antibody response above 10mlU/l, while (72%) had a titre >100mlU/l. CONCLUSION: Vaccination against Hepatitis B during infancy appear to produce protective level of antibodies at ten years of age. Even the children with antibody titres below protective level produced a sharp rise in titres with a booster dose. As this response could be expected with a natural infection, booster dose to augment the immune response produced by vaccination during infancy is not needed.Item Prevalence of hepatitis B and hepatitis C infections and their relationship to injectable drug use in a cohort of Sri Lankan prison inmates(Sri Lanka Medical Association, 2015) Niriella, M.A.; Hapangama, A.; Luke, H.P.D.P.; Pathmeswaran, A.; Kuruppuarachchi, K.A.L.A.; de Silva, H.J.INTRODUCTION: Prisoners are considered to be at high risk for Hepatitis B (HBV) and Hepatitis C (HCV) virus infections. This is attributed to intravenous drug use and high-risk sexual behaviour. There are no published studies on HBV and HCV among prison inmates or injecting drug users in Sri Lanka. OBJECTIVES: To determine prevalence of HBV and HCV infections, and their relationship to injectable drug use among Sri Lankan prisoners. METHODS: We investigated 393 (median age 42 years (range 16 to 93); 82% males) randomly selected inmates of Mahara and Welikada prisons. RESULTS: Though 167 (42.5%) admitted drug abuse, only 17 (4.3%) had ever used intravenous drugs. Twelve (70.6%) of them reported sharing needles. One inmate was positive for HBsAg but was negative for HBV-DNA. Twenty seven (6.9%) were positive for anti-HCV antibodies, of whom only 2 (0.5%) were positive for HCV-RNA. None of the injecting drug users were positive for HBV-DNA or HCV-RNA. CONCLUSIONS: The prevalence of HBV and HCV infections as well as injecting drug use was very low among this cohort of Sri Lankan prisoninmatesItem Hepatitis B, C, and HIV infections in Sri Lanka(Ceylon College of Physicians, 2006) de Silva, H.J.; Abeywickrema, I.No Abstract AvailableItem Item Lamivudine therapy for hepatitis B infection in post-renal transplant patients: results after 36 months follow-up(Wiley-Blackwell, 2005) de Silva, H.J.; Herath, C.A.; Sheriff, M.H.No Abstract Available