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This repository contains the published and unpublished research of the Faculty of Medicine by the staff members of the faculty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 Correction to: Acute-on-chronic liver failure: consensus recommendations of the Asian Pacific association for the study of the liver (APASL): an update(Springer, 2019) Sarin, S.K.; Choudhury, A.; Sharma, M.K.; Maiwall, R.; Al Mahtab, M.; Rahman, S.; Saigal, S.; Saraf, N.; Soin, A.S.; Devarbhavi, H.; Kim, D.J.; Dhiman, R.K.; Duseja, A.; Taneja, S.; Eapen, C.E.; Goel, A.; Ning, Q.; Chen, T.; Ma, K.; Duan, Z.; Yu, C.; Treeprasertsuk, S.; Hamid, S.S.; Butt, A.S.; Jafri, W.; Shukla, A.; Saraswat, V.; Tan, S.S.; Sood, A.; Midha, V.; Goyal, O.; Ghazinyan, H.; Arora, A.; Hu, J.; Sahu, M.; Rao, P.N.; Lee, G.H.; Lim, S.G.; Lesmana, L.A.; Lesmana, C.R.; Shah, S.; Prasad, V.G.M.; Payawal, D.A.; Abbas, Z.; Dokmeci, A.K.; Sollano, J.D.; Carpio, G.; Shresta, A.; Lau, G.K.; Karim, M.F.; Shiha, G.; Gani, R.; Kalista, K.F.; Yuen, M.F.; Alam, S.; Khanna, R.; Sood, V.; Lal, B.B.; Pamecha, V.; Jindal, A.; Rajan, V.; Arora, V.; Yokosuka, O.; Niriella, M.A.; Li, H.; Qi, X.; Tanaka, A.; Mochida, S.; Chaudhuri, D.R.; Gane, E.; Win, K.M.; Chen, W.T.; Rela, M.; Kapoor, D.; Rastogi, A.; Kale, P.; Rastogi, A.; Sharma, C.B.; Bajpai, M.; Singh, V.; Premkumar, M.; Maharashi, S.; Olithselvan, A.; Philips, C.A.; Srivastava, A.; Yachha, S.K.; Wani, Z.A.; Thapa, B.R.; Saraya, A.; Shalimar; Kumar, A.; Wadhawan, M.; Gupta, S.; Madan, K.; Sakhuja, P.; Vij, V.; Sharma, B.C.; Garg, H.; Garg, V.; Kalal, C.; Anand, L.; Vyas, T.; Mathur, R.P.; Kumar, G.; Jain, P.; Pasupuleti, S.S.R.; Chawla, Y.K.; Chowdhury, A.; Alam, S.; Song, D.S.; Yang, J.M.; Yoon, E.L.; APASL ACLF Research Consortium (AARC) for APASL ACLF working PartyThe article Acute-on-chronic liver failure: consensus recommendations of the Asian Pacifc association for the study of the liver (APASL): an update, written by [Shiv Sarin], was originally published electronically on the publisher’s internet portal (currently SpringerLink) on June 06, 2019 without open access. This corrects the article "Acute-on-chronic liver failure: consensus recommendations of the Asian Pacific association for the study of the liver (APASL): an update" in Hepatol Int, volume 13 on page 353. Hepatology International. 2019 ;13(4):353-390.Item Predicting acute liver failure in dengue infection(Sri Lanka Medical Association, 2012) Ranawaka, C.K.; Kumarasena, R.S.; Niriella, M.A.; Miththinda, J.K.N.D.; Pathmeswaran, A.; Dassanayake, A.S.; de Silva, A.P.; de Silva, H.J.INTRODUCTION: Dengue infections (Dl) have a diverse clinical spectrum ranging from asymptomatic illness to severe dengue. Unusual manifestations such as encephalitis, myocarditis, and acute liver failure (ALF) are increasingly recognised. AIMS: To describe the spectrum of liver dysfunction and identify possible predictors of ALF in DI Methods: Serologically confirmed patients with Dl admitted to university medical unit, Ragama from January 2009 to March 2010 were included. Data were obtained from patient records. Results: Out of 240 patients (maleifemale 57.7%:42.5%; mean age 35.6 years[SD 15.4 years]], 49(20.4%) had severe dengue, 164(68.3%) had dengue with warning signs and 27(11.2%) had dengue without warning signs. Abdominal pain, persistent nausea and vomiting (PNV), skin or mucosal bleeding, hepatomegaly and ascites was present in 52.1%J 38.3%, 16.2%, 50% and 11.7% cases respectively. Deranged AST or ALT(ASTALT), serum bilirubin(SB), alkaline phosphatase(ALP), gamma glutamyl transpeptide(GGT), and 1NR were observed in 86.7%, 8.3%, 7.5%, 25% and 10% of patients respectively. Of the 240 patients 41(17.1%) had ASTALT>1000 IU and 199(82.9%) had ASTALT<1000 1U. Only 16/41 patients with ASTALT>1000 IU developed ALF while none from the ASTALT<1000 IU group developed ALF. Presence of 2 or more of elevated SB, elevated ALP or PNV predicted the development of ALF with 93.8% sensitivity, 98.7% specificity, 83.3% positive predictive value and 99% negative predictive value withp<0.001. CONCLUSIONS: ASTALT<1000 IU excluded patients at risk of ALF. Presence of 2 or more of PNV, elevated SB or ALP in patients with Dl may indicate impending ALF. This needs further validation in a larger population.Item Intravenous N-acetylcysteine in acute liver failure associated with dengue infection(Sri Lanka Medical Association, 2010) Rumarasena, R.S.; Senanayake, S.M.; de Silva, A.P.; Biyanwila, C.; Dassanayake, A.S.; Premaratna, R.; V/ijesiriwardena, B.; de Silva, H.J.BACKGROUND: Acute liver failure is rare in dengue but has a poor outcome. N-acetylcysteine (HAC) improves survival in early stage non-acetaminophen acute liver failure. However, its usefulness has not been established in dengue associated acute liver failure. OBJECTIVES: To determine the benefit of intravenous NAC in acute liver failure due to dengue. Methods; Outcome of consecutive adult patients with serologically confirmed dengue infection associated acute liver failure (INR>1.5 with encephalopathy) was retrospectively analysed. They received NAC by intravenous infusion for 72 hours in addition to supportive management. None had taken paracetamol above the therapeutic dose, used hepatotoxic drugs or abused alcohol. Serology for Hepatitis A, B, C, leptospira, and rickettsiae was negative. All patients had negative computerized tomography of the brain. RESULTS: There were 18 patients, (10 females) aged 22-68 years. 11 had dengue hemorrhagic fever (grade 1 and 2), 7 had dengue shock syndrome, 12 had pleural effusions and 8 had ascites. 15 patients had acute liver failure and 3 acute on chronic liver failure (previously diagnosed cirrhotics). 14 patients had early stage hepatic encephalopathy (coma grades I-II), and 4 had advanced encephalopathy (coma grades III-IV). All patients with coma grades l-II recovered completely, while 3 with coma grades III-IV died. None had adverse effects attributable to NAC. CONCLUSION: These preliminary observations suggest that using intravenous NAC in the early stages of dengue associated liver failure is safe and may benefit patients.