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Article ; Online: Chronic nausea and vomiting: a diagnostic approach.

Niriella, Madunil A / Jayasena, Hiruni / Withanage, Maduri / Devanarayana, Niranga M / De Silva, Arjuna P

Expert review of gastroenterology & hepatology

2022 Volume 16, Issue 4, Page(s) 311–320

Abstract: Introduction: Chronic nausea and vomiting (CNV) are commonly encountered symptoms in medical practice. CNV is the presenting symptom in a variety of gastrointestinal and non-gastrointestinal disorders. However, in a significant percentage of patients ... ...

Abstract	Introduction: Chronic nausea and vomiting (CNV) are commonly encountered symptoms in medical practice. CNV is the presenting symptom in a variety of gastrointestinal and non-gastrointestinal disorders. However, in a significant percentage of patients without an obvious underlying cause, CNV poses a significant diagnostic challenge to the evaluating physician. Areas covered: A comprehensive clinical history and physical examination form the foundation for further diagnostic work-up. In the present review, we discuss the diagnostic approach to CNV, highlighting the epidemiology, pathophysiology, causes, and modes of evaluation of this condition. Specific investigations, carefully guided by clinical assessment and tailored for each patient, would be more beneficial in diagnosing CNV than empirically performing a blanket of investigations. Expert opinion: Whilst CNV remains a historically challenging diagnostic and therapeutic dilemma, research into this topic is limited. Hence, there is a growing call for more research into diagnostic modalities for CNV. With scientific advancement and further research, it is hoped that easy-to-use, cheap, noninvasive novel diagnostic modalities for CNV will be available soon.
MeSH term(s)	Gastric Emptying ; Gastrointestinal Tract ; Humans ; Nausea/epidemiology ; Nausea/etiology ; Vomiting/epidemiology ; Vomiting/etiology
Language	English
Publishing date	2022-03-22
Publishing country	England
Document type	Journal Article ; Review
ZDB-ID	2481021-6
ISSN	1747-4132 ; 1747-4124
ISSN (online)	1747-4132
ISSN	1747-4124
DOI	10.1080/17474124.2022.2056016
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Article ; Online: Masks in COVID-19: let's unmask the evidence.

De Silva, Arjuna P / Niriella, Madunil A / de Silva, H Janaka

Expert review of respiratory medicine

2020 Volume 15, Issue 3, Page(s) 293–299

Abstract: Introduction: One of the main issues in the novel coronavirus 2019 (COVID-19) pandemic has been the lack of uniformity of recommendations for the usage of face masks.: Areas covered: While Asian countries started using masks early during the epidemic, ...

Abstract	Introduction: One of the main issues in the novel coronavirus 2019 (COVID-19) pandemic has been the lack of uniformity of recommendations for the usage of face masks. Areas covered: While Asian countries started using masks early during the epidemic, most Western countries were slow to do so. To avoid such situations, clear guidelines, need to be established, not only regarding the use of masks but also the type of mask to suit different situations. In this article, we will examine the types of masks and review the recommendations for their use based on the available evidence for each type of mask. Expert opinion: We explore future needs in research-related mask use in COVID-19 pandemic, improvements to be made in mask design, adopting guidelines for the use of masks and the psycho-social aspects of widespread and prolonged mask use.
MeSH term(s)	COVID-19/epidemiology ; COVID-19/transmission ; Disease Transmission, Infectious/prevention & control ; Humans ; Masks/supply & distribution ; Pandemics ; Personal Protective Equipment/supply & distribution ; SARS-CoV-2
Keywords	covid19
Language	English
Publishing date	2020-11-01
Publishing country	England
Document type	Journal Article ; Review
ZDB-ID	2479146-5
ISSN	1747-6356 ; 1747-6348
ISSN (online)	1747-6356
ISSN	1747-6348
DOI	10.1080/17476348.2021.1838277
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Article ; Online: The association between steatosis and liver damage in transfusion-dependent beta thalassaemia patients.

Padeniya, Padmapani / Ediriweera, Dileepa / De Silva, Arjuna P / Niriella, Madunil / Premawardhena, Anuja

British journal of haematology

2022 Volume 200, Issue 4, Page(s) 517–523

Abstract: ... higher than in patients without significant steatosis (S0) (p = 0.03 and p = 0.004, respectively ...

Abstract	Non-alcoholic fatty liver disease (NAFLD) is a global health problem. Iron is the leading cause of liver damage in patients with transfusion-dependent thalassaemia (TDT), and data on the contribution of NAFLD to liver damage in TDT is lacking. Forty-five heavily transfused TDT patients who did not have biochemical or ultrasonic evidence of liver cirrhosis were evaluated for effects of iron overload, including the presence of diabetes mellitus, hypogonadism, serum ferritin, R2-MRI-liver, and liver enzymes alanine aminotransferase and aspartate aminotransferase. Liver fibrosis and steatosis were estimated using transient elastography (TE). Nine (20%) patients had significant steatosis (S1), and their body mass index (BMI) and liver fibrosis scores were higher than in patients without significant steatosis (S0) (p = 0.03 and p = 0.004, respectively). On regression analysis, the controlled attenuation parameter (CAP) score (i.e., degree of liver steatosis) was associated only with increasing BMI. The TE score (i.e., degree of liver fibrosis) was associated with increasing age, CAP score, male gender, and presence of diabetes. Neither liver steatosis nor fibrosis showed significant association with the liver iron concentration or iron-related organ damage (hypogonadism). In this cohort of TDT patients, steatosis of the liver, which is associated with increasing BMI, appeared to increase the risk of liver fibrosis.
MeSH term(s)	Humans ; Male ; Non-alcoholic Fatty Liver Disease/complications ; Non-alcoholic Fatty Liver Disease/pathology ; beta-Thalassemia/complications ; beta-Thalassemia/therapy ; beta-Thalassemia/pathology ; Liver/diagnostic imaging ; Liver/pathology ; Liver Cirrhosis/etiology ; Liver Cirrhosis/pathology ; Elasticity Imaging Techniques ; Diabetes Mellitus
Language	English
Publishing date	2022-10-04
Publishing country	England
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	80077-6
ISSN	1365-2141 ; 0007-1048
ISSN (online)	1365-2141
ISSN	0007-1048
DOI	10.1111/bjh.18492
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Article ; Online: Using FIB-4 score as a screening tool in the assessment of significant liver fibrosis (F2) in patients with transfusion-dependent beta thalassaemia: a cross-sectional study.

Padeniya, Padmapani / Ediriweera, Dileepa Senajith / De Silva, Arjuna P / Niriella, Madunil Anuk / Premawardhena, Anuja

BMJ open

2022 Volume 12, Issue 9, Page(s) e061156

Abstract: ... patients, 22 (49%) were males. FIB-4 score showed a significant linear correlation with TE (r=0.52;p<0.0003 ...

Abstract	Objective: To evaluate the performance of the fibrosis-4 (FIB-4) score as a screening tool to detect significant liver fibrosis (F2) compared with transient elastography (TE), among chronic transfusion-dependent beta-thalassaemia (TDT) patients in a resource-poor setting. Design: A cross-sectional study. Setting: Adolescent and Adult Thalassaemia Care Centre (University Medical Unit), Kiribathgoda, Sri Lanka. Participants: 45 TDT patients who had undergone more than 100 blood transfusions with elevated serum ferritin >2000 ng/mL were selected for the study. Patients who were serologically positive for hepatitis C antibodies were excluded. Outcome measures: TE and FIB-4 scores were estimated at the time of recruitment in all participants. Predefined cut-off values for F2, extracted from previous TE and FIB-4 scores studies, were compared. A new cut-off value for the FIB-4 score was estimated using receiver operating characteristics curve analysis to improve the sensitivity for F2 prediction. Results: Of the selected 45 TDT patients, 22 (49%) were males. FIB-4 score showed a significant linear correlation with TE (r=0.52;p<0.0003). The FIB-4 score was improbable to lead to a false classification of TDT patients to have F2 when the FIB-4 cut-off value was 1.3. On the other hand, it had a very low diagnostic yield in missing almost all (except one) of those who had F2. Using a much-lowered cut-off point of 0.32 for FIB-4, we improved the pick-up rate of F2 to 72%. Conclusions: Regardless of the cut-off point, the FIB-4 score cannot be used as a good screening tool to pick up F2 in patients with TDT, irrespective of their splenectomy status. On the contrary, at a 1.3 cut-off value, though FIB-4 is a very poor detector for F2 fibrosis, it will not erroneously diagnose F2 fibrosis in those who do not have it.
MeSH term(s)	Adolescent ; Adult ; Aspartate Aminotransferases ; Biomarkers ; Cross-Sectional Studies ; Elasticity Imaging Techniques ; Female ; Hepatitis C Antibodies ; Hepatitis C, Chronic ; Humans ; Liver/pathology ; Liver Cirrhosis/pathology ; Male ; ROC Curve ; beta-Thalassemia/diagnosis
Chemical Substances	Biomarkers ; Hepatitis C Antibodies ; Aspartate Aminotransferases (EC 2.6.1.1)
Language	English
Publishing date	2022-09-26
Publishing country	England
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	2599832-8
ISSN	2044-6055 ; 2044-6055
ISSN (online)	2044-6055
ISSN	2044-6055
DOI	10.1136/bmjopen-2022-061156
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Article ; Online: Masks in COVID-19

De Silva, Arjuna P. / Niriella, Madunil A. / de Silva, H. Janaka

Expert Review of Respiratory Medicine

let’s unmask the evidence

2020 , Page(s) 1–7

Keywords	Immunology and Allergy ; Public Health, Environmental and Occupational Health ; Pulmonary and Respiratory Medicine ; covid19
Language	English
Publisher	Informa UK Limited
Publishing country	uk
Document type	Article ; Online
ZDB-ID	2479146-5
ISSN	1747-6356 ; 1747-6348
ISSN (online)	1747-6356
ISSN	1747-6348
DOI	10.1080/17476348.2021.1838277
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Article ; Online: Effects of probiotics combined with dietary and lifestyle modification on clinical, biochemical, and radiological parameters in obese children with nonalcoholic fatty liver disease/nonalcoholic steatohepatitis: a randomized clinical trial.

Rodrigo, Thushara / Dulani, Samaranayake / Nimali Seneviratne, Sumudu / De Silva, Arjuna P / Fernando, Jerad / De Silva, H Janaka / Jayasekera / Wickramasinghe, V Pujitha

Clinical and experimental pediatrics

2021 Volume 65, Issue 6, Page(s) 304–311

Abstract: Background: Childhood obesity is a global problem associated with metabolic abnormalities. The gut-liver axis is thought to play a major role in its pathogenesis. Probiotics are known to alter the gut microbiota and, therefore, could be a therapeutic ... ...

Abstract	Background: Childhood obesity is a global problem associated with metabolic abnormalities. The gut-liver axis is thought to play a major role in its pathogenesis. Probiotics are known to alter the gut microbiota and, therefore, could be a therapeutic option in the management of childhood obesity-related complications. Purpose: This double-blind randomized placebo-controlled trial evaluated the effects of probiotics on metabolic derangement in obese children with nonalcoholic fatty liver disease/ nonalcoholic steatohepatitis (NAFLD/NASH). Methods: Obese children with NAFLD/NASH treated at the nutrition clinic of the University Paediatric Unit at Lady Ridgeway Hospital, Colombo, were recruited. Anthropometry, body fat, metabolic derangement, and liver ultrasound scan (USS) results were evaluated at baseline and after 6 months. Transient elastography (FibroScan) was performed on a subsample of these patients. Eighty-four patients were recruited and randomized into the probiotics (n=43) and placebo (n= 41) groups. The mean age was 11.3±1.9 versus 12.1±1.5 years in the probiotic and placebo groups, respectively. Baseline parameters including liver disease stage on USS, body fat percentage, fasting blood sugar, lipid profile, liver function, and C-reactive protein showed no significant intergroup differences. Results: In the probiotic group, a statistically significant reduction in body mass index was noted from the baseline value. However, the reduction was not significant compared with the placebo group. There was a significant reduction in triglycerides, aspartate transaminase (AST), alanine aminotransferase (ALT), AST/ALT ratio, and alkaline phosphatase in the placebo group over the treatment period. Although the liver disease stage on USS improved from stage II-III to stage I in a small number of patients in the probiotic-treated group, transient elastography performed in a subsample did not demonstrate significant improvement in either group. Conclusion: Our results indicate that probiotics have no advantage over lifestyle modification for improving obesityassociated metabolic derangement in children.
Language	English
Publishing date	2021-11-11
Publishing country	Korea (South)
Document type	Journal Article
ISSN	2713-4148
ISSN (online)	2713-4148
DOI	10.3345/cep.2021.00787
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Article: Masks in COVID-19: let's unmask the evidence

De Silva, Arjuna P / Niriella, Madunil A / de Silva, H Janaka

Expert Rev Respir Med

Abstract: INTRODUCTION: One of the main issues in the novel coronavirus 2019 (COVID-19) pandemic has been the lack of uniformity of recommendations for the usage of face masks. AREAS COVERED: While Asian countries started using masks early during the epidemic, ... ...

Abstract	INTRODUCTION: One of the main issues in the novel coronavirus 2019 (COVID-19) pandemic has been the lack of uniformity of recommendations for the usage of face masks. AREAS COVERED: While Asian countries started using masks early during the epidemic, most Western countries were slow to do so. To avoid such situations, clear guidelines, need to be established, not only regarding the use of masks but also the type of mask to suit different situations. In this article, we will examine the types of masks and review the recommendations for their use based on the available evidence for each type of mask. EXPERT OPINION: We explore future needs in research-related mask use in COVID-19 pandemic, improvements to be made in mask design, adopting guidelines for the use of masks and the psycho-social aspects of widespread and prolonged mask use.
Keywords	covid19
Publisher	WHO
Document type	Article
Note	WHO #Covidence: #861964
Database	COVID19

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Article ; Online: Postdischarge outcomes of COVID-19 patients from South Asia: a prospective study.

Abeysuriya, Visula / Seneviratne, Suranjith L / De Silva, Arjuna P / Mowjood, Riaz / Mowjood, Shazli / de Silva, Thushara / de Mel, Primesh / de Mel, Chandima / Wijesinha, R S / Fernando, Amitha / de Mel, Sanjay / Chandrasena, Lal

Transactions of the Royal Society of Tropical Medicine and Hygiene

2022 Volume 116, Issue 12, Page(s) 1129–1137

Abstract: ... The level of vaccination was significantly associated with disease severity (p<0.001). Early recovery was ... groups at 1, 2 and 3 mo postdischarge (p<0.05). Twenty-three patients developed complications ...

Abstract	Background: Coronavirus disease 2019 (COVID-19) may cause clinical manifestations that last for weeks or months after hospital discharge. The manifestations are heterogeneous and vary in their frequency. Their multisystem nature requires a holistic approach to management. There are sparse data from the South Asian region on the outcomes of hospital-discharged COVID-19 patients. We assessed the posthospital discharge outcomes of a cohort of Sri Lankan COVID-19 patients and explored the factors that influenced these outcomes. Methods: Data were prospectively collected from patients who were discharged following an admission to the Nawaloka Hospital, Sri Lanka with COVID-19 from March to June 2021. At discharge, their demographic, clinical and laboratory findings were recorded. The patients were categorised as having mild, moderate and severe COVID-19, based on the Sri Lanka Ministry of Health COVID-19 guidelines. Following discharge, information on health status, complications and outcomes was collected through clinic visits and preplanned telephone interviews. A validated (in Sri Lanka) version of the Short Form 36 health survey questionnaire (SF-36) was used to assess multi-item dimensions health status of the patients at 1, 2 and 3 mo postdischarge. Results: We collected data on 203 patients (male, n=111 [54.7%]). The level of vaccination was significantly associated with disease severity (p<0.001). Early recovery was seen in the mild group compared with the moderate and severe groups. At 3 mo, on average 98% of mild and 90% of moderate/severe patients had recovered. Based on the SF-36, physical functioning dimensions, role limitation due to physical and emotional health, energy/ fatigue, emotional well-being, social functioning, pain and general health were significantly different in the moderate/severe vs mild COVID-19 groups at 1, 2 and 3 mo postdischarge (p<0.05). Twenty-three patients developed complications, of which the most common were myocardial infarction with heart failure (n=6/23; 26.1%), cerebrovascular accident (n=6/23; 26.1%) and respiratory tract infections (n=3/23; 13.01%) and there were six deaths. Conclusions: In our cohort, receiving two doses of the COVID-19 vaccine was associated with reduced disease severity. Those with mild disease recovered faster than those with moderate/severe disease. At 3 mo posthospital discharge, >90% had recovered.
MeSH term(s)	Humans ; Male ; COVID-19/epidemiology ; Prospective Studies ; Patient Discharge ; SARS-CoV-2 ; COVID-19 Vaccines ; Aftercare ; Sri Lanka/epidemiology
Chemical Substances	COVID-19 Vaccines
Language	English
Publishing date	2022-04-28
Publishing country	England
Document type	Journal Article
ZDB-ID	441375-1
ISSN	1878-3503 ; 0035-9203
ISSN (online)	1878-3503
ISSN	0035-9203
DOI	10.1093/trstmh/trac039
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Article ; Online: Identification of dengue patients with high risk of severe disease, using early clinical and laboratory features, in a resource-limited setting.

Niriella, Madunil A / Liyanage, Isurujith K / Udeshika, Arundathi / Liyanapathirana, Kasun V / P De Silva, Arjuna / J de Silva, Hithnadura

Archives of virology

2020 Volume 165, Issue 9, Page(s) 2029–2035

Abstract: ... logistic regression with backward elimination (p < 0.05) was used to identify independent risk factors for CP. CP ... developed in 226 (32.4%) patients. Mortality was 1.0%. Predictors for CP (p < 0.05) within the first three ...

Abstract	Only a minority of dengue infections lead to plasma leakage (critical phase [CP]). Early identification of the risk for CP is helpful for triage of patients. This study aimed to identify early clinical predictors of CP that will aid in patient triage during early illness. A retrospective, case-record-based analysis was performed on all microbiologically confirmed (NS1-antigen- or dengue-IgM-antibody-positive), dengue patients (n = 697), admitted to our unit from 01.01.2017 to 30.06.2017. Bivariate analysis was performed to identify clinical and laboratory parameters that predicted CP. Stepwise multivariate logistic regression with backward elimination (p < 0.05) was used to identify independent risk factors for CP. CP developed in 226 (32.4%) patients. Mortality was 1.0%. Predictors for CP (p < 0.05) within the first three days included age category 41-50 years (OR = 1.96), females (OR = 2.09), diabetes (OR = 1.30), persistent vomiting (OR = 2.18), platelet count < 120,000/mm
MeSH term(s)	Adolescent ; Adult ; Aged ; Dengue Virus/classification ; Dengue Virus/genetics ; Dengue Virus/isolation & purification ; Female ; Humans ; Male ; Middle Aged ; Platelet Count ; Retrospective Studies ; Severe Dengue/blood ; Severe Dengue/diagnosis ; Severe Dengue/virology ; Young Adult
Language	English
Publishing date	2020-07-02
Publishing country	Austria
Document type	Journal Article
ZDB-ID	7491-3
ISSN	1432-8798 ; 0304-8608
ISSN (online)	1432-8798
ISSN	0304-8608
DOI	10.1007/s00705-020-04720-5
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Article ; Online: Combination of cycle threshold time, absolute lymphocyte count and neutrophil:lymphocyte ratio is predictive of hypoxia in patients with SARS-CoV-2 infection.

Abeysuriya, Visula / Seneviratne, Suranjith L / de Silva, Arjuna P / Mowjood, Riaz / Mowjood, Shazli / de Silva, Thushara / de Mel, Primesh / de Mel, Chandima / Chandrasena, Lal / Wijesinha, R S / Fernando, Amitha / de Mel, Sanjay

Transactions of the Royal Society of Tropical Medicine and Hygiene

2021 Volume 116, Issue 7, Page(s) 628–635

Abstract: ... RC vs not: 19.46±2.64 vs 22.62±3.37, p=0.0001; AL, RC vs not: 531.49±289.09 vs 764.69±481.79, p=0 ... 0001; NLR, RC vs not: 3.42±0.75 vs 2.59±0.55, p=0.0001). Receiver operating characteristics analysis ...

Abstract	Background: There is currently no clinically validated biomarker to predict respiratory compromise in sudden acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. Cycle threshold time (Ct), absolute lymphocyte count (AL) and neutrophil:lymphocyte ratio (NLR) have been previously evaluated for this purpose. We hypothesized that the combination of these parameters at presentation may be predictive of hypoxia (oxygen saturation <92%). Methods: Data were collected on 118 patients with SARS-CoV-2 infection between May 2020 and April 2021. Demographics, clinical parameters and laboratory and radiological investigation results were recorded. Respiratory compromise (RC) was defined based on symptoms and signs, hypoxia and chest X-ray abnormalities. Results: RC occurred in 61 (51.7%) of patients. The Ct, AL and NLR at median day 3 of illness were significantly different between patients with and without RC (Ct, RC vs not: 19.46±2.64 vs 22.62±3.37, p=0.0001; AL, RC vs not: 531.49±289.09 vs 764.69±481.79, p=0.0001; NLR, RC vs not: 3.42±0.75 vs 2.59±0.55, p=0.0001). Receiver operating characteristics analysis showed that a Ct <19.9, AL <630.8×103/μL and NLR >3.12 at median day 3 of symptoms was predictive of hypoxia on day 7 of illness (area under the curve 0.805, sensitivity 96.7%, specificity 69.1%). The predictive value for the parameters combined was significantly superior to their individual predictive power. Conclusions: Ct, AL and NLR used in combination on day 3 of symptoms are predictive of hypoxia on day 7 of SARS-CoV-2 illness.
MeSH term(s)	COVID-19/diagnosis ; Humans ; Hypoxia ; Lymphocyte Count ; Lymphocytes ; Neutrophils ; Prognosis ; ROC Curve ; Retrospective Studies ; SARS-CoV-2
Language	English
Publishing date	2021-12-11
Publishing country	England
Document type	Journal Article
ZDB-ID	441375-1
ISSN	1878-3503 ; 0035-9203
ISSN (online)	1878-3503
ISSN	0035-9203
DOI	10.1093/trstmh/trab182
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