Vasitha Abeysuriya

Endoscopic observations around the gastroesophageal junction in patients with symptomatic gastroesophageal reflux disease in South Asia

IntroductionWe studied the inter-relationships of endoscopic findings around the gastroesophageal junction in patients with symptomatic gastroesophageal reflux.MethodsData were collected with regard to hiatus hernia (HH), columnar-lined esophagus (CLE), reflux esophagitis (RE) and gastroesophageal flap valve (GEFV), prospectively from 1,150 patients who underwent diagnostic upper gastrointestinal endoscopy for symptomatic gastroesophageal reflux. ResultsThe frequency of HH, CLE and RE was 14.3% (n = 165), 9.5% (n = 109) and 13.3% (n = 153), respectively. In the CLE group, 48 were histologically proven to have Barrett’s esophagus. Of all RE patients, 94.8% had mild esophagitis (LA-A and B) and this was associated with younger age, male gender, presence of HH, and grade 3 or 4 gastroesophageal flap valve (GEFV). Grades 3 and 4 GEFV were associated with HH, CLE, and RE.ConclusionsSubstantial proportion of patients with symptoms of GERD has abnormal endoscopic findings around the gastroesophageal junction.

Outcome of patients with ST segment elevation myocardial infarction (STEMI) following percutaneous transluminal coronary angioplasty: a retrospective study

OBJECTIVES To study the characteristics and long term outcome of patients who had segment elevation myocardial infarction (STEMI) and treated with PTCA in a fee levying hospital in Sri Lanka. METHODS A retrospective study was conducted among patients diagnosed with STEMI and treated with PTCA in a fee levying private hospital in Colombo from 1st January 2009 to 1st November 2012. Details of patients were obtained from medical records and the survival status, cause of death and date of death where relevant, were obtained from records, patients or close relatives. RESULTS 197 patients (153 men; 77.7%) were included. More than 50% had a history of diabetes, dyslipidaemia or hypertension. The three year survival was 82.7% (95% CI: 77.9%-90.5%). Based on the Coxs Proportional Hazards model, site of arterial occlusion (proximal vs distal segment of left anterior descending artery [LAD] was significantly associated with mortality due to all causes [HR 10.98; 95% CI: 1.09-110.20]. Low ejection fraction, not on regular medication and delay of more than 3 hours between onset to door time were associated with death due to cardiovascular causes in patients whose right coronary artery or left circumflex artery was the culprit artery. CONCLUSIONS The three year survival of patients with STEMI and who had PTCA was 83%. Patients with proximal LAD occlusion were 11 times more likely to die within 3 years of PTCA as compared to those who had a distal LAD occlusion.

Assessment of 'nucleation time' as a predictor of cholelithiasis

Introduction In the formation of gallstones, crystal nucleation is a key step, which is followed by precipitation and gradual growth of cholesterol crystals. Materials and methods A case–control study was carried out among 60 patients (30 patients, 14 males and 16 females, median age of 36 years, range 33–71 years, body mass index (BMI)=25.1±0.33 kg/m2, who underwent laparoscopic cholecystectomy; 30 control individuals, 15 males and 15 females, median age of 38 years, range 33–70 years, BMI=24.5±0.23 kg/m2, who underwent laparotomy and who had normal ultrasound scans of the gallbladder and no demonstrable stones). Bile aspirated from the common bile duct was ultrafiltered and anaerobically incubated at 37°C. Incubated bile was examined daily by polarized light microscopy, for appearance of cholesterol crystals. Nucleation time (NT) of bile was assessed as the time taken for the first crystals to appear under polarized light microscopy. Results Age and BMI of control individuals were not different to those of cases studied. The overall mean NT was significantly shorter in patients versus controls (mean NT±SEM: patients, 1.76±0.2 days; vs. controls, 12.74±0.4 days, P=0.001). Of control individuals, females demonstrated a shorter NT compared with males (mean NT±SEM: females, 11.4±0.36 days; vs. males, 14.1±0.46 days, P=0.006). In contrast, there was no sex difference in NT in patients (mean NT±SEM: females, 1.7±0.24 days; vs. males, 1.8±0.2 days, P=0.7). Conclusion NT in control individuals without gallstones was significantly prolonged compared with the NT in patients with established gallstone disease. Among the control individuals, females had a significantly shorter NT than males. Hence, the assessment of NT is predictor of cholelithiasis.

Consumption pattern of iodised salt in households and serum TSH levels among 5-9 year old children in the plantation sector of Sri Lanka

INTRODUCTION Salt is the main source of iodine in areas with high rainfall and iodine deficiency is the main cause of preventable hypothyroidism. Iodisation of salt increases iodine intake, but will depend on how salt is handled. This study was carried out to assess the pattern of salt consumption in the estate population and to ascertain the relationship between household salt iodine concentration and TSH levels in children. METHODS A descriptive cross sectional study was carried out in 20 randomly selected estates in the Ratnapura district of Sri Lanka, from August to November 2009. 1683 households with at least one child between 5-9 years were surveyed to determine patterns of salt usage. A salt sample from each household was tested for adequacy of iodine (concentration ≥ 30 ppm). In phase two, 519 children were randomly selected from these households and serum TSH levels were assayed. RESULTS Salt powder (54.5%) was preferred to salt crystals. Salt crystals were washed before use in 20% households. Salt was kept away from the fire-place in 90.4% of households. Salt samples of 88.7% households had an adequate iodine concentration. Salt iodine concentration was significantly lower when salt was stored near a fire-place and washed before use (p<0.001). The median TSH level of children from households with adequate salt iodine concentrations was significantly lower than that of children from households with inadequate salt iodine concentration (p<0.001). CONCLUSIONS A significant number of households did not have adequate iodine in salt samples probably due to inappropriate handling and storage. Consumption of salt low in iodine is associated with high serum TSH levels.

Idiopathic pancreatitis is a consequence of an altering spectrum of bile nucleation time

BackgroundThe pathogenesis of idiopathic pancreatitis (IP) remains poorly understood. Our hypothesis is that IP is a sequel of micro-crystallization of hepatic bile.MethodsA prospective case control study compared 55 patients; symptomatic cholelithiasis - 30 (14 male, median age 36 years; mean BMI - 25.1 kg/m2), gallstone pancreatitis - 9 (3 male, median age 35 years; mean BMI - 24.86 kg/m2 ) and IP - 16 (9 male, median age 34 years; mean BMI -23.34 kg/m2) with 30 controls (15 male, median age 38 years; mean BMI = 24.5 kg/m2) undergoing laparotomy for conditions not related to the gall bladder and bile duct. Ultrafiltered bile from the common hepatic duct in patients and controls was incubated in anaerobic conditions and examined by polarized light microscopy to assess bile nucleation time (NT). In the analysis, the mean NT of patients with gallstones and gallstone pancreatitis was taken as a cumulative mean NT for those with established gallstone disease (EGD).ResultsPatients were similar to controls. Mean NT in all groups of patients was significantly shorter than controls (EGD cumulative mean NT, 1.73 +/- 0.2 days vs. controls, 12.74 +/- 0.4 days, P = 0.001 and IP patients mean NT, 3.1 +/- 0.24 days vs. controls, 12.74 +/- 0.4 days, P = 0.001). However, NT in those with IP was longer compared with those with EGD (mean NT in IP, 3.1 +/- 0.24 days vs. cumulative mean in EGD: 1.73 +/- 0.2 days, P = 0.002).ConclusionNucleation time of bile in patients with IP is abnormal and is intermediate to nucleation time of lithogenic bile at one end of the spectrum of lithogenicity and non-lithogenic bile, at the other end.