Browsing by Author "Perera, A."

Now showing 1 - 16 of 16

Alpha thalassaemia and extended alpha globin genes in Sri Lanka
(Elsevier-Academic Press, 2013) Suresh, S.; Fisher, C.; Ayyub, H.; Premawardhena, A.; Allen, A.; Perera, A.; Bandara, D.; Olivieri, N.; Weatherall, D.
The α-globin genes were studied in nine families with unexplained hypochromic anaemia and in 167 patients with HbE β thalassaemia in Sri Lanka. As well as the common deletion forms of α(+) thalassaemia three families from an ethnic minority were found to carry a novel form of α(0) thalassaemia, one family carried a previously reported form of α(0) thalassaemia, --(THAI), and five families had different forms of non-deletional thalassaemia. The patients with HbE β thalassaemia who had co-inherited α thalassaemia all showed an extremely mild phenotype and reduced levels of HbF and there was a highly significant paucity of α(+) thalassaemia in these patients compared with the normal population. Extended α gene arrangements, including ααα, αααα and ααααα, occurred at a low frequency and were commoner in the more severe phenotypes of HbE β thalassaemia. As well as emphasising the ameliorating effect of α thalassaemia on HbE β thalassaemia the finding of a novel form of α(0) thalassaemia in an ethnic minority, together with an unexpected diversity of forms of non-deletion α thalassaemia in Sri Lanka, further emphasises the critical importance of micro-mapping populations for determining the frequency of clinically important forms of the disease.
Auditors' response to regulators during COVID-19: disclosures of key audit matters
(Asian Review of Accounting, 2023) Rainsbury, E.; Bandara, S.; Perera, A.
Purpose New Zealand regulatory bodies guided preparers and auditors of financial statements to deal with potential COVID-19 impacts on the financial statements and audit procedures. This study provides evidence of auditors' response to the impact of COVID-19 on the reporting of key audit matters (KAMs) in audit reports of listed companies in New Zealand. The purpose of this paper is to address this issue. Design/methodology/approach A sample of 50 New Zealand listed companies was selected to compare the KAMs in 2019 (pre-COVID-19) and 2020 (during COVID-19). The study uses content analysis to evaluate the KAMs’ disclosures and descriptive analysis to examine the differences between 2019 and 2020 in terms of the auditor type, industry sector and accounting standards. Findings Auditors responded positively to the request from regulators to communicate the impacts of COVID-19. The findings show an increase in the amount and length of KAMs in 2020 compared to 2019, with 82% of companies and 61% of KAMs reporting the impact of COVID-19. The real estate and information technology sectors disclosed more on the impact than other sectors. In analysing the KAMs, accounting standards for inventories, property plant and equipment, impairment of assets, investment property, revenue from contracts with customers and leases were highly affected by COVID-19. Practical implications The findings support regulators to evaluate how well auditors communicated matters relating to COVID-19 in the audit report. Also, the findings will help standard setters to identify key accounting standards affected by COVID-19 of KAMs and provide insights to users on how the KAM reporting enhances communicative value during the pandemic. Originality/value The current study captures the impact of COVID-19 on the reporting of KAMs by comparing changes before and during the pandemic.
Colonial Period Language Planning in Sri Lanka
(Department of Linguistics, University of Kelaniya, Sri Lanka, 2016) Perera, A.
In linguistically heterogeneous societies, language planning constitutes core institutional practice for maintaining social cohesion as well as unique cultural identities. This study intends to examine the Colonial Period Language Planning in Sri Lanka. The data were collected through official documents, books, journals and thesis such as Colbrooke Cameron Papers, Language Planning by Robert. B. Kaplan etc. The first Europeans to visit Sri Lanka in modem times were the Portuguese who arrived in 1505 and the Dutch who captured Ceylon in 1656. Then the British presence in Sri Lanka began in 1796. The arrival of Europeans was a novel influence on our languages. During those periods Portuguese, Dutch and English were introduced as their official languages and Greek, Latin and Hebrew were included as the languages under the education planning. The colonisation brought European style of education to Sri Lanka, especially to prepare students for positions in the colonial administrations. All official domains were conducted in their official languages. Accordingly, those language policies were introduced to our educational system and to Sinhalese and Tamil languages. As a result, only few people could obtain a proper education and most of the people remained uneducated. Therefore, those language policies caused several social issues. Moreover, Mr. J. R. Jayawardhana introduced a new language planning proposal to change the colonial language planning in 1944. However, that proposal could not be implemented properly. This was a reason for the ethnic problem in Sri Lanka that took place after the independence.
Contribution of Postural Balance and Quadriceps Muscle Strength as Intrinsic Risk Factors of Falls in Healthy Older Adults; A Cross-Sectional Study from the Colombo District.
(Faculty of Medicine, University of Kelaniya, Sri Lanka, 2021) Perera, A.; Landege, O.; Kandege, I.
Introduction: Falls are the main source of morbidity and disability in the elderly. Many falls in older adults are certainly multifactorial, resulting from the confluence of several intrinsic, environmental, behavioural, and activity-related factors. Objective: The study aimed to identify the contribution of postural balance and quadriceps muscle strength as intrinsic risk factors of falls in healthy older adults who resides in two elders’ homes in the Colombo district. Methods: A total of 60 elders who dwelt in Salina Alwis elders’ home and Sahana Udaya elders’ home were selected using a non-probability convenient sampling method. Healthy older adults aged 65 years or above who completed inclusion criteria participated in the study. Mini BESTest was used to assess postural balance. Left and right Quadriceps Muscle Strength (QMS) measurement was obtained by modified sphygmomanometer test. Falls history within the past 6 months was obtained through an interview administrated general assessment. Results: Mean age among elders was 76.67±6.23 years (56.7% female and 42.3% male). The mean values of average QMS and postural balance among the falls group were 116.00mmHg and 18.17 and among the non-falls group were 161.13mmHg and 22.57 respectively. Independent sample t-test showed the significant difference of means in average quadriceps muscle strength (p= 0.028) and postural balance (p= 0.031) among falls and non - fall a group respectively. Conclusion: Mean quadriceps muscle strength and postural balance in the falls group were lower than the non-falls group. Therefore, we can conclude that two intrinsic risk factors (postural balance and Quadriceps muscle strength) directly contribute to falls in healthy older adults.
Dietaryadviceongdmmothers-an audit
(Sri Lanka College of Obstetricians and Gynaecologists, 2006) Jayasundar, C.; Ellepola, U.K.; Herath, H.M.R.P.; Perera, A.; Wijesundere, A.
BACKGROUND: Gestational Diabetes Mellitus (GDM) is considered a global problem and in Sri Lanka. It is emerging as a common complication in pregnancy. Hence, an audit was undertaken to evaluate dietary advice given to GDM mothers as it is the primary modality of treatment. OBJECTIVE: To ascertain the standard of dietary advice given to GDM mothers attending a tertiary care ,. ater.STUDY TYPE: Retrospective study. STUDY SETTING: Tertiary care center. STUDY SAMPLE: 49 consecutive GDM mothers, who was diagnosed in the ANC and ward. METHOD: Study was carried out from 1st of June to 1st of August 2006. A questionnaire was developed to evaluate the standard of the dietary advice in accordance with the unit policy. RESULTS: Out of the population 39% were in the age group of 21-30 and 61% in the 31-40 age category. Out of the total sample 96% of mothers received advice on a diabetic diet but out of which, only 4% had been supplemented with written format. The SHO, registrar, and senior registrar contributed dietary advice to 37% of the mothers while nursing officers have advised to 22%. The intern medical officers have advised 19% of mothers, while public health rnidwives, MOH have accounted for advising 15% and 5% respectively. The dietician advised only 2% of the mothers. Out of the mothers who were interviewed following the dietary advice, 69% understood the advice satisfactorily. Furthermore 24% stated that they understood the advice partially and 7 % reported poor understanding. In addition 16% of the mothers had requested repeated dietary advice. Finally, 56% reported satisfaction with the overall dietary management of the above medical complication. CONCLUSIONS AND RECOMMENDATIONS: The dietary advice given in our study population is unsatisfactory, considering the fact that the diet control is the primary modality of treatment in GDM. We recommend that advising on diet is a joint responsibility of medical officers, nursing officers, midwives and dieticians. Such advice should be solid and tailored to follow the Sri Lankan dietary habits and expectations. In addition the explanations should be done in a simple manner with use of a dietary advice leaflet according to a common protocol and each hospital should have a specialized supplemented with written format. The SHO, registrar, and senior registrar contributed dietary advice to 37% of the mothers while nursing officers have advised to 22%. The intern medical officers have advised 19% of mothers, while public health rnidwives, MOH have accounted for advising 15% and 5% respectively. The dietician advised only 2% of the mothers. Out of the mothers who were interviewed following the dietary advice, 69% understood the advice satisfactorily. Furthermore 24% stated that they understood the advice partially and 7 % reported poor understanding. In addition 16% of the mothers had requested repeated dietary advice. Finally, 56% reported satisfaction with the overall dietary management of the above medical complication. CONCLUSIONS AND RECOMMENDATIONS: The dietary advice given in our study population is unsatisfactory, considering the fact that the diet control is the primary modality of treatment in GDM. We recommend that advising on diet is a joint responsibility of medical officers, nursing officers, midwives and dieticians. Such advice should be solid and tailored to follow the Sri Lankan dietary habits and expectations. In addition the explanations should be done in a simple manner with use of a dietary advice leaflet according to a common protocol and each hospital should have a specialized dietician.
Entomological and epidemiological investigations in a newly established focus of cutaneous leishmaniasis in Kegalle district, Sri Lanka
(Faculty of Graduate Studies, University of Kelaniya Sri Lanka, 2022) Wickramasinghe, K.; Wijerathna, T.; Gunathilaka, N.; Perera, A.; Bandara, S.
Leishmaniasis is a protozoan infection transmitted by phlebotomine sand flies. The published information on the vector distribution, abundance and potential risk factors that are favorable for disease transmission in Kegalle district are not available. Hence, understanding the trends in disease establishment, epidemiological characteristics, and the bioclimatic suitability of the area for disease prediction. The total number of leishmaniasis patients notified in Kegalle district and Sri Lanka from 2016-2020 was obtained from the Epidemiology Unit, Sri Lanka. Rambukkana and Warakapola Medical Officer of Health (MOH) areas that have reported the highest numbers of cases from 2016 – 2018 in Kegalle district were selected as the study sites in the current study. Patients were visited and socio-economic, demographic, environmental and awareness-related information was collected using an interviewer-administered questionnaire. A randomly selected household with no records of CL in the same locality of the patient household was included as the control group to match the case group at a 1:1 ratio. Entomological surveys were conducted from July 2019- July 2020 using standard entomological techniques. Bioclimatic suitability was evaluated using ecological niche modeling (ENM). A total of 107 patients were reported from Rabukkana and Warakapola MOH areas from 2016-2020. Of them 88 were traced and included in the study. The risk factors were assessed using the chi squared test at 95% confidence intervals. Age was divided into ten-year age groups for analysis. The findings indicate that leishmaniasis in the Kegalle district progressed to the outbreak level within 3 years since the first recorded case in 2016. School students (n=22, 25%, P<0.05) and individuals between 11-20 years of age (n = 33, 37.5%, P<0.05) were identified as the main risk groups. The presence of composting sites (n=65, 73.9%, P<0.05) that provide potential breeding grounds for sand flies, abandoned lands (n=63, 71.6%, P<0.05) which are potential diurnal resting sites of adult sand flies, and suboptimal (dark or normal) lighting conditions (n=87, 98.8%, P<0.05) in the house that may facilitate vector activity were denoted as significant risk factors for leishmaniasis occurrence compared the control group. The level of awareness of the disease was poor in both the test and control groups. Ecological niche modeling revealed that the areas closer to the Kurunegala district, a predominant leishmaniasis endemic district in the intermediate zone, have high bioclimatic suitability for leishmaniasis. The sand flies including, P. argentipes (n=121, 42%) and S. zeylanica (n=164, 56.9%) were present in high densities in this area. Hence, the control efforts focused on raising awareness, while implementing vector control and effective case management, prioritizing the high-risk areas is vital.
The epidemiological trend of cutaneous leishmaniasis in Kegalle district, Sri Lanka: A newly established disease focus and assessment of bioclimatic suitability for disease establishment using ecological niche modelling
(Elsevier, 2023) Wijerathna, T.; Wickramasinghe, K.; Gunathilaka, N.; Perera, A.; Bandara, S.
Cutaneous leishmaniasis is prevalent in Sri Lanka since 1992. It remains as a health issue with increasing numbers and spreading from endemic to non-endemic areas in the county. Kegalle district is a new disease focus, which notified the first case in 2016. However, there is no documented evidence of the vector distribution, abundance and potential risk factors in this district. Two Medical Officer of Health (MOH) areas (Rambukkana and Warakapola) that had reported the highest numbers of cases in the Kagalle district was selected and recorded cases (2016-2020) were obtained. The patients were visited and socio-economic, demographic, environmental and awareness-related information was collected using an interviewer-administered questionnaire. Entomological surveys were conducted from July 2019- July 2020 using three standard entomological techniques. Bioclimatic suitability for the disease transmission was evaluated using ecological niche modelling. A total of 107 patients were reported from both MOH areas and 88 were recruited for the study. The study showed that leishmaniasis in the Kegalle district progressed to an outbreak level within 3 years after reporting the first case. School students (n = 22, 25%, P < 0.05) and individuals between 11 and 20 years of age (n = 33, 37.5%, P<0.05) were identified as the main risk groups, while the presence of composting sites (n = 65, 73.9%, P < 0.05), abandoned lands (n = 63, 71.6%, P < 0.05) in the surrounding and suboptimal (dark or normal) lighting conditions (n = 87, 98.8%, P < 0.05) in the house were identified as main risk factors. Areas closer to the adjacent district (Kurunegala), which is a known endemic district for leishmaniasis indicated a high probability (0.3-0.5) for disease transmission. Sergentomyia zeylanica (n = 164, 56.94%), was identified as the predominant sand fly species followed by Phlebotomus argentipes (n = 121, 42.01%), Sergentomyia babu insularis (n = 2, 0.69%) and Sergentomyia punjabensis (n = 1, 0.35%). Phlebotomus argentipes was captured mostly for outdoor resting sites and S. zeylanica was recoded from both indoor and outdoor. The presence of vectors that can transmit leishmaniasis in these areas along with the potential risk factors could increase the transmission risk and disease establishment in new areas that are ecologically favourable for disease transmission. Therefore, vector control entities should undertake immediate measures to stop spreading the disease into new areas.
Green Belt concept of South Korea: A lesson for urban environmental management in South Asian Developing Countries (SADC)
(Department of Zoology and Environmental Management, University of Kelaniya, Sri Lanka, 2017) Perera, A.
There are many urban environmental problems in South Asian Developing Countries. This research will discuss some of those issues and challenges of South Asian Developing Countries which are related to their urban environment and the Green Belt concept which is used in South Korea to protect urban environment of South Korea. The research problem is: what are the lessons we can learn from South Korea’s Green Belt concept for the green management in South Asian Developing Countries (SADC)? The hypothesis of this research is “South Asian Developing countries can find lessons and guidance from South Korean Green Belt concept for their Green Management.” And the research is qualitative research and based on the theoretical aspect and details which are related to the topic. Thus secondary data which are published in internet, paper articles, elements and views of International Environmental Law, Acts and other legislations as well as books and research of other authors which are relevant to the topic will be used. Finally results of the research is based on the comparison between facts what are relevant to those countries. According to the research, the concept of the Green Belt is very important concept to find solutions for urban environmental issues and to find protection of the environment of SADC. SADC can use Green Belt concept to mark boundaries among states, to develop beauty as well as shade and find some natural foods and walking parks for people for their leisure time, to reduce their urban pollution, to make natural border among their cities and to find natural air and healthy place to spend their leisure times.
Hepcidin is suppressed by erythropoiesis in hemoglobin E β-thalassemia and β-thalassemia trait
(American Society of Hematology, 2015) Jones, E.; Pasricha, S.R.; Allen, A.; Evans, P.; Fisher, C.A.; Wray, K.; Premawardhena, A.; Bandara, D.; Perera, A.; Webster, C.; Sturges, P.; Olivieri, N.F.; St Pierre, T.; Armitage, A.E.; Porter, J.B.; Weatherall, D.J.; Drakesmith, H.
Hemoglobin E (HbE) β-thalassemia is the most common severe thalassemia syndrome across Asia, and millions of people are carriers. Clinical heterogeneity in HbE β-thalassemia is incompletely explained by genotype, and the interaction of phenotypic variation with hepcidin is unknown. The effect of thalassemia carriage on hepcidin is also unknown, but it could be relevant for iron supplementation programs aimed at combating anemia. In 62 of 69 Sri Lankan patients with HbE β-thalassemia with moderate or severe phenotype, hepcidin was suppressed, and overallhepcidin inversely correlated with iron accumulation. On segregating by phenotype, there were no differences in hepcidin, erythropoiesis, orhemoglobin between severe or moderate disease, but multiple linear regression showed that erythropoiesis inversely correlated with hepcidin only in severe phenotypes. In moderate disease, no independent predictors of hepcidin were identifiable; nevertheless, the low hepcidin levels indicate a significant risk for iron overload. In a population survey of Sri Lankan schoolchildren, β-thalassemia (but not HbE) trait was associated with increased erythropoiesis and mildly suppressed hepcidin, suggesting an enhanced propensity to accumulate iron. In summary, the influence oferythropoiesis on hepcidin suppression associates with phenotypic disease variation and pathogenesis in HbE β-thalassemia and indicates that the epidemiology of β-thalassemia trait requires consideration when planning public health iron interventions.
Methemoglobinemia and ascorbate deficiency in hemoglobin E β thalassemia: metabolic and clinical implications.
(American Society of Hematology., 2012) Allen, A.; Fisher, C.; Premawardhena, A.; Bandara, D.; Perera, A.; Allen, S.; St Pierre, T.; Olivieri, N.; Weatherall, D.
ABSTRACT: During investigations of the phenotypic diversity of hemoglobin (Hb) E β thalassemia, a patient was encountered with persistently high levels of methemoglobin associated with a left-shift in the oxygen dissociation curve, profound ascorbate deficiency, and clinical features of scurvy; these abnormalities were corrected by treatment with vitamin C. Studies of erythropoietin production before and after treatment suggested that, as in an ascorbate-deficient murine model, the human hypoxia induction factor pathway is not totally dependent on ascorbate levels. A follow-up study of 45 patients with HbE β thalassemia showed that methemoglobin levels were significantly increased and that there was also a significant reduction in plasma ascorbate levels. Haptoglobin levels were significantly reduced, and the high frequency of the 2.2 haptoglobin genotype may place an additional pressure on ascorbate as a free-radical scavenger in this population. There was, in addition, a highly significant correlation between methemoglobin levels, splenectomy, and factors that modify the degree of globin-chain imbalance. Because methemoglobin levels are modified by several mechanisms and may play a role in both adaptation to anemia and vascular damage, there is a strong case for its further study in other forms of thalassemia and sickle-cell anemia, particularly when splenic function is defective.
The Prevalence of previous self-harm amongst self-poisoning patients in Sri Lanka
(Springer International, 2011) Mohamed, F.; Perera, A.; Wijayaweera, K.; Kularatne, K.; Jayamanne, S.; Eddleston, M.; Dawson, A.; Konradsen, F.; Gunnell, D.
BACKGROUND: One of the most important components of suicide prevention strategies is to target people who repeat self-harm as they are a high risk group. However, there is some evidence that the incidence of repeat self-harm is lower in Asia than in the West. The objective of this study was to investigate the prevalence of previous self-harm among a consecutive series of self-harm patients presenting to hospitals in rural Sri Lanka. METHOD: Six hundred and ninety-eight self-poisoning patients presenting to medical wards at two hospitals in Sri Lanka were interviewed about their previous episodes of self-harm. RESULTS: Sixty-one (8.7%, 95% CI 6.7-11%) patients reported at least one previous episode of self-harm [37 (10.7%) male, 24 (6.8%) female]; only 19 (2.7%, 95% CI 1.6-4.2%) patients had made more than one previous attempt. CONCLUSION: The low prevalence of previous self-harm is consistent with previous Asian research and is considerably lower than that seen in the West. Explanations for these low levels of repeat self-harm require investigation. Our data indicate that a focus on the aftercare of those who attempt suicide in Sri Lanka may have a smaller impact on suicide incidence than may be possible in the West.
A study of the contribution of Rural Tourism as a development strategy to develop the household economy of rural areas in Sri Lanka
(Research Centre for Social Sciences, Faculty of Social Sciences, University of Kelaniya, Sri Lanka, 2016) Perera, A.
The key objective of this paper is to analyze the contribution of rural tourism as a preliminary instrument of development of the household economy of rural areas in Sri Lanka. Potentials of Rural Tourism are very high as a household economic development strategy compared to other tourism related development strategies. As an island with rich natural resources and human capital, Sri Lanka has also been using Rural Tourism as an economic activity in rural areas like Meemure, Dambulla, Heeloya & Lakegala. However, using derived results the study has reviewed that the current contribution of those activities is not sufficient to eliminate various crucial economic matters of those households. The study used primary & secondary data which gathered by field trips, interviews with villagers & private tourist agents, Sri Lanka Tourism Development Authority, Department of Census & Statistics Sri Lanka & Ministry of Finance Sri Lanka to derive results using of Regressions & Correlation Co-efficient. Therefore the paper has discussed the importance of deriving a goal-oriented Rural Tourism frame work to accomplish the goal optimization of Rural Tourism activities as a household economic development strategy which has especially defined for Sri Lanka. Similarly the paper includes about other limitations which are existing at the moment regarding Rural Tourism activities such as matter of less attention of the government towards Rural Tourism as an economic activity, matter of intervention of multi-national organizations to organize Rural Tourism activities, difficulties of promoting Rural Tourism activities, influence of less developed infrastructure of rural sector on Rural Tourism and lack of a specific policy frame work for Rural Tourism in Sri Lanka with various methods to overcome these identified matters, which lead to improve the significance and the contribution of rural tourism activities as an economic development strategy to develop the household economy of rural areas in Sri Lanka.
A Study on the Language Planning Situation in British Colonial Ceylon.
(The Third International Conference on Linguistics in Sri Lanka, ICLSL 2017. Department of Linguistics, University of Kelaniya, Sri Lanka., 2017) Perera, A.
Language is one of the prominent resources that should be planned for the socio-political well-being of a multilingual and multi-ethnic country. This study intends to examine the Colonial Period Language Planning of Ceylon, particularly from 18-19 centuries, which is in the British Colonial Period. The study was done with special focus on the types of language policies introduced by the British to govern their official domains, specially the administrative process and the judicial services. The data was collected from official documents such as Colebrook and Cameron paper, books, journals and from discussions. According to the findings, English has been introduced as the only official language for administration, Judicial and other official domains in this particular time period and it was established through Colebrooke, Cameron and Dounghmore constitutional reforms. Research findings show that majority of the Ceylonese were either Sinhala or Tamil native speakers and limited number of people could work in English. According to the recommendations of this research the monolingual policy, is not suited for the multilingual and multi-ethnic country. However, British rulers should have introduced the national level for the Sinhalese and Tamil Languages. This gap caused many problems during that period and afterwards. Findings of this research can be used in preparing a better language planning Policy in Sri Lanka and the other countries where multi-ethnic groups exist.
Teaching English as a Second Language in Sri Lanka: Facing a Paradox
(Department of Linguistics, University of Kelaniya, Sri Lanka, 2016) Perera, A.
English is the most popular foreign language in Sri Lanka. This language played a key role in the process of social stratification which took place after the collapse of the feudal and the colonial systems. After teaching English for so many years in schools, why do students hesitate to follow and indirectly reject this subject at school level? There is a continuing matter of debate on whether first language (L1) contributes to or precludes the learning of a second language (L2). Internationally numerous studies have been conducted on this topic, but no clear consensus exists on whether L1 should be banned or its inclusion in classrooms should be allowed. However, few studies have identified the reasons for which students need such an inclusion. So this opinion survey was done to find out the root causes of this particular problem in Sri Lanka. This study primarily investigates the opinions of the persons who can make an influence on this issue. So, two university professors, one provincial director of English Education, two zonal directors of English Education, three instructors of English Education in three educational divisions and two instructors of English Education, attached to zonal English Support Centers were interviewed. This survey was confined to find data regarding the use of Sinhala as the mother tongue (MT) in teaching English as a second language. The findings may be useful to language education policy-makers in designing more formal and concrete guidelines to help teachers who teach English as a second language. While some interviewees agree the use of L1 judiciously in classrooms, all the interviewees agree, to make an impact on policy makers in this regard to design policies as well as a methodical approach to teach English as a second language in comparison with mother tongue (MT).
Thrombolysis with tenecteplase in acute ischaemic stroke in a tertiary care setting in Sri Lanka: A retrospective study
(Association of Sri Lankan Neurologists, 2024) Gooneratne, K.; Vithanage, L.; Talagala, I.; Lokunarangoda, N.C.; Gamage, N.; Muthumal, N.P.; Rodrigo, A.; Kosgahakumbura, J.; Liyanage, G.; Perera, A.; Ranawaka, U.K.
INTRODUCTION Alteplase (ALT) is the standard thrombolytic treatment in acute ischaemic stroke (AIS). Tenecteplase (TNK) is proven to be effective in acute coronary syndrome, is relatively cheap, widely available and can easily be given as a single intravenous (IV) bolus. Despite evidence for its use, there is equivocal guidance for the use of TNK in AIS. On the background of a global reduction in stroke admissions, treatment interventions and prolonged treatment time metrics due to the COVID-19 pandemic, this study highlights the experience with TNK in a tertiary care setting in Sri Lanka, during the pandemic. OBJECTIVES To describe the outcomes at 48 hours among stroke patients who underwent thrombolysis with TNK at District General Hospital Hambantota, Sri Lanka over a period of one year. METHODS We retrospectively reviewed records of adults with AIS thrombolysed with 0.25 mg/kg TNK. The National Institutes of Health Stroke Scale (NIHSS) was assessed on admission and at 24-hours following treatment. Patients were observed for 48-hours for potential adverse events. RESULTS We thrombolysed 20 consecutive patients over one-year. The baseline mean NIHSS was 9.7 (standard deviation (SD)=4.4; range 4-22), and the 24h-post thrombolysis mean NIHSS was 6.0 (SD=7.3; range 0-28). Seventy percent (n=14) showed an improved NIHSS of at least 1-point after thrombolysis (mean difference=3.7; SD=6.46), and 55% (n=11) displayed a major clinical improvement (change in NIHSS ≥ 4). Ten percent (n=2) developed major adverse effects (one intra-cranial haemorrhage; one haemorrhagic transformation). There were no deaths. CONCLUSIONS TNK 0.25mg/kg for the treatment of AIS appeared efficacious and safe in our case series. The limitation in this study was the low number of patients who underwent thrombolysis during the study period, as a probable effect of the COVID-19 pandemic. Thrombolysis with TNK could be a cost-effective alternative to alteplase in resourcelimited South Asian settings.
රූකඩ කලාව ආශ්‍රිත උරුම කළමනාකරණය
(Department of Archaeology, University of Kelaniya, Sri Lanka, 2014) Anjali, K.M.; Munasinghe, M.A.D.L.D.; Samarakoon, Y.; Perera, A.; Pushpakumara, S.