Browsing by Author "Ranawaka, U. K."

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The Changing face of transient ischaemic attacks
(Ceylon College of Physicians, 2019) Mettananda, K. C. D.; Ranawaka, U. K.
ABSTRACT: A transient ischaemic attack (TIA) is a major warning of an impending stroke. The risk of recurrent TIA or stroke is highest during the first 24 hours. 80% of recurrence risk is reduced with early initiation of effective treatment. Many things have changed regarding TIAs over the last decade. The definition of TIA has changed from a time-based to a tissue-based one. Strategies for investigation and treatment have changed, with specialist evaluation and management recommended for all TIAs within 24 hours of symptom onset. Dedicated TIA clinics have revolutionized the approach to TIA management. Improving awareness on early recognition and establishing pathways for rapid delivery of optimal care for TIAs will go a long way in minimizing the burden of stroke in Sri Lanka. KEYWORDS: Transient ischaemic attacks, Stroke, prevention, NICE 2019 guidelines, Sri Lanka
Going viral: a COVID-19 story
(Ceylon College of Physicians., 2020) Ranawaka, U. K.
No Abstract Available
Melioidosis with a subdural collection - a case report.
(BioMed Central,London, 2019) Amarasena, H. L. P.; Silva, F. H. D. S.; Tilakaratna, P. M. Y. I.; Jayamanne, S. F.; Ranawaka, U. K.
BACKGROUND:Melioidosis is an infection caused by Burkholderia pseudomallei, which is more prevalent in the tropics and leads to significant morbidity and mortality. It characteristically produces widespread caseous lesions and abscesses, and can present with varied clinical manifestations. Melioidosis involving the central nervous system is uncommon. CASE PRESENTATION: A 42-year-old Sri Lankan male with type 2 diabetes presented with a febrile illness of 6 days with headache and constitutional symptoms. Clinical examination was unremarkable. Four days later, he developed focal seizures involving the left leg and numbness of the left side. Initial laboratory investigations were suggestive of a bacterial infection. Blood culture was reported as positive for a Pseudomonas species, which was resistant to gentamicin. Contrast enhanced CT and MRI scans of the brain showed a subdural collection in the right fronto-temporo-parietal region with possible abscess formation. Melioidosis antibody testing using indirect hemagglutination method was reactive with a titre more than 1/10,240. He was treated with intravenous meropenem and oral co-trimoxazole for 8 weeks (Intensive phase). The subdural collection was managed conservatively, and seizures were treated with oral antiepileptics. At 7 weeks, follow-up contrast enhanced MRI showed improvement of the subdural collection, and inflammatory markers had normalized. He was discharged after 8 weeks, and treated with oral co-trimoxazole and doxycycline for 6 months (eradication phase). At 6 months follow-up, the patient is asymptomatic. CONCLUSIONS: Cerebral melioidosis is an unusual presentation of melioidosis where the diagnosis can be easily missed. Knowledge of the protean manifestations of melioidosis is of paramount importance in order to detect and treat this potentially fatal infection appropriately, especially in tropical countries where the disease is endemic.
Sex differences in stroke in a Sri Lankan cohort
(Karger, 2024-12) Ranawaka, U. K.; Mettananda, C. D.; Nugawela, M.; Pathirana, J.; Chandrasiri, J.; Jayawardena, C.; Amarasekara, D.; Hettarachchi, R.; Premawansa, G.; Pathmeswaran, A.
INTRODUCTION Stroke characteristics, subtypes, and risk factors in women may differ from men. Data on sex differences in stroke are scarce in developing countries, especially the South Asian region. We aimed to describe the sex differences in patients with stroke admitted to a tertiary care hospital in Sri Lanka. METHODS Consecutive patients with stroke enrolled in the Ragama Stroke Registry over 3 years (2020–2023) were studied. Sex differences in demographics, presentation delays, clinical characteristics, stroke subtypes, risk factors, stroke severity, and early functional outcomes were compared using χ2 test, independent sample t test and Wilcoxon rank-sum test. Associations of early functional dependence were studied using multiple logistic regression. RESULTS Of 949 patients with stroke, 387 (40.8%) were women, with a median age of 66 (interquartile range [IQR] 57–73) years compared to 63 (IQR 54–70) years in men (p < 0.001). Women had more ischaemic strokes (85.8% vs. 78.6% in men, p = 0.005). Swallowing difficulty (p = 0.039) and bladder involvement (p = 0.001) were more common in women, whereas dysarthria (p = 0.002) and cerebellar signs (p = 0.005) were more common in men. More women had hypertension (74.4% vs. 59.4%, p < 0.001) and diabetes (52.2% vs. 41.6%, p = 0.001), whereas smoking (0.3% vs. 35.1%, p < 0.001), alcohol use (0.3% vs. 55.0%, p < 0.001), and other substance abuse (0.8% vs. 5.2%, p < 0.001) were almost exclusively seen in men. No differences were noted in delays to hospital admission (delay ≥4.5 h: women 45.4% vs. men 41.3%, p = 0.222). There were no sex differences in the rates of CT scanning (women 100% vs. men 99.6%, p = 0.516) or thrombolysis for ischaemic stroke (women 7.8% vs. men 10.2%, p = 0.458), but more men received stroke unit care (women 37.2% vs. men 45.4%, p = 0.012). No differences were noted between sexes in the clinical (Oxfordshire classification, p = 0.671) or aetiological (TOAST criteria, p = 0.364) subtypes of stroke. Stroke severity on admission was similar between sexes (median NIHSS score; women 8.0 vs. men 8.0, p = 0.897). More women had a discharge Barthel index (BI) <60 than men (62.6% vs. 53.5%, p = 0.007), but female sex was not associated with BI <60 on multivariate logistic regression (p = 0.134). There was no difference in in-hospital mortality (women 5.9% vs. men 5.9%, p = 0.963). CONCLUSIONS Women with stroke in this Sri Lankan cohort were older, had different risk factor profiles and clinical stroke characteristics, and had more ischaemic strokes. Female sex was not independently associated with functional disability on discharge or in-hospital mortality.
Transient Ischaemic Attacks: It’s time for timely action!
(Ceylon Medical Assn., 2020) Mettananda, C.D.; Ranawaka, U. K.
No Abstract Available