Browsing by Author "Wickramasinghe, N."

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The association between symptoms of gastroesophageal reflux disease and perceived stress: A countrywide study of Sri Lanka
(Public Library of Science, 2023) Wickramasinghe, N.; Thuraisingham, A.; Jayalath, A.; Wickramasinghe, D.; Samarasekara, N.; Yazaki, E.; Devanarayana, N.M.
BACKGROUND/AIMS: Stress is a known associated factor for gastroesophageal reflux disease (GERD). However, the dynamics between stress and GERD are not fully studied, especially in Sri Lanka. Our objective was to assess it. METHODS: For this cross-sectional descriptive study, 1200 individuals (age ranged 18-70 years, mean 42.7 years [SD 14.4 years], 46.1% males), were recruited using stratified random cluster sampling from all 25 districts of Sri Lanka. An interviewer-administered questionnaire, which included a country-validated GERD symptom screening tool, and the Perceived Stress Scale (PSS), was used to assess GERD symptoms and stress. Probable GERD was defined as those having heartburn and/ or regurgitation at least once per week which is on par with globally accepted criteria. Those who did not fulfill these criteria were considered as controls. RESULTS: PSS score was higher in those with probable GERD (mean 13.75 [standard deviation (SD) 6.87]) than in controls (mean 10.93 [SD 6.80]), (p <0.001, Mann-Whitney U test). The adjusted odds ratio for GERD symptoms was 1.96 times higher (95% confidence interval 1.50-2.55) in the moderate to high-stress level compared to the low-stress level participants. PSS score correlated significantly with the GERD screening tool score (R 0.242, p <0.001). Heartburn, regurgitation, chest pain, cough, and burping were significantly frequent in those with moderate to high-stress levels (p <0.001). Those with higher stress scores were more likely to use acid-lowering drugs (p = 0.006). CONCLUSIONS: Individuals exposed to higher levels of stress are more likely to have GERD symptoms. Therefore, stress reduction should be an important part of GERD symptom management.
Community prevalence of childhood asthma and atopy
(Sri Lanka Medical Association, 2005) Perera, K.P.J.; Rathnayake, A.; Wickramasinghe, N.; Muthukumarana, S.
OBJECTIVES: To estimate prevalence of childhood asthma, allergic rhino conjunctivitis and eczema in the community using an interviewer administered questionnaire. To estimate the extent of prophylaxis usage in asthma. SETTINGS: A cross sectional descriptive study in 2003. METHOD: Sample consists of children between 6 months to 13 years (n=2005) in 4 PHM areas randomly selected from Ragama. Diagnosis was based on presence of symptoms in preceding 12 months. Information gathered using a pre-tested questionnaire. Study was ethically approved. Data analysis - Epi Info version 6. RESULTS: Mean age was 6.7 years and 52% were males. Asthma prevalence was 13%. Prevalence in infancy - 4%, 1-5 years -13%, 5-10 years - 15% and 10- 13 years - 11%. Prevalence in males -14%. In females -11% (p=0.03). Lifetime prevalence - 19%. Current wheezing rate - 1.6%. Prevalence of allergic rhinitis - 5%, allergic conjunctivitis 3% and eczema 0.8%. Of all asthmatics, 70% were mild intermittent, 23% mild persistent and 7% moderate persistent. 49% of those who required prophylaxis were already on prophylaxis. Of them, 92% on steroid inhalers. CONCLUSIONS: Prevalence of asthma and allergic rhinitis and eczema are less than when reported by parents (Parent reported prevalence were 23%, 11% and 3% respectively). The majority of asthma was mild intermittent type. Usage of prophylactic medications was nearly 50%.
Disturbances, Riots, Revolt: The Maritime Provinces of Sri Lanka in 1796-97
(University of Kelaniya, 2005) Wickramasinghe, N.
In February 1796, the British captured the strategic harbour of Trincomalee and proceeded to expel the Dutch from the island. The government of the maritime provinces was vested in the Government of Fort St. George and control in Ceylon was exercised by the military led by Colonel James Stuart. The events that occurred a few months later, in December 1796 have been described as a ‘full scale revolt against the new British administration’, as ‘disturbances’ and as ‘riots’ in the rare studies pertaining to the period that all tend to echo the voice of contemporary witnesses and duplicate the viewpoint of the report of the De Meuron Commission of Investigation. The events of 1796-1797 have not evoked a sizeable interest among historians of the British period mainly because the official documents of the years 1796-1798 are not available in the Sri Lanka Archives. By far the most details of the events based on primary sources appear in Colvin R. de Silva’s Ceylon under British Occupation published in 1942, although the focus of his work is inevitably on the colonial administration’s response to the revolt rather than on the people as historical agents. My paper will be based on a reading afresh of those documents at the India Office Library in London (in June). Sri Lankan historiography has rarely addressed the issue of the consciousness of the participants either in the ‘revolt’ of 1797 or even in the more famed revolts that occurred in 1818 and 1848. I hope to assess the relevance of frames of analysis such as ‘moral economy of the crowd’, ‘autonomous domain of the subaltern’, ‘legitmation’ to the study of revolts in Sri Lanka. Some of the questions I hope to find answers is through a careful reading of colonial documents as well as the rare petitions written by the ‘natives’ to the British officials are the following: Was the uprising of 1797 lifted up by a leadership above localism and generalized into an anti-colonial campaign? Did religion constitute a significant component of peasant consciousness? If not why did the people rebel? Thus my paper aims at filling a gap in the scholarship of the British administration of Ceylon of the early period 1796-1802 which remains one of the most understudied periods of the history of the island.
Effect of Artocarpus heterophyllus and Asteracanthus longifolia on glucose tolerance in normal human subjects and in maturity-onset diabetic patients
(Elsevier, 1991) Fernando, M.R.; Wickramasinghe, N.; Thabrew, M.I.; Ariyananda, P.L.; Karunanayake, E.H.
Investigations were carried out to evaluate the effects of hot-water extracts of Artocarpus heterophyllus leaves and Asteracanthus longifolia whole plant material on the glucose tolerance of normal human subjects and maturity-onset diabetic patients. The extracts of both Artocarpus heterophyllus and Asteracanthus longifolia significantly improved glucose tolerance in the normal subjects and the diabetic patients when investigated at oral doses equivalent to 20 g/kg of starting material.
Efficacy and Safety of Oral Hydroxyurea in Patients with Transfusion Dependent β Thalassaemia: a Randomized Double-Blind Placebo-Controlled Clinical Trial
(Sri Lanka Medical Association, 2020) Yasara, N.; Wickramarathne, N.; Silva, I.; Hameed, N.; Attanayaka, A.M.K.R.; Jayasinghe, V.L.; Wickramasinghe, N.; Rodrigo, R.; Perera, L.; Mettananda, K.C.D.; Manamperi, A.; Premawardhena, A.; Mettananda, S.
INTRODUCTION AND OBJECTIVES: Patients with β- thalassaemia require blood transfusions and iron chelation for life. Hydroxyurea is a licenced medication for sickle cell disease but its usefulness in transfusion dependent β-thalassaemia is unclear. Here, we aim to assess the efficacy and safety of oral hydroxyurea in patients with transfusion dependent β-thalassaemia. METHODS: A phase III randomized double-blind placebo-controlled clinical trial was conducted at Thalassaemia Unit of Colombo North Teaching Hospital in 2019. Forty-one patients with transfusion dependent β-thalassaemia were randomized into hydroxyurea (10-20mg/kg/day) or placebo (pharmaceutically inert capsule identical to hydroxyurea) groups. Transfused blood volume, pre-transfusion haemoglobin, haemoglobin F level and side effects were monitored monthly during 6- month treatment and 6-month follow-up periods. Adverse events were assessed by trained medical officers. The study was approved by ethics committee of University of Kelaniya and registered in Sri Lanka Clinical Trials Registry (SLCTR/ 2018/024). RESULTS: Of the 41 (hydroxyurea-20; placebo-21) patients, three discontinued treatment due to thrombocytopenia (hydroxyurea-2) and rash (placebo-1). Baseline characteristics of two groups were similar. Mean pre-transfusion haemoglobin (8.52+0.57 vs 8.38+0.55, p=0.45) and haemoglobin F levels (4.3+7.1% vs 3.1+1.9%, p=0.48) were higher in hydroxyurea group compared to placebo. Also, transfused blood volume was lower in hydroxyurea group (102+24ml/kg vs 111+27ml/kg, p=0.3). However, none were statistically significant. Based on elevation of haemoglobin F (>1.5% from baseline), we identified 6/18 patients as hydroxyurea responders. Hydroxyurea responders required significantly lower blood volume (87+13ml/kg) compared to non-responders (110+25ml/kg, p=0.05) and placebo group (111+27ml/kg, p<0.05) while maintaining higher pre-transfusion haemoglobin level (8.6+0.5 vs 8.4+0.5 and 8.3+0.5). No serious side effects were reported. CONCLUSIONS: One-third of patients with transfusion dependent β-thalassaemia responded to hydroxyurea treatment requiring 20% less blood compared to controls. No serious side effects were reported following hydroxyurea treatment.
Gastroesophageal reflux disease in Sri Lanka: An island-wide epidemiological survey assessing the prevalence and associated factors
(Public Library of Science, 2024) Wickramasinghe, N.; Thuraisingham, A.; Jayalath, A.; Wickramasinghe, D.; Samarasekera, D.N.; Yazaki, E.; Devanarayana, N.M.
Gastroesophageal reflux disease (GERD) is commonly encountered in clinical practice in Sri Lanka. However, its prevalence in Sri Lanka is unknown. Our objective was to study the island-wide prevalence of GERD symptoms in Sri Lanka and its associated factors. A total of 1200 individuals aged 18-70 years (male: female 1: 1.16, mean age 42.7 years [SD 14.4 years]). were recruited from all 25 districts of the country, using stratified random sampling. An interviewer-administered, country-validated questionnaire was used to assess the GERD symptom prevalence and associated factors. Weight, height, waist, and hip circumference were measured. Heartburn and/or regurgitation at least once a week, an internationally used criterion for probable GERD was used to diagnose GERD. In this study, GERD symptom prevalence was 25.3% (male 42.1% and female 57.9%). Factors independently associated with GERD were inadequate sleep, snacking at midnight, sleeping within two hours of consuming a meal, skipping breakfast, increased mental stress, and certain medications used such as statins, and antihypertensive medications (p<0.001, univariate and logistic regression analysis). 38.4% of the study population have been using medication for heartburn and regurgitation in the past 3 months and 19.8% were on proton pump inhibitors. To conclude, the prevalence of GERD symptoms in Sri Lanka (25.3%) is higher than its estimated global prevalence of 13.8%. Several meal-related lifestyle habits, mental stress, and the use of some medications are significantly associated with GERD, indicating the importance of lifestyle modification and stress reduction in its management.
Hydroxyurea for transfusion dependent β-thalassaemia: A randomized double-blind placebo-controlled clinical trial
(Sri Lanka Medical Association, 2021) Yasara, N.; Wickramarathne, N.; Silva, I.; Hameed, N.; Attanayaka, A.M.K.R.; Jayasinghe, V.L.; Gunathilaka, P.A.C.K.; Wickramasinghe, N.; Rodrigo, R.; Perera, L; Perera, P.S.; Mettananda, K.C.D.; Manamperi, A.; Premawardhena, A.; Mettananda, S.
Introduction and objectives Hydroxyurea induces fetal haemoglobin in vitro however, its clinical usefulness in β-thalassaemia is unclear. Here, we aim to assess the efficacy and safety of oral hydroxyurea in patients with transfusion dependent β-thalassaemia. Methods A phase 3 randomized double-blind placebo-controlled clinical trial was conducted at Colombo North Teaching Hospital in 2019/20. Sixty patients with transfusion dependent β-thalassaemia were randomized into hydroxyurea (10-20mg/kg/day) or placebo groups. Transfused blood volume, pre-transfusion haemoglobin, fetal haemoglobin and adverse effects were monitored during 6-month treatment and post-treatment periods. The study was approved by the ethics committee of University of Kelaniya and registered in Sri Lanka Clinical Trials Registry (SLCTR/2018/024). Results Fifty-four (hydroxyurea-27; placebo-27) patients completed the trial. Mean pre-transfusion haemoglobin (8.2±0.8g/ dLvs8.0±0.88g/dL, p=0.43) and fetal haemoglobin levels (7.9±11.2%vs4.6±4.3%, p=0.17) were higher in hydroxyurea group compared to placebo. Also, transfused blood volume was lower in the hydroxyurea group (94±29ml/kgvs102±28ml/kg, p=0.34). However, none were statistically significant. Based on elevation of fetal haemoglobin (>1.5% from baseline), we identified 12/27 patients who respond well to hydroxyurea (hydroxyurea-responders). Hydroxyurea-responders required significantly lower blood volume (77±27ml/kg) compared to non-responders (108±24ml/kg, p<0.01) and placebo group (102±28ml/kg, p<0.05). HbE β-thalassaemia sub-type (p<0.01) and Xmn1 polymorphism of γ-globin gene (p<0.05) were significant predictors of response to hydroxyurea. No serious side effects due to hydroxyurea were reported. Conclusion Over 40% of patients with transfusion dependent β-thalassaemia- specifically those with HbE β-thalassaemia and Xmn1 polymorphism of γ-globin gene- responded to hydroxyurea and required 25% less blood compared to controls. No serious adverse effects were reported following hydroxyurea treatment.
A Preliminary investigation of the possible hypoglycaemic activity of Asteracanthus longifolia
(Elsevier, 1989) Fernando, M.R.; Wickramasinghe, N.; Thabrew, M.I.; Karunanayaka, E.H.
Investigations were carried out to confirm or otherwise disprove the view held by many Ayurvedic and other traditional medical practitioners in Sri Lanka, that Asteracanthus longifolia possesses hypoglycaemic properties. The effects of an aqueous extract of the whole plant on fasting blood glucose level and glucose tolerance were investigated using Sprague-Dawley rats. The results indicate that aqueous extracts of A. longifolia can significantly lower the fasting blood glucose level and markedly improve the glucose tolerance of the rats. The hypoglycaemic effect produced by a therapeutic dose (equivalent to 5 g/kg of starting material) was comparable to that produced by a therapeutic dose (15 mg/kg of tolbutamide. The magnitude of the hypoglycaemic effect was found to vary with the dosage administered and the storage time of the prepared extract.
A randomised double-blind placebo-controlled clinical trial of oral hydroxyurea for transfusion-dependent β-thalassaemia
(Nature Publishing Group, 2022) Yasara, N.; Wickramarathne, N.; Mettananda, C.; Silva, I.; Hameed, N.; Attanayaka, K.; Rodrigo, R.; Wickramasinghe, N.; Perera, L.; Manamperi, A.; Premawardhena, A.; Mettananda, S.
Hydroxyurea is an antimetabolite drug that induces fetal haemoglobin in sickle cell disease. However, its clinical usefulness in β-thalassaemia is unproven. We conducted a randomised, double-blind, placebo-controlled clinical trial to evaluate the efficacy and safety of hydroxyurea in transfusion-dependent β-thalassaemia. Sixty patients were assigned 1:1 to oral hydroxyurea 10-20 mg/kg/day or placebo for 6 months by stratified block randomisation. Hydroxyurea treatment did not alter the blood transfusion volume overall. However, a significantly higher proportion of patients on hydroxyurea showed increases in fetal haemoglobin percentage (89% vs. 59%; p < 0.05) and reductions in erythropoietic stress as measured by soluble transferrin receptor concentration (79% vs. 40%; p < 0.05). Based on fetal haemoglobin induction (> 1.5%), 44% of patients were identified as hydroxyurea-responders. Hydroxyurea-responders, required significantly lower blood volume (77 ± SD27ml/kg) compared to hydroxyurea-non-responders (108 ± SD24ml/kg; p < 0.01) and placebo-receivers (102 ± 28ml/kg; p < 0.05). Response to hydroxyurea was significantly higher in patients with HbE β-thalassaemia genotype (50% vs. 0%; p < 0.01) and Xmn1 polymorphism of the γ-globin gene (67% vs. 27%; p < 0.05). We conclude that oral hydroxyurea increased fetal haemoglobin percentage and reduced erythropoietic stress of ineffective erythropoiesis in patients with transfusion-dependent β-thalassaemia. Hydroxyurea reduced the transfusion burden in approximately 40% of patients. Response to hydroxyurea was higher in patients with HbE β-thalassaemia genotype and Xmn1 polymorphism of the γ-globin gene.
Vulvitis granulomatosa, Melkersson-Rosenthal syndrome, and Crohn's disease: dramatic response to infliximab therapy
(Wiley-Blackwell, 2012) Wickramasinghe, N.; Gunasekara, C.N.; Fernando, W.S.; Hewavisenthi, J.; de Silva, H.J.
No Abstract Available