Browsing by Author "Wijekoon, N."

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The Burden of diabetes mellitus and impaired fasting glucose in an urban population of Sri Lanka
(Wiley-Blackwell, 2013) Pinidiyapathirage, M.J.; Kasturiratne, A.; Ranawaka, U.K.; Gunasekara, D.; Wijekoon, N.; Medagoda, K.; Perera, S.; Takeuchi, F.; Kato, N.; Warnakulasuriya, T.; Wickremasinghe, A.R.
AIMS: To describe the burden of diabetes mellitus and impaired fasting glucose in middle-aged residents (35-64 years) in an urban area of Sri Lanka. METHODS: A cross-sectional survey was conducted in the Ragama Medical Officer of Health area, from which 2986 participants (1349 men and 1637 women) were randomly selected from the electoral registry between January and December 2007. The participants underwent a physical examination and had their height, weight, waist and hip circumferences and blood pressure measured by trained personnel. Fasting blood samples were taken for measurement of glucose, HbA(1c) and lipids. The prevalence of diabetes (fasting plasma glucose > 7 mmol/l) and impaired fasting glycaemia (fasting plasma glucose 5.6-6.9 mmol/l) and major predictors of diabetes in Sri Lanka were estimated from the population-based data. RESULTS: Age-adjusted prevalence of diabetes mellitus in this urban population was 20.3% in men and 19.8% in women. Through the present screening, 263 patients with diabetes and 1262 with impaired fasting glucose levels were identified. The prevalence of newly detected diabetes was 35.7% of all patients with diabetes. Among patients with diabetes, only 23.8% were optimally controlled. In the regression models, high BMI, high waist circumference, high blood pressure and hypercholesterolaemia increased the fasting plasma glucose concentration, independent of age, sex and a family history of diabetes. CONCLUSIONS: Our data demonstrate the heavy burden of diabetes in this urban population. Short- and long-term control strategies are required, not only for optimal therapy among those affected, but also for nationwide primary prevention of diabetes
The burden of diabetes mellitus in an urban population of Sri Lanka
(Sri Lanka Medical Association, 2011) Pinidiyapathirage, M.J.; Kasturiratne, A.; Williams, S.; Wijekoon, N.; Pathmeswaran, A.; Ranawaka, U.K.; Warnakulasuriya, T.; Takeuchi, F.; Kato, N.; Wickremasinghe, A.R.
INTRODUCTION AND OBJECTIVES: To describe the burden of diabetes in middle and old aged residents (35-64 years) in an urban area of Sri Lanka. METHODS: A cross-sectional survey was conducted in the Ragama Medical Officer of Health area, in which 2986 participants (1349 men and 1637 women) were randomly selected from the electoral registry between January and December 2007. The participants underwent a physical examination and had their height, weight, waist and hip circumferences and 51ood pressure measured by trained personnel. Blood samples were taken after a 14 hour fast for measurement of glucose, HbAlc and lipids. The prevalence of diabetes (fasting plasma glucose [FPG] >7mmol/L) and impaired fasting glycaemia [IFG] (FPG=5.6-6.9mmol/L) and major predictors of diabetes in Sri Lanka were estimated from the population based data. RESULTS: In the whole sample two thirds of the participants were diagnosed as either people with diabetes (20%) or IFG (45%). Among the diabetics only 23.8% were optimally controlled. Through the present screening, 235 diabetics (7.9%) and 1257 (42.1%) participants with impaired fasting glucose levels were newly identified. Old age (OR=5.1, 55-64 years vs. 35-44 years), male sex (OR=3.1), family history (OR- 2.7), central obesity (OR-1.8), and reduced physical activity (OR=1.3) were significantly associated with increased risk of diabetes. CONCLUSIONS: Our data demonstrate the heavy burden of diabetes in the general population. Short and long term control strategies are required not only for optimal-therapy among those affected but also for nationwide primary prevention of pre-diabetes.
Chinese medicine NeuroAiD efficacy on stroke recovery - extension study (CHIMES-E): A multicenter study of long-term efficacy
(Karger Publisher, 2015) Venketasubramanian, N.; Young, S.H.; Tay, S.S.; Umapathi, T.; Lao, A.Y.; Gan, H.H.; Baroque II, A.C.; Navarro, J.C.; Chang, H.M.; Advincula, J.M.; Muengtaweepongsa, S.; Chan, B.P.; Chua, C.L.; Wijekoon, N.; de Silva, H.A.; Hiyadan, J.H.; Suwanwela, N.C.; Wong, K.S.; Poungvarin, N.; Eow, G.B.; Lee, C.F.; Chen, C.L.
BACKGROUND: The CHInese Medicine NeuroAiD Efficacy on Stroke recovery (CHIMES) study was an international randomized double-blind placebo-controlled trial of MLC601 (NeuroAiD) in subjects with cerebral infarction of intermediate severity within 72 h. CHIMES-E (Extension) aimed at evaluating the effects of the initial 3-month treatment with MLC601 on long-term outcome for up to 2 years. METHODS: All subjects randomized in CHIMES were eligible for CHIMES-E. Inclusion criteria for CHIMES were age ≥18, baseline National Institute of Health Stroke Scale of 6-14, and pre-stroke modified Rankin Scale (mRS) ≤1. Initial CHIMES treatment allocation blinding was maintained, although no further study treatment was provided in CHIMES-E. Subjects received standard care and rehabilitation as prescribed by the treating physician. mRS, Barthel Index (BI), and occurrence of medical events were ascertained at months 6, 12, 18, and 24. The primary outcome was mRS at 24 months. Secondary outcomes were mRS and BI at other time points. RESULTS: CHIMES-E included 880 subjects (mean age 61.8 ± 11.3; 36% women). Adjusted OR for mRS ordinal analysis was 1.08 (95% CI 0.85-1.37, p = 0.543) and mRS dichotomy ≤1 was 1.29 (95% CI 0.96-1.74, p = 0.093) at 24 months. However, the treatment effect was significantly in favor of MLC601 for mRS dichotomy ≤1 at 6 months (OR 1.49, 95% CI 1.11-2.01, p = 0.008), 12 months (OR 1.41, 95% CI 1.05-1.90, p = 0.023), and 18 months (OR 1.36, 95% CI 1.01-1.83, p = 0.045), and for BI dichotomy ≥95 at 6 months (OR 1.55, 95% CI 1.14-2.10, p = 0.005) but not at other time points. Subgroup analyses showed no treatment heterogeneity. Rates of death and occurrence of vascular and other medical events were similar between groups. CONCLUSIONS: While the benefits of a 3-month treatment with MLC601 did not reach statistical significance for the primary endpoint at 2 years, the odds of functional independence defined as mRS ≤1 was significantly increased at 6 months and persisted up to 18 months after a stroke. © 2015 S. Karger AG, Basel.
Comparison of urban diabetics with optimal and suboptimal control
(British Medical Association, London, 2011) Pinidiyapathirage, M.; Warnakulasuriya, T.; Kasturiratne, A.; Ranawaka, U.; Gunasekera, D.; Wijekoon, N.; Medagoda, K.; Perera, S.; Takeuchi, F.; Kato, N.; Wickremasinghe, A.R.
Introduction The prevalence of Diabetes Mellitus in Sri Lanka is increasing. We describe the characteristics of patients with optimal and suboptimal control of diabetes among known diabetics in a 35–64-year-old urban population resident in the Ragama Medical Officer of Health (Ragama MOH) area of Sri Lanka. Methods A cross sectional study was conducted among 2986 randomly selected 35–64 year olds in the Ragama MOH area from January to September 2007. A detailed history was taken and participants were subjected to a physical examination and assay of fasting blood glucose and HbA1C. A HBA1C <6.5 was taken as evidence of optimal control. Results There were 474 persons (194 males and 280 females) who gave a past history of diabetes. 9 males and 9 females were not on any treatment. 27 persons (9 males and 18 females) were on insulin. Of the 474 diabetics, 113 (48 males and 65 females) had a HbA1c <6.5. The average fasting blood glucose of diabetics with optimal control was 120+21 mg/dl. The mean fasting blood glucose level of the 361 subjects with sub optimal control was 190+70 mg/dl. Optimal glycaemic control was not associated with alcohol intake, smoking, obesity, central obesity and low physical activity levels. Conclusions Most known diabetics had access to treatment but only approximately 25% were optimally treated. The need to optimally manage these patients is highlighted.
Comparison of urban diabetics with optimal and suboptimal control
(BMJ Publishing Group, 2011) Pinidiyapathirage, J.; Warnakulasuriya, T.; Kasturiratne, A.; Ranawaka, U.; Gunasekara, D.; Wijekoon, N.; Medagoda, K.; Perera, S.; Takeuchi, F.; Kato, N.; Wickremasinghe, A.R.
INTRODUCTION: The prevalence of Diabetes Mellitus in Sri Lanka is increasing. We describe the characteristics of patients with optimal and suboptimal control of diabetes among known diabetics in a 35–64-year-old urban population resident in the Ragama Medical Officer of Health (Ragama MOH) area of Sri Lanka. METHODS: A cross sectional study was conducted among 2986 randomly selected 35–64 year olds in the Ragama MOH area from January to September 2007. A detailed history was taken and participants were subjected to a physical examination and assay of fasting blood glucose and HbA1C. A HBA1C <6.5 was taken as evidence of optimal control. RESULTS: There were 474 persons (194 males and 280 females) who gave a past history of diabetes. 9 males and 9 females were not on any treatment. 27 persons (9 males and 18 females) were on insulin. Of the 474 diabetics, 113 (48 males and 65 females) had a HbA1c <6.5. The average fasting blood glucose of diabetics with optimal control was 120+21 mg/dl. The mean fasting blood glucose level of the 361 subjects with sub optimal control was 190+70 mg/dl. Optimal glycaemic control was not associated with alcohol intake, smoking, obesity, central obesity and low physical activity levels. CONCLUSIONS: Most known diabetics had access to treatment but only approximately 25% were optimally treated. The need to optimally manage these patients is highlighted.
Corporate governance and corporate failure
(2012) Lakshan, A.M.I.; Wijekoon, N.
The purpose of this research is to examine the influence of corporate governance characteristics on the corporate failure of listed companies in Sri Lanka. This study utilized publicly available data from annual reports of a sample of 70 failed firms and a sample of matched 70 non failed firms listed on Colombo stock market for a period covering the 2002 to 2008 financial years with logistic regression analysis. Corporate governance characteristics comprises with board size, CEO duality, outside directors, outsiders’ ownership, audit opinion, presence of an audit committee and remuneration of board members. Outside director ratio, presence of an audit committee and remuneration of board members turn out to be negatively associated with the probability of corporate failure, While CEO duality is positively related with the likelihood of corporate failure. Board size, auditor's opinion and outside ownership do not appear to be significant determinants. The paper offers evidence on the extent to which corporate failure associated with corporate governance. It would be educational to investors, financial analysts, accounting professionals, management and be helpful for regulatory authorities in making decisions, evaluations and policies.
Duplication errors due to brand name confusion; It is not always the name-Short case series
(John Wiley & Sons, 2023) Mamunuwa, N.; Jayamanne, S.; Wijekoon, N.; Coombes, J.; Perera, D.; Shanika, T.; Mohamed, F.; Lynch, C.; de Silva, A.; Dawson, A.
Confusion of drug names has been identified as a leading cause of medication errors and potential iatrogenic harm. Most of these errors occur because of look-alike or sound-alike drugs. This case series gives examples of duplication errors due to brand confusion, where there are no similarities in the names.
Effect of Combined Treatment with MLC601 (NeuroAiDTM) and Rehabilitation on Post-Stroke Recovery: The CHIMES and CHIMES-E Studies
(Karger, 2018) Suwanwela, N.C.; Chen, C.L.H.; Lee, C.F.; Young, S.H.; Tay, S.S.; Umapathi, T.; Lao, A.Y.; Gan, H.H.; Baroque li, A.C.; Navarro, J.C.; Chang, H.M.; Advincula, J.M.; Muengtaweepongsa, S.; Chan, B.P.L.; Chua, C.L.; Wijekoon, N.; de Silva, H.A.; Hiyadan, J.H.B.; Wong, K.S.L.; Poungyarin, N.; Eow, G.B; Venketasubramanian, N.; CHIMES-E Study Investigators
BACKGROUND AND PURPOSE: MLC601 has been shown in preclinical studies to enhance neurorestorative mechanisms after stroke. The aim of this post hoc analysis was to assess whether combining MLC601 and rehabilitation has an effect on improving functional outcomes after stroke. METHODS: Data from the CHInese Medicine NeuroAiD Efficacy on Stroke (CHIMES) and CHIMES-Extension (CHIMES-E) studies were analyzed. CHIMES-E was a 24-month follow-up study of subjects included in CHIMES, a multi-centre, double-blind placebo-controlled trial which randomized subjects with acute ischemic stroke, to either MLC601 or placebo for 3 months in addition to standard stroke treatment and rehabilitation. Subjects were stratified according to whether they received or did not receive persistent rehabilitation up to month (M)3 (non- randomized allocation) and by treatment group. The modified Rankin Scale (mRS) and Barthel Index were assessed at month (M) 3, M6, M12, M18, and M24. RESULTS: Of 880 subjects in CHIMES-E, data on rehabilitation at M3 were available in 807 (91.7%, mean age 61.8 ± 11.3 years, 36% female). After adjusting for prognostic factors of poor outcome (age, sex, pre-stroke mRS, baseline National Institute of Health Stroke Scale, and stroke onset-to-study-treatment time), subjects who received persistent rehabilitation showed consistently higher treatment effect in favor of MLC601 for all time points on mRS 0-1 dichotomy analysis (ORs 1.85 at M3, 2.18 at M6, 2.42 at M12, 1.94 at M18, 1.87 at M24), mRS ordinal analysis (ORs 1.37 at M3, 1.40 at M6, 1.53 at M12, 1.50 at M18, 1.38 at M24), and BI ≥95 dichotomy analysis (ORs 1.39 at M3, 1.95 at M6, 1.56 at M12, 1.56 at M18, 1.46 at M24) compared to those who did not receive persistent rehabilitation. CONCLUSIONS: More subjects on MLC601 improved to functional independence compared to placebo among subjects receiving persistent rehabilitation up to M3. The larger treatment effect of MLC601 was sustained over 2 years which supports the hypothesis that MLC601 combined with rehabilitation might have beneficial and sustained effects on neuro-repair processes after stroke. There is a need for more data on the effect of combining rehabilitation programs with stroke recovery treatments.
Impact of a ward based clinical pharmacist intervention on improving the quality use of medicines in patients with chronic non communicable diseases in a tertiary hospital
(Sri Lanka Medical Association, 2014) Shanika, L.G.T.; Jayamanne, S.; Wijekoon, N.; Coombes, J.; Coombes, I.; Perera, D.; Dawson, A.; de Silva, H.A.
INTRODUCTION AND OBJECTIVES: To investigate the impact of a ward based clinical pharmacy service (CPS) on appropriate prescribing of discharge medications. METHODS: This is a non-randomised controlled trial conducted to assess CPS in a medical unit. Eligible patients admitted with non-communicable chronic diseases were considered. The female and the maie wards were the control and intervention during initial phase. Groups were swapped between two wards during next phase. The control patients received usual management. Intervention received CPS in addition to the existing management. Both clinical and demographic data were collected until discharge. Appropriateness of prescribing was assessed at discharge with the Medication Appropriateness Index (MAI). RESULTS: 354 (2140 medications) and 359 (2232 medications) patients' data were evaluated respectively in, control and intervention. Medications received per patient in both groups were similar. Appropriateness of discharged medications in intervention' group was significantly higher compared to control, 66% (235/359) and 34% (120/354) respectively (p< 0.0001). Furthermore, the mean MAI score per patient was significantly lower in intervention compared to th.e control (0.99 vs. 4.1, p< 0.001). Proportion of appropriate prescriptions in relation to all MAI criteria was significantly lower in intervention group compared to the control, all (p< 0.01). Among the drugs prescribed in the intervention [5% (112/2232)] and control groups, [20% (420/2140)] respectively had at least one inappropriate MAI criterion (p< 0.0001). CONCLUSIONS: This study demonstrates that a ward based CPS can reduce inappropriate prescribing of medications at discharge providing an opportunity to improve quality use of medicine.
Impact of a ward-based clinical pharmacist on improving medication knowledge and adherence in patients with chronic non-communicable diseases
(Sri lanka Medical Association, 2015) Shanika, L.G.T.; Wijekoon, N.; Jayamanne, S.; Coombes, J.; Coombes, I.; Perera, D.; Pathiraja, V.; Dawson, A.; de Silva, H.A.
INTRODUCTION AND OBJECTIVES: This is the first study done in Sri Lanka to evaluate the benefit of a ward-based pharmacist on improving medication knowledge and adherence in patients with chronic non-communicable diseases. METHOD: This is a part of a controlled trial conducted in a tertiary care hospital to evaluate ward-based clinical pharmacy service. Intervention group (IG) received a ward-based pharmacist's service during hospitalization to optimize the patients' drug therapy. At discharge the pharmacist counseled patients regarding all aspects (name, indication, dose, frequency, side effects, and actions for side effects, timing, monitoring and storage) of long term medications and written instructions were also provided. Control group (CG) received usual care without a ward-based pharmacist. The knowledge and adherence were assessed over the phone on the 6th day after discharge by a different pharmacist. Previously validated knowledge and adherence questionnaires were used. RESULTS: There were 334 and 311 patients in the IG and CG, respectively, The IG had a significantly higher average medication knowledge compared to the CG {IG-75.81+19.14 vs. CG-40.84+19.20; P < 0.001). Proportion of drugs with correct answers, to all 9 dimensions tested, was greater in the IG compared to the CG (P < 0.001). IG had a significantly higher medication adherence score compared to the CG (IG-92.97±15.04 vs. CG-80.42±28,29; P <0.001). A significantly large number of individuals in the IG had high adherence score on Morisky adherence scale compared to the CG (P < 0.001). CONCLUSION: Discharge counseling by a ward-based pharmacist improves medication knowledge and adherence of patients on long term medications.
Impact of a ward-based clinical pharmacy service in reducing drug-related hospital re-admissions in patients with chronic non-communicable diseases; evidence from a controlled trial in Sri Lanka
(Sri lanka Medical Association, 2015) Shanika, L.G.T.; Wijekoon, N.; Jayamanne, S.; Coombes, J.; Mamunuwa, N.; Dawson, A.; de Silva, H.A.
INTRODUCTION AND OBJECTIVES: Literature showed that pharmacists' interventions helped to reduce drug related hospital re-admissions. The objective of this study was to determine the impact of a ward-based clinical pharmacy service on drug related hospital re-admissions in Sri Lanka. METHOD: This was a part of a controlled trial conducted in a tertiary care hospital in Sri Lanka to evaluate the clinical pharmacy service. The intervention group (IG) received a clinical pharmacist's service in addition to the standard care provided to control group (CG). The pharmacist performed a prospective medications review of patients with chronic non-communicable diseases during hospital stay and made recommendations to the health care team when appropriate. At discharge reconciliation of discharge prescription was done. Patients were educated about discharge medicines to improve knowledge and compliance. Both groups were followed up monthly for six months to identify drug-related hospital re-admissions. RESULTS: Of 137 drug-related re-admissions, 93 (involving 87/356 patients) were from the CG, and 44 (involving 42/361 patients) were from the IG {P < 0.001). Non-compliance was the main reason for re-admissions in the CG. Significantly higher incidence of non-compliance per patient were recorded in CG (CG vs. IG: 13.8% vs. 4.2%; P < 0.001). There was a significantly higher percentage of re-admissions per patient in the CG due to unintentional omission of drugs on discharge prescription (CG vs. IG: 4.5% vs. 0.3%; P < 0.001). The percentage of re-admissions per patient due to adverse drug reactions was similar in the two groups. CONCLUSION: The ward-based clinical pharmacy service is useful in reducing drug related hospital re-admissions in patients with chronic non-communicable diseases. clinical pharmacist's service in addition to the standard care provided to control group (CG). The pharmacist performed a prospective medications review of patients with chronic non-communicable diseases during hospital stay and made recommendations to the health care team when appropriate. At discharge reconciliation of discharge prescription was done. Patients were educated about discharge medicines to improve knowledge and compliance. Both groups were followed up monthly for six months to identify drug-related hospital re-admissions. RESULTS: Of 137 drug-related re-admissions, 93 (involving 87/356 patients) were from the CG, and 44 (involving 42/361 patients) were from the IG {P < 0.001). Non-compliance was the main reason for re-admissions in the CG. Significantly higher incidence of non-compliance per patient were recorded in CG (CG vs. IG: 13.8% vs. 4.2%; P < 0.001). There was a significantly higher percentage of re-admissions per patient in the CG due to unintentional omission of drugs on discharge prescription (CG vs. IG: 4.5% vs. 0.3%; P < 0.001). The percentage of re-admissions per patient due to adverse drug reactions was similar in the two groups. CONCLUSION: The ward-based clinical pharmacy service is useful in reducing drug related hospital re-admissions in patients with chronic non-communicable diseases.
An Integrated Model to Predict Corporate Failure of Listed Companies in Sri Lanka
(International Journal of Business and Social Research, 2015) Wijekoon, N.; Azeez, A.A.
The primary objective of this study is to develop an integrated model to predict corporate failure of listed companies in Sri Lanka. The logistic regression analysis was employed to a data set of 70 matched-pairs of failed and non-failed companies listed in the Colombo Stock Exchange (CSE) in Sri Lanka over the period 2002 to 2010. A total of fifteen financial ratios and eight corporate governance variables were used as predictor variables of corporate failure. Analysis of the statistical testing results indicated that model consists with both corporate governance variables and financial ratios improved the prediction accuracy to reach 88.57 per cent one year prior to failure. Furthermore, predictive accuracy of this model in all three years prior to failure is above 80 per cent. Hence model is robust in obtaining accurate results for up to three years prior to failure. It was further found that two financial ratios, working capital to total assets and cash flow from operating activities to total assets, and two corporate governance variables, outside director ratio and company audit committee are having more explanatory power to predict corporate failure. Therefore, model developed in this study can assist investors, managers, shareholders, financial institutions, auditors and regulatory agents in Sri Lanka to forecast corporate failure of listed companies.
International financial reporting standards for small and medium-sized entities: a new institutional sociology perspective
(Meditari Accountancy Research, 2022) Wijekoon, N.; Samkin, G.; Sharma, U.
Purpose This paper aims to extend the literature by examining the need for International Financial Reporting Standards (IFRS) for Sri Lankan small and medium entities (SMEs) and investigating the institutional pressures that drove the adoption of the IFRS for SMEs in a developing country, Sri Lanka. Design/methodology/approach The theoretical framework adopted in this study draws on insights from new institutional sociology theory. An interview-based qualitative research was conducted with accountants and owners of SMEs, representatives from government agencies and the accounting standards-setting authority of Sri Lanka. Findings The emphasis on the need for international accounting standards for SMEs due to international structures and activities is not a priority for Sri Lankan SMEs. Sri Lankan SME owners do not receive requests to provide internationally comparable financial statements from their trade partners and international activities such as foreign exports, borrowings and ownerships are irrelevant business activities for them. Hence, findings reveal that the decision to adopt the IFRS for SMEs was in response to institutional pressures rather than alleged benefits of internationally comparable financial information. It appears from the results that the influence of local users’ needs and the government interference on the development of accounting standards does not exist in Sri Lanka. Research limitations/implications The research is limited to a single country. The data were collected from SMEs in Sri Lanka, as intended by the research boundary.[AQ1] The study has implications for policy makers, and standard setters charged with developing and implementing an appropriate financial reporting framework for SMEs. Originality/value The extant literature on IFRS for SMEs is sparse and mostly conducted through questionnaire surveys with a single user group of SME financial information.
Predicting corporate failure of listed companies in Sri Lanka
(2012) Lakshan, A.M.I.; Wijekoon, N.
The purpose of this research is to develop a model to predict corporate failure of listed companies in Sri Lanka. This study utilized publicly available data from annual repots of a sample of 70 failed firms and a sample of matched 70 non failed firms listed on Colombo stock market for a period covering the 2002 to 2008 financial years with logistic regression analysis. A total of seven corporate governance variables were used as predictor variables of corporate failure. Analysis of the statistical testing results indicated that Model consists with corporate governance variables improved the prediction accuracy to reach 82.86% one year prior to failure. Furthermore, predictive accuracy of the Model in all three years prior to failure is above 73%. Hence model is robust in obtaining accurate results for up to three years prior to failure. Final model includes four corporate governance variables, outside director ratio, CEO duality, remuneration of board of directors and company audit committee. These variables are having more explanatory power to predict corporate failure. Therefore, model developed in this study can assist investors, managers, shareholders, financial institutions, auditors and regulatory agents in Sri Lanka to forecast corporate failure of listed companies.
Prognostic factors and pattern of long-term recovery with MLC601 (NeuroAiD™) in the chinese medicine neuroAiD efficacy on stroke recovery - extension study
(Karger, 2017) Venketasubramanian, N.; Lee, C.F.; Young, S.H.; Tay, S.S.; Umapathi, T.; Lao, A.Y.; Gan, H.H.; Chua, C.L.; Wijekoon, N.; de Silva, H.A.; Hiyadan, J.H.; Suwanwela, N.C.; Wong, K.S.; Poungvarin, N.; Eow, G.B.; Chen, C.L.; CHIMES-E Study Investigators
BACKGROUND: The Chinese Medicine NeuroAiD Efficacy on Stroke recovery - Extension (CHIMES-E) study is among the few acute stroke trials with long-term outcome data. We aimed to evaluate the recovery pattern and the influence of prognostic factors on treatment effect of MLC601 over 2 years. METHODS: The CHIMES-E study evaluated the 2 years outcome of subjects aged ≥18 years with acute ischemic stroke, National Institutes of Health Stroke Scale (NIHSS) score 6-14, pre-stroke modified Rankin Scale (mRS) score ≤1 included in a multicenter, randomized, double-blind, placebo-controlled trial of MLC601 for 3 months. Standard stroke care and rehabilitation were allowed during follow-up with mRS score being assessed in-person at month (M) 3 and by telephone at M1, M6, M12, M18 and M24. RESULTS: Data from 880 subjects were analyzed. There was no difference in baseline characteristics between treatment groups. The proportion of subjects with mRS score 0-1 increased over time in favor of MLC601 most notably from M3 to M6, thereafter remaining stable up to M24, while the proportion deteriorating to mRS score ≥2 remained low at all time points. Older age (p < 0.01), female sex (p = 0.06), higher baseline NIHSS score (p < 0.01) and longer onset to treatment time (OTT; p < 0.01) were found to be predictors of poorer outcome at M3. Greater treatment effect, with more subjects improving on MLC601 than placebo, was seen among subjects with 2 or more prognostic factors (OR 1.65 at M3, 1.78 at M6, 1.90 at M12, 1.65 at M18, 1.39 at M24), especially in subjects with more severe stroke or longer OTT. CONCLUSIONS: The sustained benefits of MLC601 over 2 years were due to more subjects improving to functional independence at M6 and beyond compared to placebo. Selection of subjects with poorer prognosis, particularly those with more severe NIHSS score and longer OTT delay, as well as a long follow-up period, may improve the power of future trials investigating the treatment effect of neuroprotective or neurorestorative therapies.
Synergistic effect of combining MLC601 and rehabilitation on post-stroke recovery: The Chimes-E Study
(Asia Pacific Stroke Organization, Hong Kong Stroke Society and Jiangsu Stroke Association & karger publishing, 2017) Suwanwela, N.; Lee, C.F.; Christopher, L.H.; Chen; Sherry, H.; Young; Tay, S.S.; Umapathi, T.; Lao, A.Y.; Gan, H.H.; Alejandro, C.; Baroque; Jose, C.; Navarro; Hang, H.M.; Joel, M.; Advincula; Muengtaweepongsa, S.; Chan, B.P.L.; Chua, C.L.C.; Wijekoon, N.; de Silva, H.A.; Hiyadan, J.H.B.; Wong, K.S.L.; Poungvarin, N.; Eow, G.B.; Venketasubramanian, N.
BACKGROUND AND RATIONALE: MLC601 has been shown to enhance natural neuro-repair mechanisms after stroke and may also facilitate rehabilitation-stimulated recovery processes. We aimed to assess the effect of MLC601 and concomitant rehabilitation on stroke recovery in the CHIMES-E study to test the hypotheses that there would be a synergistic effect. METHODS: The CHIMES-E study recruited 880 subjects aged ≥18 years with acute ischemic stroke (AIS), National Institute of Health Stroke Scale (NIHSS) 6–14, and pre-stroke modified Rankin Scale (mRS) ≤1 in a planned double-blind extension study of CHIMES trial with MLC601 or matching placebo given for 3 months in addition to standard stroke care and rehabilitation prescribed by the treating physicians. From Month (M) 3 to M24, mRS was compared between MLC601 and placebo. RESULTS: The study population had a mean age of 61.8 ± 11.3 with 318 (36%) women. Data on rehabilitation and mRS at M3 were available in 807 (91.7%) subjects. Treatment groups were balanced in baseline characteristics except for NIHSS mean score being higher in the rehabilitation group (Rehab) (p = 0.013). Stratification of subjects according to rehabilitation status (Rehab or NoRehab) showed a higher treatment effect of MLC601 on both mRS shift and dichotomy (0–1 vs. 2–6) from M3 to M24 in Rehab group, after adjusting for baseline differences and poorer prognosis factors. In the Rehab group, the adjusted odds of functional independence (mRS of ≤1) increased significantly over time in favor of MLC601 from M3 to M24, with the highest OR at M12 of 2.42 (1.53, 3.81). CONCLUSION: Combining MLC601 and rehabilitation increases improvement of functional recovery over 2 years, supporting a synergistic effect on brain neuro-repair processes after AIS, with more subjects improving to functional independence compared to placebo.
The use of financial ratios in predicting corporate failure in Sri Lanka
(2013) Lakshan, A.M.I.; Wijekoon, N.
The purpose of this research is to develop a model using financial ratios to predict corporate failure of listed companies in Sri Lanka. This study utilized publicly available data from annual reports of a sample of 70 failed firms and a sample of matched 70 non failed firms listed on Colombo stock market for a period covering the 2002 to 2008 financial years with logistic regression analysis. A total of fifteen financial ratios were used as predictor variables of corporate failure. Analysis of the statistical testing results indicated that the prediction accuracy of the model consists with financial ratios is 77.86% one year prior to failure. Furthermore, predictive accuracy of the model in all three years prior to failure is above 72%. Hence model is robust in obtaining accurate results for up to three years prior to failure. Final model includes three financial ratios; working capital to total assets, debt ratio and cash flow from operating activities to total assets. These variables are having more explanatory power to predict corporate failure. Therefore, model developed in this study can assist investors, managers, shareholders, financial institutions, auditors and regulatory agents in Sri Lanka to forecast corporate failure of listed companies.