Conference Papers

Now showing 1 - 3 of 3

Premorbid blood pressure control of incident transient ischaemic attacks and strokes; prevalence and determinants; Analysis of individual patient data over 10 Years
(Lippincott Williams & Wilkins, 2017) Mettananda, C.; Li, L.; Lau, G.; Wharton, R.; Bull, L.; McCulloch, E.; Welch, S.; Mehta, Z.; Silver, L.; Rothwell, P.; Oxford Vascular Study
BACKGROUND: Uncontrolled blood pressure is the most important modifiable risk factor for strokes. AIMS AND METHODS: We determined the prevalence and determinants of blood pressure control in patients with incident transient ischaemic attacks(TIA) and strokes from 2002-2012 in a population-based cohort(Oxford Vascular Study). Controlled blood pressure(BP) was defined as having BP<140/90mmHg and was studied in different cardiovascular risk groups according to the Framingham 10-year general cardiovascular risk(CV-Risk) predicted at time of event and 10years pre-event; low(≤ 10%), moderate(11-19%) and high(≥ 20%) risk. We also studied the associations of controlled BP adjusted for age and sex. RESULTS: Among 1741 patients with incident TIA/strokes, 1051 (60.4%) had known hypertension, of which 891 (84.8%) were on anti-hypertensive treatment. However, only 698 (40.1%) of all and 306 (29.1%) of treated patients had controlled BP. On predicted 10-year CV-Risk at event, 861 (72.5%) of 1188 (77.0%) in high risk group had known hypertension, of which 758 (88.0%) were on treatment. However, only 346 (29.1%) of all in high-risk group and 190 (25.1%) of treated high risk patients had controlled BP. In contrast, 120 (88.2%) of 136 (8.8%) in low risk group had controlled BP. Risk stratification without scoring for BP showed consistent results except the number in high-risk group dropped to 863 (55.9%). Analysis with CV-risk 10years pre-event also showed similar trends. Age(adjusted OR=0.97, 95%CI=0.97-0.98, p<0.001), high CV-risk at event/10years pre-event (0.97, 0.95-0.99, p<0.013, 0.95-0.99, p=0.008), being treated for hypertension(0.43, 0.35-0.52, p<0.001), BMI≥ 30Kg/m2(0.72, 0.55-0.92, p=0.010) and high total cholesterol(0.91, 0.84-0.99, p<0.026) were negatively associated with controlled BP. However history of atrial fibrillation(1.35, 1.03-1.77, p=0.030) and physical dependency(modified-Rankin-Scale>2; 1.54, 1.15-2.06, p<0.001) were positively associated with controlled BP. CONCLUSIONS: Premorbid blood pressure control in patients with incident TIA/strokes was inadequate especially in high-risk patients. Controlling BP to targets in elderly and high CV-risk patients would be important in reducing incident TIA/strokes.
Epidemiology of stroke subtypes and aetiology among Sri Lankan stroke patients
(Sage Publishing, 2020) Mettananda, C.; Wettasinghe, L,; Eshani, M.D.P.; Ranawaka, U.
BACKGROUND AND AIMS: Prevalence of stroke is on the rise in south Asia and the epidemiology is different to western countries. However, prevalence of stroke subtypes and aetiology is not reported of Sri Lanka. Therefore, we aimed to describe the same of Sri Lanka. METHODS: We analyzed all the acute stroke admissions to a stroke unit of a tertiary care hospital in Sri Lanka over 5 year from October 2013 to 2018. Data were collected prospectively using an interviewer administered questionnaire by interviewing patients and perusing medical records. Ischaemic strokes were classified on OCSP (Oxfordshire Community Stroke Project) and TOAST(Trial of Org 10172 in Acute Stroke Treatment) classifications RESULTS: 891 patients were admitted to stroke unit over 5 years; 765(85.5%) ischaemic strokes, 129 (14.5%) intracerebral haemorrhages (ICH), and 0(0%) sub-arachnoid haemorrhages (SAH). Of the ischemic strokes 16(1.8%) were total anterior circulation, 253(29.0%) partial anterior circulation, 543(62.3%) lacunar, 59(6.8%) posterior circulation infarcts on OCSP classification. 542 of ischaemic stroke patients who had complete investigations for TOAST classification were studied for aetiology of stroke. Atrial fibrillation was reported in only 14(2.7%) and more than 50% carotid stenosis was seen in 22(4.1%) ischaemic stroke patients. 17(3.1%) were of large artery atherosclerosis, 369(68.1%) small vessel occlusion, 11(2.0%) cardioembolic and 145(26.8%) undermined aetiology. CONCLUSIONS: Prevalence of ischaemic strokes, ICH and SAH were not different to western statistics in this Sri Lankan cohort of stroke patients. However, cardio-embolic and large artery strokes were less common compared to west and lacunar strokes were the commonest of ischemic strokes.
Viral characteristics and genomics of early onset, single organ specific presentations in dengue
(Sri Lanka Medical Association, 2013) Premaratna, R.; Perera, H.K.K.; Chan, K.H.; Yeung, M.F.; Mettananda, C.; Peiris, J.S.M.; de Silva, H.J.
INTRODUCTION AND OBJECTIVES: Early onset neurological, hepatic and cardiac complications of dengue are increasingly recognized. However, doubts exist as to whether such complications of dengue are consequences of dengue shock syndrome rather than direct organ involvement. We studied virus characteristics and their genomics in patients who presented with early onset single organ involvement due to dengue, without features of DSS. METHODS: Blood samples were collected at admission of seven patients, who presented to the Professorial Medical Unit, Colombo North Teaching Hospital Ragama during 2011-2012, confirmed as having acute dengue by PCR. Samples were analysed with single-tube, nested RT-PCR using type-specific primers. Viral RNA was extracted and sequencing was performed. The dengue virus sequences were aligned with other sequences that are available in the GenBank and maximum-likelihood (ML) tree was made. RESULTS: Early onset organ specific manifestations included; self-limiting fits and clouding of consciousness on the 2nd day, rise in AST (1337iu/L) and ALT (749iu/L) on the 4th day and T wave inversions in the ECG on the 3rd day. Seven Dengue 1 viruses were isolated, which were in close homology in all 7 patients, based on the maximum likelihood tree with 1000 boot-straps. CONCLUSIONS: All the strains detected were clustered within the Genotype I clade of dengue-1 and in close homology with the dengue-1 viruses detected in the country in the recent past. The significance of viral characteristics and genomics related to organ specific manifestations need further study.

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