Conference Papers
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This collection contains abstracts of conference papers, presented at local and international conferences by the staff of the Faculty of Medicine
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Item Carotid artery stenosis in patients with ischaemic stroke in a tertiary care centre: Prevalence and associated factors(Ceylon College of Physicians, 2019) Ranawaka, U.K.; Mettananda, K.C.D.; Eshani, M.D.P.; Wettasinghe, L.M.; Somaratne, S.; Premadasa, H.M.S.D.; Sirigampola, C.; Upasena, A.; Sathkorala, W.; Pathmeswaran, A.OBJECTIVES: Data on the prevalence of carotid artery stenosis (CAS) among Sri Lankan stroke patients is limited. We sought to determine the prevalence and associated factors of significant CAS in patients with ischaemic stroke admitted to a Sri Lankan stroke unit. METHODS: We prospectively studied all stroke patients admitted to a stroke unit in a tertiary care hospital over a five-year period. Presence and degree of CAS was evaluated by doppler ultrasonography (US). Degree of CAS was classified as low {<50%), moderate (50-69%), significant (70-99%) or total occlusion (100%) according to NASCET criteria. Factors associated with significant CAS were identified by stepwise multiple logistic regression analysis. RESULTS: Out of 867 stroke patients studied, 704 (81.2%) had ischaemic strokes (59.7% male, mean age 59.0 ± 10.3 years), and 550 (78.1%) of them had carotid doppler data available. 528 (96.0%) had low degree stenosis, 12 (2.2%) had moderate stenosis, 7 (1.3%) had significant stenosis and 3 (0.5%) had total occlusion. Older age was associated with significant CAS (OR 1.14, p=0.011) on stepwise multiple logistic regression analysis. Sex, smoking, BMI, total cholesterol, LDL cholesterol, history of diabetes mellitus, hypertension, hyperlipidemia or ischemic heart disease, and premorbid aspirin or statin use were not associated with significant CAS. CONCLUSIONS: Significant CAS is seen in only 1.8% of Sri Lankan patients with ischaemic stroke at this tertiary care centre. These figures are much lower compared to Western data. Our findings have implications for the use of management approaches such as thrombectomy and carotid endarterectomy in Sri Lankan patients. ACKNOWLEDGEMENTS: EMDP and WLM were supported by a research grant from the National Stroke Association of Sri Lanka.Item The Adaptation and Validation of Stroke and Aphasia Quality of Life (SAQOL-39) Scale for the Sinhala Language in the Sri Lankan Context.(19th Conference on Postgraduate Research, International Postgraduate Research Conference 2018, Faculty of Graduate Studies,University of Kelaniya, Sri Lanka, 2018) Karunathilake, K.M.M.G.S.L.; Rathnayake, S.; Ranawaka, U.K.Stroke and aphasia rehabilitation aims to improve the quality of life of the individuals affected. Aphasia is a disturbance of the language. Most of scales for measuring health-related quality of life in stroke exclude people with aphasia due to inability to communicate during the questionnaires. However, it is vital to identify the effect on quality of life among individuals with aphasia to provide proper rehabilitation. No reliable measure was developed in Sri Lankan context to analyze this, which became the research question of the present study. The Stroke and Aphasia Quality of Life Scale-39 which is the commonest, valid and reliable measures was used in assessing quality of life among aphasia and it was analyzed applying to the Sri Lankan context. The following were the aims of the study, translate and adapt the (SAQOL-39) Scale for the Sinhala Language in the Sri Lankan context, identify its reliability and validity, identify the relationship between the severity level of communication and the quality of life level and analyze the most affected domain among aphasia population. The original (English) version of the SAQOL-39 has been adapted and translated using Delphi method. The sociocultural and linguistically adapted Sinhala version was administered on a group of 35 patients with aphasia to examine the test-retest reliability, inter rater reliability internal consistency reliability as well as the concurrent validity of the instrument. The inclusion criteria of the study population were as following, Aphasia resulting from a stroke at least after 6 months from the onset and not with the evidence of psychiatric illnesses and cognitive difficulty. 10 patients were used for the test retest assessment. And for the inter rater reliability assessment 2 raters were used. The Sinhala version of SAQOL-39 exhibited high test-retest reliability (ICC =0.83) as well as the inter rater reliability (ICC=0.99). This instrument exhibited high internal consistency (Chronbach's∝ =0.845) and also the concurrent validity was examined with the WHOQOL BREF and found a significant correlation between SAQOL-39 and WHOQOL-BREF (r=0.75, p=0.000). The most affected domain of the aphasia patients as the communication domain was identified through this study and it was also identified that there is a significant positive correlation (r=0.685, p=0.000) between the severity level of aphasia and quality of life. Despite the small sample size, the Sinhala version of the SAQOL-39 showed good internal consistency, inter rater reliability, test-retest reliability and concurrent validity. The importance of communication ability in perceiving the quality of life in patients with aphasia has also been highlighted.Item Hyperhomocysteinaemia and stroke: a case-control study(Sri Lanka Medical Assosiation, 2004) Ranawaka, U.K.; Niriella, M.A.; Hewamadduma, C.A.A.; Kanakkahewa, N.; Thilakarathna, N.T.; Wickremasinghe, A.R.; Wijesekera, J.C.OBJECTIVES: We sought to identify the importance of hyperhomocysteinaemia as an independent risk factor for stroke. METHODOLOGY: This was a case control study of patients with stroke (n=48) and pair matched controls (age and sex matched; n=48) at the Institute of Neurology, NHSL. Prior ethical approval was obtained from the Ethical Review Committee of the SLMA. Fasting total plasma homocysteine (tHcy) was compared between the two groups. Logistic regression analysis was performed to determine the contribution of hyperhomocysteinaemia as a risk factor for stroke, after controlling for other risk factors, using the 50th percentile of tHcy among controls (tHcy 50) as cut-off value. All strokes (n=48) and ischaemic strokes (n=43) were analysed separately. RESULTS: Cases (mean age = 55.69 years) and controls (mean age = 54.64 years) were well matched. tHcy among controls (mean=16.5l umol/1) was higher than observed from elsewhere, even after excluding those with vascular risk factors (mean=13.8 umol/1). The mean tHcy levels were significantly higher in cases (23.12 umol/1) than in controls (16.51 umol/1, p<0.001). There was no significant difference in tHcy between ischaemic and haemorrhagic strokes, and lacunar and non-lacunar strokes. Logistic regression analysis showed that tHcy 50 was an independent risk factor for haemorrhagic strokes (OR 2.583, p=0.05), and for ischaemic strokes (OR 2.663, p=0.05). CONCLUSION: tHcy levels may be higher than usual among Sri Lankan populations. Hyperhocysteinaemia is an independent risk factor for stroke.