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 Impact of COVID-19 on stroke admissions in a Sri Lankan tertiary care hospital:Data from the Ragama stroke registry(Ceylon College of Physicians, 2021) Deelaka, A.G.S.; Dep WDC, W.D.C.; Nanayakkara, Y.P.; Chandrasiri, H.M.J.; Mettananda, K.C.D.; Pathmeswaran, A.; Ranawaka, U.K.Introduction and Objectives The coronavirus disease 2019 (COVID-19) pandemic has had a tremendous impact on stroke care globally. We investigated the impact of the pandemic on stroke admissions in a Sri Lankan tertiary care hospital. Methods We studied the number of admissions to the Stroke Unit and the University Medical Unit, Colombo North Teaching Hospital (CNTH) over four years, and delays in seeking medical care of patients admitted to the Stroke Unit. We compared data during a calendar year of COVID pandemic (01.04.2020 - 31.03.2021) with the preceding 3 pre-COVID years (01.04.2017 一 31.03.2020). Data regarding COVID year was compared with pre-COVID years using independent-samples t-test and nonparametric test. Results Mean number of stroke admissions per month during the pandemic was significantly lower compared to that of pre-COVID years: Stroke Unit (monthly mean admissions, COVID year vs pre-COVID years; 11 ± 3.5 vs 20 ± 3.1; pv0.01); University Medical Unit (12 ± .2 vs 18 ± 3.4; p<0.01). The lowest number of admissions was reported during the period with the highest COVID caseload in Sri Lanka. However, there was no significant difference in the median delays to seeking medical care between the COVID pandemic and pre-COVID years: delay to first medical contact: 2.0 h vs 2.4 h, p=0.208; first hospital admission: 3.0 h vs 3.0 h; p=0.993, admission to CNTH: 3.4 h vs 5.0 h; p=0.174. Conclusions Stroke admissions were significantly lower during the COVID pandemic, but there was no difference in the delays in seeking medical care during the same period.Item Spontaneous intracerebral haemorrhages from a Sri Lankan tertiary care center: 5-year data(Ceylon College of Physicians, 2021) Dep, W.D.C.; Deelaka, A.G.S.; Somaratne, K.G.S.K.; Meegahapola, H.; Premadasa, H.M.S.D.; Kurukulasuriya, S.A.F.; Mettananda, K.C.D.; Ranawaka, U.K.Introduction and Objectives Epidemiological data on spontaneous intracerebral haemorrhage (sICH) is limited from South Asia. We sought to describe epidemiology of sICH in a Sri Lankan cohort. Methods We studied all patients with stroke admitted to the Stroke Unit, Colombo North Teaching Hospital over five years. Data from sICH patients regarding treatment seeking delays, clinical char-jcteristics, risk factors, stroke severity and functional outcome were compared with ischa-mic stroke (IS) patients. Resists 984 patients (mean age 58.7 years; 62.1% males) were studied: sICH 15.0% (147 patients), IS 85.0%. sICH patients: mean age 58.0 years; 67.3% males. sICH patients presented to hospital earlier (<3h sICH 70.6%, IS 37.2%, p<0.001) and had more severe strokes (NIHSS>15) (sICH 21.3%, IS 12.2%; p<0.001). Hypertension was commoner in sICH group (sICH 72.6%, IS 63.5%; p=0.034), whereas diabetes (sICH 39.0%, IS 51.6%; p=0.005) and smoking (sICH 16.6%, IS 25.5%; p=0.021) were less common. Altered consciousness (sICH 30.3%, IS 18.3%; p=0.001), dysphagia (sICH 55.9%, IS 34.4%; p<0.001), bladder involvement (sICH 56.6%, IS 28.7%; p<0.001), and seizures (sICH 4.1%, IS 1.5%; p=0.029) were commoner among sICH patients. sICH patients had more severe disability on discharge (Barthel index 0-60: sICH 71.1%, IS 45.2%; p<0.001; modified Rankin scale (mRS) 3-6: sICH 76.7%, IS 52.1%; p<0.001). sICH location (lobar vs. deep) and presence of intraventricular haemorrhage was not associated with stroke severity. Lobar ICHs had more severe disability on discharge (Barthel index <60: p=0.037; mRS>3: p=0.020). On logistic regression, sICH was independently associated with early presentation to hospital (OR 1.79; p=0.039), and severe disability on discharge (Barthel index <60: OR 2.42, p=0.028; mRS>3: OR 2.70, p=0.012). Conclusions sICH patients sought medical attention early and had different clinical profiles, more severe strokes and more severe disabilities.Item Epidemiology of Stroke Subtypes and Aetiologies Among Sri Lankan Stroke Patients(Sri Lanka Medical Association, 2020) Mettananda, K.C.D.; Eshani, M.D.P.; Wettasinghe, L.M.; Ranawaka, U.K.INTRODUCTION AND OBJECTIVES: Epidemiology of stroke subtypes in Asian countries is different from western countries. Data on stroke subtypes and aetiologies are limited from Sri Lanka. Therefore, we aimed to describe the same in Sri Lankans stroke patients. METHODS: We analyzed all the acute stroke admissions to Colombo North stroke unit over 5 years from 2013-2018 using the stroke registry. Data were collected prospectively using an interviewer-administered questionnaire and perusing medical records. Ischaemic strokes were classified into clinical subtypes using Oxfordshire Community Stroke Project (OCSP) and aetiological subtypes using Trial of Org 10172 in Acute Stroke Treatment (TOAST) classifications. RESULTS: 891 patients were admitted over 5 years; 765(85.5%) ischaemic strokes and 129 (14.5%) intracerebral haemorrhages (ICH). 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 ischaemic stroke patients who had complete investigations for TOAST classification were studied for aetiology of stroke. 17(3.1%) were of large artery atherosclerosis, 369(68.1%) small vessel occlusion, 11(2.0%) cardioembolic and 145(26.8%) of undermined aetiology. CONCLUSIONS: Prevalence of ischaemic strokes and ICH were not different from western statistics but ischemic stroke subtypes and aetiologies were different in Sri Lankans. Total anterior circulation strokes were significantly lower and lacunar strokes were significantly higher among Sri Lankans compared to Western populations. Small vessel disease was the commonest cause of ischemic strokes and cardio-embolic and large artery strokes were less common compared to White Caucasians.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 Validation of the World Health Organization/ International Society of Hypertension (WHO/ISH) cardiovascular risk predictions in Sri Lankans based on findings from a prospective cohort study(Ceylon College of Physicians, 2020) Thulani, U.B.; Mettananda, K.C.D.; Warnakulasuriya, D.T.D.; Peiris, T.S.G.; Kasturiratne, K.T.A.A.; Ranawaka, U.K.; Chackrewarthy, S.; Dassanayake, A.S.; Kurukulasooriya, S.A.F.; Niriella, M.A.; de Silva, S.T.; Pathmeswaran, A.P.; Kato, N.; de Silva, H.J.; Wickremasinghe, A.R.INTRODUCTION AND OBJECTIVES: There are no cardiovascular(CV)-risk prediction models specifically for Sri Lankans. Different risk prediction models not validated among Sri Lankans are being used to predict CV-risk of Sri Lankans. We validated the WHO/ISH (SEAR-B) risk prediction charts prospectively in a population-based cohort of Sri Lankans. METHOD: We selected participants between 40-64 years, by stratified random sampling of the Ragama Medical Officer of Health area in 2007 and followed them up for 10-years. Risk predictions for 10-years were calculated using WHO/ISH (SEAR-B) charts with- and without-cholesterol in 2007. We identified all new-onset cardiovascular events(CVE) from 2007-2017 by interviewing participants and perusing medical-records/death-certificates in 2017. We validated the risk predictions against observed CVEs. RESULTS: Baseline cohort consisted of 2517 participants (males 1132 (45%), mean age 53.7 (SD: 6.7 years). We observed 215 (8.6%) CVEs over 10-years. WHO/ISH (SEAR B) charts with and without-cholesterol predicted 9.3% (235/2517) and 4.2% (106/2517) to be of high CV-risk ≥20%), respectively. Risk predictions of both WHO/ISH (SEAR B) charts with- and without-cholesterol were in agreement in 2033/2517 (80.3%). Risk predictions of WHO/ISH (SEAR B) charts with and with out-cholesterol were in agreement with observed CVE percentages among all except in high risk females predicted by WHO/ISH (SEAR B) chart with-cholesterol (observed risk 15.3% (95% Cl 12.5 - 18.2%) and predicted risk 2::20%). CONCLUSIONS: WHO/ISH (SEAR B) risk charts provide good 10-year CV-risk predictions for Sri Lankans. The predictions of the two charts, with and without-cholesterol, appear to be in agreement but the chart with-cholesterol seems to be more predictive than the chart without-cholesterol. Risk charts are more predictive in males than in females. The predictive accuracy was best when stratified into two categories; low (<20%) and high (≥20%) risk.Item Usefulness of berg balance scale, six-minute walk test and timed up and go test as fall risk predictors in post stroke adults attending rehabilitation hospital, Ragama(Journal of the Ceylon College of Physicians, 2020) Bandara, K.M.T.; Pathmeswaran, A.; Ranawaka, U.K.INTRODUCTION AND OBJECTIVES: Stroke is a major risk factor for falls. However, there are no established practices for predicting fall risk in Sri Lankan stroke care settings. We sought to determine the usefulness of three clinical tests: Berg Balance Scale (BBS), Six Minute Walk Test (6MWT) and Timed Up and Go test (TUG) as fall risk predictors in post stroke individuals and to introduce cut-off values. METHODS: Participants were recruited from the physiotherapy unit, Rehabilitation Hospital, Ragama. History of falls was recorded from patient's interview. Each participant underwent BBS, 6MWT and TUG test. Scores were compared with international cut-off values. Receiver Operating Characteristic (ROC) curves were constructed to describe sensitivity, specificity and predictive values. Optimum cut-off values for fall risk discrimination were determined. RESULTS: We studied 74 stroke patients (mean age 56.5±28.5, males 67.6%) and 17 (23%) had history of falls. There was no significant difference in the baseline characteristics between fallers' and non-fallers. Cut-off values for fall prediction were as follows; BBS < 45, AUC = 0.773, p=0.001; 6MWT < 193 meters, AUC = 0.686, p=0.020; TUG ⪀23s, AUC = 0.662, p=0. 044. CONCLUSION: All three scales were associated with risk of falls. The BBS performed better in predicting fall risk in stroke individuals than TUG and 6MWT. We recommend the use of physical performance tests such as BBS, 6MWT and TUG test to predict fall risk in stroke patients in Sri Lanka.Item Incidence and prevalence of stroke and time trends in vascular risk factors among urban/semi-urban Sri Lankans: A population-based cohort study(Ceylon College of Physicians, 2020) Mettananda, K.C.D.; Ranawaka, U.K.; Wickramarathna, K.B.; Kottahachchi, D.C.; Kurukulasuriya, S.A.F.; Matha, M.B.C.; Dassanayake, A.S.; Kasturiratne, K.T.A.A.; Pathmeswaran, A.; Wickremasinghe, A.R.; de Silva, H.J.INTRODUCTION AND OBJECTIVES: Incidence of stroke is declining in developed countries, but is increasing in developing countries. There is no data on incidence of stroke in Sri Lanka, and only limited data on prevalence of stroke. METHODS: We studied a population-based cohort (35-64 years) selected by stratified random sampling from an urban/semi-urban health administrative area (Ragama Health Study) in 2007, and evaluated them again in 2014 with regard to new onset stroke and prevalence of vascular risk factors. Possible stroke patients were independently reviewed by a neurologist and a physician with regard to the diagnosis of stroke. The prevalence of stroke (at baseline) was estimated. Prevalence of vascular risk factors in the population were compared between 2007 and 2014. RESULTS: The baseline cohort in 2007 consisted of 2985 individuals (females 54.5%, mean age 52.4 ± 7.8 years). Of them, 2204 attended follow-up in 2014 (female 57.6%, mean age 59.2±7.6 years). 19 had a history of strokes at enrolment (stroke prevalence 6.37/1000 population) and 24 episodes of strokes occurred over the 7 years (annual incidence of stroke 1.56/1000 population). Risk factor prevalence in 2007 and 2014 were; hypertension 48.7% and 64.3%; hyperlipidaemia 35.5% and 39.3%; diabetes mellitus 28.2% and 35.7%; and obesity 2.6% and 17.9%, respectively. CONCLUSION: Stroke incidence and prevalence rates of Sri Lanka lie between those of developed and developing countries. Prevalence of vascular risks have increased over time in this urban/semi urban Sri Lankan population.Item Seizure patterns, preconception care and pregnancy outcomes in women with epilepsy in a tertiary care hospital(Journal of the Ceylon College of Physicians, 2020) Motha, M.B.C.; Palihawadana, T.S.; Jayasinghe, C.; Ranawaka, U.K.INTRODUCTION AND OBJECTIVES: Data on epilepsy in pregnancy is limited from South Asia and other resource-limited countries. We sought to describe seizure patterns, preconception care and pregnancy outcomes in women with epilepsy attending a Sri Lankan tertiary care hospital. METHOD: All pregnant women with epilepsy admitted to University Obstetrics Unit, Colombo North Teaching Hospital during the period January 2017 February 2020 were recruited. Data were collected by a single physician using an interviewer-administered questionnaire. RESULTS: Out of 9520 pregnant women screened, 63 had a history of epilepsy (prevalence 6.6/1000); 46% generalized epilepsy, 22.2% focal epilepsy. Of 38 women on antiepileptics at conception, only 44.7% were given folic acid 5 mg preconceptionally. 42.9% were seizure free over preceding 2 years. Majority (55%) had a seizure during current pregnancy (average number of seizures per patient: 1s1 trimester 1.85, 2nd trimester 2.2, 3rd trimester 2.95, postpartum 2.5). 18.4% of seizure events were attributed to sleep deprivation, and 2.7% to unsatisfactory drug compliance. 81.6% were on monotherapy at conception and 18.4% were on two antiepileptic. 22.2% had a hypertensive disorder of pregnancy and 9.5% spontaneous premature delivery. 33.3% underwent caesarian delivery. 1.58% each had a stillbirth and neonatal death. Low birth weight was seen in 42.9%. Major congenital malformations were found in 11.1% of newborns. CONCLUSIONS: Pre-conceptional folic acid coverage was poor. Seizures occurred in more than half of the women and were more common in third trimester and postpartum. Rates of hypertensive disorders, caesarean deliveries, low birth weight and congenital malformations were high.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 Incidence and predictors of metabolic syndrome among urban, adult Sri Lankans: a community cohort, 7-year follow-up study(European Association for the Study of Diabetes, 2017) de Silva, S.T.; Niriella, M.A.; Kasturiratne, A.; Kottahachchi, D.; Ranawaka, U.K.; Dassanayake, A.; de Silva, A.P.; Pathmeswaran, P.; Wickremasinghe, R.; Kato, N.; de Silva, H.J.BACKGROUND AND AIMS In 2007, we reported a 38.9% prevalence of metabolic syndrome (MetS) in an urban, adult population. Published data on incident MetS from South Asia is lacking. This study investigated the incidence and risk factors for MetS after a 7-year follow-up of the initial cohort. MATERIALS AND METHODS: The study population (selected by age-stratified random sampling from the Ragama MOH area) was screened in 2007 (aged 35-64 years) and re-evaluated in 2014 (aged 42-71 years). On both occasions, structured interview, anthropometric measurements, liver ultrasound, biochemical and serological tests were performed. MetS was diagnosed on established International Diabetes Federation (IDF 2012) criteria. Total body fat (TBF) and visceral fat percentage (VFP) were measured in 2014, using impedance. Abnormal TBF was defined as >32% for females and >25% for males. Abnormal VFP was defined as >10% for both sexes. Non-alcoholic fatty liver disease (NAFLD) was diagnosed on established ultrasound criteria, safe alcohol consumption (Asian standards: <14 units/week for men, <7 units/week for women) and absence of hepatitis B and C markers. RESULTS: 2137/2967 (72.0%) of the initial cohort attended follow-up [1229 (57.5%) women; mean-age 52.4 (SD-7.7) years]. 1000/2137 [548 (54.8%) women; mean age 57.5 years (SD-7.74)] had MetS (prevalence-46.8%). Out of 1246 individuals who initially did not have MetS in 2007, 318 [225 (70.8%) women; mean age 57.5 (SD 7.7) years] had developed incident MetS after 7 years (annual incidence-2.13%). Comparison of incident MetS with those with no MetS in 2014 is shown in Table 1. On logistic regression, female sex (OR 3.6, p<0.001), central obesity [OR 4.58, p<0.001], BMI >23kg/m2 [OR 4.84, p<0.001], increase in weight 2%-5% [OR 2.02, p<0.001], increase in weight >5% [OR 5.3, p<0.001), increase in waist circumference (WC) 5-10-cm [OR 3.68, p<0.001], increase in WC >10cm [OR 10.34, p<0.001] and NAFLD (OR 2.44, p<0.001) in 2007 were independently predictive of incident MetS in 2014. Abnormal VFP [OR 4.23, p<0.001] and abnormal TBF [OR 5.25, p<0.001] were also associated with incident MetS. CONCLUSION: In this prospective community study, the annual incidence of MetS was 2.13%. Female gender, increase in weight and WC from baseline and the presence of NAFLD predicted the development of incident MetS. Obesity at baseline was the only defining individual component of MetS that predicted future MetS.
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