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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    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.
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    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.
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    Stroke subtypes in Sri Lanka
    (Sri Lanka Medical Association, 1997) Gunatilake, S.B.; Premawardhena, A.
    AIM: Data on stroke subtypes in Sri Lanka are limited. This is due to the unavailability of brain imaging facilities in most government hospitals in the country. In two leading private hospitals in Colombo, a high proportion of stroke patients are subjected to computerised tomography (CT) scanning. Therefore it was decide to study the stroke patients admitted to these two hospitals to determine the stroke subtypes METHODS: A prospective study of 103 consecutive first -ever stroke patients who were under the eare of the first author during the period 15lhMay 1995 lo30th August 1996 were studied. Diagnosis of stroke was made according to the WI10 definition. Transient ischaemic attacks (TIA) were not included in the study. The pathological subtype was confirmed by CT scan in 99 patients RESULTS: The age of the patients ranged from 37 to 94 years (mean 65y). 87 patients were over the age of 50 years. The proportion of pathological subtypes confirmed by CT scanning was cerebral infarction (CI) 74%, intracerebral haemorrhage (ICH) 19% and subarachnoid haemorrhage (SAII) 6%. Of the 74 infarcts 31 (23%) were cortical, 30 (22%) were lacunar, 12(9%) were cerebellar and brains tern and 1 (0.7%) was a border zone infarct, In-hospilal mortality was 19% for all strokes: 14% for infarcts and 35% for haemorrhages. Mortality was lowest in (he lacunar stroke group (3%). In the cortical infarct group the mortality was 16%, in the ICH group 22% and in the SAM group 50%. CONCLUSION: Direct comparisons with stroke subtypes seen in other countries are not possible due to differences in methodology. In developed countries in the West cerebral infarcs account for about 80% of alI first-ever strokes and of these 13 to 21% are lacunar strokes. Countries in the East like Japan and Hongkong have reported higher proportion of haemorrhages; 27% of first-ever strokes in Hong Kong. In Sri Lanka The proportion of stroke subtypes seem to be intermediate between these countries from die west and east. Lacunar .stroke .seem to be commoner in Sri Lanka than in other countries. These differences may be because of differences in risk factors prevalent in our country.
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    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.
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    Differences in ischaemic and haemorrhagic strokes in Sri Lanka: 7-year data from the Ragama Stroke Registry
    (American Academy of Neurology & Lippincott Williams & Wilkins, 2015) Ranawaka, U.; Peiris, A.; Thirumavalavan, K.; Premawansa, G.; Kasturiratne, A.
    OBJECTIVE:We sought to describe the differences in stroke characteristics of patients with ischaemic and haemorrhagic stroke attending a Sri Lankan tertiary care hospital. BACKGROUND:The burden of stroke in South Asia is high, but epidemiological data are limited from the region. DESIGN/METHODS:The Ragama Stroke Registry is the first comprehensive stroke registry in Sri Lanka capturing data of all stroke patients admitted to an entire hospital. We collected data from all consenting patients with stroke admitted to the Colombo North Teaching Hospital over a seven-year period. We compared data from ischaemic stroke patients (IS group) with intracerebral haemorrhage patients (ICH group) regarding demographic characteristics, clinical features, risk factors, stroke severity and early disability. RESULTS:A total of 2690 patients were studied [mean age (SD) 64.4 (12.3) years; 58.6[percnt] males]; IS group- 2185 patients (81.3[percnt]); ICH group- 411 patients (15.3[percnt]). No differences were noted in age & sex distribution between ICH and IS groups. ICH patients presented to hospital earlier (<6 hours- ICH 74.5[percnt], IS 54.0[percnt], p<0.05). Altered consciousness, dysphasia, dysphagia, gaze palsy and bladder involvement were commoner among ICH patients (p<0.05). Previous history of stroke/ TIA, diabetes, heart disease, obesity/overweight and smoking were commoner in IS group. ICH patients presented with more severe strokes (NIHSS score >7 in ICH 67.6[percnt] vs. IS 43.8[percnt], p<0.05), and had more severe initial disability according to Barthel index and modified Rankin scale (p<0.05). CONCLUSIONS:Clinical and risk factor profiles were different between ICH and IS patients. Stroke severity and functional disability were higher among ICH patients. Study Supported by:Ragama Stroke Registry has been partly supported by research grants from the University of Kelaniya and Research Institute, International Medical Centre of Japan. Disclosure: Dr. Ranawaka has nothing to disclose. Dr. Peiris has nothing to disclose. Dr. Thirumavalavan has nothing to disclose. Dr. Premawansa has nothing to disclose. Dr. Kasthuriratne has nothing to disclose.