Medicine
Permanent URI for this communityhttp://repository.kln.ac.lk/handle/123456789/12
This repository contains the published and unpublished research of the Faculty of Medicine by the staff members of the faculty
Browse
23 results
Search Results
Item Unilateral basal ganglia infarction presenting as sudden onset daytime sleepiness(Sri Lanka College of Internal Medicine, 2024) Mettananda, K.C.D.; De Saram, E.M.T.K.; Wickramasinghe, M.K.I.I.; Siriwardana, S.A.S.R.Basal ganglia (BG) are involved in motor coordination. BG strokes usually present with problems controlling speech, movements, mood and posture leading to abulia which is a prominent feature. BG stroke presenting with daytime sleepiness is not well reported. We report a 63-year- old Asian woman with hypertension presenting with sudden onset daytime sleepiness due to basal ganglia infarction. This case highlights the importance of considering BG infarction as a differential diagnosis for sudden onset daytime sleepiness.Item Prevalence of acute frozen shoulder with functional limitation following cardiac surgery: A descriptive study from Sri Lanka(Ceylon College of Physicians, 2023) Kurukulasuriya, S.A.F.; Mettananda, K.C.D.INTRODUCTION: A high incidence of frozen shoulder (FS), of up to 33% is reported in patients undergoing cardiac surgery, which is tenfold higher than in the normal population. Early diagnosis and treatment may prevent progression to chronic, treatmentresistant disease. However, data on the prevalence of acute FS following cardiac surgery in Sri Lanka is not known. The aim of this study was to identify the prevalence and associations of acute FS following coronary artery bypass graft with or without valve replacement in two cardiac surgical units in Sri Lanka. METHODS: We studied consecutive patients who underwent cardiac surgery from April 2022 to November 2022. Patients were recruited to the study before discharge from the hospital and were reviewed at 2 and 12 weeks following surgery. Acute FS was diagnosed in the presence of pain and limitation in lateral rotation, abduction, and medial rotation. Data on demographics and risk factors were collected using an interviewer-administered questionnaire. RESULTS: We studied 142 patients, 110 (77%) males, mean age of 60.3 SD years (range 28-78 years), 142 had coronary artery bypass grafting (CABG) and 3 of them additionally had valve replacement. Of them, 55 (38.7%) developed FS at 12 weeks post-surgery. Prevalence of FS was highest among the 50-60-year age group, 25 (45%). Development of post-surgical acute FS was more in patients with ischaemic heart disease (OR 5.5, p <0.01), hyperlipidaemia (OR 15.1, p<0.01), and who did not have regular post-op physiotherapy (6.1 p<0.01). CONCLUSION: More than one-third of patients undergoing cardiac surgery developed acute FS at 12 weeks. Patients with ischaemic heart disease, and hyperlipidaemia, and who did not engage in regular post-op physiotherapy were at high risk of developing acute FS.Item Adherence to good pharmacy practices of community pharmacies in the Gampaha District, Sri Lanka(Sri Lanka Medical Association, 2023) Basnayaka, B.M.T.D.D.; Ashara, S.F.; Ashik, K.J.M.; Bandara, B.M.M.P.; Bandara, H.M.A.C.; Basnayake, B.M.M.S.M.; Mettananda, K.C.D.INTRODUCTION: The guidelines for good pharmacy practices (GPP) were introduced in 2019 in Sri Lanka but their adherence is not studied. We studied the adherence to GPP of community pharmacies in the Gampaha district of Sri Lanka. OBJECTIVES: To determine the adherence to good pharmacy practices (GPP) of community pharmacies in the Gampaha district, Sri Lanka. METHODS: We did a descriptive cross-sectional study of all community pharmacies in the Gampaha district from 18th January to 8th February 2023. Data were collected using a self-administered online questionnaire developed using the guideline of GPP-2019 issued by the National Medicine Regulatory Authority (NMRA). The questionnaire comprised of 50-questions covering five broad areas of GPP; characteristics of the pharmacists, services and facilities provided, medicine storage, data management, and dispensing/distribution of medicines. Each question was given a mark and the final score was converted to a percentage. RESULTS: We received responses from 194 pharmacies. The mean adherence score was 68.8 (SD 12.8, range 24-97) %. 53.1% of the pharmacies had a score of more than 70% and 79.4% of pharmacies were aware of the GPP guideline by NMRA. 75% of pharmacies had a licensed pharmacist constantly. 92.3% of pharmacies were equipped with air conditioners, and 96.9% were equipped with a refrigerator. However, only 34% of pharmacies had a facade, “pharmacy” written in all three languages (Sinhala, Tamil, English) and 23.71% of pharmacies dispensed antibiotics without a prescription. CONCLUSIONS: Only half of the community pharmacies in the Gampaha district were adherent to GPP.Item Identification of type 2 diabetes patients with non-alcoholic fatty liver disease who are at increased risk of significant hepatic fibrosis: a cross-sectional study(Sri Lanka Medical Association, 2023) Mettananda, K.C.D.; Egodage, T.; Dantanarayana, C.; Solangarachchi, M.B.; Fernando, R.; Ranaweera, L.; Siriwardhena, S.; Ranawaka, C.K.; Kottahachchi, D.; Pathmeswaran, A.; Dassanayake, A.S.; de Silva, H.J.INTRODUCTION: Annual screening of patients with diabetes for fatty liver, and identifying those with significant hepatic fibrosis using the FIB-4 score and vibration-controlled transient elastography (VCTE) has been recommended to detect patients who may progress to advanced hepatic fibrosis/cirrhosis. However, VCTE is not freely available in resource-limited settings. OBJECTIVES: To identify clinical and biochemical predictors of significant liver fibrosis in diabetics with fatty liver. METHODS: We conducted a cross-sectional study among all consenting adults with T2DM and non-alcoholic fatty liver disease (NAFLD) attending the Colombo North Teaching Hospital, Ragama, Sri Lanka from November 2021 to November 2022. FIB-4 scores were calculated and patients with a score ≥1.3 underwent VCTE. Risk associations for liver fibrosis were identified by comparing patients with significant fibrosis (LSM ≥8 kPa) with those without significant fibrosis (FIB-4<1.3). RESULTS: A total of 363 persons were investigated. Of these, 243 had a score of FIB-4 <1.3. Of the 120 with a FIB-4 ≥1.3, 76 had LSM ≥8 kPa. Significant fibrosis was individually associated with age (OR 1.01, p<0.0001), duration of diabetes (OR 1.02, p=0.006), family history of liver disease (OR 1.42, p=0.035), waist (OR 1.04, p=0.035), and FIB-4 (OR 2.08, p<0.0001). However, on adjusted analysis, significant fibrosis was only associated with a family history of liver disease (OR 2.69, p=0.044) and FIB-4 (OR 1.43, p<0.001). CONCLUSION: In patients with T2DM and fatty liver, advancing age, increased duration of diabetes, a family history of liver disease, waist circumference and a high FIB-4 score increase the risk of significant hepatic fibrosis. Targeted interventions in this group may help prevent progression to advanced hepatic fibrosis/cirrhosis.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 Standards of care of management of diabetes among rural cohort in Sri Lanka - a descriptive study(Sri Lanka College of Internal Medicine, 2021) Chathuranga, P.A.D.U.; Meegodawidanage, N.; Rathnayaka, T.M.; Luke, W.A.N.V.; Mettananda, K.C.D.Introduction: Type 2 Diabetes mellitus (T2DM) is a challenge to health care leading to increase in morbidity and mortality. Objective: We conducted a descriptive study in rural Sri Lanka to assess the standards of care and disease control among patients with diabetes to identify areas for improvement. Methods: A retrospective follow-up study was conducted in five hospitals in Anuradhapura district. All type 2 diabetic patients, diagnosed and started on oral hypoglycemic drugs 24 months prior to recruitment, who attended the above clinics during the study period were enrolled to the study. Data on demographics, medications and blood sugar control were collected using an interviewer-administered questionnaire and perusing medical records. Drug compliance was studied using a self-administered questionnaire. Results: Control of Diabetes and other cardiovascular risk factors 2 years following initiation of oral hypoglycaemic drugs in 421 patients (19.2% male, mean age 58.3±10.4 years) were studied. Even after 2 years of medications, 48.2% were overweight, 34.0% obese and 53.9% were physically inactive. Prevalence of medication use among them were, metformin 96.7%, statins 64.1 % and anti-hypertensives 49.4%. Their mean Fasting Blood Sugar(FBS) was 139±54.3 mg/dl and Body Mass Index(BMI) was 26.5±4.5kgm-2. Poor compliance to medication was found in 60.3%. Sub-optimal risk factor control, FBS >130mg/dl, blood pressure >130/80mmHg, and LDL >100mg/dl were seen in 45.1.%, 19.94% and 16.1%, respectively. Conclusion: Even though majority were started on necessary medicines, FBS control was poor in this rural population. The reasons behind poor FBS control need to be studied and addressed to improve care of patients with diabetes in rural Sri Lanka.Item Prevalence and correlates of carotid artery stenosis in a cohort of Sri Lankan ischaemic stroke patients(BioMed Central, 2021) Mettananda, K.C.D.; Eshani, M.D.P.; Wettasinghe, L.M.; Somaratne, S.; Nanayakkkara, Y.P.; Sathkorala, W.; Upasena, A.; Sirigampola, C.; Tilakaratna, P.M.Y.; Pathmeswaran, A.; Ranawaka, U.K.Background: Large artery atherosclerotic disease is an important cause of stroke, accounting for 15–46% of ischaemic strokes in population-based studies. Therefore, current guidelines from west recommend urgent carotid imaging in all ischaemic strokes or transient ischaemic attacks and referral for carotid endarterectomy. However, the clinical features and epidemiology of stroke in Asians are diferent from those in Caucasians and therefore the applicability of these recommendations to Asians is controversial. Data on the prevalence of carotid artery stenosis (CAS) among South Asian stroke patients is limited. Therefore, we sought to determine the prevalence and associated factors of signifcant CAS in a cohort of Sri Lankan patients with ischaemic stroke. Methods: We prospectively studied all ischaemic stroke patients who underwent carotid doppler ultrasonography admitted to the stroke unit of a Sri Lankan tertiary care hospital over 5 years. We defned carotid stenosis as low (<50%), moderate (50–69%) or severe (70–99%) or total-occlusion (100%) by North American Symptomatic Trial Collaborators (NASCET) criteria. We identifed the factors associated with CAS≥50% and≥70% by stepwise multiple logistic regression analysis. Results: A total of 550 ischaemic stroke patients (326 (59.3%) male, mean age was 58.9±10.2 years) had carotid doppler ultrasonography. Of them, 528 (96.0%) had low-grade, 12 (2.2%) moderate and 7 (1.3%) severe stenosis and 3 (0.5%) had total occlusion. On multivariate logistic regression, age was associated with CAS≥50% (OR 1.12, p=0.001) and CAS≥70% (OR 1.14, p=0.016), but none of the other vascular risk factors studied (sex, hypertension, diabetes mellitus, smoking, past history of TIA, stroke or ischemic heart disease) showed signifcant associations. Conclusions: Carotid stenosis is a minor cause of ischemic stroke in Sri Lankans compared to western populations with only 4.0% having CAS≥50 and 3.5% eligible for carotid endarterectomy. Our fndings have implications for the management of acute strokes in Sri Lanka.Item Antiplatelet therapy for transient ischaemic attacks and acute minor strokes: current best practice and future(Ceylon College of Physicians, 2021) Mettananda, K.C.D.ABSTRACT: In patients presenting with transient ischaemic attacks and acute minor noncardioembolic ischemic strokes (NIHSS score ≤3) who did not receive intravenous alteplase, treatment with dual antiplatelet therapy with aspirin and clopidogrel, started within 24 hours of symptom onset and continued for 21 days is effective in reducing a recurrent ischemic stroke up to 90 days from the symptom onset. However, as the long-term risk of major disabling bleeding with aspirin-based antiplatelet treatment is higher in patients aged 75 years or older, routine co-prescription of proton pump inhibitor should be encouraged. KEYWORDS: Antiplatelet, Stroke, Transient-ischaemicattack, Prevention, Dual-antiplateletItem 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(Public Library of Science, 2021) Thulani, U.B.; Mettananda, K.C.D.; Warnakulasuriya, D.T.D.; Peiris, T.S.G.; Kasturiratne, K.T.A.A.; Ranawaka, U.K.; Chakrewarthy, S.; Dassanayake, A.S.; Kurukulasooriya, S.A.F.; Niriella, M.A.; de Silva, S.T.; Pathmeswaran, A.; Kato, N.; de Silva, H.J.; Wickremasinghe, A.R.INTRODUCTION AND OBJECTIVES: There are no cardiovascular (CV) risk prediction models for Sri Lankans. Different risk prediction models not validated for 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 40-64 year-old participants from the Ragama Medical Officer of Health (MOH) area in 2007 by stratified random sampling and followed them up for 10 years. Ten-year risk predictions of a fatal/non-fatal cardiovascular event (CVE) in 2007 were calculated using WHO/ISH (SEAR-B) charts with and without cholesterol. The CVEs that occurred from 2007-2017 were ascertained. Risk predictions in 2007 were validated against observed CVEs in 2017. RESULTS: Of 2517 participants, the mean age was 53.7 year (SD: 6.7) and 1132 (45%) were males. Using WHO/ISH chart with cholesterol, the percentages of subjects with a 10-year CV risk <10%, 10-19%, 20%-29%, 30-39%, ≥40% were 80.7%, 9.9%, 3.8%, 2.5% and 3.1%, respectively. 142 non-fatal and 73 fatal CVEs were observed during follow-up. Among the cohort, 9.4% were predicted of having a CV risk ≥20% and 8.6% CVEs were observed in the risk category. CVEs were within the predictions of WHO/ISH charts with and without cholesterol in both high (≥20%) and low(<20%) risk males, but only in low(<20%) risk females. The predictions of WHO/ISH charts, with-and without-cholesterol were in agreement in 81% of subjects (ĸ = 0.429; p<0.001). CONCLUSIONS: WHO/ISH (SEAR B) risk prediction charts with-and without-cholesterol may be used in Sri Lanka. Risk charts are more predictive in males than in females and for lower-risk categories. The predictions when stratifying into 2 categories, low risk (<20%) and high risk (≥20%), are more appropriate in clinical practice.
- «
- 1 (current)
- 2
- 3
- »