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This repository contains the published and unpublished research of the Faculty of Medicine by the staff members of the faculty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
5 results
Search Results
Item Thrombolysis with tenecteplase in acute ischaemic stroke in a tertiary care setting in Sri Lanka: A retrospective study(Association of Sri Lankan Neurologists, 2024) Gooneratne, K.; Vithanage, L.; Talagala, I.; Lokunarangoda, N.C.; Gamage, N.; Muthumal, N.P.; Rodrigo, A.; Kosgahakumbura, J.; Liyanage, G.; Perera, A.; Ranawaka, U.K.INTRODUCTION Alteplase (ALT) is the standard thrombolytic treatment in acute ischaemic stroke (AIS). Tenecteplase (TNK) is proven to be effective in acute coronary syndrome, is relatively cheap, widely available and can easily be given as a single intravenous (IV) bolus. Despite evidence for its use, there is equivocal guidance for the use of TNK in AIS. On the background of a global reduction in stroke admissions, treatment interventions and prolonged treatment time metrics due to the COVID-19 pandemic, this study highlights the experience with TNK in a tertiary care setting in Sri Lanka, during the pandemic. OBJECTIVES To describe the outcomes at 48 hours among stroke patients who underwent thrombolysis with TNK at District General Hospital Hambantota, Sri Lanka over a period of one year. METHODS We retrospectively reviewed records of adults with AIS thrombolysed with 0.25 mg/kg TNK. The National Institutes of Health Stroke Scale (NIHSS) was assessed on admission and at 24-hours following treatment. Patients were observed for 48-hours for potential adverse events. RESULTS We thrombolysed 20 consecutive patients over one-year. The baseline mean NIHSS was 9.7 (standard deviation (SD)=4.4; range 4-22), and the 24h-post thrombolysis mean NIHSS was 6.0 (SD=7.3; range 0-28). Seventy percent (n=14) showed an improved NIHSS of at least 1-point after thrombolysis (mean difference=3.7; SD=6.46), and 55% (n=11) displayed a major clinical improvement (change in NIHSS ≥ 4). Ten percent (n=2) developed major adverse effects (one intra-cranial haemorrhage; one haemorrhagic transformation). There were no deaths. CONCLUSIONS TNK 0.25mg/kg for the treatment of AIS appeared efficacious and safe in our case series. The limitation in this study was the low number of patients who underwent thrombolysis during the study period, as a probable effect of the COVID-19 pandemic. Thrombolysis with TNK could be a cost-effective alternative to alteplase in resourcelimited South Asian settings.Item Contribution of Postural Balance and Quadriceps Muscle Strength as Intrinsic Risk Factors of Falls in Healthy Older Adults; A Cross-Sectional Study from the Colombo District.(Faculty of Medicine, University of Kelaniya, Sri Lanka, 2021) Perera, A.; Landege, O.; Kandege, I.Introduction: Falls are the main source of morbidity and disability in the elderly. Many falls in older adults are certainly multifactorial, resulting from the confluence of several intrinsic, environmental, behavioural, and activity-related factors. Objective: The study aimed to identify the contribution of postural balance and quadriceps muscle strength as intrinsic risk factors of falls in healthy older adults who resides in two elders’ homes in the Colombo district. Methods: A total of 60 elders who dwelt in Salina Alwis elders’ home and Sahana Udaya elders’ home were selected using a non-probability convenient sampling method. Healthy older adults aged 65 years or above who completed inclusion criteria participated in the study. Mini BESTest was used to assess postural balance. Left and right Quadriceps Muscle Strength (QMS) measurement was obtained by modified sphygmomanometer test. Falls history within the past 6 months was obtained through an interview administrated general assessment. Results: Mean age among elders was 76.67±6.23 years (56.7% female and 42.3% male). The mean values of average QMS and postural balance among the falls group were 116.00mmHg and 18.17 and among the non-falls group were 161.13mmHg and 22.57 respectively. Independent sample t-test showed the significant difference of means in average quadriceps muscle strength (p= 0.028) and postural balance (p= 0.031) among falls and non - fall a group respectively. Conclusion: Mean quadriceps muscle strength and postural balance in the falls group were lower than the non-falls group. Therefore, we can conclude that two intrinsic risk factors (postural balance and Quadriceps muscle strength) directly contribute to falls in healthy older adults.Item Methemoglobinemia and ascorbate deficiency in hemoglobin E β thalassemia: metabolic and clinical implications.(American Society of Hematology., 2012) Allen, A.; Fisher, C.; Premawardhena, A.; Bandara, D.; Perera, A.; Allen, S.; St Pierre, T.; Olivieri, N.; Weatherall, D.ABSTRACT: During investigations of the phenotypic diversity of hemoglobin (Hb) E β thalassemia, a patient was encountered with persistently high levels of methemoglobin associated with a left-shift in the oxygen dissociation curve, profound ascorbate deficiency, and clinical features of scurvy; these abnormalities were corrected by treatment with vitamin C. Studies of erythropoietin production before and after treatment suggested that, as in an ascorbate-deficient murine model, the human hypoxia induction factor pathway is not totally dependent on ascorbate levels. A follow-up study of 45 patients with HbE β thalassemia showed that methemoglobin levels were significantly increased and that there was also a significant reduction in plasma ascorbate levels. Haptoglobin levels were significantly reduced, and the high frequency of the 2.2 haptoglobin genotype may place an additional pressure on ascorbate as a free-radical scavenger in this population. There was, in addition, a highly significant correlation between methemoglobin levels, splenectomy, and factors that modify the degree of globin-chain imbalance. Because methemoglobin levels are modified by several mechanisms and may play a role in both adaptation to anemia and vascular damage, there is a strong case for its further study in other forms of thalassemia and sickle-cell anemia, particularly when splenic function is defective.Item Hepcidin is suppressed by erythropoiesis in hemoglobin E β-thalassemia and β-thalassemia trait(American Society of Hematology, 2015) Jones, E.; Pasricha, S.R.; Allen, A.; Evans, P.; Fisher, C.A.; Wray, K.; Premawardhena, A.; Bandara, D.; Perera, A.; Webster, C.; Sturges, P.; Olivieri, N.F.; St Pierre, T.; Armitage, A.E.; Porter, J.B.; Weatherall, D.J.; Drakesmith, H.Hemoglobin E (HbE) β-thalassemia is the most common severe thalassemia syndrome across Asia, and millions of people are carriers. Clinical heterogeneity in HbE β-thalassemia is incompletely explained by genotype, and the interaction of phenotypic variation with hepcidin is unknown. The effect of thalassemia carriage on hepcidin is also unknown, but it could be relevant for iron supplementation programs aimed at combating anemia. In 62 of 69 Sri Lankan patients with HbE β-thalassemia with moderate or severe phenotype, hepcidin was suppressed, and overallhepcidin inversely correlated with iron accumulation. On segregating by phenotype, there were no differences in hepcidin, erythropoiesis, orhemoglobin between severe or moderate disease, but multiple linear regression showed that erythropoiesis inversely correlated with hepcidin only in severe phenotypes. In moderate disease, no independent predictors of hepcidin were identifiable; nevertheless, the low hepcidin levels indicate a significant risk for iron overload. In a population survey of Sri Lankan schoolchildren, β-thalassemia (but not HbE) trait was associated with increased erythropoiesis and mildly suppressed hepcidin, suggesting an enhanced propensity to accumulate iron. In summary, the influence oferythropoiesis on hepcidin suppression associates with phenotypic disease variation and pathogenesis in HbE β-thalassemia and indicates that the epidemiology of β-thalassemia trait requires consideration when planning public health iron interventions.Item Dietaryadviceongdmmothers-an audit(Sri Lanka College of Obstetricians and Gynaecologists, 2006) Jayasundar, C.; Ellepola, U.K.; Herath, H.M.R.P.; Perera, A.; Wijesundere, A.BACKGROUND: Gestational Diabetes Mellitus (GDM) is considered a global problem and in Sri Lanka. It is emerging as a common complication in pregnancy. Hence, an audit was undertaken to evaluate dietary advice given to GDM mothers as it is the primary modality of treatment. OBJECTIVE: To ascertain the standard of dietary advice given to GDM mothers attending a tertiary care ,. ater.STUDY TYPE: Retrospective study. STUDY SETTING: Tertiary care center. STUDY SAMPLE: 49 consecutive GDM mothers, who was diagnosed in the ANC and ward. METHOD: Study was carried out from 1st of June to 1st of August 2006. A questionnaire was developed to evaluate the standard of the dietary advice in accordance with the unit policy. RESULTS: Out of the population 39% were in the age group of 21-30 and 61% in the 31-40 age category. Out of the total sample 96% of mothers received advice on a diabetic diet but out of which, only 4% had been supplemented with written format. The SHO, registrar, and senior registrar contributed dietary advice to 37% of the mothers while nursing officers have advised to 22%. The intern medical officers have advised 19% of mothers, while public health rnidwives, MOH have accounted for advising 15% and 5% respectively. The dietician advised only 2% of the mothers. Out of the mothers who were interviewed following the dietary advice, 69% understood the advice satisfactorily. Furthermore 24% stated that they understood the advice partially and 7 % reported poor understanding. In addition 16% of the mothers had requested repeated dietary advice. Finally, 56% reported satisfaction with the overall dietary management of the above medical complication. CONCLUSIONS AND RECOMMENDATIONS: The dietary advice given in our study population is unsatisfactory, considering the fact that the diet control is the primary modality of treatment in GDM. We recommend that advising on diet is a joint responsibility of medical officers, nursing officers, midwives and dieticians. Such advice should be solid and tailored to follow the Sri Lankan dietary habits and expectations. In addition the explanations should be done in a simple manner with use of a dietary advice leaflet according to a common protocol and each hospital should have a specialized supplemented with written format. The SHO, registrar, and senior registrar contributed dietary advice to 37% of the mothers while nursing officers have advised to 22%. The intern medical officers have advised 19% of mothers, while public health rnidwives, MOH have accounted for advising 15% and 5% respectively. The dietician advised only 2% of the mothers. Out of the mothers who were interviewed following the dietary advice, 69% understood the advice satisfactorily. Furthermore 24% stated that they understood the advice partially and 7 % reported poor understanding. In addition 16% of the mothers had requested repeated dietary advice. Finally, 56% reported satisfaction with the overall dietary management of the above medical complication. CONCLUSIONS AND RECOMMENDATIONS: The dietary advice given in our study population is unsatisfactory, considering the fact that the diet control is the primary modality of treatment in GDM. We recommend that advising on diet is a joint responsibility of medical officers, nursing officers, midwives and dieticians. Such advice should be solid and tailored to follow the Sri Lankan dietary habits and expectations. In addition the explanations should be done in a simple manner with use of a dietary advice leaflet according to a common protocol and each hospital should have a specialized dietician.