Browsing by Author "Gunatilake, S."

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Atlanto-axial subluxation:importance of early recognition
(The Kandy Society of Medicine, 1996) Gunatilake, S.; Seneviratne, S.L.; Premawardhena, A.P.; de Silva, H.J.
We report three cases which illustrate the importance of the early recognition of atlanto-axial subluxation by being aware of the disorders it is often associated with.
The Course of epilepsy
(1996) Gunatilake, S.
Drinking well water and occupational exposure to Herbicides is associated with chronic kidney disease, in Padavi-Sripura, Sri Lanka
(Environmental Health Journal, 2015) Jayasumana, C.; Paranagama, P.A.; Agampodi, S.; Wijewardane, C.; Gunatilake, S.; Siribaddana, S
Background The chronic kidney disease of unknown etiology (CKDu) among paddy farmers in was first reported in 1994 and has now become most important public health issue in dry zone of Sri Lanka. The objective was to identify risk factors associated with the epidemic in an area with high prevalence. Methods A case control study was carried out in Padavi-Sripura hospital in Trincomalee district. CKDu patients were defined using health ministry criteria. All confirmed cases (N = 125) fulfilling the entry criteria were recruited to the study. Control selection (N = 180) was done from people visiting the hospital for CKDu screening. Socio-demographic and data related to usage of applying pesticides and fertilizers were studied. Drinking water was also analyzed using ICP-MS and ELISA to determine the levels of metals and glyphosate. Results Majority of patients were farmers (N = 107, 85.6%) and were educated up to ‘Ordinary Level’ (N = 92, 73.6%). We specifically analyzed for the effect modification of, farming by sex, which showed a significantly higher risk for male farmers with OR 4.69 (95% CI 1.06- 20.69) in comparison to their female counterparts. In the multivariable analysis the highest risk for CKDu was observed among participants who drank well water (OR 2.52, 95% CI 1.12-5.70) and had history of drinking water from an abandoned well (OR 5.43, 95% CI 2.88- 10.26) and spray glyphosate (OR 5.12, 95% CI 2.33-11.26) as a pesticide. Water analysis showed significantly higher amount of hardness, electrical conductivity and glyphosate levels in abandoned wells. In addition Ca, Mg, Ba, Sr, Fe, Ti, V and Sr were high in abandoned wells. Surface water from reservoirs in the endemic area also showed contamination with glyphosate but at a much lower level. Glyphosate was not seen in water samples in the Colombo district. Conclusion The current study strongly favors the hypothesis that CKDu epidemic among farmers in dry zone of Sri Lanka is associated with, history of drinking water from a well that was abandoned. In addition, it is associated with spraying glyphosate and other pesticides in paddy fields. Farmers do not use personnel protective equipments and wears scanty clothing due to heat when spraying pesticides.
Intracerebral haemorrhage - risk factors, subtypes and mortality
(Sri Lanka Medical Association, 1998) Gunatilake, S.; Premawardhena, A.
INTRODUCTION : No data are available regarding intracerebral haemorrhage among Sri Lankans. In a hospital based study in Colombo we identified 49 consecutive patients with intra cerebral haemorrhage and they were studied to determine the risk factors, site and size of haemorrhage, clinical severity and mortality. METHODS : Consecutive patients with intracerebral haemorrhage admitted to two private hospitals were included in the study. They were assessed prospectively during the hospital stay using a protocol. Diagnosis of intracerebral haemorrhage was made by CT scanning. Abstracts/SLMA Sessions 1998 RESULTS : Of the 49, 43 had intracerebral haemorrhage and 6 had subarachnoid haemorrhage. 31were males and 18 were females. Age ranged from 34 to 92 years. Distribution of the intra cerebral haemorrhage was as follows. Basal ganglia 30. lobar 5, massive supratentorial 04, celebellar 01, unknown 3. Of the basal ganglia haemorrhage 20 were putaminal, 8 were thalamic, 2 were caudate. 9 had in addition intra ventricular haemorrhage. 19(44%) patients were known hypertensives and 9 had diabetes mellitus. Of the patients with intracerebral haemorrhage, 06 were unconscious. 20 were drowsy and 17 were alert on admission. Of the subarachnoid haemorrhages 1 was unconsious and 5 were drowsy. In- hospital mortality for intracerebral haemorrhage was 30% and for sub-arachnoid haemorrhage was 83%. CONCLUSIONS : Intra cerebral haemorrhage is a important cause of morbidity and mortality in hospitalised patients. 30% mortality is low when compared to other countries. Hypertension is an important risk factor and measures should be taken to improve detection and treatment of hypertension.
Laughing seizures due to a midline intraventricular neoplasm in tuberous sclerosis
(British Medical Association, 1995) Gunatilake, S.; de Silva, D.G.H.
Laughing seizures have been described in association with hypothalamic hamartomas and precocious puberty. Laughing seizures due to a neoplasm arising from the floor of the left lateral ventricle extending down towards the hypothalamus in a child with tuberous sclerosis is reported. This combination has not been reported before and emphasises the importance of imaging to diagnose such midline lesions in children with paroxysmal laughing.
Neurological disorders associated with COVID-19 in Sri Lanka
(BioMed Central,, 2023) Chang, T.; Wijeyekoon, R.; Keshavaraj, A.; Ranawaka, U.; Senanayake, S.; Ratnayake, P.; Senanayake, B.; Caldera, M.C.; Pathirana, G.; Sirisena, D.; Wanigasinghe, J.; Gunatilake, S.; ASN COVID-19 Study Group
BACKGROUND: Neurological manifestations of SARS-CoV-2 infection have been reported from many countries around the world, including the South Asian region. This surveillance study aimed to describe the spectrum of neurological disorders associated with COVID-19 in Sri Lanka. METHODS: COVID-19 patients manifesting neurological disorders one week prior and up to six weeks after infection were recruited from all the neurology centres of the government hospitals in Sri Lanka from May 2021 – May 2022. Data was collected using a structured data form that was electronically transmitted to a central repository. All patients were evaluated and managed by a neurologist. Data were analysed using simple descriptive analysis to characterise demographic and disease related variables, and simple comparisons and logistic regression were performed to analyse outcomes and their associations. RESULTS: One hundred and eighty-four patients with neurological manifestations associated with COVID-19 were recruited from all nine provinces in Sri Lanka. Ischaemic stroke (31%) was the commonest neurological manifestation followed by encephalopathy (13.6%), Guillain–Barre syndrome (GBS) (9.2%) and encephalitis (7.6%). Ischaemic stroke, encephalitis and encephalopathy presented within 6 days of onset of COVID-19 symptoms, whereas GBS and myelitis presented up to 10 days post onset while epilepsy and Bell palsy presented up to 20 – 40 days post onset. Haemorrhagic stroke presented either just prior to or at onset, or 10 – 25 days post onset of COVID-19 symptomatic infection. An increased frequency of children presenting with encephalitis and encephalopathy was observed during the Omicron variant predominant period. A poor outcome (no recovery or death) was associated with supplemental oxygen requirement during admission (Odds Ratio: 12.94; p=0.046). CONCLUSIONS: The spectrum and frequencies of COVID-19 associated neurological disorders in Sri Lanka were similar to that reported from other countries, with strokes and encephalopathy being the commonest. Requiring supplemental oxygen during hospitalisation was associated with a poor outcome.
Phosphate fertilizer is a main source of arsenic in areas affected with chronic kidney disease of unknown etiology in Sri Lanka
(SpringerPlus, 2015) Jayasumana, C.; Fonseka, S.; Fernando, A.; Jayalath, K.; Amarasinghe, M.; Gunatilake, S.; Siribaddana, S.; Paranagama, P.A.
Chronic Kidney Disease of unknown etiology (CKDu) has escalated into an epidemic in North Central Province (NCP) and adjacent farming areas in the dry zone of Sri Lanka. Studies have shown that this special type of CKD is a toxic nephropathy and arsenic may play a causative role along with a number of other heavy metals. We investigated the hypothesis that chemical fertilizers and pesticide could be a source of arsenic. 226 samples of Fertilizers and 273 samples of pesticides were collected and analyzed using atomic absorption spectrometry and inductively coupled plasma mass spectrometry for arsenic and other heavy metals in two university laboratories. Almost all the agrochemicals available to the farmers in the study area are contaminated with arsenic. The highest amount was in triple super phosphate (TSP) with a mean value of 31 mg/kg. Also TSP is a rich source of other nephrotoxic metals including Cr, Co, Ni, Pb and V. Annually more than 0.1 million tons of TSP is imported to Sri Lanka containing approximately 2100 kg of arsenic. The next highest concentration was seen in the rock phosphate obtained from an open pit mine in NCP (8.56 mg/kg). Organic fertilizer contained very low amounts of arsenic. Arsenic contamination in pesticides varied from 0.18 mg/kg to 2.53 mg/kg although arsenic containing pesticides are banned in Sri Lanka. Glyphosate the most widely used pesticide in Sri Lanka contains average of 1.9 mg/kg arsenic. Findings suggest that agrochemicals especially phosphate fertilizers are a major source of inorganic arsenic in CKDu endemic areas. Organic fertilizer available in Sri Lanka is comparatively very low in arsenic and hence the farmers in CKDu endemic areas in Sri Lanka should be encouraged to minimize the use of imported chemical fertilizer and use organic fertilizers instead.
The Physician neurologist:what do they do?what should they do?and why don't they?
(Ceylon College of Physicians, 2002) Gunatilake, S.
No Abstract Available
Presence of arsenic in Sri Lankan rice
(Springer, 2015) Jayasumana, C.; Paranagama, P.A.; Fonseka, S.; Amarasinghe, M.; Gunatilake, S.; Siribaddana, S.
Background: Arsenic and heavy metals are implicated in causation of CKDu among farmers in dry zone of Sri Lanka. Rice has been identified as a major source of arsenic in research carried out in other countries. We analyzed 120 samples of new improved varieties (NIVs) and 50 samples of traditional varieties (TV) of rice for total arsenic content. Findings: Rice cultivated in Sri Lanka is contaminated with arsenic. Agrochemical dependent NIVs contain considerable amount (20.6 -540.4 μg/Kg) of arsenic. There is no difference between the arsenic content in NIV rice samples from areas where there is high or low prevalence of CKDu. TVs that are cultivated without using agrochemicals contain significantly less arsenic (11.6 - 64.2 μg/Kg). However, it is evident that the TVs also contain toxic metals if they are grown with fertilizers and pesticides. Conclusion: A high proportion of arsenic in rice exists in the inorganic form. Sri Lanka is a nation with high per capita consumption of rice. Codex Alimentarius recommends the maximum allowable limit for inorganic arsenic in rice as 200 μg/kg. Assuming that 70% of the total arsenic content exists in the inorganic form, this corresponds to a level of about 286 μg/kg of total arsenic. As such, 11.6% of the samples of NIVs exceeded this maximum recommended level in polished rice. Inorganic arsenic is a non-threshold carcinogen. Research should be focused on developing rice varieties that do not retain arsenic within the rice grain.
Stroke: Infarct or haemorrhage - Does it matter?
(The Kandy Society of Medicine, 1995) Gunatilake, S.
Strokes - family physician's perspective
(College of General Practitioners of Sri Lanka, 1993) Gunatilake, S.