Medicine
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This repository contains the published and unpublished research of the Faculty of Medicine by the staff members of the faculty
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Item Stroke in old age(Ceylon College of Physicians, 2024) Ranawaka, U.Strokes are more common in old age, and with an increasingly ageing population, Sri Lanka is likely to witness a dramatic increase in older patients with stroke. Strokes are different, are more severe and lead to more deaths and disability in old age, requiring different approaches to management. However, decision making on treatment and prevention of stroke in old age is hampered by a lack of robust evidence, as clinical trial data on stroke in old age is limited. Available data suggest that effective treatment and prevention options are underutilized due to a sense of therapeutic nihilism and concerns over safety of medications. More research is clearly needed to define the optimal treatment and preventive strategies.Item 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.Item Audit of stroke care in a Sri Lankan stroke unit(Asia Pacific Stroke Organization, Hong Kong Stroke Society and Jiangsu Stroke Association & Karger publishing, 2017) Ranawaka, U.; Tissera, G.; Silva, S.; Nanayakkara, Y.; Goonetilleke, C.; Muwanwella, P.; Sooryabandara, V.; Hill, K.; Markus, R.BACKGROUND AND RATIONALE: Data on quality of stroke care is limited from Sri Lanka, and available data suggests poor quality of care. We sought to evaluate quality of care in a Sri Lankan tertiary care centre using internationally accepted criteria. METHODS: All patients admitted with acute stroke to the Stroke Unit of the Colombo North Teaching Hospital, Ragama over a 2-year period (January 2015-December 2016) were prospectively enrolled. Stroke care was evaluated with the Stroke Foundation, Australia Acute Stroke Audit Tool. RESULTS: 156 patients were studied {54.5% males; mean age (SD) 59 years (9.3); 83.3% ischaemic stroke}. 92.3% were living with spouse/ family. Private transport was the mode of arrival in 87.8%. CT scanning was done in 92.2%. None of the patients received thrombolysis. 39.7% were functionally independent (mRS 0–2) at 7–10 days. 71.6% were discharged on anti-hypertensive. Of those with ischemic stroke, 88.2% received anti-platelets and 95.5% statins. Swallowing screening was done in 92.5%, and for mal swallowing assessment by a speech therapist in 52.6%. Assessment by a physiotherapist was done in 96.7%, occupational therapist in 85.8%, mental health specialist in 96.8%, and communication assessment by a speech therapist in 76.6%. Multi-disciplinary team met with care-givers in 83.1%. Care-giver needs assessment was done in 96.1%, and 90.3% of care-givers received training in home care.52.6% were discharged home with rehabilitation support, and 32.1% were transferred for in-patient rehabilitation. All patients/care-givers received education before dis charge, 96.1% received a community care plan, and 93.5% were given a discharge summary. CONCLUSION: Quality of acute stroke care was satisfactory in almost all the domains studied. Care related to neuro-imaging, secondary preventive treatments, multi-disciplinary team assessment, provision of early rehabilitation services, patient education, care giver support and discharge planning was especially good. Stroke care of good quality is feasible even in resource-limited settings.Item Stroke awareness in patients with incident stroke compared to patients without stroke or ischemic heart disease(Demos Publications, 2020) Ranawaka, U.; Mettananda, C.; Thilakarathna, C.; Peiris, A.; Kasturiratne, A.; Tilakaratna, Y.BACKGROUND: Stroke awareness is known to influence treatment seeking and risk reduction behavior, but there is limited data from Sri Lanka and South Asia. AIM: To describe stroke awareness in incident stroke patients and to compare with patients without stroke and/or ischemic heart disease (IHD) in a Sri Lankan tertiary-care center. METHODS: We studied awareness of stroke in all incident stroke patients admitted to a tertiary-care center in Sri Lanka and compared with a group of age- and sex-matched patients without stroke and/or IHD, over 2 years. Knowledge on stroke mechanisms, risk factors, symptoms, prognosis, treatment, and prevention were evaluated using a 40-item interviewer-administered questionnaire and converted to a composite score of 100%. Total awareness was categorized as Very poor (<24%), Poor (25%-49%), Good (50%-74%), and Very good (>74%). RESULTS: One hundred and sixty four incident stroke patients (mean age 62.0 ± 11.5 years; 64.6% males) and 164 patients without stroke and/or IHD were studied. Mean stroke awareness was 47.79% ± 14.6 in stroke patients, and 47.73% ± 14.9 in the nonstroke and/or IHD patients (P = .95). Of the associations studied, better stroke awareness (>50%) was associated only with higher education levels (OR 1.90, 95%CI 1.33-2.72, P < .001) in stroke patients. CONCLUSIONS: Stroke awareness is not satisfactory in incident stroke patients and is no better than in patients without stroke and/or IHD. Better stroke awareness was associated with higher education levels. Keywords: Sri Lanka; Stroke; awareness; comparison; stroke-patients.Item 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.