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Mettananda KCD, Eshani MDP, Wettasinghe LM, Somaratne S, Nanayakkkara YP, Sathkorala W, Upasena A, Sirigampola C, Tilakaratna PMY, Pathmeswaran A, Ranawaka UK. Prevalence and correlates of carotid artery stenosis in a cohort of Sri Lankan ischaemic stroke patients. BMC Neurol 2021; 21:385. [PMID: 34607563 PMCID: PMC8489097 DOI: 10.1186/s12883-021-02415-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Accepted: 09/21/2021] [Indexed: 01/04/2023] Open
Abstract
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 different 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 significant 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 defined 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 identified 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 significant 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 findings have implications for the management of acute strokes in Sri Lanka.
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Affiliation(s)
- K C D Mettananda
- Department of Pharmacology, Faculty of Medicine, University of Kelaniya, Talagolla Road, Ragama, Sri Lanka. .,Stroke Unit, Colombo North Teaching Hospital, Ragama, Sri Lanka.
| | - M D P Eshani
- Department of Pharmacology, Faculty of Medicine, University of Kelaniya, Talagolla Road, Ragama, Sri Lanka.,Department of Medicine, Faculty of Medicine, University of Kelaniya, Ragama, Sri Lanka
| | - L M Wettasinghe
- Department of Pharmacology, Faculty of Medicine, University of Kelaniya, Talagolla Road, Ragama, Sri Lanka.,Department of Medicine, Faculty of Medicine, University of Kelaniya, Ragama, Sri Lanka
| | - S Somaratne
- Stroke Unit, Colombo North Teaching Hospital, Ragama, Sri Lanka
| | | | - W Sathkorala
- Radiology Unit, North Colombo Teaching Hospital, Ragama, Sri Lanka
| | - A Upasena
- Radiology Unit, North Colombo Teaching Hospital, Ragama, Sri Lanka
| | - C Sirigampola
- Stroke Unit, Colombo North Teaching Hospital, Ragama, Sri Lanka
| | - P M Y Tilakaratna
- Department of Medicine, Faculty of Medicine, University of Kelaniya, Ragama, Sri Lanka.,University Medical Unit, North Colombo Teaching Hospital, Ragama, Sri Lanka
| | - A Pathmeswaran
- Department of Public Health, Faculty of Medicine, University of Kelaniya, Ragama, Sri Lanka
| | - U K Ranawaka
- Stroke Unit, Colombo North Teaching Hospital, Ragama, Sri Lanka.,Department of Medicine, Faculty of Medicine, University of Kelaniya, Ragama, Sri Lanka.,University Medical Unit, North Colombo Teaching Hospital, Ragama, Sri Lanka
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Thulani UB, Mettananda KCD, Warnakulasuriya DTD, Peiris TSG, Kasturiratne KTAA, Ranawaka UK, Chakrewarthy S, Dassanayake AS, Kurukulasooriya SAF, Niriella MA, de Silva ST, Pathmeswaran AP, Kato N, de Silva HJ, Wickremasinghe AR. 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. PLoS One 2021; 16:e0252267. [PMID: 34097699 PMCID: PMC8183983 DOI: 10.1371/journal.pone.0252267] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Accepted: 05/13/2021] [Indexed: 11/19/2022] Open
Abstract
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.
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Affiliation(s)
- U. B. Thulani
- Department of Public Health, Faculty of Medicine, University of Kelaniya, Ragama, Sri Lanka
| | - K. C. D. Mettananda
- Department of Pharmacology, Faculty of Medicine, University of Kelaniya, Ragama, Sri Lanka
- * E-mail:
| | | | - T. S. G. Peiris
- Department of Mathematics, Faculty of Engineering, University of Moratuwa, Moratuwa, Sri Lanka
| | | | - U. K. Ranawaka
- Department of Medicine, Faculty of Medicine, University of Kelaniya, Ragama, Sri Lanka
| | - S. Chakrewarthy
- Department of Biochemistry, Faculty of Medicine, University of Kelaniya, Ragama, Sri Lanka
| | - A. S. Dassanayake
- Department of Pharmacology, Faculty of Medicine, University of Kelaniya, Ragama, Sri Lanka
| | | | - M. A. Niriella
- Department of Medicine, Faculty of Medicine, University of Kelaniya, Ragama, Sri Lanka
| | - S. T. de Silva
- Department of Medicine, Faculty of Medicine, University of Kelaniya, Ragama, Sri Lanka
| | - A. P. Pathmeswaran
- Department of Public Health, Faculty of Medicine, University of Kelaniya, Ragama, Sri Lanka
| | - N. Kato
- National Center for Global Health and Medicine, Toyama, Shinjuku-ku, Tokyo, Japan
| | - H. J. de Silva
- Department of Medicine, Faculty of Medicine, University of Kelaniya, Ragama, Sri Lanka
| | - A. R. Wickremasinghe
- Department of Public Health, Faculty of Medicine, University of Kelaniya, Ragama, Sri Lanka
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Amarasena HLP, Silva FHDS, Tilakaratna PMYI, Jayamanne SF, Ranawaka UK. Melioidosis with a subdural collection - a case report. BMC Infect Dis 2019; 19:143. [PMID: 30755178 PMCID: PMC6373098 DOI: 10.1186/s12879-019-3782-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2018] [Accepted: 02/06/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Melioidosis is an infection caused by Burkholderia pseudomallei, which is more prevalent in the tropics and leads to significant morbidity and mortality. It characteristically produces widespread caseous lesions and abscesses, and can present with varied clinical manifestations. Melioidosis involving the central nervous system is uncommon. CASE PRESENTATION A 42-year-old Sri Lankan male with type 2 diabetes presented with a febrile illness of 6 days with headache and constitutional symptoms. Clinical examination was unremarkable. Four days later, he developed focal seizures involving the left leg and numbness of the left side. Initial laboratory investigations were suggestive of a bacterial infection. Blood culture was reported as positive for a Pseudomonas species, which was resistant to gentamicin. Contrast enhanced CT and MRI scans of the brain showed a subdural collection in the right fronto-temporo-parietal region with possible abscess formation. Melioidosis antibody testing using indirect hemagglutination method was reactive with a titre more than 1/10,240. He was treated with intravenous meropenem and oral co-trimoxazole for 8 weeks (Intensive phase). The subdural collection was managed conservatively, and seizures were treated with oral antiepileptics. At 7 weeks, follow-up contrast enhanced MRI showed improvement of the subdural collection, and inflammatory markers had normalized. He was discharged after 8 weeks, and treated with oral co-trimoxazole and doxycycline for 6 months (eradication phase). At 6 months follow-up, the patient is asymptomatic. CONCLUSIONS Cerebral melioidosis is an unusual presentation of melioidosis where the diagnosis can be easily missed. Knowledge of the protean manifestations of melioidosis is of paramount importance in order to detect and treat this potentially fatal infection appropriately, especially in tropical countries where the disease is endemic.
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Affiliation(s)
- H L P Amarasena
- Professorial Medical Unit, Colombo North Teaching Hospital, Ragama, Sri Lanka
| | - F H D S Silva
- Professorial Medical Unit, Colombo North Teaching Hospital, Ragama, Sri Lanka
| | - P M Y I Tilakaratna
- Department of Medicine, Faculty of Medicine, University of Kelaniya, Kelaniya, Sri Lanka
| | - S F Jayamanne
- Department of Medicine, Faculty of Medicine, University of Kelaniya, Kelaniya, Sri Lanka
| | - U K Ranawaka
- Department of Medicine, Faculty of Medicine, University of Kelaniya, Kelaniya, Sri Lanka.
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Hankey GJ, Ford AH, Yi Q, Eikelboom JW, Lees KR, Chen C, Xavier D, Navarro JC, Ranawaka UK, Uddin W, Ricci S, Gommans J, Schmidt R, Almeida OP, van Bockxmeer FM. Effect of B Vitamins and Lowering Homocysteine on Cognitive Impairment in Patients With Previous Stroke or Transient Ischemic Attack: A Prespecified Secondary Analysis of a Randomized, Placebo-Controlled Trial and Meta-Analysis. Stroke 2013; 44:2232-9. [DOI: 10.1161/strokeaha.113.001886] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Pinidiyapathirage MJ, Kasturiratne A, Ranawaka UK, Gunasekara D, Wijekoon N, Medagoda K, Perera S, Takeuchi F, Kato N, Warnakulasuriya T, Wickremasinghe AR. The burden of diabetes mellitus and impaired fasting glucose in an urban population of Sri Lanka. Diabet Med 2013; 30:326-32. [PMID: 22998091 PMCID: PMC3593011 DOI: 10.1111/dme.12013] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/16/2012] [Indexed: 11/29/2022]
Abstract
AIMS To describe the burden of diabetes mellitus and impaired fasting glucose in middle-aged residents (35-64 years) in an urban area of Sri Lanka. METHODS A cross-sectional survey was conducted in the Ragama Medical Officer of Health area, from which 2986 participants (1349 men and 1637 women) were randomly selected from the electoral registry between January and December 2007. The participants underwent a physical examination and had their height, weight, waist and hip circumferences and blood pressure measured by trained personnel. Fasting blood samples were taken for measurement of glucose, HbA(1c) and lipids. The prevalence of diabetes (fasting plasma glucose > 7 mmol/l) and impaired fasting glycaemia (fasting plasma glucose 5.6-6.9 mmol/l) and major predictors of diabetes in Sri Lanka were estimated from the population-based data. RESULTS Age-adjusted prevalence of diabetes mellitus in this urban population was 20.3% in men and 19.8% in women. Through the present screening, 263 patients with diabetes and 1262 with impaired fasting glucose levels were identified. The prevalence of newly detected diabetes was 35.7% of all patients with diabetes. Among patients with diabetes, only 23.8% were optimally controlled. In the regression models, high BMI, high waist circumference, high blood pressure and hypercholesterolaemia increased the fasting plasma glucose concentration, independent of age, sex and a family history of diabetes. CONCLUSIONS Our data demonstrate the heavy burden of diabetes in this urban population. Short- and long-term control strategies are required, not only for optimal therapy among those affected, but also for nationwide primary prevention of diabetes.
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Chackrewarthy S, Gunasekera D, Pathmeswaren A, Wijekoon CN, Ranawaka UK, Kato N, Takeuchi F, Wickremasinghe AR. A Comparison between Revised NCEP ATP III and IDF Definitions in Diagnosing Metabolic Syndrome in an Urban Sri Lankan Population: The Ragama Health Study. ISRN Endocrinol 2013; 2013:320176. [PMID: 23533799 PMCID: PMC3600172 DOI: 10.1155/2013/320176] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/27/2012] [Accepted: 01/29/2013] [Indexed: 12/18/2022]
Abstract
Background. The prevalence of metabolic syndrome (MetS) within individual cohorts varies with the definition used. The aim of this study was to compare the prevalence of MetS between IDF and revised NCEP ATP III criteria in an urban Sri Lankan population and to investigate the characteristics of discrepant cases. Methods. 2985 individuals, aged 35-65 years, were recruited to the study. Anthropometric and blood pressure measurements and laboratory investigations were carried out following standard protocols. Results. Age and sex-adjusted prevalences of MetS were 46.1% and 38.9% by revised NCEP and IDF definitions, respectively. IDF criteria failed to identify 21% of men and 7% of women identified by the revised NCEP criteria. The discrepant group had more adverse metabolic profiles despite having a lower waist circumference than those diagnosed by both criteria. Conclusion. MetS is common in this urban Sri Lankan cohort regardless of the definition used. The revised NCEP definition was more appropriate in identifying the metabolically abnormal but nonobese individuals, especially among the males predisposed to type 2 diabetes or cardiovascular disease. Further research is needed to determine the suitability of the currently accepted Asian-specific cut-offs for waist circumference in Sri Lankan adults.
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Affiliation(s)
- S. Chackrewarthy
- Faculty of Medicine, University of Kelaniya, 11010 Ragama, Sri Lanka
| | - D. Gunasekera
- Faculty of Medicine, University of Kelaniya, 11010 Ragama, Sri Lanka
| | - A. Pathmeswaren
- Faculty of Medicine, University of Kelaniya, 11010 Ragama, Sri Lanka
| | - C. N. Wijekoon
- Faculty of Medicine, University of Kelaniya, 11010 Ragama, Sri Lanka
| | - U. K. Ranawaka
- Faculty of Medicine, University of Kelaniya, 11010 Ragama, Sri Lanka
| | - N. Kato
- Department of Gene Diagnostics and Therapeutics, Research Institute, National Center for Global Health and Medicine, 1-21-1 Toyama, Shinjuku-ku, Tokoyo 162-8655, Japan
| | - F. Takeuchi
- Department of Gene Diagnostics and Therapeutics, Research Institute, National Center for Global Health and Medicine, 1-21-1 Toyama, Shinjuku-ku, Tokoyo 162-8655, Japan
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Bell DJ, Wijegunasinghe D, Samarakoon S, Palipana H, Gunasekera S, de Silva HA, Lalloo DG, Ranawaka UK, de Silva HJ. Neurophysiological findings in patients 1 year after snake bite induced neurotoxicity in Sri Lanka. Trans R Soc Trop Med Hyg 2010; 104:351-6. [PMID: 20096908 DOI: 10.1016/j.trstmh.2009.12.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2009] [Revised: 12/10/2009] [Accepted: 12/10/2009] [Indexed: 10/19/2022] Open
Abstract
Snake bite causes significant morbidity and mortality in Sri Lanka. Snake venoms contain neurotoxins that block neuromuscular junction transmission. Presynaptic neurotoxicity most commonly causes destruction of nerve terminals with recovery by regrowth, whilst postsynaptic neurotoxicity usually involves competition at the acetylcholine receptor. The aim of this study was to investigate whether there were long-term clinical or neurophysiological changes in snake bite survivors 1 year after their envenoming. Detailed neurophysiological tests and clinical examinations were performed on 26 snake bite victims who had presented with neurotoxicity 12 months previously, and their results were compared with controls recruited from the same communities. Significant differences were observed in some nerve conduction parameters in some snake bite victims compared with controls, predominantly in those thought to have elapid bites, including prolongation of sensory, motor and F-wave latencies and reduction of conduction velocities. There was no evidence of any residual deficits in neuromuscular junction transmission. These results suggest a possible demyelinating type polyneuropathy. None of the cases or controls had abnormalities on clinical examination. This is one of the few studies to report possible long-term neurological damage following systemic neurotoxicity after snake bite. The clinical significance of these neurophysiological abnormalities is uncertain and further studies are required to investigate whether the abnormalities persist and to see whether clinical consequences develop.
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Affiliation(s)
- D J Bell
- Tropical and Infectious Diseases Unit, Royal Liverpool University Hospital, Liverpool L7 8XP, UK.
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Affiliation(s)
- A A Chang
- Neurologist Institute of Neurology, National Hospital of Sri Lanka.
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Ranawaka UK, Chang AA, Wijesekera JC. Young patients with movement disorders. Ceylon Med J 2004; 48:142-3. [PMID: 15125408 DOI: 10.4038/cmj.v48i4.3334] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- U K Ranawaka
- Institute of Neurology, National Hospital of Sri Lanka, Colombo.
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Ranawaka UK, Fernando MAH, Gunasekera TGSM, Senanayake BSN, Gunawardena DRR, Wijesekera JC, Fernando DJS. Audit of stroke care at the Institute of Neurology, National Hospital of Sri Lanka, 1994-1997. Ceylon Med J 2002; 47:86-8. [PMID: 12449773 DOI: 10.4038/cmj.v47i3.3435] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE To audit the process of stroke care. DESIGN Retrospective case record evaluation using an audit package designed by the Royal College of Physicians of London. SETTING Institute of Neurology, National Hospital of Sri Lanka, Colombo. PATIENTS 263 patients with stroke admitted over a period of 3 years. MEASUREMENTS Documentation of 60 audit items related to 13 aspects of stroke care. RESULTS The process of care was considered 'very good' for only 11 (18.3%), and 'good' for only 9 (15%) of the audit items. Care was 'average' for 5 (8.3%), 'poor' for 9 (15%) and 'very poor' for 26 (43.3%) of the items. CONCLUSIONS Stroke care was suboptimal in many aspects. Care related to rehabilitation oriented neurological assessments, initiation of secondary preventive measures, rehabilitation planning and discharge planning were especially deficient. Competing interests: none declared. Some of the data reported in this paper have been presented at the Annual Scientific Sessions of the Sri Lanka Medical Association, 1998.
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Affiliation(s)
- U K Ranawaka
- Institute of Neurology, National Hospital of Sri Lanka, Colombo
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Affiliation(s)
- A T Alibhoy
- Institute of Neurology, National Hospital of Sri Lanka, Colombo
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12
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Affiliation(s)
- U K Ranawaka
- Institute of Neurology, National Hospital of Sri Lanka, Colombo
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Alibhoy AT, Ranawaka UK, Wijesekera JC. Primary writing tremor. Ceylon Med J 2000; 45:137-8. [PMID: 11192998 DOI: 10.4038/cmj.v45i3.8119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Alibhoy AT, Senanayake B, Fernando MA, Ranawaka UK, Wijesekera JC. A case of hereditary sensory and autonomic neuropathy (HSAN) type II. Ceylon Med J 2000; 45:32-3. [PMID: 11006618 DOI: 10.4038/cmj.v45i1.7954] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
We describe a case of hereditary sensory and autonomic neuropathy (HSAN) type II in a child with a penetrating foot ulcer, acral sensory impairment, and anhidrosis. This is the first documentation of HSAN in Sri Lanka.
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Affiliation(s)
- A T Alibhoy
- Institute of Neurology, National Hospital of Sri Lanka
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Senanayake B, Fernando MA, Ranawaka UK, Gunasekara TG, Alibhoy AT, Wijesekara JC. Acute primary axonal Guillain-Barré syndrome. Ceylon Med J 2000; 45:36-8. [PMID: 11006620 DOI: 10.4038/cmj.v45i1.7956] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- B Senanayake
- Institute of Neurology, National Hospital of Sri Lanka
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