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Wanninayake L, Rajapaksha D, Nair N, Gunarathne K, Ranawaka U. Guillain-Barre syndrome of acute motor axonal neuropathy (AMAN) type associated with herpes zoster: a case report. BMC Neurol 2024; 24:109. [PMID: 38570806 PMCID: PMC10988903 DOI: 10.1186/s12883-024-03607-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Accepted: 03/18/2024] [Indexed: 04/05/2024] Open
Abstract
Guillain Barre syndrome (GBS) following Varicella zoster is a rare presentation and has only been reported in a few cases around the world. Of the reported cases, the type of GBS is not specified in the majority, and where specified is of the acute inflammatory demyelinating polyradiculoneuropathy (AIDP) type. We report a case of acute motor axonal neuropathy (AMAN) type GBS following herpes zoster in a 27-year-old male who presented with bilateral lower limb weakness and left sided lower motor neuron type facial nerve palsy a week after herpes zoster infection.
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Affiliation(s)
- Leonard Wanninayake
- Department of Pharmacology, Faculty of Medicine, University of Colombo, Colombo, Sri Lanka.
| | | | - Narmada Nair
- Colombo North Teaching Hospital, Ragama, Sri Lanka
| | | | - Udaya Ranawaka
- Department of Medicine, Faculty of Medicine, University of Kelaniya, Ragama, Sri Lanka
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Fernando N, Ranawaka U. Azygous anterior cerebral artery infarction. Pract Neurol 2024; 24:157-159. [PMID: 38050154 PMCID: PMC10958280 DOI: 10.1136/pn-2023-003955] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/05/2023] [Indexed: 12/06/2023]
Affiliation(s)
- Nilshan Fernando
- University Medical Unit, Colombo North Teaching Hospital, Ragama, Sri Lanka
| | - Udaya Ranawaka
- University Medical Unit, Colombo North Teaching Hospital, Ragama, Sri Lanka
- Department of Medicine, Faculty of Medicine, University of Kelaniya, Ragama, Sri Lanka
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Chang T, Wijeyekoon R, Keshavaraj A, Ranawaka U, Senanayake S, Ratnayake P, Senanayake B, Caldera MC, Pathirana G, Sirisena D, Wanigasinghe J, Gunatilake S. Neurological disorders associated with COVID-19 in Sri Lanka. BMC Neurol 2023; 23:351. [PMID: 37794324 PMCID: PMC10548601 DOI: 10.1186/s12883-023-03399-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Accepted: 09/20/2023] [Indexed: 10/06/2023] Open
Abstract
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.
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Affiliation(s)
- Thashi Chang
- Department of Clinical Medicine, Faculty of Medicine, University of Colombo, Colombo, Sri Lanka.
| | - Ruwani Wijeyekoon
- Association of Sri Lankan Neurologists, Wijerama Mawatha, Colombo, Sri Lanka
| | | | - Udaya Ranawaka
- Department of Medicine, Faculty of Medicine, University of Kelaniya, Kelaniya, Sri Lanka
| | | | | | | | | | | | | | - Jithangi Wanigasinghe
- Department of Paediatrics, Faculty of Medicine, University of Colombo, Colombo, Sri Lanka
| | - Saman Gunatilake
- Department of Medicine, University of Sri Jayewardenepura, Nugegoda, Sri Lanka
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Isuru A, Hapangama A, Ediriweera D, Samarasinghe L, Fonseka M, Ranawaka U. Prevalence and predictors of new onset depression in the acute phase of stroke. Asian J Psychiatr 2021; 59:102636. [PMID: 33848806 DOI: 10.1016/j.ajp.2021.102636] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Revised: 02/25/2021] [Accepted: 03/25/2021] [Indexed: 12/17/2022]
Abstract
INTRODUCTION Post-stroke depression (PSD) is known to be associated with poor functional outcome and high mortality. There is limited data on the prevalence and associated factors of depression in the acute phase after stroke. OBJECTIVES To determine the prevalence of PSD in the acute phase and its correlates among patients with stroke in a tertiary care hospital in Sri Lanka. METHOD A cross sectional descriptive study was conducted among patients with stroke admitted to the stroke unit of a tertiary care hospital in Sri Lanka over a 3-year period. Demographic and clinical information was obtained using an interviewer administered questionnaire. Depression was diagnosed using the ICD-10 criteria. Group comparisons were performed using Pearson's Chi-square test and Mann-Whitney U test Multiple logistic regression was used to identify factors associated with PSD. RESULTS Of 374 patients, 106 patients experienced moderate to severe PSD, with a prevalence of 28.3 % (95 % CI: 23.8 %-32.9 %). Of them, 54.7 % were females, 49 % were above the age of 60 years, and 79.9 % had ischemic strokes. Female gender (OR-2.77, 95 % CI: 1.46-5.07, P = 0.002), a longer duration of hypertension (OR-1.31, 95 % CI: 1.01-1.721, P = 0.004), strokes involving the temporal lobe (OR-7.25, 95 % CI: 2.81-20.25, P < 0.001) and post-stroke functional disability (OR- O.98, 95 % CI:0.97-0.99, P = 0.001) were associated with PSD on multivariate analysis. CONCLUSION More than one fourth of the patients suffered from PSD in the acute phase of stroke. Female gender, longer history of hypertension, physical dependence and temporal lobe strokes were predictive of PSD.
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Affiliation(s)
- Amila Isuru
- Department of Psychiatry, Faculty of Medicine and Allied Sciences, Rajarata University of Sri Lanka and University Psychiatry Unit, Colombo North Teaching Hospital, Ragama, Sri Lanka.
| | - Aruni Hapangama
- Department of Psychiatry, Faculty of Medicine, University of Kelaniya, Sri Lanka
| | - Dileepa Ediriweera
- Health Data Science Unit, Faculty of Medicine, University of Kelaniya, Sri Lanka
| | | | - Madhavi Fonseka
- University Psychiatry Unit, North Colombo Teaching Hospital, Ragama, Sri Lanka
| | - Udaya Ranawaka
- Department of Medicine, University of Sri Lanka, Sri Lanka
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Pinidiyapathirage J, Kasthuriratne A, Bennie JA, Pathmeswaran A, Biddle SJH, De Silva HJ, Chackrewarthy S, Dassanayake AS, Ranawaka U, Kato N, Wickremasinghe AR. Physical Activity Tracking Among Sri Lankan Adults: Findings From a 7-Year Follow-up of the Ragama Health Study. Asia Pac J Public Health 2021; 33:205-212. [PMID: 33577353 DOI: 10.1177/1010539520971179] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Limited data are available on physical activity tracking among adults in low- and middle-income countries. Using a longitudinal design, we assessed trends and correlates of physical activity among Sri Lankan adults. Individuals selected through age-stratified random sampling, were screened initially in 2007 (n = 2986) and reevaluated in 2014 (n = 2148). On both occasions, structured interviews and clinical measurements were completed. Approximately 40% of the participants engaged in recommended levels of physical activity both at baseline and follow-up. One-fifth reported increased physical activity at follow-up, a similar proportion reported being persistently inactive or a reduction in physical activity. In the adjusted analysis, being persistently active was associated with male sex, a lower educational level and income, being free of any chronic disease conditions, better self-rated health, and sitting time <8 hours. Our findings support public health interventions to help maintain recommended physical activity levels over time, particularly for subgroups at high-risk of physical inactivity.
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Affiliation(s)
- Janani Pinidiyapathirage
- University of Southern Queensland, Toowoomba, Queensland, Australia.,University of Kelaniya, Ragama, Sri Lanka.,Griffith University, Gold Coast, Queensland, Australia
| | | | - Jason A Bennie
- University of Southern Queensland, Toowoomba, Queensland, Australia
| | | | | | | | | | | | | | - Norihiro Kato
- National Centre for Global Health and Medicine Research Institute, Shinjuku-ku, Tokyo, Japan
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Kasturiratne A, Ediriweera DS, De Silva ST, Niriella MA, Thulani UB, Pathmeswaran A, Dassanayake AS, De Silva AP, Chackrewarthy S, Ranawaka U, Kato N, Wickremasinghe AR, de Silva HJ. Patterns and predictors of mortality in a semi-urban population-based cohort in Sri Lanka: findings from the Ragama Health Study. BMJ Open 2020; 10:e038772. [PMID: 32994253 PMCID: PMC7526314 DOI: 10.1136/bmjopen-2020-038772] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE To describe patterns and predictors of mortality in a semi-urban population in Sri Lanka. DESIGN A prospective population-based cohort study. SETTING Ragama Medical Officer of Health area in the Gampaha district, Sri Lanka. PARTICIPANTS Adults between 35 and 64 years of age were recruited using an age stratified random sampling technique in 2007. MEASURES At baseline, we recorded socio-demographic, lifestyle, anthropometric, biochemical and clinical data of the participants. Over 10 years, we obtained the cause and date of death from the death registration documents of deceased participants. We determined the survival probability of the cohort over 10 years and estimated Hazard ratios (HRs) for all-cause mortality (ACM), cardiovascular mortality (CVM) and cancer-related mortality (CRM) using Cox's proportional hazards model. We also estimated the survival probabilities for men and women in each 10-year age group and standardised mortality ratio relative to the source population. RESULTS There were 169 deaths over 10 years with standardised mortality rates of 5.3 and 2.4 per 1000 years of follow-up for men and women, respectively. Independent predictors of: ACM were older age, lower income, smoking and diabetes mellitus while gender, education, occupation, harmful alcohol use, waist circumference and hypertension were not; CVM were older age, lower income, smoking, diabetes and hypertension while gender and harmful alcohol use were not; CRM was older age while gender, smoking and diabetes were not. Those engaged in clerical and technical occupations or unemployed had a lower risk of CRM as compared with those engaged in elementary occupations. CONCLUSIONS Older age, lower income, smoking, diabetes and hypertension strongly predict mortality in this cohort. Addressing the identified modifiable predictors through behavioural modification will improve longevity in similar populations.
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Affiliation(s)
| | - Dileepa Senajith Ediriweera
- Centre for Health Informatics, Biostatistics and Epidemiology, University of Kelaniya Faculty of Medicine, Ragama, Sri Lanka
| | | | - Madunil Anuk Niriella
- Department of Medicine, University of Kelaniya Faculty of Medicine, Ragama, Sri Lanka
| | - Uthuru Beddage Thulani
- Department of Public Health, University of Kelaniya Faculty of Medicine, Ragama, Sri Lanka
| | | | | | | | - Sureka Chackrewarthy
- Department of Biochemistry and Clinical Chemistry, University of Kelaniya Faculty of Medicine, Ragama, Sri Lanka
| | - Udaya Ranawaka
- Department of Medicine, University of Kelaniya Faculty of Medicine, Ragama, Sri Lanka
| | - Norihiro Kato
- Department of Gene Diagnostics and Therapeutics, National Center for Global Health and Medicine Research Institute, Shinjuku-ku, Tokyo, Japan
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Ranawaka U, Mettananda C, Thilakarathna C, Peiris A, Kasturiratna A, Tilakaratna Y. Stroke Awareness in Patients with Incident Stroke Compared to Patients without Stroke or Ischemic Heart Disease. J Stroke Cerebrovasc Dis 2020; 29:104790. [PMID: 32280001 DOI: 10.1016/j.jstrokecerebrovasdis.2020.104790] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2019] [Revised: 02/21/2020] [Accepted: 02/24/2020] [Indexed: 11/26/2022] Open
Abstract
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.
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Affiliation(s)
- Udaya Ranawaka
- Department of Medicine, Faculty of Medicine, University of Kelaniya, Sri Lanka; Professorial Medical Unit, North Colombo Teaching hospital, Ragama, Sri Lanka
| | - Chamila Mettananda
- Department of Pharmacology, Faculty of Medicine, University of Kelaniya, Sri Lanka.
| | | | - Anushka Peiris
- Department of Medicine, Faculty of Medicine, University of Kelaniya, Sri Lanka
| | | | - Yasoma Tilakaratna
- Department of Medicine, Faculty of Medicine, University of Kelaniya, Sri Lanka
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Premawardhena A, Ranawaka U, Pilapitiya T, Weerasinghe G, Hapangama A, Hettiarachchi S, Pathmeswaran A, Salvin K, Silva I, Hameed N, Weatherall M, Olivieri N, Weatherall D. Headache: an important symptom possibly linked to white matter lesions in thalassaemia. Br J Haematol 2019; 185:541-548. [DOI: 10.1111/bjh.15825] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2018] [Accepted: 01/07/2019] [Indexed: 01/03/2023]
Affiliation(s)
| | - Udaya Ranawaka
- Faculty of Medicine University of Kelaniya Ragama Sri Lanka
| | | | | | | | | | | | | | - Ishari Silva
- Hemals Thalassaemia Care Centre North Colombo (Teaching) Hospital Ragama Ragama Sri Lanka
| | - Nizri Hameed
- Hemals Thalassaemia Care Centre North Colombo (Teaching) Hospital Ragama Ragama Sri Lanka
| | | | - Nancy Olivieri
- Professor, Pediatrics, Medicine and Public Health Sciences University of Toronto Canada
| | - David Weatherall
- Weatherall Institute of Molecular Medicine University of Oxford Oxford UK
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Phan TG, Mori D, Deng X, Rajindrajith S, Ranawaka U, Fan Ng TF, Bucardo-Rivera F, Orlandi P, Ahmed K, Delwart E. Small circular single stranded DNA viral genomes in unexplained cases of human encephalitis, diarrhea, and in untreated sewage. Virology 2015; 482:98-104. [PMID: 25839169 DOI: 10.1016/j.virol.2015.03.011] [Citation(s) in RCA: 71] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2015] [Revised: 02/16/2015] [Accepted: 03/03/2015] [Indexed: 01/02/2023]
Abstract
Viruses with small circular ssDNA genomes encoding a replication initiator protein can infect a wide range of eukaryotic organisms ranging from mammals to fungi. The genomes of two such viruses, a cyclovirus (CyCV-SL) and gemycircularvirus (GemyCV-SL) were detected by deep sequencing of the cerebrospinal fluids of Sri Lankan patients with unexplained encephalitis. One and three out of 201 CSF samples (1.5%) from unexplained encephalitis patients tested by PCR were CyCV-SL and GemyCV-SL DNA positive respectively. Nucleotide similarity searches of pre-existing metagenomics datasets revealed closely related genomes in feces from unexplained cases of diarrhea from Nicaragua and Brazil and in untreated sewage from Nepal. Whether the tropism of the cyclovirus and gemycircularvirus reported here include humans or other cellular sources in or on the human body remains to be determined.
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Affiliation(s)
- Tung Gia Phan
- Blood Systems Research Institute, San Francisco, CA 94118, USA; Department of Laboratory Medicine, University of California at San Francisco, San Francisco, CA 94118, USA
| | - Daisuke Mori
- Department of Microbiology, Faculty of Medicine, Oita University, Yufu 879-5593, Japan
| | - Xutao Deng
- Blood Systems Research Institute, San Francisco, CA 94118, USA
| | - Shaman Rajindrajith
- Department of Pediatrics, Faculty of Medicine, University of Kelaniya, Ragama, Sri Lanka
| | - Udaya Ranawaka
- Department of Medicine, Faculty of Medicine, University of Kelaniya, Ragama, Sri Lanka
| | - Terry Fei Fan Ng
- Blood Systems Research Institute, San Francisco, CA 94118, USA; Department of Laboratory Medicine, University of California at San Francisco, San Francisco, CA 94118, USA
| | | | | | - Kamruddin Ahmed
- Department of Microbiology, Faculty of Medicine, Oita University, Yufu 879-5593, Japan; Research Promotion Institute, Oita University, Yufu 879-5593, Oita, Japan; Department of Pathobiology and Medical Diagnostics, Faculty of Medicine, Universiti Malaysia Sabah, 88400 Kota Kinabalu, Sabah, Malaysia
| | - Eric Delwart
- Blood Systems Research Institute, San Francisco, CA 94118, USA; Department of Laboratory Medicine, University of California at San Francisco, San Francisco, CA 94118, USA.
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Mori D, Ranawaka U, Yamada K, Rajindrajith S, Miya K, Perera HKK, Matsumoto T, Dassanayake M, Mitui MT, Mori H, Nishizono A, Söderlund-Venermo M, Ahmed K. Human bocavirus in patients with encephalitis, Sri Lanka, 2009-2010. Emerg Infect Dis 2014; 19:1859-62. [PMID: 24188380 PMCID: PMC3837659 DOI: 10.3201/eid1911.121548] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
We identified human bocavirus (HBoV) DNA by PCR in cerebrospinal fluid from adults and children with encephalitis in Sri Lanka. HBoV types 1, 2, and 3 were identified among these cases. Phylogenetic analysis of HBoV1 strain sequences found no subclustering with strains previously identified among encephalitis cases in Bangladesh.
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Mori D, Ranawaka U, Yamada K, Rajindrajith S, Miya K, Matsumoto T, Mitui M, Mori H, Nishizono A, Söderlund-Venermo M, Ahmed K. P193 Bocavirus encephalitis in Sri Lankan children and adults. Int J Antimicrob Agents 2013. [DOI: 10.1016/s0924-8579(13)70435-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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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Ranawaka U, Alexander F, Nawaratne D, Liyanage H, Kulatunga A, Tissera N, Cooray M, Kasthuriratne A, Wickramasinghe R. Factors Affecting Early Outcome in Sri Lankan Patients with Stroke (P06.234). Neurology 2012. [DOI: 10.1212/wnl.78.1_meetingabstracts.p06.234] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Pinidiyapathirage M, Warnakulasuriya T, Kasturiratne A, Ranawaka U, Gunasekera D, Wijekoon N, Medagoda K, Perera S, Takeuchi F, Kato N, Wickremasinghe A. P2-326 Comparison of urban diabetics with optimal and suboptimal control. J Epidemiol Community Health 2011. [DOI: 10.1136/jech.2011.142976k.58] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Hankey GJ, Algra A, Chen C, Wong MC, Cheung R, Wong L, Divjak I, Ferro J, de Freitas G, Gommans J, Groppa S, Hill M, Spence D, Lees K, Lisheng L, Navarro J, Ranawaka U, Ricci S, Schmidt R, Slivka A, Tan K, Tsiskaridze A, Uddin W, Vanhooren G, Xavier D, Armitage J, Hobbs M, Le M, Sudlow C, Wheatley K, Yi Q, Bulder M, Eikelboom JW, Hankey GJ, Ho WK, Jamrozik K, Klijn K, Koedam E, Langton P, Nijboer E, Tuch P, Pizzi J, Tang M, Antenucci M, Chew Y, Chinnery D, Cockayne C, Loh K, McMullin L, Smith F, Schmidt R, Chen C, Wong MC, de Freitas G, Hankey GJ, Loh K, Song S. VITATOPS, the VITAmins TO prevent stroke trial: rationale and design of a randomised trial of B-vitamin therapy in patients with recent transient ischaemic attack or stroke (NCT00097669) (ISRCTN74743444). Int J Stroke 2008; 2:144-50. [PMID: 18705976 DOI: 10.1111/j.1747-4949.2007.00111.x] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Epidemiological studies suggest that raised plasma concentrations of total homocysteine (tHcy) may be a common, causal and treatable risk factor for atherothromboembolic ischaemic stroke, dementia and depression. Although tHcy can be lowered effectively with small doses of folic acid, vitamin B(12) and vitamin B(6), it is not known whether lowering tHcy, by means of B vitamin therapy, can prevent stroke and other major atherothromboembolic vascular events. AIM To determine whether the addition of B-vitamin supplements (folic acid 2 mg, B(6) 25 mg, B(12) 500 microg) to best medical and surgical management will reduce the combined incidence of stroke, myocardial infarction (MI) and vascular death in patients with recent stroke or transient ischaemic attack (TIA) of the brain or eye. DESIGN A prospective, international, multicentre, randomised, double blind, placebo-controlled clinical trial. SETTING One hundred and four medical centres in 20 countries on five continents. SUBJECTS Eight thousand (6600 recruited as of 5 January, 2006) patients with recent (<7 months) stroke (ischaemic or haemorrhagic) or TIA (brain or eye). RANDOMISATION Randomisation and data collection are performed by means of a central telephone service or secure internet site. INTERVENTION One tablet daily of either placebo or B vitamins (folic acid 2 mg, B(6) 25 mg, B(12) 500 mug). PRIMARY OUTCOME The composite of stroke, MI or death from any vascular cause, whichever occurs first. Outcome and serious adverse events are adjudicated blinded to treatment allocation. SECONDARY OUTCOMES TIA, unstable angina, revascularisation procedures, dementia, depression. STATISTICAL POWER: With 8000 patients followed up for a median of 2 years and an annual incidence of the primary outcome of 8% among patients assigned placebo, the study will have at least 80% power to detect a relative reduction of 15% in the incidence of the primary outcome among patients assigned B vitamins (to 6.8%/year), applying a two-tailed level of significance of 5%. CONCLUSION VITATOPS aims to recruit and follow-up 8000 patients between 1998 and 2008, and provide a reliable estimate of the safety and effectiveness of folic acid, vitamin B(12), and vitamin B(6) supplementation in reducing recurrent serious vascular events among a wide range of patients with TIA and stroke throughout the world.
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Gunasekera H, Ranawaka U, Wijesekera J. Mitochondrial myopathy with chronic progressive external ophthalmoplegia. Ceylon Med J 2002; 47:69-70. [PMID: 12140885 DOI: 10.4038/cmj.v47i2.3460] [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]
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Ranawaka U, Seneviratne S, Gunasekera S, Sutharson R, Wijesekera J. A young man with widespread arterial occlusions and stroke. Ceylon Med J 1998; 43:121-3. [PMID: 9704560] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
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Seneviratne S, Ranawaka U, Gunasekera S, Senanayake B, Fernando A, Wijesekera J. Wakeful but unaware for several years. Ceylon Med J 1998; 43:123-4. [PMID: 9704561] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
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