37 results on '"Wijekoon N"'
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2. Duplication errors due to brand name confusion; It is not always the name—Short case series
- Author
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Mamunuwa, N., primary, Jayamanne, S., additional, Wijekoon, N., additional, Coombes, J., additional, Perera, D., additional, Shanika, T., additional, Mohamed, F., additional, Lynch, C., additional, De Silva, A., additional, and Dawson, A., additional
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- 2023
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3. Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries
- Author
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Adisa, A, Bahrami-Hessari, M, Bhangu, A, George, C, Ghosh, D, Glasbey, J, Haque, P, Ingabire, J, Kamarajah, S, Kudrna, L, Ledda, V, Li, E, Lillywhite, R, Mittal, R, Nepogodiev, D, Ntirenganya, F, Picciochi, M, Simões, J, Booth, L, Elliot, R, Kennerton, A, Pettigrove, K, Pinney, L, Richard, H, Tottman, R, Wheatstone, P, Wolfenden, J, Smith, A, Sayed, A, Goswami, A, Malik, A, Mclean, A, Hassan, A, Nazimi, A, Aladna, A, Abdelgawad, A, Saed, A, Abdelmageed, A, Ghannam, A, Mahmoud, A, Alvi, A, Ismail, A, Adesunkanmi, A, Ebrahim, A, Al-Mallah, A, Alqallaf, A, Durrani, A, Gabr, A, Kirfi, A, Altaf, A, Almutairi, A, Sabbagh, A, Ajiya, A, Haddud, A, Alnsour, A, Singh, A, Mittal, A, Semple, A, Adeniran, A, Negussie, A, Oladimeji, A, Muhammad, A, Yassin, A, Gungor, A, Tarsitano, A, Soibiharry, A, Dyas, A, Frankel, A, Peckham-Cooper, A, Truss, A, Issaka, A, Ads, A, Aderogba, A, Adeyeye, A, Ademuyiwa, A, Sleem, A, Papa, A, Cordova, A, Appiah-Kubi, A, Meead, A, Nacion, A, Michael, A, Forneris, A, Duro, A, Gonzalez, A, Altouny, A, Ghazal, A, Khalifa, A, Ozair, A, Quzli, A, Haddad, A, Othman, A, Yahaya, A, Elsherbiny, A, Nazer, A, Tarek, A, Abu-Zaid, A, Al-Nusairi, A, Azab, A, Elagili, A, Elkazaz, A, Kedwany, A, Nuhu, A, Sakr, A, Shehta, A, Shirazi, A, Mohamed, A, Sherif, A, Awad, A, Abbas, A, Abdelrahman, A, Ammar, A, Azzam, A, Ciftci, A, Dural, A, Sanli, A, Rahy-Martín, A, Tantri, A, Khan, A, Al-Touny, A, Tariq, A, Gmati, A, Costas-Chavarri, A, Auerkari, A, Landaluce-Olavarria, A, Puri, A, Radhakrishnan, A, Ubom, A, Pradhan, A, Turna, A, Adepiti, A, Kuriyama, A, Kassam, A, Hassouneh, A, El-Hussuna, A, Habeebullah, A, Mousli, A, Biloslavo, A, Hoang, A, Kirk, A, Santini, A, Melero, A, Calvache, A, Baduell, A, Chan, A, Abrate, A, Balduzzi, A, Sánchez, A, Navarrete-Peón, A, Porcu, A, Brolese, A, Barranquero, A, Saibene, A, Adam, A, Vagge, A, Maquilón, A, Leon-Andrino, A, Sekulić, A, Trifunovski, A, Mako, A, Bedada, A, Broglia, A, Coppola, A, Giani, A, Grandi, A, Iacomino, A, Moro, 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Infiesta García, C, Moreno, C, Magalhães, C, Prada, C, Zapata, C, Senni, C, Flumignan, C, Martinez-Perez, C, Duarte, C, Garcia, C, Anderson, C, Hing, C, Cullinane, C, Cina, C, Zabkiewicz, C, Sohrabi, C, Guldogan, C, Ciubotaru, C, Desai, C, Raut, C, Demetriou, C, Handford, C, Okpani, C, Paranjape, C, Koh, C, Khatri, C, Parmar, C, Mok, C, Caricato, C, Marafante, C, Echieh, C, Tan, C, Ong, C, Conso, C, Jardinez, C, Konrads, C, Warner, C, Makwe, C, Henein, C, Fleming, C, Roland, C, Maurus, C, Nitschke, C, Mittermair, C, Mallmann, C, Andro, C, Harmston, C, Kuppler, C, Lotz, C, Nahm, C, Rowe, C, Ryalino, C, Wallis, C, Millward, C, Anthoulakis, C, Apostolou, C, Chouliaras, C, Kalfountzos, C, Kaselas, C, Vosinakis, C, Okereke, C, Chean, C, Barlow, C, Tatar, C, Clancy, C, Forde, C, Sharpin, C, Mccarthy, C, Nestor, C, Warden, C, Ávila, C, Massaguer, C, Fang, C, Martins, C, Guerci, C, Mauriello, C, Holzmeister, C, Miller, C, Weber, C, Wiesinger, C, Kenington, C, Noel, C, Sue-Chue-Lam, C, Adumah, 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J, Parry, J, Ryan, J, Tomlinson, J, Wheeler, J, Wilkins, J, Balogun, J, Hodgetts, J, Vatish, J, Žatecký, J, Dziakova, J, Martin, J, Beatty, J, Stijns, J, Faiz, J, Ripollés-Melchor, J, Mata, J, Vásquez, J, Mitra, J, Tuech, J, Mvukiyehe, J, Fallah, J, Díaz, J, Vishnoi, J, Van Den Eynde, J, Rickard, J, Rolinger, J, Kaplowitz, J, Meyer, J, Reid, J, Rossaak, J, Smelt, J, Thomas, J, Reyes, J, Davies, J, Luc, J, Alonso, J, Hajiioannou, J, Querney, J, Van Acker, J, Pu, J, Cama, J, Simoes, J, Cozens, J, Barbosa-Breda, J, Ribeiro, J, De Haro, J, Nigh, J, Bowen, J, Pollok, J, Strotmann, J, Doerner, J, Edwards, J, Green, J, Massoud, J, Mcgrath, J, Squiers, J, Street, J, Windsor, J, Santoshi, J, Meara, J, Abebrese, J, Reilly, J, Zabaleta, J, Phillips, J, Herron, J, Horsnell, J, Dawson, J, Sheen, J, Kauppila, J, Konsten, J, Raurich-Leandro, J, Romera, J, Nuñez, J, Gass, J, Blanco, J, Calvache, J, Iturralde, J, D’Addino, J, Hermosa, J, Guillen, J, Beristain-Hernandez, J, Sole-Sedeno, J, Vives, J, Attwood, J, Furey, J, Hadaya, J, Mckay, J, Meilak, J, Natale, J, Shalhoub, J, Jung, J, Arthur, J, Kealey, J, Wright, J, Moreau, J, Miskovic, J, Juloski, J, Bauset, J, Segura-Sampedro, J, Cisneros, J, Gomez-Rosado, J, Arneja, J, Heider, J, Fernández, J, Plata-Bello, J, Villanueva, J, Olaogun, J, Hing, J, Košir, J, Daruwalla, J, Yeung, J, Wormald, J, Seyi-Olajide, J, Rani, J, Wong, K, Hristova, K, Kajal, K, Algarni, K, Theivendran, K, Futaba, K, Elsayem, K, Kapur, K, Bailey, K, El-Boghdadly, K, Ataya, K, Lacorbiniere, K, Shah, K, Tellez, K, Szyluk, K, Rangasamy, K, Iyengar, K, Szabómihályová, K, Atkinson, K, Camargo-Parra, K, Galliard, K, Dickson, K, Singh, K, Qader, K, Hasan, K, Spellar, K, Feeney, K, Ajenifuja, K, Oh, K, Okunade, K, Adanu, K, Bateman, K, Saracoglu, K, Ho, K, Enwerem, K, Mishra, K, Verhoeff, K, Bensoltane, K, Larabi, K, Hamdan, K, Nadi, K, Fozo, K, Abdelwahab, K, Al-Sayaghi, K, Dajani, K, Algahtany, K, Abdel-Galil, K, Ahmed, K, Bajunaid, K, Bhatti, K, Sofi, K, 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Dennis, Rory, Scaramuzzo, Rosa, Macías, Rosa Montero, Sánchez, Rosa, Ogu, Rosemary, Ramely, Rosnelifaizur, Sgarzani, Rossella, Ramli, Roszalina, Hillier, Roxane, Thumbadoo, Ruben, Ooi, Rucira, Abdus-Salam, Rukiyat, Masri, Ruqaya, Hodgson, Russell, Mathew, Ryan, Wade, Ryckie, D'archi, Sabatino, Khan, Sabina, Ngaserin, Sabrina, Kale, Sachin, Hassan, Sadiq, Merghani, Safa, Benamar, Safia, Muhammad, Sagir, Badran, Saif, Elsahli, Saifaleslam, Heta, Saimir, Hammouche, Salah, Baeesa, Saleh, Paiella, Salvatore, Eldeen, Samaher Taj Eldeen Hassan Taj, Arkani, Samara, Mittal, Samarth, Hirji, Sameer, Tebha, Sameer, Emile, Sameh, Dbouk, Samer, Bandyopadhyay, Samik Kumar, Muhammad, Saminu, Olori, Samson, Asirifi, Samuel Amoako, Hailu, Samuel, Ling, Samuel, Newman, Samuel, Ross, Samuel, Wanjara, Samuel, Kumar, Sandip, Seneviratne, Sanjeewa, Tamburello, Sara, Suarez, Sara Busto, Ingallinella, Sara, Irshaidat, Sara, Konswa, Sara, Mambrilla, Sara, Nasser, Sara, Parini, Sara, Pitoni, Sara, Ornaghi, Sara, 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Mayo-Yáñez, Miguel, Melo, Miguel Rocha, Ruiz-Marín, Miguel, Eiras, Miguel Angel Freiria, Cunha, Miguel F, Pertea, Mihaela, Slavchev, Mihail, Davidescu, Mihnea, Prieto, Mikel, Agapov, Mikhail, Gahwagi, Milad, Prats, Milagros Carrasco, Rudic, Milan, Verbic, Milena Senica, Kostusiak, Milosz, Stoleriu, Mircea Gabriel, Lucas, Miriam Abellan, Barone, Mirko, Ahmad, Misbahu, Alemu, Misganaw Alemu Adimass, Fatima, Mishal, Ida, Mitsuru, Sahu, Mo, Muhaisen, Mo'nes, Salem, Moacyr, Emara, Moataz Maher, Oludara, Mobolaji, Sotudeh, Mohadeseh, Kassab, Mohamad B, Abdelkhalek, Mohamed, Alsori, Mohamed, Anwar, Mohamed, El-Kassas, Mohamed, Elbahnasawy, Mohamed, Eldabaa, Mohamed, Rabie, Mohamed, Hassanin, Mohamed Abdelghafor, Thaha, Mohamed Adhnan, Ali, Mohamed Shafi Mahboob, Alhamid, Mohammad, Almoshantaf, Mohammad Badr, Keramati, Mohammad Reza, Bafaquh, Mohammed, Abuzaid, Mohammed, Al-Shehari, Mohammed, Alharthi, Mohammed, Alkahlan, Mohammed, Alwash, Mohammed, Alyousef, Mohammed, Amir, Mohammed, 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Pazmiño, Patricio Andrés Freile, Coughlin, Patrick, Kirchweger, Patrick, Pessaux, Patrick, Maguire, Patrick J, Petrone, Patrizio, Cullis, Paul, Köglberger, Paul, Marriott, Paul, Nankivell, Paul, Santos-Costa, Paulo, Martins, Paulo N, Panahi, Pedram, Botelho, Pedro, Teixeira, Pedro, Escobar, Pedro, Vázquez, Pedro José Gil, Gribnev, Petar, Nolte, Peter, Agbonrofo, Peter, Bobak, Peter, Choong, Peter, Elbe, Peter, Hutchinson, Peter, Labib, Peter, Paal, Peter, Pockney, Peter, Reemst, Peter, Szatmary, Peter, Vaughan-Shaw, Peter G, Alexander, Philip, Pucher, Philip, Stather, Philip, Foessleitner, Philipp, Winnand, Philipp, Zehnder, Philipp, Kruse, Philippe, Matos, Philomena Alice Wawer, Lapolla, Pierfrancesco, Cicerchia, Pierfranco Maria, Solli, Piergiorgio, Di Lascio, Pierpaolo, Zarif, Pierre, Champagne, Pierre-Olivier, Anoldo, Pietro, Bertoglio, Pietro, Fransvea, Pietro, Familiari, Pietro, Lombardi, Pietro Maria, Stogowski, Piotr Tomasz, Bruzzaniti, Placido, Tripathi, Prashant, D'sa, 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Beron, Reinaldo Isaacs, Függer, Reinhold, Othman, Rema, Saad, Rema, Amores, Remedios Revilla, Colombari, Renan Carlo, Radivojević, Renata Curic, Patrone, Renato, Novysedlák, René, Huatuco, René Manuel Palacios, Baertschiger, Reto, Liang, Rhea, Luckwell, Rhys, Escrevente, Ricardo, Rezende, Ricardo Fernandes, Cruz, Ricardo Pedrini, Lenzi, Riccardo, Rosati, Riccardo, Donovan, Richard, Egan, Richard, Morris, Richard, Page, Richard, Seglenieks, Richard, Unsworth, Richard, Wilkin, Richard, Skipworth, Richard Je, Davies, Richard Justin, Bezirci, Rifat, Talwar, Rishi, Azami, Rizwan, Bohmer, Rob, Crichton, Robert, Fruscio, Robert, Hooker, Robert, Jach, Robert, Parker, Robert, Pillerstorff, Robert, Sinnerton, Robert, Stabler, Robert, O'connell, Robert Michael, Ragozzino, Roberta, Tutino, Roberta, Angelico, Roberta, Cammarata, Roberto, Colasanti, Roberto, Macchiavello, Roberto, Peltrini, Roberto, Pirrello, Roberto, Vaschetti, Roberto, Pires, Robinson Esteves, Papalia, Rocco, Arrangoiz, Rodrigo, 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Sara, Konswa, Sara, Mambrilla, Sara, Nasser, Sara, Parini, Sara, Pitoni, Sara, Ornaghi, Sara, Rodrigues, Sara Castanheira, Abdelmohsen, Sarah, Aitken, Sarah, Tian, Sarah, Badiani, Sarit, Ahmad, Sarwat, Swed, Sarya, Muthu, Sathish, Lakpriya, Sathya, Alzahrani, Saud, Mikalauskas, Saulius, Lasrado, Savita, Satoskar, Savni, Bawa, Sayesha, Altiner, Saygin, Garcia, Sean, Stevens, Sean, Demir, Sebahattin, Ken-Amoah, Sebastian, Tranca, Sebastian, Ziemann, Sebastian, Awad, Selmy, Atici, Semra Demirli, Subramaniam, Sentilnathan, Erel, Serap, Jiang, Serena, Efetov, Sergey, Efremov, Sergey, Katorkin, Sergey, Valladares, Sergio Chávez, Contreras, Sergio Marcos, Meriç, Serhat, Zenger, Serkan, Safi, Seyer, Leventoğlu, Sezai, Elsalhawy, Shady, Shaikh, Shafaque, Sheik, Shahila, Islam, Shahnoor, Shamim, Shahzad, Waqar, Shahzad Hussain, Ahmad, Shahzaib, Farid, Shahzaib, Seraj, Shaikh Sanjid, Sundarraju, Shalini, Karandikar, Sharad, Sambhwani, Sharan, Chopra, Sharat, Chowdhury, Sharfuddin, Laura, Sharon, 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Safranovs, Toms Janis, Risteski, Toni, Pang, Tony, Akinyemi, Tosin, Yotsov, Tsanko, Laeke, Tsegazeab, Kochiyama, Tsukasa, Sholadoye, Tunde T, Alekberli, Tural, Ezomike, Uchechukwu, Giustizieri, Ugo, Grossi, Ugo, Köksoy, Ülkü Ceren, Bork, Ulrich, Kisser, Ulrich, Ronellenfitsch, Ulrich, Saeed, Umar, Bracale, Umberto, Jayarajah, Umesh, Rauf, Umme Habiba Abdul, Bumbasirevic, Uros, Ferrer, Ursula María Jariod, Ahmed, Usama, Bello, Usman Mohammed, Jogiat, Uzair, Sadia, Uzma, Galandarov, Vagif, Narayanan, Vairavan, Calu, Valentin, Bianchi, Valentina, Ciniero, Valeria, Tonini, Valeria, Silvestri, Vania, Vijay, Vardhini, Dewan, Varun, Lohsiriwat, Varut, Thuduvage, Vasanthika, Mousafeiris, Vasileios, Dragisic, Vedran, Sasireka, Veerasamy, Santric, Veljko, Kusuma, Venkata Ramana Murthy, Kolli, Venkata Satish, Alonso, Veronica, De Simone, Veronica, Picotti, Veronica, Martínez, Verónica Martín, Panduro-Correa, Vicky, Kakotkin, Victor, Angulo, Victor Pinto, Turrado-Rodriguez, Victor, Krishnamoorthy, Vijay, Ban, Vin Shen, Shah, Vinay, Maiola, Vincenza, Giordano, Vincenzo, La Vaccara, Vincenzo, Lizzi, Vincenzo, Papagni, Vincenzo, Schiavone, Vincenzo, Satchithanantham, Vinojan, Garcia-Virto, Virginia, Jimenez, Virginia, Kumar, Vishal, Shelat, Vishal, Bhat, Vivek, Sodhai, Vivek, Graziadei, Vivien, Kutuzov, Vladislav, Stoyanov, Vladislav, Oktseloglou, Vlasios, Flis, Vojko, Elhassan, Wael Atif Fadl, Yang, Wah, Soon, Wai Cheong, Tashkandi, Wail, Al-Khyatt, Waleed, Mabood, Waleed, Bijou, Walid, Wijenayake, Wasantha, D, Wasim, Krawczyk, Wiktor, Atkins, William, Bolton, William, White, William, Ceelen, Wim, Vagena, Xanthoula, Gozal, Yaacov, Baba, Yabasin Iddrisu, Subramani, Yamini, Jansen, Yanina, Mittal, Yash, Kara, Yasi̇n, Zwain, Yasir, Noureldin, Yasser, Alawneh, Yazan, Aydin, Yener, Lam, Yick Ho, Tang, Yita, Lim, Yizhe, Dean, Yomna, Tanas, Yousef, Su, Yu-Xiong, Fujimoto, Yuki, Altinel, Yuksel, Frolova, Yulia, Oshodi, Yusuf, Fadel, Zahir T, Zahid, Zahra, Elahi, Zain, Djama, Zakarya, Zaheen, Zakia, Jawad, Zaynab, Demetrashvili, Zaza, Gebremeskel, Zersenay, Gudisa, Zewdie, Alyami, Ziyad, Garoufalia, Zoe, Li, Zoe, Zimak, Zoran, Radin, Zorana, and Balogh, Zsolt J
- Abstract
Background: Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods: This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was coprioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low-middle-income countries. Results: In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of 'single-use' consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low-middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion: This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high- and low-middle-income countries.
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- 2023
4. CHInese Medicine NeuroAiD Efficacy On Stroke Recovery - Extension Study (CHIMES-E): A Multicenter Study of Long-Term Efficacy: O73
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Venketasubramanian, N., Young, S. H., Tay, S. S., Umapathi, T., Lao, A. Y., Gan, H. H., Baroque, A. C.II, Navarro, J. C., Chang, H. M., Advincula, J. M., Muengtaweepongsa, S., Chan, B. P.L., Chua, C. L., Wijekoon, N., De Silva, H. A., Hiyadan, J. H.B., Suwanwela, N. C., Wong, K. S.L., Poungvarin, N., Eow, G. B., Lee, C. F., and Chen, C. L.H.
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- 2015
5. Surgical management of perianal abscess in neonates and infants.
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Tan Tanny S.P., Wijekoon N., Nataraja R.M., Lynch A., Pacilli M., Tan Tanny S.P., Wijekoon N., Nataraja R.M., Lynch A., and Pacilli M.
- Abstract
BACKGROUND: The optimal management of perianal abscess in neonates and infants remains unclear, including the need for laying open of the fistula and the role of microscopy and culture studies (MCS). We aimed to report the recurrence rate following incision and drainage alone (I&D) compared to incision and drainage with laying open of the fistula (I&DF) and to determine the value of MCS in perianal abscess management. METHOD(S): Following ethical approval (16326Q), a 10-year (2007-2017) review of children younger than 1 year presenting with a perianal abscess was performed. Presence of a fistula was sought in all patients. Data are presented as number of cases (%), median (range) and analysed using Fisher's exact test and Mann-Whitney U-test. P-values of <0.05 were considered significant. RESULT(S): We identified 108 patients (107 (99.1%) males) with 111 abscesses (three bilateral); 26 in I&D group and 85 in I&DF group. Initial abscess occurred to the right of midline in 64 cases (58%) and to the left of midline in 47 cases (42%). Twenty-two (20%) recurred after 30 (6-372) days. Sixty-five (59%) had MCS performed. Recurrence was higher in I&D group (9/26) versus I&DF group (13/85) (P = 0.04 (relative risk 2.2, 95% confidence interval 1.0-4.5)). There was no difference in recurrence within each group between patients with or without MCS (I&D group, P = 0.1; I&DF group, P = 0.3). CONCLUSION(S): The recurrence of surgically managed perianal abscess is lower when a fistula is identified and laid open at the initial operation. There is little value of MCS in the management of paediatric perianal abscess.Copyright © 2020 Royal Australasian College of Surgeons.
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- 2021
6. The burden of diabetes mellitus and impaired fasting glucose in an urban population of Sri Lanka
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Pinidiyapathirage, M. J., Kasturiratne, A., Ranawaka, U. K., Gunasekara, D., Wijekoon, N., Medagoda, K., Perera, S., Takeuchi, F., Kato, N., Warnakulasuriya, T., and Wickremasinghe, A. R.
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- 2013
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7. The value of routine histopathological analysis in patients with fistula in-ano
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Wijekoon, N. S. and Samarasekera, D. N.
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- 2010
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8. Sister Mary Joseph’s Nodule as the Sole Presenting Feature of Disseminated Squamous Cell Cancer of the Esophagus: A Rare Case
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Wijekoon, N. S. and Samarasekera, D. N.
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- 2007
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9. Clinical state of the paediatric acute scrotum in south-eastern Victoria.
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Pacilli M., Nataraja R.M., Tan Tanny S.P., Wijekoon N., Pacilli M., Nataraja R.M., Tan Tanny S.P., and Wijekoon N.
- Abstract
BACKGROUND: Acute scrotal pain is a common paediatric surgical presentation. Delays in treatment can result in testicular loss from torsion. It is unclear where delays occur. We aimed to investigate presentations with an acute scrotum to identify any potential areas of delay. METHOD(S): We conducted a prospective study (April 2017-November 2018) of paediatric patients (<18years) presenting with acute scrotal pain. Data collected included: patient demographics, history/examination findings, mode of presentation, clinical timeline details and outcomes. RESULT(S): A total of 107 acute scrotum presentations were identified: 58 (54.2%) testicular appendage torsion, 23 (21.5%) testicular torsion, 6 (5.6%) epididymo-orchidits and 20 (18.7%) other diagnoses. Median age at presentation was 11years (4 months-16years). Fifty-seven (53.3%) underwent emergency surgery, of whom 23 (40.4%) had testicular torsion, with 2 requiring orchidectomy. Median time from onset of symptoms to seeking medical opinion was 5.5 (0-135) h. Once assessed by a medical professional, the route to paediatric surgical review via general practitioner (GP) and local emergency department (ED) to paediatric ED was 4.84 (1.67-24.5) h; via GP to paediatric ED was 2.58 (0.75-25.5) h; via local ED to paediatric ED was 2.25 (1-7.75) h; and directly to paediatric ED was 0.45 (0-1.42) h. CONCLUSION(S): Delays in assessment and treatment of acute scrotal pain occur from the time parents are aware of symptoms to seeking medical opinion. Education to increase awareness may reduce time delays. GPs should refer patients directly to a paediatric ED. Local EDs should manage paediatric cases as per the local surgeons' skill base.Copyright © 2019 Royal Australasian College of Surgeons.
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- 2019
10. Central segmental pancreatectomy
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Pratheepan, P, primary, Wijekoon, N, additional, and Sivaganesh, S, additional
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- 2013
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11. Proctocolectomy for persistent haematochezia in a patient with Cronkhite-Canada Syndrome
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Wijekoon, N., primary, Samarasinghe, M., additional, Dalpatadu, U., additional, Nuzair, N., additional, Pratheepan, P., additional, and Samarasekera, D., additional
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- 2012
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12. P2-326 Comparison of urban diabetics with optimal and suboptimal control
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Pinidiyapathirage, M., primary, Warnakulasuriya, T., additional, Kasturiratne, A., additional, Ranawaka, U., additional, Gunasekera, D., additional, Wijekoon, N., additional, Medagoda, K., additional, Perera, S., additional, Takeuchi, F., additional, Kato, N., additional, and Wickremasinghe, A., additional
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- 2011
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13. A case of giant, isolated renal angiomyolipoma in an elderly female.
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De Silva, W. A. S., Wijekoon, N. S., Quintus, K. D. C., Rajasinghe, S. K., and Dissanayaka, D. M. I.
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- 2010
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14. Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries
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Global Health Research Unit on Global Surgery, National Institute for Health and Care Research, Adisa, Adewale, Bahrami-Hessari, Michael, Bhangu, Aneel, George, Christina, Ghosh, Dhruv, Glasbey, James, Haque, Parvez, Ingabire, J C Allen, Kamarajah, Sivesh Kathir, Kudrna, Laura, Ledda, Virginia, Li, Elizabeth, Lillywhite, Robert, Mittal, Rohin, Nepogodiev, Dmitri, Ntirenganya, Faustin, Picciochi, Maria, Simões, Joana Filipa Ferreira, Booth, L, Elliot, R, Kennerton, A S, Pettigrove, K L, Pinney, L, Richard, H, Tottman, R, Wheatstone, P, Wolfenden, John W D, Smith, A, Sayed, A Emad, Goswami, Aakansha Giri, Malik, Aamer, Mclean, Aaron Lawson, Hassan, Abbas, Nazimi, Abd Jabar, Aladna, Abdallah, Abdelgawad, Abdalrahman, Saed, Abdel, Abdelmageed, Abdelfatah, Ghannam, Abdelilah, Mahmoud, Abdelrahman, Alvi, Abdul, Ismail, Abdulaziz, Adesunkanmi, Abdulhafiz, Ebrahim, Abdulla, Al-Mallah, Abdullah, Alqallaf, Abdullah, Durrani, Abdullah, Gabr, Abdullah, Kirfi, Abdullahi Musa, Altaf, Abdulmalik, Almutairi, Abdulmjeed, Sabbagh, Abdulrahman J, Ajiya, Abdulrazak, Haddud, Abdurrahman, Alnsour, Abed Alfattah Mahmoud, Singh, Abhinav, Mittal, Abhishek, Semple, Abigail, Adeniran, Abiodun, Negussie, Abraham, Oladimeji, Abraham, Muhammad, Abubakar Bala, Yassin, Abubaker, Gungor, Abuzer, Tarsitano, Achille, Soibiharry, Adaiah, Dyas, Adam, Frankel, Adam, Peckham-Cooper, Adam, Truss, Adam, Issaka, Adamu, Ads, Adel Mohamed, Aderogba, Adeleke Akeem, Adeyeye, Ademola, Ademuyiwa, Adesoji, Sleem, Adham, Papa, Adrian, Cordova, Adriana, Appiah-Kubi, Adu, Meead, Adullah, Nacion, Aeris Jane D, Michael, Afieharo, Forneris, Agustin Albani, Duro, Agustin, Gonzalez, Agustin Rodriguez, Altouny, Ahmad, Ghazal, Ahmad, Khalifa, Ahmad, Ozair, Ahmad, Quzli, Ahmad, Haddad, Ahmad, Othman, Ahmad Faidzal, Yahaya, Ahmad Shuib, Elsherbiny, Ahmed, Nazer, Ahmed, Tarek, Ahmed, Abu-Zaid, Ahmed, Al-Nusairi, Ahmed, Azab, Ahmed, Elagili, Ahmed, Elkazaz, Ahmed, Kedwany, Ahmed, Nuhu, Ahmed Mohammed, Sakr, Ahmed, Shehta, Ahmed, Shirazi, Ahmed, Mohamed, Ahmed Mohamed Ibrahim, Sherif, Ahmed Elshawadfy, Awad, Ahmed K, Abbas, Ahmed M, Abdelrahman, Ahmed Saber, Ammar, Ahmed Siddique, Azzam, Ahmed Y, Ciftci, Ahmet Burak, Dural, Ahmet Cem, Sanli, Ahmet Necati, Rahy-Martín, Aida Cristina, Tantri, Aida Rosita, Khan, Aimal, Al-Touny, Aiman, Tariq, Aiman, Gmati, Aimen, Costas-Chavarri, Ainhoa, Auerkari, Aino, Landaluce-Olavarria, Aitor, Puri, Ajay, Radhakrishnan, Ajay, Ubom, Akaninyene Eseme, Pradhan, Akhilesh, Turna, Akif, Adepiti, Akinfolarin, Kuriyama, Akira, Kassam, Al-Faraaz, Hassouneh, Ala, El-Hussuna, Alaa, Habeebullah, Alaa, Ads, Alaa Mohamed, Mousli, Alaa, Biloslavo, Alan, Hoang, Alan, Kirk, Alan, Santini, Alasdair, Melero, Alba Vazquez, Calvache, Albaro José Nieto, Baduell, Albert, Chan, Albert, Abrate, Alberto, Balduzzi, Alberto, Sánchez, Alberto Cabañero, Navarrete-Peón, Alberto, Porcu, Alberto, Brolese, Alberto, Barranquero, Alberto G, Saibene, Alberto Maria, Adam, Albushra Altayeb, Vagge, Aldo, Maquilón, Alejandra Jara, Leon-Andrino, Alejandro, Sekulić, Aleksandar, Trifunovski, Aleksandar, Mako, Aleksandro, Bedada, Alemayehu Ginbo, Broglia, Alessandro, Coppola, Alessandro, Giani, Alessandro, Grandi, Alessandro, Iacomino, Alessandro, Moro, Alessandro, D’amico, Alessia, Malagnino, Alessia, Tang, Alethea, Doyle, Alex, Alfieri, Alex, Haynes, Alex, Wilkins, Alex, Baldwin, Alexander, Heriot, Alexander, Laird, Alexander, Lazarides, Alexander, O'connor, Alexander, Trulson, Alexander, Rokohl, Alexander Christopher, Caziuc, Alexandra, Triantafyllou, Alexandra, Anesi, Alexandre, Nikova, Alexandrina, Andrianakis, Alexandros, Charalabopoulos, Alexandros, Tsolakidis, Alexandros, Chirca, Alexandru, Arnaud, Alexis P, Narvaez-Rojas, Alexis Rafael, Kavalakat, Alfie, Spina, Alfio, Recordare, Alfonso, Annicchiarico, Alfredo, Conti, Alfredo, Mohammed, Alhassan Datti, Kocataş, Ali, Almhimid, Ali, Arnaout, Ali, Fahmy, Ali, Mangi, Ali, Modabber, Ali, Ulas, Ali Bilal, Mohamedahmed, Ali Yasen Y, Frontali, Alice, Moynihan, Alice, Yunus, Alif, Ahmad, Aline, Kent, Alistair J, Khamees, Almu'atasim, Ugwu, Aloy Okechukwu, Turan, Alparslan, Mohammed, Alsnosy Abdullah Khalefa, Navarro-Barrios, Alvaro, Yebes, Alvaro, De Sousa, Álvaro Francisco Lopes, Moreno, Amabelle, Sethi, Aman, Dawson, Amanda Caroline, Othman, Amani Alsayd Abdulsalam, Kaur, Amanjot, Wolde, Amanuel, Antonelli, Amedeo, Scifo, Amedeo, Alhamad, Ameen, Davis, Amelia, Alderazi, Amer, Harky, Amer, Mohammed-Durosinlorun, Amina, Seguya, Amina, Okhakhu, Amina, Chamakhi, Amine, Sebai, Amine, Souadka, Amine, Asla, Amir, Agrawal, Amit, Persad, Amit, Gupta, Amit, Elgazar, Amr, Kulkarni, Amruta, Coates, Amy, Bellés, Ana Ciscar, Hadzibegovic, Ana Danic, Jotic, Ana, Kowark, Ana, Martins, Ana, Pineda, Ana Mejía, Peral, Ana, Gollarte, Ana Sánchez, Senent-Boza, Ana, Camarena, Ana Isabel Avellaneda, Castaño-Leon, Ana M, Bravo, Ana Maria Minaya, Moro, Ana María Gimeno, Musina, Ana-Maria, Tapia-Herrero, Ana-María, Kothari, Anai, Gupta, Anand, Raja, Anand, Aljaiuossi, Anas, Taha, Anas, Majbar, Anass Mohammed, Prodromidou, Anastasia, Kanatas, Anastasios, Gupte, Anaya, Zakaria, Andee Dzulkarnaen, Balla, Andrea, Barberis, Andrea, Bondurri, Andrea, Bottari, Andrea, Costantino, Andrea, Figus, Andrea, Lauretta, Andrea, Mingoli, Andrea, Romanzi, Andrea, Sagnotta, Andrea, Scacchi, Andrea, Picchetto, Andrea, Valadez, Andrea Estefania Cueto, Luzzi, Andrea-Pierre, Älgå, Andreas, Fontalis, Andreas, Hecker, Andreas, Demetriades, Andreas K, Serban, Andreea-Madalina, Văcărașu, Andrei Bogdan, Cokan, Andrej, Isaza-Restrepo, Andres, Beamish, Andrew, Schache, Andrew, Stevenson, Andrew, Yiu, Andrew, Cockbain, Andrew J, Litvin, Andrey, Abad-Motos, Ane, Becerra, Angel, Ramos, Ángel Cilleruelo, Chiaradia, Angela, Dell, Angela, Romano, Angela, Pascale, Angelo, Marra, Angelo Alessandro, Dimas, Angelos, Kolias, Angelos, Cerovac, Anis, Koneru, Anish, Tidjane, Anisse, Agbeko, Anita Eseenam, Bajaj, Ankur, Gosain, Ankush, Allan, Anna, Carreras-Castañer, Anna, D'amore, Anna, Dare, Anna, Maffioli, Anna, Palepa, Anna, Paspala, Anna, Konney, Anna, Gatta, Anna Nunzia Della, Ezanno, Anne-Cecile, Yiallourou, Anneza, Kinnair, Anthony, Rayner, Anthony, Scafa, Anthony Kevin, Bowan, Antoinette Bediako, Veglia, Antonella, Russo, Antonino, Maniaci, Antonino, Castaldi, Antonio, Gil-Moreno, Antonio, Maffuz-Aziz, Antonio, Meola, Antonio, Nenna, Antonio, Ferrer, Antonio Perez, Bonilla, Antonio Ramos, Ramos-De La Medina, Antonio, Infante, Antonio Rodriguez, Santoro, Antonio, Laganà, Antonio Simone, Bateman, Antony, Michael, Antony Louis Rex, Abozid, Anwaar, Seidu, Anwar Sadat, Lowery, Aoife, Tantraworasin, Apichat, Rasheed, Aqsa, Picciariello, Arcangelo, Isik, Arda, Saif, Areeba, Anjum, Arfa, Ioannidis, Argyrios, Abeldaño, Ariel, Hussain, Arif, Nathan, Arjun, Bedzhanyan, Arkady, Perfecto, Arkaitz, De Virgilio, Armando, Galvan, Armando, Sablotzki, Armin, Böttcher, Arne, Pellacani, Arrigo, Gatti, Arthur, Ibrahimli, Arturan, Menon, Arun, Sahni, Arun, Mwenda, Aruyaru Stanley, Choudhry, Asad, Jayawardane, Asanka, Gupta, Ashish, Ramasamy, Ashok, Mitul, Ashrarur Rahman, Bawa, Ashvind, Nugur, Ashwani, Rammohan, Ashwin, Sachdeva, Ashwin, Mehraj, Asif, Yildirim, Asif, Alqaseer, Asma, Radwan, Asmaa, Sallam, Asser, Syllaios, Athanasios, Tampakis, Athanasios, Alwael, Athari, Samara, Athina, Eroglu, Atilla, Rahman, Atiqur, Ulkucu, Attila, Zaránd, Attila, Dulskas, Audrius, Tawiah, Augustine, Zani, Augusto, Vas, Aurelia, Lukosiute-Urboniene, Ausra, Adamu, Auwal, Aujayeb, Avinash, Malik, Awais Amjad, İplikçi, Ayberk, Mahmud, Ayesha, Cil, Aylin Pelin, Makanjuola, Ayomide, Akwaisah, Ayoub, Galandarova, Aysuna, Saracoglu, Ayten, Regan, Azel, Barlas, Aziz Mutlu, Alhassan, Baba Alhaji Bin, Mostafa, Badr, Hamida, Baha Ben, Torun, Bahar Canbay, Abdullah, Bahiyah, Balagobi, Balasingam, Banky, Balazs, Singh, Baljit, Alegbeleye, Bamidele, Yigit, Banu, Hajjaj, Baraa Nabil, Burgos-Blasco, Barbara, Seeliger, Barbara, Alayande, Barnabas, Alhazmi, Barrag, Enodien, Bassey, Torre, Beatrice, Pérez, Beatriz Gómez, Tamayo, Beatriz Villota, De Andrés-Asenjo, Beatriz, Quintana-Villamandos, Begoña, Girgin, Behiç, Barmayehvar, Behrad, Beisenov, Bekzat, Creavin, Ben, Dunne, Ben, Marson, Ben, Waterson, Ben, Martin, Benjamin, Zucker, Benjamin, Wong, Benjamin Ngie Xiong, Ozmen, Berk Baris, Hammond, Bernard, Mbwele, Bernard, Núñez, Bernardo, Dhondt, Bert, Gafsi, Besma, Mcleish, Bethan, Lieske, Bettina, Tailor, Bhavesh, La Pira, Biagia, Picardi, Biagio, Zampogna, Biagio, Casagranda, Biagio, Festa, Bianca Maria, Panda, Bijnya, Kirmani, Bilal, Sulaiman, Bilal, Gurung, Binay, Zacharia, Bincy, Bette, Birgit, Ayana, Birhanu, Nikolovska, Bisera, Vilaró, Blanca Capdevila, De Vega Sánchez, Blanca, Hameed, Bm Zeeshan, Diaconescu, Bogdan, Kovacevic, Bojan, Bumber, Boris, Sakakushev, Boris, Tadic, Boris, Malek, Bouhani, Alrayes, Bourhan, Thomas, Bradley, Gális, Branislav, Gallagher, Brendan, Knowles, Brett, Cunningham, Brian, Daley, Brian, Mishra, Brijesh, Ashford, Bruce, Pirozzi, Brunella Maria, Berselli, Bruno, Martinez-Leo, Bruno, Sensi, Bruno, Nardo, Bruno, Celik, Burak, Giray, Burak, Abud, Burçin, Almiqlash, Bushray, Pramesh, C S, Taskiran, Cagatay, De Campos Prado, Caio Antonio, Cipolla, Calogero, Kumar, Calvin, English, Camilla, Riccetti, Camilla, Vanni, Camilla, Brasset, Camille, Downey, Candice, Duffy, Caoimhe, Chwat, Carina, Cutmore, Carina, Sars, Carl, Ratto, Carlo, Pacilio, Carlo Alberto, De La Infiesta García, Carlos, Moreno, Carlos Guijarro, Magalhães, Carlos, Prada, Carlos, Zapata, Carlos Shiraishi, Senni, Carlotta, Flumignan, Carolina Dutra Queiroz, Martinez-Perez, Carolina, Duarte, Carolina Lugo, Garcia, Carolina Soledad Romero, Anderson, Caroline, Hing, Caroline, Cullinane, Carolyn, Cina, Caterina, Zabkiewicz, Catheriner, Sohrabi, Catrin, Guldogan, Cem Emir, Ciubotaru, Cezar, Desai, Chaitya, Raut, Chandrajit, Demetriou, Charis, Handford, Charles, Okpani, Charles, Paranjape, Charudutt, Koh, Cherry, Khatri, Chetan, Parmar, Chetan, Mok, Chi Wei, Caricato, Chiara, Marafante, Chiara, Echieh, Chidiebere Peter, Tan, Chih Ying, Ong, Chon Sum, Conso, Christel, Jardinez, Christiaan, Konrads, Christian, Warner, Christian, Makwe, Christian Chigozie, Henein, Christin, Fleming, Christina, Roland, Christina L, Maurus, Christine, Nitschke, Christine, Mittermair, Christof, Mallmann, Christoph, Andro, Christophe, Harmston, Christopher, Kuppler, Christopher, Lotz, Christopher, Nahm, Christopher, Rowe, Christopher, Ryalino, Christopher, Wallis, Christopher, Millward, Christopher Paul, Anthoulakis, Christos, Apostolou, Christos, Chouliaras, Christos, Kalfountzos, Christos, Kaselas, Christos, Vosinakis, Christos, Okereke, Chukwuma, Chean, Chung Shen, Barlow, Ciaran, Tatar, Cihad, Clancy, Cillian, Forde, Cillian, Sharpin, Claire, Mccarthy, Claire, Nestor, Claire, Warden, Claire, Ávila, Clara Castro, Massaguer, Clara, Fang, Clarissa Ern Hui, Martins, Claudia Pinto, Guerci, Claudio, Mauriello, Claudio, Holzmeister, Clemens, Miller, Clemens, Weber, Clemens, Wiesinger, Clemens Georg, Kenington, Cleo, Noel, Colin, Sue-Chue-Lam, Colin, Adumah, Collins, Neary, Colm, Sen, Comert, Fitzgerald, Conall, Ezeme, Constantine, Nastos, Constantinos, Mesina, Cristian, Bombardini, Cristina, Torregrosa, Cristina, Valdespino, Cristina Puentes, Don, Cristine Pathirannehalage, Wickramasinghe, Dakshitha, Milanesi, Damiano, Armijos, Daniel, Asiimwe, Daniel, Beswick, Daniel, Clerc, Daniel, Cox, Daniel, Doherty, Daniel, Martínez, Daniel Fernández, Lechuga, Daniel Garay, Gero, Daniel, Gil-Sala, Daniel, Lindegger, Daniel, Reim, Daniel, Shaerf, Daniel, Shmukler, Daniel, Branzan, Daniela, Filipescu, Daniela, Rega, Daniela, Bernardi, Daniele, Bissacco, Daniele, Fusario, Daniele, Morezzi, Daniele, Sabella, Danielle, Zimak, Danijela Mrazovac, Vinci, Danilo, Sale, Danjuma, Khan, Danyal Zaman, Thereska, Dariel, Andreotti, Dario, Tartaglia, Dario, Abdulai, Darling Ramatu, Mukherjee, Dattatreya, Verdi, Daunia, Idowu, David, John, David, Johnson, David, Moro-Valdezate, David, Naumann, David, Omar, David, Proud, David, Roberts, David, Guzmán, David Santos, Watson, David, Bergkvist, David Julià, Lumenta, David Benjamin, Ferrari, Davide, Rizzo, Davide, Degarege, Dawit, Castillo, Dayan Fanery Campino, Douglas, Deborah, Wright, Deborah, Nanjiani, Deedar, Bratus, Dejan, Altun, Demet, Sievers, Denise, Vaysburg, Dennis, Katechia, Devvrat, Ghosh, Dhruva, Azize, Diallo Abdoul, Rodrigues, Diana, Pachajoa, Diana Alejandra Pantoja, Hayne, Dickon, Mutter, Didier, Raimondo, Diego, Eskinazi, Diego, Sasia, Diego, Corallino, Diletta, Muduly, Dillip, Grewal, Dilraj, Hadzhiev, Dimitar, Peristeri, Dimitra, Pournaras, Dimitri, Raptis, Dimitri Aristotle, Angelou, Dimitrios, Haidopoulos, Dimitrios, Magouliotis, Dimitrios, Moris, Dimitrios, Schizas, Dimitrios, Symeonidis, Dimitrios, Tsironis, Dimitrios, Korkolis, Dimitrios, Tatsis, Dimitris, Thekkinkattil, Dinesh, Bulian, Dirk Rolf, Pandey, Diwakar, Vatansever, Dogan, Parker, Dominic, Wiedemann, Dominik, Borselle, Dominika, Pedini, Domiziana, Schweitzer, Donald, Venskutonis, Donatas, Otokwala, Job, Adamu, Kabir Musa, Pk, Parvathy, Garod, Mebanshanbor, Ellafi, Amera Ali Dakheel, Zivkovic, Dragana, Jelovac, Drago, Wijeysundera, Duminda, Mcpherson, Duncan, Ryan, Éanna, Ugwu, Ebere, Baidoo, Ebikela Ivie, Shaddad, Ebrahim, Memişoğlu, Ecem, Naranjo, Eddy P Lincango, Brodkin, Edgar, Segalini, Edoardo, Viglietta, Edoardo, Hendriks, Eduard, Bonci, Eduard-Alexandru, Sá-Marta, Eduarda, Ortega, Eduardo Nieto, Gomez, Eduardo Garcia-Loarte, Joviliano, Edwaldo Edner, Clune, Edward, Horwell, Edward, Mains, Edward, Vasarhelyi, Edward, Caruana, Edward J, Nevins, Edward J, Yenli, Edwin Mwintiereh Ta-Ang, Baili, Efstratia, Lostoridis, Eftychios, Morgan, Eghosa, Shiban, Ehab, Latif, Ejaz, Tampaki, Ekaterini Christina, Ezenwa, Ekene, Irune, Ekpemi, Borg, Elaine, Eisa, Elamin, Gialamas, Eleftherios, Parvez, Elena, Theophilidou, Elena, Toma, Elena Adelina, Arnaoutoglou, 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R, Mohan, R, Singh, R, Sivaprakasam, R, Seenivasagam, R, Rajendram, R, Radulescu, R, Goicea, R, Seshadri, R, Sarı, R, Nataraja, R, Aslam, R, Abdelemam, R, Shrestha, R, Bharathan, R, Pellini, R, Guevara, R, Agarwal, R, Vissapragada, R, Alharmi, R, Sayyed, R, Browning, R, Critchley, R, Mallick, R, Alarabi, R, Beron, R, Függer, R, Othman, R, Saad, R, Amores, R, Colombari, R, Radivojević, R, Patrone, R, Novysedlák, R, Huatuco, R, Baertschiger, R, Liang, R, Luckwell, R, Escrevente, R, Rezende, R, Cruz, R, Lenzi, R, Rosati, R, Donovan, R, Egan, R, Morris, R, Page, R, Seglenieks, R, Unsworth, R, Wilkin, R, Skipworth, R, Davies, R, Bezirci, R, Talwar, R, Azami, R, Bohmer, R, Crichton, R, Fruscio, R, Hooker, R, Jach, R, Parker, R, Pillerstorff, R, Sinnerton, R, Stabler, R, O'Connell, R, Ragozzino, R, Tutino, R, Angelico, R, Cammarata, R, Colasanti, R, Macchiavello, R, Peltrini, R, Pirrello, R, Vaschetti, R, Pires, R, Papalia, R, Arrangoiz, R, Hompes, R, Salah, R, Pinto, R, Flumignan, R, Callan, R, Cuthbert, R, Dennis, R, Scaramuzzo, R, Macías, R, Sánchez, R, Ogu, R, Ramely, R, Sgarzani, R, Ramli, R, Hillier, R, Thumbadoo, R, Ooi, R, Abdus-Salam, R, Masri, R, Hodgson, R, Mathew, R, Wade, R, D'Archi, S, Khan, S, Ngaserin, S, Kale, S, Hassan, S, Merghani, S, Benamar, S, Muhammad, S, Badran, S, Elsahli, S, Heta, S, Hammouche, S, Baeesa, S, Paiella, S, Eldeen, S, Arkani, S, Mittal, S, Hirji, S, Tebha, S, Emile, S, Dbouk, S, Bandyopadhyay, S, Olori, S, Asirifi, S, Hailu, S, Ling, S, Newman, S, Ross, S, Wanjara, S, Kumar, S, Seneviratne, S, Tamburello, S, Suarez, S, Ingallinella, S, Irshaidat, S, Konswa, S, Mambrilla, S, Nasser, S, Parini, S, Pitoni, S, Ornaghi, S, Rodrigues, S, Abdelmohsen, S, Aitken, S, Tian, S, Badiani, S, Ahmad, S, Swed, S, Muthu, S, Lakpriya, S, Alzahrani, S, Mikalauskas, S, Lasrado, S, Satoskar, S, Bawa, S, Altiner, S, Garcia, S, Stevens, S, Demir, S, Ken-Amoah, S, Tranca, S, Ziemann, S, Awad, S, Atici, S, Subramaniam, S, Erel, S, Jiang, S, Efetov, S, Efremov, S, Katorkin, S, Valladares, S, Contreras, S, Meriç, S, Zenger, S, Safi, S, Leventoğlu, S, Elsalhawy, S, Shaikh, S, Sheik, S, Islam, S, Shamim, S, Waqar, S, Farid, S, Seraj, S, Sundarraju, S, Karandikar, S, Sambhwani, S, Chopra, S, Chowdhury, S, Laura, S, Ahmed, S, Wason, S, Tan, S, Fraser, S, Williams, S, Ghozy, S, Abdelmawgoud, S, Shehata, S, Sharma, S, Al-Touny, S, Ramzanali, S, Nah, S, Jansen, S, Rajan, S, Dindyal, S, Amin, S, Shoukrie, S, Karar, S, Patkar, S, Abdulsalam, S, Lin, S, Hegde, S, Fiorelli, S, Quaresima, S, Redondo, S, Palmisano, S, Ruggiero, S, Balogun, S, Cais, S, Cole, S, Federer, S, Le Roux, S, Ippoliti, S, Meneghini, S, Viola, S, Manfredelli, S, Novello, S, Gananadha, S, Mesli, S, Tani, S, Malik, S, Anastasiadou, S, Boligo, S, Esposito, S, Valanci, S, Xenaki, S, Pejkova, S, Trungu, S, Basu, S, Alkhatib, S, Pérez-Bertólez, S, Flores, S, Donoghue, S, Lunca, S, Orsoo, S, Potamianos, S, Devarakonda, S, Suresh, S, Croghan, S, Turi, S, Capella, S, Lucchini, S, Magnone, S, Salizzoni, S, Scabini, S, Scaringi, S, Cioffi, S, Seyfried, S, Degener, S, Potten, S, Taha-Mehlitz, S, Ali, S, Angamuthu, S, Mcaleer, S, Knight, S, White, S, Mantziari, S, Kykalos, S, Goh, S, Ibrahim, S, Elzwai, S, Bansal, S, Tripathy, S, Amrayev, S, Anwar, S, Banerjee, S, Thakar, S, Saeed, S, Venkatappa, S, Das, S, Techapongsatorn, S, Dube, S, Lee, S, González-Suárez, S, Henriques, S, Konjevoda, S, Gisbertz, S, Bravo, S, Mannan, S, Bukhari, S, Zafar, S, Batista, S, Chin, S, Arif, T, Lawal, T, Aktokmakyan, T, Osborn, T, Szakmany, T, Sztipits, T, Triantafyllou, T, Valadez, T, Singh, T, Khaliq, T, Patel, T, Fadalla, T, Jichi, T, Sammour, T, Al-Shaiji, T, Naggs, T, Barišić, T, Nikolouzakis, T, Bisgin, T, Perra, T, Uprak, T, Dagklis, T, Liakakos, T, Sidiropoulos, T, Adjeso, T, Dölker, T, Oung, T, Aherne, T, Diehl, T, Pinkney, T, Raymond, T, Rhomberg, T, Schmitz-Rixen, T, Madhuri, T, Lohmann, T, Yeoh, T, Zaimis, T, Bright, T, Vilz, T, Glowka, T, Board, T, Hardcastle, T, Cohnert, T, Mahečić, T, William, T, Klatte, T, Abbott, T, Watcyn-Jones, T, Mendes, T, Kulis, T, Sečan, T, Campagnaro, T, Frisoni, T, Simoncini, T, Violante, T, Safranovs, T, Risteski, T, Pang, T, Akinyemi, T, Yotsov, T, Laeke, T, Kochiyama, T, Sholadoye, T, Alekberli, T, Ezomike, U, Giustizieri, U, Grossi, U, Köksoy, Ü, Bork, U, Kisser, U, Ronellenfitsch, U, Saeed, U, Bracale, U, Jayarajah, U, Rauf, U, Bumbasirevic, U, Ferrer, U, Ahmed, U, Bello, U, Jogiat, U, Sadia, U, Galandarov, V, Narayanan, V, Calu, V, Bianchi, V, Ciniero, V, Tonini, V, Silvestri, V, Vijay, V, Dewan, V, Lohsiriwat, V, Thuduvage, V, Mousafeiris, V, Dragisic, V, Sasireka, V, Santric, V, Kusuma, V, Kolli, V, Alonso, V, De Simone, V, Picotti, V, Martínez, V, Panduro-Correa, V, Kakotkin, V, Angulo, V, Turrado-Rodriguez, V, Krishnamoorthy, V, Ban, V, Shah, V, Maiola, V, Giordano, V, La Vaccara, V, Lizzi, V, Papagni, V, Schiavone, V, Satchithanantham, V, Garcia-Virto, V, Jimenez, V, Kumar, V, Shelat, V, Bhat, V, Sodhai, V, Graziadei, V, Kutuzov, V, Stoyanov, V, Oktseloglou, V, Flis, V, Elhassan, W, Yang, W, Soon, W, Tashkandi, W, Al-Khyatt, W, Mabood, W, Bijou, W, Wijenayake, W, D, W, Krawczyk, W, Atkins, W, Bolton, W, White, W, Ceelen, W, Vagena, X, Gozal, Y, Baba, Y, Subramani, Y, Jansen, Y, Mittal, Y, Kara, Y, Zwain, Y, Noureldin, Y, Alawneh, Y, Aydin, Y, Lam, Y, Tang, Y, Lim, Y, Dean, Y, Tanas, Y, Su, Y, Fujimoto, Y, Altinel, Y, Frolova, Y, Oshodi, Y, Fadel, Z, Zahid, Z, Elahi, Z, Djama, Z, Zaheen, Z, Jawad, Z, Demetrashvili, Z, Gebremeskel, Z, Gudisa, Z, Alyami, Z, Garoufalia, Z, Li, Z, Zimak, Z, Radin, Z, and Balogh, Z
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general surgery ,acute care surgery ,Settore MED/18 - CHIRURGIA GENERALE ,climate change ,trauma ,Settore MED/40 - Ginecologia E Ostetricia ,environmental impact ,surgery ,Settore MED/31 - Otorinolaringoiatria ,None ,Medicine and Health Sciences ,Surgery ,operating theatre ,environment - Abstract
Background: Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods: This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low-middle-income countries. Results: In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of 'single-use' consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low-middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion: This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high- and low-middle-income countries.
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- 2023
15. Diagnostic outcome of pro bono neurogenetic diagnostic service in Sri Lanka: A wealth creation.
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Gonawala L, Wijekoon N, Attanayake D, Ratnayake P, Sirisena D, Gunasekara H, Dissanayake A, Keshavaraj A, Mohan C, Steinbusch HWM, Hoffman EP, Dalal A, and de Silva KRD
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- Humans, Sri Lanka, Molecular Diagnostic Techniques economics, Molecular Diagnostic Techniques standards, Molecular Diagnostic Techniques methods, Muscular Dystrophy, Duchenne diagnosis, Muscular Dystrophy, Duchenne genetics, Huntington Disease genetics, Huntington Disease diagnosis, Genetic Testing economics, Genetic Testing standards, Genetic Testing methods
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The inherited disease community in Sri Lanka has been widely neglected. This article aimed to present accumulated knowledge in establishing a pro bono cost-effective national, island-wide, free-of-charge molecular diagnostic service, suggesting a model for other developing countries. The project provided 637 molecular diagnostic tests and reports free of charge to a nation with limited resources. We pioneered the implementation of mobile clinics and home visits, where the research team acted as barefoot doctors with the concept of the doctor and the researcher at the patient's doorstep. Establishing pro bono, cost-effective molecular diagnostics is feasible in developing countries with limited resources and state funding through the effort of dedicated postgraduate students. This service could provide an accurate molecular diagnosis of Duchenne muscular dystrophy, Huntington's disease, Spinocerebellar ataxia, and Spinal muscular atrophy, a diagnostic yield of 54% (343/637), of which 43% (147/343) of the patients identified as amenable for available gene therapies. Initiated human resource development by double doctoral degree opportunities with international collaborations. Established a neurobiobank and a national registry in Sri Lanka, a rich and unique repository, wealth creation for translational collaborative research and sharing of information in neurological diseases, as well as a lodestar for aspiring initiatives from other developing countries., (© 2024. The Author(s).)
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- 2024
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16. Dirofilariasis Causing Pediatric Acute Scrotum: A Case Series and Review of the Literature.
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Wijekoon N, Antony D, Muhunthan T, and Samarasinghe M
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Introduction: Dirofilarial infestation has been reported as an extremely rare cause of pediatric acute scrotum. We aimed to evaluate clinical, radiological, and intraoperative findings of children who underwent surgical management for acute scrotum due to dirofilariasis in an endemic country., Materials and Methods: A retrospective study of patient records of children who underwent surgery for acute scrotum due to dirofilariasis between 2018 and 2022., Results: There were eight emergency presentations for acute scrotum due to dirofilariasis. Three presentations (37.5%) were not associated with scrotal pain. The median age at presentation was 59 (range: 19-100) months. Four patients (67.7%) underwent emergency scrotal exploration at the first presentation and another one during the second presentation. Recurrent episodes were seen in two patients who were initially managed nonsurgically with antibiotics alone. Ultrasonography was performed in all six patients and revealed a parasitic nodule in three (50%)., Conclusions: Dirofilariasis causing acute scrotum may cause significant diagnostic dilemma for clinicians. It may resemble idiopathic scrotal edema since it predominantly affects boys under 6 years of age and is painless in a significant proportion. However, left unoperated, it appears to have a high recurrence rate., Competing Interests: There are no conflicts of interest., (Copyright: © 2024 Journal of Indian Association of Pediatric Surgeons.)
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- 2024
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17. Treatment modalities for paediatric functional daytime lower urinary tract disorders: an updated review.
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Wijekoon N and Deshpande A
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Paediatric functional bladder disorders especially those causing daytime symptoms are a common cause of significant psychosocial and/or physical morbidity and impaired quality of life. Despite the availability of many therapeutic modalities, a significant number of children appear to be refractory to treatment and continue to have symptoms. In this review, we aim to evaluate the current evidence in the use of existing and novel therapeutic options for the management of daytime lower urinary tract disorders in children. We also aim to highlight the controversies around the terminology and diagnosis of paediatric lower urinary tract dysfunction (LUTD) and specific conditions. The article will then provide a reasonable critique of the existing and emerging treatment modalities in functional daytime LUTD in children including their mode of action, efficacy, indications, and recent advances. These include standard urotherapy, specific urotherapy comprised of biofeedback, alarm therapy and electrical neural stimulation and pharmacotherapy involving selective and non-selective anticholinergics, ß
3 adrenergic agonists, alpha blockers and botulinum toxin. A better understanding of this common clinical problem may help clinicians achieve better profiling of these children's diagnoses to further enable specific, targeted treatment., Competing Interests: The authors declare that there is no conflict of interest., (© The Author(s), 2024.)- Published
- 2024
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18. Title-molecular diagnostics of dystrophinopathies in Sri Lanka towards phenotype predictions: an insight from a South Asian resource limited setting.
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Wijekoon N, Gonawala L, Ratnayake P, Liyanage R, Amaratunga D, Hathout Y, Steinbusch HWM, Dalal A, Hoffman EP, and de Silva KRD
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- Adult, Humans, Child, Sri Lanka, Algorithms, Phenotype, Pathology, Molecular, Resource-Limited Settings
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Background: The phenotype of Duchenne muscular dystrophy (DMD) and Becker muscular dystrophy (BMD) patients is determined by the type of DMD gene variation, its location, effect on reading frame, and its size. The primary objective of this investigation was to determine the frequency and distribution of DMD gene variants (deletions/duplications) in Sri Lanka through the utilization of a combined approach involving multiplex polymerase chain reaction (mPCR) followed by Multiplex Ligation Dependent Probe Amplification (MLPA) and compare to the international literature. The current consensus is that MLPA is a labor efficient yet expensive technique for identifying deletions and duplications in the DMD gene., Methodology: Genetic analysis was performed in a cohort of 236 clinically suspected pediatric and adult myopathy patients in Sri Lanka, using mPCR and MLPA. A comparative analysis was conducted between our findings and literature data., Results: In the entire patient cohort (n = 236), mPCR solely was able to identify deletions in the DMD gene in 131/236 patients (DMD-120, BMD-11). In the same cohort, MLPA confirmed deletions in 149/236 patients [DMD-138, BMD -11]. These findings suggest that mPCR has a detection rate of 95% (131/138) among all patients who received a diagnosis. The distal and proximal deletion hotspots for DMD were exons 45-55 and 6-15. Exon 45-60 identified as a novel in-frame variation hotspot. Exon 45-59 was a hotspot for BMD deletions. Comparisons with the international literature show significant variations observed in deletion and duplication frequencies in DMD gene across different populations., Conclusion: DMD gene deletions and duplications are concentrated in exons 45-55 and 2-20 respectively, which match global variation hotspots. Disparities in deletion and duplication frequencies were observed when comparing our data to other Asian and Western populations. Identified a 95% deletion detection rate for mPCR, making it a viable initial molecular diagnostic approach for low-resource countries where MLPA could be used to evaluate negative mPCR cases and cases with ambiguous mutation borders. Our findings may have important implications in the early identification of DMD with limited resources in Sri Lanka and to develop tailored molecular diagnostic algorithms that are regional and population specific and easily implemented in resource limited settings., (© 2024. The Author(s).)
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- 2024
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19. Duchenne Muscular Dystrophy from Brain to Muscle: The Role of Brain Dystrophin Isoforms in Motor Functions.
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Wijekoon N, Gonawala L, Ratnayake P, Amaratunga D, Hathout Y, Mohan C, Steinbusch HWM, Dalal A, Hoffman EP, and de Silva KRD
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Brain function and its effect on motor performance in Duchenne muscular dystrophy (DMD) is an emerging concept. The present study explored how cumulative dystrophin isoform loss, age, and a corticosteroid treatment affect DMD motor outcomes. A total of 133 genetically confirmed DMD patients from Sri Lanka were divided into two groups based on whether their shorter dystrophin isoforms (Dp140, Dp116, and Dp71) were affected: Group 1, containing patients with Dp140, Dp116, and Dp71 affected (n = 98), and Group 2, containing unaffected patients (n = 35). A subset of 52 patients (Group 1, n = 38; Group 2, n = 14) was followed for up to three follow-ups performed in an average of 28-month intervals. The effect of the cumulative loss of shorter dystrophin isoforms on the natural history of DMD was analyzed. A total of 74/133 (56%) patients encountered developmental delays, with 66/74 (89%) being in Group 1 and 8/74 (11%) being in Group 2 ( p < 0.001). Motor developmental delays were predominant. The hip and knee muscular strength, according to the Medical Research Council (MRC) scale and the North Star Ambulatory Assessment (NSAA) activities, "standing on one leg R", "standing on one leg L", and "walk", declined rapidly in Group 1 ( p < 0.001 In the follow-up analysis, Group 1 patients became wheelchair-bound at a younger age than those of Group 2 ( p = 0.004). DMD motor dysfunction is linked to DMD mutations that affect shorter dystrophin isoforms. When stratifying individuals for clinical trials, considering the DMD mutation site and its impact on a shorter dystrophin isoform is crucial., Competing Interests: The authors declare no conflicts of interest.
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- 2023
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20. Integrated genomic, proteomic and cognitive assessment in Duchenne Muscular Dystrophy suggest astrocyte centric pathology.
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Wijekoon N, Gonawala L, Ratnayake P, Dissanayaka P, Gunarathne I, Amaratunga D, Liyanage R, Senanayaka S, Wijesekara S, Gunasekara HH, Vanarsa K, Castillo J, Hathout Y, Dalal A, Steinbusch HWM, Hoffman E, Mohan C, and de Silva KRD
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Introduction: Documented Duchenne Muscular Dystrophy (DMD) biomarkers are confined to Caucasians and are poor indicators of cognitive difficulties and neuropsychological alterations., Materials and Methods: This study correlates serum protein signatures with cognitive performance in DMD patients of South Asian origin. Study included 25 DMD patients aged 6-16 years. Cognitive profiles were assessed by Wechsler Intelligence Scale for Children. Serum proteome profiling of 1317 proteins was performed in eight DMD patients and eight age-matched healthy volunteers., Results: Among the several novel observations we report, better cognitive performance in DMD was associated with increased serum levels of MMP9 and FN1 but decreased Siglec-3, C4b, and C3b. Worse cognitive performance was associated with increased serum levels of LDH-H1 and PDGF-BB but reduced GDF-11, MMP12, TPSB2, and G1B. Secondly, better cognitive performance in Processing Speed (PSI) and Perceptual Reasoning (PRI) domains was associated with intact Dp116, Dp140, and Dp71 dystrophin isoforms while better performance in Verbal Comprehension (VCI) and Working Memory (WMI) domains was associated with intact Dp116 and Dp140 isoforms. Finally, functional pathways shared with Alzheimer's Disease (AD) point towards an astrocyte-centric model for DMD., Conclusion: Astrocytic dysfunction leading to synaptic dysfunction reported previously in AD may be a common pathogenic mechanism underlying both AD and DMD, linking protein alterations to cognitive impairment. This new insight may pave the path towards novel therapeutic approaches targeting reactive astrocytes., Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper, (© 2023 The Authors.)
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- 2023
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21. Therapeutic Implications of Some Natural Products for Neuroimmune Diseases: A Narrative of Clinical Studies Review.
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Wijeweera G, Wijekoon N, Gonawala L, Imran Y, Mohan C, and De Silva KRD
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Neuroimmune diseases are a group of disorders that occur due to the dysregulation of both the nervous and immune systems, and these illnesses impact tens of millions of people worldwide. However, patients who suffer from these debilitating conditions have very few FDA-approved treatment options. Neuroimmune crosstalk is important for controlling the immune system both centrally and peripherally to maintain tissue homeostasis. This review aims to provide readers with information on how natural products modulate neuroimmune crosstalk and the therapeutic implications of natural products, including curcumin, epigallocatechin-3-gallate (EGCG), ginkgo special extract, ashwagandha, Centella asiatica, Bacopa monnieri, ginseng, and cannabis to mitigate the progression of neuroimmune diseases, such as Alzheimer's disease, multiple sclerosis, amyotrophic lateral sclerosis, Parkinson's disease, depression, and anxiety disorders. The majority of the natural products based clinical studies mentioned in this study have yielded positive results. To achieve the expected results from natural products based clinical studies, researchers should focus on enhancing bioavailability and determining the synergistic mechanisms of herbal compounds and extracts, which will lead to the discovery of more effective phytomedicines while averting the probable negative effects of natural product extracts. Therefore, future studies developing nutraceuticals to mitigate neuroimmune diseases that incorporate phytochemicals to produce synergistic effects must analyse efficacy, bioavailability, gut-brain axis function safety, chemical modifications, and encapsulation with nanoparticles., Competing Interests: The authors declare that they have no conflicts of interest., (Copyright © 2023 Gayathri Wijeweera et al.)
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- 2023
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22. Gene therapy for selected neuromuscular and trinucleotide repeat disorders - An insight to subsume South Asia for multicenter clinical trials.
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Wijekoon N, Gonawala L, Ratnayake P, Sirisena D, Gunasekara H, Dissanayake A, Senanayake S, Keshavaraj A, Hathout Y, Steinbusch HWM, Mohan C, Dalal A, Hoffman E, and D de Silva KR
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Background: In this article, the authors discuss how they utilized the genetic mutation data in Sri Lankan Duchenne muscular dystrophy (DMD), Spinal muscular atrophy (SMA), Spinocerebellar ataxia (SCA) and Huntington's disease (HD) patients and compare the available literature from South Asian countries to identifying potential candidates for available gene therapy for DMD, SMA, SCA and HD patients., Methods: Rare disease patients (n = 623) with the characteristic clinical findings suspected of HD, SCA, SMA and Muscular Dystrophy were genetically confirmed using Multiplex Ligation Dependent Probe Amplification (MLPA), and single plex PCR. A survey was conducted in the "Wiley database on Gene Therapy Trials Worldwide" to identify DMD, SMA, SCA, and HD gene therapy clinical trials performed worldwide up to April 2021. In order to identify candidates for gene therapy in other neighboring countries we compared our findings with available literature from India and Pakistan which has utilized the same molecular diagnostic protocol to our study., Results: From the overall cohort of 623 rare disease patients with the characteristic clinical findings suspected of HD, SCA, SMA and Muscular Dystrophy, n = 343 (55%) [Muscular Dystrophy- 65%; (DMD-139, Becker Muscular Dystrophy -BMD-11), SCA type 1-3-53% (SCA1-61,SCA2- 23, SCA3- 39), HD- 52% (45) and SMA- 34% (22)] patients were positive for molecular diagnostics by MLPA and single plex PCR. A total of 147 patients in Sri Lanka amenable to available gene therapy; [DMD-83, SMA-15 and HD-49] were identified. A comparison of Sri Lankan finding with available literature from India and Pakistan identified a total of 1257 patients [DMD-1076, SMA- 57, and HD-124] from these three South Asian Countries as amenable for existing gene therapy trials. DMD, SMA, and HD gene therapy clinical trials (113 studies) performed worldwide up to April 2021 were concentrated mostly (99%) in High Income Countries (HIC) and Upper Middle-Income Countries (UMIC). However, studies on the potential use of anti-sense oligonucleotides (ASO) for treatment of SCAs have yet to reach clinical trials., Conclusion: Most genetic therapies for neurodegenerative and neuromuscular disorders have been evaluated for efficacy primarily in Western populations. No multicenter gene therapy clinical trial sites for DMD, SMA and HD in the South Asian region, leading to lack of knowledge on the safety and efficacy of such personalized therapies in other populations, including South Asians. By fostering collaboration between researchers, clinicians, patient advocacy groups, government and industry in gene therapy initiatives for the inherited-diseases community in the developing world would link the Global North and Global South and breathe life into the motto "Together we can make a difference"., Competing Interests: The authors declare that they have no competing interests., (© 2023 The Authors.)
- Published
- 2023
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23. Dirofilarial nodule as a differential diagnosis for subcutaneous lumps in children.
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Wijekoon N, Antony D, Muhunthan T, and Samarasinghe M
- Subjects
- Adult, Animals, Humans, Male, Female, Child, Child, Preschool, Diagnosis, Differential, Retrospective Studies, Scrotum, Dirofilariasis diagnosis, Dirofilariasis epidemiology, Dirofilariasis parasitology, Abdominal Wall
- Abstract
Purpose: Subcutaneous nodules in children are commonly caused by pilomatrixoma, dermoid cysts, soft tissue tumors, etc. Parasitic infections are reported to cause subcutaneous nodules and are infrequently described, mostly in the adult literature. We aim to describe the clinicopathological features of subcutaneous lumps caused by dirofilarial infestation in children in an endemic country., Methods: A retrospective analysis was performed of all patients presenting with the above condition to Lady Ridgeway Hospital from 2018 to 2022 and their relevant details were captured in a proforma., Results: There were 55 patients with a male to female ratio of 2:1. The mean age at presentation was 50 months (7-156 months). The mean duration was 97 days (1-820 days). The common sites involved were scrotum (30.9%), back (14.5%), abdominal wall (102.7%) and face (10.9%). The majority had a painless nodule (70.9%), while ten (18.2%) had features of acute inflammation. Thirty (55.5%) had preoperative ultrasonography which showed features of parasitic nodules in 26 (47.3%). Parasite was demonstrated in histopathological analysis only in 30 patients (54.5%)., Conclusion: Dirofilarial nodule should be considered in the differential diagnosis of subcutaneous lumps in children, especially in the endemic areas., (© 2022. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)
- Published
- 2022
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24. Generic and disease-specific health-related quality of life in patients with Hirschsprung disease: A systematic review and meta-analysis.
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Huizer V, Wijekoon N, Roorda D, Oosterlaan J, Benninga MA, van Heurn LE, Rajindrajith S, and Derikx JP
- Subjects
- Adolescent, Adult, Child, Child, Preschool, Constipation psychology, Humans, Infant, Infant, Newborn, Quality of Life psychology, Self Report, Young Adult, Fecal Incontinence etiology, Hirschsprung Disease surgery
- Abstract
Background: Patients with Hirschsprung disease (HD) are at risk of persistent constipation, fecal incontinence or recurrent enterocolitis after surgical treatment, which in turn may impact physical and psychosocial functioning. Generic health-related quality of life (HRQoL) and disease-specific health-related quality of life are relevant outcome measures to assess the impact of HD on the QoL of these patients., Aim: To summarize all available evidence on HRQoL of patients with HD after surgery and the impact of possible moderating factors., Methods: Pubmed, Web of Sciences, PsycInfo and Embase were searched with search terms related to 'Hirschsprung disease', 'Pediatrics' and 'Quality of life'. Mean and standard deviation of generic HRQoL overall and domain scores were extracted from each study, as well as data describing potential factors associated with QoL. Random effect models were used for meta-analytic aggregation of generic HRQoL scores. Meta-regression was used to assess the relationship between patient and clinical characteristics and generic HRQoL. Disease-specific HRQoL outcomes of patients with HD were systematically reviewed., Results: Seventeen articles were included in the systematic review ( n = 1137 patients) and 15 in the quantitative meta-analysis ( n = 1024 patients). Four studies reported disease-specific HRQoL. Patient's age ranged between 0 and 21 years. Meta-analytic aggregation showed a non-significantly impaired generic HRQoL ( d = -0.168 [95%CI: -0.481; 0.145], P = 0.293, I
2 = 94.9) in patients with HD compared to healthy controls. Physical ( d = -0.042 [95%CI: -0.419; 0.335], P = 0.829, I2 = 95.1), psychosocial ( d = -0.159 [95%CI: -0.458; 0.141], P = 0.299, I2 = 93.6) and social HRQoL ( d = -0.092 [95%CI: -0.642; 0.457], P = 0.742, I² = 92.3) were also not significantly lower compared to healthy controls. There was no relation between health-related outcomes and the sex of the patients and whether generic HRQoL was measured by parental proxy or self-report. Disease-specific complaints of patients with HD impaired physical HRQoL, but not psychosocial and social HRQoL., Conclusion: In this systematic review and meta-analysis, no evidence was found for impaired generic HRQoL in patients with HD compared to healthy controls, neither for moderating effects of sex, parental proxy or self-report., Competing Interests: Conflict-of-interest statement: All authors have no conflict of interest to disclose., (©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.)- Published
- 2022
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25. Biopiracy: Abolish Corporate Hijacking of Indigenous Medicinal Entities.
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Imran Y, Wijekoon N, Gonawala L, Chiang YC, and De Silva KRD
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- Agriculture, Biodiversity, Biotechnology, Humans, Seeds growth & development, Conservation of Natural Resources, Medicine, Traditional trends, Plants, Medicinal, Theft
- Abstract
Biopiracy as "a silent disease" is hardly detectable because it does not leave traces frequently. The corporate hijacking of food is the most important health hazard in this era; giant commercial enterprises are using intellectual property rights to patent indigenous medicinal plants, seeds, genetic resources, and traditional medicines. The new era of biotechnology relies on the genes of living organisms as raw materials. The "Gene Rush" has thus become similar to that of the old "Gold Rush." Sri Lanka has been spotted in the top 34 biodiversity hotspots globally. Moreover, localized in the tropics, human generations in Sri Lanka have utilized the array of plant species for herbal treatments and treatment of diseases. Sri Lanka after its 30-year civil war is moving towards a solid growth and conservation of the environment which is a major component in a sustainable development where the conservation of biodiversity plays a significant role. In this paper, we present an overview of typical cases of global biopiracy, bioprospecting via introduction of cost-effective deoxyribonucleic acid (DNA) fingerprinting and international protocol with Private-Public-People Partnership concept as excellent forms of utilization of natural resources. We propose certain perspectives as scientists towards abolishing biopiracy and also to foster the fair utilization of natural resources; since the economy of most developing countries is agriculture based, the gross domestic product of the developing countries could be increased by enhanced bioprospecting via introduction of cost-effective DNA fingerprinting technologies and thus not being a pray of corporate hijacking."Biopiracy is biological theft; illegal collection of indigenous plants by corporations who patent them for their own use" (Vandana Shiva)., Competing Interests: The authors declare that there are no conflicts of interest., (Copyright © 2021 Yoonus Imran et al.)
- Published
- 2021
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26. Model-Based Approach to Improve Clinical Outcomes in Neonates With Opioid Withdrawal Syndrome Using Real-World Data.
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Wijekoon N, Aduroja O, Biggs JM, El-Metwally D, and Gopalakrishnan M
- Subjects
- Electronic Health Records, Female, Hospitalization, Humans, Infant, Newborn, Length of Stay, Longitudinal Studies, Male, Methadone administration & dosage, Methadone adverse effects, Morphine administration & dosage, Morphine adverse effects, Retrospective Studies, Analgesics, Opioid administration & dosage, Analgesics, Opioid adverse effects, Substance Withdrawal Syndrome drug therapy
- Abstract
At least 60% of the neonates with opioid withdrawal syndrome (NOWS) require morphine to control withdrawal symptoms. Currently, the morphine dosing strategies are empiric, not optimal and associated with longer hospital stay. The aim of the study was to develop a quantitative, model-based, real-world data-driven approach to morphine dosing to improve clinical outcomes, such as reducing time on treatment. Longitudinal morphine dose, clinical response (Modified Finnegan Score (MFS)), and baseline risk factors were collected using a retrospective cohort design from the electronic medical records of neonates with NOWS (N = 177) admitted to the University of Maryland Medical Center. A dynamic linear mixed effects model was developed to describe the relationship between MFS and morphine dose adjusting for baseline risk factors using a split-sample data approach (70% training: 30% test). The training model was evaluated in the test dataset using a simulation based approach. Maternal methadone and benzodiazepine use, and race were significant predictors of the MFS response. Positive autocorrelations of 0.56 and 0.12 were estimated between consecutive MFS responses. On an average, for a 1,000 μg increase in the morphine dose, the MFS decreased by 0.3 units. The model evaluation showed that observed and predicted median time on treatment were similar (13.0 vs. 13.8 days). A model-based framework was developed to describe the MFS-morphine dose relationship using real-world data that could potentially be used to develop an adaptive, individualized morphine dosing strategy to improve clinical outcomes in infants with NOWS., (© 2020 The Authors. Clinical Pharmacology & Therapeutics © 2020 American Society for Clinical Pharmacology and Therapeutics.)
- Published
- 2021
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27. Tolerability and effectiveness of every-other-day atorvastatin compared to daily atorvastatin in patients with muscle symptoms: A randomized controlled clinical trial.
- Author
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Wijekoon N, Wijekoon S, Bulugahapitiya U, Pathirana N, Wickramasinghe M, Paranavitane S, Kottage A, Wijayawardena S, Karunarathne M, Samarasinghe M, Sumanadasa S, and Herath Y
- Abstract
Despite limited evidence, non-daily dosing of statins is recommended for managing muscle symptoms associated with statin therapy. We assessed the tolerability and effectiveness of every-other-day atorvastatin compared to daily atorvastatin in patients having muscle symptoms associated with atorvastatin therapy. A parallel-group, outcome-assessment-blinded, randomized controlled clinical trial was conducted at Colombo South Teaching Hospital, Sri Lanka. Patients with muscle pain, tenderness or cramps alone or in combination for ≥2 weeks while on daily atorvastatin for ≥1 month, with no alternative cause, were recruited. Patient's regular atorvastatin dose was given every-other-day to those in intervention group (IG) and daily to those in control group (CG). Primary outcomes were assessed at 24 weeks and included composite of myalgia and myositis, LDL-cholesterol level and percentage reduction of LDL-cholesterol from baseline. Number recruited was 49 to IG (women:79.6%; mean-age:60.6 ± 8.7years) and 52 to CG (women:73.1%; mean-age:61.7 ± 9.8years). Mean atorvastatin dose per day was 8.6 mg (SD = 4 mg) and 17.6 mg (SD = 8.4 mg) in IG and CG, respectively. Composite of myalgia and myositis at 24 weeks was 79.6% in IG and 69.2% in CG (OR = 1.7, 95% CI 0.7-4.3; p = 0.234). IG failed to show noninferiority for mean LDL-cholesterol (difference:0.31 mmol/L; upper limit 97.5% CI:0.61 mmol/L; p for noninferiority = 0.989) and for mean percentage reduction of LDL-cholesterol from baseline (difference:3.13%; upper limit 97.5% CI:15.5%; p for noninferiority = 0.718). At 24 weeks, mean creatine kinase and discomfort due to muscle symptoms (assessed with Visual Analogue Scale) were not different between the two groups. Findings of this study do not favor every-other-day atorvastatin as an option for managing patients with muscle symptoms associated with atorvastatin therapy., (© 2020 The Authors.)
- Published
- 2020
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28. A biobank in Sri Lanka that links East and West.
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Wijekoon N, Gonawala L, Wijesinghe P, Steinbusch HW, Mohan C, and de Silva KRD
- Subjects
- Academic Medical Centers organization & administration, Academic Medical Centers statistics & numerical data, Humans, Sri Lanka, Biological Specimen Banks organization & administration, Biological Specimen Banks statistics & numerical data, Biotechnology organization & administration, Biotechnology statistics & numerical data, Nervous System Diseases diagnosis, Nervous System Diseases genetics, Neurosciences organization & administration, Neurosciences statistics & numerical data
- Published
- 2020
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29. What We Fail to See in Neuro-Genetic Diseases: A Bird's Eye View from the Developing World.
- Author
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Samaranayake N, Dissanayaka P, Gunarathna I, Gonawala L, Wijekoon N, Rathnayake P, Sirisena D, Gunasekara H, Dissanayake A, Senanayake S, Anand A, Satyamoorthy K, Dalal A, and de Silva KRD
- Abstract
Background: Progressive neurological genetic diseases are not rare. They cause psychosocial damages to its victims. This article focuses on common psychosocial issues faced by those from the developing world., Methods: A multicentre observational survey of 246 patients from teaching hospitals in Sri Lanka. Participants were clinically and genetically confirmed by neurologists and the Interdisciplinary Centre for Innovation in Biotechnology and Neuroscience (ICIBN) respectively from 2014 to 2018. Convenience sample with random geographical distribution. Factors were equally weighted. ANOVA, Student's t-test and chi-square analysis were used. Statistical Software R Statistics-version 3.5 and one-sample t-test with CI = 95% was used. This study meets the ethical guidelines of the local institutional review boards which are in compliance with the Helsinki Declaration., Results: Sample included 184 males and 62 females of 3-76 years with either Duchenne muscular dystrophy (n=121), spinocerebellar ataxia ( n = 87) or Huntington disease ( n = 38). Mean income of the affected is lower than the standard average monthly income ( P ≤ .001). Consultation visits depend on the monthly income (CI 20421.074-34709.361; P ≤ .001)., Conclusion: Poverty is inversely proportionate to the patients' living conditions. As developing countries are financially challenged, it is a societal challenge to rebuild our values to enhance their living status., Competing Interests: The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article., (© 2020 Indian Academy of Neurosciences (IAN).)
- Published
- 2020
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30. Surgical management of perianal abscess in neonates and infants.
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Tan Tanny SP, Wijekoon N, Nataraja RM, Lynch A, and Pacilli M
- Subjects
- Child, Drainage, Humans, Infant, Infant, Newborn, Male, Recurrence, Retrospective Studies, Treatment Outcome, Abscess surgery, Anus Diseases surgery, Rectal Fistula surgery, Skin Diseases
- Abstract
Background: The optimal management of perianal abscess in neonates and infants remains unclear, including the need for laying open of the fistula and the role of microscopy and culture studies (MCS). We aimed to report the recurrence rate following incision and drainage alone (I&D) compared to incision and drainage with laying open of the fistula (I&DF) and to determine the value of MCS in perianal abscess management., Methods: Following ethical approval (16326Q), a 10-year (2007-2017) review of children younger than 1 year presenting with a perianal abscess was performed. Presence of a fistula was sought in all patients. Data are presented as number of cases (%), median (range) and analysed using Fisher's exact test and Mann-Whitney U-test. P-values of <0.05 were considered significant., Results: We identified 108 patients (107 (99.1%) males) with 111 abscesses (three bilateral); 26 in I&D group and 85 in I&DF group. Initial abscess occurred to the right of midline in 64 cases (58%) and to the left of midline in 47 cases (42%). Twenty-two (20%) recurred after 30 (6-372) days. Sixty-five (59%) had MCS performed. Recurrence was higher in I&D group (9/26) versus I&DF group (13/85) (P = 0.04 (relative risk 2.2, 95% confidence interval 1.0-4.5)). There was no difference in recurrence within each group between patients with or without MCS (I&D group, P = 0.1; I&DF group, P = 0.3)., Conclusion: The recurrence of surgically managed perianal abscess is lower when a fistula is identified and laid open at the initial operation. There is little value of MCS in the management of paediatric perianal abscess., (© 2020 Royal Australasian College of Surgeons.)
- Published
- 2020
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31. Clinical state of the paediatric acute scrotum in south-eastern Victoria.
- Author
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Tan Tanny SP, Wijekoon N, Pacilli M, and Nataraja RM
- Subjects
- Acute Pain diagnosis, Adolescent, Age Factors, Child, Child, Preschool, Epididymitis complications, Epididymitis therapy, Humans, Infant, Male, Orchiectomy, Orchitis complications, Orchitis therapy, Prospective Studies, Spermatic Cord Torsion complications, Spermatic Cord Torsion therapy, Victoria, Acute Pain etiology, Epididymitis diagnosis, Orchitis diagnosis, Scrotum, Spermatic Cord Torsion diagnosis
- Abstract
Background: Acute scrotal pain is a common paediatric surgical presentation. Delays in treatment can result in testicular loss from torsion. It is unclear where delays occur. We aimed to investigate presentations with an acute scrotum to identify any potential areas of delay., Methods: We conducted a prospective study (April 2017-November 2018) of paediatric patients (<18 years) presenting with acute scrotal pain. Data collected included: patient demographics, history/examination findings, mode of presentation, clinical timeline details and outcomes., Results: A total of 107 acute scrotum presentations were identified: 58 (54.2%) testicular appendage torsion, 23 (21.5%) testicular torsion, 6 (5.6%) epididymo-orchidits and 20 (18.7%) other diagnoses. Median age at presentation was 11 years (4 months-16 years). Fifty-seven (53.3%) underwent emergency surgery, of whom 23 (40.4%) had testicular torsion, with 2 requiring orchidectomy. Median time from onset of symptoms to seeking medical opinion was 5.5 (0-135) h. Once assessed by a medical professional, the route to paediatric surgical review via general practitioner (GP) and local emergency department (ED) to paediatric ED was 4.84 (1.67-24.5) h; via GP to paediatric ED was 2.58 (0.75-25.5) h; via local ED to paediatric ED was 2.25 (1-7.75) h; and directly to paediatric ED was 0.45 (0-1.42) h., Conclusion: Delays in assessment and treatment of acute scrotal pain occur from the time parents are aware of symptoms to seeking medical opinion. Education to increase awareness may reduce time delays. GPs should refer patients directly to a paediatric ED. Local EDs should manage paediatric cases as per the local surgeons' skill base., (© 2019 Royal Australasian College of Surgeons.)
- Published
- 2019
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32. Validation of the Sinhala Version of the Addenbrooke's Cognitive Examination-Revised for the Detection of Dementia in Sri Lanka: Comparison with the Mini-Mental Status Examination and the Montreal Cognitive Assessment.
- Author
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Suriyakumara V, Srikanth S, Wijeyekoon R, Gunasekara H, Muthukuda C, Rajapaksha D, Weerasekara R, Gonawala L, Wijekoon N, and de Silva KRD
- Subjects
- Adult, Aged, Aged, 80 and over, Female, Humans, Male, Middle Aged, Observer Variation, Psychometrics, Reference Values, Reproducibility of Results, Socioeconomic Factors, Sri Lanka, Translations, Cognition, Dementia diagnosis, Dementia psychology, Mental Status and Dementia Tests, Neuropsychological Tests
- Abstract
Background: Sri Lanka is a rapidly aging country, where dementia prevalence will increase significantly in the future. Thus, inexpensive and sensitive cognitive screening tools are crucial., Objectives: To assess the reliability, validity, and diagnostic accuracy of the Sinhalese version of the Addenbrooke's Cognitive Examination-Revised (ACE-R s)., Method: The ACE-R was translated into Sinhala with cultural and linguistic adaptations and administered, together with the Sinhala version of the Montreal Cognitive Assessment (MoCA), to 99 patients with dementia and 93 gender-matched controls., Results: The ACE-R s cutoff score for dementia was 80 (sensitivity 91.9%, specificity 76.3%). The areas under the curve for the ACE-R s, Mini-Mental State Examination (MMSE) and MoCA were 0.90, 0.86, and 0.86, respectively. The -ACE-R s had good interrater reliability (intraclass correlation = 0.94), test-retest reliability (intraclass correlation = 0.99), and internal consistency (Cronbach's α = 0.8442)., Conclusions: The ACE-R s is sensitive, specific and reliable to detect dementia in persons aged ≥50 years in a Sinhala-speaking population and its diagnostic accuracy is superior to previously validated tools (MMSE and MoCA)., (© 2019 S. Karger AG, Basel.)
- Published
- 2019
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33. Effect of Combined Treatment with MLC601 (NeuroAiDTM) and Rehabilitation on Post-Stroke Recovery: The CHIMES and CHIMES-E Studies.
- Author
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Suwanwela NC, Chen CLH, Lee CF, Young SH, Tay SS, Umapathi T, Lao AY, Gan HH, Baroque Ii AC, Navarro JC, Chang HM, Advincula JM, Muengtaweepongsa S, Chan BPL, Chua CL, Wijekoon N, de Silva HA, Hiyadan JHB, Wong KSL, Poungvarin N, Eow GB, and Venketasubramanian N
- Subjects
- Aged, Asia, Combined Modality Therapy, Disability Evaluation, Drugs, Chinese Herbal adverse effects, Female, Humans, Independent Living, Male, Middle Aged, Multicenter Studies as Topic, Neuroprotective Agents adverse effects, Randomized Controlled Trials as Topic, Recovery of Function, Stroke diagnosis, Stroke physiopathology, Stroke Rehabilitation adverse effects, Time Factors, Treatment Outcome, Drugs, Chinese Herbal therapeutic use, Neuroprotective Agents therapeutic use, Stroke therapy, Stroke Rehabilitation methods
- Abstract
Background and Purpose: MLC601 has been shown in preclinical studies to enhance neurorestorative mechanisms after stroke. The aim of this post hoc analysis was to assess whether combining MLC601 and rehabilitation has an effect on improving functional outcomes after stroke., Methods: Data from the CHInese Medicine NeuroAiD Efficacy on Stroke (CHIMES) and CHIMES-Extension (CHIMES-E) studies were analyzed. CHIMES-E was a 24-month follow-up study of subjects included in CHIMES, a multi-centre, double-blind placebo-controlled trial which randomized subjects with acute ischemic stroke, to either MLC601 or placebo for 3 months in addition to standard stroke treatment and rehabilitation. Subjects were stratified according to whether they received or did not receive persistent rehabilitation up to month (M)3 (non- randomized allocation) and by treatment group. The modified Rankin Scale (mRS) and Barthel Index were assessed at month (M) 3, M6, M12, M18, and M24., Results: Of 880 subjects in CHIMES-E, data on rehabilitation at M3 were available in 807 (91.7%, mean age 61.8 ± 11.3 years, 36% female). After adjusting for prognostic factors of poor outcome (age, sex, pre-stroke mRS, baseline National Institute of Health Stroke Scale, and stroke onset-to-study-treatment time), subjects who received persistent rehabilitation showed consistently higher treatment effect in favor of MLC601 for all time points on mRS 0-1 dichotomy analysis (ORs 1.85 at M3, 2.18 at M6, 2.42 at M12, 1.94 at M18, 1.87 at M24), mRS ordinal analysis (ORs 1.37 at M3, 1.40 at M6, 1.53 at M12, 1.50 at M18, 1.38 at M24), and BI ≥95 dichotomy analysis (ORs 1.39 at M3, 1.95 at M6, 1.56 at M12, 1.56 at M18, 1.46 at M24) compared to those who did not receive persistent rehabilitation., Conclusions: More subjects on MLC601 improved to functional independence compared to placebo among subjects receiving persistent rehabilitation up to M3. The larger treatment effect of MLC601 was sustained over 2 years which supports the hypothesis that MLC601 combined with rehabilitation might have beneficial and sustained effects on neuro-repair processes after stroke. There is a need for more data on the effect of combining rehabilitation programs with stroke recovery treatments., (© 2018 The Author(s) Published by S. Karger AG, Basel.)
- Published
- 2018
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34. Prognostic Factors and Pattern of Long-Term Recovery with MLC601 (NeuroAiD™) in the Chinese Medicine NeuroAiD Efficacy on Stroke Recovery - Extension Study.
- Author
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Venketasubramanian N, Lee CF, Young SH, Tay SS, Umapathi T, Lao AY, Gan HH, Baroque Ii AC, Navarro JC, Chang HM, Advincula JM, Muengtaweepongsa S, Chan BP, Chua CL, Wijekoon N, de Silva HA, Hiyadan JH, Suwanwela NC, Wong KS, Poungvarin N, Eow GB, and Chen CL
- Subjects
- Aged, Asia, Disability Evaluation, Double-Blind Method, Drugs, Chinese Herbal adverse effects, Female, Humans, Male, Middle Aged, Neuroprotective Agents adverse effects, Odds Ratio, Recovery of Function, Risk Factors, Stroke diagnosis, Stroke physiopathology, Stroke psychology, Stroke Rehabilitation adverse effects, Time Factors, Treatment Outcome, Drugs, Chinese Herbal therapeutic use, Neuroprotective Agents therapeutic use, Stroke drug therapy, Stroke Rehabilitation methods
- Abstract
Background: The Chinese Medicine NeuroAiD Efficacy on Stroke recovery - Extension (CHIMES-E) study is among the few acute stroke trials with long-term outcome data. We aimed to evaluate the recovery pattern and the influence of prognostic factors on treatment effect of MLC601 over 2 years., Methods: The CHIMES-E study evaluated the 2 years outcome of subjects aged ≥18 years with acute ischemic stroke, National Institutes of Health Stroke Scale (NIHSS) score 6-14, pre-stroke modified Rankin Scale (mRS) score ≤1 included in a multicenter, randomized, double-blind, placebo-controlled trial of MLC601 for 3 months. Standard stroke care and rehabilitation were allowed during follow-up with mRS score being assessed in-person at month (M) 3 and by telephone at M1, M6, M12, M18 and M24., Results: Data from 880 subjects were analyzed. There was no difference in baseline characteristics between treatment groups. The proportion of subjects with mRS score 0-1 increased over time in favor of MLC601 most notably from M3 to M6, thereafter remaining stable up to M24, while the proportion deteriorating to mRS score ≥2 remained low at all time points. Older age (p < 0.01), female sex (p = 0.06), higher baseline NIHSS score (p < 0.01) and longer onset to treatment time (OTT; p < 0.01) were found to be predictors of poorer outcome at M3. Greater treatment effect, with more subjects improving on MLC601 than placebo, was seen among subjects with 2 or more prognostic factors (OR 1.65 at M3, 1.78 at M6, 1.90 at M12, 1.65 at M18, 1.39 at M24), especially in subjects with more severe stroke or longer OTT., Conclusions: The sustained benefits of MLC601 over 2 years were due to more subjects improving to functional independence at M6 and beyond compared to placebo. Selection of subjects with poorer prognosis, particularly those with more severe NIHSS score and longer OTT delay, as well as a long follow-up period, may improve the power of future trials investigating the treatment effect of neuroprotective or neurorestorative therapies., (© 2016 The Author(s) Published by S. Karger AG, Basel.)
- Published
- 2017
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35. Differences in expression of Wnt antagonist Dkk1 in healthy versus pathological bone samples.
- Author
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Ray S, Khassawna TE, Sommer U, Thormann U, Wijekoon ND, Lips K, Heiss C, and Alt V
- Subjects
- Adult, Aged, Animals, Chondrocytes chemistry, Female, Humans, Male, Middle Aged, Osteocytes chemistry, Rats, Sprague-Dawley, Sensitivity and Specificity, Bone and Bones pathology, Intercellular Signaling Peptides and Proteins analysis, Osteoarthritis pathology
- Abstract
Wnt/β-catenin signalling components was shown to affect bone cells function including chondrocytes.Secreted Dkk1, a potent osteogenesis inhibiting factor mediates bone loss in diseased bones by suppressing the biological actions of Wnt proteins. In addition, increased Dkk1 signalling inhibits chondrogenesis in new bone formation. Recent findings also show there exists a cross-talk between the chondrocytes and the cells of the osteoblast lineage, which are the most affected cell types in muskuloskeletal disorders. This study investigated whether spatial expression of Dkk1 is confined to only osteoblasts, osteocytes or chondrocytes. The second objective was to detect a difference in the Dkk1 expression pattern in healthy subjects when compared to pathological state. To elucidate the cell specificity of Dickkopf-1 (Dkk1) in healthy bones, samples from female Sprague-Dawley rats were tested against two different antibodies with the two most widely accepted visualization system (ABC and Envision). The findings show Dkk1 specificity predominantly for osteoblasts, chondrocytes and osteocytes depending upon the antibody used. In addition, Dkk1 expression was evaluated in different cells of human osteoarthritis (OA) and rheumatoid arthritis (OA) patients. Its overexpression in pathologic state also suggests the role of Dkk1 in bone formation. This is scientifically and clinically important in studying the effect of Dkk1 in bone healing and in designing treatments for patients with compromised bone status. Taking into consideration the paradigm that cartilage and subchondral bone behave as an interconnected functional unit, normalization of cell behaviour in one compartment may have benefits in both tissues., (© 2016 The Authors Journal of Microscopy © 2016 Royal Microscopical Society.)
- Published
- 2017
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36. Dystrophin induced cognitive impairment: mechanisms, models and therapeutic strategies.
- Author
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Anand A, Tyagi R, Mohanty M, Goyal M, Silva KR, and Wijekoon N
- Abstract
Existence of conserved domains in dystrophin and its associated complexes provide an opportunity to understand the role of dystrophin associated signalling and its association with neuronal metabolism in a variety of model organisms. We critically reviewed the studies till 2013 through established search engines and databases. Thus, we review the role of dystrophin and its isoforms in different animal models at developmental stages in the neuronal metabolism to enhance the therapeutic strategies. Dystrophin interacts with other proteins in such a way that, when affected, it results in co-morbidities including autism and other neuropsychiatric disorders. It is speculated that various signalling molecules may converge to disrupt neuronal metabolism not adequately studied. TGF-β, RhoGAP and CAM mediated signalling molecules are the chief cause of mortalities due to respiratory and cardiac involvement but remain underevaluated targets for cognitive impairment in DMD/BMD. Manipulation of these signalling pathways could be potent intervention in dystrophin induced cognitive impairment while complementary therapeutic approaches may also be helpful in the treatment of cognitive impairment associated with DMD/BMD.
- Published
- 2015
- Full Text
- View/download PDF
37. Disease-related knowledge in inflammatory bowel disease: experience of a tertiary care centre in a developing country in South Asia.
- Author
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Subasinghe D, Wijekoon NS, Nawarathne NM, and Samarasekera DN
- Subjects
- Adult, Aged, Colitis, Ulcerative therapy, Crohn Disease therapy, Developing Countries, Female, Humans, Male, Middle Aged, Professional-Patient Relations, Sri Lanka, Surveys and Questionnaires, Colitis, Ulcerative diagnosis, Crohn Disease diagnosis, Inflammatory Bowel Diseases diagnosis, Inflammatory Bowel Diseases therapy, Patient Education as Topic methods
- Abstract
Introduction: Disease-related knowledge plays a critical role in facilitating patients' acceptance of their diagnosis and compliance with active participation in the treatment of inflammatory bowel disease (IBD). The aim of this study was to analyse the deficits in knowledge for future health education programmes., Methods: A validated questionnaire was used to assess and analyse disease-related knowledge among patients with ulcerative colitis (UC) and Crohn's disease who attended outpatient gastroenterology clinics of a tertiary care hospital in Sri Lanka., Results: There were 184 patients (83 males) with a mean age of 44.5 (range 20-78) years. 83.2 percent of the patients had UC. The mean duration of IBD was 8.17 (range 1-28) years, and 33.7 percent of the patients had IBD for over ten years. The mean Crohn's and Colitis Knowledge questionnaire score was 6.86. The majority (68.5 percent) of the patients were aware that sulfasalazine can be used to reduce exacerbations. There was no statistical difference in disease-related knowledge between genders, but the level of education showed a significant difference. Only 14.1 percent of patients were aware that prolonged IBD is a risk factor for colorectal cancer and that screening for colorectal cancer is important. 9.2 percent of the study population was aware of restorative proctocolectomy., Conclusion: There is a lack of knowledge regarding colorectal cancer risk and surgical interventions. There was no significant difference in the knowledge scores between genders but there was a significant association with the educational level.
- Published
- 2010
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