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This narrative review provides a summary introduction to the relationship between stroke and physical and cognitive frailty syndromes and the neuro-inflammatory similarities (including inflammaging) between the two. The review argues the potential effects of Post COVID-19 Neurological Syndrome (PCNS, also known as Long COVID) with similar pathophysiology. Many patients who have suffered from acute stroke experience long-lasting symptoms affecting several organs including fatigue, brain fog, reduced physical activity, loss of energy, and loss of cognitive reserve, culminating in the loss of independence and poor quality of life. This is very similar to the emerging reports of PCNS from different parts of the world. Stroke, particularly in older adults with comorbidities appears to impact the health and welfare of patients by reducing central neuronal input and neuromuscular function, with muscular atrophy and neuropsychiatric complications. The cumulative effects can potentially lead to a range of physical and cognitive frailty syndromes, which, in many cases may be attributed to persistent, maladapted, low grade, chronic inflammation. Meanwhile, post-COVID-19 Neurological Syndrome (also known as Long COVID Syndrome) appears to share a similar trajectory, adding further urgency for investigations into the mechanisms underlying this constellation of symptoms.
Ebrahim Bani Hassan; Steven Phu; Elyce Warburton; Nihara Humaith; Tissa Wijeratne. Frailty in Stroke; a Narrated Review. Life 2021, 11, 891 .
AMA StyleEbrahim Bani Hassan, Steven Phu, Elyce Warburton, Nihara Humaith, Tissa Wijeratne. Frailty in Stroke; a Narrated Review. Life. 2021; 11 (9):891.
Chicago/Turabian StyleEbrahim Bani Hassan; Steven Phu; Elyce Warburton; Nihara Humaith; Tissa Wijeratne. 2021. "Frailty in Stroke; a Narrated Review." Life 11, no. 9: 891.
Every five minutes someone in the world is diagnosed with multiple sclerosis
Lakshini Gunasekera; Tissa Wijeratne. Keep S’Myelin: World Brain Day 2021 Editorial for Residents and Junior Doctors Page—Neurology International MDPI. Neurology International 2021, 13, 402 -403.
AMA StyleLakshini Gunasekera, Tissa Wijeratne. Keep S’Myelin: World Brain Day 2021 Editorial for Residents and Junior Doctors Page—Neurology International MDPI. Neurology International. 2021; 13 (3):402-403.
Chicago/Turabian StyleLakshini Gunasekera; Tissa Wijeratne. 2021. "Keep S’Myelin: World Brain Day 2021 Editorial for Residents and Junior Doctors Page—Neurology International MDPI." Neurology International 13, no. 3: 402-403.
Tissa Wijeratne; William Carroll. World Brain Day 2021: Global campaign to stop multiple sclerosis. Multiple Sclerosis Journal 2021, 27, 1318 -1319.
AMA StyleTissa Wijeratne, William Carroll. World Brain Day 2021: Global campaign to stop multiple sclerosis. Multiple Sclerosis Journal. 2021; 27 (9):1318-1319.
Chicago/Turabian StyleTissa Wijeratne; William Carroll. 2021. "World Brain Day 2021: Global campaign to stop multiple sclerosis." Multiple Sclerosis Journal 27, no. 9: 1318-1319.
The use of video and music as an intrinsic, dissociative attentional stimulus during exercise is thought to distract from the physical discomfort of exercise, and contribute to improved exercise adherence; however, the effects of video-based feedback and engagement during pedaling on exercise performance and motivation are poorly understood. The aims of the present study were twofold. Firstly, to develop a novel video-based engagement regime for pedaling that links pedaling cadence with the play rate of a video, and secondly, to employ an instrumented pedaling device to assess the influence of the video engagement paradigm on cadence performance and exercise motivation. Eighteen healthy subjects participated in 15-min-duration pedaling sessions while targeting a specific low cadence (60 rotations per minute) and high cadence (100 rotations per minute), including pedaling with the provision of (i) target pedaling cadence information only, (ii) visual feedback on cadence control, including pedaling duration, pedaling cadence, and cadence deviation from target, and (iii) real-time engagement, which involved pedaling at the target speed to maintain the playback rate of a pre-recorded video. Cadence deviation from the target was evaluated, and self-reported exercise motivation examined with a post-exercise survey. Pedaling-cadence deviations significantly reduced with cadence feedback at both low and high cadence (p< 0.05). Participants reported enjoying feedback and video-based engagement during pedaling, with 83% of participants feeling that engagement motivated them to perform pedaling-based exercise. In conclusion, real-time cadence control feedback and video-based engagement during pedaling for healthy individuals may improve performance in targeted pedaling tasks. Through dissociation from the physical cues associated with exercise and fatigue, feedback and engagement may ultimately increase enjoyment and exercise compliance and adherence of pedaling-based exercise. The findings may be useful in prescription and maintenance of targeted pedaling exercises for stroke rehabilitation and exercise therapy.
Mukesh Soni; Tissa Wijeratne; David Ackland. The Effect of Real-Time Video-Based Engagement and Feedback during Pedaling on Cadence Control and Exercise Motivation: A Proof-of-Concept Study. Bioengineering 2021, 8, 95 .
AMA StyleMukesh Soni, Tissa Wijeratne, David Ackland. The Effect of Real-Time Video-Based Engagement and Feedback during Pedaling on Cadence Control and Exercise Motivation: A Proof-of-Concept Study. Bioengineering. 2021; 8 (7):95.
Chicago/Turabian StyleMukesh Soni; Tissa Wijeratne; David Ackland. 2021. "The Effect of Real-Time Video-Based Engagement and Feedback during Pedaling on Cadence Control and Exercise Motivation: A Proof-of-Concept Study." Bioengineering 8, no. 7: 95.
In this narrated review, we draw attention to the use of happiness as a novel outcome measure in clinical research studies regarding patients with stroke. Commonly used outcome measures in clinical trials in stroke rehabilitation include the modified Rankin Score (mRS), Functional Impairment Measures (FIM), Barthel Index and quality of life (QoL). Despite being a part of QoL, happiness is arguably a significant construct on its own. While QoL assesses perceptions of various extrinsic aspects of life, happiness may be used as a measure of subjective enjoyment of life after an illness. We review the literature discussing the use of happiness as a formal outcome measure in stroke care and subacute and long-term stroke rehabilitation. Ultimately we recommend the wider use of happiness as an outcome measure where appropriate in these settings.
Tissa Wijeratne; Carmela Sales; Chanith Wijeratne; Mihajlo Jakovljevic. Happiness: A Novel Outcome Measure in Stroke? Therapeutics and Clinical Risk Management 2021, ume 17, 747 -754.
AMA StyleTissa Wijeratne, Carmela Sales, Chanith Wijeratne, Mihajlo Jakovljevic. Happiness: A Novel Outcome Measure in Stroke? Therapeutics and Clinical Risk Management. 2021; ume 17 ():747-754.
Chicago/Turabian StyleTissa Wijeratne; Carmela Sales; Chanith Wijeratne; Mihajlo Jakovljevic. 2021. "Happiness: A Novel Outcome Measure in Stroke?" Therapeutics and Clinical Risk Management ume 17, no. : 747-754.
Tissa Wijeratne; William Carroll. World Brain Day 2021: Join us to “Stop Multiple Sclerosis”: A World Federation of Neurology and Multiple Sclerosis International Federation Collaboration. Canadian Journal of Neurological Sciences / Journal Canadien des Sciences Neurologiques 2021, 1 -2.
AMA StyleTissa Wijeratne, William Carroll. World Brain Day 2021: Join us to “Stop Multiple Sclerosis”: A World Federation of Neurology and Multiple Sclerosis International Federation Collaboration. Canadian Journal of Neurological Sciences / Journal Canadien des Sciences Neurologiques. 2021; ():1-2.
Chicago/Turabian StyleTissa Wijeratne; William Carroll. 2021. "World Brain Day 2021: Join us to “Stop Multiple Sclerosis”: A World Federation of Neurology and Multiple Sclerosis International Federation Collaboration." Canadian Journal of Neurological Sciences / Journal Canadien des Sciences Neurologiques , no. : 1-2.
The World Federation of Neurology (WFN) celebrates World Brain Day on every July 22, focusing on a different theme each year.1Wijeratne T Grisold W Dodick D Carroll W World Brain Day 2019: migraine, the painful truth.The Lancet Neurology. 2019; 18: 914Summary Full Text Full Text PDF PubMed Scopus (0) Google Scholar As highlighted in your Editorial,2The Lancet NeurologyMultiple sclerosis under the spotlight.The Lancet Neurology. 2021; 20: 497Summary Full Text Full Text PDF Google Scholar the theme for this World Brain Day is “Stop Multiple Sclerosis” (video), and the WFN is working jointly with the Multiple Sclerosis International Federation (MSIF), as well as with clinicians and experts affiliated with advocacy organisations throughout Asia and Oceania, Europe, Africa, and the Americas. Many public awareness programmes and educational and social media activities are promoting the movement to stop multiple sclerosis, commencing July 22, 2021, and continuing until October, 2021.
Tissa Wijeratne; Wolfgang Grisold; Peer Baneke; Anne Helme; Rachel King; William Carroll. World Brain Day 2021: a call to stop multiple sclerosis. The Lancet Neurology 2021, 1 .
AMA StyleTissa Wijeratne, Wolfgang Grisold, Peer Baneke, Anne Helme, Rachel King, William Carroll. World Brain Day 2021: a call to stop multiple sclerosis. The Lancet Neurology. 2021; ():1.
Chicago/Turabian StyleTissa Wijeratne; Wolfgang Grisold; Peer Baneke; Anne Helme; Rachel King; William Carroll. 2021. "World Brain Day 2021: a call to stop multiple sclerosis." The Lancet Neurology , no. : 1.
Tissa Wijeratne; Wolfgang Grisold; William Carroll. World Brain Day 2021 campaign continue to gain the momentum; join us to stop multiple sclerosis. Journal of the Neurological Sciences 2021, 427, 117547 .
AMA StyleTissa Wijeratne, Wolfgang Grisold, William Carroll. World Brain Day 2021 campaign continue to gain the momentum; join us to stop multiple sclerosis. Journal of the Neurological Sciences. 2021; 427 ():117547.
Chicago/Turabian StyleTissa Wijeratne; Wolfgang Grisold; William Carroll. 2021. "World Brain Day 2021 campaign continue to gain the momentum; join us to stop multiple sclerosis." Journal of the Neurological Sciences 427, no. : 117547.
Editorial on the Research Topic: Accelerated Globalization and Its Impact to the World's Health Care Achievement The traditional world economic order was inherited from the Colonial Age, with an assumed hierarchy of rich industrialized nations from the Northern hemisphere and largely poorer and underdeveloped nations in the Southern hemisphere. Capital investment and technology dissemination has historically moved southwards. Production of quality goods and services has occurred in the Global South using local affordable and skilled labor, while the same goods and services were mostly consumed by rich customers coming from the Global North or exported northwards to these same regions. Over the course of several consecutive industrial revolutions this mainstream flow remained prominent and visible throughout most of the XVIII–XX centuries (1). This traditional pattern met a serious challenge during the post-WWII decades. The Cold War lasted for 45 years and brought heavy industrial development among the so-called Second World socialist economies led by the USSR. Many of the cutting-edge technologies of the time were disseminated by state-sponsored talent breeding programs in communist countries with the space and military industries being the most prominent examples (2). In 1989–1991 the era of the Cold War ended, and there was an acceleration of globalization worldwide driven to a large extent by commercial interests of powerful multinational businesses, but with very little dissemination of health-related technologies. Among the consequences of this change were market-driven dissemination of industrial technologies toward many of the historically under-developed economies, combined with an outsourcing of manufacturing to these areas. A milestone example of this profound change was the economic reforms introduced by Deng Xiaoping in the People's Republic of China in 1978, which has resulted in China following an exceptionally upward economic pathway since 1989 (3). Changes taking place over the next 30 years shall gradually become known as the Rise of Emerging Markets led by the BRIC nations (Brazil, Russia, India, China) (4). Few other LMICs nations such as Mexico, Nigeria, South Africa, Singapore, Indonesia, Vietnam remain characterized by long term rapid real GDP growth but at significantly smaller scale of national economies (5). Happening alongside an economic slowdown in Western economies, particularly since the last global recession of 2007–2017, this evolution has changed the entire global macroeconomic landscape and reflects heavily in the health care arena. A recently released Brookings Institute report based on International Monetary Fund (IMF) data provides a clear illustration of this change. The report observes that EM7 nations (seven major emerging markets: BRIC + Turkey, Indonesia, and Mexico) have contributed one-half of the world's economic growth (in terms of real GDP growth rates) in comparison to G7 countries (USA, Japan, Germany, UK, France, Canada, Italy), which have contributed jointly to only one-quarter of the world's growth in 2018–2019 (6). To emphasize this point further, at a previous Davos forum (7) it was stated that in the past decade China, as the classical case of an economic overachiever, contributed alone to approximately one-third of all global economic growth. This shift means that now we have an acceleration of South-South global trade. Major investors in the most rapidly developing world regions do not typically come from major Western, Organization for Economic Co-operation and Development (OECD) member economies, or Japan anymore (8). Instead, such capital and technology investments frequently are outsourced from China, India, Russia, or Middle Eastern countries. It is noteworthy to highlight that these South-South trade-flows include pharmaceutical ingredients and products incl. their manufacturing (India is an example of the global powerhouse in generics—copycat medicines manufacturing), affordable medical technologies, health-related tourism, but not yet health services. Huge chunk of this demand for health services is outsourcing from a massive growth of Non-communicable Diseases related morbidity across the Global South and LMICs nations (9). In the sense of these upcoming challenges and long term shortage of disposable resources to be allocated, cost-effective health care has become essential (10). Ongoing pandemics has essentially made these capacities overstretched even more (11). This Research Topic was created in order to address the core challenges created by globalization for national health and socioeconomic systems worldwide (12). The ongoing 4.0 Industrial Revolution, robotics, and internet addiction issues are among its prominent consequences (13). Throughout its life cycle it has attracted a total of four contributions. First one of them entitled: “Bootstrap ARDL on Health Expenditure, CO2 Emissions, and GDP Growth Relationship for 18 OECD Countries” has brought a surprising perspective on the dynamic relationship among CO2 emissions, health care expenditure, and GDP growth for the 18 OECD countries over the period of 1975–2017. In their conclusive remarks authors observe that limitations of national CO2 emissions remain the mainstay of OECD countries policies. Recommendations were to adopt measures and policies to protect the quality of the environment to reduce the occurrence of health diseases (Wang et al.). Another contribution entitled: “Realization of the EU's Cohesion Policy in Health Care in the Visegrad Group Countries in the Perspective 2014–2020.” An overview of European Union's cohesion policy in the field of health care was provided for Poland, the Czech Republic, the Slovak Republic and Hungary—the Visegrad Group–VG4—in the period of 2014–2020. The VG4 countries appears to have distinctive benefits from these EU...
Mihajlo Jakovljevic; Márta Péntek; Tissa Wijeratne; Guvenc Kockaya; Louis-François Pau. Editorial: Accelerated Globalization and Its Impact to the World's Health Care Achievement. Frontiers in Public Health 2021, 9, 1 .
AMA StyleMihajlo Jakovljevic, Márta Péntek, Tissa Wijeratne, Guvenc Kockaya, Louis-François Pau. Editorial: Accelerated Globalization and Its Impact to the World's Health Care Achievement. Frontiers in Public Health. 2021; 9 ():1.
Chicago/Turabian StyleMihajlo Jakovljevic; Márta Péntek; Tissa Wijeratne; Guvenc Kockaya; Louis-François Pau. 2021. "Editorial: Accelerated Globalization and Its Impact to the World's Health Care Achievement." Frontiers in Public Health 9, no. : 1.
Ischemic Stroke precedes depression. Post-stroke depression (PSD) is a major driver for poor recovery, negative quality of life, poor rehabilitation outcomes and poor functional ability. In this systematic review, we analysed the inflammatory basis of post-stroke depression, which involves bioenergetic failure, deranged iron homeostasis (calcium influx, Na influx, potassium efflux etc), excitotoxicity, acidotoxicity, disruption of the blood brain barrier, cytokine-mediated cytotoxicity, reactive oxygen mediated toxicity, activation of cyclooxygenase pathway and generation of toxic products. This process subsequently results in cell death, maladapted, persistent neuro-inflammation and deranged neuronal networks in mood-related brain regions. Furthermore, an in-depth review likewise reveals that anatomic structures related to post-stroke depression may be localized to complex circuitries involving the cortical and subcortical regions.
Tissa Wijeratne; Carmela Sales. Understanding Why Post-Stroke Depression May Be the Norm Rather Than the Exception: The Anatomical and Neuroinflammatory Correlates of Post-Stroke Depression. Journal of Clinical Medicine 2021, 10, 1674 .
AMA StyleTissa Wijeratne, Carmela Sales. Understanding Why Post-Stroke Depression May Be the Norm Rather Than the Exception: The Anatomical and Neuroinflammatory Correlates of Post-Stroke Depression. Journal of Clinical Medicine. 2021; 10 (8):1674.
Chicago/Turabian StyleTissa Wijeratne; Carmela Sales. 2021. "Understanding Why Post-Stroke Depression May Be the Norm Rather Than the Exception: The Anatomical and Neuroinflammatory Correlates of Post-Stroke Depression." Journal of Clinical Medicine 10, no. 8: 1674.
There is an accumulating volume of research into neurological manifestations of COVID‐19. However, inconsistent study designs, inadequate controls, poorly‐validated tests, and differing settings, interventions, and cultural norms weaken study quality, comparability, and thus the understanding of the spectrum, burden and pathophysiology of these complications. Therefore, a global COVID‐19 Neuro Research Coalition, together with the WHO, has reviewed reports of COVID‐19 neurological complications and harmonised clinical measures for future research. This will facilitate well‐designed studies using precise, consistent case definitions of SARS‐CoV2 infection and neurological complications, with standardised forms for pooled data analyses that non‐specialists can use, including in low‐income settings.
Ettore Beghi; MRCP Benedict D. Michael PhD; Erica Westenberg Msc; Andrea S. Winkler Md; Global COVID‐19 Neuro Research Coalition; Benedict D. Michael; Tom Solomon; Erica Westenberg; Samuel Knauss; Jim Sejvar; Omar Siddiqi; M. Netravathi; Augustina Charway‐Felli; Foad Abd‐Allah; Claudio Bassetti; Maria Lúcia Brito Ferreira; Sherry Hsiang‐Yi Chou; Josep Dalmau; Guillermo Delgado‐García; Ava Easton; Julius Emmrich; Matthias Endres; Agnès Fleury; Jennifer A. Frontera; David García‐Azorín; Alla Guekht; Raimund Helbok; Kerstin Hellwig; Günter Höglinger; Fan Kee Hoo; Christine Klein; Suzannah Lant; Molly McNett; Elena Moro; Alessandro Padovani; Bettina Pfausler; Kameshwar Prasad; Gustavo C. Roman; Fred S. Sarfo; Parthasarathy Satishchandra; Deanna Saylor; Marianna Spatola; Peter Spencer; Richard J. Stark; Matthis Synofzik; Pille Taba; Fabrizio Tagliavini; Kiran T. Thakur; Thirugnanam Umapathi; Jeevagan Vijayabala; Karin Weissenborn; Tissa Wijeratne; Greta K. Wood; William M. Carroll; Celia Oreja‐Guevara; Matilde Leonardi; Erich Schmutzhard. Approaches to Understanding COVID ‐19 and its Neurological Associations. Annals of Neurology 2021, 89, 1059 -1067.
AMA StyleEttore Beghi, MRCP Benedict D. Michael PhD, Erica Westenberg Msc, Andrea S. Winkler Md, Global COVID‐19 Neuro Research Coalition, Benedict D. Michael, Tom Solomon, Erica Westenberg, Samuel Knauss, Jim Sejvar, Omar Siddiqi, M. Netravathi, Augustina Charway‐Felli, Foad Abd‐Allah, Claudio Bassetti, Maria Lúcia Brito Ferreira, Sherry Hsiang‐Yi Chou, Josep Dalmau, Guillermo Delgado‐García, Ava Easton, Julius Emmrich, Matthias Endres, Agnès Fleury, Jennifer A. Frontera, David García‐Azorín, Alla Guekht, Raimund Helbok, Kerstin Hellwig, Günter Höglinger, Fan Kee Hoo, Christine Klein, Suzannah Lant, Molly McNett, Elena Moro, Alessandro Padovani, Bettina Pfausler, Kameshwar Prasad, Gustavo C. Roman, Fred S. Sarfo, Parthasarathy Satishchandra, Deanna Saylor, Marianna Spatola, Peter Spencer, Richard J. Stark, Matthis Synofzik, Pille Taba, Fabrizio Tagliavini, Kiran T. Thakur, Thirugnanam Umapathi, Jeevagan Vijayabala, Karin Weissenborn, Tissa Wijeratne, Greta K. Wood, William M. Carroll, Celia Oreja‐Guevara, Matilde Leonardi, Erich Schmutzhard. Approaches to Understanding COVID ‐19 and its Neurological Associations. Annals of Neurology. 2021; 89 (6):1059-1067.
Chicago/Turabian StyleEttore Beghi; MRCP Benedict D. Michael PhD; Erica Westenberg Msc; Andrea S. Winkler Md; Global COVID‐19 Neuro Research Coalition; Benedict D. Michael; Tom Solomon; Erica Westenberg; Samuel Knauss; Jim Sejvar; Omar Siddiqi; M. Netravathi; Augustina Charway‐Felli; Foad Abd‐Allah; Claudio Bassetti; Maria Lúcia Brito Ferreira; Sherry Hsiang‐Yi Chou; Josep Dalmau; Guillermo Delgado‐García; Ava Easton; Julius Emmrich; Matthias Endres; Agnès Fleury; Jennifer A. Frontera; David García‐Azorín; Alla Guekht; Raimund Helbok; Kerstin Hellwig; Günter Höglinger; Fan Kee Hoo; Christine Klein; Suzannah Lant; Molly McNett; Elena Moro; Alessandro Padovani; Bettina Pfausler; Kameshwar Prasad; Gustavo C. Roman; Fred S. Sarfo; Parthasarathy Satishchandra; Deanna Saylor; Marianna Spatola; Peter Spencer; Richard J. Stark; Matthis Synofzik; Pille Taba; Fabrizio Tagliavini; Kiran T. Thakur; Thirugnanam Umapathi; Jeevagan Vijayabala; Karin Weissenborn; Tissa Wijeratne; Greta K. Wood; William M. Carroll; Celia Oreja‐Guevara; Matilde Leonardi; Erich Schmutzhard. 2021. "Approaches to Understanding COVID ‐19 and its Neurological Associations." Annals of Neurology 89, no. 6: 1059-1067.
Stroke is one of the leading causes of adult disability and the second leading cause of death worldwide. The immune system actively participates in the pathobiological process of acute ischemic stroke (AIS), during the index event and the repair process. Research on neurovascular inflammation has created a renewed interest in the use of easily available biomarkers reflective of innate and adaptive immunological changes with potential diagnostic, prognostic, and therapeutic implications particularly in AIS. The current scoping review aimed to assess the significance the neutrophil to lymphocyte (NLR) in AIS and its related complications and explore their association with post-stroke recovery trajectory. The Arksey and O’Malley methodological framework was employed to review the published papers on the neutrophil–lymphocyte ratio (NLR) and AIS in late November 2020. Only studies published in English from 2000–2020 were included in this scoping review. Fifty-three published papers were reviewed. This review’s key finding is that a canonical inflammatory response occurs in the hyperacute, acute, subacute, and chronic stages of stroke. An excessive circulating innate immune cells (neutrophils) and reduced circulating adaptive immune cells (lymphocytes) are associated with poorer outcomes during the acute interventions as well as the recovery trajectory. This scoping review’s findings highlights the utility of a systems biology-based approach in stroke care.
Tissa Wijeratne; Carmela Sales; Rohit Menon; Leila Karimi; Mihajlo Jakovljevic. Highlighting the Role of Universally Available and Innate Immune Cell Counts in Acute Ischemic Stroke: A Scoping Review. Sustainability 2021, 13, 4069 .
AMA StyleTissa Wijeratne, Carmela Sales, Rohit Menon, Leila Karimi, Mihajlo Jakovljevic. Highlighting the Role of Universally Available and Innate Immune Cell Counts in Acute Ischemic Stroke: A Scoping Review. Sustainability. 2021; 13 (7):4069.
Chicago/Turabian StyleTissa Wijeratne; Carmela Sales; Rohit Menon; Leila Karimi; Mihajlo Jakovljevic. 2021. "Highlighting the Role of Universally Available and Innate Immune Cell Counts in Acute Ischemic Stroke: A Scoping Review." Sustainability 13, no. 7: 4069.
Background With headache experienced by up to 75% of adults worldwide in the last year, primary headache disorders constitute a major public health problem, yet they remain under-diagnosed and under-treated. Headache prevalence and burden is changing as society evolves, with headache now occurring earlier in life. Contributing factors, mostly associated with changing life style, such as stress, bad posture, physical inactivity, sleep disturbance, poor diet and excess use of digital technology may be associated with the phenomenon that could be labelled as ‘21st century headache’. This is especially notable in workplace and learning environments where headache impacts mental clarity and therefore cognitive performance. The headache-related impact on productivity and absenteeism negatively influences an individual’s behaviour and quality of life, and is also associated with a high economic cost. Since the majority of sufferers opt to self-treat rather than seek medical advice, substantial knowledge on headache prevalence, causation and burden is unknown globally. Mapping the entire population of headache sufferers can close this knowledge gap, leading to better headache management. The broad use of digital technology to gather real world data on headache triggers, burden and management strategies, in self-treated population will allow these sufferers to access appropriate support and medication, and therefore improve quality of life. Conclusion These data can yield important insights into a substantial global healthcare issue and form the basis for improved patient awareness, professional education, clinical study design and drug development.
Peter J. Goadsby; Michel Lantéri-Minet; Martin C. Michel; Mario Peres; Mamoru Shibata; Andreas Straube; Tissa Wijeratne; Caty Ebel-Bitoun; Luminita Constantin; Simon Hitier. 21st century headache: mapping new territory. The Journal of Headache and Pain 2021, 22, 1 -4.
AMA StylePeter J. Goadsby, Michel Lantéri-Minet, Martin C. Michel, Mario Peres, Mamoru Shibata, Andreas Straube, Tissa Wijeratne, Caty Ebel-Bitoun, Luminita Constantin, Simon Hitier. 21st century headache: mapping new territory. The Journal of Headache and Pain. 2021; 22 (1):1-4.
Chicago/Turabian StylePeter J. Goadsby; Michel Lantéri-Minet; Martin C. Michel; Mario Peres; Mamoru Shibata; Andreas Straube; Tissa Wijeratne; Caty Ebel-Bitoun; Luminita Constantin; Simon Hitier. 2021. "21st century headache: mapping new territory." The Journal of Headache and Pain 22, no. 1: 1-4.
Background Stroke is a leading cause of disability worldwide and the cardiovascular fitness levels of stroke survivors are diminished to an extent that impairs functioning and activities of daily living performance. While cardiovascular training seems an empirically appropriate intervention, the optimal dosage and intensity of cardiovascular training in stroke survivors remains unclear. The aim was to determine the safety and feasibility of moderate-intensity cardiovascular training following stroke, including measurement of adherence to training. Methods A pilot, prospective, patient- and assessor-blinded randomised controlled trial conducted in a tertiary, metropolitan hospital-based community rehabilitation centre. Eligibility criteria included ambulant (> 100 m), 6 weeks-12 months post stroke. Moderate-intensity fitness training or control (low-intensity) exercise was offered biweekly for 12 weeks. Outcome measures included adverse events, peak oxygen uptake (VO2), functional exercise capacity (6-Minute Walk Test, 10-m Walk Test) and health-related quality of life (Short Form-36) and mood (Patient Health Questionnaire, PHQ9). Results Feasibility: Seventy-one (50%) of 141 screened participants were eligible (29% did not agree to participate). Twenty participants (10 intervention, 10 control) were recruited. The median (%; IQR) supervised sessions was 19.5 (81%; 12, 20); and 20 (83%; 19, 22) in the intervention and control groups, respectively. Progression of duration and intensity was limited; mean of 10 sessions to achieve target duration (30 min). There were no adverse events. Baseline peak oxygen uptake (VO2) levels were low (15.94 ml/kg/min). Significant improvements in VO2 peak in both groups were observed (p < 0.05). Although there were no significant between-group differences, this feasibility trial was not powered to detect change. Conclusions Moderate-intensity fitness training was safe but achievement of target duration and intensity was challenging for stroke survivors. A definitive adequately-powered randomised trial is required. Alternative fitness training protocols may need to be explored. Trial registration The trial protocol was prospectively registered on the Australian New Zealand Clinical Trials Registry (ACTRN 12613000822785) on 25/07/2013.
Hanna Reynolds; Sarah Steinfort; Jane Tillyard; Sarah Ellis; Alan Hayes; Erik D. Hanson; Tissa Wijeratne; Elizabeth H. Skinner. Feasibility and adherence to moderate intensity cardiovascular fitness training following stroke: a pilot randomized controlled trial. BMC Neurology 2021, 21, 1 -12.
AMA StyleHanna Reynolds, Sarah Steinfort, Jane Tillyard, Sarah Ellis, Alan Hayes, Erik D. Hanson, Tissa Wijeratne, Elizabeth H. Skinner. Feasibility and adherence to moderate intensity cardiovascular fitness training following stroke: a pilot randomized controlled trial. BMC Neurology. 2021; 21 (1):1-12.
Chicago/Turabian StyleHanna Reynolds; Sarah Steinfort; Jane Tillyard; Sarah Ellis; Alan Hayes; Erik D. Hanson; Tissa Wijeratne; Elizabeth H. Skinner. 2021. "Feasibility and adherence to moderate intensity cardiovascular fitness training following stroke: a pilot randomized controlled trial." BMC Neurology 21, no. 1: 1-12.
Migraine is one of the leading causes of disability worldwide and patients with acute migraine frequently present to emergency departments (ED). The current literature suggests that ED treatment of migraine headache varies across institutions. Considering this, we conducted a scoping review to summarize trends in medication prescribing patterns for acute migraine treatment in the ED setting. Trends were evaluated for factors influencing treatment choices, with particular attention placed on opioids and migraine specific therapy. This scoping review was based on the Arksey and O’Malley methodological framework and included studies published between 1 January 2000 and 31 May 2020. 14 publications met the inclusion criteria. The most common classes of medication prescribed were anti-emetics or Non-steroidal anti-inflammatory drugs (NSAID), but rates varied between studies. There was a concerning trend towards an underutilization of triptans and overutilization of opiates. The use of specific clinical treatment goals (e.g., two-hour pain free freedom response) was also not evident. Additionally, 88% (n = 8) of the nine studies commenting on adherence to hospital or evidence-based guidelines stated that practices were non-adherent. Overall, the reviewed literature reveals treatment practices for acute migraine in the ED are heterogeneous and deviate from established international recommendations.
Jun Lim; Leila Karimi; Tissa Wijeratne. An Evaluation of Medication Prescribing Patterns for Acute Migraine in the Emergency Department: A Scoping Review. Journal of Clinical Medicine 2021, 10, 1191 .
AMA StyleJun Lim, Leila Karimi, Tissa Wijeratne. An Evaluation of Medication Prescribing Patterns for Acute Migraine in the Emergency Department: A Scoping Review. Journal of Clinical Medicine. 2021; 10 (6):1191.
Chicago/Turabian StyleJun Lim; Leila Karimi; Tissa Wijeratne. 2021. "An Evaluation of Medication Prescribing Patterns for Acute Migraine in the Emergency Department: A Scoping Review." Journal of Clinical Medicine 10, no. 6: 1191.
Neutrophil counts (innate immunity) and lymphocyte counts (adaptive immunity) are common markers of inflammation in the context of acute stroke, and Neutrophil lymphocyte ratio (NLR) is likely to be expected to predict the post-stroke outcome. This study aimed to explore the predictive value of NLR to predict the very early mortality during the acute hospital admission (death within the first week of hospital stay) as this has management implications for the ongoing investigations, family discussions and resource allocation. This the first such study attempting at exploring the role of NLR in hyperacute in-patient mortality in the world to the best of our knowledge. This retrospective study included 120 patients (60 acute stroke patients who died within the first week of the hospital stay and 60 age, sex-matched controls who were discharged within two weeks of the hospital admission, alive. We reviewed the total white cell counts of these patients (first 72 hours of the hospital admission) and NLR was calculated manually. While there was no statistically significant difference between mean neutrophil counts and mean lymphocyte counts between the two cohorts [neutrophil counts (mean, SD), 8.52(3.20) in the death cohort, 6.48(2.20) among survivors and lymphocyte (mean, SD), 1.83(1.48) in the death cohort,1.66 (0.69) among survivors], there was a statistically significant difference in NLR between the two cohorts. NLR (mean, SD) was 6.51 (4.98) in the death cohort while the survivors had mean NLR of 4.64 with an SD 2.90 with a p-value of 0.048. Hypertension, diabetes, atrial fibrillation, previous vascular events were common in both groups indicating the value of exploring the evidence of background compromised vascular system and metabolic syndrome and bringing the systems biology approach to the management of stroke.
Tissa Wijeratne; Carmela Sales; Leila Karimi; Mihajlo Jakovljevic. Elevated Neutrophil to Lymphocyte Ratio Predicts In-hospital Mortality Among Stroke Patients in a Metropolitan hospital in Australia, Universal Value-added measure in Stroke Care. 2021, 1 .
AMA StyleTissa Wijeratne, Carmela Sales, Leila Karimi, Mihajlo Jakovljevic. Elevated Neutrophil to Lymphocyte Ratio Predicts In-hospital Mortality Among Stroke Patients in a Metropolitan hospital in Australia, Universal Value-added measure in Stroke Care. . 2021; ():1.
Chicago/Turabian StyleTissa Wijeratne; Carmela Sales; Leila Karimi; Mihajlo Jakovljevic. 2021. "Elevated Neutrophil to Lymphocyte Ratio Predicts In-hospital Mortality Among Stroke Patients in a Metropolitan hospital in Australia, Universal Value-added measure in Stroke Care." , no. : 1.
Background: Neurological disorders are the leading cause disability in Australia and the world. Combating the perceived difficulty of neurology or “neurophobia” and improving physician education is a key component in addressing this problem. We aim to conduct the first study to identify whether neurophobia exists in medical students and junior doctors in an Australian population and try to identify factors that may contribute to this in this population. Methods: A 24 question online validated survey was distributed via email broadcast to all medical students and junior doctors at a metropolitan tertiary care centre in Australia. Responses were collected over 6 weeks with weekly reminder emails for 4 weeks after the initial invitation email. Results: 114 medical students and junior doctors participated in the study. Participants perceived neurology as the most difficult medical speciality compared to 10 other medical specialties (p=0.001). The top three factors contributing to this perceived difficulty were: a lack of understanding of neuroanatomy, lack of diagnostic certainty and lack of clinical exposure. 65% of the participants stated that they had too little planned teaching in neurology with only 36% of the participants having performed a neurology rotation during medical school. Conclusion: The prevalence of neurophobia in this Australian cohort of medical students and junior doctors is consistent with previous findings from around the world. This concerning finding requires further examination into the contributing factors in order to created trials of targeted interventions in order to resolve this.
Alex Lai Ming Yeung; Leila Karimi; Tissa Wijeratne. Neurophobia: A Study of Australian Medical Students and Junior Doctors. 2021, 1 .
AMA StyleAlex Lai Ming Yeung, Leila Karimi, Tissa Wijeratne. Neurophobia: A Study of Australian Medical Students and Junior Doctors. . 2021; ():1.
Chicago/Turabian StyleAlex Lai Ming Yeung; Leila Karimi; Tissa Wijeratne. 2021. "Neurophobia: A Study of Australian Medical Students and Junior Doctors." , no. : 1.
Background Neurological disorders are the leading cause disability in Australia and the world. Combating the perceived difficulty of neurology or “neurophobia” and improving physician education is a key component in addressing this problem. We aim to conduct the first study to identify whether neurophobia exists in medical students and junior doctors in an Australian population and try to identify factors that may contribute to this in this population. Methods A 24 question online validated survey was distributed via email broadcast to all medical students and junior doctors at a metropolitan tertiary care centre in Australia. Responses were collected over 6 weeks with weekly reminder emails for 4 weeks after the initial invitation email. Results 114 medical students and junior doctors participated in the study. Participants perceived neurology as the most difficult medical speciality compared to 10 other medical specialties (p=0.001). The top three factors contributing to this perceived difficulty were: a lack of understanding of neuroanatomy, lack of diagnostic certainty and lack of clinical exposure. 65% of the participants stated that they had too little planned teaching in neurology with only 36% of the participants having performed a neurology rotation during medical school. Conclusion The prevalence of neurophobia in this Australian cohort of medical students and junior doctors is consistent with previous findings from around the world. This concerning finding requires further examination into the contributing factors in order to created trials of targeted interventions in order to resolve this.
Alex Yeung; Leila Karimi; Tissa Wijeratne. Neurophobia: A study of Australian medical students and junior doctors. 2021, 1 .
AMA StyleAlex Yeung, Leila Karimi, Tissa Wijeratne. Neurophobia: A study of Australian medical students and junior doctors. . 2021; ():1.
Chicago/Turabian StyleAlex Yeung; Leila Karimi; Tissa Wijeratne. 2021. "Neurophobia: A study of Australian medical students and junior doctors." , no. : 1.
We present the data of serial systemic immune inflammation indices (SSIIi) over four months in the setting of PCNS. The clinical details of this case were published previously [[1]Wijeratne T. Sales C.A. Crewther S.G. Nguyen V. Karimi L. First Australian case of good recovery of a COVID-19 patient with severe neurological symptoms post prolonged hospitalization.Cureus. 2020; 12e10366PubMed Google Scholar]. The patient showed evidence of PCNS on discharge with persistent fatigue, brain fog, tiredness with a modified Rankin score of 3 at three months post-discharge [[2]Wijeratne T. Crewther S. Post-COVID 19 neurological syndrome (PCNS); a novel syndrome with challenges for the global neurology community.J. Neurol. Sci. 2020; 419: 117179Abstract Full Text Full Text PDF PubMed Scopus (2) Google Scholar]. His SSIIi over four months are shown in Fig. 1 (note the first SII (normal at 252)on 12/02/2020 was three weeks before the COVID-19 infection.).Fig. 1Serial systemic immune inflmmatory indices (SSIIi) over a four months period in a case of Post Covid-19 Neurological Syndrome (PCNS).View Large Image Figure ViewerDownload Hi-res image Download (PPT)
Tissa Wijeratne; Chanith Wijeratne. Clinical utility of serial systemic immune inflammation indices (SSIIi) in the context of post covid-19 neurological syndrome (PCNS). Journal of the Neurological Sciences 2021, 423, 117356 -117356.
AMA StyleTissa Wijeratne, Chanith Wijeratne. Clinical utility of serial systemic immune inflammation indices (SSIIi) in the context of post covid-19 neurological syndrome (PCNS). Journal of the Neurological Sciences. 2021; 423 ():117356-117356.
Chicago/Turabian StyleTissa Wijeratne; Chanith Wijeratne. 2021. "Clinical utility of serial systemic immune inflammation indices (SSIIi) in the context of post covid-19 neurological syndrome (PCNS)." Journal of the Neurological Sciences 423, no. : 117356-117356.
Stroke represents one of the most important causes of morbidity ( eighty million patients with disabling of ongoing effects of stroke at a given time, globally) and mortality (the second leading cause of death) worldwide. Innovative systems biology-based approach is likely to increase the understanding of the underpinning of acute stroke promise to enhance stroke prevention, acute treatment, and neurorehabilitation. Recent growing body of evidence with shared pathobiology with COVID-19 and the critically important role of inflammation in the context of stroke points to far-reaching consequences of acute stroke, just as in the case of COVID-19 ( post-acute event issues as well as long term issues ) . So far, stroke typically defined by late-appearing disease manifestation by the range of stroke subtypes as defined by the WHO or American Stroke Association. This definition neglects the underlying pathobiological mechanisms such as low-grade chronic inflammation and already compromised vascular system. Diseases such as stroke is hardly a simple result of a single problem, but rather a complex cascade of pathobiological processes and interactions in a complex biochemical environment. The evidence of changes in innate immunity and adaptive immunity during the index event of acute stroke and recovery over next 3-12 months can be easily elicited with simple bedside blood tests such as neutrophil-lymphocyte ratio (NLR) with well over 300 published papers including several systematic reviews and meta-analyses confirming this. Global standard operating procedures (SOP) of stroke care dictated by the national and international stroke guidelines at present. It is imperative to explore the evidence of systems biology approach in current stroke guidelines. This is likely to be a key turning point in managing stroke across the continuum (prevention, management of acute event and rehabilitation).
Tissa Wijeratne; Carmela Sales; Leila Karimi; Mihajlo Jakovljevicd. Scoping Review of Existing Stroke Guidelines; Argument for a Value-Added Change. 2021, 1 .
AMA StyleTissa Wijeratne, Carmela Sales, Leila Karimi, Mihajlo Jakovljevicd. Scoping Review of Existing Stroke Guidelines; Argument for a Value-Added Change. . 2021; ():1.
Chicago/Turabian StyleTissa Wijeratne; Carmela Sales; Leila Karimi; Mihajlo Jakovljevicd. 2021. "Scoping Review of Existing Stroke Guidelines; Argument for a Value-Added Change." , no. : 1.