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Idrees M, Taimuri MA, Azhar A, Khan NA, Kalsoom U, Sajid A, Akilimali A. Deep brain stimulation for post-stroke rehabilitation in Pakistan. Ann Med Surg (Lond) 2024; 86:5966-5972. [PMID: 39359821 PMCID: PMC11444625 DOI: 10.1097/ms9.0000000000002511] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2024] [Accepted: 08/16/2024] [Indexed: 10/04/2024] Open
Abstract
Stroke has a high prevalence in Pakistan, at an alarming rate of 250 per 100 000 people. Although various treatment options are available, they are not ideal for Pakistan due to their high cost, restricted availability, and time sensitivity. In 1997, the FDA-approved deep brain stimulation (DBS) for Parkinson's disease and it was first performed in Pakistan in 2014. DBS has also proved effective for restoring post-stroke mobility, according to a trial from August 2023. DBS has the potential to revolutionize post-stroke rehabilitation in Pakistan; however, further research is required into its effectiveness and its limitations must be addressed first.
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Affiliation(s)
| | - Muskan A Taimuri
- Department of Internal Medicine, Dow University of Health Sciences
| | - Ayesha Azhar
- Department of Internal Medicine, Dow University of Health Sciences
| | - Najam A Khan
- Department of Internal Medicine, Dow University of Health Sciences
| | | | - Aiman Sajid
- Sir Syed College of Medical Sciences, Karachi
| | - Aymar Akilimali
- Department of Research, Medical Research Circle, Goma, DR Congo
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Liu W, Man X, Wang Y, Wang Q, Wang Z, Qi J, Qin Q, Han B, Sun J. Tirofiban mediates neuroprotective effects in acute ischemic stroke by reducing inflammatory response. Neuroscience 2024; 555:32-40. [PMID: 39025399 DOI: 10.1016/j.neuroscience.2024.07.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2024] [Revised: 07/03/2024] [Accepted: 07/10/2024] [Indexed: 07/20/2024]
Abstract
Growing evidence suggests that neuroinflammation is a critical driver of the development, worsening, and cell death observed in acute ischemic stroke (AIS). While prior research has demonstrated that tirofiban enhances functional recovery in AIS patients by suppressing platelet aggregation, its impact and underlying mechanisms in AIS-related neuroinflammation remain elusive. The current study established an AIS mouse model employing photochemical techniques and assessed neurological function and brain infarct size using the modified neurological severity scale (mNSS) and 2,3,5-Triphenyltetrazolium chloride (TTC) staining, respectively. Tirofiban significantly reduced the volume of cerebral infarction in AIS mice, accompanied by an enhancement in their neurological functions. Terminal deoxynucleotidyl transferase dUTP nick end labeling (TUNEL) assays along with experiments assessing oxidative stress showed that tirofiban mitigated oxidative damage and apoptosis in the ischemic penumbra post-AIS. Additionally, DNA microarray analysis revealed alterations in gene expression patterns in the ischemic penumbra after tirofiban treatment. Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway enrichment analysis showed that most gene-level downregulated signaling pathways were closely related to the inflammatory response. Moreover, the protein microarray analysis revealed that tirofiban diminished the expression levels of inflammatory cytokines, such as interleukin-1 (IL-1), IL-6, and tumor necrosis factor-alpha, in the ischemic penumbra. Additionally, immunofluorescence staining showed that tirofiban regulated inflammatory responses by altering the state and phenotype of microglia. In conclusion, this study suggests that tirofiban reduces inflammatory response by regulating microglial state and phenotype and lowering the levels of inflammatory factors, providing neuroprotection in acute ischemic stroke.
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Affiliation(s)
- Wei Liu
- Department of Emergency Medicine, The Affiliated Hospital of Qingdao University, College of Medicine, Qingdao University, Qingdao 266003, China
| | - Xu Man
- Department of Integrative Medicine, The Affiliated Hospital of Qingdao University, College of Medicine, Qingdao University, Qingdao 266003, China
| | - Yongbin Wang
- Department of Emergency Medicine, The Affiliated Hospital of Qingdao University, College of Medicine, Qingdao University, Qingdao 266003, China
| | - Qingqing Wang
- Department of Emergency Medicine, The Affiliated Hospital of Qingdao University, College of Medicine, Qingdao University, Qingdao 266003, China
| | - Zhiyuan Wang
- Department of Emergency Medicine, The Affiliated Hospital of Qingdao University, College of Medicine, Qingdao University, Qingdao 266003, China
| | - Jianjiao Qi
- Department of Emergency Medicine, The Affiliated Hospital of Qingdao University, College of Medicine, Qingdao University, Qingdao 266003, China
| | - Qiaoji Qin
- Department of Emergency Medicine, The Affiliated Hospital of Qingdao University, College of Medicine, Qingdao University, Qingdao 266003, China
| | - Ban Han
- Department of Neurology, The Affiliated Hospital of Qingdao University, College of Medicine, Qingdao University, Qingdao 266003, China.
| | - Jinping Sun
- Department of Emergency Medicine, The Affiliated Hospital of Qingdao University, College of Medicine, Qingdao University, Qingdao 266003, China.
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Bai R, Li M, Bhurtyal A, Zhu W, Dong W, Dong D, Sun J, Su Y, Li Y. Temporal Mortality Trends Attributable to Stroke in South Asia: An Age-Period-Cohort Analysis. Healthcare (Basel) 2024; 12:1809. [PMID: 39337150 PMCID: PMC11430981 DOI: 10.3390/healthcare12181809] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2024] [Revised: 09/02/2024] [Accepted: 09/05/2024] [Indexed: 09/30/2024] Open
Abstract
South Asia contributes the most to stroke mortality worldwide. This study aimed to determine the long-term trends in stroke mortality across four South Asian countries and its associations with age, period, and birth cohort. In 2019, nearly one million stroke deaths occurred across South Asia, and the associated age-standardized mortality rate (ASMR) was 80.2 per 100,000. Between 1990 and 2019, India had the largest decrease in the ASMR (-35.8%) across the four South Asian countries. While Pakistan had the smallest decrease in the ASMR (-7.6%), an increase was detected among males aged 15 to 34 years and females aged 15 to 19 years. Despite a 22.8% decrease in the ASMR, Bangladesh had the highest ASMR across the four South Asian countries. Nepal reported a witness increase in the stroke ASMR after 2006. Improved period and cohort effects on stroke mortality were generally indicated across the analyzed countries, except for recent-period effects in males from Nepal and cohort effects from those born after the 1970s in Pakistan. Stroke mortality has decreased in the four South Asian countries over the past 30 years, but potentially unfavorable period and cohort effects have emerged in males in Nepal and both sexes in Pakistan. Governmental and societal efforts are needed to maintain decreasing trends in stroke mortality.
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Affiliation(s)
- Ruhai Bai
- School of Public Affairs, Nanjing University of Science and Technology, Nanjing 210094, China
- Clinical Medical Research Center, Children's Hospital of Nanjing Medical University, Nanjing 210008, China
| | - Minmin Li
- Department of Nutrition and Food Risk Monitoring, Shaanxi Provincial Center for Disease Control and Prevention, Xi'an 710054, China
| | - Ashok Bhurtyal
- Central Department of Public Health, Institute of Medicine, Tribhuvan University, Kathmandu 46000, Nepal
| | - Wenxuan Zhu
- Health Science Center, Xi'an Jiaotong University, Xi'an 710061, China
| | - Wanyue Dong
- School of Health Economics and Management, Nanjing Chinese Medicine University, Nanjing 210023, China
| | - Di Dong
- Duke Global Health Institute, Duke University, Durham, NC 27710, USA
- Global Health Research Center, Duke-Kunshan University, Kunshan 215316, China
| | - Jing Sun
- Rural Health Research Institute, Charles Sturt University, Leeds Parade, Orange, NSW 2800, Australia
| | - Yanfang Su
- Department of Global Health, University of Washington, Seattle, WA 98105, USA
| | - Yan Li
- School of Public Health, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China
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Mehmood Z, Khan SU, Khan B, Mansoor Shah S, Khan A, Ali H, Jawad Ahmed S, Ur Rehman M, Nawaz H, Uliqbal R. Management of Ischemic Stroke in a Tertiary Care Hospital in Khyber Pakhtunkhwa: Existing Status and Prospective Opportunities. Cureus 2024; 16:e63094. [PMID: 39055431 PMCID: PMC11270627 DOI: 10.7759/cureus.63094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/25/2024] [Indexed: 07/27/2024] Open
Abstract
Background and objective Khyber Pakhtunkhwa is the third largest province of Pakistan by population and has a high incidence of ischemic stroke. We evaluated all patients who presented to the largest tertiary care facility in the province to learn about the current trends in the management of ischemic stroke and explore future opportunities in this regard. Materials and methods This prospective observational research was carried out at the Lady Reading Hospital-Medical Teaching Institute (LRH-MTI), Peshawar, in the province of Khyber Pakhtunkhwa (KP). The hospital's ethics committee granted the required permissions for the research. Any patient with an ischemic stroke diagnosis, regardless of age, met the inclusion criteria if their diagnosis was confirmed by clinical assessment, imaging (such as CT or MRI), or both. The clinical parameters that were evaluated included the duration since the patient's reported onset of symptoms, the patient's first mode of transfer to the hospital (such as ambulance, private vehicle, or other means), and the date and time of admission to the hospital. A structured database containing the data was utilized, and IBM SPSS Statistics for Windows, Version 25 (released 2017; IBM Corp., Armonk, New York, United States) was used for statistical analysis. Results One hundred fifty-six stroke patients were diagnosed throughout the study period, with 76 of them having an ischemic stroke, accounting for 49% of all stroke cases. Approximately 43% (n = 33) of the patients were from Peshawar, with the remaining patients coming from adjacent districts. There was only a small percentage (19%, n = 15) of patients who were eligible for any thrombolytic therapy, and the majority (93%) were brought by private vehicles. There was a significant association between age and arrival in the emergency room (p = 0.003). Conclusion The study reveals subpar ischemic stroke management in Khyber Pakhtunkhwa, requiring coordinated efforts, modernization of treatment methods, and increased public awareness to improve patient outcomes.
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Affiliation(s)
- Zafar Mehmood
- Neurology, Lady Reading Hospital-Medical Teaching Institute (LRH-MTI), Peshawar, PAK
| | - Sami Ullah Khan
- Neurology, Lady Reading Hospital-Medical Teaching Institute (LRH-MTI), Peshawar, PAK
- Internal Medicine, Ayub Teaching Hospital, Abbotabad, Abbotabad, PAK
| | - Bilal Khan
- Neurosurgery, Lady Reading Hospital-Medical Teaching Institute (LRH-MTI), Peshawar, PAK
| | - Syed Mansoor Shah
- Neurosurgery, Lady Reading Hospital-Medical Teaching Institute (LRH-MTI), Peshawar, PAK
| | - Abdullah Khan
- Neurosurgery, Queen Elizabeth Hospital Birmingham, University Hospitals Birmingham NHS Foundation Trust, Birmingham, GBR
| | - Hubab Ali
- Clinical Neurosciences, Royal Infirmary, Edinburgh, GBR
| | - Syed Jawad Ahmed
- Neurosurgery, Lady Reading Hospital-Medical Teaching Institute (LRH-MTI), Peshawar, PAK
| | - Muneeb Ur Rehman
- Radiology, Lady Reading Hospital-Medical Teaching Institute (LRH-MTI), Peshawar, PAK
| | - Hina Nawaz
- Neurology, Lady Reading Hospital-Medical Teaching Institute (LRH-MTI), Peshawar, PAK
| | - Riaz Uliqbal
- Neurosurgery, Lady Reading Hospital-Medical Teaching Institute (LRH-MTI), Peshawar, PAK
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Rupasinghe CD, Ammar Bokhari S, Lutfi I, Noureen M, Islam F, Khan M, Amin F, Muthanna FMS. Frequency of Stroke and Factors Associated With It Among Old Age Hypertensive Patients in Karachi, Pakistan: A Cross-Sectional Study. Cureus 2022; 14:e23123. [PMID: 35425677 PMCID: PMC9004609 DOI: 10.7759/cureus.23123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/07/2022] [Indexed: 11/18/2022] Open
Abstract
Introduction: Worldwide, stroke has become the major cause of mortality and morbidity among the old age population. Hypertension is one of the factors associated with stroke. Individuals with hypertension are at high risk of developing stroke. This study was conducted to determine the frequency of stroke factors associated with it among old-age hypertensive patients in Karachi, Pakistan. Methods: It was a cross-sectional study conducted in outpatient departments (OPD) of two tertiary care hospitals of Karachi, Pakistan, including Jinnah Postgraduate Medical Center (JPMC) and Ziauddin Hospital. Eligible patients were invited to be a part of the study, and informed consent was taken from them before data collection. Results: Multivariable logistic regression analysis showed that age (adjusted odds ratio [AOR]: 1.06, 95% CI: 1.03-1.11), smoking (AOR: 1.76, 95% CI: 1.14-2.72), lack of physical activity (AOR:2.57, 95% CI: 1.60-4.14), medication adherence (AOR: 4.22, 95% CI: 2.69-6.62), and dyslipidemia (AOR: 1.98, 95% CI: 1.23-3.21) were significantly related to prevalence of stroke in hypertensive population over 60 years or above. Conclusion: The prevalence of stroke was high in the hypertensive population aged above 60 years and above. The study found that factors significantly associated with stroke among the hypertensive population aged 60 years or above, included age, smoking, lack of physical activity, medication adherence, BMI, and dyslipidemia.
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Farooq A, Venketasubramanian N, Wasay M. Stroke Care in Pakistan. Cerebrovasc Dis Extra 2021; 11:118-121. [PMID: 34695824 PMCID: PMC8613565 DOI: 10.1159/000519554] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2021] [Accepted: 09/06/2021] [Indexed: 11/19/2022] Open
Abstract
Increasing incidence of stroke and lack of infrastructure in both urban and rural areas needs immediate attention in Pakistan. There is a high proportion of young stroke with poor stroke outcomes. Acute stroke care is scarce in Pakistan due to the small number of neurologists (1 neurologist per 1 million population), few stroke units, and limited availability of alteplase (recombinant tissue plasminogen activator) in the country.
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Affiliation(s)
- Anjum Farooq
- Department of Neurology, Bolan University of Medical and Health Sciences, Quetta, Pakistan and President Pakistan Stroke Society, Quetta, Pakistan
| | | | - Mohammad Wasay
- Department of Medicine, Aga Khan University, Karachi, Pakistan
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Ullah I, Arsh A, Zahir A, Jan S. Motor relearning program along with electrical stimulation for improving upper limb function in stroke patients: A quasi experimental study. Pak J Med Sci 2020; 36:1613-1617. [PMID: 33235584 PMCID: PMC7674909 DOI: 10.12669/pjms.36.7.2351] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Objective: To determine the effectiveness of motor relearning program along with electrical stimulation for improving upper limb function in patients with sub-acute stroke. Methods: A quasi experimental study was conducted at Physiotherapy Department of SAIDU Group of Teaching Hospitals Swat Khyber Pakhtunkhwa from January to June 2019. Forty four subjects with post stroke duration of 3-9 months (sub-acute) participated in the study. Subjects received electrical stimulations for the effected arm for 15 minutes along with motor relearning programme for an hour five days a week for six weeks. The upper limb sub scales of motor assessment scale were used to collect pre and post treatment data. SPSS version 20 was used to analyze the data. Results: The mean age of the participants was 54.95±13.2 years. Out of 44 participants 31(70.5%) were male and 13 (29.5%) were female. Pretreatment upper arm function, hand movement and advance hand activities scores were 1.36 ± 0.49, 1.18 ± 0.39 and 1.04 ± 0.21 respectively while their post treatment scores were 5.18 ± 0.96, 4.77 ± 1.02 and 3.95 ± 1.21 respectively. There was significant differences (P<0.05) between pre and post treatment scores of upper arm function, hand movement and advance hand activities. Conclusion: Motor relearning program along with electrical stimulation significantly improves upper limb function in patients with sub-acute stroke.
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Affiliation(s)
- Ikram Ullah
- Ikram Ullah, BSPT, PP-DPT, MSPT. Physiotherapist, Saidu Group of Teaching Hospitals Swat, Pakistan
| | - Aatik Arsh
- Aatik Arsh, DPT, MSPT. Lecturer, Institute of Physical Medicine and Rehabilitation, Khyber Medical University Peshawar, Pakistan
| | - Aneela Zahir
- Aneel Zahir, DPT. Lecturer, Department of Health Sciences, NCS University System Peshawar, Pakistan
| | - Shafqatullah Jan
- Shafqatullah Jan, BSPT, MSPT. Physiotherapist, Pakistan Institute of Prosthetics and Orthotic Sciences Peshawar, Peshawar, Pakista
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Pandian JD, Kalkonde Y, Sebastian IA, Felix C, Urimubenshi G, Bosch J. Stroke systems of care in low-income and middle-income countries: challenges and opportunities. Lancet 2020; 396:1443-1451. [PMID: 33129395 DOI: 10.1016/s0140-6736(20)31374-x] [Citation(s) in RCA: 46] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2020] [Revised: 04/18/2020] [Accepted: 06/09/2020] [Indexed: 12/27/2022]
Abstract
The burden of stroke is higher in low-income and middle-income countries (LMICs) than in high-income countries and is rising. Even though there are global policies and guidelines for implementing stroke care, there are many challenges in setting up stroke services in LMICs. Despite these challenges, there are many models of stroke care available in LMICs-eg, multidisciplinary team care led by a stroke neurologist, specialist-led care by neurologists, physician-led care, hub and spoke models incorporating stroke telemedicine (ie, telestroke), and task sharing involving community health workers. Alternative strategies have been developed, such as reorganising the existing hospital infrastructure by training health professionals to implement protocol-driven care. The future challenge is to identify what elements of organised stroke care can be implemented to make the largest gain. Simple interventions such as swallowing assessments, bowel and bladder care, mobility assessments, and consistent secondary prevention can prove to be key elements to improving post-discharge morbidity and mortality in LMICs.
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Affiliation(s)
- Jeyaraj D Pandian
- Department of Neurology, Christian Medical College, Ludhiana, India.
| | | | | | - Cynthia Felix
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
| | - Gerard Urimubenshi
- College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda; Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
| | - Jackie Bosch
- School of Rehabilitation Science, McMaster University, Hamilton, ON, Canada
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Abstract
In Pakistan, stroke is one of the major contributors to the health problem. The increasing incidence of stroke and lack of infrastructure in both urban and rural areas requires immediate attention. Multiple societies and groups have been established to highlight the growing problem, but necessary steps must be taken at the government level to improve and design a better stroke care system in the country.
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Affiliation(s)
- Arsalan Anwar
- Internal Medicine Department, Dr. Ruth Pfau Hospital, Karachi, Pakistan
| | - Sidra Saleem
- Internal Medicine Department, Dr. Ruth Pfau Hospital, Karachi, Pakistan
| | - Alifiya Aamir
- Internal Medicine Department, Dr. Ruth Pfau Hospital, Karachi, Pakistan
| | - Mufaddal Diwan
- Internal Medicine Department, Dr. Ruth Pfau Hospital, Karachi, Pakistan
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10
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Acute Stroke Interventions Performed by Cardiologists. JACC Cardiovasc Interv 2019; 12:1703-1710. [DOI: 10.1016/j.jcin.2019.05.052] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2019] [Revised: 05/22/2019] [Accepted: 05/28/2019] [Indexed: 11/22/2022]
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Shamim M, Khan NI. Neuroprotective effect ofPanax ginsengextract against cerebral ischemia–reperfusion-injury-induced oxidative stress in middle cerebral artery occlusion models. Facets (Ott) 2019. [DOI: 10.1139/facets-2018-0025] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
The present study investigated the in vivo neuroprotective role of Panax ginseng extract (PGE) pretreatment against transient cerebral ischemia in a middle cerebral artery occlusion (MCAO) model. Rats were randomly divided as follows: group I, control; group II, sham-operated; group III, where animals were subjected to MCAO surgery; and group IV, where animals were orally administered 10 mL PGE per day (200 mg/kg of body weight per day) for 30 d followed by MCAO induction at day 31. Following 24 h of reperfusion, blood and tissue (brain, liver, and kidney) samples were collected for biochemical and histopathological examination. Biochemical testing included lipid profile, liver enzymes, kidney function tests, C-reactive protein (CRP), lactate dehydrogenase (LDH), glucose, and total protein estimation. Tissue antioxidants (catalase, superoxide dismutase, and glutathione) were assessed in brain, liver, and kidney tissues. MCAO-induced histopathological changes were also examined in the tissues. Pretreatment with PGE showed significant improvement in tissue antioxidant status in brain, liver and kidney tissues. PGE treatment maintains plasma lipid profile, liver enzymes, kidney function, and CRP, LDH, and glucose levels. Histologically, monocytes and macrophage infiltration were observed in the tissues of MCAO animals, whereas PGE treatment preserved tissue architecture and minimal monocyte infiltration. PGE supplementation showed a neuroprotective effect against ischemia–reperfusion injury by effectively increasing endogenous antioxidant enzyme activity.
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Affiliation(s)
- Mufzala Shamim
- Pathophysiology Research Unit, Department of Physiology, University of Karachi, Karachi 75270, Pakistan
| | - Nazish Iqbal Khan
- Pathophysiology Research Unit, Department of Physiology, University of Karachi, Karachi 75270, Pakistan
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Dar NZ, Khan SA, Ahmad A, Maqsood S. Awareness of Stroke and Health-seeking Practices among Hypertensive Patients in a Tertiary Care Hospital: A Cross-sectional Survey. Cureus 2019; 11:e4774. [PMID: 31367493 PMCID: PMC6666879 DOI: 10.7759/cureus.4774] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Introduction: Stroke is a major cause of death with hypertension being identified as an important modifiable risk factor. Prompt identification of stroke symptoms and timely management is noted to be significant in lowering both morbidity and mortality. Baseline stroke knowledge in hypertensive patients is crucial to develop effectively targeted, and appropriate health promotion campaigns; thus, the main objectives of this study are to assess the awareness of stroke and to determine health-seeking practices among hypertensive patients. Materials and methods: A standardized questionnaire survey regarding awareness and practices about stroke among hypertensive patients was conducted in a tertiary care hospital of Islamabad. The sample size was calculated as 384. Results: Out of 384 patients evaluated, 80.5% had heard about stroke, 71.6% knew someone with stroke, and 76% identified the brain as the organ affected. Sudden onset numbness of limb (66.9%) and hypertension (93.5%) were common warning symptom and risk factor identified. 87.5% would take stroke patients to a hospital. Only 45.1% of the patients took their medications regularly, and 38% checked their blood pressure. Conclusion: Majority of hypertensive patients were aware of stroke but the awareness of risk factors and warning signs was poor. Stroke prevention practices were also sub-optimal. There is a need to increase knowledge regarding risk factors, which will benefit the community at large.
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Affiliation(s)
- Nayab Z Dar
- Miscellaneous, Shifa International Hospital, Islamabad, PAK
| | | | - Arsalan Ahmad
- Neurology, Shifa International Hospital, Islamabad, PAK
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Cameron AC, Bogie J, Abdul-Rahim AH, Ahmed N, Mazya M, Mikulik R, Hacke W, Lees KR. Professional guideline versus product label selection for treatment with IV thrombolysis: An analysis from SITS registry. Eur Stroke J 2017; 3:39-46. [PMID: 31008336 DOI: 10.1177/2396987317747737] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2017] [Accepted: 10/30/2017] [Indexed: 11/16/2022] Open
Abstract
Introduction Thrombolysis usage in ischaemic stroke varies across sites. Divergent advice from professional guidelines and product labels may contribute. Patients and methods We analysed SITS-International registry patients enrolled January 2010 through June 2016. We grouped sites into organisational tertiles by number of patients arriving ≤2.5 h and treated ≤3 h, percentage arriving ≤2.5 h and treated ≤3 h, and numbers treated ≤3 h. We assigned scores of 1-3 (lower/middle/upper) per variable and 2 for onsite thrombectomy. We classified sites as lower efficiency (summed scores 3-5), medium efficiency (6-8) or higher efficiency (9-11). Sites were also grouped by adherence with European product label and ESO guideline: 'label adherent' (>95% on-label), 'guideline adherent' (≥5% off-label, ≥95% on-guideline) or 'guideline non-adherent' (>5% off-guideline). We cross-tabulated site-efficiency and adherence. We estimated the potential benefit of universally selecting by ESO guidance, using onset-to-treatment time-specific numbers needed to treat for day 90 mRS 0-1. Results A total of 56,689 patients at 597 sites were included: 163 sites were higher efficiency, 204 medium efficiency and 230 lower efficiency. Fifty-six sites were 'label adherent', 204 'guideline adherent' and 337 'guideline non-adherent'. There were strong associations between site-efficiency and adherence (P < 0.001). Almost all 'label adherent' sites (55, 98%) were lower efficiency. If all patients were treated by ESO guidelines, an additional 17,031 would receive alteplase, which translates into 1922 more patients with favourable three-month outcomes. Discussion Adherence with product labels is highest in lower efficiency sites. Closer alignment with professional guidelines would increase patients treated and favourable outcomes. Conclusion Product labels should be revised to allow treatment of patients ≤4.5 h from onset and aged ≥80 years.
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Affiliation(s)
- Alan C Cameron
- 1Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
| | - James Bogie
- 1Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
| | - Azmil H Abdul-Rahim
- 2Institute of Neuroscience and Psychology, University of Glasgow, Glasgow, UK
| | - Niaz Ahmed
- 3Department of Neurology, Karolinska University Hospital, Stockholm, Sweden.,Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden
| | - Michael Mazya
- 3Department of Neurology, Karolinska University Hospital, Stockholm, Sweden.,Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden
| | - Robert Mikulik
- International Clinical Research Centre, Neurology Department, St Anne's Hospital and Masaryk University, Brno, Czech Republic
| | - Werner Hacke
- Department of Neurology, University of Heidelberg, Heidelberg, Germany
| | - Kennedy R Lees
- 1Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
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Ramadan H, Patterson C, Maguire S, Melvin I, Kain K, Teale E, Forster A. Incidence of first stroke and ethnic differences in stroke pattern in Bradford, UK: Bradford Stroke Study. Int J Stroke 2017; 13:374-378. [PMID: 29192873 DOI: 10.1177/1747493017743052] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background Information on ethnic disparities in stroke between White and Pakistani population in Europe is scarce. Bradford District has the largest proportion of Pakistani people in England; this provides a unique opportunity to study the difference in stroke between the two major ethnic groups. Aim To determine the first-ever-stroke incidence and examine the disparities in stroke patterns between Whites and Pakistanis in Bradford. Methods Prospective 12 months study consisting of 273,327 adults (≥18 years) residents. Stroke cases were identified by multiple overlapping approaches. Results In the study period, 541 first-ever-strokes were recorded. The crude incidence rate was 198 per 100,000 person-years. Age adjusted-standardized rate to the World Health Organization world population of first-ever-stroke is 155 and 101 per 100,000 person-years in Pakistanis and Whites respectively. Four hundred and thirty-eight patients (81%) were Whites, 83 (15.3%) were Pakistanis, 11 (2%) were Indian and Bangladeshis, and 9 (1.7%) were of other ethnic origin. Pakistanis were significantly younger and had more obesity ( p = 0.049), and diabetes mellitus (DM) ( p = <0.001). They were less likely to suffer from atrial fibrillation ( p = <0.001), be ex- or current smokers ( p = <0.001), and drink alcohol above the recommended level ( p = 0.007) compared with Whites. In comparison with Whites, higher rates of age-adjusted stroke (1.5-fold), lacunar infarction (threefold), and ischemic infarction due to large artery disease (twofold) were found in the Pakistanis. Conclusions The incidence of first-ever-stroke is higher in the Pakistanis compared with the Whites in Bradford, UK. Etiology and vascular risk factors vary between the ethnic groups. This information should be considered when investigating stroke etiology, and when planning prevention and care provision to improve outcomes after stroke.
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Affiliation(s)
- Hawraman Ramadan
- 1 Neurology Department, 1906 Bradford Teaching Hospitals NHS Foundation Trust , Bradford, UK
| | - Chris Patterson
- 1 Neurology Department, 1906 Bradford Teaching Hospitals NHS Foundation Trust , Bradford, UK
| | - Stuart Maguire
- 1 Neurology Department, 1906 Bradford Teaching Hospitals NHS Foundation Trust , Bradford, UK
| | - Ian Melvin
- 1 Neurology Department, 1906 Bradford Teaching Hospitals NHS Foundation Trust , Bradford, UK
| | - Kirti Kain
- 2 Division of Cardiovascular & Diabetes Research, University of Leeds, Leeds, UK
| | - Elizabeth Teale
- 3 Academic Unit of Elderly Care and Rehabilitation, 70535 University of Leeds , Leeds, UK
| | - Anne Forster
- 3 Academic Unit of Elderly Care and Rehabilitation, 70535 University of Leeds , Leeds, UK
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