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Gupta P, Gupta A, Gupta K, Bansal S, Sharma M, Balakrishnan I. Prevalence, Outcomes, and Predictors of Prolonged Corrected QT Interval in Hydroxychloroquine-Naïve Hospitalized COVID-19 Patients. Cardiovasc Toxicol 2024:10.1007/s12012-024-09886-x. [PMID: 38954228 DOI: 10.1007/s12012-024-09886-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2023] [Accepted: 06/19/2024] [Indexed: 07/04/2024]
Abstract
The studies regarding prevalence, outcomes, and predictors of prolonged corrected QT (QTc) among COVID-19 patients not on QTc-prolonging medication are not available in the literature. In this retrospective cohort study, the QTc of 295 hospital-admitted COVID-19 patients was analyzed and its association with in-hospital mortality was determined. The QTc was prolonged in 14.6% (43/295) of the study population. Prolonged QTc was seen in patients with older age (P = 0.018), coronary artery disease (P = 0.001), congestive heart failure (P = 0.042), elevated N-terminal-pro-B-type natriuretic peptide (NT-ProBNP) (P < 0.0001), and on remdesivir (P = 0.046). No episode of torsades de pointes arrhythmia or any arrhythmic death was observed among patients with prolonged QTc. The mortality was significantly high in patients with prolonged QTc (P = 0.003). The multivariate logistic regression analysis showed coronary artery disease (odds ratio (OR): 4.153, 95% CI 1.37-14.86; P = 0.013), and NT-ProBNP (ng/L) (OR: 1.000, 95% CI 1.000-1.000; P = 0.007) as predictors of prolonged QTc. The prolonged QTc was associated with the worst in-hospital survival (p by log-rank 0.001). A significant independent association was observed between prolonged QTc and in-hospital mortality in multivariate cox-regression analysis (adjusted hazard ratio: 3.861; (95% CI 1.719-6.523), P < 0.0001). QTc was found to be a marker of underlying comorbidities among COVID-19 patients. Prolonged QTc in hospitalized COVID-19 patients was independently associated with in-hospital mortality.
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Affiliation(s)
- Praveen Gupta
- Department of Cardiology, Vardhman Mahavir Medical College & Safdarjung Hospital, New Delhi, 110029, India.
| | - Anunay Gupta
- Department of Cardiology, Vardhman Mahavir Medical College & Safdarjung Hospital, New Delhi, 110029, India
| | - Kapil Gupta
- Department of Anesthesia and Critical Care, Vardhman Mahavir Medical College & Safdarjung Hospital, New Delhi, 110029, India
| | - Sandeep Bansal
- Department of Cardiology, Vardhman Mahavir Medical College & Safdarjung Hospital, New Delhi, 110029, India
| | - Monica Sharma
- Department of Hematology, Vardhman Mahavir Medical College & Safdarjung Hospital, New Delhi, 110029, India
| | - Ira Balakrishnan
- Department of Anesthesia and Critical Care, Vardhman Mahavir Medical College & Safdarjung Hospital, New Delhi, 110029, India
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Niveditha M, Kasana R, Barua AR, Barthakur M, Undela K. Assessment of disease pattern and drug utilization among neurology intensive care unit patients in a developing country: an observational analysis. Hosp Pract (1995) 2024:1-7. [PMID: 38781014 DOI: 10.1080/21548331.2024.2358747] [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: 01/07/2024] [Accepted: 05/20/2024] [Indexed: 05/25/2024]
Abstract
OBJECTIVE This study aimed to assess the disease pattern and drug utilization among admitted patients in a tertiary-care hospital's neurology intensive care unit (neuro ICU). METHODS A prospective observational cohort study was conducted between August 2022 and January 2023. Patients of any age and gender admitted to the neuro ICU were included, but those who declined to participate were excluded. Demographics, clinical, and medication details were consistently gathered and maintained until discharge. The World Health Organization (WHO)/International Network of Rational Use of Drugs (INRUD) prescribing indicators and the Anatomical Therapeutic Chemical (ATC) classification/Defined Daily Dose (DDD) system were used to evaluate drug use. RESULTS A total of 516 patients were included, predominantly male (65.1%), with an average age of 54.62 ± 15.02 years. The most common diagnosis was stroke [72.3%, comprised of hemorrhagic (46.7%) and ischemic (25.6%)], followed by seizure disorders (6.6%), and central nervous system infections (5.4%). Patients received an average of 7.8 medications, 32.3% prescribed by generic name, 16.0% antibiotics, 74.1% injections, and 100% essential drugs. A (28.5%), C (19.2%), N (17.3%), J (19.2%), B (13.5%), and R (2.3%) were commonly prescribed ATC classes of medications. Number of DDDs was maximum for pantoprazole and furosemide. Based on discharged status, 41.0% were discharged on request, 24.8% against medical advice, 23.8% routine, and 10.2% mortality during hospitalization. CONCLUSION Our study reveals a high prevalence of hemorrhagic stroke, especially among men, diverging from global ischemic stroke trends. Irregular hypertension treatment is the primary cause, exacerbated by low healthcare knowledge in rural areas, where patients often discharge on request, probably due to poor socio-economic conditions. Urgent public awareness campaigns and further research are needed to address this elevated hemorrhagic stroke incidence.
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Affiliation(s)
- Mamidi Niveditha
- Department of Pharmacy Practice, National Institute of Pharmaceutical Education and Research (NIPER) Guwahati, Kamrup, Assam, India
| | - Ruby Kasana
- Department of Pharmacy Practice, National Institute of Pharmaceutical Education and Research (NIPER) Guwahati, Kamrup, Assam, India
| | - Amit Ranjan Barua
- Department of Neurology and Critical Care, Guwahati Neurological Research Centre (GNRC) Institute of Medical Science, North Guwahati, Assam, India
| | - Mausumi Barthakur
- Department of Neurophysiology, Guwahati Neurological Research Centre (GNRC) Institute of Medical Science, North Guwahati, Assam, India
| | - Krishna Undela
- Department of Pharmacy Practice, National Institute of Pharmaceutical Education and Research (NIPER) Guwahati, Kamrup, Assam, India
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Hedau VN, Patil T. Mounting Stroke Crisis in India: A Systematic Review. Cureus 2024; 16:e57058. [PMID: 38681344 PMCID: PMC11052531 DOI: 10.7759/cureus.57058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2023] [Accepted: 03/27/2024] [Indexed: 05/01/2024] Open
Abstract
Stroke, a neurological disorder, has emerged as a formidable health challenge in India, with its incidence on the rise. Increased risk factors, which also correlate with economic prosperity, are linked to this rise, including hypertension, diabetes, obesity, sedentary lifestyle, and alcohol intake. Particularly worrisome is the impact on young adults, a pivotal segment of India's workforce. Stroke encompasses various clinical subtypes and cerebrovascular disorders (CVDs), contributing to its multifaceted nature. Globally, stroke's escalating burden is concerning, affecting developing nations. To combat this trend effectively and advance prevention and treatment strategies, comprehensive and robust data on stroke prevalence and impact are urgently required. In India, these encompass individuals with elevated BMIs, and those afflicted by hypertension, diabetes, or a familial history of stroke. Disparities in stroke incidence and prevalence manifest across India, with differences in urban and rural settings, gender-based variations, and regional disparities. Early detection, dietary changes, effective risk factor management, and equitable access to stroke care are required to address this issue. Government initiatives, like the National Programme for Prevention and Control of Cancer, Diabetes, Cardiovascular Diseases, and Stroke (NPCDCS) 2019, provide guidelines, but effective implementation and awareness campaigns are vital. Overcoming barriers to stroke care, especially in rural areas, calls for improved infrastructure, awareness campaigns, and support systems. Data standardization and comprehensive population studies are pivotal for informed public health policies.
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Affiliation(s)
- Vedant N Hedau
- Medicine, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Tushar Patil
- Neurology, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
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Ali RJ, Manorenj S, Zafar R. Knowledge of stroke and the window period for thrombolytic therapy in ischemic stroke among South Indians: A hospital-based survey with educational intervention. J Neurosci Rural Pract 2024; 15:111-116. [PMID: 38476435 PMCID: PMC10927053 DOI: 10.25259/jnrp_312_2023] [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: 06/04/2023] [Accepted: 12/16/2023] [Indexed: 03/14/2024] Open
Abstract
Objectives The objective of this study was to determine the awareness of stroke in regards to the risk factors, warning symptoms, and knowledge of the therapeutic window period among varied strata of non-medical people attending a tertiary care center. Materials and Methods The interventional study involved the collection of data regarding awareness of stroke using a structured questionnaire with a total score of 16. Pre-intervention assessment was followed by intervention in the form of education regarding awareness of stroke administered one-on-one for personalized and effective comprehension by subjects. Then, subjects were asked to recall the information that was delivered to them and were scored accordingly. Results Among the 500 subjects included, 51% were female. About 76.8% of participants were young (age <50 years), and 83.4% were literate. Only 25.4% of participants were aware of the brain as the site of stroke. About 32.2% of candidates were aware of a few risk factors for stroke. Among them, the majority of participants were aware of hypertension (24%) as a risk factor. The most known warning symptom was "Numbness" or weakness of arm. The majority of the subjects (97.8%) were unaware of a therapeutic window period for stroke being 4.5 h or below. The mean pre-intervention score was 2.52 ± 1.65 while the mean post-intervention score was 15.10 ± 1.79 (P < 0.0001). Conclusion The study showed that even among literate participants, only a meager number of subjects were aware of the golden window period of intravenous thrombolysis. Educational intervention by means of an in-person and one-on-one explanation achieved significant levels of understanding of stroke. The study could be used to formulate large-scale educational programs that focus on spreading awareness of symptoms and risk factors while also instilling the importance of timely medical intervention for efficient thrombolytic therapy.
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Affiliation(s)
- Reem Jaffar Ali
- Department of Neurology, Princess Esra Hospital, Deccan College of Medical Sciences, Hyderabad, Telangana, India
| | - Sandhya Manorenj
- Department of Neurology, Princess Esra Hospital, Deccan College of Medical Sciences, Hyderabad, Telangana, India
| | - Ruqya Zafar
- Department of Neurology, Princess Esra Hospital, Deccan College of Medical Sciences, Hyderabad, Telangana, India
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Gupta P, Gupta A, Bansal S, Balakrishnan I. Cardiac troponin in hospitalized COVID-19 patients: Incidence, predictors, and outcomes. Ann Clin Biochem 2023:45632231216599. [PMID: 37944990 DOI: 10.1177/00045632231216599] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2023]
Abstract
BACKGROUND The incidence, predictors, and association of cardiac troponin with mortality in hospitalized COVID-19 were not adequately studied in the past and were also not reported from an Indian hospital. METHODS In this retrospective cohort study, the cardiac troponin of 240 hospitalized COVID-19 patients was measured. The incidence, predictors, and association of elevated cardiac troponin with in-hospital mortality were determined among hospitalized COVID-19 patients. RESULTS The cardiac troponin was elevated in 12.9% (31/240) of the patients. The troponin was elevated in the patients in the older age group (64 years vs. 55 years, p = .002), severe COVID-19 illness (SpO2 < 90%) (93.5% vs. 60.8%, p < .001), low arterial oxygen saturation (SpO2) (80% vs. 88%, p = .001), and low PaO2/FiO2 ratio (p < .0001). The patients with elevated cardiac troponin had elevated total leukocyte counts (TLC) (p = .001), liver enzyme (p = .025), serum creatinine (p = .011), N-terminal-Pro Brain natriuretic peptide (p < .0001), and d-dimer (p < .0001). The majority of the patients with elevated cardiac troponin were admitted to the intensive care unit (90.3% vs. 51.2%; p < .0001), were on a ventilator (61.3% vs. 21.5%; p < .0001), and had higher mortality (64.5% vs. 19.6%; p < .0001). The Kaplan-Meir survival analysis showed that the patients with elevated troponin had worse survival (p log-rank<.0001). Age, NT-ProBNP, d-dimer, and ventilator were the predictors of elevated troponin in multivariate logistic regression analysis. The Cox-regression analysis showed a significant association between elevated cardiac troponin and in-hospital mortality (adjusted hazard ratio 2.13; 95% confidence interval [CI] 1.145-3.97; p = .017). Two-thirds (65%) of patients with elevated cardiac troponin died during their hospital stay. CONCLUSIONS COVID-19 patients with elevated cardiac troponin had severe COVID illness, were more commonly admitted to an intensive care unit, were on a ventilator, and had high in-hospital mortality.
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Affiliation(s)
- Praveen Gupta
- Department of Cardiology, Vardhman Mahavir Medical College & Safdarjung Hospital, New Delhi, India
| | - Anunay Gupta
- Department of Cardiology, Vardhman Mahavir Medical College & Safdarjung Hospital, New Delhi, India
| | - Sandeep Bansal
- Department of Cardiology, Vardhman Mahavir Medical College & Safdarjung Hospital, New Delhi, India
| | - Ira Balakrishnan
- Department of Anesthesia and Critical Care, Vardhman Mahavir Medical College & Safdarjung Hospital, New Delhi, India
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Jones SP, Injety RJ, Pandian JD, Ratra S, Sylaja PN, Babu V, Srivastava MP, Sharma S, Sharma S, Webster J, Koirala A, Kaushal P, Kulkarni GB, Dixit A, Sharma A, Prajapati J, Weldon JC, Kuroski JA, Watkins CL, Lightbody CE. Healthcare professionals' perspectives of the provision of, and challenges for, eating, drinking and psychological support post stroke: findings from semistructured interviews across India. BMJ Open 2023; 13:e069150. [PMID: 37880173 PMCID: PMC10603406 DOI: 10.1136/bmjopen-2022-069150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Accepted: 09/21/2023] [Indexed: 10/27/2023] Open
Abstract
AIM This qualitative study explores with health professionals the provision of, and challenges for, postdischarge stroke care, focussing on eating, drinking and psychological support across India. DESIGN Qualitative semistructured interviews. SETTING Seven geographically diverse hospitals taking part in a Global Health Research Programme on Improving Stroke Care in India. PARTICIPANTS A purposive sample of healthcare professionals with current experience of working with patients who had a stroke. RESULTS Interviews with 66 healthcare professionals (23 nurses (14 staff nurses; 7 senior nurse officers; 1 intensive care unit nurse; 1 palliative care nurse)); 16 doctors (10 neurologists; 6 physicians); 10 physiotherapists; 5 speech and language therapists; 4 occupational therapists; 4 dieticians; 2 psychiatrists; and 2 social workers resulted in three main themes: integrated inpatient discharge care planning processes; postdischarge patient and caregiver role and challenges; patient and caregiver engagement post discharge. CONCLUSIONS Discharge planning was integrated and customised, although resources were limited in some sites. Task shifting compensated for a lack of specialists but was limited by staff education and training. Caregivers faced challenges in accessing and providing postdischarge care. Postdischarge care was mainly hospital based, supported by teleservices, especially for rural populations. Further research is needed to understand postdischarge care provision and the needs of stroke survivors and their caregivers.
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Affiliation(s)
- Stephanie P Jones
- School of Nursing and Midwifery, University of Central Lancashire, Preston, UK
| | - Ranjit J Injety
- Department of Neurology, Christian Medical College and Hospital Ludhiana, Ludhiana, Punjab, India
| | - Jeyaraj D Pandian
- Department of Neurology, Christian Medical College and Hospital Ludhiana, Ludhiana, Punjab, India
| | - Sanjali Ratra
- Department of Neurology, Christian Medical College and Hospital Ludhiana, Ludhiana, Punjab, India
| | - P N Sylaja
- Department of Neurology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, Kerala, India
| | - Veena Babu
- Department of Neurology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, Kerala, India
| | - Mv Padma Srivastava
- Department of Neurology, All India Institute of Medical Sciences, New Delhi, India
| | - Sakshi Sharma
- Department of Neurology, All India Institute of Medical Sciences, New Delhi, India
| | - Sudhir Sharma
- Department of Neurology, Indira Gandhi Medical College, Shimla, Himachal Pradesh, India
| | - Jemin Webster
- Department of Medicine, Baptist Christian Hospital Tezpur, Tezpur, Assam, India
| | - Amrit Koirala
- Department of Medicine, Baptist Christian Hospital Tezpur, Tezpur, Assam, India
| | - Pawna Kaushal
- Department of Neurology, Indira Gandhi Medical College, Shimla, Himachal Pradesh, India
| | - Girish Baburao Kulkarni
- Department of Neurology, National Institute of Mental Health and Neuro Sciences, Bangalore, Karnataka, India
| | - Anand Dixit
- Department of Neurology, National Institute of Mental Health and Neuro Sciences, Bangalore, Karnataka, India
| | - Arvind Sharma
- Department of Neurology, Zydus Research Center, Ahmedabad, Gujarat, India
| | - Jagruti Prajapati
- Department of Neurology, Zydus Research Center, Ahmedabad, Gujarat, India
| | - Jo Catherine Weldon
- School of Nursing and Midwifery, University of Central Lancashire, Preston, UK
| | - Jennifer A Kuroski
- School of Nursing and Midwifery, University of Central Lancashire, Preston, UK
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Kalita J, Bharadwaz MP, Aditi A. Prevalence, contributing factors, and economic implications of strokes among older adults: a study of North-East India. Sci Rep 2023; 13:16880. [PMID: 37803041 PMCID: PMC10558533 DOI: 10.1038/s41598-023-43977-z] [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: 07/16/2023] [Accepted: 10/01/2023] [Indexed: 10/08/2023] Open
Abstract
Stroke is a significant cause of mortality and disability in India, with its economic impact on the rise. This study aims to investigate the prevalence and factors associated with stroke among the elderly population in seven north-eastern states of India and its economic consequences. Data from the initial phase of the Longitudinal Ageing Study in India (2017-2018) were utilized, and bivariate and multivariate analyses were done. Stroke prevalence (1.53%) was notable among both genders, with approximately 1% in females and 2.3% in males. Individuals with low physical activity, higher socio-economic status, and unemployment faced a higher risk of stroke. Females exhibited a 60% lower likelihood [AOR 0.40; (CI 0.250-0.627)] of stroke compared to males and hypertension was a significant risk factor. Stroke patients incur up to INR 50,000 of financial burden, with a considerable proportion facing disability in comprehension and speech. The economic burden of stroke-related hospitalization was significantly high, emphasizing the need for government-funded health insurance to cover stroke-related medications and reducing out-of-pocket expenses for patients seeking treatment in healthcare facilities. The study highlights the urgency for better schemes to address the growing threat of strokes in the north-eastern parts of India for comprehensively tackling this public health challenge.
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Affiliation(s)
- Jumi Kalita
- Lalit Chandra Bharali College, Guwahati, Assam, India
| | | | - Aditi Aditi
- Department of Survey Research and Data Analytics, International Institute for Population Sciences, Mumbai, 400088, India.
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Shah A, Diwan A. Stumbling Blocks to Stroke Thrombolysis: An Indian Perspective. Indian J Crit Care Med 2023; 27:616-619. [PMID: 37719355 PMCID: PMC10504641 DOI: 10.5005/jp-journals-10071-24517] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Accepted: 07/26/2023] [Indexed: 09/19/2023] Open
Abstract
Background and purpose Stroke is a leading cause of morbidity and mortality worldwide. Developing countries, however, still lag behind in providing timely thrombolytic therapy (TLT) to many eligible patients owing to various reasons. This study aims to identify such factors. Materials and methods This was a descriptive observational study undertaken over a period of 18 months at a tertiary care teaching hospital and included 252 acute ischemic stroke patients of which 200 were not thrombolyzed. The reasons for nonthrombolysis were recorded and analyzed. Results The study included 252 acute ischemic stroke patients of which only 20% were thrombolyzed. Of the 200 nonthrombolyzed patients, 55% arrived out of the window period while patient-related factors were the second biggest factor preventing thrombolysis. Hospital factors at 14% and financial constraints at 4.5% contributed significantly. Delayed consent emerged as an important factor making 6% of the delays. Conclusion Stroke thrombolysis still faces various pre- and intrahospital barriers in India. There is an urgent need to improve infrastructure and organizational streamlining to enable eligible patients to receive prompt treatment. How to cite this article Shah A, Diwan A. Stumbling Blocks to Stroke Thrombolysis: An Indian Perspective. Indian J Crit Care Med 2023;27(9):616-619.
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Affiliation(s)
- Aviral Shah
- Department of Medicine, Atal Bihari Vajpayee Institute of Medical Sciences and Dr Ram Manohar Lohia Hospital, New Delhi, India
| | - Arundhati Diwan
- Department of Medicine, Bharati Vidyapeeth (Deemed to be University) Medical College, Pune, Maharashtra, India
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George J, Sylaja PN, Sreedharan SE. Recurrence of Cryptogenic (ESUS) Strokes in the First Year: Predictors and Outcome-A South Indian Study. Ann Indian Acad Neurol 2023; 26:728-732. [PMID: 38022488 PMCID: PMC10666862 DOI: 10.4103/aian.aian_282_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2023] [Revised: 06/09/2023] [Accepted: 06/24/2023] [Indexed: 12/01/2023] Open
Abstract
Introduction Around 9-25% of ischemic strokes are embolic stroke of undetermined source (ESUS) with an annual recurrence risk of 4.5-5%. Regarding ESUS, studies from India are limited. Here, we studied the prevalence of cryptogenic ESUS among stroke subtypes, recurrence risk and outcome at 1 year, and their predictors. Materials and Methods We performed a single-center study of ambispective nature. Patients above 18 years of age with a diagnosis of cryptogenic (ESUS) strokes from January 1, 2017, to December 31, 2020 (4 years), with a 1-year follow-up were recruited in our study. All the patients underwent neuroimaging computerised tomography/magnetic resonance tomography (CT/MRI) with angiography, electrocardiogram (ECG), transthoracic echo (TTE), and rhythm monitoring. Functional outcome was measured using the modified Rankin scale with scores 0-2 taken as good outcome. Results We had 234 (11.21% of total ischemic strokes) subjects satisfying the criteria for ESUS over the study period with a mean age of 58.2 ± 12.8 years. 46 patients had a history of stroke/transient ischemic attack (TIA) at admission. 9.4% had a recurrent event at 1 year. The most important neuroimaging predictor of recurrent strokes was multiple embolic followed by superficial watershed pattern. Around 10% had more than one marker of atrial cardiopathy positive. While the risk factors, coronary artery disease (CAD), and neuroimaging pattern showed an association with recurrent events at 1 year on bivariate analysis, only the latter two remained significant on multivariate analysis. Conclusions Our cohort of ESUS had a higher annual recurrence risk than reported before. Though vascular risk factors and ipsilateral vessel abnormalities were more in the recurrent ESUS group, it did not significantly affect the recurrence risk at 1 year. CAD and multiple embolic patterns on imaging showed an association with recurrent strokes, suggesting a possible cardiac substrate in our ESUS population as well.
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Affiliation(s)
- Jithin George
- Department of Neurology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, Kerala, India
| | - P. N. Sylaja
- Department of Neurology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, Kerala, India
| | - Sapna E. Sreedharan
- Department of Neurology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, Kerala, India
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Alruily M, El-Ghany SA, Mostafa AM, Ezz M, El-Aziz AAA. A-Tuning Ensemble Machine Learning Technique for Cerebral Stroke Prediction. APPLIED SCIENCES 2023; 13:5047. [DOI: 10.3390/app13085047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/01/2023]
Abstract
A cerebral stroke is a medical problem that occurs when the blood flowing to a section of the brain is suddenly cut off, causing damage to the brain. Brain cells gradually die because of interruptions in blood supply and other nutrients to the brain, resulting in disabilities, depending on the affected region. Early recognition and detection of symptoms can aid in the rapid treatment of strokes and result in better health by reducing the severity of a stroke episode. In this paper, the Random Forest (RF), Extreme Gradient Boosting (XGBoost), and light gradient-boosting machine (LightGBM) were used as machine learning (ML) algorithms for predicting the likelihood of a cerebral stroke by applying an open-access stroke prediction dataset. The stroke prediction dataset was pre-processed by handling missing values using the KNN imputer technique, eliminating outliers, applying the one-hot encoding method, and normalizing the features with different ranges of values. After data splitting, synthetic minority oversampling (SMO) was applied to balance the stroke samples and no-stroke classes. Furthermore, to fine-tune the hyper-parameters of the ML algorithm, we employed a random search technique that could achieve the best parameter values. After applying the tuning process, we stacked the parameters to a tuning ensemble RXLM that was analyzed and compared with traditional classifiers. The performance metrics after tuning the hyper-parameters achieved promising results with all ML algorithms.
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Affiliation(s)
- Meshrif Alruily
- Computer Science Department, College of Computer and Information Sciences, Jouf University, Sakaka 72388, Aljouf, Saudi Arabia
| | - Sameh Abd El-Ghany
- Information Systems Department, College of Computer and Information Sciences, Jouf University, Sakaka 72388, Aljouf, Saudi Arabia
| | - Ayman Mohamed Mostafa
- Information Systems Department, College of Computer and Information Sciences, Jouf University, Sakaka 72388, Aljouf, Saudi Arabia
| | - Mohamed Ezz
- Computer Science Department, College of Computer and Information Sciences, Jouf University, Sakaka 72388, Aljouf, Saudi Arabia
| | - A. A. Abd El-Aziz
- Information Systems Department, College of Computer and Information Sciences, Jouf University, Sakaka 72388, Aljouf, Saudi Arabia
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Mazumdar B, Donovan NJ, Duncan ES. Identifying an Appropriate Picture Stimulus for a Bangla Picture Description Task. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2023; 66:1334-1350. [PMID: 36947697 DOI: 10.1044/2022_jslhr-22-00152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
PURPOSE The absence of culture- and language-specific aphasia assessment in Bangla underscores a critical problem in communication sciences and disorders. Aphasia occurs in ~41% of Bangla-speaking stroke survivors. In the past 40 years, stroke incidence has doubled in low- and middle-income countries, such as Bangladesh and India, where there are ~250 million native Bangla speakers. This study aims to initiate the first step toward identifying an appropriate picture stimulus for the Bangla picture description task (PDT) intended for inclusion in a Bangla aphasia assessment. Researchers have reported the importance of cultural relevance and three visuographic variables of a picture (high-context, color, and photograph vs. black-and-white line drawing) for faster comprehension and comprehensive language production in people with aphasia and neurologically healthy adults. METHOD Ninety-six neurologically healthy native Bangla speakers of three age groups (young 19-30, middle age 40-55, and older 65-89 years) were recruited to compare spontaneous language production for four selected culturally related and nonrelated picture stimuli with and without the three visuographic variables. Five linguistic variables were used to analyze the language samples. RESULTS The results demonstrated a significant (a) picture type effect for moving-average type-token ratio, words per minute (WPM), and mean length of utterance in morphemes (MLU) and (b) age group effect for WPM, MLU, and complexity index. CONCLUSIONS This study suggests that a culturally related high-context color photograph is the optimal choice for the Bangla PDT. This study also indicates reduced fluency, grammatical complexity, and syntactic complexity in healthy Bangla-speaking adults aged 65 years and above. SUPPLEMENTAL MATERIAL https://doi.org/10.23641/asha.22233664.
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Affiliation(s)
- Barnali Mazumdar
- Department of Speech and Hearing Sciences, Portland State University, OR
| | - Neila J Donovan
- Department of Communication Sciences & Disorders, Louisiana State University, Baton Rouge
| | - E Susan Duncan
- Department of Communication Sciences & Disorders, Louisiana State University, Baton Rouge
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Muacevic A, Adler JR, Deodhe NP. Implementation of the Gamut of Physiotherapy Maneuvers in Restoration and Normalization of Functional Potencies in a Patient With a Hemorrhagic Stroke: A Case Report. Cureus 2022; 14:e33035. [PMID: 36721551 PMCID: PMC9883064 DOI: 10.7759/cureus.33035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2022] [Accepted: 12/28/2022] [Indexed: 12/29/2022] Open
Abstract
A stroke is a medical emergency characterized by a sudden onset of focal neurological deficits due to an interruption in the blood flow to the brain tissues, with signs and symptoms persisting for more than 24 hours. Motor, sensory, recognition, language, and perceptual deficiencies are typical signs of the disease, depending on the areas affected, the size of the injury, and the origin of the injury. Patients who have had a stroke frequently have problems like weakness, stiffness, and altered movement patterns in addition to poor balance and mobility issues. Numerous physiotherapeutic strategies concentrate on helping stroke victims recover quickly. Stroke-related mortality rates have decreased over the past few decades due to advancements in stroke therapy and rehabilitation. One approach that can be primarily used to normalization of tone is facilitation by Rood's technique. The present case report is of a 45-year-old female with a history of hypertension presented with complaints of weakness on the right side of the body. The patient had right hemiplegia with more involvement of the right upper extremity. The patient underwent a decompressive craniotomy. On investigation, the magnetic resonance imaging (MRI) report revealed an area of blood density attenuation with multiple air foci in the left gangliocapsular region. Treatment was started after the patient was operated on. An approach-oriented rehabilitation program was planned for the patient. Physiotherapy maneuvers such as the proprioceptive neuromuscular facilitation (PNF) approach and Rood's approach were used to restore and normalize functional potencies and recover the patient's condition. Oral facial facilitation was also used for swallowing frequency control, sensory awareness, and motor control. Posttreatment changes such as changes in muscle tone, strength, and mobility, which are essential for patients with the activity of daily living (ADLs), were observed. Outcome measures used in this patient are the Functional Independence of Measures (FIM) scale, Brunnstrom grading, voluntary control grading, and the National Institute of Health Stroke Scale (NIHSS).
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Kumar A, Yadav AK, Singh VK, Pathak A, Chaurasia RN, Mishra VN, Joshi D. Caregiver Burden in Caregivers of Stroke Survivors: A Hospital-Based Study. Ann Indian Acad Neurol 2022; 25:1092-1098. [PMID: 36911438 PMCID: PMC9996526 DOI: 10.4103/aian.aian_318_22] [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: 04/07/2022] [Revised: 05/22/2022] [Accepted: 06/20/2022] [Indexed: 11/22/2022] Open
Abstract
Background A principal caregiver (CG) is directly affected by the patient's health problems leading to CG strain. In the present study, we evaluated the different factors related to increased CG burden in stroke survivors and assessed the relationship between patient's personal and clinical characteristics and CG's stress. Material and Methods In this prospective, follow-up study, a total of 141 principle CGs of 164 First-ever stroke (FES) survivors were subjected to the Caregivers Strain Index (CSI) and Oberst Caregiving Burden Scale (OCBS) at 30 days (n = 141), 90 days (n = 129), and 6 months (n = 119) after informed consent. Patients were subjected to modified Rankin Scale (mRS) and Barthel index score assessment at the end of 30 days. Results The mean age of CG was 49.8 ± 21.0 years, approximately 20 years lesser than that of the patients. 102 (72.34%) CGs were females. Urinary incontinence (p < 0.006) morbidity at 30 days, mRS (p = 0.004), and moderate to the severe neurological deficit on admission (p = 0.003) were the patient factors in FES cases leading to significant CGs stress. CG factors responsible for major stress were long caregiving hours (P < 0.001), anxiety (P < 0.001), disturbed night sleep (P < 0.001), financial stress (P < 0.001), younger age (P = 0.002), and CGs being daughters-in-law (P = 0.039). Conclusion CG burden increases with increased severity of stroke. Integrated stroke rehabilitation services should also address CGs issues along with patients.
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Affiliation(s)
- Anand Kumar
- Department of Neurology, Banaras Hindu University, Institute of Medical Sciences, Varanasi, Uttar Pradesh, India
| | - Ajay Kumar Yadav
- Department of Neurology, Banaras Hindu University, Institute of Medical Sciences, Varanasi, Uttar Pradesh, India
| | - Varun Kumar Singh
- Department of Neurology, Banaras Hindu University, Institute of Medical Sciences, Varanasi, Uttar Pradesh, India
| | - Abhishek Pathak
- Department of Neurology, Banaras Hindu University, Institute of Medical Sciences, Varanasi, Uttar Pradesh, India
| | - Rameshwar Nath Chaurasia
- Department of Neurology, Banaras Hindu University, Institute of Medical Sciences, Varanasi, Uttar Pradesh, India
| | - Vijaya Nath Mishra
- Department of Neurology, Banaras Hindu University, Institute of Medical Sciences, Varanasi, Uttar Pradesh, India
| | - Deepika Joshi
- Department of Neurology, Banaras Hindu University, Institute of Medical Sciences, Varanasi, Uttar Pradesh, India
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Harjpal P, Qureshi MI, Kovela RK, Jain M. Efficacy of Bilateral Lower-Limb Training Over Unilateral Lower-Limb Training To Reeducate Balance and Walking in Post-Stroke Survivors: A Randomized Clinical Trial. Cureus 2022; 14:e30748. [DOI: 10.7759/cureus.30748] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2022] [Accepted: 10/27/2022] [Indexed: 11/07/2022] Open
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Harjpal P, Qureshi MI, Kovela RK, Jain M. Bilateral Lower Limb Training for Post-stroke Survivors: A Bibliometric Analysis. Cureus 2022; 14:e29615. [PMID: 36321041 PMCID: PMC9603067 DOI: 10.7759/cureus.29615] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Accepted: 09/26/2022] [Indexed: 11/27/2022] Open
Abstract
Stroke is one of the most disabling conditions affecting the middle-aged population all around the world. This study aims to explore the rehabilitation of stroke patients using bibliometric analysis, which includes statistical analysis of recent articles, books, and other kinds of publications, to assess scientific output and determine the significance of scientific investigations in terms of both quality and quantity. In this study, an analysis of global trends in research in bilateral lower limb training for training balance and walking for patients in the subacute stage post-stroke between 1988 and 2021 was done. All the articles were obtained from PubMed databases. CiteSpace software was used to analyze the relationship between publications and country, journals, institutions, authors, references, and the keywords used. A total of 160 publications were included in the analysis. There was a tremendous increase in the research of physiotherapy intervention in patients who had residual disability post-stroke with a publication rate of 7.1 articles per year of publications. The use of the sophisticated PubMed database to extract articles allowed for a thorough and powerful bibliometric analysis of stroke rehabilitation research published between 1988 and 2020. In general, the number of studies on bilateral training has increased in recent decades. This historical overview of rehabilitation for post-stroke survivors will serve as a valuable starting point for future study into possible collaborators, focus issues, and trends. This bibliometric analysis highlights the potential value of exercise therapy for stroke survivors in creating more effective hemiplegia rehabilitation programs. This research may encourage the use of strengthening in the therapeutic therapy of hemiplegia balance. The groundwork will be laid for future research on strengthening stroke to be organized and given top priority.
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A Deep Learning-Based Upper Limb Rehabilitation Exercise Status Identification System. ARABIAN JOURNAL FOR SCIENCE AND ENGINEERING 2022. [DOI: 10.1007/s13369-022-06702-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Nair BB, Sakthivel NR. An Upper Limb Rehabilitation Exercise Status Identification System Based on Machine Learning and IoT. ARABIAN JOURNAL FOR SCIENCE AND ENGINEERING 2022. [DOI: 10.1007/s13369-021-06152-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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18
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Jones SP, Baqai K, Clegg A, Georgiou R, Harris C, Holland EJ, Kalkonde Y, Lightbody CE, Maulik PK, Srivastava PMV, Pandian JD, Kulsum P, Sylaja PN, Watkins CL, Hackett ML. Stroke in India: A systematic review of the incidence, prevalence, and case fatality. Int J Stroke 2022; 17:132-140. [PMID: 34114912 PMCID: PMC8821978 DOI: 10.1177/17474930211027834] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Accepted: 06/01/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND The burden of stroke is increasing in India; stroke is now the fourth leading cause of death and the fifth leading cause of disability. Previous research suggests that the incidence of stroke in India ranges between 105 and 152/100,000 people per year. However, there is a paucity of available data and a lack of uniform methods across published studies. AIM To identify high-quality prospective studies reporting the epidemiology of stroke in India. SUMMARY OF REVIEW A search strategy was modified from the Cochrane Stroke Strategy and adapted for a range of bibliographic databases from January 1997 to August 2020. From 7717 identified records, nine studies were selected for inclusion; three population-based registries, a further three population-based registries also using community-based ascertainment and three community-based door-to-door surveys. Studies represented the four cities of Mumbai, Trivandrum, Ludhiana, Kolkata, the state of Punjab, and 12 villages of Baruipur in the state of West Bengal. The total population denominator was 22,479,509 and 11,654 (mean 1294 SD 1710) people were identified with incident stroke. Crude incidence of stroke ranged from 108 to 172/100,000 people per year, crude prevalence from 26 to 757/100,000 people per year, and one-month case fatality rates from 18% to 42%. CONCLUSIONS Further high-quality evidence is needed across India to guide stroke policy and inform the development and organization of stroke services. Future researchers should consider the World Health Organization STEPwise approach to Surveillance framework, including longitudinal data collection, the inclusion of census population data, and a combination of hospital-registry and comprehensive community ascertainment strategies to ensure complete stroke identification.
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Affiliation(s)
| | - Kamran Baqai
- University of Central Lancashire, Preston, Lancashire, UK
| | - Andrew Clegg
- University of Central Lancashire, Preston, Lancashire, UK
| | | | - Cath Harris
- University of Central Lancashire, Preston, Lancashire, UK
| | | | - Yogeshwar Kalkonde
- Society for Education, Action and Research in Community Health, Gadchiroli, India
| | | | - Pallab K Maulik
- The George Institute for Global Health, New Delhi, India
- University of New South Wales, Sydney, Australia
- Manipal University, Manipal, India
| | | | | | - Patel Kulsum
- University of Central Lancashire, Preston, Lancashire, UK
| | - PN Sylaja
- Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, Kerala, India
| | | | - Maree L Hackett
- University of Central Lancashire, Preston, Lancashire, UK
- The George Institute for Global Health, University of New South Wales, New South Wales, Australia
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Nayak RR, Narayanaswamy S. Association of serum calcium levels with infarct volume and stroke scores in acute ischemic stroke patients: An observational study. CASPIAN JOURNAL OF INTERNAL MEDICINE 2022; 13:780-785. [PMID: 36420322 PMCID: PMC9659820 DOI: 10.22088/cjim.13.4.779] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
BACKGROUND Stroke vastly contributes to death and disability worldwide. Acute ischemic stroke (AIS) is caused by a reduction in supply of blood to the brain. Accumulation of unnecessary intracellular serum calcium in AIS induces the cytotoxic actions that activates enzymes involved in cell death. The present investigation assessed the relationship of total serum calcium level (at admission) and initial diffusion weighted imaging (DWI) infarct volume and correlated with National Institute of Health Stroke Scale (NIHSS) scores. METHODS A hospital-based observational study was conducted on 74 consecutive patients identified with AIS fulfilling the inclusion criteria. NIHSS scores and serum ionized calcium were calculated in every patient and compared with DWI infarct volume for assessing correlation between these three. Statistical software R Version 4.0.2 and Microsoft Excel were used for statistical analysis. RESULTS Out of the 74 patients, most of them were in age group of 50-69 years, with a male preponderance (68.9%). A significant association was noticed between diabetes and dyslipidemia with age (P=0.01499). A strong negative correlation was observed between NIHSS scores (at admission & discharge) with ionized calcium, while a strong positive correlation was noticed between stroke scores with infarct volume. A statistically significant negative correlation was recorded between serum calcium (on admission) and infarct size (r=-0.851755, P=0.0001). The mean of NIHSS scores on admission (8.24±5.19) has been remarkably higher when compared with NIHSS scores at discharge (5.25±3.89). CONCLUSION In patients with AIS examined within 6-24 hours of symptoms onset, serum ionized calcium and volume of infarct on DWI showed inverse association. Serum calcium serves as a marker of severity and acts as prognostic factor in AIS.
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Affiliation(s)
- Ramya R Nayak
- Department of General Medicine, Ramaiah Medical College and Hospital, Bengaluru 560 054, Karnataka, India
| | - Srikanth Narayanaswamy
- Department of General Medicine, Ramaiah Medical College and Hospital, Bengaluru 560 054, Karnataka, India
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20
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Effect of Community Education Program on Stroke Symptoms and Treatment on School and College Students from South India: A Longitudinal Observational Study. Healthcare (Basel) 2021; 9:healthcare9121637. [PMID: 34946363 PMCID: PMC8702212 DOI: 10.3390/healthcare9121637] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Revised: 11/19/2021] [Accepted: 11/23/2021] [Indexed: 11/17/2022] Open
Abstract
Community awareness regarding stroke signs, risk factors, and actions that help reduce the risk and complications of stroke is poorly addressed, as it is thought to be the best approach to control and prevent stroke. Aim: To establish the awareness of stroke and its management among high school and college students using an educational intervention. A questionnaire was administered to students from five high schools and four colleges with different areas of focus, (arts, science and commerce), types (public, semi-public and private), and economic locations before and after an educational lecture on stroke. The lecture covered the following elements: stroke definition, signs, risk factors, actions, time window for thrombolytic therapy, and types of rehabilitation interventions. This study included 1036 participants, of whom 36.3% were male and 56.4% were high school students, and the mean age was 17.15 ± 1.29 (15-22) years. Before the lecture, 147 participants were unaware of a single sign of stroke, and 124 did not know the risk factors. After the intervention, 439 participants knew four signs of stroke, and 196 knew 12 risk factors. Female students had better knowledge about stroke signs (odds ratio (OR), 3.08; 95% confidence interval (95% CI), 2.15-4.43). Hypertension (52.7%) and weakness (59.85%) were the most known signs and risk factors. The proportion of students who selected traditional medicine as the mode of treatment decreased from 34.75% to 8.59% after the lecture. Other rehabilitation methods (e.g., physical therapy, occupational therapy, speech therapy and counseling) were chosen by more than 80% of the students. The results of the current study showed that the awareness on stroke risk factors and management among the school and college students can be significantly improved with regular educational interventions, and therefore stroke can be prevented to some extent.
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21
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Tiwari S, Joshi A, Rai N, Satpathy P. Impact of Stroke on Quality of Life of Stroke Survivors and Their Caregivers: A Qualitative Study from India. J Neurosci Rural Pract 2021; 12:680-688. [PMID: 34737502 PMCID: PMC8559087 DOI: 10.1055/s-0041-1735323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
Abstract
Objectives Stroke is a significant global public health challenge attributable to an array of disabilities it causes alongside an impairment in cognition. The monetary impact of stroke care includes acute treatment expenses as well as outrageous expenses of postdischarge chronic hospital care and rehabilitation services. The current study aimed to study the perceptions along with experiences of stroke survivors and caregivers. Materials and Methods In-depth interviews (IDIs) of stroke survivors and their primary caregivers were conducted at their home 2 months after their discharge from the hospital in Bhopal, India. These IDIs were later analyzed. Results The following eight themes emerged: pervasive and irreversible, multifunction loss and dependency, holistic impact on the health of person and family, money and matter, nonaccommodative cost and baffled belief, professional paralysis, social crisis, and slow and obscured progress. The added obligation of taking care of a disabled stroke survivor along with adjusting their own lifestyle with financial apprehensions, worry about future, prolonged hours of care, and stress are major factors that increase the burden of the caregivers. Conclusion Caregivers should be sensitized with proper counseling and training through health care institutions to ensure appropriate care and management of stroke survivors at home, as it will also help in addressing their psychosocial needs, and minimizing the knowledge gap, doubts and uncertainties about the disease and its aftereffects.
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Affiliation(s)
- Sharad Tiwari
- National Mental Health Program, National Health Mission, Madhya Pradesh, India
| | - Ankur Joshi
- Department of Community and Family Medicine, All India Institute of Medical Sciences, Bhopal, India
| | - Nirendra Rai
- Department of Neurology, All India Institute of Medical Sciences, Bhopal, India
| | - Parmeshwar Satpathy
- Department of Community Medicine, Veer Surendra Sai Institute of Medical Sciences and Research, Burla, Odisha, India
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22
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Ram CVS, Kumar S, Renjen PN, Kumar GP, Swaminathan J, Reddy CR, Kondati S, Sharma M, Selvan VLA, Sundaram M, Vasudevan A, Lackland D. Risk factors predisposing to acute stroke in India: a prospective study. J Hypertens 2021; 39:2183-2189. [PMID: 34620808 DOI: 10.1097/hjh.0000000000002915] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
BACKGROUND Stroke is an important neurological disorder with significant morbidity and mortality. In India, the risk factors for stroke (obesity, diabetes mellitus, alcoholism, hypertension, and sedentary lifestyle) are mounting with economic growth and increasing the disease burden. OBJECTIVE To assess the severity and risk factors of stroke in India and identify any new predisposing factors. METHODS A multicentric (six tertiary care hospitals across India) prospective observational study (from September 2016 to July 2017) was conducted on 526 stroke patients, presenting within the first 24 h to examine the risk factors for ischemic and hemorrhagic strokes. Severity was determined using the National Institutes of Health Stroke Scale (NIHSS). RESULTS Predominantly male (72.3%), 75% of the sample was >50 years old, with a mean body mass index (BMI) of 25.8 ± 4.3 kg/m2 and 14.6% obese patients. Hypertension and diabetes mellitus were the commonest comorbidities, followed by a history of ischemic heart disease and familial history of stroke. 20.5% of patients had mild strokes, 57.4% had moderate, 8.4% experienced moderate-severe strokes, whereas 7.2% had severe strokes. Regarding the admission diagnoses, 56.8% were ischemic, 18.6% were hemorrhagic, 1.1% had a transient ischemic attack, 6.6% suffered recurrent strokes, and 17% were other forms. CONCLUSION The foremost risk factors for stroke in India, hypertension and diabetes, need to be controlled and treated like other global high-risk populations for stroke prevention. The NIHSS scores highlight the relationship between risk factors and stroke severity.
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Affiliation(s)
- C Venkata S Ram
- Stroke Research Group, Apollo Group of Hospitals, Apollo Research & Innovations Institute, Hyderabad, India
| | - Sudhir Kumar
- Stroke Research Group, Apollo Group of Hospitals, Apollo Research & Innovations Institute, Hyderabad, India
| | - Pushpendra Nath Renjen
- Stroke Research Group, Apollo Group of Hospitals, Apollo Research & Innovations Institute, Hyderabad, India
| | - G Praveen Kumar
- Stroke Research Group, Apollo Group of Hospitals, Apollo Research & Innovations Institute, Hyderabad, India
| | - Jayanthi Swaminathan
- Stroke Research Group, Apollo Group of Hospitals, Apollo Research & Innovations Institute, Hyderabad, India
| | - C Rajesh Reddy
- Stroke Research Group, Apollo Group of Hospitals, Apollo Research & Innovations Institute, Hyderabad, India
| | - Sathyanarayana Kondati
- Stroke Research Group, Apollo Group of Hospitals, Apollo Research & Innovations Institute, Hyderabad, India
| | - Mukesh Sharma
- Stroke Research Group, Apollo Group of Hospitals, Apollo Research & Innovations Institute, Hyderabad, India
| | - V L Arul Selvan
- Stroke Research Group, Apollo Group of Hospitals, Apollo Research & Innovations Institute, Hyderabad, India
| | - Meenakshi Sundaram
- Stroke Research Group, Apollo Group of Hospitals, Apollo Research & Innovations Institute, Hyderabad, India
| | | | - Daniel Lackland
- World Hypertension League, Medical University of South Carolina, Charleston, USA
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Dutta D, Aruchamy S, Mandal S, Sen S. Poststroke Grasp Ability Assessment using an Intelligent Data Glove based on Action Research Arm Test: Development, Algorithms, and Experiments. IEEE Trans Biomed Eng 2021; 69:945-954. [PMID: 34495824 DOI: 10.1109/tbme.2021.3110432] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
Growing impact of poststroke upper extremity (UE) functional limitations entails newer dimensions in assessment methodologies. This has compelled researchers to think way beyond traditional stroke assessment scales during the out-patient rehabilitation phase. In concurrence with this, sensor-driven quantitative evaluation of poststroke UE functional limitations has become a fertile field of research. Here, we have emphasized an instrumented wearable for systematic monitoring of stroke patients with right-hemiparesis for evaluating their grasp abilities deploying intelligent algorithms. An instrumented glove housing 6 flex sensors, 3 force sensors, and a motion processing unit was developed to administer 19 activities of Action Research Arm Test (ARAT) while experimenting on 20 voluntarily participating subjects. After necessary signal conditioning, meaningful features were extracted, and subsequently the most appropriate ones were selected using the ReliefF algorithm. An optimally tuned support vector classifier was employed to classify patients with different degrees of disability and an accuracy of 92% was achieved supported by a high area under the receiver operating characteristic score. Furthermore, selected features could provide additional information that revealed the causes of grasp limitations. This would assist physicians in planning more effective poststroke rehabilitation strategies. Results of the one-way ANOVA test conducted on actual and predicted ARAT scores of the subjects indicated remarkable prospects of the proposed glove-based method in poststroke grasp ability assessment and rehabilitation.
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Praveen Kumar P, D. M, Siva Sankar Reddy L, Dastagiri Reddy Y, Somasekhar G, Sirisha N, Nagaraju K, Shouib M, Rizwaan A. A new cerebral ischemic injury model in rats, preventive effect of gallic acid and in silico approaches. Saudi J Biol Sci 2021; 28:5204-5213. [PMID: 34466098 PMCID: PMC8381014 DOI: 10.1016/j.sjbs.2021.05.044] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Revised: 05/17/2021] [Accepted: 05/18/2021] [Indexed: 12/14/2022] Open
Abstract
Current study was designed multiple occlusions and reperfusion of bilateral carotid arteries induced cerebral injury model and evaluated the protective effect of gallic acid on it. In silico study was involved to study gallic acid binding affinity on cerebrotonic proteins compared with standard drugs using Autodoc vina tool. Cerebral ischemia was induced by occlusion of bilateral common carotid arteries for 10 mins followed by 10 reperfusions (1 cycle), cycle was continued to 3 cycles (MO/RCA), then pathological changes were observed by estimation of brain antioxidants as superoxide dismutase, glutathione, catalase, oxidants like malonaldehyde, cerebral infarction area, histopathology, and study gallic acid treatment against cerebral injury. Gallic acid exhibited a strong binding affinity on targeted cerebrotoxic proteins. MO/RCA rat brain antioxidant levels were significantly decreased and increased MDA levels (p < 0.0001), Infarction size compared to sham rats. Gallic acid treatment rat brain MDA levels significantly decreased (p < 0.4476) and increased SOD (p < 0.0001), CAT (p < 0.0001), GSH (p < 0.0001), cerebral infarction area when compared to MO/RCA group. Developed model showed significant cerebral ischemic injury in rats, injury was ameliorated by Gallic acid treatment and in silico approaches also inhibit the cerebrotoxic protein function by targeting on active sites.
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Affiliation(s)
- P. Praveen Kumar
- Santhiram College of Pharmacy, Nandyal, Kurnool, Andhra Pradesh, India
| | - Madhuri D.
- Creative Educational Societys College of Pharmacy, Kurnool, Andhra Pradesh, India
| | | | | | - G. Somasekhar
- SKU College of Pharmaceutical Sciences, Anantapur, Andhra Pradesh, India
| | - N.V.L. Sirisha
- Nitte College of Pharmaceutical Sciences, Banglaore, Karnataka, India
| | - K. Nagaraju
- C.R Reddy College of Pharmacy, Eluru, West Godavari, Andhra Pradesh, India
| | - M.S. Shouib
- Creative Educational Societys College of Pharmacy, Kurnool, Andhra Pradesh, India
| | - A.S. Rizwaan
- Creative Educational Societys College of Pharmacy, Kurnool, Andhra Pradesh, India
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Patil S, Mishra VN, Singh V, Joshi D, Chaurasia RN, Pathak A. Spectrum of neurological diseases across gangetic belt: a hospital based prospective observational study. Int J Neurosci 2021; 133:676-681. [PMID: 34380003 DOI: 10.1080/00207454.2021.1967348] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVE Neurological disorders are the most common cause of morbidity and mortality in riverside cities. Earlier studies reported the presence of heavy metals in the riverside of Gangetic belt. Our study objective was to determine the prevalence of neurological diseases in Ganga riverside and further divided into sections as just across riverside within 25 kms and non-riverside as 25 kms away from the Ganga river. METHODS This was a prospective observational study conducted in a tertiary care hospital of selected Gangetic belt. RESULTS A total of 2016 patients were recorded in this period. Mean age of the participants was 47.89 years, majority were males 59.2%. Most of the patients n = 1154 were from within 25 kms of Ganga riverside and n = 862 patients were from non-riverside (25 kms away from Ganga river). Common neurological diseases were ischemic stroke 22.7%, haemorrhagic stroke 20.7%, seizures 13.7%, septic encephalopathy 9.4%, neuropathy 8.9%, Parkinson's disease 4.3%, myopathy 4.1%, myelitis 2.8%, headache 2.4%, amyotrophic lateral sclerosis 1.9% and functional disorder 1.9%. CONCLUSION Present study showed that neurological diseases were more common in Ganga riverside and stroke including ischemic and hemorrhagic are most common neurological diseases noted in our study.
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Affiliation(s)
- Sooraj Patil
- Department of Neurology, Institute of Medical Science, Banaras Hindu University, Varanasi, UP, India
| | - Vijaya Nath Mishra
- Department of Neurology, Institute of Medical Science, Banaras Hindu University, Varanasi, UP, India
| | - Vineeta Singh
- Department of Neurology, Institute of Medical Science, Banaras Hindu University, Varanasi, UP, India
| | - Deepika Joshi
- Department of Neurology, Institute of Medical Science, Banaras Hindu University, Varanasi, UP, India
| | - Rameshwar Nath Chaurasia
- Department of Neurology, Institute of Medical Science, Banaras Hindu University, Varanasi, UP, India
| | - Abhishek Pathak
- Department of Neurology, Institute of Medical Science, Banaras Hindu University, Varanasi, UP, India
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Jayawardana KS, Crowfoot G, Janssen H, Nayak P, Solomon JM, English CK. Comparing the physical activity of stroke survivors in high-income countries and low to middle-income countries. PHYSIOTHERAPY RESEARCH INTERNATIONAL 2021; 26:e1918. [PMID: 34228383 DOI: 10.1002/pri.1918] [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: 11/04/2020] [Revised: 04/19/2021] [Accepted: 06/22/2021] [Indexed: 11/07/2022]
Abstract
BACKGROUND Low physical activity levels in people with stroke may contribute to higher risk of cardiovascular disease morbidity and mortality. Differences in economic status, culture and the built environment may influence the applicability of interventions developed in high income countries (HIC) for stroke survivors in low to middle-income countries (LMIC). PURPOSE To compare physical activity levels of stroke survivors in HIC and LMIC and to explore the influence of lower limb impairment on physical activity levels. METHODS AND MATERIALS An exploratory secondary analysis of observational data on physical activity levels of stroke survivors from Australia (HIC) and India (LMIC). Physical activity variables (step count, light physical activity (LPA) and moderate-to-vigorous physical activity (MVPA)) were measured by accelerometery. Comparisons of physical activity levels between (a) Australian and Indian stroke survivors and (b) participants with and without lower limb impairments were performed using independent t-tests or Mann-Whitney U tests. RESULTS There were no significant differences in physical activity levels between (i) Australian and Indian stroke survivors (step count mean difference 201 steps [-1375 to 974], LPA mean difference -24 min [-22 to 69], MVPA mean difference 2 min [-8 to 3]), and (ii) stroke survivors with and without lower limb impairments in either country. CONCLUSION Stroke survivors were highly inactive in both countries. Despite differences in economic status, cultural influences and the built environment, the physical activity of stroke survivors in Australia and India did not differ. People with and without lower limb impairment also had similar physical activity levels.
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Affiliation(s)
- Krishni S Jayawardana
- School of Health Sciences, University of Newcastle, Callaghan, New South Wales, Australia
| | - Gary Crowfoot
- Hunter Medical Research Institute, Newcastle, New South Wales, Australia
| | - Heidi Janssen
- Hunter Medical Research Institute, Newcastle, New South Wales, Australia
| | - Pradeepa Nayak
- Department of Physiotherapy, Manipal College of Health Professions, Manipal Academy of Higher Education, Udupi, India
| | - John M Solomon
- Department of Physiotherapy, Manipal College of Health Professions, Manipal Academy of Higher Education, Udupi, India
| | - Coralie K English
- School of Health Sciences, University of Newcastle, Callaghan, New South Wales, Australia
- Hunter Medical Research Institute, Newcastle, New South Wales, Australia
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Girnar GA, Mahajan HS. Cerebral ischemic stroke and different approaches for treatment of stroke. FUTURE JOURNAL OF PHARMACEUTICAL SCIENCES 2021. [DOI: 10.1186/s43094-021-00289-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Cerebral ischemia can be considered a lethal disease as it is a leading cause of death worldwide with no prompt line of treatment. The factors which make this disease more fatal are failure of drugs while crossing BBB, very low availability of the drug in the brain, inefficiency of drug molecule in the clinical studies, limited availability of clinical data, lack of awareness about this disease, and many more.
Main body
This review focuses on reasons and mechanisms of stroke, classification of brain ischemia; it also reveals the current scenario of stroke in India. Very few drugs are effective for the treatment of stroke. This compilation furnishes conventional and recent treatments of stroke along with their hurdles like the gap between preclinical and clinical studies. This review also suggests effective routes of administration of drugs for the treatment of brain ischemia specifically nose-to-brain route and effectiveness of different dosage forms precisely nanoformulations, as the most effective dosage form.
Conclusion
By following different guidelines and treatments, the risk of brain ischemia can be minimized as well as some advanced techniques for the treatment of this disease proving their efficiency. One of the important aspects in the success of the treatment for this disease is the route of administration of the drug. Among all routes, intranasal drug delivery presents a potential approach and is supposed to be the next-generation therapy for brain disorders. The nose-to-brain route is very effective, and it shows some promising results in case of stroke treatment. The strategy is still under investigation despite various successful lab-scale studies; there are numerous challenges to reach the product in the market. Research is going on to get a better understanding of this strategy. We believe that detailed studies to resolve pitfalls will lead to the successful development of an intranasal formulation for the management of ischemic brain injury such as stroke.
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Uy J, Ketkar AG, Portnoy A, Kim JJ. Cost-utility analysis of heart surgeries for young adults with severe rheumatic mitral valve disease in India. Int J Cardiol 2021; 338:50-57. [PMID: 34090957 DOI: 10.1016/j.ijcard.2021.05.059] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Revised: 04/30/2021] [Accepted: 05/31/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Rheumatic mitral valve disease (RMVD) is a major cause of acquired valvular disease in India. We compared the cost-effectiveness of surgical treatment strategies for young adults with severe RMVD from an Indian public payer perspective. METHODS We developed a Markov model to reflect the burden of RMVD among a hypothetical cohort of 20-year-olds in India and to estimate quality-adjusted life years (QALYs) and lifetime costs associated with three strategies: (1) Repair; (2) Mechanical valve replacement (MVR-M); and (3) Bioprosthetic valve replacement (MVR-B), compared to a baseline strategy involving a mix of surgeries approximating the standard of care in India (32% Repair, 33% MVR-M, 35% MVR-B). Data on disease burden, intervention effects, and direct medical costs (2018 US$) were obtained from the literature. Deterministic and probabilistic sensitivity analyses were conducted to assess model uncertainty. RESULTS Repair ($2530, 9.7 QALYs) was less costly and more effective than the standard of care ($2990, 8.7 QALYs) and MVR-M ($3220, 6.2 QALYs). The incremental cost-effective ratio for MVR-B ($3190, 10.1 QALYs) compared to Repair was $1590 per QALY, which may be cost-effective at a threshold of India's per-capita gross domestic product (GDP: $2005). The optimal choice between Repair or MVR-B was sensitive to variations in surgery costs, background mortality, and risks for reoperation. CONCLUSIONS Our model-based analysis suggests that Repair is the optimal strategy and MVR-M should not be recommended for this subpopulation. MVR-B may be cost-effective in contexts where quality of Repair is not assured, newer generation bioprostheses are used, or the costs of the bioprosthetic valve decrease.
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Affiliation(s)
- Jhanna Uy
- Health Sciences Program, School of Science and Engineering, Ateneo de Manila University, Metro Manila, Philippines.
| | | | - Allison Portnoy
- Center for Health Decision Science, Harvard T.H. Chan School of Public Health, Boston, MA, USA.
| | - Jane J Kim
- Center for Health Decision Science, Harvard T.H. Chan School of Public Health, Boston, MA, USA.
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Sadanandan S, D'Silva F, Renjith V. Body Cathexis among Stroke Survivors: A Cross-Sectional Study. J Neurosci Rural Pract 2021; 12:33-38. [PMID: 33531757 PMCID: PMC7846317 DOI: 10.1055/s-0040-1716807] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Background
Stroke results in functional dependence and poor quality of life. Body cathexis is a measure of one’s perceived body image. Stroke survivors often experience stress, anxiety, and disturbances in body image.
Objectives
The objective of the study was to explore the body cathexis of stroke survivors.
Materials and Methods
The cross-sectional survey was conducted at two rural community settings of Kozhikode district, Kerala. Using a purposive sampling, 151 stroke survivors were recruited.
Results
The mean age of the participants was 64.58 years. About 53.6% participants were males and majority of the participants had ischemic stroke (76.2%). About one-third of participants had moderately severe disability. Among the participants, the body cathexis scale (BCS) ranged from 176 to 202. The overall mean (standard deviation) BCS score was 190.09 (5.04). Satisfaction or dissatisfaction toward each body part was analyzed and found that significant areas of dissatisfaction were energy level (98%), wrist (88.1%), elimination (86.1%), fingers (76.2%), and arms (73.5%). The BCS scores compared with the sides of lesion, gender differences, and duration of stroke showed no significant differences in the mean (p>0.05).
Conclusions
Stroke survivors are found to experience disturbances in body image. Low energy level, poor functioning of upper extremities, and disturbed elimination patterns add primarily to body image disturbances. Body cathexis does not differ with side of lesion, gender differences, and duration of stroke.
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Affiliation(s)
- Soumya Sadanandan
- Department of Medicine, Government Medical College, Kozhikode, Kerala, India
| | - Fatima D'Silva
- Nitte Usha Institute of Nursing Sciences, Constituent College of Nitte (Deemed to be University), Deralakattee, Karnataka, India
| | - Vishnu Renjith
- School of Nursing and Midwifery, Royal College of Surgeons in Ireland-Bahrain (RCSI Bahrain), Bahrain
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Shankaranarayana AM, Gururaj S, Natarajan M, Balasubramanian CK, Solomon JM. Gait training interventions for patients with stroke in India: A systematic review. Gait Posture 2021; 83:132-140. [PMID: 33137637 DOI: 10.1016/j.gaitpost.2020.10.012] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Revised: 10/01/2020] [Accepted: 10/11/2020] [Indexed: 02/02/2023]
Abstract
BACKGROUND Gait is considered to be the most important determinant of functional independence in activities of daily living. The challenges faced by stroke survivors in India differ from the western population due to economic, cultural, and geographical factors and this, in turn, may influence the choice of intervention. Hence, there is a need to understand the current gait training trends for stroke survivors in low resource settings like India. RESEARCH QUESTION To systematically review the literature on interventional strategies for improving gait among stroke survivors in India. METHODS Six databases were searched to identify RCTs delivering gait training to stroke survivors having some gait deficits in terms of speed or any other kinematic parameters. Studies of the English language from India were included. Two independent reviewers screened, extracted data, and assessed the study quality. A descriptive synthesis was undertaken and the data was summarized. RESULTS Of 2112 potentially relevant articles, 12 studies with a total of 412 participants were included after title, abstract and full-text screening. Studies tested the efficacy of interventions such as mirror therapy, motor imagery, transcutaneous electrical nerve stimulation, strengthening, and task-based training. The outcome measures were kinematic gait-analysis, gait velocity, Functional Ambulation Categories, Timed Up and Go, Fugl-Meyer Assessment. From the results of this review, active task-based gait training and strengthening along with motor priming seems to be the most tested interventions. Future studies may need to design interventions targeting both impairment and function to bring about maximum improvement in gait after stroke. SIGNIFICANCE Reviews addressing gait practices in developing countries for people with stroke are scarce. The present review would assist physiotherapists in developing countries to utilize evidence-based criteria for the selection of gait training approaches post-stroke. Due to the environmental and contextual demands, the effect of interventions for recovery among stroke survivors should be improvised in low resource settings. This review can be a source of recommendation in giving effective strategies for clinical practice.
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Affiliation(s)
- Apoorva M Shankaranarayana
- Department of Physiotherapy, Manipal College of Health Professions, Manipal Academy of Higher Education, Manipal, India.
| | - Sanjana Gururaj
- Department of Physiotherapy, Manipal College of Health Professions, Manipal Academy of Higher Education, Manipal, India.
| | - Manikandan Natarajan
- Department of Physiotherapy, Manipal College of Health Professions, Manipal Academy of Higher Education, Manipal, India; Centre for Comprehensive Stroke Rehabilitation and Research (CCSRR), Manipal Academy of Higher Education, Manipal, Karnataka, India.
| | | | - John M Solomon
- Department of Physiotherapy, Manipal College of Health Professions, Manipal Academy of Higher Education, Manipal, India; Centre for Comprehensive Stroke Rehabilitation and Research (CCSRR), Manipal Academy of Higher Education, Manipal, Karnataka, India.
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Tiwari S, Joshi A, Rai N, Misbah A, Satpathy P. Community-based longitudinal follow-up of Stroke patients discharged from a tertiary care center in Central India. J Family Med Prim Care 2020; 9:6102-6108. [PMID: 33681047 PMCID: PMC7928101 DOI: 10.4103/jfmpc.jfmpc_1196_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Revised: 09/08/2020] [Accepted: 10/08/2020] [Indexed: 11/28/2022] Open
Abstract
Context: Stroke is a condition that may affect the functionality of a person to a significant degree; however, there is very little data available that speaks about the objective state of a patient from a revalidated scale after the post-stroke event. Aims: To fill the knowledge gap and generate first-hand evidence about the post-stroke events in the community. To study post-stroke well-being of patients discharged from health facility and assess them longitudinally by Relevant Physical Examination, National Institute of Health stroke scale, and Modified Rankin Scale. Methods and Materials: Forty patients who suffered from first episode of stroke were followed in their home longitudinally by Relevant Physical Examination, National Institute of Health (NIH) stroke scale and Modified Rankin Scale. Patients under study were first visited after 2 months of discharge from the hospital set up after which two more follow-up visits were conducted at 2 months interval each. Results: There was an improvement in muscle power, sensation in the upper and lower limb, gait, and posture as well as language and vision in the patients in three subsequent visits. There was no significant difference in the fine movements of the patients. There was a gradual improvement in NIH score and there was a dominant presence of moderate-severe disability among the patients. Conclusions: Quantitative scales largely showed on a primary basis that on the physical dimension of the disease, the effects of Stroke were affecting the functioning of the body at optimum capacity and harmony.
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Affiliation(s)
- Sharad Tiwari
- National Mental Health Program, National Health Mission, Madhya Pradesh, India
| | - Ankur Joshi
- Department of Community and Family Medicine, All India Institute of Medical Sciences, Bhopal, Madhya Pradesh, India
| | - Nirendra Rai
- Department of Neurology, All India Institute of Medical Sciences, Bhopal, Madhya Pradesh, India
| | - Afrah Misbah
- Department of Community and Family Medicine, All India Institute of Medical Sciences, Bhopal, Madhya Pradesh, India
| | - Parmeshwar Satpathy
- Department of Community and Family Medicine, All India Institute of Medical Sciences, Bhopal, Madhya Pradesh, India
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Kaur H, Nehra A, Chopra S, Sati H, Bhatia R, Kumaran SS, Pandey RM, Padma Srivastava MV. Development and Validation of a Comprehensive Neuropsychological and Language Rehabilitation for Stroke Survivors: A Home-Based Caregiver-Delivered Intervention Program. Ann Indian Acad Neurol 2020; 23:S116-S122. [PMID: 33343135 PMCID: PMC7731686 DOI: 10.4103/aian.aian_500_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Revised: 07/28/2020] [Accepted: 08/03/2020] [Indexed: 11/30/2022] Open
Abstract
Context: Aphasia is a major disabling condition after a stroke that profoundly affects the quality of life of stroke survivors (SS) and their caregivers. Comprehensive neuropsychological rehabilitation has emerged as a complementary intervention that helps in improving the associated cognitive and psychological deficits and quality of life following a brain injury. A standardized, simple, and easy to administer intervention that can be delivered as a home-based intervention can assist in faster recovery. Aims: To describe the development, validation, and feasibility of a home-based, caregiver-delivered comprehensive neuropsychological and language rehabilitation for SS. Methods and Material: A culture-specific picture and task-based 8-week training workbook and manual were developed based on extensive review and focused group discussions. This intervention targeted areas of language (comprehension, fluency, and naming) and cognition (working memory, attention and concentration, executive functioning, and response inhibition). It was standardized on 40 healthy controls (HC) and 15 SS. Before recruitment, written informed consent was obtained from each patient, their primary caregiver, and the HCs. Results: All tasks were found to be effective in discriminating the performance of SS from the HC. The performance of the HC with respect to the errors and the time taken for each task was used for the hierarchical arrangement of the tasks. The developed intervention was later validated on 15 SS where they significantly improved in the pre-post assessment of language functioning (P < 0.001), quality of life (P < 0.001), and depression (P < 0.001). Conclusions: This intervention can be feasible to administer as a home-based intervention and may help to alleviate language and neuropsychological complaints after stroke in low-literate or mixed-cultural populations. Further, large sample size studies are recommended.
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Affiliation(s)
- Harsimarpreet Kaur
- Clinical Neuropsychology, Neurosciences Centre, All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - Ashima Nehra
- Clinical Neuropsychology, Neurosciences Centre, All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - Sakshi Chopra
- Clinical Neuropsychology, Neurosciences Centre, All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - Hemchandra Sati
- Department of Biostatistics, All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - Rohit Bhatia
- Department of Neurology, All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - Senthil S Kumaran
- Department of NMR, All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - R M Pandey
- Department of Biostatistics, All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - M V Padma Srivastava
- Department of Neurology, All India Institute of Medical Sciences (AIIMS), New Delhi, India
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Kulshrestha S, Agrawal M, Singh AK, Kulshreshtha D. Post Stroke Rehabilitation Using Computer-based Cognitive Intervention (CBCI): A Systematic Review. CURRENT PSYCHIATRY RESEARCH AND REVIEWS 2020. [DOI: 10.2174/2666082216999200622135105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Background:
Cognitive impairment as a consequence of stroke is a major cause affecting
the patient’s functional independence, activity participation, daily living skills, and occupation. Almost
75% of post-stroke patients are diagnosed with significant cognitive impairment, which includes
problems with attention, orientation, memory, language, and perception. Along with effective
pharmaceutical cures, cognitive intervention as a part of rehabilitation approaches that may prevent,
delay, or treat cognitive impairment is becoming increasingly important. Many studies have reported
improvement in cognitive functions of post-stroke patients after using computer-based cognitive
intervention (CBCI). CBCI can be an effective add-on to available rehabilitation programs.
Objective:
This article provides reviews related to relevant literature and, represents a structure to
specify the efficacy of CBCI for the rehabilitation of post-stroke patients for future research.
Methods:
We searched many search engines namely MEDLINE, Web of Science, clinical key and
The Cochrane Library, for studies investigating the effect of cognitive intervention based on a computer
program for post-stroke patients. The results of selected studies were summarized. Total 19
publications from January 2007 to January 2019 are included in this review. The search terms entered
were a combination of these search areas that defined (1) the population as adults who had suffered
a stroke and cognitive dysfunction, (2) intervention search term included cognitive abilities, cognitive
training, and computer-based training; computer-based cognitive intervention for rehabilitation.
Results:
The results after computer-based training showed improvement in various cognitive functions
such as; memory, attention and executive functions of post-stroke patients. However, a significant
difference between the study groups has not been observed in all the studies. Most studies analyzed
in this research project indicated that such interventions might contribute to the improvement
of cognitive function, especially attention concentration and memory. Of the 19 kinds of research
that discussed CBCI outcomes 18 found significant improvements for one or more cognitive functions.
When the effect size for CBCI was reported, effects were large in comparison to other traditional
cognitive interventions of post-stroke patients.
Conclusion:
Studies related to cognitive functions strongly support CBCI except few have reported
a significant difference. The review of all the studies suggests that CBCI may help to change the
functional aspect of post-stroke patients by improving their cognitive functions. In this field, it is a
challenge to conduct well designed and sufficiently powered studies due to low budgets availability,
the limited number of available patients, heterogeneity of the population, and ethical considerations.
Future studies should examine all the challenges, limitations, and valuable insights into the study
and emphasize the need for a carefully designed computer-based cognitive intervention program for
the future. Future studies should target to compare CBCI with active and passive control conditions
and include a larger sample size.
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Affiliation(s)
- Sudhi Kulshrestha
- Amity Institute of Behavioral and Allied Sciences, Amity University, Lucknow, India
| | - Manju Agrawal
- Amity Institute of Behavioral and Allied Sciences, Amity University, Lucknow, India
| | - Ajai K. Singh
- Department of Neurology, Dr. Ram ManoharLohia Institute of Medical Sciences, Lucknow, India
| | - Dinkar Kulshreshtha
- Department of Neurology, Dr. Ram ManoharLohia Institute of Medical Sciences, Lucknow, India
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Influence of leg length discrepancy on balance and gait in post-stroke patients: a correlational study. BULLETIN OF FACULTY OF PHYSICAL THERAPY 2020. [DOI: 10.1186/s43161-020-00012-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
A frequent complaint by stroke patients presenting for physiotherapy was perceived shortness of the affected lower limb and inability to weight bear onto the affected side. So, the present study aimed to evaluate influence of limb length discrepancy (LLD) on balance and gait parameters in patients with stroke.
Subjects and methods
Twenty participants were recruited based on the inclusion and exclusion criteria and were divided into two groups group A (LLD ≤ 1 cm) and group B (LLD > 1 cm). Postural sway was measured under wide base eyes open, wide base eyes closed, narrow base eyes open, and narrow base eyes closed conditions. Weight-bearing asymmetry and functional balance were assessed using the percentage body weight asymmetry and Berg balance scale. Also, step leg ratio and 10-M walk test was used to assess gait parameters.
Results
Intergroup comparison of postural sway exhibited a significant difference between groups in the AP direction in wide-based eyes open (WBEO), wide-based eyes closed (WBEC), narrow-based eyes open (NBEO), and narrow-based eyes closed (NBEC) conditions whereas only in NBEC condition in mediolateral direction; with group B (LLD > 1 cm) displaying a greater mean postural sway in all the conditions. The correlation of LLD with postural sway showed a significant positive correlation within AP direction under all the conditions and in WBEC and NBEC conditions in mediolateral direction. Intergroup comparison of step length ratio (SLR) showed a statistical difference between groups, and a negative correlation was found between LLD and SLR. A negative correlation was also seen between percentage weight-bearing asymmetry (PWBA) and speed as well as Berg’s balance scale (BBS), and a positive correlation was observed between BBS and speed.
Conclusion
Leg length discrepancy results in a significant decrease in balance control in the sagittal and frontal planes in patients with stroke. It also adds to the asymmetries in their gait. Therefore, LLD should be considered as a factor for balance and gait asymmetries in post-stroke patients.
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Kurmi S, Mathews E, Kodali PB, Thankappan KR. Awareness of Stroke Warning Symptoms, Risk Factors, and Response to Acute Stroke in Biswanath District, Assam, India. ACTA ACUST UNITED AC 2020; 3:88-91. [PMID: 34308148 DOI: 10.1177/2516608520962349] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Introduction This study was undertaken with the following objectives: (a) to find out the awareness of warning symptoms and risk factors of stroke, (b) response to acute stroke, and (c) factors associated with awareness, risk factors, and response to acute stroke among community-dwelling adults in Biswanath district of Assam. Methods Using a cross-sectional design, a community-based study was done among 340 adults (mean age 38 years, men 55%) selected using multistage cluster sampling. Information on sociodemographic variables, stroke warning symptoms, risk factors, and response to acute stroke was collected using an adapted World Health Organization (WHO) STEPs stroke surveillance tool. Bivariate and logistic regression analysis were done to find out the factors associated with stroke warning symptoms, risk factors, and response to acute stroke. A "P" value < .05 was considered for statistical significance. Results Awareness of stroke was significantly higher among males (P < .01), better educated (P < .01), government employees (P < .05), high-income group (P < .01), and those who reported receiving information from a professional source (P < .01) compared to their counterparts. Knowledge of at least one stroke risk factor and providing at least one correct response to acute stroke was higher among males, better educated, government employees, higher income groups, and those who received information from professional source compared to their counterparts (P < .05). Conclusion Awareness of stroke warning symptoms, risk factors, and response to acute stroke needs to be improved focusing on women, low education groups, those working in the nongovernment sector, and low-income groups by health professionals.
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Affiliation(s)
- Sima Kurmi
- Department of Public Health and Community Medicine, Central University of Kerala, Kasaragod, Periye, Kerala, India
| | - Elezebeth Mathews
- Department of Public Health and Community Medicine, Central University of Kerala, Kasaragod, Periye, Kerala, India.,DBT/Wellcome Trust India Alliance Fellow
| | - Prakash Babu Kodali
- Department of Public Health and Community Medicine, Central University of Kerala, Kasaragod, Periye, Kerala, India
| | - K R Thankappan
- Department of Public Health and Community Medicine, Central University of Kerala, Kasaragod, Periye, Kerala, India
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Deshpande S, Mohapatra S, Girish N. Influence of task-oriented circuit training on upper limb function among rural community-dwelling survivors of stroke. INTERNATIONAL JOURNAL OF THERAPY AND REHABILITATION 2020. [DOI: 10.12968/ijtr.2019.0072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Background Task-oriented circuit training using a Multi-Activities workstation emphasises goal-oriented tasks practiced in a circuit or series in order to learn a new skill. It can be used for upper limb rehabilitation among stroke patients in a community setting, but there is currently very little evidence available regarding its use in this patient group and setting. This study aimed to explore the influence of task-oriented circuit training using a Multi-Activities workstation on upper limb function among community-dwelling individuals with chronic stroke. Methods A pre-test–post-test study was conducted involving 17 community-dwelling individuals with chronic stroke who were attending a stroke rehabilitation centre. Six weeks of task-oriented circuit training was given using a Multi-Activities workstation aimed to improve strength, range of motion and dexterity. Streamlined Wolf Motor Function Test and Chedoke Arm and Hand Activity Inventory were used to measure outcomes. Wilcoxon signed-rank test was used for data analysis. Results A total of 12 sessions of task-oriented circuit training using Multi-Activities workstations did not result in any statistically significant differences in outcome measures. Conclusions Task-oriented circuit training using the Multi-Activities workstation did not improve upper limb function in community-dwelling individuals with chronic stroke.
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Affiliation(s)
- Shruti Deshpande
- Department of Physiotherapy, Manipal College of Health Professions, Manipal Academy of Higher Education, Karnataka, India
| | - Sidhiparada Mohapatra
- Department of Physiotherapy, Manipal College of Health Professions, Manipal Academy of Higher Education, Karnataka, India
| | - N Girish
- Department of Physiotherapy, Manipal College of Health Professions, Manipal Academy of Higher Education, Karnataka, India
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Rajendran SR, Periyasamy S, Manjuladevi MT, George N. Evaluation of Serum Ferritin as a Prognostic Marker in Acute Hemorrhagic Stroke. J Neurosci Rural Pract 2020; 11:72-77. [PMID: 32140006 PMCID: PMC7055639 DOI: 10.1055/s-0039-1700597] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Background
Acute hemorrhagic stroke (AHS) resulting from intracerebral hemorrhage (ICH) is a rampant neurological disorder with devastating consequences, particularly in Indians. Recently, serum ferritin levels have been related to adverse cardiovascular and stroke outcomes. We aimed to evaluate the prognostic utility of serum ferritin in AHS.
Materials and Methods
Admission serum ferritin levels were estimated in 50 AHS patients with primary supratentorial hemorrhage. Study subjects were categorized based on their prognostic scores in modified Rankin scale (mRS) assessment. Ferritin levels were compared across the study groups, correlated with mRS and other ICH severity indicators.
Results
Serum ferritin and other ICH severity indices such as Glasgow coma scale (GCS) and ICH volume were significantly altered in the mRS groups by the end of 7th and 30th days of hospitalization. Elevated ferritin levels, ICH volume together with decreased GCS, characterized the groups with adverse prognosis. Serum ferritin moderately correlated with GCS (
r
= –0.643), ICH volume (
r
= 0.562), and had significantly higher correlations with long-term prognostic scores of 7th day mRS (
r
= 0.802) and 30th day mRS (
r
= 0.916).
Conclusion
Elevated admission serum ferritin levels indicate poor AHS short-term and long-term outcomes, thereby making serum ferritin a possible prognostic index for the same.
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Affiliation(s)
- Sowri Rajan Rajendran
- Department of General Medicine, Trichy SRM Medical College Hospital & Research Centre, (Affiliated to The Tamil Nadu Dr. M.G.R. Medical University), Irungalur, Trichy, Tamil Nadu, India
| | - Sivakumar Periyasamy
- Department of General Medicine, Trichy SRM Medical College Hospital & Research Centre, (Affiliated to The Tamil Nadu Dr. M.G.R. Medical University), Irungalur, Trichy, Tamil Nadu, India
| | - Moonishaa Thiyagarajan Manjuladevi
- Department of Biochemistry, Trichy SRM Medical College Hospital & Research Centre, (Affiliated to The Tamil Nadu Dr. M.G.R. Medical University), Irungalur, Trichy, Tamil Nadu, India
| | - Neethu George
- Department of Community Medicine, Dhanalakshmi Srinivasan Medical College and Hospital (Affiliated to The Tamil Nadu Dr. M.G.R. Medical University), Siruvachur, Perambalur, Tamil Nadu, India
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38
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Goel D, Gupta R, Keshri T, Rana S. Prevalence of atrial fibrillation in acute ischemic stroke patients: A hospital-based study from India. Brain Circ 2020; 6:19-25. [PMID: 32166196 PMCID: PMC7045538 DOI: 10.4103/bc.bc_19_19] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Revised: 09/01/2019] [Accepted: 10/07/2019] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND: Secondary stroke prevention is as important as the treatment of acute ischemic stroke in regards to halt neurological disability and to lower down mortality due to recurrent episodes. The effective secondary prevention depends on finding the specific risk factors leading to cerebro-vascular insult. AIMS AND OBJECTIVES: We aimed this study to find prevalence of persistent/Paroxysmal AF in stroke patients from single center hospital based study. METHODS: Hospital based study enrolled all prospective patients of acute ischemic stroke from January 2016 to December 2018. All patients were subjected to test for risk factors analysis after detail clinical history and examination of these patients. Following variables were recorded; age, gender, stroke territory, stroke severity by NIHSS (National Institute of Health Stroke Scale), LDL-C (Low Density Lipoprotein - cholesterol) of more than 100 mg/dl, HBA1C (Glycosylated Hemoglobin) of more than 6.5, Homocystine of more than 15 Mc Mol/L, 2D-Echocardiographic abnormalities, electrocardiography/24 hour Holter Monitoring, cerebral angiography of brain and neck findings and outcome of patients in 90 days follow-up based on Modified Rankin Scale. Results: Total 246 patients (69.5% men and 30.5% women) of Acute Ischemic stroke were recorded during study period. Mean age was 61.4 years, with 31 (12.4%) patients were below 45 years. Atrial fibrillation (AF) was detected either on conventional ECG or 24 hour Holter monitoring in 62 (25.2%) patients. CONCLUSION: Stroke with AF is found in 25% patients, more common in elderly, female large atrial size and associated with poor outcome.
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Affiliation(s)
- Deepak Goel
- Department of Neurology, Himalayan Hospital of Medical Sciences, Swami Ram Himalayan University, Dehradun, Uttarakhand, India
| | - Rekha Gupta
- Department of Neurocritical Care, Max Institute of Neurosciences, Dehradun, Uttarakhand, India
| | - Tulika Keshri
- Department of Neurology, Max Institute of Neurosciences, Dehradun, Uttarakhand, India
| | - Sanyal Rana
- Department of Neurology, Max Institute of Neurosciences, Dehradun, Uttarakhand, India
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39
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Hegde A, Menon G, Kumar V, Lakshmi Prasad G, Kongwad LI, Nair R, Nayak R. Clinical Profile and Predictors of Outcome in Spontaneous Intracerebral Hemorrhage from a Tertiary Care Centre in South India. Stroke Res Treat 2020; 2020:2192709. [PMID: 32411342 PMCID: PMC7204327 DOI: 10.1155/2020/2192709] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2019] [Accepted: 11/05/2019] [Indexed: 11/18/2022] Open
Abstract
Background. This article attempts to evaluate the clinical profile and outcome determinants following hypertensive SICH in a South Indian population. The study represents the largest series of SICH reported from a single centre in India. Materials and Methods. Prospective data collection and analysis of patients with SICH admitted to our centre between 1st January 2015 and 31st December 2018. The variables analysed include: age, sex, comorbidities, Glasgow coma score (GCS) on admission, radiological features, treatment modality, and outcome at three months. Modified Rankin score (mRS) was used to assess the outcome at discharge and three months. Results. Our study group of 905 patients included 638 males and 267 females and the mean age at presentation was 58.10 ± 12.76 years. The study group included 523 patients (57.8%) previously diagnosed hypertensive, of whom 36.3% (n = 190) were on irregular medication. The most frequent locations of hematoma were basal ganglia (478), thalamus (202), lobar (106), cerebellar (61), brainstem (31), and primary intraventricular haemorrhage (27). Secondary intraventricular extension was seen in 425 (47%) patients on admission. The mean volume of the clot on admission was 23.45 ± 19.79 ml, and clot progression was seen in only 46 (5.08%) cases. Surgical evacuation through craniotomy was done in 147 (16.8%) patients, and external ventricular drainage (EVD) was placed in 56 (6.2%) patients. Overall 3-month mortality was 30.1% (266 patients). On the last follow up a favorable outcome (mRS 0-3) was observed in 412 (45.53%) patients and a poor outcome (mRS 4-5) in 207 patients (22.87%). Independent predictors of mortality are Age >70 (p = <0.001, OR 4.806, 95% CI 3.064-7.54), admission GCS <8 (p = <0.001, OR7.684, 95% CI 5.055#x2013;11.68), and Hematoma volume >30 ml (p = <0.001, OR 2.45, 95% CI 1.626-3.691). Intraventricular haemorrhage was an additional poor outcome predictor (p < 0.015, CI 1.105-2.585). Surgical evacuation reduced mortality in the group, but morbidity rates remained the same. Conclusions. SICH predominantly affects a younger population in India in comparison to the Western society. Elderly age, poor GCS on admission, clot volume above 30 ml and intraventricular extension remain the most consistent predictors of death and poor outcome. Further studies are needed to assess the risk of SICH among hypertensive patients and to prognosticate the outcome after SICH using novel predictors, including biomarkers.
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Affiliation(s)
- Ajay Hegde
- Department of Neurosurgery, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, India
- Institute of Neurological Sciences, NHS Greater Glasgow and Clyde, UK
| | - Girish Menon
- Department of Neurosurgery, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, India
| | - Vinod Kumar
- Department of Neurosurgery, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, India
| | - G. Lakshmi Prasad
- Department of Neurosurgery, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, India
| | - Lakshman I. Kongwad
- Department of Neurosurgery, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, India
| | - Rajesh Nair
- Department of Neurosurgery, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, India
| | - Raghavendra Nayak
- Department of Neurosurgery, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, India
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40
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Patil M, Gupta A, Khanna M, Taly AB, Soni A, Kumar JK, Thennarasu K. Cognitive and Functional Outcomes following Inpatient Rehabilitation in Patients with Acquired Brain Injury: A Prospective Follow-up Study. J Neurosci Rural Pract 2019; 8:357-363. [PMID: 28694613 PMCID: PMC5488554 DOI: 10.4103/jnrp.jnrp_53_17] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES To study the effects of cognitive retraining and inpatient rehabilitation to study the effects of cognitive retraining and inpatient rehabilitation in patients with acquired brain injury (ABI). DESIGN AND SETTING This was a prospective follow-up study in a neurological rehabilitation department of quaternary research hospital. PATIENTS AND METHODS Thirty patients with ABI, mean age 36.43 years (standard deviation [SD] 12.6, range 18-60), mean duration of illness 77.87 days (SD 91.78, range 21-300 days) with cognitive, physical, and motor-sensory deficits underwent inpatient rehabilitation for minimum of 14 sessions over a period of 3 weeks. Nineteen patients (63%) reported in the follow-up of minimum 3 months after discharge. Type of ABI, cognitive status (using Montreal Cognitive assessment scale [MoCA] and cognitive Functional Independence Measure [Cog FIM]®), and functional status (motor FIM®) were noted at admission, discharge, and follow-up and scores were compared. RESULTS Patients received inpatient rehabilitation addressing cognitive and functional impairments. Baseline MoCA, motor FIM, and Cog FIM scores were 15.27 (SD = 7.2, range 3-30), 31.57 (SD = 15.6, range 12-63), and 23.47 (SD = 9.7, range 5-35), respectively. All the parameters improved significantly at the time of discharge (MoCA = 19.6 ± 7.4 range 3-30, motor FIM® = 61.33 ± 18.7 range 12-89, Cog FIM® =27.23 ± 8.10 range 9-35). Patients were discharged with home-based programs. Nineteen patients reported in follow-up and observed to have maintained cognition on MoCA (18.8 ± 6.8 range 6-27), significantly improved (P < 0.01) on Cog FIM® (28.0 ± 7.7 range 14-35) and motor FIM® =72.89 ± 16.2 range 40-96) as compare to discharge scores. CONCLUSIONS Cognitive and functional outcomes improve significantly with dedicated and specialized inpatient rehabilitation in ABI patients, which is sustainable over a period.
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Affiliation(s)
- Maitreyi Patil
- Department of Neurological Rehabilitation, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Anupam Gupta
- Department of Neurological Rehabilitation, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Meeka Khanna
- Department of Neurological Rehabilitation, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Arun B Taly
- Department of Neurology, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Amit Soni
- Department of Clinical Psychology, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - J Keshav Kumar
- Department of Clinical Psychology, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - K Thennarasu
- Department of Biostatistics, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
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41
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Ke C, Gupta R, Xavier D, Prabhakaran D, Mathur P, Kalkonde YV, Kolpak P, Suraweera W, Jha P. Divergent trends in ischaemic heart disease and stroke mortality in India from 2000 to 2015: a nationally representative mortality study. THE LANCET GLOBAL HEALTH 2019; 6:e914-e923. [PMID: 30012272 PMCID: PMC6942542 DOI: 10.1016/s2214-109x(18)30242-0] [Citation(s) in RCA: 54] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2018] [Revised: 04/15/2018] [Accepted: 04/27/2018] [Indexed: 12/12/2022] Open
Abstract
Introduction India accounts for about a fifth of cardiovascular deaths globally, but nationally representative data on mortality trends are not yet available. In this nationwide mortality study, we aimed to assess the trends in ischaemic heart disease and stroke mortality over 15 years using the Million Death Study. Methods We determined national and subnational cardiovascular mortality rates and trends by sex and birth cohort using cause of death ascertained by verbal autopsy from 2001 to 2013 among 2·4 million households. We derived mortality rates for ischaemic heart disease and stroke by applying mortality proportions to UN mortality estimates for India and projected the rates from 2000 to 2015. Findings Cardiovascular disease caused more than 2·1 million deaths in India in 2015 at all ages, or more than a quarter of all deaths. At ages 30–69 years, of 1·3 million cardiovascular deaths, 0·9 million (68·4%) were caused by ischaemic heart disease and 0·4 million (28·0%) by stroke. At these ages, the probability of dying from ischaemic heart disease increased during 2000–15, from 10·4% to 13·1% in men and 4·8% to 6·6% in women. Ischaemic heart disease mortality rates in rural areas increased rapidly and surpassed those in urban areas. By contrast, the probability of dying from stroke decreased from 5·7% to 5·0% in men and 5·0% to 3·9% in women. A third of premature stroke deaths occurred in the northeastern states, inhabited by a sixth of India’s population, where rates increased significantly and were three times higher than the national average. The increased mortality rates of ischaemic heart disease nationally and stroke in the northeastern states were higher in the cohorts of adults born in the 1970s onwards, than in earlier decades. A large and growing proportion of the ischaemic heart disease nationally and stroke deaths in high-burden states reported earlier diagnosis of cardiovascular disease, but low medication use. Interpretation The unexpectedly diverse patterns of cardiovascular mortality require investigation to identify the role of established and new cardiovascular risk factors. Secondary prevention with effective and inexpensive long-term treatment and adult smoking cessation could prevent substantial numbers of premature deaths. Without progress against the control of cardiovascular disease in India, global goals to reduce non-communicable diseases by 2030 will be difficult to achieve. Funding Fogarty International Center of the US National Institutes of Health, Dalla Lana School of Public Health, University of Toronto, Indian Council of Medical Research, and the Disease Control Priorities.
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Affiliation(s)
- Calvin Ke
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada; Department of Medicine, University of Toronto, Toronto, ON, Canada; Centre for Global Health Research, St Michael's Hospital, and Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Rajeev Gupta
- Academic Research Development Unit, Rajasthan University of Health Sciences, Jaipur, Rajasthan, India
| | - Denis Xavier
- St John's Medical College and Research Institute, Bangalore, India
| | | | - Prashant Mathur
- National Centre for Diseases Informatics & Research, Indian Council of Medical Research, Bangalore, India
| | - Yogeshwar V Kalkonde
- Society for Education, Action and Research in Community Health, Gadchiroli, Maharashtra, India
| | - Patrycja Kolpak
- Centre for Global Health Research, St Michael's Hospital, and Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Wilson Suraweera
- Centre for Global Health Research, St Michael's Hospital, and Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Prabhat Jha
- Centre for Global Health Research, St Michael's Hospital, and Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.
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42
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Murthy MKS, Thomas PT, Dasgupta M. Potential for a comprehensive stroke education: Assessing awareness about stroke among community health workers - A qualitative study from Urban Bangalore, Karnataka, India. J Family Med Prim Care 2019; 8:2424-2428. [PMID: 31463270 PMCID: PMC6691436 DOI: 10.4103/jfmpc.jfmpc_303_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Context: The incidence of stroke is evolving to be a major public health issue in recent years. The situation is aggravated by the limited public awareness about its risk factors and treatment procedures. It is important to explore the level of awareness of the Accredited Social Health Activists (ASHAs) about stroke as they work in the community as part of the public healthcare delivery systems. Aims: The aim of this study was to explore the awareness about stroke among the ASHAs through a qualitative study. Settings and Design: The study was conducted in the institution using a cross-sectional qualitative approach. Methods and Material: A focus group discussion with 12 ASHAs from Bengaluru district of Karnataka was conducted. Statistical Analysis Used: Data were analyzed manually through direct content analysis. Results: It was revealed that the ASHAs did not have adequate general awareness about stroke, its causes, and related treatment procedures. The ASHAs overgeneralized the causes to lifestyle factors, such as smoking, drinking, and so on. Conclusions: The study showed the level of awareness of stroke among the ASHAs is inadequate at present, and they would benefit from systematic sensitisation programmes. Limited awareness could lead to failure to identify the early warning signs and appropriate, timely help. A need of a comprehensive educational program to increase their awareness is emphasized.
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Affiliation(s)
- Meena K S Murthy
- Department of Mental Health Education, National Institute of Mental Health and Neuro Sciences, Bengaluru, Karnataka, India
| | - Priya T Thomas
- Department of Psychiatric Social Work, National Institute of Mental Health and Neuro Sciences, Bengaluru, Karnataka, India
| | - Madhuporna Dasgupta
- Department of Mental Health Education, National Institute of Mental Health and Neuro Sciences, Bengaluru, Karnataka, India
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43
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He W, Liu Y, Feng J, Huang Q, Xu J, Liu X, Yu C, Zhu W, Wang T, Jin D, Liu H, Huang Y, Chen B. The Epidemiological Characteristics of Stroke in Hunan Province, China. Front Neurol 2018; 9:583. [PMID: 30072946 PMCID: PMC6060238 DOI: 10.3389/fneur.2018.00583] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2018] [Accepted: 06/28/2018] [Indexed: 11/13/2022] Open
Abstract
Previous studies have shown that Hunan Province has a high incidence of stroke and a high proportion of intracerebral hemorrhage (ICH). Considering the changes over the past three decades, little is known about the current epidemiological characteristics of stroke in Hunan Province. In 2013, a cross-sectional study was conducted at seven national disease surveillance points (DSPs) in Hunan Province. A multistage cluster sampling method was used to select a representative sample. A total of 21,156 participants aged 20 years and older were examined. Among the 21,156 participants, the number of prevalent strokes, incident strokes and deaths was 307, 87, and 36, respectively. The 2010 China census-standardized prevalence, incidence and mortality were 1191.0 per 100,000 people [95% confidence interval (CI) 1044.8-1337.2], 333.6 per 100,000 person-years (95% CI 255.7-411.5) and 129.7 per 100,000 person-years (95% CI 81.1-178.3), respectively. Ischemic stroke (IS), ICH, subarachnoid hemorrhage (SAH), and stroke of undetermined type (UND) constituted 50.6, 41.4, 5.7, and 2.3% of all incident stroke cases, respectively. Tianxin, Liuyang, Wuling, and Hongjiang have high proportions of ICH (61.5, 58.3, 60, and 50%, respectively). Hypertension is the most common risk factor for prevalent stroke (71.34%), followed by smoking (30.62%) and alcohol use (25.73%). In conclusion, Hunan Province has an extremely heavy stroke burden. The high proportion of ICH is not limited to the Changsha community; it represents an important issue for all of Hunan Province.
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Affiliation(s)
- Wei He
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, China
| | - Yunhai Liu
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, China.,Hunan Clinical Research Center for Cerebrovascular Disease, Changsha, China
| | - Jie Feng
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, China.,Hunan Clinical Research Center for Cerebrovascular Disease, Changsha, China
| | - Qing Huang
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, China.,Hunan Clinical Research Center for Cerebrovascular Disease, Changsha, China
| | - Ji Xu
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, China
| | - Xiaojuan Liu
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, China.,Hunan Clinical Research Center for Cerebrovascular Disease, Changsha, China
| | - Cheng Yu
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, China
| | - Wenbin Zhu
- Department of Anesthesiology and Perioperative Medicine, Oregon Health and Science University, Portland, OR, United States
| | - Te Wang
- Department of Neurology, Changsha Central Hospital, Changsha, China
| | - Donghui Jin
- Hunan Provincial Center for Disease Control and Prevention, Changsha, China
| | - Huilin Liu
- Hunan Provincial Center for Disease Control and Prevention, Changsha, China
| | - Yuelong Huang
- Hunan Provincial Center for Disease Control and Prevention, Changsha, China
| | - Biyun Chen
- Hunan Provincial Center for Disease Control and Prevention, Changsha, China
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44
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Nagendra CV, Kumar TSS, Bohra V, Wilben V, Karan V, Huded V. Factors Affecting the Effective Management of Acute Stroke: A Prospective Observational Study. Indian J Crit Care Med 2018; 22:138-143. [PMID: 29657369 PMCID: PMC5879854 DOI: 10.4103/ijccm.ijccm_232_17] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Background Stroke, characterized by sudden loss of cerebral function, is among one of the leading cause of death and disability world over. The newer treatment modalities have changed the landscape of stroke treatment but are very much time bound. Aim To characterize pre-hospital and in-hospital factors affecting acute stroke management thus defining lacunae in stroke management. Subjects and Methods A prospective observational study, conducted at the emergency department of a tertiary care center in southern India from August 2015 to July 2016. All stroke patients presenting within first 24 hours of onset were included. A pre -defined Knowledge-Attitude-Practice (KAP) questionnaire was used. Results Total of 133 patients were eligible out of which 28 were excluded for various reasons. Majority were >60 years age and male (61%). About 60% arrived within window. Distance from the hospital was one of the major factors for arrival within the window period. When compared by KAP questionnaire, bystanders of those arriving within window period had better awareness of stroke symptoms. Conclusions Improving awareness of stroke symptoms and increasing availability of EMS is likely increase chances of stroke patients receiving appropriate acute management.
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Affiliation(s)
- C V Nagendra
- Department of Emergency Medicine, Narayana Institute of Cardiac Sciences, Bengaluru, Karnataka, India
| | - T S Srinath Kumar
- Department of Emergency Medicine, Narayana Institute of Cardiac Sciences, Bengaluru, Karnataka, India
| | - Vikram Bohra
- Department of Neurology, Narayana Institute of Cardiac Sciences, Bengaluru, Karnataka, India
| | - Viju Wilben
- Department of Emergency Medicine, Narayana Institute of Cardiac Sciences, Bengaluru, Karnataka, India
| | - Vivek Karan
- Department of Neurology, Narayana Institute of Cardiac Sciences, Bengaluru, Karnataka, India
| | - Vikram Huded
- Department of Neurology, Narayana Institute of Cardiac Sciences, Bengaluru, Karnataka, India
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Brainin M, Feigin V, Martins S, Matz K, Roy J, Sandercock P, Teuschl Y, Tuomilehto J, Wiseman A. Cut stroke in half: Polypill for primary prevention in stroke. Int J Stroke 2018; 13:633-647. [PMID: 29461155 DOI: 10.1177/1747493018761190] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
This review summarizes the potential for polypill therapies for stroke prevention. While a number of studies applying different approaches regarding polypill have been performed, none of them has had a focus on stroke as the main outcome. A combination pill containing drugs such as statins, diuretics, and other antihypertensives is currently available in various formats. Estimates focusing mostly on primary prevention show that using such a combination drug a reduction in the 5-year stroke incidence by 50% can be achieved - especially in low- and middle-income countries with a high prevalence of risk factors even among people at young ages. A combination of a large supporting population-wide program with a registry-based quality control is the most likely perspective and can be achieved within a reasonable time frame and potentially have significant influence in young stroke populations.
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Affiliation(s)
- Michael Brainin
- 1 Department for Clinical Neuroscience and Preventive Medicine, Danube University Krems, Krems, Austria
| | - Valery Feigin
- 2 National Institute for Stroke and Applied Neurosciences, Auckland University of Technology, School of Public Health and Psychosocial Studies, Auckland, New Zealand
| | - Sheila Martins
- 3 Neurology and Neurosurgery Service, Hospital Moinhos de Vento, Brazil
| | - Karl Matz
- 4 Department of Neurology, University Hospital Tulln, Tulln, Austria
| | - Jayanta Roy
- 5 AMRI Institute of Neurosciences, Kolkata, India
| | - Peter Sandercock
- 6 Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
| | - Yvonne Teuschl
- 1 Department for Clinical Neuroscience and Preventive Medicine, Danube University Krems, Krems, Austria
| | - Jaakko Tuomilehto
- 7 Dasman Diabetes Institute, Kuwait City, Kuwait.,8 Chronic Disease Prevention Unit, National Institute for Health and Welfare, Helsinki, Finland.,9 Saudi Diabetes Research Group, King Abdulaziz University, Jeddah, Saudi Arabia
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Chenna V, Kaul S, Tandra S, Yareeda S, Mathukumalli N, Kohat AK, Kandadai RM, Turaga S, Sheik JA, Meena AK, Borgohain R. Predictors of Intracerebral Hemorrhage in Acute Stroke Patients Receiving Intravenous Recombinant Tissue Plasminogen Activator. Ann Indian Acad Neurol 2018; 21:214-219. [PMID: 30258265 PMCID: PMC6137634 DOI: 10.4103/aian.aian_228_17] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Background: Symptomatic Intracerebral hemorrhage (sICH) is a serious complication of recombinant tissue-plasminogen activator (rt-PA) therapy for acute ischemic stroke (AIS). Objective: To estimate the prevalence and predictors of sICH in patients after receiving IV rt-PA for AIS. Material and Methods: Consecutive patients of AIS thrombolysed between January 2010 and June 2016 in a University hospital in Hyderabad (India) were studied prospectively for sICH and it's various variables compared with the control group without sICH to determine any sigificantant difference. Results: Out of 113 patients , sICH was detected in 12 (10.61%) whose mean age(58±12.0 years) and gender ratio ( 2:1 ) was not statistically significant from controls. In s ICH group mean NIHSS score was 16.53± 5.81 vs 10.19± 5.06 in controls (p<0.001), gap between stroke onset and thrombolysis was 227.50±46.15 min vs 178.50± 69.20 min in controls(p=0.018). At presentation mean blood sugar was 208.75±90.97 mg/dl in sICH group vs 146.83±70.21 mg/dl in controls (p=0.002). Prior diabetes was in 7(53.30%) vs 23 (22.8%) in controls (p= 0.014)and hypertension in 11 (91.7%) vs (56(55.4%) in controls (p= 0.026) The mortality in sICH was 7 (58.30%)vs 4 (4.94%) in controls (p<.0.001). At 3 months mean mRS ofsICH patients was 5.57± 0.54 vs 2.17± 1.69 in controls (p<.05). Conclusion: High NIHSS score, increased stroke onset to thrombolysis time , high blood sugar at presentation ,prior diabetes and hypertension increase the chances of sICH. None of these contraindicate thrombolysing strokes but should caution the physician.
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Affiliation(s)
- Vijay Chenna
- Department of Neurology, Nizam's Institute of Medical Sciences, Hyderabad, Telangana, India
| | - Subhash Kaul
- Department of Neurology, Nizam's Institute of Medical Sciences, Hyderabad, Telangana, India
| | - Swetha Tandra
- Department of Neurology, Nizam's Institute of Medical Sciences, Hyderabad, Telangana, India
| | - Sireesha Yareeda
- Department of Neurology, Nizam's Institute of Medical Sciences, Hyderabad, Telangana, India
| | - Neeharika Mathukumalli
- Department of Neurology, Nizam's Institute of Medical Sciences, Hyderabad, Telangana, India
| | - Abhijeet Kumar Kohat
- Department of Neurology, Nizam's Institute of Medical Sciences, Hyderabad, Telangana, India
| | | | - Suryaprabha Turaga
- Department of Neurology, Nizam's Institute of Medical Sciences, Hyderabad, Telangana, India
| | - Jabeen Afshan Sheik
- Department of Neurology, Nizam's Institute of Medical Sciences, Hyderabad, Telangana, India
| | - A K Meena
- Department of Neurology, Nizam's Institute of Medical Sciences, Hyderabad, Telangana, India
| | - Rupam Borgohain
- Department of Neurology, Nizam's Institute of Medical Sciences, Hyderabad, Telangana, India
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Kumar KV, Joshua AM, Kedambadi R, Mithra PP. Eclectic/mixed model method for upper extremity functional recovery in stroke rehabilitation: A pilot study. J Nat Sci Biol Med 2017; 8:75-81. [PMID: 28250679 PMCID: PMC5320828 DOI: 10.4103/0976-9668.198357] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Background: Eclectic treatment method is a flexible approach that uses techniques drawn from various schools of thought involving several treatment methods and allows the therapist to adapt to each client's individual needs. Wider application for eclectic approach is however limited in stroke rehabilitation. Aim: The objective is to find out whether eclectic approach improves upper extremity (UE) functional recovery in acute stroke rehabilitation. Methodology: Twenty-five postacute unilateral supratentorial stroke subjects recruited from tertiary care hospitals recovered with Stage 2–5 in Brunnstorm stage of UE motor recovery (BRS-UE) underwent 45 min of eclectic approach for UE every day involving seven different treatment methods (5 min for each method) for 6 days consecutively. The outcome was UE subscale of the Fugl-Meyer Motor test (UE-FM), UE subscale of the Stroke Rehabilitation Assessment of Movement (UE-STREAM), Wolf Motor Function test (WMFT-FAS), and Stroke Impact Scale-16 (SIS-16) was collected at the end of the sixth session. Results: All the participants showed significant improvement in all the outcome measures. The Stage 2 and 3 subjects showed UE-STREAM (P = 0.007) WMFT-FAS (P < 0.001), SIS (P = 0.023) respectively and for Stage 4 and 5 the subjects have shown UE FM (P < 0.001), WMFT-FAS (P < 0.001), SIS (P = 0.004) with large magnitude of treatment effect for all stages of BRS-UE. Conclusion: Our study findings are in favor of integrating eclectic approach than single intervention/approach in clinical practice to improve the UE functional recovery for motor rehabilitation when the stroke occurs.
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Affiliation(s)
- K Vijaya Kumar
- Department of Physiotherapy, Center for Basic Sciences, Kasturba Medical College, Manipal University, Mangaluru, Karnataka, India
| | - Abraham M Joshua
- Department of Physiotherapy, Kasturba Medical College, Manipal University, Mangaluru, Karnataka, India
| | - Rakshith Kedambadi
- Department of Neurology, Kasturba Medical College, Manipal University, Mangaluru, Karnataka, India
| | - P Prasanna Mithra
- Department of Community Medicine, Kasturba Medical College, Manipal University, Mangaluru, Karnataka, India
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William AG, Pannu A, Kate MP, Jaison V, Gupta L, Bose S, Sahonta R, Sebastian I, Pandian JD. Quality Indicators of Intravenous Thrombolysis from North India. Ann Indian Acad Neurol 2017; 20:393-398. [PMID: 29184343 PMCID: PMC5682744 DOI: 10.4103/aian.aian_277_17] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Background: Data on intravenous (IV) thrombolysis using tissue plasminogen activator (tPA) are limited from low- and middle-income countries. We aimed to assess the quality indicators of IV thrombolysis in our stroke unit. Methods: All stroke patients admitted in our hospital from October 2008 to April 2017 were included in this study. Data were collected prospectively by trained research staff in a detailed case record form. Outcome was assessed using modified Rankin Scale (mRS, 0–1 good outcome). Results: Of the total 4720 stroke patients seen, 944 (20%) came within window period (<4.5 h). Of these, 214 (4.5%) were eligible for thrombolysis and 170 (3.6%) were thrombolysed, relatives of 23 (23/214, 10.7%) patients denied consent, and 21 (9.8%) patients could not afford tPA. The mean age of thrombolysed patients was 58.4 (range 19–95) years. Median NIHSS at admission was 12 (interquartile range 2–24). Average onset-to-door (O-D) time was 76.8 (5–219) min, door-to-examination (D-E) time was 17.8 (5–105) min, door-to-CT (D-CT) time was 48 (1–205) min, and door-to-needle (D-N) time was 90 (20–285) min. At 6 months, 110 (64.7%) patients were contactable and 82 (74.5%) patients had good outcome (mRS 0–1). Conclusion: Thrombolysis rate has steadily increased at the center without undue adverse effects even in the elderly. D-E and D-CT times have reduced, but O-D and D-N times need further improvement. More patients could be thrombolysed if the cost of tPA is reduced and the consent process is waived.
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Affiliation(s)
| | - Aman Pannu
- Department of Neurology, Christian Medical College, Ludhiana, Punjab, India
| | | | - Vineeth Jaison
- Department of Neurology, Christian Medical College, Ludhiana, Punjab, India
| | - Leenu Gupta
- Department of Neurology, Christian Medical College, Ludhiana, Punjab, India
| | - Smrithi Bose
- Department of Neurology, Christian Medical College, Ludhiana, Punjab, India
| | - Rajeshwar Sahonta
- Department of Neurology, Christian Medical College, Ludhiana, Punjab, India
| | - Ivy Sebastian
- Department of Neurology, Christian Medical College, Ludhiana, Punjab, India
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Hu GQ, Du X, Li YJ, Gao XQ, Chen BQ, Yu L. Inhibition of cerebral ischemia/reperfusion injury-induced apoptosis: nicotiflorin and JAK2/STAT3 pathway. Neural Regen Res 2017; 12:96-102. [PMID: 28250754 PMCID: PMC5319249 DOI: 10.4103/1673-5374.198992] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Nicotiflorin is a flavonoid extracted from Carthamus tinctorius. Previous studies have shown its cerebral protective effect, but the mechanism is undefined. In this study, we aimed to determine whether nicotiflorin protects against cerebral ischemia/reperfusion injury-induced apoptosis through the JAK2/STAT3 pathway. The cerebral ischemia/reperfusion injury model was established by middle cerebral artery occlusion/reperfusion. Nicotiflorin (10 mg/kg) was administered by tail vein injection. Cell apoptosis in the ischemic cerebral cortex was examined by hematoxylin-eosin staining and terminal deoxynucleotidyl transferase dUTP nick end labeling assay. Bcl-2 and Bax expression levels in ischemic cerebral cortex were examined by immunohistochemial staining. Additionally, p-JAK2, p-STAT3, Bcl-2, Bax, and caspase-3 levels in ischemic cerebral cortex were examined by western blot assay. Nicotiflorin altered the shape and structure of injured neurons, decreased the number of apoptotic cells, down-regulates expression of p-JAK2, p-STAT3, caspase-3, and Bax, decreased Bax immunoredactivity, and increased Bcl-2 protein expression and immunoreactivity. These results suggest that nicotiflorin protects against cerebral ischemia/reperfusion injury-induced apoptosis via the JAK2/STAT3 pathway.
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Affiliation(s)
- Guang-Qiang Hu
- Department of Anatomy, Southwest Medical University, Luzhou, Sichuan Province, China
| | - Xi Du
- Department of Chemistry, Southwest Medical University, Luzhou, Sichuan Province, China
| | - Yong-Jie Li
- Drug Discovery Research Center, Southwest Medical University, Luzhou, Sichuan Province, China
| | - Xiao-Qing Gao
- Department of Anatomy and Neurobiology, Southwest Medical University, Luzhou, Sichuan Province, China
| | - Bi-Qiong Chen
- Department of Chemistry, Southwest Medical University, Luzhou, Sichuan Province, China
| | - Lu Yu
- Department of Chemistry, Southwest Medical University, Luzhou, Sichuan Province, China
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Abraham SV, Krishnan SV, Thaha F, Balakrishnan JM, Thomas T, Palatty BU. Factors delaying management of acute stroke: An Indian scenario. Int J Crit Illn Inj Sci 2017; 7:224-230. [PMID: 29291175 PMCID: PMC5737064 DOI: 10.4103/ijciis.ijciis_20_17] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background and Purpose: The purpose of this study was to assess factors causing delay in treatment of acute stroke in a tertiary care institute in South India. Methods: All clinically suspected cases of acute stroke presenting to the emergency department over a period of 1 year were prospectively followed up and data collected as per a preset pro forma. The various time intervals from stroke onset to definitive management and other pertinent data were collected. The time delays have been evaluated in the decision tree model: Chi-squared Automatic Interaction Detection. Significance was assessed at 5% level of significance (P < 0.05). Results: The mean prehospital time delay for all clinically suspected stroke (n = 361) in our institute was 716 min and the median time 190 min. The mean total in-hospital delay was 94.17 ± 54.5 min and median time being 82 min. The onset of symptoms to first medical contact was the main interval that influenced the prehospital delay. Computed tomographic (CT) diagnosis to stroke unit admission influenced the in-hospital delay the most. Conclusions: Lack of awareness regarding stroke leads to delayed seeking of treatment for the same. The factors that contribute to the in-hospital delay included patient admission procedure delay, lack of staff to transport the patient, and the distance between the stroke unit and CT room. Educating the community with regard to “stroke” and implementation of a better pre- and in-hospital stroke care system is a need of the hour in the country.
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Affiliation(s)
- Siju V Abraham
- Department of Emergency Medicine, Jubilee Mission Medical College and Research Institute, Thrissur, Kerala, India
| | - S Vimal Krishnan
- Department of Emergency Medicine, Jubilee Mission Medical College and Research Institute, Thrissur, Kerala, India
| | - Fazil Thaha
- Department of Neurology, Jubilee Mission Medical College and Research Institute, Thrissur, Kerala, India
| | | | - Tom Thomas
- Department of Community Medicine, Jubilee Mission Medical College and Research Institute, Thrissur, Kerala, India
| | - Babu Urumese Palatty
- Department of Emergency Medicine, Jubilee Mission Medical College and Research Institute, Thrissur, Kerala, India
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