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Behl T, Kaur I, Sehgal A, Khandige PS, Imran M, Gulati M, Khalid Anwer M, Elossaily GM, Ali N, Wal P, Gasmi A. The link between Alzheimer's disease and stroke: A detrimental synergism. Ageing Res Rev 2024; 99:102388. [PMID: 38914265 DOI: 10.1016/j.arr.2024.102388] [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: 04/02/2024] [Revised: 05/05/2024] [Accepted: 05/06/2024] [Indexed: 06/26/2024]
Abstract
Being age-related disorders, both Alzheimer's disease (AD) and stroke share multiple risk factors, such as hypertension, smoking, diabetes, and apolipoprotein E (APOE) Ɛ4 genotype, and coexist in patients. Accumulation of amyloid-β plaques and neurofibrillary tangled impair cognitive potential, leading to AD. Blocked blood flow in the neuronal tissues, causes neurodegeneration and cell death in stroke. AD is commonly characterized by cerebral amyloid angiopathy, which significantly elevates the risk of hemorrhagic stroke. Patients with AD and stroke have been both reported to exhibit greater cognitive impairment, followed by multiple pathophysiological mechanisms shared between the two. The manuscript aims to elucidate the relationship between AD and stroke, as well as the common pathways and risk factors while understanding the preventive therapies that might limit the negative impacts of this correlation, with diagnostic modalities and current AD treatments. The authors provide a comprehensive review of the link and aid the healthcare professionals to identify suitable targets and risk factors, that may retard cognitive decline and neurodegeneration in patients. However, more intricate research is required in this regard and an interdisciplinary approach that would target both the vascular and neurodegenerative factors would improve the quality of life in AD patients.
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Affiliation(s)
- Tapan Behl
- Amity School of Pharmaceutical Sciences, Amity University, Mohali, Punjab, India.
| | - Ishnoor Kaur
- University of Glasgow, College of Medical, Veterinary and Life Sciences, Glasgow, United Kingdom
| | - Aayush Sehgal
- GHG Khalsa College of Pharmacy, Gurusar Sadhar, Ludhiana, Punjab, India
| | - Prasanna Shama Khandige
- NITTE (Deemed to be University), NGSM Institute of Pharmaceutical Sciences, Department of Pharmacology, Mangaluru, Karnataka, India
| | - Mohd Imran
- Department of Pharmaceutical Chemistry, College of Pharmacy, Northern Border University, Rafha 91911, Saudi Arabia
| | - Monica Gulati
- School of Pharmaceutical Sciences, Lovely Professional University, Phagwara, Punjab 1444411, India; ARCCIM, Faculty of Health, University of Technology Sydney, Ultimo, NSW 20227, Australia
| | - Md Khalid Anwer
- Department of Pharmaceutics, College of Pharmacy, Prince Sattam Bin Abdulaziz University, Alkharj, Saudi Arabia
| | - Gehan M Elossaily
- Department of Baisc Medical Sciences, College of Medicine, AlMaarefa University, P.O. Box 71666, Riyadh 11597, Saudi Arabia
| | - Nemat Ali
- Department of Pharmacology and Toxicology, College of Pharmacy, King Saud University, P.O. Box 2457, Riyadh 11451, Saudi Arabia
| | - Pranay Wal
- PSIT Kanpur, Department of Pharmacy, Uttar Pradesh, India
| | - Amin Gasmi
- Societe Francophone de Nutritherapie et de Nutrigenetique Appliquee, Villeurbanne, France; International Institute of Nutrition and Micronutrition Sciences, Saint Etienne, France
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Kumar A, Khurana D, Pattanaik S, Kumar M, Kaur S, Krishnan NC, Ghai S, Modi M, Nagi M, Chellappa R, Gairolla J, Munjal DK, Kumar P. A mobile application-based post-stroke care strategy for survivors and their caregivers for prevention and management of post-stroke complications - "Stroke Home Care:" Development and feasibility. J Neurosci Rural Pract 2024; 15:217-226. [PMID: 38746514 PMCID: PMC11090587 DOI: 10.25259/jnrp_411_2023] [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: 07/24/2023] [Accepted: 09/10/2023] [Indexed: 05/16/2024] Open
Abstract
Objectives In developing nations such as India, a disparity exists between the available resources for stroke rehabilitation and the substantial burden of stroke cases. Consequently, the provision of cost-effective and multidisciplinary post-stroke rehabilitation care to stroke survivors becomes of paramount importance. The utilization of mobile applications (apps) for stroke care has been on the rise, offering a personalized and pragmatic solution with the potential for wider reach in settings constrained by limited resources. To address the unmet needs in the prevention and management of post-stroke complications, we conceptualized a strategy known as a mobile application-based post-stroke care strategy for both survivors and their caregivers. Materials and Methods The scope of the app's focus was determined based on the incidence of post-stroke complications within a prospective cohort of stroke patients, in conjunction with existing literature. An initial "web-based mobile app" prototype was crafted to align with the identified focus area. Before the development of the final app version, a feasibility study was conducted involving 30 participant dyads (comprising a patient and a caregiver). Content validity was evaluated by a panel of 20 stroke experts encompassing neurologists, nurses, physiotherapists, and psychologists. Results The "Stroke Home Care" (SHC) mobile app was conceived as a web-based educational tool aimed at preventing and managing post-stroke complications. It seeks to train caregivers of immobile stroke patients in the administration of preventive and therapeutic care procedures, thereby potentially enhancing survivors' quality of life and alleviating caregivers' burden. The feasibility and validity studies indicated "high satisfaction" levels among most caregivers and experts (>75%), with the remainder expressing "satisfaction" and no "dissatisfaction" regarding app utilities. Stroke experts unanimously deemed the app "appropriate", with consensus on contents, video quality, video length, and voice clarity. Caregivers reported "satisfactory" user experiences, encountering no issues during app installation or operation. Suggestions from both caregivers and experts were integrated into the final app version. Conclusion The "SHC" app represents a feasible and well-received innovation tailored for the use by caregivers of stroke survivors. Consequently, the initial feasibility of the developed app serves as a precursor to a randomized controlled clinical trial aimed at substantiating its effectiveness within the post-stroke survivor and caregiver population. Notably, within resource-constrained contexts, this app has the potential to be a pivotal tool for post-stroke care.
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Affiliation(s)
- Ashok Kumar
- National Institute of Nursing Education, Chandigarh, India
| | - Dheeraj Khurana
- Department of Neurology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Smita Pattanaik
- Department of Pharmacology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Mukesh Kumar
- Department of Industrial Engineering, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Sukhpal Kaur
- National Institute of Nursing Education, Chandigarh, India
| | | | - Sandhya Ghai
- National Institute of Nursing Education, Chandigarh, India
| | - Manish Modi
- Department of Neurology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Manisha Nagi
- National Institute of Nursing Education, Chandigarh, India
| | - Rajan Chellappa
- Department of Physical Medicine and Rehabilitation, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | | | - Divesh Kumar Munjal
- Department of Neurology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Pramod Kumar
- Department of Nursing, Post Graduate Institute of Medical Education and Research, Chandigarh, India
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Karn AK, Narayan S, Qavi A, Maurya PKK, Singh A, Kulshreshtha D. Sequential carotid Doppler study in acute stroke and its clinical correlation: A prospective study. J Neurosci Rural Pract 2024; 15:42-46. [PMID: 38476433 PMCID: PMC10927035 DOI: 10.25259/jnrp_342_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: 06/23/2023] [Accepted: 08/31/2023] [Indexed: 03/14/2024] Open
Abstract
Objectives Resistive index (RI) and pulsatility index (PI) assessed on carotid Doppler assess the hemodynamic status of cranial vasculature. They are related to the severity of stroke and help determine the overall outcome. This study was done to compare the hospital stay and stroke severity with RI and PI of both internal carotid arteries. Materials and Methods Patients >18 years of age presenting within 48 h of anterior circulation stroke (either ischemic or hemorrhagic) were included. They were divided into two groups based on their length of stay (LOS). They were assessed clinically on days 1, 3, and 5, and underwent a carotid Doppler study on the same days. The Doppler parameters were correlated with the LOS and stroke severity for possible associations. Results One hundred and one patients were included. Forty-seven patients had a favorable outcome based on LOS. In this group, significant decrease in RI and PI scores was seen from days 1 to 3. In patients with unfavorable outcome, there was a significant increase in PI on days 1-3 and days 1-5. The National Institutes of Health Stroke Scale decreased significantly from days 1 to 5 in favorable group. Conclusion For those with an unfavorable outcome and prolonged LOS, PI continues to increase suggesting a failure of autoregulation. Carotid Doppler can be a simple bedside tool to predict outcome in patients with acute stroke.
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Affiliation(s)
- Ashutosh Kumar Karn
- Department of Neurology, Dr. Ram Manohar Lohia Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Shamrendra Narayan
- Department of Radiodiagnosis, Dr. Ram Manohar Lohia Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Abdul Qavi
- Department of Neurology, Dr. Ram Manohar Lohia Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Pradeep Kumar Kumar Maurya
- Department of Neurology, Dr. Ram Manohar Lohia Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Ajai Singh
- Department of Neurology, Dr. Ram Manohar Lohia Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Dinkar Kulshreshtha
- Department of Neurology, Dr. Ram Manohar Lohia Institute of Medical Sciences, Lucknow, Uttar Pradesh, 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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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: 27] [Impact Index Per Article: 13.5] [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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Kamal A, Khoja A, Usmani B, Magsi S, Malani A, Peera Z, Sattar S, Ahmed Akram M, Shahnawaz S, Zulfiqar M, Muqeet A, Zaidi F, Sayani S, Artani A, Azam I, Saleem S. Effect of 5-Minute Movies Shown via a Mobile Phone App on Risk Factors and Mortality After Stroke in a Low- to Middle-Income Country: Randomized Controlled Trial for the Stroke Caregiver Dyad Education Intervention (Movies4Stroke). JMIR Mhealth Uhealth 2020; 8:e12113. [PMID: 32012080 PMCID: PMC7013656 DOI: 10.2196/12113] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2018] [Revised: 03/01/2019] [Accepted: 07/19/2019] [Indexed: 11/13/2022] Open
Abstract
Background Pakistan is the sixth most populous nation in the world and has an estimated 4 million stroke survivors. Most survivors are taken care of by community-based caregivers, and there are no inpatient rehabilitation facilities. Objective The objective of this study was to evaluate the effectiveness and safety of locally designed 5-min movies rolled out in order of relevance that are thematically delivered in a 3-month program to deliver poststroke education to stroke survivor and caregiver dyads returning to the community. Methods This study was a randomized controlled, outcome assessor–blinded, parallel group, single-center superiority trial in which participants (stroke survivor-caregiver dyads) with first-ever stroke (both ischemic and hemorrhagic) incidence were randomized within 48 hours of their stroke into either the video-based education intervention group or the control group. The video-based education intervention group had health education delivered through short videos that were shown to the participants and their caregivers at the time of admission, before discharge, and the first and third months of follow-up after discharge. The control group had standardized care including predischarge education and counseling according to defined protocols. All participants enrolled in the video education intervention and control groups were followed for 12 months after discharge for outcome assessment in the outpatient stroke clinics. The primary outcome measures were the proportion of participants achieving control of blood pressure, blood sugar, and blood cholesterol in the video intervention versus the control group. Several predefined secondary outcomes were included in this study, of which we report the mortality and functional disability in this paper. Analysis was by performed using the intention-to-treat principle. Results A total of 310 stroke survivors and their caregiver dyads (participant dyads) were recruited over a duration of 6 months. In total, 155 participant dyads were randomized into the intervention and control groups, each. The primary outcome of control of three major risk factors revealed that at 12 months, there was a greater percentage of participants with a systolic BP<125 mm Hg (18/54, 33% vs 11/52, 21%; P=.16), diastolic BP<85 mm Hg (44/54, 81% vs 37/52, 71%; P=.21), HbA1c level<7% (36/55, 65% vs 30/40, 75%; P=.32), and low-density lipoprotein level<100 mg/dL (36/51, 70% vs 30/45, 67%; P=.68) in the intervention group than in the control group. The secondary outcome reported is the mortality among the stroke survivors because the number of stroke-related complications was higher in the control group than in the intervention group (13/155, 8.4% vs 2/155, 1.3%), and this difference was statistically significant (P<.001). Conclusions The Movies4Stroke trial failed to achieve its primary specified outcome. However, secondary outcomes that directly related to survival skills of stroke survivors demonstrated the effectiveness of the video-based intervention on improving stroke-related mortality and survival without disability. Trial Registration ClinicalTrials.gov NCT02202330; https://www.clinicaltrials.gov/ct2/show/NCT02202330
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Affiliation(s)
- Ayeesha Kamal
- Aga Khan University, Stroke Services and Research, Karachi, Pakistan
| | - Adeel Khoja
- Aga Khan University, Stroke Services and Research, Karachi, Pakistan
| | - Bushra Usmani
- Aga Khan University, Stroke Services and Research, Karachi, Pakistan
| | - Shahvaiz Magsi
- Aga Khan University, Stroke Services and Research, Karachi, Pakistan
| | - Aresha Malani
- Aga Khan University, Stroke Services and Research, Karachi, Pakistan
| | - Zahra Peera
- Aga Khan University, Stroke Services and Research, Karachi, Pakistan
| | - Saadia Sattar
- Aga Khan University, Stroke Services and Research, Karachi, Pakistan
| | | | - Sumaira Shahnawaz
- Aga Khan University, Stroke Services and Research, Karachi, Pakistan
| | - Maryam Zulfiqar
- Aga Khan University, Stroke Services and Research, Karachi, Pakistan
| | - Abdul Muqeet
- Aga Khan Development Network, Digital Health Resource Center, Karachi, Pakistan
| | - Fabiha Zaidi
- Aga Khan Development Network, Digital Health Resource Center, Karachi, Pakistan
| | - Saleem Sayani
- Aga Khan Development Network, Digital Health Resource Center, Karachi, Pakistan
| | - Azmina Artani
- Aga Khan University, Stroke Services and Research, Karachi, Pakistan
| | - Iqbal Azam
- Aga Khan University, Community Health Sciences, Karachi, Pakistan
| | - Sarah Saleem
- Aga Khan University, Community Health Sciences, Karachi, Pakistan
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Vijayan M, Reddy PH. Stroke, Vascular Dementia, and Alzheimer's Disease: Molecular Links. J Alzheimers Dis 2018; 54:427-43. [PMID: 27567871 DOI: 10.3233/jad-160527] [Citation(s) in RCA: 162] [Impact Index Per Article: 27.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Stroke is a brain disease that occurs when blood flow stops, resulting in reduced oxygen supply to neurons. Stroke occurs at any time and at any age, but increases after the age of 55. It is the second leading cause of death and the third leading cause of disability-adjusted, life-years. The pathophysiology of ischemic stroke is complex and recent molecular, cellular, and animal models and postmortem brain studies have revealed that multiple cellular changes have been implicated, including oxidative stress/mitochondrial dysfunction, inflammatory responses, micro RNA alterations, and marked changes in brain proteins. These cellular changes provide new information for developing therapeutic strategies for ischemic stroke treatment. Research also revealed that stroke increases with a number of modifiable factors and most strokes can be prevented and/or controlled through pharmacological or surgical interventions and lifestyle changes. Ischemic stroke is the major risk factor for vascular dementia and Alzheimer's disease. This review summarizes the latest research findings on stroke, including causal factors and molecular links between stroke and vascular disease/Alzheimer's disease.
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Affiliation(s)
- Murali Vijayan
- Garrison Institute on Aging, Texas Tech University Health Sciences Center, Lubbock, TX, USA
| | - P Hemachandra Reddy
- Garrison Institute on Aging, Texas Tech University Health Sciences Center, Lubbock, TX, USA.,Cell Biology and Biochemistry, Texas Tech University Health Sciences Center, Lubbock, TX, USA.,Neuroscience and Pharmacology, Texas Tech University Health Sciences Center, Lubbock, TX, USA.,Department of Neurology, Texas Tech University Health Sciences Center, Lubbock, TX, USA.,Department of Speech, Language and Hearing Sciences Texas Tech University Health Sciences Center, Lubbock, TX, USA.,Garrison Institute on Aging, South West Campus, Texas Tech University Health Sciences Center, Lubbock, TX, USA
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Srilatha K, Bobby Z, Subrahmanyam DK, NithinKumar U. Insulin resistance and elevated C-reactive protein among first-degree relatives of ischemic stroke patients. Diabetes Metab Syndr 2017; 11 Suppl 2:S873-S878. [PMID: 28705458 DOI: 10.1016/j.dsx.2017.07.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2017] [Accepted: 07/01/2017] [Indexed: 11/22/2022]
Abstract
BACKGROUND Family history is one of the non-modifiable risk factors for ischemic stroke. Atherosclerosis and thrombosis are the two major mechanisms for cardiovascular disease and stroke. Screening of family members is an important method to identify individuals at risk. Therefore, this study was planned to assess the atherosclerotic risk factors in first-degree relatives of patients with ischemic stroke. METHODOLOGY Case group included 40 first-degree relatives of ischemic stroke patients between 30 and 50 years of age. Forty age and gender matched apparently healthy subjects without major risk factors were recruited as controls. Their blood samples were analysed for routine biochemical parameters, Fasting Insulin, high sensitivity C-reactive protein and Homocysteine. RESULTS First-degree relatives showed dyslipidemia (High total cholesterol, elevated Low Density Lipoprotein and elevated Non-High Density Lipoprotein), hyperinsulinemia and insulin resistance compared to controls. They had high levels of high sensitivity C-reactive protein (p=0.045). There was positive correlation between fasting insulin and Homeostasis Model Assessment of Insulin Resistance with high sensitivity C-reactive protein among first-degree relatives. CONCLUSION First-degree relatives of ischemic stroke patients exhibited hyperinsulinemia, Insulin resistance and dyslipidemia. Insulin resistance, a low grade inflammatory state that leads to increased C-reactive protein which triggers the development of atherosclerosis. So screening for insulin resistance and dyslipidemia in first-degree relatives of ischemic stroke patients may help in preventing adverse vascular events.
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Affiliation(s)
- Krishnamoorthy Srilatha
- Department of Biochemistry, Jawaharlal Institute of Post Graduate Medical Education and Research, Puducherry, 605006, India.
| | - Zachariah Bobby
- Department of Biochemistry, Jawaharlal Institute of Post Graduate Medical Education and Research, Puducherry, 605006, India
| | - D K Subrahmanyam
- Department of Medicine, Jawaharlal Institute of Post graduate Medical Education and Research, Puducherry, 605006, India
| | - Uppoor NithinKumar
- Department of Biochemistry, Jawaharlal Institute of Post Graduate Medical Education and Research, Puducherry, 605006, India
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Karthik R, Menaka R. Computer-aided detection and characterization of stroke lesion – a short review on the current state-of-the art methods. IMAGING SCIENCE JOURNAL 2017. [DOI: 10.1080/13682199.2017.1370879] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Affiliation(s)
- R. Karthik
- School of Electronics Engineering, VIT University, Chennai, India
| | - R. Menaka
- School of Electronics Engineering, VIT University, Chennai, India
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Prakash V, Ganesan M, Vasanthan R, Hariohm K. Do Commonly Used Functional Outcome Measures Capture Activities that Are Relevant for People with Stroke in India? Top Stroke Rehabil 2016; 24:200-205. [DOI: 10.1080/10749357.2016.1234190] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- V. Prakash
- Ashok & Rita Patel Institute of Physiotherapy, Charotar University of Science and Technology, Anand, India
| | - Mohan Ganesan
- Department of Physical Therapy, Clarke University, Dubuque, IA, USA
| | - R. Vasanthan
- Department of Physiotherapy, Manipal University, Manipal, India
| | - K. Hariohm
- Spring Physiotherapy Centre, Chennai, India
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Vijayan M, Chinniah R, Ravi PM, Sivanadham R, Mosses Joseph AK, Vellaiappan NA, Krishnan JI, Karuppiah B. MTHFR (C677T) CT genotype and CT-apoE3/3 genotypic combination predisposes the risk of ischemic stroke. Gene 2016; 591:465-70. [PMID: 27378745 DOI: 10.1016/j.gene.2016.06.062] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2016] [Revised: 06/10/2016] [Accepted: 06/30/2016] [Indexed: 11/16/2022]
Abstract
The predisposition to ischemic stroke (IS) might involve interactions of several genes and environmental factors. The present study was aimed to evaluate the influence of polymorphisms in methylenetetrahydrofolate reductase (MTHFR-C677T) and apolipoprotein-E (apo-E) as risk factors for IS patients in south Indian population. 200 IS patients and 193 age and sex matched controls were genotyped for MTHFR-C677T and apoE by Polymerase Chain Reaction-Restriction Fragment Length Polymorphism (PCR-RFLP) method. Statistically significant association was observed for MTHFR CT genotype (IS-Pooled: OR=4.29; p=5.01×10(-5); IS-Males: OR=4.13; p=0.001; IS-Females: OR=8.62; p=0.027; IS-Large Vessel Disease (LVD)- Pooled: OR=4.14; p=0.0002) and T allele (IS-Pooled: OR=4.82; p=1.49×10(-5); IS-Males: OR=4.33; p=0.0002; IS-Females: OR=7.99; p=0.031; IS-LVD-Pooled: OR=4.13; p=0.0001). Further, reduced frequencies of CC genotype (IS-Pooled: OR=0.20; p=9.80×10(-6); IS-Males: OR=0.25; p=0.001; IS-Females: OR=0.12; p=0.027; IS-LVD-Pooled: OR=0.23; p=0.0001) and C allele (IS-Pooled: OR=0.21; p=1.49×10(-5); IS-Males: OR=0.23; p=0.0002; IS-Females: OR=0.13; p=0.031; IS-LVD-Pooled: OR=0.24; p=0.0001) were observed in IS patients than the controls. No association was observed for apoE genotypes/alleles in IS/LVD cases. Our study demonstrated the presence of risk for MTHFR CT genotype/T allele and 'CT-3/3' (n=33 vs. 5; OR=7.42; p=0.001) genotypic combination in the development of IS in south India. Further, follow-up study of these stroke cases i.e., in later stages of the disease whether they are developing the neurological disorders such as Alzheimer's Disease (AD) and vascular dementia (VaD) is needed to draw a fruitful conclusion in connection between neurological disorders and with these two polymorphisms, before translating it into clinical practice.
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Affiliation(s)
- Murali Vijayan
- Department of Biotechnology & Genetic Engineering, School of Biotechnology, Bharathidasan University, Tiruchirappalli 620 024, Tamil Nadu, India; Department of Immunology, School of Biological Sciences, Madurai Kamaraj University, Madurai 625 021, Tamil Nadu, India
| | - Rathika Chinniah
- Department of Immunology, School of Biological Sciences, Madurai Kamaraj University, Madurai 625 021, Tamil Nadu, India
| | - Padma Malini Ravi
- Department of Immunology, School of Biological Sciences, Madurai Kamaraj University, Madurai 625 021, Tamil Nadu, India
| | - Ramgopal Sivanadham
- Department of Immunology, School of Biological Sciences, Madurai Kamaraj University, Madurai 625 021, Tamil Nadu, India
| | | | | | | | - Balakrishnan Karuppiah
- Department of Immunology, School of Biological Sciences, Madurai Kamaraj University, Madurai 625 021, Tamil Nadu, India.
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Murali V, Rathika C, Ramgopal S, Padma Malini R, Arun Kumar MJ, Neethi Arasu V, Jeyaram Illiayaraja K, Balakrishnan K. Susceptible and protective associations of HLA DRB1*/DQB1* alleles and haplotypes with ischaemic stroke. Int J Immunogenet 2016; 43:159-65. [PMID: 27105925 DOI: 10.1111/iji.12266] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2016] [Revised: 03/10/2016] [Accepted: 04/04/2016] [Indexed: 11/30/2022]
Abstract
Stroke has emerged as the second commonest cause of mortality worldwide and is a major public health problem. For the first time, we present here the association of human leucocyte antigen (HLA)-DRB1*/DQB1* alleles and haplotypes with ischaemic stroke in South Indian patients. Ischaemic stroke (IS) cases and controls were genotyped for HLA-DRB1*/DQB1* alleles by polymerase chain reaction sequence-specific primers (PCR-SSP) method. The frequencies of HLA class II alleles such as DRB1*04, DRB1*07, DRB1*11, DRB1*12, DRB1*13, DQB1*02 and DQB1*07 were high in IS patients than in the age- and gender-matched controls, suggesting that the individuals with these alleles are susceptible to ischaemic stroke in South India. The frequencies of alleles such as DRB1*03, DRB1*10, DRB1*14, DQB1*04 and DQB1*05 were less in IS cases than in the controls, suggesting a protective association. Haplotypes DRB1*04-DQB1*0301, DRB1*07-DQB1*02, DRB1*07-DQB1*0301, DRB1*11-DQB1*0301 and DRB1*13-DQB1*06 were found to be high in IS patients conferring susceptibility. The frequency of haplotype DRB1*10-DQB1*05 was high in controls conferring protection. IS-LVD and gender-stratified analysis too confirmed these susceptible and protective associations. Thus, HLA-DRB1*/DQB1* alleles and haplotypes strongly predispose South Indian population to ischaemic stroke. Further studies in different populations with large sample size or the meta-analysis are needed to explain the exact mechanism of associations of HLA gene(s) with IS.
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Affiliation(s)
- V Murali
- Department of Biotechnology & Genetic Engineering, School of Biotechnology, Bharathidasan University, Tiruchirappalli, Tamil Nadu, India
| | - C Rathika
- Department of Immunology, School of Biological Sciences, Madurai Kamaraj University, Madurai, Tamil Nadu, India
| | - S Ramgopal
- Department of Immunology, School of Biological Sciences, Madurai Kamaraj University, Madurai, Tamil Nadu, India
| | - R Padma Malini
- Department of Immunology, School of Biological Sciences, Madurai Kamaraj University, Madurai, Tamil Nadu, India
| | | | | | | | - K Balakrishnan
- Department of Immunology, School of Biological Sciences, Madurai Kamaraj University, Madurai, Tamil Nadu, India
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Sureshkumar K, Murthy GVS, Munuswamy S, Goenka S, Kuper H. 'Care for Stroke', a web-based, smartphone-enabled educational intervention for management of physical disabilities following stroke: feasibility in the Indian context. ACTA ACUST UNITED AC 2015; 1:127-136. [PMID: 26246902 PMCID: PMC4516008 DOI: 10.1136/bmjinnov-2015-000056] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2015] [Accepted: 05/16/2015] [Indexed: 12/26/2022]
Abstract
INTRODUCTION Stroke rehabilitation is a process targeted towards restoration or maintenance of the physical, mental, intellectual and social abilities of an individual affected by stroke. Unlike high-income countries, the resources for stroke rehabilitation are very limited in many low-income and middle-income countries (LMICs). Provision of cost-effective, post-stroke multidisciplinary rehabilitation services for the stroke survivors therefore becomes crucial to address the unmet needs and growing magnitude of disability experienced by the stroke survivors in LMICs. In order to meet the growing need for post-stroke rehabilitation services in India, we developed a web-based Smartphone-enabled educational intervention for management of physical disabilities following a stroke. METHODS On the basis of the findings from the rehabilitation needs assessment study, guidance from the expert group and available evidence from systematic reviews, the framework of the intervention content was designed. Web-based application designing and development by Professional application developers were subsequently undertaken. RESULTS The application is called 'Care for Stroke'. It is a web-based educational intervention for management of physical disabilities following a stroke. This intervention is developed for use by the Stroke survivors who have any kind of rehabilitation needs to independently participate in his/her family and social roles. DISCUSSION 'Care for stroke' is an innovative intervention which could be tested not just for its feasibility and acceptability but also for its clinical and cost-effectiveness through rigorously designed, randomised clinical trials. It is very important to test this intervention in LMICs where the rehabilitation and information needs of the stroke survivors seem to be substantial and largely unmet.
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Affiliation(s)
- K Sureshkumar
- International Centre for Evidence in Disability, London School of Hygiene and Tropical Medicine , London , UK
| | - G V S Murthy
- International Centre for Evidence in Disability, London School of Hygiene and Tropical Medicine , London , UK
| | - Suresh Munuswamy
- Institute of Public Health-Hyderabad , Hyderabad, Telangana , India
| | | | - Hannah Kuper
- International Centre for Evidence in Disability, London School of Hygiene and Tropical Medicine , London , UK
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Menon J, Joseph J, Thachil A, Attacheril TV, Banerjee A. Surveillance of Noncommunicable Diseases by Community Health Workers in
Kerala: The Epidemiology of Noncommunicable Diseases in Rural Areas (ENDIRA)
Study. Glob Heart 2014; 9:409-17. [DOI: 10.1016/j.gheart.2014.07.003] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2014] [Revised: 06/29/2014] [Accepted: 07/17/2014] [Indexed: 12/15/2022] Open
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Vijayan M, Chinniah R, Ravi PM, Mosses Joseph AK, Vellaiappan NA, Krishnan JI, Karuppiah B. ACE-II genotype and I allele predicts ischemic stroke among males in south India. Meta Gene 2014; 2:661-9. [PMID: 25606450 PMCID: PMC4287818 DOI: 10.1016/j.mgene.2014.09.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2014] [Revised: 08/22/2014] [Accepted: 09/02/2014] [Indexed: 12/31/2022] Open
Abstract
Two hundred ischemic stroke patients and 193 age and sex matched healthy controls were studied for the presence of Angiotensin Converting Enzyme Insertion/Deletion (ACE I/D) gene polymorphism. The PCR studies revealed that ACE 'II' (OR = 2.055; p = 0.004) genotype and 'I' (OR = 1.411; p = 0.018) alleles were significantly associated with IS patients. Gender specific analysis revealed a strong association of 'II' (OR = 2.044; p = 0.014) genotype and 'I' (OR = 1.531; p = 0.011) allele with male sex. Classification of patients based on TOAST criteria, revealed a significant association for 'II' genotype (OR = 1.713; p = 0.043) and 'I' (OR = 1.382; p = 0.039) allele in LVD patients only. When the data was stratified based on age and sex, a statistically significant association was observed for ACE 'II' genotype (OR = 2.288; p = 0.006) and 'I' allele (OR = 1.395; p = 0.054) in IS male patients of > 50 years of age. The ACE 'D' allele was found to be increased in controls (OR = 0.709; p = 0.018) than IS patients. Multivariate logistic regression analysis showed that smoking and diabetes were the most powerful independent risk factor in LVD type of stroke. Thus, we presented here an evidence for a strong association of ACE 'II' genotype and 'I' allele compounded by factors such as smoking and diabetes among south Indian IS patients.
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Affiliation(s)
- Murali Vijayan
- Department of Biotechnology & Genetic Engineering, Bharathidasan University, Tiruchirappalli-620 024, Tamil Nadu, India
| | - Rathika Chinniah
- Department of Immunology, School of Biological Sciences, Madurai Kamaraj University, Madurai-625 021, Tamil Nadu, India
| | - Padma Malini Ravi
- Department of Immunology, School of Biological Sciences, Madurai Kamaraj University, Madurai-625 021, Tamil Nadu, India
| | | | | | | | - Balakrishnan Karuppiah
- Department of Immunology, School of Biological Sciences, Madurai Kamaraj University, Madurai-625 021, Tamil Nadu, India
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Poor Awareness of Stroke—A Hospital-Based Study from South India: An Urgent Need For Awareness Programs. J Stroke Cerebrovasc Dis 2014; 23:2091-2098. [DOI: 10.1016/j.jstrokecerebrovasdis.2014.03.017] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2014] [Revised: 03/17/2014] [Accepted: 03/21/2014] [Indexed: 11/20/2022] Open
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Mangat A, Grewal D, Kaur P, Jyotsna R, Singh R, Pandian JD. Dietary patterns in stroke patients in Northwest India. Nutr Neurosci 2013; 16:288-92. [PMID: 23433119 DOI: 10.1179/1476830513y.0000000058] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
OBJECTIVES Little is known about the dietary patterns among stroke patients in India. We explored the dietary patterns in stroke patients and attempted to correlate the dietary patterns with stroke characteristics. METHODS This hospital-based study was carried out in a tertiary referral centre in Northwest India from March 2008 to September 2009. All first ever stroke (ischaemic and hemorrhagic) patients were interviewed by the dietician using an oral diet questionnaire. The demographic information and risk factors were noted and outcome was assessed after 30 days using modified Rankin scale (≤2 = good outcome). RESULTS A total of 210 stroke patients were enrolled. The mean age was 60 ± 14 years and 126 (60%) patients were men. Hypertension (167 (79.5%)) was the major risk factor. All patients consumed cereals and beverages. Consumption of other food items in the diet were as follows: milk and milk products (203 (96.7%)), saturated fats (butter, butter oil, cream) (133 (63.3%)), bakery items (139 (66.2%)), fried snacks (116 (55.2%)), fruits (96 (45.7%)), and juices (20 (9.5%)). Large proportion of the patients (112 (53.6%)) consumed more food calories than recommended. Use of fried snacks was significant in patients who consumed alcohol (P = 0.03) and patients who had diabetes mellitus were more likely to use saturated fats (P = 0.01). DISCUSSION Majority of the patients consumed milk and milk products. Fruits and juices were consumed by a small proportion of patients. Our results provide opportunities for stroke prevention by diet modification.
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Affiliation(s)
- Arshi Mangat
- Christian Medical College, Ludhiana, Punjab, India
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Gupta A, Verma HK, Gupta S. Technology and research developments in carotid image registration. Biomed Signal Process Control 2012. [DOI: 10.1016/j.bspc.2012.05.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Pandian JD, Kaur A, Jyotsna R, Sylaja PN, Vijaya P, Padma MV, Venkateswaralu K, Sukumaran S, Mathew R, Kaur P, Singh YP, Radhakrishnan K. Complications in Acute Stroke in India (CAST-I): A Multicenter Study. J Stroke Cerebrovasc Dis 2012; 21:695-703. [DOI: 10.1016/j.jstrokecerebrovasdis.2011.03.003] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2011] [Revised: 03/04/2011] [Accepted: 03/09/2011] [Indexed: 10/18/2022] Open
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Feasibility of Functional Electrical Stimulation-Assisted Neurorehabilitation following Stroke in India: A Case Series. Case Rep Neurol Med 2012; 2012:830873. [PMID: 22953091 PMCID: PMC3420748 DOI: 10.1155/2012/830873] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2012] [Accepted: 06/21/2012] [Indexed: 11/17/2022] Open
Abstract
Functional Electrical Stimulation (FES) facilitates ambulatory function after paralysis by electrically activating the muscles of the lower extremities. The Odstock Dropped Foot Stimulator (ODFS, Odstock, UK) called ODFS Pace, was used for heel-switch triggered FES-assisted walking. The ODFS is recommended as an intervention for neurologically impaired gait in the Royal College of Physicians (UK) Clinical Guidelines on Stroke. Based on the guidelines by the National Institute of Clinical Excellence (NICE, UK), we started first clinical study in India on ODFS Pace as an orthotic intervention for daily use. In this preliminary study, we also investigated improvement in volitional walking following 6 sessions (3 times per week, for 2 weeks) of 30 minutes of FES-assisted treadmill walking on 7 chronic (>6 months after stroke) stroke survivors. We found that short-duration, moderately intensive FES-assisted gait therapy improved volitional gait in 3 out of 7 stroke survivors suffering from foot drop. Even in absence of improvement in volitional walking, there were no adverse effects and the subjects found heel-switch triggered FES-assisted walking mostly “easy” (6 out of 7). Therefore FES is promising as an orthotic intervention for daily use; however, tailoring the intensity and/or frequency based on patient's ability may make it viable as a therapeutic intervention.
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Raju RS, Sarma PS, Pandian JD. Psychosocial Problems, Quality of Life, and Functional Independence Among Indian Stroke Survivors. Stroke 2010; 41:2932-7. [DOI: 10.1161/strokeaha.110.596817] [Citation(s) in RCA: 65] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Rinu Susan Raju
- From the Stroke Unit (R.S.R., J.P.), Christian Medical College, Ludhiana, Punjab, India; Achutha Menon Centre for Health Science Studies (P.S.S.), Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, Kerala, India
| | - Prabhakaran S. Sarma
- From the Stroke Unit (R.S.R., J.P.), Christian Medical College, Ludhiana, Punjab, India; Achutha Menon Centre for Health Science Studies (P.S.S.), Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, Kerala, India
| | - Jeyaraj D. Pandian
- From the Stroke Unit (R.S.R., J.P.), Christian Medical College, Ludhiana, Punjab, India; Achutha Menon Centre for Health Science Studies (P.S.S.), Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, Kerala, India
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Hassan KM, Rohatgi S. Brain Attack : Time to Act Now. Med J Armed Forces India 2009; 65:62-5. [PMID: 27408194 PMCID: PMC4921513 DOI: 10.1016/s0377-1237(09)80059-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2008] [Accepted: 11/27/2008] [Indexed: 10/18/2022] Open
Affiliation(s)
- KM Hassan
- Associate Professor (Medicine) & Neurologist, Command Hospital (SC) Pune 411 040
| | - S Rohatgi
- Professor and Head of Department, Consultant (Medicine & Neurology), Department of Internal Medicine, AFMC, Pune 411 040
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Dhamija RK, Arora S, Gaba P, Jais M, Kaintura A, Kumar M, Bhattacharjee J. Study of genetic, metabolic and inflammatory risk factors in patients of acute ischemic stroke. Indian J Clin Biochem 2008; 23:136-43. [DOI: 10.1007/s12291-008-0031-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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