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Hu B, Pei J, Wan C, Liu S, Xu Z, Zou Y, Li Z, Tang Z. Mechanisms of Postischemic Stroke Angiogenesis: A Multifaceted Approach. J Inflamm Res 2024; 17:4625-4646. [PMID: 39045531 PMCID: PMC11264385 DOI: 10.2147/jir.s461427] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2024] [Accepted: 06/26/2024] [Indexed: 07/25/2024] Open
Abstract
Ischemic stroke constitutes a significant global health care challenge, and a comprehensive understanding of its recovery mechanisms is imperative for the development of innovative therapeutic strategies. Angiogenesis, a pivotal element of ischemic tissue repair, facilitates the restoration of blood flow to damaged regions, thereby promoting neuronal regeneration and functional recovery. Nevertheless, the mechanisms underlying postischemic stroke angiogenesis remain incompletely elucidated. This review meticulously examines the constituents of the neurovascular unit, ion channels, molecular mediators, and signaling pathways implicated in angiogenesis following stroke. Furthermore, it delves into prospective therapeutic strategies informed by these factors. Our objective is to provide detailed and exhaustive information on the intricate mechanisms governing postischemic stroke angiogenesis, thus providing a robust scientific foundation for the advancement of novel neurorepair therapies.
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Affiliation(s)
- Bin Hu
- Department of Neurosurgery, The First Affiliated Hospital of Kunming Medical University, Kunming, People’s Republic of China
| | - Jingchun Pei
- Department of Neurosurgery, The First Affiliated Hospital of Kunming Medical University, Kunming, People’s Republic of China
| | - Cheng Wan
- Department of Neurosurgery, The First Affiliated Hospital of Kunming Medical University, Kunming, People’s Republic of China
- Department of Medical Imaging, The First Affiliated Hospital of Kunming Medical University, Kunming, People’s Republic of China
| | - Shuangshuang Liu
- Department of Neurosurgery, The First Affiliated Hospital of Kunming Medical University, Kunming, People’s Republic of China
| | - Zhe Xu
- Department of Biochemistry and Molecular Biology, School of Basic Medical Sciences, Kunming Medical University, Kunming, People’s Republic of China
- School of Basic Medical Sciences, Qujing Medical College, Qujing, People’s Republic of China
| | - Yongwei Zou
- Department of Neurosurgery, The First Affiliated Hospital of Kunming Medical University, Kunming, People’s Republic of China
| | - Zhigao Li
- Department of Neurosurgery, The First Affiliated Hospital of Kunming Medical University, Kunming, People’s Republic of China
| | - Zhiwei Tang
- Department of Neurosurgery, The First Affiliated Hospital of Kunming Medical University, Kunming, People’s Republic of China
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Li J, Wan J, Wang H. Role of frailty in predicting outcomes after stroke: a systematic review and meta-analysis. Front Psychiatry 2024; 15:1347476. [PMID: 39035605 PMCID: PMC11257970 DOI: 10.3389/fpsyt.2024.1347476] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2023] [Accepted: 06/03/2024] [Indexed: 07/23/2024] Open
Abstract
Background Stroke is considered the second most common cause of death and the third leading cause of disability worldwide. Frailty, characterized by increased vulnerability to stressors, is emerging as a key factor affecting outcomes in older adults and stroke patients. This study aimed to estimate the prevalence of frailty in acute stroke patients and assess its association with mortality and poor functional outcome. Methods Medline, Google Scholar, and Science Direct databases were systematically searched for English-language studies that included adult stroke patients (>16 years), have defined frailty, and reported mortality and functional outcomes. Meta-analysis was done using STATA 14.2, and the results were expressed as pooled odds ratios (OR) with 95% confidence intervals (CI). Heterogeneity was assessed using the I2 statistic and the Chi-square test. Study quality was evaluated using the Newcastle Ottawa Scale (NOS). Results Twenty-five studies were included in the analysis. Frailty prevalence in stroke patients was 23% (95% CI 22% - 23%). Unadjusted analysis showed an OR of 2.66 (95% CI: 1.93 - 3.67) for mortality and 2.04 (95% CI: 1.49 - 2.80) for poor functional outcome. Adjusted estimates indicated an OR of 1.22 (95% CI: 1.1 - 1.35) for mortality and 1.21 (95% CI: 1.04 - 1.41) for poor functional outcome, with substantial heterogeneity for both adjusted and unadjusted analyses. No publication bias was detected for the prevalence of frailty. However, there was a publication bias for the association between frailty and mortality. Conclusions Frailty was significantly associated with increased mortality and poorer functional outcomes in stroke patients. Our study highlights the need to focus on frailty in stroke patients to improve outcomes and quality of life. Further research should aim to standardize assessment of frailty and reduce heterogeneity in study outcomes. Systematic review registration https://www.crd.york.ac.uk/prospero/#searchadvanced, CRD42023470325.
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Affiliation(s)
- Jing Li
- Department of Neurology, People’s Hospital of Anji, Anji County, Huzhou, Zhejiang, China
| | - Jinping Wan
- Department of Neurology, Guigang City People’s Hospital, Guigang, Guangxi, China
| | - Hua Wang
- Department of Neurology, People’s Hospital of Anji, Anji County, Huzhou, Zhejiang, China
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Mahajan C, Kapoor I, Prabhakar H. The Urban-Rural Divide in Neurocritical Care in Low-Income and Middle-Income Countries. Neurocrit Care 2024:10.1007/s12028-024-02040-z. [PMID: 38960992 DOI: 10.1007/s12028-024-02040-z] [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: 02/26/2024] [Accepted: 06/05/2024] [Indexed: 07/05/2024]
Abstract
The term "urban-rural divide" encompasses several dimensions and has remained an important concern for any country. The economic disparity; lack of infrastructure; dearth of medical specialists; limited opportunities to education, training, and health care; lower level of sanitation; and isolating effect of geographical location deepens this gap, especially in low-income and middle-income countries (LMICs). This article gives an overview of the rural-urban differences in terms of facilities related to neurocritical care (NCC) in LMICs. Issues related to common clinical conditions such as stroke, traumatic brain injury, myasthenia gravis, epilepsy, tubercular meningitis, and tracheostomy are also discussed. To facilitate delivery of NCC in resource-limited settings, proposed strategies include strengthening preventive measures, focusing on basics, having a multidisciplinary approach, promoting training and education, and conducting cost-effective research and collaborative efforts. The rural areas of LMICs bear the maximum impact because of their limited access to preventive health services, high incidence of acquired brain injury, inability to have timely management of neurological emergencies, and scarcity of specialist services in a resource-deprived health center. An increase in the health budget allocation for rural areas, NCC education and training of the workforce, and provision of telemedicine services for rapid diagnosis, management, and neurorehabilitation are some of the steps that can be quite helpful.
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Affiliation(s)
- Charu Mahajan
- Department of Neuroanaesthesiology and Critical Care, Neurosciences Centre, All India Institute of Medical Sciences, New Delhi, 110029, India
| | - Indu Kapoor
- Department of Neuroanaesthesiology and Critical Care, Neurosciences Centre, All India Institute of Medical Sciences, New Delhi, 110029, India
| | - Hemanshu Prabhakar
- Department of Neuroanaesthesiology and Critical Care, Neurosciences Centre, All India Institute of Medical Sciences, New Delhi, 110029, India.
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Arora S, Agrawal A, Vishnu VY, Singh MB, Goyal V, Srivastava PMV. Navigating the Nexus: Acute Kidney Injury in Acute Stroke - A Prospective Cohort Study. Ann Indian Acad Neurol 2024; 27:384-392. [PMID: 39172071 PMCID: PMC11418761 DOI: 10.4103/aian.aian_177_24] [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: 03/10/2024] [Revised: 04/30/2024] [Accepted: 05/07/2024] [Indexed: 08/23/2024] Open
Abstract
BACKGROUND Acute kidney injury (AKI) is prevalent in patients with acute stroke. Although AKI is linked to poor clinical outcomes, data about its incidence and effect on stroke outcomes is limited. METHODS This was a prospective observational study carried out at a single tertiary care center that analyzed the data of 204 consecutive subjects with acute ischemic stroke and intracerebral hemorrhage. Considering serum creatinine at admission as the baseline, AKI was defined as a rise in serum creatinine value of 0.3 mg/dl over 48 h or a percentage increase of at least 50% from baseline over 7 days during hospitalization. The primary outcome was to measure the prevalence of AKI in patients with acute stroke. Secondary outcome measures were all-cause mortality, duration of hospital stay, need for dialysis, and comparison of outcomes in ischemic and hemorrhagic stroke. For both the stroke subtypes, we employed a multivariate logistic regression model, with AKI and hospital mortality being the outcomes. Covariates included gender, age, ventilatory requirement, duration of hospital stay, and National Institutes of Health Stroke Scale score at admission. RESULTS There were 144 cases of ischemic stroke with 12 deaths (8.3%) and 60 cases of intracranial hemorrhage (ICH) with 22 deaths (36.7%). The mean age was 55 years, 72.6% were males, and AKI complicated 34% of ischemic stroke and 66.7% of ICH hospitalizations. AKI was linked to increased hospital mortality from ischemic stroke (odds ratio [OR] 27.21, 95% CI 3.39-218.13) and hemorrhagic stroke (OR 5.12, 95% CI 1.29-20.28) in multivariate analysis stratified by stroke type. CONCLUSIONS AKI complicates stroke frequently and increases hospital mortality. Additional studies are required to assess if the association is causal and if remedies to prevent AKI would decrease mortality.
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Affiliation(s)
- Sameer Arora
- Department of Neurology, Narayana Hospital, Gurugram, Haryana, India
| | - Arpit Agrawal
- Department of Neurology, DKSPGI (Dau Kalyan Singh Postgraduate Institute), Raipur, Chhattisgarh, India
| | - Venugopalan Y. Vishnu
- Department of Neurology, All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - Mamta B. Singh
- Department of Neurology, All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - Vinay Goyal
- Department of Neurology, Medanta Hospital, Medicity, Gurugram, Haryana, India
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Pandit AK, Jatwani A, Tangri P, Srivastava MVP, Bhatia R, Kale SS, Gaikwad S, Srivastava AK, Garg A, Joseph LS, Vibha D, Vishnu VY, Singh RK, Radhakrishnan DM, Das A, Agarwal A. Safety and Efficacy of Injection Tenecteplase in 4.5 to 24 Hours Imaging Eligible Window Patients with Acute Ischemic Stroke (EAST-AIS) - Study Protocol. Ann Indian Acad Neurol 2024; 27:408-412. [PMID: 39196809 PMCID: PMC11418772 DOI: 10.4103/aian.aian_23_24] [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: 01/09/2024] [Revised: 05/03/2024] [Accepted: 05/03/2024] [Indexed: 08/30/2024] Open
Abstract
BACKGROUND AND AIMS Tenecteplase is used as the standard of care treatment for thrombolysis in acute ischemic stroke (AIS) patients within 4.5 h of symptom onset. Documented reports were less certain to claim the benefits of it in an extended window period. EAST-AIS (CTRI/2022/03/040718) trial is designed to determine the success rate of thrombolysis in an extended window period for good clinical outcomes. STUDY DESIGN It is a randomized, placebo-controlled trial of tenecteplase administered within 4.5-24 h of stroke onset (with or without large vessel occlusion) based on evidence of salvageable tissue through baseline computed tomography perfusion (CTP) or magnetic resonance imaging (MRI) scan. Criteria of patient inclusion are as follows: patients of both genders (male and female), age >18 years, pre-stroke modified Ranking Scale (mRS) <2, baseline NIHSS >5, CTP showing penumbra-ischemic core ratio >1.8, absolute difference in volume >10 ml, and ischemic core volume <70 ml. The sample size for the study is 100 patients: 50 in the tenecteplase arm (0.25 mg/kg body weight; maximum- 25 mg) and 50 in the placebo arm (controls). STUDY OUTCOMES The study's primary objective is safety endpoints along with the efficacy of tenecteplase assessed using the mRS score at 90 days of stroke onset. CONCLUSION The result obtained from EAST-AIS will determine the safety and efficacy of tenecteplase injection administered 4.5-24 h following the symptom onset for AIS patients within the territory of Internal Carotid Artery (ICA), Middle Cerebral Artery (MCA), or Anterior Cerebral Artery (ACA) occlusion.
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Affiliation(s)
- Awadh Kishor Pandit
- Department of Neurology, All India Institute of Medical Sciences, New Delhi, India
| | - Arti Jatwani
- Department of Neurology, All India Institute of Medical Sciences, New Delhi, India
| | - Poorvi Tangri
- Department of Neurology, All India Institute of Medical Sciences, New Delhi, India
| | | | - Rohit Bhatia
- Department of Neurology, All India Institute of Medical Sciences, New Delhi, India
| | - Shashank Sharad Kale
- Department of Neurology, All India Institute of Medical Sciences, New Delhi, India
| | - Shailesh Gaikwad
- Department of Neuroimaging & Interventional Neuroradiology, All India Institute of Medical Sciences, New Delhi, India
| | | | - Ajay Garg
- Department of Neuroradiology, All India Institute of Medical Sciences, New Delhi, India
| | - Leve Sebastian Joseph
- Department of Neuroradiology, All India Institute of Medical Sciences, New Delhi, India
| | - Deepti Vibha
- Department of Neurology, All India Institute of Medical Sciences, New Delhi, India
| | | | - Rajesh Kumar Singh
- Department of Neurology, All India Institute of Medical Sciences, New Delhi, India
| | | | - Animesh Das
- Department of Neurology, All India Institute of Medical Sciences, New Delhi, India
| | - Ayush Agarwal
- Department of Neurology, All India Institute of Medical Sciences, New Delhi, India
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Rathor E, Arasada C, Kulkarni A, Shaikh MA. Study of Serum Gamma-Glutamyl Transferase Levels in Patients With Acute Ischemic Stroke. Cureus 2024; 16:e65336. [PMID: 39055973 PMCID: PMC11270811 DOI: 10.7759/cureus.65336] [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] [Accepted: 07/25/2024] [Indexed: 07/28/2024] Open
Abstract
Background Gamma-glutamyl transferase (GGT) mediates intracellular uptake of glutathione which is a known antioxidant. GGT levels are found to be elevated in conditions of oxidative stress. Ischemic stroke results in anoxic injury, which liberates free radicals, causing glutathione to rise, which may be accompanied by a rise in serum GGT levels. This study aimed to compare serum GGT levels in acute ischemic stroke patients with normal controls and to ascertain the relation of serum GGT levels with National Institute of Health Stroke Scale (NIHSS) scores. Materials and methods This cross-sectional study was carried out in a tertiary care hospital in South India from August 2023 to February 2024. The study included 57 patients who presented with acute ischemic stroke within 24 hours of onset and 57 age- and sex-matched controls. The serum GGT levels of the cases were compared with age- and sex-matched controls using an independent t-test. Mean serum GGT levels were compared among groups with varying NIHSS scores and different locations of infarction using the ANOVA test. Serum GGT levels were also compared based on age, gender, and various comorbidities. Results The mean serum GGT levels were significantly increased (p < 0.0001) in acute ischemic stroke patients, 43.96 ± 28.02 (mean ± SD), when compared to controls, 26.14 ± 5.93 (mean ± SD). The difference in serum GGT levels with NIHSS scores of 5-15 (moderate strokes) with 34.17 ± 18.39 (mean ± SD), 16-20 (moderate-severe strokes) with 46.64 ± 21.95 (mean ± SD), and >21 (severe stroke) with 84.62 ± 39.35 (mean ± SD) was significant (p < 0.00001). Serum GGT levels were not significant while comparing age, gender, location of infarction, type 2 diabetes mellitus, and hypertension. Conclusion Serum GGT levels were significantly elevated in acute ischemic stroke patients within 24 hours of presentation. Serum GGT levels were significantly elevated with increasing severity of stroke as calculated by NIHSS scores at the time of presentation. Serum GGT levels are a potential marker of ischemic stroke and its severity.
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Affiliation(s)
- Eeshaan Rathor
- Internal Medicine, Ramaiah Medical College, Bengaluru, IND
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Bindal P, Kumar V, Kapil L, Singh C, Singh A. Therapeutic management of ischemic stroke. NAUNYN-SCHMIEDEBERG'S ARCHIVES OF PHARMACOLOGY 2024; 397:2651-2679. [PMID: 37966570 DOI: 10.1007/s00210-023-02804-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Accepted: 10/19/2023] [Indexed: 11/16/2023]
Abstract
Stroke is the third leading cause of years lost due to disability and the second-largest cause of mortality worldwide. Most occurrences of stroke are brought on by the sudden occlusion of an artery (ischemic stroke), but sometimes they are brought on by bleeding into brain tissue after a blood vessel has ruptured (hemorrhagic stroke). Alteplase is the only therapy the American Food and Drug Administration has approved for ischemic stroke under the thrombolysis category. Current views as well as relevant clinical research on the diagnosis, assessment, and management of stroke are reviewed to suggest appropriate treatment strategies. We searched PubMed and Google Scholar for the available therapeutic regimes in the past, present, and future. With the advent of endovascular therapy in 2015 and intravenous thrombolysis in 1995, the therapeutic options for ischemic stroke have expanded significantly. A novel approach such as vagus nerve stimulation could be life-changing for many stroke patients. Therapeutic hypothermia, the process of cooling the body or brain to preserve organ integrity, is one of the most potent neuroprotectants in both clinical and preclinical contexts. The rapid intervention has been linked to more favorable clinical results. This study focuses on the pathogenesis of stroke, as well as its recent advancements, future prospects, and potential therapeutic targets in stroke therapy.
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Affiliation(s)
- Priya Bindal
- Department of Pharmacology, ISF College of Pharmacy, Moga 142001, Affiliated to I.K Gujral Punjab Technical University, Jalandhar, Punjab, India
| | - Vishal Kumar
- Department of Pharmacology, ISF College of Pharmacy, Moga 142001, Affiliated to I.K Gujral Punjab Technical University, Jalandhar, Punjab, India
| | - Lakshay Kapil
- Department of Pharmacology, ISF College of Pharmacy, Moga 142001, Affiliated to I.K Gujral Punjab Technical University, Jalandhar, Punjab, India
| | - Charan Singh
- Department of Pharmaceutical Sciences, HNB Garhwal University (A Central University), Chauras Campus, Distt. Tehri Garhwal, Uttarakhand, 246174, India
| | - Arti Singh
- Department of Pharmacology, ISF College of Pharmacy, Moga 142001, Affiliated to I.K Gujral Punjab Technical University, Jalandhar, Punjab, India.
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Balaji D, Rangan AS, Suthakaran PK, Gopalakrishnan KV, Balaji S, Kumar Sivasamy M. A Study to Estimate the Red Cell Width Distribution and the Mean Platelet Volume in Predicting the 30-Day Mortality in Acute Ischemic Stroke Patients. Cureus 2024; 16:e57899. [PMID: 38725750 PMCID: PMC11079703 DOI: 10.7759/cureus.57899] [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: 03/07/2024] [Accepted: 04/09/2024] [Indexed: 05/12/2024] Open
Abstract
Background Acute ischemic stroke, a clinical disorder caused by nontraumatic cerebrovascular disease, has an acute onset, frequently causes neurological deficit, and may persist for >24 hours or can be fatal in <24 hours. This study aimed to assess the red cell width distribution (RDW) and the mean platelet volume (MPV) in predicting 30-day mortality in acute ischemic stroke patients. In general, patients with acute ischemic stroke have a rather high mortality rate in the first 30 days due to various complications, but post the 30-day mark, the prognosis is comparatively better. Material and methods The present study was conducted on patients with a confirmed diagnosis of acute ischemic stroke based on history, physical examination, CT scan, and/or diffusion-weighted MRI scan performed during the first 24 hours. It was a prospective and cross-sectional study done at Saveetha Medical College over a period of two years. The data was collected by using the intra-hospital network and was analyzed using the IBM SPSS Statistics for Windows, Version 20 (Released 2011; IBM Corp., Armonk, New York, United States). Results In the present study, among 100 patients, the mean age was 57.4 ± 13.36 years. About 55% of our subjects were males in our study. The RDW on the 1stday was 14.17 ± 0.708, and it reduced drastically on the 30thday to1st 13.55 ± 1.11, and it was statically significant (p = 0.000). The MPV on day 1 was 11.11 ± 0.969 and, on day 30, was 10.82 ± 0.90; the MPV was reduced considerably on day 30, which was statistically significant (p = 0.000). RDW on the 1st day was significantly correlated with the MPV and the volume of stroke. The correlation was significant at the 0.01 level (two-tailed). On the 30th day of acute ischemic stroke patients, the red blood cell (RBC) width was significantly correlated with the MPV. The correlation was significant at the 0.01 level (two-tailed). At the end of 30 days, 10% mortality was observed in the present study. Day 30 saw a significant decrease in the MPV and RDW, particularly in the moderate to severe and severe categories. The National Institutes of Health Stroke Scale (NIHSS) score and the volume of stroke were significantly associated with the 30-day outcome. Conclusion The RDW and the MPV are well correlated in predicting the 30-day mortality in acute ischemic stroke patients. This could potentially be used as a significant marker for predicting mortality in stroke patients in the future, but to increase the generalization, further studies need to be carried out at other demographically distinct medical centers.
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Affiliation(s)
- Dhanush Balaji
- Internal Medicine, Saveetha Medical College Hospital, Saveetha Institute of Medical and Technical Sciences, Chennai, IND
| | - Abinaya Srinivasa Rangan
- Internal Medicine, Saveetha Medical College Hospital, Saveetha Institute of Medical and Technical Sciences, Chennai, IND
| | - Prasanna Karthik Suthakaran
- Internal Medicine, Saveetha Medical College Hospital, Saveetha Institute of Medical and Technical Sciences, Chennai, IND
| | | | - Selva Balaji
- Internal Medicine, Saveetha Medical College Hospital, Saveetha Institute of Medical and Technical Sciences, Chennai, IND
| | - Manoj Kumar Sivasamy
- Internal Medicine, Saveetha Medical College Hospital, Saveetha Institute of Medical and Technical Sciences, Chennai, IND
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Priya S, Mardi V, Kapoor S, Kumar A, Saroj U, Dungdung A, Rishu R. Association of Glycated Hemoglobin With Acute Ischemic Stroke in a Tertiary Care Center in a Tribal Region of Jharkhand. Cureus 2024; 16:e58797. [PMID: 38784369 PMCID: PMC11112394 DOI: 10.7759/cureus.58797] [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] [Accepted: 04/22/2024] [Indexed: 05/25/2024] Open
Abstract
BACKGROUND Increased glycated hemoglobin (HbA1c) levels have shown an association with an increased risk of stroke in patients admitted to a tertiary care center in Jharkhand. OBJECTIVES To find out and estimate the risk of acute ischemic stroke in patients with increased HbA1c levels compared with controls. METHODS This observational case-control study was conducted on patients admitted to the department of general medicine at a tertiary care center in Ranchi from June 2021 to November 2022. The patients included in this study were those aged 18 years or older and who were clinically and radiologically diagnosed with acute ischemic stroke. Only patients with a first episode of stroke were included, and patients with hemorrhagic stroke or transient ischemic attack were excluded from this study. An equal number of control participants were also included. Ion exchange high-performance liquid chromatography was used to perform the HbA1c tests. The same method was used to measure HbA1c levels in the controls. All findings were recorded in a Microsoft Excel sheet (Microsoft Corporation, Redmond, WA), and the data were analyzed using SPSS version 22.0 software (IBM Corp., Armonk, NY). After performing a descriptive statistical analysis, the findings were classified over a range of values and described accordingly. For each variable, an independent t-test was performed to compare the cases with the controls. A multivariable logistic regression analysis was used to choose the appropriate potential factors to determine the association in the multivariable analysis. RESULTS A total of 185 cases and 185 controls were included. The mean age of the cases with ischemic stroke was 63.77 ± 10.312, and that of the controls was 53.18 ± 11.35 (p < 0.01). The mean HbA1c level in the patients of acute ischemic stroke was 6.97 ± 1.84, and that of the controls was 5.99 ± 1.69 (p < 0.01). The mean random blood sugar (RBS) value in the ischemic stroke cases was 170.21 ± 84.16, and that of the controls was 150.03 ± 82.25 (p = 0.02). To compare the factors that were determined to be statistically significant between ischemic stroke cases and controls, a multivariable logistic regression analysis was performed. The HbA1c p-value was 0.01, the odds ratio (OR) was 1.280, and the 95% CI was 1.11-1.48. The other variables apart from HbA1c that were statistically significant between the ischemic stroke cases and the controls were age (p < 0.01, OR: 1.280, 95% CI: 1.06-1.11), hypertension (p = 0.618, OR: 1.130, 95% CI: 0.70-1.83), and high-density lipoprotein (p = 0.055, OR: 0.975, 95% CI: 0.95-1.00). When other cofounders were considered, it was concluded that with a 1% increase in HbA1c, the risk of stroke increases by 28% (OR: 1.28, 95% CI: 1.11-1.48). To compare the variables that were determined to be statistically significant between the control and ischemic stroke case groups, a multivariable logistic regression was used. The area under the receiver operating characteristic curve for HbA1c was 0.773 and RBS was 0.600. CONCLUSION This study shows that higher HbA1c levels in patients increase the risk of ischemic stroke. This study brings to light the need to screen the population periodically for diabetes by routinely testing for Hba1c in those who are at high risk of diabetes. Stroke risk can be reduced with early management and intervention. This study also concludes that HbA1c is a better predictor for assessing the risk of ischemic stroke than RBS levels.
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Affiliation(s)
- Shimpy Priya
- General Medicine, Rajendra Institute of Medical Sciences, Ranchi, IND
| | - Vikas Mardi
- General Medicine, Rajendra Institute of Medical Sciences, Ranchi, IND
| | - Siddharth Kapoor
- General Medicine, Rajendra Institute of Medical Sciences, Ranchi, IND
| | - Abhay Kumar
- General Medicine, Rajendra Institute of Medical Sciences, Ranchi, IND
| | - Usha Saroj
- Blood Bank, Rajendra Institute of Medical Sciences, Ranchi, IND
| | - Ajit Dungdung
- Internal Medicine, Rajendra Institute of Medical Sciences, Ranchi, IND
| | - Raunak Rishu
- Radiology, Jawaharlal Nehru Medical College, Aligarh, IND
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Kidwai J, Brumberg J, Gatts J. Aphasia and high-tech communication support: a survey of SLPs in USA and India. Disabil Rehabil Assist Technol 2024; 19:566-575. [PMID: 35972860 DOI: 10.1080/17483107.2022.2109072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2021] [Revised: 07/26/2022] [Accepted: 07/29/2022] [Indexed: 10/15/2022]
Abstract
PURPOSE This survey was conducted to investigate American and Indian clinician's preference and usage of high-tech communication supports (HTCS) for aphasia rehabilitation to identify factors in each country that support the use of HTCS for improving post-aphasia communicative outcomes. In this study, HTCS include speech-generating augmentative and alternative communication (AAC) devices with varying methods of access. METHOD The survey exploring clinically practicing speech-language pathologists' (SLPs) training, assessment and aphasia rehabilitation practices using HTCS, was electronically distributed in both countries. The raw responses from the US SLPs (n = 56) and Indian SLPs (n = 43) were collected, segregated and then converted into percentages for all 41 survey questions. RESULTS The responses from SLPs indicated higher (70%) and lower use (58%) of HTCS for aphasia in a developed country (USA) and developing country (India), respectively. In the US, identifiable factors for successful use of HTCS for aphasia rehabilitation were familiarity in procuring and programming the device, caregiver training and effectiveness in reducing the time of communicating through the device. In India, factors leading to successful inclusion of HTCS were AAC coursework and clinical training for clinicians and availability of HTCS at affordable prices for clients. CONCLUSION There is a considerable difference in the educational and clinical practice of AAC as SLPs in the US tend to have more clinical AAC experience with a stronger network for device dissemination in comparison to SLPs in India leading to higher usage of high-tech AAC for aphasia rehabilitation in a developed country.Implications for RehabilitationFor the SLPs,Improve exposure to programming AAC devices in developed countries and increase coursework, clinical training and exposure to programming AAC devices in developing countries.Enhance awareness about integrating high-tech AAC devices in intervention programs.Improve efficiency by minimizing the time in message creation on high-tech AAC device in developed countries. For the bioengineers,Develop AAC application interfaces in regional languages for easier usage in developing countries.
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Affiliation(s)
- Juhi Kidwai
- Department of Communicative Sciences & Disorders, New York University, New York, NY, USA
| | - Jonathan Brumberg
- Department of Speech-Language-Hearing: Sciences and Disorders, University of Kansas, Lawrence, KS, USA
| | - Julie Gatts
- Department of Speech-Language-Hearing: Sciences and Disorders, University of Kansas, Lawrence, KS, USA
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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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Edakkattil S, Abraham SV, Panattil NJ, Gafoor FA, Jacob L, Liu R. Prehospital Factors Associated with Delayed Hospital Arrival of Stroke Patients: A Regional Single-Center Study from India. Ann Indian Acad Neurol 2024; 27:165-171. [PMID: 38751933 PMCID: PMC11093158 DOI: 10.4103/aian.aian_1091_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: 12/16/2023] [Revised: 03/01/2024] [Accepted: 03/03/2024] [Indexed: 05/18/2024] Open
Abstract
Background Only a small percentage of patients with acute stroke are currently eligible for thrombolysis, partly due to severe delays in hospital arrival. We had previously conducted the first regional study to assess the factors delaying acute stroke care in India. The present study aims to understand and describe in depth the variables associated with prehospital delay among patients admitted with an acute ischemic stroke. Methods Data were prospectively collected by conducting an in-depth interview of 470 acute ischemic stroke patients and their bystanders, aged above 18 years, presenting to the Department of Emergency Medicine, Jubilee Mission Medical College and Research Institute, Thrissur. Patients who arrived within 4.5 h of symptom onset were considered as "early arrival" and those who arrived after 4.5 h were considered as "delayed arrival." Univariate and multivariate analyses were undertaken to determine associations between variables of interest and delays to hospital presentation. Results Of the 470 patients who met the inclusion criteria, 73 patients reached within 4.5 h (15.5%), whereas 397 patients arrived after 4.5 h. The mean age of acute stroke patients who reached within 4.5 h was 63 ± 13.7 years, whereas the mean age of those who reached after 4.5 h was 63 ± 12.1 years. Binary logistic regression performed to quantify the associations of prehospital factors showed an increased risk of prehospital delay among individuals with lack of awareness (odds ratio [OR] = 5.16 [3.040-8.757], P < 0.001), followed by those for whom a vehicle was not available at the site of event (OR = 3.745 [1.864-7.522], P < 0.001). Within the predefined socioeconomic strata, compared to lower class, upper middle class had less risk (OR = 0.135 [0.018-1.035], P = 0.054), whereas the distance from first medical contact to emergency department contributed moderate risk (OR = 1.071 [1.028-1.116], P < 0.001) for prehospital delay. Conclusions Health promotion techniques that increase public knowledge about the early signs of stroke, transferring patients directly to hospitals with thrombolysis capabilities, and making ambulance services more widely available are appropriate measures to reduce prehospital delay.
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Affiliation(s)
- Sachin Edakkattil
- Department of Emergency Medicine, Jubilee Mission Hospital, Medical College and Research Institute, Thrissur, Kerala, India
| | - Siju V. Abraham
- Department of Emergency Medicine, Jubilee Mission Hospital, Medical College and Research Institute, Thrissur, Kerala, India
| | - Neenu J. Panattil
- Department of Emergency Medicine, Jubilee Mission Hospital, Medical College and Research Institute, Thrissur, Kerala, India
| | - Faris A. Gafoor
- Department of Emergency Medicine, Jubilee Mission Hospital, Medical College and Research Institute, Thrissur, Kerala, India
| | - Leenus Jacob
- Department of Emergency Medicine, Jubilee Mission Hospital, Medical College and Research Institute, Thrissur, Kerala, India
| | - Renyu Liu
- Department of Anesthesiology and Critical Care, and Neurology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, USA
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13
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Vamshi G, D S N B K P, Sampath A, Dammalli M, Kumar P, B S G, Pasala PK, Somasekhar G, Challa MC, Alluril R, Narala VR. Possible cerebroprotective effect of citronellal: molecular docking, MD simulation and in vivo investigations. J Biomol Struct Dyn 2024; 42:1208-1219. [PMID: 37286367 DOI: 10.1080/07391102.2023.2220025] [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: 12/30/2022] [Accepted: 03/28/2023] [Indexed: 06/09/2023]
Abstract
This study focused on molecular docking, dynamic simulation, and in vivo approaches to examine the molecular interactions between citronellal (CT) and neurotoxic proteins. In silico studies of CT were performed using proteins involved in the pathophysiology of stroke, such as interleukin-6 (IL-6), interleukin-12 (IL-12), TNF-α, and nitric oxide synthase (NOS), to determine the binding affinity based on their interactions. The docking results of CT revealed that, among the targets, NOS had a better binding energy of -6.4 Kcal/mol. NOS showed good hydrophobic interactions: TYR A, 347; VAL A, 352; PRO A, 350; TYR A, 373 amino acids. Interactions with IL-6, TNF-α, and IL-12 resulted in lower binding affinities of -3.7, -3.9 and -3.1 Kcal/mol. Based on molecular dynamics simulations of 100 ns, the binding affinity of CT (-66.782 ± 7.309 kJ/mol) was well complemented, and NOS stability at the docked site was confirmed. In in vivo studies, cerebral stroke was induced by occlusion of the bilateral common carotid arteries for 30 min and reperfusion for 4 h. CT treatment protected the brain by decreasing cerebral infarction size, increasing GSH(p < 0.001***), decreasing MPO (p < 0.001***), MDA (p < 0.001***), NO production (p < 0.01**), and AChE (p < 0.001***) compared to stroke rats. Histopathological examination revealed that CT treatment reduced the severity of cerebral damage. The investigation concluded that CT strongly binds to NOS, as observed in molecular docking and dynamic simulation studies, which are involved in nitric oxide production, leading to cerebral damage, and CT treatment reduces NO production and oxidative stress parameters, and increases antioxidants via inhibition of NOS function.Communicated by Ramaswamy H. Sarma.
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Affiliation(s)
- G Vamshi
- SKU College of Pharmaceutical Sciences, SKU, Ananthapuramu, Andhra Pradesh, India
| | - Prasanth D S N B K
- Department of Pharmacognosy, KVSR Siddhartha College of Pharmaceutical Sciences, Vijayawada, Andhra Pradesh, India
| | - A Sampath
- Department of QA, EQRX International Inc, Cambridge, Massachusetts, USA
| | - Manjunath Dammalli
- Department of Biotechnology, Siddaganga Institute of Technosslogy, Tumkur, Karnataka, India
| | - Pankaj Kumar
- Nitte (Deemed to be University), NGSM Institute of Pharmaceutical Sciences (NGSMIPS), Mangaluru, India
| | - Gowrishankar B S
- Department of Biotechnology, Siddaganga Institute of Technosslogy, Tumkur, Karnataka, India
| | | | - G Somasekhar
- SKU College of Pharmaceutical Sciences, SKU, Ananthapuramu, Andhra Pradesh, India
| | | | - Ramesh Alluril
- Vishnu Institute of Pharmaceutical Education & Research, Medak, Telangana, India
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14
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Arya NP, Seth NH, Burile GC, Raghuveer R. Targeted Physiotherapy for an Interesting Case of Spontaneously Resolving Extracapsular Infarct: A Case Report. Cureus 2024; 16:e52348. [PMID: 38361730 PMCID: PMC10867550 DOI: 10.7759/cureus.52348] [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: 12/28/2023] [Accepted: 01/15/2024] [Indexed: 02/17/2024] Open
Abstract
Stroke is a prevalent and disabling illness that is becoming more common in developing countries. After a stroke, physical inactivity frequently results in long-term deconditioning and disappointing consequences. This case study focuses on an infrequent 0.3% of ischemic stroke cases that occur in the external capsular (ECC) or extreme capsular (EXC) region. In sub-insular infarcts, ECC-EXC lesions are distinct and frequently linked to the anterior opercular syndrome. We are presenting the case of an 86-year-old female patient who had a fall and loss of consciousness. Diagnostic tests revealed that the patient had an extracapsular ischemic event; due to unstable vital signs and frequent drop in saturation of peripheral oxygen (SpO2) levels, the patient was intubated and admitted to the intensive care unit (ICU). When stable, the patient experienced generalized weakness, for which she was referred for physical therapy. Balance and gait impairments were secondary to weakness. A planned two-week structured physiotherapy intervention was created with an emphasis on gait training, muscle strengthening, and balance. Adaptive gait training, progressive exercises, and balancing activities addressed the patient's limitations. This case study demonstrates how an elderly individual with an external capsule ischemic event can benefit from targeted physical therapy for increasing muscle strength, balance, and gait performance. Positive results emphasize how crucial early and targeted physiotherapy is for supporting stroke survivors' neurological recovery.
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Affiliation(s)
- Neha P Arya
- Neurophysiotherapy, Ravi Nair Physiotherapy College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Nikita H Seth
- Neurophysiotherapy, Ravi Nair Physiotherapy College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Ghanishtha C Burile
- Neurophysiotherapy, Ravi Nair Physiotherapy College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Raghumahanti Raghuveer
- Neurophysiotherapy, Ravi Nair Physiotherapy College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
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15
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Verma SJ, Gulati P, Injety RJ, Arora D, Dhasan A, Singhania A, Khatter H, Sharma M, Sylaja PN, Pandian JD. Secondary prevention by structured semi-interactive stroke prevention package in INDIA (SPRINT INDIA): Findings from the process evaluation of a randomized controlled trial. Eur Stroke J 2023; 8:1053-1063. [PMID: 37585729 PMCID: PMC10683732 DOI: 10.1177/23969873231192291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2023] [Accepted: 07/02/2023] [Indexed: 08/18/2023] Open
Abstract
INTRODUCTION Secondary Prevention by Structured Semi-Interactive Stroke Prevention Package in INDIA Trial delivered secondary stroke awareness intervention to sub-acute stroke patients in form of workbook, videos and SMS across 31 centres in 12 languages. Trial was stopped for futility due to fewer vascular outcomes than anticipated. Trial results indicated that trial intervention, did not lead to reduction in vascular events. We carried out process evaluation, to evaluate trial implementation and participant's perspectives, to comprehend the trial's futile outcomes. MATERIALS AND METHODS Using mixed methods approach, qualitative interviews and quantitative data from case report forms, workbooks and questionnaires were analysed to measure intervention fidelity and contamination. Using purposive sampling, 115 interviews of patient-caregiver dyads and health professionals at 11 centres and 2 focus group discussions were held. RESULTS AND DISCUSSION Iterative thematic analysis of qualitative data was done with RE-AIM and realist models. There was good fidelity to intervention and adherence to protocol; however, there was dilution of inclusion criteria by randomly enrolling uneducated and caregiver-dependent patients. Centre coordinators provided counselling to both arms, not specified by protocol, causing bias. Coordinators found it difficult to keep patients motivated to view intervention which was corroborated by fidelity questionnaire showing decreased viewing of intervention for a year. Cardiovascular protection improved in routine care by virtue of participating in trial. No contamination of intervention was reported. CONCLUSION The intervention was acceptable by patients and caregivers, which could be made a community-based programme. Reasons identified for decreased viewing were repetitive content and non-availability of personal cellular device.
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Affiliation(s)
- Shweta Jain Verma
- Department of Neurology, Christian Medical College, Ludhiana, Punjab, India
| | - Puja Gulati
- School of Pharmacy, Desh Bhagat University, Mandi Gobindgarh, Punjab, India
| | - Ranjit J Injety
- Department of Neurology, Christian Medical College, Ludhiana, Punjab, India
| | - Deepti Arora
- Department of Neurology, Christian Medical College, Ludhiana, Punjab, India
| | - Aneesh Dhasan
- Department of Neurology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, Kerala, India
| | - Anusha Singhania
- Department of Neurology, Christian Medical College, Ludhiana, Punjab, India
| | - Himani Khatter
- Department of Neurology, Christian Medical College, Ludhiana, Punjab, India
| | - Meenakshi Sharma
- Non-Communicable Diseases Section, Indian Council of Medical Research, New Delhi, India
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Shankaranarayana AM, Pattan YS, Hegde N, Natarajan M, Pai AR, Nayak R, Solomon JM. Activity monitoring of stroke patients by physiotherapist and caregivers in a hospital setting: A pilot study. F1000Res 2023; 11:1227. [PMID: 37954409 PMCID: PMC10638484 DOI: 10.12688/f1000research.124675.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/08/2023] [Indexed: 11/14/2023] Open
Abstract
Background Activity monitoring is a necessary technique to ensure stroke survivors' activity levels in the hospital are within optimal levels as this is important for enhanced motor recovery. However, this could be time-consuming for healthcare professionals like physiotherapists. Activity monitoring by caregivers could be an alternate option. Therefore, our aim was to compare the activity monitoring of stroke survivors by caregivers and physiotherapists during early phase in a hospital setting. Methods An observation study was carried out in the neuroscience ward in a tertiary care hospital among 17 stroke survivors. Physiotherapist and caregivers were instructed to use an activity log chart that was developed during previous research conducted by the same authors for observing the activities performed by the patients every 15 minutes from 8 AM to 5 PM across one day. Data collected were analysed using Stata 15. Kappa statistics were carried out to determine the agreement of the observations between the two raters. Results A total of 10 male and seven female caregivers of stroke survivors with a mean age of 40.11 ± 9.2 years and a trained physiotherapist participated in the study. A total of 272 observations of caregivers were in agreement with that of the physiotherapist. Inter-rater Kappa statistics showed 60% agreement between the physiotherapist and the caregivers (p<0.05). Conclusions There was moderate agreement between the physiotherapist and caregiver for activity monitoring of stroke survivors. This suggests behavioural mapping by caregivers may be a potential alternative solution in healthcare settings.
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Affiliation(s)
- Apoorva M. Shankaranarayana
- Department of Physiotherapy, Manipal College of Health Professions, Manipal Academy of Higher Education, Manipal, Karnataka, 576104, India
| | - Yakub Sameerkhan Pattan
- Department of Physiotherapy, Manipal College of Health Professions, Manipal Academy of Higher Education, Manipal, Karnataka, 576104, India
| | - Nikhil Hegde
- Department of Physiotherapy, Manipal College of Health Professions, Manipal Academy of Higher Education, Manipal, Karnataka, 576104, India
| | - Manikandan Natarajan
- Department of Physiotherapy, Manipal College of Health Professions, Manipal Academy of Higher Education, Manipal, Karnataka, 576104, India
- Centre for Comprehensive Stroke Rehabilitation and Research, Manipal College of Health Professions, Manipal Academy of Higher Education, Manipal, Karnataka, 576104, India
| | - Aparna R. Pai
- Department of Neurology, Kasturba Medical College Hospital, Manipal Academy of Higher Education, Manipal, Karnataka, 576104, India
| | - Raghavendra Nayak
- Department of Neurosurgery, Kasturba Medical College Hospital, Manipal Academy of Higher Education, Manipal, Karnataka, 576104, India
| | - John M. Solomon
- Department of Physiotherapy, Manipal College of Health Professions, Manipal Academy of Higher Education, Manipal, Karnataka, 576104, India
- Centre for Comprehensive Stroke Rehabilitation and Research, Manipal College of Health Professions, Manipal Academy of Higher Education, Manipal, Karnataka, 576104, India
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Panda BK, Suryawanshi VR, Attarde G, Borkar N, Iyer S, Shah J. Correlation of Quality Metrics of Acute Stroke Care with Clinical Outcomes in an Indian Tertiary-care University Hospital: A Prospective Evidence-based Study. Indian J Crit Care Med 2023; 27:806-815. [PMID: 37936803 PMCID: PMC10626231 DOI: 10.5005/jp-journals-10071-24566] [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: 08/09/2023] [Accepted: 09/25/2023] [Indexed: 11/09/2023] Open
Abstract
Aim To characterize the impact of adherence to quality metrics of stroke care on the clinical outcomes of ischemic stroke (IS) and intracerebral hemorrhage (ICH) admissions. Methods Consecutive patients with acute stroke were prospectively followed up for their demographic and clinical characteristics, acute stroke management, and associated clinical outcomes at discharge. Stroke quality metrics [adopted from the American Heart Association (AHA)/American Stroke Association's Get with The Guidelines (GWTG)] with a specific interest in an association between acute reperfusion therapies and functional recovery in stroke patients are analyzed and presented. A composite measure of care was considered "0 (non-adherence) to 1 (adherence)." An all-or-none measure of care was calculated to check whether eligible patients received all the quality-of-care interventions. Multivariate Cox regression models were used to study an association between optimal adherence and clinical outcomes. Results During the study period, of the total 256 stroke admissions, 200 (78.1%) patients had IS, and the remaining 56 (21.9%) patients had ICH. The median [interquartile range (IQR)] age of total stroke admissions was 57 (36-78) years. Male preponderance was observed (IS: 80% and ICH: 67.9%). The conformity of performance metrics in IS patients was from 69.1% [95% confidence interval (CI), 68.5-69.6] for the use of deep vein thrombosis prophylaxis (DVTp) to 97.8% (95% CI, 96.2-98.6) for the use of statins. In ICH patients, it ranged from 61.7% (95% CI, 60.4-62.5) for the use of DVTp to 89.9% (95% CI, 88.6-89.7) for stroke rehabilitation. The unadjusted odds ratio (OR) of mortality (in-hospital plus the 28th-day postdischarge) was higher in ICH patients vs IS patients (4.42, p = 0.005). Optimal adherence with intravenous recombinant tissue plasminogen activator (IV-rtPA) therapy [hazards ratio (HR) = 0.23], in-hospital acute measures [IS (HR = 0.41) and ICH (HR = 0.63)], and discharge measures [IS (HR = 0.35) and ICH (HR = 0.45)] were associated with reduced hazards of the 28th-day mortality in both cohorts. Compared to ICH, IS patients had significantly improved neurofunctional recovery [modified Rankin score (mRS) ≤ 2, p < 0.01]. Conclusion Adherence to quality metrics and performance measures was associated with low mortality and favorable clinical outcomes. Also, DVTp as an in-hospital (acute) measure of stroke care needs attention in both cerebrovascular events. How to cite this article Panda BK, Suryawanshi VR, Attarde G, Borkar N, Iyer S, Shah J. Correlation of Quality Metrics of Acute Stroke Care with Clinical Outcomes in an Indian Tertiary-care University Hospital: A Prospective Evidence-based Study. Indian J Crit Care Med 2023;27(11):806-815.
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Affiliation(s)
- Bijoy Kumar Panda
- Department of Pharmacy Practice, Krishna Institute of Pharmacy, Krishna Vishwa Vidyapeeth (Deemed to be University), Karad, Maharashtra, India
| | - Vaibhav R Suryawanshi
- Department of Pharmacy Practice, Poona College of Pharmacy, Bharati Vidyapeeth (Deemed to be University), Pune, Maharashtra, India
| | - Gargi Attarde
- Department of Pharmacy Practice, Poona College of Pharmacy, Bharati Vidyapeeth (Deemed to be University), Pune, Maharashtra, India
| | - Nilima Borkar
- Department of Pharmacy Practice, Poona College of Pharmacy, Bharati Vidyapeeth (Deemed to be University), Pune, Maharashtra, India
| | - Shivakumar Iyer
- Department of Critical Care Medicine, Bharati Vidyapeeth (Deemed to be University), Medical College, Pune, Maharashtra, India
| | - Jignesh Shah
- Department of Critical Care Medicine, Bharati Vidyapeeth (Deemed to be University), Medical College, Pune, Maharashtra, India
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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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Kibret AK, Mekie Yitayal M, Eriku GA, Gashaw M, Yalew ES, Weldetsadik FK. Self-reported musculoskeletal disorders and associated factors among HIV/AIDS patients following ART at University of Gondar Comprehensive Specialized Hospital, Gondar, Ethiopia, 2021: Aa cross-sectional study design. BMC Infect Dis 2023; 23:540. [PMID: 37596525 PMCID: PMC10436402 DOI: 10.1186/s12879-023-08497-1] [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: 12/15/2022] [Accepted: 07/31/2023] [Indexed: 08/20/2023] Open
Abstract
BACKGROUND Musculoskeletal disorders is an inflammatory, degenerative diseases and disorders that cause pain and functional impairments. Musculoskeletal disorders are common and the major global health concern among people with human immunodeficiency virus/acquired immunodeficiency syndrome which causes physical disability. Despite, it is a recognized health problem among human immunodeficiency virus-positive patients, there is a lack of data on musculoskeletal disorders among patients following anti-retroviral therapy in sub-Saharan Africa, particularly Ethiopia. Therefore, the main aim of the study was to assess the prevalence and associated factors of musculoskeletal disorders among adult human immunodeficiency virus-positive patients following anti-retroviral therapy. METHOD An institutional-based cross-sectional study was conducted from September 1st to October 1st, 2021 at University of Gondar Comprehensive Specialized Hospital, Gondar, Ethiopia. The data was collected through an interview-administered questionnaire and patient medical record review of 324 participants. Binary logistic regression was used to identify associated risk factors of musculoskeletal disorders. The strength of the association was detected by the adjusted odds ratio and P-value. RESULT The annual prevalence of musculoskeletal disorders among participants was 158 (48.5%) with [95% CI: 43%, 54%], opportunistic infection [AOR, 10.43; 95% CI = 2.76-42.25], type of ART medication used, CD4-count [AOR, 0.13; 95% CI 0.03-0.85], and change in anti-retroviral therapy regimen change [AOR, 8.14; 95%CI 2.06-32.09] were significantly associated with musculoskeletal disorders. CONCLUSION The prevalence of musculoskeletal disorders was moderate. Recent CD4 count, opportunistic infection, antiretroviral therapy regime at initiation, and anti-retroviral therapy regime change were significantly associated with musculoskeletal disorder. A multidisciplinary approach is required for preventing and treating musculoskeletal disorders among human immunodeficiency virus-positive patients following anti-retroviral therapy.
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Affiliation(s)
- Alemu Kassaw Kibret
- Department of Physiotherapy, School of Medicine, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia.
| | - Melisew Mekie Yitayal
- Department of Physiotherapy, School of Medicine, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Getachew Azeze Eriku
- Department of Physiotherapy, School of Medicine, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Moges Gashaw
- Department of Physiotherapy, School of Medicine, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Ermias Solomon Yalew
- Department of Physiotherapy, School of Medicine, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Fkrte Kebede Weldetsadik
- Department of Physiotherapy, School of Medicine, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
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20
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Bawiskar N, Kumar S, Acharya S, Kothari N, Gemnani RR. Association of Serum Calcium With Infarct Size and Severity in Acute Ischemic Stroke: A Rural Hospital-Based Cross-Sectional Study. Cureus 2023; 15:e43015. [PMID: 37674968 PMCID: PMC10478013 DOI: 10.7759/cureus.43015] [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: 06/25/2023] [Accepted: 08/05/2023] [Indexed: 09/08/2023] Open
Abstract
Background One of the major mediators of ischemic neuronal cell death is calcium. It has been found that elevated serum calcium is associated with a better prognosis in patients with ischemic stroke. This study highlights the association of serum calcium, albumin-corrected calcium, and ionic calcium with the size of acute ischemic stroke as well as severity outcome in terms of the National Institutes of Health Stroke Scale (NIHSS) score and Barthel Index. Methods This cross-sectional study was conducted on 85 cases of acute ischemic stroke (based on a computerized tomography scan of the brain) from September 2019 to October 2021. All included patients had undergone complete clinical history, systemic examination, as well as estimation of serum total calcium, albumin corrected calcium, and ionic calcium. NIHSS score and Barthel Index were used to access the severity of each subject. Results A significant positive correlation was seen between infarct size with NIHSS with a correlation coefficient of 0.35. A significant negative correlation was seen between infarct size with serum calcium, albumin-corrected calcium, and Barthel Index with a correlation coefficient of -0.483, -0.354, and -0.365 respectively. No correlation was seen between infarct size and ionic calcium with a correlation coefficient of 0.082. Conclusion It can be concluded that higher normal levels of serum calcium and albumin-corrected calcium are associated with a smaller-sized infarct and had less severity index among patients with acute ischemic stroke.
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Affiliation(s)
- Nipun Bawiskar
- Medicine, Jawaharlal Nehru Medical College, Datta Meghe Institute of Medical Science (Deemed to be University), Wardha, IND
| | - Sunil Kumar
- Medicine, Jawaharlal Nehru Medical College, Datta Meghe Institute of Medical Science (Deemed to be University), Wardha, IND
| | - Sourya Acharya
- Medicine, Jawaharlal Nehru Medical College, Datta Meghe Institute of Medical Science (Deemed to be University), Wardha, IND
| | - Nirmesh Kothari
- Medicine, Jawaharlal Nehru Medical College, Datta Meghe Institute of Medical Science (Deemed to be University), Wardha, IND
| | - Rinkle R Gemnani
- Medicine, Jawaharlal Nehru Medical College, Datta Meghe Institute of Medical Science (Deemed to be University), Wardha, IND
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Akter R, Sharma N, Ahmed S, Srivastav AK. Combined effect of Brunnstrom's hand rehabilitation and functional electrical stimulation for improving hand function in patients with chronic stroke: A randomized controlled trial. J Bodyw Mov Ther 2023; 35:84-90. [PMID: 37330808 DOI: 10.1016/j.jbmt.2023.04.021] [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: 08/29/2021] [Revised: 09/22/2022] [Accepted: 04/11/2023] [Indexed: 06/19/2023]
Abstract
BACKGROUND Motor recovery of the upper extremity is one of the most common challenging outcomes after stroke. OBJECTIVE To find out the combined effects of Brunnstrom hand rehabilitation (BHR) and functional electrical stimulation for improving hand functions in patients with chronic stroke. STUDY DESIGN Randomized controlled trial. METHOD 25 participants, both male (n = 11) and female (n = 14), age group between 40 and 70 years were randomly divided into control group (n = 12) and experimental group (n = 13). The treatment protocol was continued 5 days per week, for 4 weeks. The experimental group received Brunnstrom hand training and functional electrical stimulation (FES) along with conventional physiotherapy. The control group received only conventional physiotherapy. Participants were evaluated at baseline and after 4 weeks of intervention. OUTCOME MEASURES Fugl Meyer Assessment scale-upper extremity, Modified Ashworth scale, Handheld Dynamometer, and Jabsen Taylor Hand Function Test. Paired t-test was used to compare within-group variables and an independent t-test was used for between-group comparisons. P-value was set as 0.05 to minimize type-1 error. RESULTS Statistically significant difference was obtained in favor of the experimental group undergoing FMA (p < .001), MAS (p = .004), JTHF (p = .018), and HHD (p < .001) in between-group analysis. However, both groups showed significant improvement [experimental group; FMA-UE (p < .001), MAS (p < .001); JTHF (p < .001), and HHD (p < .001), and control group; FMA-UE (p < .001), MAS (p < .001), JTHF (p < .001) and HHD (p < .001)] in within-group analysis at post-intervention. CONCLUSION Brunnstrom hand rehabilitation and FES in combination were found to be more effective in improving hand function than conventional physiotherapy treatment. CLINICAL TRIAL REGISTRATION URL: http://www.ctri.nic.in. No: CTRI/2019/06/019,905.
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Affiliation(s)
- Rahemun Akter
- Department of Physiotherapy and Rehabilitation, Mount Adora Hospital, Akhalia, Sylhet, 3100, Bangladesh
| | - Nidhi Sharma
- Department of Neuro-physiotherapy, Maharishi Markandeshwar Institute of Physiotherapy and Rehabilitation, Maharishi Markandeshwar (Deemed-to-be) University, Mullana, 133207, Haryana, India
| | - Sohel Ahmed
- Department of Physiotherapy and Rehabilitation, Mount Adora Hospital, Akhalia, Sylhet, 3100, Bangladesh; Physiotherapy Research Foundation, Akhalia, 3100, Sylhet, Bangladesh.
| | - Adarsh Kumar Srivastav
- School of Health Science, Chhatrapati Shahu Ji Maharaj University, Kanpur, 208024, India
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Prasanth BK, Eashwar VMA, Mahalakshmi K, Ramachandran K. Epidemiology of non-communicable diseases among transgender population residing in Chennai district, Tamil Nadu. J Family Med Prim Care 2023; 12:762-767. [PMID: 37312794 PMCID: PMC10259543 DOI: 10.4103/jfmpc.jfmpc_1751_22] [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] [Received: 09/02/2022] [Revised: 01/18/2023] [Accepted: 01/25/2023] [Indexed: 06/15/2023] Open
Abstract
Introduction There is a paucity of research on non-communicable diseases (NCDs) like diabetes, hypertension and coronary heart diseases among transgenders, with more importance given to diseases like HIV. The study was undertaken to determine the prevalence of NCDs, their risk factors and the associated factors among transgenders residing in Chennai district, Tamil Nadu. Methodology This is a descriptive cross-sectional study done among 145 transgenders residing in the Chennai district, Tamil Nadu, selected by snowball sampling method. Data were collected by a pre-tested semi-structured questionnaire, anthropometric data were measured, and blood pressure was measured by a mercury sphygmomanometer using standard protocols. Data were entered in Excel software and analysed by using SPSS version 25. Results The mean age of the study participants was 36 ± 4.2 years. Nearly 91% had only up to school education. Around 26.7% suffered from type 2 diabetes mellitus, 15.1% had a history of hypertension, 36.3% were newly diagnosed hypertensives, and 13.9% were overweight/obese. Almost 40% were either current tobacco or alcohol consumers. There was a statistically significant association found between overweight/obesity and education, work, and income of study participants. Conclusion The high prevalence of NCDs among the study participants warrants health education among transgenders to get screened for common NCDs. Further research is needed to understand the risks of NCDs among transgenders.
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Affiliation(s)
- Balan Krishna Prasanth
- Department of Community Medicine, Sree Balaji Medical College and Hospital, Bharath Institute of Higher Education and Research, Chennai, Tamil Nadu, India
| | | | - Krishnan Mahalakshmi
- Department of Microbiology, Sree Balaji Dental College and Hospital, Bharath Institute of Higher Education and Research, Chennai, Tamil Nadu, India
| | - Karthikeyan Ramachandran
- Department of Physical Medicine and Rehabilitation, SRM Medical College Hospital and Research Centre, Kattankulathur, Tamil Nadu, India
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23
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Prevalence of Stroke in the Elderly: A Systematic Review and Meta-Analysis. INTERDISCIPLINARY NEUROSURGERY 2023. [DOI: 10.1016/j.inat.2023.101746] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/15/2023] Open
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24
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Kamalakannan S, Karunakaran V, Balaji A, Vijaykaran AS, Ramachandran S, Nagarajan R. Evaluation of the feasibility and acceptability of ReWin-A digital therapeutic rehabilitation innovation for people with stroke-related disabilities in India. Front Neurol 2023; 13:936787. [PMID: 36712415 PMCID: PMC9879701 DOI: 10.3389/fneur.2022.936787] [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: 05/05/2022] [Accepted: 12/23/2022] [Indexed: 01/15/2023] Open
Abstract
Background Developing culturally appropriate, scalable interventions to meet the growing needs for stroke rehabilitation is a significant problem of public health concern. Therefore, systematic development and evaluation of a scalable, inclusive, technology-driven solution for community-based stroke care are of immense public health importance in India. ReWin is a digital therapeutics platform that was developed systematically. This study aimed to evaluate its feasibility and acceptability in an Indian context. Objectives Phase-1: To pilot the intervention for identifying operational issues and finalize the intervention. Phase-2: To assess the feasibility and acceptability of ReWin intervention in an Indian context. Methods Design: Mixed-methods research design. Setting: Participant's home and rehabilitation centers. Participants were selected from rehabilitation centers in South India. Participants: Ten stroke survivors and their caregivers, as well as four rehabilitation service providers were recruited for phase 1. Thirty stroke survivors who were treated and discharged from the hospital, and their caregivers as well as 10 rehabilitation service providers were recruited for Phase 2. Intervention: ReWin a digital therapeutic platform with the provider and patient app for the rehabilitation of physical disabilities following stroke was piloted. Process: Evaluation of the intervention was completed in two phases. In the first phase, the preliminary intervention was field-tested with 10 stroke survivors and four rehabilitation service providers for 2 weeks. In the second phase, the finalized intervention was provided to a further 30 stroke survivors to be used in their homes with support from their carers as well as to 10 rehabilitation service providers for 4 weeks. Outcome measures: Primary outcomes: (1) operational difficulties in using the ReWin intervention; (2) feasibility and acceptability of the ReWin intervention in an Indian setting. Results Field-testing identified operational difficulties related to 1. Therapeutic content; 2. Format; 3. Navigation; 4. Connectivity, 5. Video-streaming, 6. Language; and 7. Comprehensibility of the animated content. The intervention was reviewed, revised and finalized before pilot testing. Findings from the pilot testing showed that the ReWin intervention was feasible and acceptable. About 76% of the participants had used ReWin for more than half of the intervention period of 4 weeks. Ninety percentage of the stroke care providers and about 60% of the stroke survivors and caregivers felt that the content of ReWin was very relevant to the needs of the stroke survivors. Forty percentage of the stroke survivors and caregivers rated ReWin intervention as excellent. Another 45% of the stroke survivors and caregivers as well as 90% of the stroke care providers rated ReWin intervention as very good based on its overall credibility, usability, and user-friendliness. Conclusions ReWin has all the essential components to connect care providers and consumers not just for stroke rehabilitation but for several other health conditions with the use of several other technological features that support rehabilitation of persons with disabilities and strengthen rehabilitation in health systems worldwide. It is critical to amalgamate ReWin and other evidence-based interventions for rehabilitation to innovate scalable solutions and promote universal health coverage for stroke care worldwide.
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Affiliation(s)
- Sureshkumar Kamalakannan
- Department of Social Work, Education and Community-Wellbeing, Northumbria University, Newcastle upon Tyne, United Kingdom,*Correspondence: Sureshkumar Kamalakannan ✉
| | | | - Ashwin Balaji
- InGage Technologies Pvt., Ltd., Chennai, Tamil Nadu, India
| | | | - Sivakumar Ramachandran
- Faculty of Physiotherapy, Sri Ramachandra Institute of Higher Education and Research, Chennai, Tamil Nadu, India
| | - Ramakumar Nagarajan
- Department of Neurological Rehabilitation, Chennai Advanced Rehabilitation Centre, Chennai, Tamil Nadu, India
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Malgaonkar N, Ramachandran M, Patel SD, Dsouza SA. Occupational Therapists' Perceptions of Home Program Provision for Stroke Survivors in a Lower- and Middle-Income Country: An Exploratory Study. Occup Ther Health Care 2023; 37:54-74. [PMID: 34253118 DOI: 10.1080/07380577.2021.1930326] [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: 01/05/2023]
Abstract
This qualitative study aimed to understand occupational therapists' experiences of providing home programs to stroke survivors in India. Using an interpretative phenomenological approach, eight practicing occupational therapists were interviewed in depth about home programs for individuals recovering from stroke. Two broad themes with subthemes emerged describing the organizational factors, sociocultural and economic influences on home program provision as well as describing how the occupational therapists addressed the challenges to facilitate home program provision and adherence. The findings can inform occupational therapy practice in lower- and middle-income countries like India and other countries where existing practice recommendations for stroke rehabilitation and core professional tenets may be challenged.
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Affiliation(s)
- Neha Malgaonkar
- Department of Occupational Therapy, Manipal College of Health Professions, Manipal Academy of Higher Education, Manipal, Karnataka, India.,Physical Medicine and Rehabilitation Department, Kokilaben Dhirubhai Ambani Hospital and Research Institute, Mumbai, India
| | - Meena Ramachandran
- Department of Occupational Therapy, Manipal College of Health Professions, Manipal Academy of Higher Education, Manipal, Karnataka, India.,Bridgepoint Collaboratory for Research and Innovation, Sinai Health, Toronto, Canada
| | - Sefali Dushyant Patel
- Department of Occupational Therapy, Manipal College of Health Professions, Manipal Academy of Higher Education, Manipal, Karnataka, India.,Catholic Relief Services, Hanoi, Vietnam
| | - Sebestina Anita Dsouza
- Department of Occupational Therapy, Manipal College of Health Professions, Manipal Academy of Higher Education, Manipal, Karnataka, India.,Centre for Studies on Healthy Aging, Manipal College of Health Professions, Manipal Academy of Higher Education, Manipal, Karnataka, India
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Sundarakumar JS, Menesgere AL, Jain S, Hameed SKS, Ravindranath V. Prevalence of neuropsychiatric conditions and cognitive impairment in two parallel, aging study cohorts from rural and urban India. Alzheimers Dement 2022. [PMID: 36573020 DOI: 10.1002/alz.12741] [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: 10/27/2021] [Revised: 03/24/2022] [Accepted: 05/18/2022] [Indexed: 12/28/2022]
Abstract
INTRODUCTION With the rising proportion of the elderly in India, the burden of neuropsychiatric conditions and cognitive impairment is escalating. METHODS Baseline data of cognitively healthy subjects ≥45 years of age, from two longitudinal, aging cohorts in rural (n = 3262) and urban (n = 693) India, were used to calculate prevalence of depression, early-life stressful events, stroke, head injury, and cognitive impairment. RESULTS Depression prevalence was significantly higher in rural than urban subjects, with female preponderance in both groups. Early life stressor (parental death) and head injury were significantly more common in rural than in urban India, whereas stroke was more in urban India. There was no significant difference in overall prevalence of cognitive impairment between the rural and urban cohorts; however, women had higher prevalence than men in rural, whereas this was reverse in urban subjects. Depression and stroke were significantly associated with cognitive impairment in the rural cohort. DISCUSSION Longitudinal assessment of these neuropsychiatric conditions, with parallel cognitive monitoring, will help identify their causal relationship with dementia.
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Affiliation(s)
| | | | - Shubham Jain
- Centre for Brain Research, Indian Institute of Science, Bangalore, India
| | - Shafeeq K S Hameed
- Centre for Brain Research, Indian Institute of Science, Bangalore, India
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- Centre for Brain Research, Indian Institute of Science, Bangalore, India
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Reddy VPK, Mulimani NM. Comparison of the Outcome and Efficacy of Single-Layer versus Dual-Layer Mesh Stent among Carotid Stenosis Patients Attending a Tertiary Care Setting—A Prospective Observational Study. JOURNAL OF CLINICAL INTERVENTIONAL RADIOLOGY ISVIR 2022. [DOI: 10.1055/s-0042-1759799] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Abstract
Introduction The effect of stent design whether single-layer or double-layer on long-term durability of carotid artery stenting (CAS) is unknown. The aim of this article was to compare the clinical outcome and efficacy of single-layer versus dual-layer mesh stent for CAS among carotid stenosis patients.
Methods A prospective observational study was conducted among 41 consecutive patients, who underwent CAS procedures between November 2019 and November 2021. Procedural data and outcomes for patients treated with the single-layer stent (n = 19patients) and double-layer stent (n = 22) were compared. Procedural efficacy and complications were considered as primary outcome variable. SPSS version 22 was used for statistical analysis.
Results Mean age of study population in dual-layer stents group was 63.86 ± 11.08 years and it was 61.47 ± 8.26 years in single-layer stent group. There was no statistically significant difference between two groups with age, stenosis, side of stenosis, prestenting angioplasty, and poststenting angioplasty (p-value >0.05). Out of 22 participants with dual-layer stent, only one (4.5%) participant experienced five episodes of transient ischemic attack in last 1 month. Both clinical and associated complaints were more in dual-layer group compared with single layer. One (5.26%) participant in single-layer group had reclusion/restenosis at 30 days. Majority in single-(57.8%) and double-layer (63.64%) stents group showed modified Rankin Scale score of 0.
Conclusion Restenosis after CAS occurred less frequently in patients treated with double-layer mesh when compared with single-layer stent. However, both stents were equally effective at preventing peri procedural complications.
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Affiliation(s)
| | - Navin M. Mulimani
- Department of Interventional Radiology, Dr KLEs Prabhakar Kore Hospital & MRC, Belagavi, Karnataka, India
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Muacevic A, Adler JR. Effect of Late-Onset Stroke Rehabilitation on Medical Morbidities and Functional Recovery: A Single-Center Observational Study. Cureus 2022; 14:e33002. [PMID: 36712731 PMCID: PMC9879282 DOI: 10.7759/cureus.33002] [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] [Accepted: 12/27/2022] [Indexed: 12/28/2022] Open
Abstract
Background The concept of focused rehabilitative care and a dedicated rehabilitation setup is fairly less known among the people of developing countries. The main objective of the study is to assess the effect of late-onset stroke rehabilitation on its overall prognosis and to see whether and how the late initiation of rehabilitation would pose a significant effect on functional recovery and adverse medical outcomes Methods A single-center, prospective observational study was conducted in a tertiary rehabilitation center for a duration of one and a half years. The subjects admitted to the Department of Physical Medicine and Rehabilitation were divided into three groups with respect to the onset to admission interval (OAI). Patients who got admitted within 30 days (OAI≤ 30 days) were considered the early rehabilitation group. OAI between 31 and 150 days was the late rehabilitation group and OAI of 151 days or more was the very late rehabilitation group. Barthel Index (BI), Modified Rankin Score (MRS), and 6-minute walk test (6MWT) were used as functional outcome measures at admission and discharge from indoors. Results Maximum complications were observed in the late rehabilitation group, i.e. 2.75±2.74, with an overall mean of 2.02±2.04 (p=0.003). Functional recovery assessed using BI shows a significant difference between the early (35.79±8.86) and late (40.62±10.5) rehabilitation groups (p= 0.0005). 6MWT at discharge showed significant improvement in the early rehabilitation group (p=0.005). Conclusion Early onset of rehabilitation showed better functional recovery and fewer adverse medical outcomes in stroke patients. A longer length of hospital stay (LOHS), with a mean duration of 88 ±2 days was needed for patients with higher OAIs.
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Nambiar V, Raj M, Vasudevan D, Bhaskaran R, Sudevan R. One-year mortality after acute stroke: a prospective cohort study from a comprehensive stroke care centre, Kerala, India. BMJ Open 2022; 12:e061258. [PMID: 36442894 PMCID: PMC9710353 DOI: 10.1136/bmjopen-2022-061258] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVES The primary objective was to report the 1-year all-cause mortality among patients with stroke. The secondary objectives were (1) to report the mortality stratified by type of stroke and sex and (2) to report predictors of 1-year mortality among patients with stroke. DESIGN A prospective cohort study. SETTING Institutional-stroke care unit of a tertiary care hospital PARTICIPANTS: Patients who were treated in the study institution during 2016-2020 for acute stroke and were followed up for a period of 1 year after stroke in the same institution. MAIN OUTCOME MEASURES The main outcome measures were the mortality proportion of any stroke and first ever stroke cohorts at select time points, including in-hospital stay, along with 2 weeks, 2 months, 6 months and 1 year after index stroke. The secondary outcomes were (1) mortality proportions stratified by sex and type of stroke and (2) predictors of 1-year mortality for any stroke and first ever stroke. RESULTS We recruited a total of 1336 patients. The mean age of participants was 61.6 years (13.5 years). The mortality figures for 2 weeks, 2 months, 6 months and 12 months after discharge were 79 (5.9%), 88 (6.7%), 101 (7.6%) and 114 (8.5%), respectively, in the full cohort. The in-hospital mortality was 45 (3.4%). The adjusted analysis revealed 3 predictors for 1-year mortality after first ever stroke-age, pre-treatment National Institutes of Health Stroke Scale (NIHSS) score and Modified Rankin Scale (mRS) score at baseline. The same for the full cohort had only two predictors-age and pre-treatment NIHSS score. CONCLUSION Mortality of stroke at 1-year follow-up in the study population is low in comparison to several studies published earlier. The predictors of 1-year mortality after stroke included age, NIHSS score at baseline and mRS score at baseline.
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Affiliation(s)
- Vivek Nambiar
- Division of Stroke, Department of Neurology, Amrita Institute of Medical Sciences and Research Centre, Cochin, India
| | - Manu Raj
- Department of Pediatrics and Pediatric Cardiology, Amrita Institute of Medical Sciences and Research Centre, Cochin, India
| | - Damodaran Vasudevan
- Department of Health Sciences Research, Amrita Institute of Medical Sciences and Research Centre, Cochin, India
| | - Renjitha Bhaskaran
- Department of Biostatistics, Amrita Institute of Medical Sciences, Cochin, India
| | - Remya Sudevan
- Department of Health Sciences Research, Amrita Institute of Medical Sciences, Amrita viswa vidyapeetham, Cochin, India
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Rao NL, Kotian GB, Shetty JK, Shelley BP, Dmello MK, Lobo EC, Shankar SP, Almeida SD, Shah SR. Receptor for Advanced Glycation End Product, Organ Crosstalk, and Pathomechanism Targets for Comprehensive Molecular Therapeutics in Diabetic Ischemic Stroke. Biomolecules 2022; 12:1712. [PMID: 36421725 PMCID: PMC9687999 DOI: 10.3390/biom12111712] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2022] [Revised: 11/03/2022] [Accepted: 11/05/2022] [Indexed: 08/10/2023] Open
Abstract
Diabetes mellitus, a well-established risk factor for stroke, is related to higher mortality and poorer outcomes following the stroke event. Advanced glycation end products(AGEs), their receptors RAGEs, other ligands, and several other processes contribute to the cerebrovascular pathomechanism interaction in the diabetes-ischemic stroke combination. Critical reappraisal of molecular targets and therapeutic agents to mitigate them is required to identify key elements for therapeutic interventions that may improve patient outcomes. This scoping review maps evidence on the key roles of AGEs, RAGEs, other ligands such as Leukotriene B4 (LTB4), High-mobility group box 1 (HMGB1) nuclear protein, brain-kidney-muscle crosstalk, alternate pathomechanisms in neurodegeneration, and cognitive decline related to diabetic ischemic stroke. RAGE, HMGB1, nitric oxide, and polyamine mechanisms are important therapeutic targets, inflicting common consequences of neuroinflammation and oxidative stress. Experimental findings on a number of existing-emerging therapeutic agents and natural compounds against key targets are promising. The lack of large clinical trials with adequate follow-up periods is a gap that requires addressing to validate the emerging therapeutic agents. Five therapeutic components, which include agents to mitigate the AGE-RAGE axis, improved biomarkers for risk stratification, better renal dysfunction management, adjunctive anti-inflammatory-antioxidant therapies, and innovative neuromuscular stimulation for rehabilitation, are identified. A comprehensive therapeutic strategy that features all the identified components is needed for outcome improvement in diabetic stroke patients.
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Affiliation(s)
- Nivedita L Rao
- Department of Biochemistry, Yenepoya Medical College, Yenepoya (deemed to be University), Mangalore 575018, Karnataka, India
| | - Greeshma B Kotian
- Department of Biochemistry, Yenepoya Medical College, Yenepoya (deemed to be University), Mangalore 575018, Karnataka, India
| | - Jeevan K Shetty
- Department of Biochemistry, School of Medicine, Royal College of Surgeons in Ireland Medical University of Bahrain, Muharraq 228, Bahrain
| | - Bhaskara P Shelley
- Department of Neurology, Yenepoya Medical College, Yenepoya (deemed to be University), Mangalore 575018, Karnataka, India
| | - Mackwin Kenwood Dmello
- Department of Public Health, KS Hegde Medical Academy, Nitte (Deemed to be University), Mangalore 575018, Karnataka, India
| | - Eric C Lobo
- Department of Biochemistry, Yenepoya Medical College, Yenepoya (deemed to be University), Mangalore 575018, Karnataka, India
| | - Suchetha Padar Shankar
- College of Physiotherapy, Dayananda Sagar University, Bangalore 560111, Karnataka, India
| | - Shellette D Almeida
- School of Physiotherapy, D. Y. Patil (Deemed to be University), Navi Mumbai 400706, Maharashtra, India
| | - Saiqa R Shah
- Department of Biochemistry, Yenepoya Medical College, Yenepoya (deemed to be University), Mangalore 575018, Karnataka, India
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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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Nedumgattil AR, Satyan S, Mohan M, Mathew J, Menon A. Visual Morbidity in Stroke Survivors: A Pilot Study. Ann Indian Acad Neurol 2022; 25:1192-1194. [PMID: 36911473 PMCID: PMC9996517 DOI: 10.4103/aian.aian_440_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Revised: 07/11/2022] [Accepted: 07/30/2022] [Indexed: 11/06/2022] Open
Affiliation(s)
- Arya R. Nedumgattil
- Department of Ophthalmology, Little Flower Hospital and Research Center, Angamaly, Kerala, India
| | - Sanitha Satyan
- Department of Ophthalmology, Little Flower Hospital and Research Center, Angamaly, Kerala, India
| | - Madhukar Mohan
- Department of Neurology, Little Flower Hospital and Research Center, Angamaly, Kerala, India
| | - Jomal Mathew
- Department of Neurology, Little Flower Hospital and Research Center, Angamaly, Kerala, India
| | - Ashok Menon
- Department of Neurology, Little Flower Hospital and Research Center, Angamaly, Kerala, India
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Tu WJ, Hua Y, Yan F, Bian H, Yang Y, Lou M, Kang D, He L, Chu L, Zeng J, Wu J, Chen H, Han J, Ma L, Cao L, Wang L. Prevalence of stroke in China, 2013-2019: A population-based study. THE LANCET REGIONAL HEALTH. WESTERN PACIFIC 2022; 28:100550. [PMID: 36507089 PMCID: PMC9727498 DOI: 10.1016/j.lanwpc.2022.100550] [Citation(s) in RCA: 72] [Impact Index Per Article: 36.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Background The stroke burden in China has increased during the past 40 years. The present study aimed to determine the recent trends in the prevalence of stroke from 2013 to 2019 stratified by sociodemographic characteristics, including sex, age, residence, ethnicity, and province within a population-based screening project in China. Methods We made use of data generated from 2013 to 2019 in the China Stroke High-risk Population Screening Program. All living subjects with confirmed stroke at interview were considered to have prevalent stroke. All analyses of prevalence of stroke were weighted and results were presented as percentage and 95% confidence interval (CI). Findings A total of 4229,616 Chinese adults aged ≥40 years from 227 cities in the 31 provinces were finally included. The enrollment rate ranged from 58.8% (2017) to 67.8% (2013). The weighted prevalence of stroke increased annually from 2013 to 2019, being 2.28% (95% CI: 2.28-2.28%) in 2013, 2.34% (2.34-2.35%) in 2014, 2.43% (2.43-2.43%) in 2015, 2.48% (2.48-2.48%) in 2016, 2.52% (2.52-2.52%) in 2017, 2.55% (2.55-2.55%) in 2018, and 2.58% (2.58-2.58%) in 2019 (p for trend <0.001). The weighted prevalence of stroke was higher for male sex, older age, and residence in rural and northeast areas. Interpretation The prevalence of stroke in China and most provinces has continued to increase in the past 7 years (2013-2019). These findings, especially in provinces with high stroke prevalence, can help public health officials to increase province capacity for stroke and related risk factors prevention. Fundings This study was supported by grants from the National Major Public Health Service Projects.
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Affiliation(s)
- Wen-Jun Tu
- The General Office of Stroke Prevention Project Committee, National Health Commission of the People's Republic of China, Beijing, China
- Institute of Radiation Medicine, Chinese Academy of Medical Sciences & Peking Union Medical College, Tianjin, China
| | - Yang Hua
- Department of Ultrasound Vascular, Xuanwu Hospital Capital Medical University, Beijing, China
| | - Feng Yan
- Department of Neurosurgery, Capital Medical University Xuanwu Hospital, Beijing, China
| | - Hetao Bian
- The General Office of Stroke Prevention Project Committee, National Health Commission of the People's Republic of China, Beijing, China
| | - Yi Yang
- Department of Neurology, the First Bethune Hospital of Jilin University, Changchun, China
| | - Min Lou
- Department of Neurology, the Second Affiliated Hospital of Zhejiang University, Hangzhou, China
| | - Dezhi Kang
- Department of Neurosurgery, the First Affiliated Hospital of Fujian Medical University, Fuzhou, China
| | - Li He
- Department of Neurology, West China Hospital of Sichuan University, Chengdu, China
| | - Lan Chu
- Department of Neurology, the Affiliated Hospital of Guizhou Medical University, Guiyang, China
| | - Jingsheng Zeng
- Department of Neurology, the First Affiliated Hospital of Sun Yat–sen University, Guangzhou, China
| | - Jian Wu
- Department of Neurology, Beijing Tsinghua Changgung Memoria Hospital, Beijing, China
| | - Huisheng Chen
- Department of Neurology, The General Hospital of Northern Theater Command of the Chinese People's Liberation Army, Shenyang, China
| | - Jianfeng Han
- Department of Neurology, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Lin Ma
- Department of Interventional Radiology, Shanghai Tongji Hospital, Tongji University School of Medicine, Shanghai, China
| | - Lei Cao
- The General Office of Stroke Prevention Project Committee, National Health Commission of the People's Republic of China, Beijing, China
| | - Longde Wang
- The General Office of Stroke Prevention Project Committee, National Health Commission of the People's Republic of China, Beijing, China
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Application of Machine Learning Techniques for Characterization of Ischemic Stroke with MRI Images: A Review. Diagnostics (Basel) 2022; 12:diagnostics12102535. [DOI: 10.3390/diagnostics12102535] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Revised: 10/07/2022] [Accepted: 10/14/2022] [Indexed: 11/16/2022] Open
Abstract
Magnetic resonance imaging (MRI) is a standard tool for the diagnosis of stroke, but its manual interpretation by experts is arduous and time-consuming. Thus, there is a need for computer-aided-diagnosis (CAD) models for the automatic segmentation and classification of stroke on brain MRI. The heterogeneity of stroke pathogenesis, morphology, image acquisition modalities, sequences, and intralesional tissue signal intensity, as well as lesion-to-normal tissue contrast, pose significant challenges to the development of such systems. Machine learning (ML) is increasingly being used in predictive neuroimaging diagnosis and prognostication. This paper reviews image processing and machine learning techniques that have been applied to detect ischemic stroke on brain MRI, including details on image acquisition, pre-processing, techniques to segment, extraction of features, and classification into stroke types. The main objective of this work is to find the state-of-art machine learning techniques used to predict the ischemic stroke and their application in clinical set-up. The article selection is performed according to PRISMA guideline. The state-of-the-art on automated MRI stroke diagnosis, with a focus on machine learning, is discussed, along with its advantages and limitations. We found that the various machine learning models discussed in this article are able to detect the infarcts with an acceptable accuracy of 70–90%. However, no one has highlighted the time complexity to predict the stroke in the model developed, which is an important factor. The work concludes with proposals for future recommendations for building efficient and robust deep learning (DL) models for quantitative brain MRI analysis. In recent work, with the application of DL approaches, using large datasets to train the models has improved the detection accuracy and reduced computational complexity. We suggest that the design of a decision support system based on artificial intelligence (AI) and clinical data presenting symptoms is essential to support clinicians to accelerate diagnosis and timeous therapy in the emergency management of stroke.
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Khanna M, Sivadas D, Gupta A, Haldar P, Prakash NB. Impact of inpatient rehabilitation on quality of life among stroke patients. J Neurosci Rural Pract 2022; 13:800-803. [PMID: 36743772 PMCID: PMC9893941 DOI: 10.25259/jnrp-2022-1-18-r1-(2322)] [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: 09/16/2022] [Accepted: 09/20/2022] [Indexed: 11/19/2022] Open
Abstract
Objective Despite remarkable progression in the treatment of stroke, the life quality and social related events caused by stroke have received limited attention in our country. Quality of life (QOL) assessment is an important part of the evaluation of stroke patients and their management. The objective of this study was to assess QOL in patients with stroke at the time of admission in rehabilitation unit and to assess the impact of inpatient rehabilitation on change in QOL in these patients. Materials and Methods Adult patients with first arterial stroke of any duration, with presentation as hemiplegia, were recruited. The clinical outcome scales and 36-Item Short Form Health Survey (SF-36) parameters for QOL were assessed at both admission and discharge. The scales used were Scandinavian stroke scale (SSS), Barthel Index (BI), and modified Rankin Scale. SF-36 scores were assessed after 6 weeks of discharge also. Results Ten patients with median age of 36.5 years and median duration of stroke 75 days were recruited. There was significant improvement in functional scores of BI and SSS scales at the time of discharge. Majority of the components of both physical and mental domains of QOL SF-36 questionnaire showed significant improvement. The QOL scores after 6 weeks of discharge did not show significant change except for the emotional well-being. Conclusion The QOL in patients with stroke improves with inpatient rehabilitation along with motor and functional scores. Improved functional independence leads to better emotional state after discharge also.
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Affiliation(s)
- Meeka Khanna
- Department of Neurological Rehabilitation, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Dhinla Sivadas
- 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
| | - Partha Haldar
- Centre for Community Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Navin B. Prakash
- Department of Neurological Rehabilitation, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
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Jain PK, Dubey A, Saba L, Khanna NN, Laird JR, Nicolaides A, Fouda MM, Suri JS, Sharma N. Attention-Based UNet Deep Learning Model for Plaque Segmentation in Carotid Ultrasound for Stroke Risk Stratification: An Artificial Intelligence Paradigm. J Cardiovasc Dev Dis 2022; 9:326. [PMID: 36286278 PMCID: PMC9604424 DOI: 10.3390/jcdd9100326] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2022] [Revised: 09/06/2022] [Accepted: 09/14/2022] [Indexed: 11/17/2022] Open
Abstract
Stroke and cardiovascular diseases (CVD) significantly affect the world population. The early detection of such events may prevent the burden of death and costly surgery. Conventional methods are neither automated nor clinically accurate. Artificial Intelligence-based methods of automatically detecting and predicting the severity of CVD and stroke in their early stages are of prime importance. This study proposes an attention-channel-based UNet deep learning (DL) model that identifies the carotid plaques in the internal carotid artery (ICA) and common carotid artery (CCA) images. Our experiments consist of 970 ICA images from the UK, 379 CCA images from diabetic Japanese patients, and 300 CCA images from post-menopausal women from Hong Kong. We combined both CCA images to form an integrated database of 679 images. A rotation transformation technique was applied to 679 CCA images, doubling the database for the experiments. The cross-validation K5 (80% training: 20% testing) protocol was applied for accuracy determination. The results of the Attention-UNet model are benchmarked against UNet, UNet++, and UNet3P models. Visual plaque segmentation showed improvement in the Attention-UNet results compared to the other three models. The correlation coefficient (CC) value for Attention-UNet is 0.96, compared to 0.93, 0.96, and 0.92 for UNet, UNet++, and UNet3P models. Similarly, the AUC value for Attention-UNet is 0.97, compared to 0.964, 0.966, and 0.965 for other models. Conclusively, the Attention-UNet model is beneficial in segmenting very bright and fuzzy plaque images that are hard to diagnose using other methods. Further, we present a multi-ethnic, multi-center, racial bias-free study of stroke risk assessment.
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Affiliation(s)
- Pankaj K. Jain
- School of Biomedical Engineering, Indian Institute of Technology (BHU), Varanasi 221005, India
| | - Abhishek Dubey
- School of Biomedical Engineering, Indian Institute of Technology (BHU), Varanasi 221005, India
- Department of Electronics and Communication, Shree Mata Vaishno Devi University, Jammu 182301, India
| | - Luca Saba
- Department of Radiology, Azienda Ospedaliero Universitaria (A.O.U.), 09100 Cagliari, Italy
| | - Narender N. Khanna
- Department of Cardiology, Indraprastha APOLLO Hospital, New Delhi 110076, India
| | - John R. Laird
- Heart and Vascular Institute, Adventist Heath St. Helena, St. Helena, CA 94574, USA
| | - Andrew Nicolaides
- Vascular Screening and Diagnostic Centre and University of Nicosia Medical School, Nicosia 2409, Cyprus
| | - Mostafa M. Fouda
- Department of Electrical and Computer Engineering, Idaho State University, Pocatello, ID 83209, USA
| | - Jasjit S. Suri
- Stroke Diagnostic and Monitoring Division, AtheroPoint™, Roseville, CA 95661, USA
| | - Neeraj Sharma
- Department of Electronics and Communication, Shree Mata Vaishno Devi University, Jammu 182301, India
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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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Mondal MBA, Hasan ATMH, Khan N, Mohammad QD. Prevalence and risk factors of stroke in Bangladesh: A nationwide population-based survey. eNeurologicalSci 2022; 28:100414. [PMID: 35769921 PMCID: PMC9234580 DOI: 10.1016/j.ensci.2022.100414] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Revised: 06/10/2022] [Accepted: 06/11/2022] [Indexed: 11/28/2022] Open
Abstract
Background A paucity of high-quality epidemiological survey on stroke in Bangladesh emphasizes the need for a drastic effort at the national level to study the burden of stroke in Bangladesh. Therefore, this community survey was conducted with to estimate the prevalence of stroke and its associated common risk factors among Bangladeshi population. Methods This was a population-based cross-sectional study, carried out in 8 administrative divisions and 64 districts to estimate the prevalence of stroke throughout the country. The study adopted a two-stage cluster random sampling approach. The calculated sample size was 25,287. A semi-structured questionnaire was used to identify suspected stroke patients who were subsequently confirmed by consultant neurologists. Result In the first stage, a total number of 25,287 respondents were interviewed throughout the country. Interviewers identified 561 respondents as suspected stroke through the Questionnaire for Verifying Stroke Free Status (QVSFS) system in 64 districts. Of the 25,287 respondents 13,878 (54.9%) were male and 11,409 (45.1%) were female. Mean age was 39.9 years. In the second stage, all suspected stroke cases (561) were further examined by neurologists and finally 288 patients were confirmed as stroke which provided a prevalence of 11.39 per 1000 population. The highest stroke prevalence (14.71 per thousand) were found in Mymensingh division and lowest (7.62 per thousand) found in Rajshahi division. The stroke prevalence varied in different age groups. It was 30.10 per thousand in the age group of >60 years and 4.60 in the age group below 40 years. The prevalence of stroke among male was twice that of female (13.62 versus 8.68 per thousand). The prevalence was slightly higher in rural areas (11.85 versus 11.07). About 50.4% respondents had some idea about stroke. Out of a total of 288 cases, 79.7% (213) patients had an ischemic stroke, 15.7% (42) had hemorrhagic, and 4.6% (12) were diagnosed as subarachnoid hemorrhage. The majority of the stroke patients had hypertension (79.2%), followed by dyslipidemia (38.9%), tobacco use in any form (37.2%), diabetes (28.8%), ischemic heart disease (20.1%). Conclusion We have found a stroke prevalence of 11.39 per 1000 population, the highest being in the Mymensingh division. The prevalence was much higher in the elderly and male population. More than three fourth had an ischemic stroke. Hypertension, dyslipidemia, tobacco use, diabetes, ischemic heart disease are the most common risk factors observed among stroke patients. New FindingsThis is the first-ever nationwide survey in Bangladesh that revealed a stroke prevalence of 11.39 per thousand. There was a wide regional variation in stroke prevalence. The prevalence was twice among males.
Impact of the study resultThe study result will help the policymakers in deciding and planning regional policy guidelines to tackle the stroke burden. It will also help the clinicians to identify common risk factors among stroke patients and take precautionary measures
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Affiliation(s)
| | - A T M Hasibul Hasan
- Neurology, National Institute of Neurosciences and Hospital, Dhaka-1207, Bangladesh
| | | | - Quazi Deen Mohammad
- Neurology, National Institute of Neurosciences and Hospital, Dhaka-1207, Bangladesh
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Lokkanahalli SS, Handargal NH, Papali MM, Subash N. Serum Uric Acid and Lipid Levels in Patients With Acute Ischemic Stroke: A Cross-Sectional Study. Cureus 2022; 14:e28114. [PMID: 36003346 PMCID: PMC9392846 DOI: 10.7759/cureus.28114] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/17/2022] [Indexed: 11/05/2022] Open
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40
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Khanna M, Sivadas D, Gupta A, Haldar P, Prakash NB. Impact of Inpatient Rehabilitation on Quality of Life Among Stroke Patients. J Neurosci Rural Pract 2022. [DOI: 10.1055/s-0042-1751224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022] Open
Abstract
Abstract
Background Despite remarkable progression in the treatment of stroke, the quality of life (QoL) and social-related events caused by stroke have received limited attention in our country. The assessment of QOL is an important part of the evaluation of stroke patients and their management.
Objective To assess the QoL in patients with stroke at the time of admission in the rehabilitation unit and assess the impact of inpatient rehabilitation on change in QoL in these patients.
Materials and methods Adult patients with first arterial stroke of any duration, with presentation as hemiplegia were recruited. The clinical outcome scales and SF-36 parameters for QOL were assessed at both admission and discharge. The scales used were Scandinavian Stroke Scale (SSS), Barthel Index (BI), modified Rankin Scale (mRS). SF-36 scores were assessed after 6 weeks of discharge also.
Results Ten patients with a median age of 36.5 years and a median duration of stroke 75 days were recruited. There was significant improvement in functional scores of BI and SSS scales at the time of discharge. Majority of the components of both physical and mental domains of QOL SF-36 questionnaire showed significant improvement. The QOL scores after 6 weeks of discharge did not show significant change except for the emotional well-being.
Conclusion The QOL in patients with stroke improves with inpatient rehabilitation along with motor and functional scores. Improved functional independence leads to better emotional state after discharge also.
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Affiliation(s)
- Meeka Khanna
- Department of Neurological Rehabilitation, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Dhinla Sivadas
- 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
| | - Partha Haldar
- Centre for Community Medicine, All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - Navin B Prakash
- Department of Neurological Rehabilitation, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
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Lu T, Ma L, Xu Q, Wang X. Blood Th17 cells and IL-17A as candidate biomarkers estimating the progression of cognitive impairment in stroke patients. J Clin Lab Anal 2022; 36:e24581. [PMID: 35808926 PMCID: PMC9396181 DOI: 10.1002/jcla.24581] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Revised: 06/16/2022] [Accepted: 06/20/2022] [Indexed: 11/05/2022] Open
Abstract
Background T helper (Th) cells regulate immunity and inflammation to engage in cognitive impairment in several neurological diseases, while their clinical relevance in stroke patients is not clear. The current study intended to assess the relationship of Th1 cells, Th17 cells, interferon‐gamma (IFN‐γ), and interleukin (IL)‐17A with cognitive function in stroke patients. Methods One hundred twenty stroke patients and 40 controls were enrolled in this muticenter study. Th1 and Th17 cells in peripheral blood were assessed by flow cytometry; meanwhile, IFN‐γ and IL‐17A in serum were detected by enzyme‐linked immunosorbent assay. Cognitive function of stroke patients was evaluated by Mini‐Mental State Examination (MMSE) score at enrollment (baseline), year 1, year 2, and year 3. Results Th1 cells (p = 0.037) and IFN‐γ (p = 0.048) were slightly increased, while Th17 cells (p < 0.001) and IL‐17A (p < 0.001) were greatly elevated in stroke patients compared with controls. Th17 cells (rs = −0.374, p < 0.001) and IL‐17A (rs = −0.267, p = 0.003) were negatively correlated with MMSE score at baseline, but Th1 cells and IFN‐γ were not. Meanwhile, Th17 cells (p = 0.001) and IL‐17A (p = 0.024) were increased in patients with cognitive impairment compared to those without cognitive impairment. Notably, Th17 cells were positively associated with 1‐year (rs = 0.331, p < 0.001), 2‐year (rs = 0.261, p = 0.006), and 3‐year (rs = 0.256, p = 0.011) MMSE decline; IL‐17A was positively correlated with 1‐year (rs = 0.262, p = 0.005), 2‐year (rs = 0.193, p = 0.045), but not 3‐year MMSE decline. However, both Th1 cells and IFN‐γ were not linked with MMSE decline. Conclusion Th17 cells and IL‐17A estimate the progression of cognitive impairment in stroke patients.
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Affiliation(s)
- Tianming Lu
- Department of Neurology, Chifeng City Hospital in Inner Mongolia, Chifeng, China
| | - Le Ma
- Department of Neurology, Chifeng City Hospital in Inner Mongolia, Chifeng, China
| | - Qingmei Xu
- Department of Neurology, Inner Mongolia Forestry General Hospital, Ya Ke Shi, China
| | - Xinxin Wang
- Department of Anesthesiology, Chifeng City Tumor Hospital, Chifeng, China
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Ghatge SB, Surya N, Modi D. Rapid Recovery from Subacute to Chronic Ischemic Stroke Following Revascularization by Carotid Stenting: Preliminary Findings. Neurol India 2022; 70:1487-1491. [PMID: 36076648 DOI: 10.4103/0028-3886.355160] [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: 11/04/2022]
Abstract
Background Rapid neurological recovery from subacute to chronic ischemic stroke in subset of patients following carotid revascularization was observed. Objective Retrospective analysis of data of the patients who had shown rapid recovery from subacute to chronic ischemic stroke following revascularization by Carotid stenting. Materials and Methods We retrospectively analyzed pooled data from our carotid stenting patients done during January 2009 to January 2020.The inclusion criterion of the study was patients with rapid recovery within 24 h following revascularization by carotid stenting. There were total of 12 such patients. There were 8 males and 4 females. Apart from NIHSS, stroke severity was measured on MRI by ASPECTS score and cognitive function by MMSE. Each of these patients has undergone Carotid Stenting with distal protection for high-grade stenosis. Results All of these 12 patients had Prestenting ASPECTS score ranging 8-10. Prestenting NIHSS score was ranging from 6-12 with an average of 8. Postprocedure NIHSS score was decreased to a range of 0-4 with average of 3.Prestenting MMSE was ranging 14-20 with an average of 18 score which turned into Post-stenting MMSE scale ranging 24-28 with an average of 26.Each of these patients shows decrease in NIHSS score by at least 50% in 24h to be called rapid recovery or Lazarus phenomenon. Additionally, they show significant improvement in cognitive function on MMSE scale. Conclusion Rapid recovery from subacute to chronic ischemic stroke following revascularization by Carotid Stenting is potentially feasible in subset of patient who has mild to moderate deficit but high ASPECTS score.
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Affiliation(s)
- Sharad B Ghatge
- Department of Radiology, Division of Interventional Neuroradiology, Sir JJ Hospital and Grant Government Medical College; Department of Neuroradiology and Neurointervention, Bombay Hospital and Medical Research Centre, Mumbai, India
| | - Nirmal Surya
- Department of Neurology, Bombay Hospital and Medical Research Centre, Mumbai, India
| | - Dhaval Modi
- Department of Neuroradiology and Neurointervention, Bombay Hospital and Medical Research Centre, Mumbai, India
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Dhandapani M, Joseph J, Sharma S, Dabla S, Varkey BP, Narasimha VL, Varghese A, Dhandapani S. The Quality of Life of Stroke Survivors in the Indian Setting: A Systematic Review and Meta-Analysis. Ann Indian Acad Neurol 2022; 25:376-382. [PMID: 35936592 PMCID: PMC9350769 DOI: 10.4103/aian.aian_1069_21] [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: 12/13/2021] [Revised: 01/17/2022] [Accepted: 01/27/2022] [Indexed: 11/06/2022] Open
Abstract
Background The significant burden of stroke on the mortality rates of developing countries, including India, is well-documented in the literature. However, robust data regarding the aggregates of evidence on the quality of life (QOL) of stroke survivors is limited. Objective To gather relevant information for policymakers on the QOL of stroke survivors based on observational studies conducted in the Indian setting. Methods We searched PubMed, Scopus, and Google Scholar for studies conducted in the Indian setting. The methodological quality of each study was scored, and data were extracted from the published reports. The risk of bias assessment was conducted based on the JBI Critical Appraisal Checklist criteria. The relevant data regarding QOL were analyzed by a random effects model using R software. Results 16 studies were included in the systematic review in which the majority of the studies recruited study participants in the hospital-based setting with an average duration of 3-6 months following the stroke episode. Our findings suggest that the pooled mean quality of life in the four dimensions of the World Health Organization Quality of Life instrument (WHOQOL-BREF) were ranged from 46.86 to 61.37 and the overall Stroke Specific Quality of Life scale (SS-QOL) mean score was 157.16. There was a significant inconsistency among the included studies as heterogeneity was high (I2 >97%). Conclusion Assessment of the quality of life among stroke survivors is a crucial step to predict the illness' imposed burden and ascertain the effectiveness of the treatment. The present meta-analysis elucidates the aggregate estimates of quality of life and contributes to the research on the quality of life following a stroke in an Indian context.
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Affiliation(s)
- Manju Dhandapani
- Lecturer, National Institute of Nursing Education, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Jaison Joseph
- Department of Psychiatric Nursing, College of Nursing, Pt. B.D. Sharma University of Health Sciences, Rohtak, Haryana, India
| | - Suresh Sharma
- Principal, College of Nursing, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Surekha Dabla
- Head of Department, Department of Neurology, Pt. B.D. Sharma University of Health Sciences, Rohtak, Haryana, India
| | - Biji P. Varkey
- Nursing Officer, Department of Neurology, Post Graduate Institute of Medical Sciences, Pt. BD Sharma University of Health Sciences, Rohtak, Haryana, India
| | | | - Abin Varghese
- Assistant Professor, College of Nursing, AIIMS, Nagpur, Maharashtra, India
| | - Sivashanmugam Dhandapani
- Professor, Department of Neurosurgery, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
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Divya M, Narkeesh A. Therapeutic Effect of Multi-Channel Transcranial Direct Current Stimulation (M-tDCS) on Recovery of Cognitive Domains, Motor Functions of Paretic Hand and Gait in Subacute Stroke Survivors-A Randomized Controlled Trial Protocol. Neurosci Insights 2022; 17:26331055221087741. [PMID: 35392020 PMCID: PMC8980417 DOI: 10.1177/26331055221087741] [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: 10/05/2021] [Accepted: 02/28/2022] [Indexed: 11/26/2022] Open
Abstract
Background There has been rapid drift of rehabilitation professionals toward the clinical use of technology aided electrical interventions. Brain is a cortical hub of functionally related neural connections. Motor learning entails strong interaction with the cognitive domains. So better outcomes may be expected by optimally targeting functionally correlated areas simultaneously through tDCS. Aim To determine the therapeutic effect of Multi Channel tDCS in combination with Functional electrical stimulation, SaeboFlex and conventional rehabilitation on recovery of Cognitive Domains, Motor Functions of Paretic Hand, and Gait in individuals with subacute Stroke. Methods This is prospective, randomized, double blind controlled clinical trial. Subacute Stroke Survivors with the age Group (40-75 years) will constitute the Population of the study. Participants will be randomly allocated to experimental or control group. Participants of Experimental group will receive Multi channel tDCS, Functional electrical stimulation, Saebo Flex Training and conventional rehabilitation. Participants of the group B will receive FES, training with SaeboFlex, conventional physiotherapy intervention similar to as given to the participants of group A and sham multi channel tDCS. Outcome Measures The primary outcome measures of the study will be Fugl Meyer assessment, Electroencephalogram and secondary outcome measures of the study will be Grip strength, Pinch strength, Nine hole peg test( NHPT), Wisconsin gait scale, Montreal cognitive assessment, Electroencephaloraphy to observe the cortical changes and tDCS adverse effect questionnaire and stroke specific quality of Life scale. Statistical Analysis The primary analysis of the study will be done at the end of 4 weeks. Statistical analysis of data will be done using SPSS Version 22 with the help of a statistician. Conclusion An insight into the therapeutic interventions augmenting, cognitive and motor domains simultaneously may yield better outcomes in the field of stroke rehabilitation thereby improving quality of life of stroke survivors.
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Affiliation(s)
- Midha Divya
- Department of Physiotherapy, Punjabi University, Patiala, Punjab, India
| | - Arumugam Narkeesh
- Department of Physiotherapy, Punjabi University, Patiala, Punjab, India
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Padmanabhan KN, Dominic M, Chidambaram HH, Vp C, Rajkumar RK, Sirajudeen SA. Comparison of Siriraj Stroke Score with Computed Tomography to Differentiate Acute Embolic and Hemorrhagic Stroke in a Tertiary Care-Teaching Center. EURASIAN JOURNAL OF EMERGENCY MEDICINE 2022. [DOI: 10.4274/eajem.galenos.2021.26576] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
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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: 26] [Impact Index Per Article: 13.0] [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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Gorthi SP, Garg D. Stroke Epidemiology among Young Persons in India: Every Step Counts. Ann Indian Acad Neurol 2022; 25:1-2. [PMID: 35342255 PMCID: PMC8954312 DOI: 10.4103/aian.aian_935_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Accepted: 10/25/2021] [Indexed: 11/19/2022] Open
Affiliation(s)
- Sankar P Gorthi
- Department of Neurology, Bharati Vidyapeeth (DTU) Medical College, Pune, Maharashtra, India
| | - Divyani Garg
- Department of Neurology, Neo Hospital, Noida, Uttar Pradesh, India
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Singla M, Singh G, Kaur P, Pandian J. Epidemiology of young stroke in the ludhiana population-based stroke registry. Ann Indian Acad Neurol 2022; 25:114-119. [PMID: 35342262 PMCID: PMC8954304 DOI: 10.4103/aian.aian_711_21] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2021] [Revised: 09/12/2021] [Accepted: 09/29/2021] [Indexed: 11/30/2022] Open
Abstract
Objective: The objective of the study was to determine incidence, risk factors, and short-term outcomes of young stroke in Ludhiana city, Northwest India. Methods: Data were collected on first-ever stroke in patients of age ≥18 years, from hospitals, diagnostic imaging centers, general practitioners, and municipal corporation during March 2011–March 2013 in Ludhiana city, using the World Health Organization Stepwise Approach to Surveillance (WHO STEPS). Outcome was documented using the modified Rankin Scale at 28 days. Results: Of 2948 patients, 700 (24%) were in the age group 18–49 years. Annual incidence in this age group was 46/100,000 person-years (95% confidence interval [CI], 41–51/100,000). Hypertension (84%), diabetes mellitus (48%), and atrial fibrillation (AF) (12%) were found more common in >49 years age group, as compared with 18–49 years age group. Drug abuse (8.7% vs. 6% in age >49 years; P = 0.04) and tobacco intake (8.7% vs. 5.6% in age >49 years; P = 0.02) was more common in young people, that is, 18–49 years age group in comparison to older patients, >49 years age group. Recovery was better in younger subjects (60% vs. 46% in age >49 years P < 0.001). In a multivariable analysis, younger people were more often literate (odds ratio [OR] 2.52; 95% CI, 1.68–3.77; P < 0.001), employed (OR 3.92; 95% CI, 2.20–5.21; P < 0.001), and 374 (60%) had good clinical outcome, modified Rankin Scale <2 at 28 days follow-up as compared with 938 (46%) older patients (OR 1.52; 95% CI, 1.15–2.00; P = 0.003). Conclusion: Hypertension, diabetes mellitus, drug addiction, and tobacco intake were significantly associated with young stroke. Outcome was also better in younger people.
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Dalai S, Limaye U, Kolli S, Maturu MVS, Narayana RV, Pati R, Korada SK, Vankineni K, Sameera A, Datla AV. Endovascular Treatment of Acute Ischemic Stroke in Patients Younger than 18 Years. JOURNAL OF CLINICAL INTERVENTIONAL RADIOLOGY ISVIR 2021. [DOI: 10.1055/s-0041-1740568] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Abstract
AbstractRapid and effective revascularization is very important in the treatment of acute ischemic stroke (AIS). Endovascular treatment is a promising modality in the management of AIS in young patients. We evaluated the clinical and imaging records in 14 patients younger than 18 years presenting within 6 hours of AIS. They received endovascular therapy (ET) either by mechanical thrombectomy, thromboaspiration, or both (Solumbra) between July 2017 and June 2021 in our institute. The National Institute of Health Stroke Scale (NIHSS) score was calculated on admission and before the discharge of all patients. The 90-day modified Rankin Scale (mRS) score on disability-free outcome was also evaluated. The mean preprocedure NIHSS score was 10.78 ± 2.11 that improved to 4.5 ± 1.88 after the procedure. Thrombolysis in cerebral infarction (TICI) grade 2b and 3 blood flow could be established in 12 (85.72%) patients. One patient had TICI 2a flow and one patient had recurrent occlusion despite repeated recanalization (TICI grade 0). The disability-free outcome, mRS score at 90 days was 0 to 1 in 12 (85.72%) patients, mRS score 2 in one (7.14%) patient, and mRS score 3 in one patient (7.14%). We did not have any major complication related to the procedure. ET provides high rates of arterial recanalization and favorable disability-free outcomes in young patients with AIS.
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Affiliation(s)
- Sibasankar Dalai
- Department of Interventional Neuroradiology, Medicover Hospitals, Visakhapatnam, Andhra Pradesh, India
| | - Uday Limaye
- Department of Neurointervention, Lilavati Hospital, Mumbai, Maharashtra, India
| | - Satyarao Kolli
- Department of Neurology, Medicover Hospitals, Visakhapatnam, Andhra Pradesh, India
| | | | | | - Rajesh Pati
- Department of Neurology, Medicover Hospitals, Visakhapatnam, Andhra Pradesh, India
| | - Suresh Kumar Korada
- Department of Neurology, Seven Hills Hospitals, Visakhapatnam, Andhra Pradesh, India
| | - Kuchelababu Vankineni
- Department of Anaesthesiology and Critical Care, Seven Hills Hospitals, Visakhapatnam, Andhra Pradesh, India
| | - Anantamakula Sameera
- Department of Radiodiagnosis, Medicover Hospitals, Visakhapatnam, Andhra Pradesh, India
| | - Aravind Varma Datla
- Department of Internal Medicine, Medicover Hospitals, Visakhapatnam, Andhra Pradesh, India
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Inamdar MA, Raghavendra U, Gudigar A, Chakole Y, Hegde A, Menon GR, Barua P, Palmer EE, Cheong KH, Chan WY, Ciaccio EJ, Acharya UR. A Review on Computer Aided Diagnosis of Acute Brain Stroke. SENSORS (BASEL, SWITZERLAND) 2021; 21:8507. [PMID: 34960599 PMCID: PMC8707263 DOI: 10.3390/s21248507] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Revised: 12/05/2021] [Accepted: 12/09/2021] [Indexed: 01/01/2023]
Abstract
Amongst the most common causes of death globally, stroke is one of top three affecting over 100 million people worldwide annually. There are two classes of stroke, namely ischemic stroke (due to impairment of blood supply, accounting for ~70% of all strokes) and hemorrhagic stroke (due to bleeding), both of which can result, if untreated, in permanently damaged brain tissue. The discovery that the affected brain tissue (i.e., 'ischemic penumbra') can be salvaged from permanent damage and the bourgeoning growth in computer aided diagnosis has led to major advances in stroke management. Abiding to the Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA) guidelines, we have surveyed a total of 177 research papers published between 2010 and 2021 to highlight the current status and challenges faced by computer aided diagnosis (CAD), machine learning (ML) and deep learning (DL) based techniques for CT and MRI as prime modalities for stroke detection and lesion region segmentation. This work concludes by showcasing the current requirement of this domain, the preferred modality, and prospective research areas.
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Affiliation(s)
- Mahesh Anil Inamdar
- Department of Mechatronics, Manipal Institute of Technology, Manipal Academy of Higher Education, Manipal 576104, India;
| | - Udupi Raghavendra
- Department of Instrumentation and Control Engineering, Manipal Institute of Technology, Manipal Academy of Higher Education, Manipal 576104, India; (A.G.); (Y.C.)
| | - Anjan Gudigar
- Department of Instrumentation and Control Engineering, Manipal Institute of Technology, Manipal Academy of Higher Education, Manipal 576104, India; (A.G.); (Y.C.)
| | - Yashas Chakole
- Department of Instrumentation and Control Engineering, Manipal Institute of Technology, Manipal Academy of Higher Education, Manipal 576104, India; (A.G.); (Y.C.)
| | - Ajay Hegde
- Department of Neurosurgery, Kasturba Medical College, Manipal Academy of Higher Education, Manipal 576104, India; (A.H.); (G.R.M.)
| | - Girish R. Menon
- Department of Neurosurgery, Kasturba Medical College, Manipal Academy of Higher Education, Manipal 576104, India; (A.H.); (G.R.M.)
| | - Prabal Barua
- School of Management & Enterprise, University of Southern Queensland, Toowoomba, QLD 4350, Australia;
- Faculty of Engineering and Information Technology, University of Technology, Sydney, NSW 2007, Australia
- Cogninet Brain Team, Cogninet Australia, Sydney, NSW 2010, Australia
| | - Elizabeth Emma Palmer
- School of Women’s and Children’s Health, University of New South Wales, Sydney, NSW 2052, Australia;
| | - Kang Hao Cheong
- Science, Mathematics and Technology Cluster, Singapore University of Technology and Design, Singapore 487372, Singapore;
| | - Wai Yee Chan
- Department of Biomedical Imaging, Research Imaging Centre, University of Malaya, Kuala Lumpur 59100, Malaysia;
| | - Edward J. Ciaccio
- Department of Medicine, Columbia University, New York, NY 10032, USA;
| | - U. Rajendra Acharya
- Department of Biomedical Engineering, Faculty of Engineering, University of Malaya, Kuala Lumpur 50603, Malaysia;
- School of Engineering, Ngee Ann Polytechnic, Singapore 599489, Singapore
- Department of Biomedical Engineering, School of Science and Technology, SUSS University, Singapore 599491, Singapore
- Department of Biomedical Informatics and Medical Engineering, Asia University, Taichung 41354, Taiwan
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