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Background@#and Purpose New studies have shown that endovascular thrombectomy (EVT) is safe and effective for acute ischemic stroke (AIS) patients with large ischemic areas. The aim of our study is to conduct a living systematic review and meta-analysis of randomized trials comparing EVT versus medical management only. @*Methods@#We searched MEDLINE, Embase, and the Cochrane Library to identify randomized controlled trials (RCTs) comparing EVT versus medical management alone in AIS patients with large ischemic regions. We conducted our meta-analysis using fixed-effect models to compare functional independence, mortality, and symptomatic intracranial hemorrhage (sICH) between EVT and standard medical management only. We assessed the risk of bias using the Cochrane risk-of-bias tool and the certainty of evidence for each outcome using the Grading of Recommendations, Assessment, Development, and Evaluations approach. @*Results@#Of 14,513 citations, we included 3 RCTs with a total of 1,010 participants. We found low-certainty evidence of possibly a large increase in the proportion of patients with functional independence (risk difference [RD] 30.3%, 95% CI 15.0% to 52.3%), low-certainty evidence of possibly a small non-significant decrease in mortality (RD -0.7%, 95% CI -3.8% to 3.5%), and low-certainty evidence of possibly a small non-significant increase in sICH (RD 3.1%, 95% CI -0.3% to 9.8%) for AIS patients with large infarcts who underwent EVT compared to medical management only. @*Conclusion@#Low-certainty evidence shows that there is possibly a large increase in functional independence, a small non-significant decrease in mortality, and a small non-significant increase in sICH amongst AIS patients with large infarcts undergoing EVT compared to medical management only.
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Background@#and Purpose Intracranial arterial stenosis (ICAS)-related stroke occurs due to three primary mechanisms with distinct infarct patterns: (1) borderzone infarcts (BZI) due to impaired distal perfusion, (2) territorial infarcts due to distal plaque/thrombus embolization, and (3) plaque progression occluding perforators. The objective of the systematic review is to determine whether BZI secondary to ICAS is associated with a higher risk of recurrent stroke or neurological deterioration. @*Methods@#As part of this registered systematic review (CRD42021265230), a comprehensive search was performed to identify relevant papers and conference abstracts (with ≥20 patients) reporting initial infarct patterns and recurrence rates in patients with symptomatic ICAS. Subgroup analyses were performed for studies including any BZI versus isolated BZI and those excluding posterior circulation stroke. The study outcome included neurological deterioration or recurrent stroke during follow-up. For all outcome events, corresponding risk ratios (RRs) and 95% confidence intervals (95% CI) were calculated. @*Results@#A literature search yielded 4,478 records with 32 selected during the title/abstract triage for full text; 11 met inclusion criteria and 8 studies were included in the analysis (n=1,219 patients; 341 with BZI). The meta-analysis demonstrated that the RR of outcome in the BZI group compared to the no BZI group was 2.10 (95% CI 1.52–2.90). Limiting the analysis to studies including any BZI, the RR was 2.10 (95% CI 1.38–3.18). For isolated BZI, RR was 2.59 (95% CI 1.24–5.41). RR was 2.96 (95% CI 1.71–5.12) for studies only including anterior circulation stroke patients. @*Conclusion@#This systematic review and meta-analysis suggests that the presence of BZI secondary to ICAS may be an imaging biomarker that predicts neurological deterioration and/or stroke recurrence.
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Background/Aim: Chronic pancreatitis (CP) is surgically treated in selected patient populations. Frey's procedure (FP) is the most commonly described procedure for CP with head mass. This study is being conducted to determine the long-term outcome and ef?cacy of FP in patients with CP in South India of various etiologies. Methods: This is a retrospective study of patients who underwent FP at our institution. Clinical features, perioperative ?ndings, and follow-up results were evaluated. A subgroup analysis of pain relief was performed between alcoholics and non-alcoholic groups and between patients receiving FP alone and FP with additional procedures. Of the 181 patients, alcohol was Results: the causative factor in 99 (54.69%), gallstones in 20 (11.04%), and idiopathic in 62 (34.25%). With a median follow-up of 43.49 months (range 12-72 months), 78 (43.09%) patients experienced complete pain relief. Due to persistent pain and the presence of preoperative diabetes mellitus (DM), pain relief in patients with postoperative complications was incomplete. New DM and exocrine dysfunction were reported in 25 years (13.81%) and 15 (8.28%) patients. Patients with a history of alcohol abuse, smoking, weight loss, and postoperative complications are associated with newly developed diabetes. FP is a Conclusion: safe surgical option for CP with acceptable perioperative complications and appropriate short-term and long-term pain management in properly selected patients. Continuous pain and preoperative DM were independent predictors of incomplete pain relief after FP. Symptoms associated with alcohol abuse, smoking, and weight loss were associated with the development of post-FP DM in the study population.
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Background: The usage pattern and effectiveness of various treatment strategies for benign positional paroxysmal vertigo (BPPV) have not been widely reported in routine clinical settings in India. The aim of the study was to understand treatment patterns and level of symptom improvement in Indian patients presenting with symptoms of BPPV in clinical practice.Methods:A cross-sectional pan-India survey was conducted with leading neurologists and otolaryngologists. A detailed questionnaire was shared with specialists which was followed by semi-structured telephonic interviews to gather a deeper understanding of their treatment practices. The obtained data was analyzed using appropriate statistical methods.Results:A total of 5 neurologists and 8 ENT specialists completed the survey. Physicians reported that age, but not gender, was an important factor when selecting appropriate treatment. Specialists reported that in their clinical practice symptom improvement is better with betahistine plus maneuvers compared to betahistine only alone (97% verses90% cure rate) and is comparable with maneuvers (97% verses98% cure rate, respectively). Dix Hallpike and supine roll test using videonystagmography were the most recommended tests used to diagnose BPPV. Betahistine plus maneuvers was the most commonly prescribed treatment for BPPV, and clinicians observed greater decrease in the severity of BPPV symptoms with betahistine plus maneuvers versus betahistine alone or maneuvers. The Visual analog scale (VAS) was the most widely usedscale for assessing severity of BPPV symptoms.Conclusions: These findings indicate that betahistine plus maneuvers provides better control over symptom severity in patients with BPPV.
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Objective: We undertook a prescription-based study to identify the provider and institution-level factors related to achieving guideline-recommended control of hypertension and diabetes mellitus in Kerala, India. Methods: This cross-sectional study in primary and secondary care hospitals in Kerala included both public and private institutions. One practitioner was selected from each institution. Data on institutional and provider factors were collected using a structured questionnaire. Prescriptions were photographically captured and data on disease status and drugs prescribed were recorded. Factors associated with disease control were identified using binary logistic regression. Results: Totally 4679 prescriptions were included for analysis. For hypertension-only patients, control levels were 31.5% and was significantly higher in public hospitals (Adjusted odds ratio (AOR) 1.96, 95% confidence intervals (CI) 1.50e2.57). Among patients with diabetes only, diabetes control was seen in 36.6%. When both conditions were present, control was achieved in only 17.0% patients. Being prescribed two or more drugs indicated lower control, whatever the respective condition. Among antihypertensive prescriptions rationality of 26.7% were questioned, such as lack of Renin Angiotensin System (RAS) inhibitor in diabetic hypertensives, dual RAS blockage, and indication for beta-blocker monotherapy. Conclusions: In this prescription-based study in Kerala, India, a majority of hypertensive patients did not have controlled blood pressure levels, particularly if diabetes coexisted. This has serious implications as Kerala is the state with the highest burden of hypertension in India. Several prescription patterns were of questionable rationality. Further research and actions on rationality of anti-hypertensive prescriptions and barriers to treatment intensification is warranted.
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Background: Coal?fired thermal power plants (TPPs) have a serious impact on soil, air, and water quality resulting in deterioration of health and environment around the plant. Objective: The present study was undertaken with the objectives of assessing the respiratory health status of the population around the plant and to measure selected heavy metals in fly ash, air, water, and soil samples. Materials and Methods: The current cross?sectional study was conducted among 3533 adult residents living in two strata within 10 km radius around the TPP in Udupi district of Karnataka state. Data were collected by using semi-structured questionnaire and spirometry and environmental air monitoring by DustTrak aerosol monitor, water, and soil samples were collected for analysis. Results: Majority of the study participants were in the age group of >45 years (41.4%). 70.6% were females and 0.39% were trans?genders. 4.3% were suffering from various respiratory problems. Bivariable logistic regression showed subjects aged 46–65 years and >65 years have 2.91 times and 4.42 times higher odds of respiratory disease as compared to those with age ?45 years. Multivariable logistic regression showed significant association between higher age group (P < 0.0001) and in subjects who had closed window during cooking (P < 0.006). Levels of heavy metals in soil samples and particulate matter 2.5 were well within permissible limits whereas the ground water samples had excess levels of iron, manganese, and copper. Conclusion: The present study has implications for policymaking to protect the environment and health of vulnerable populations in industrial clusters and the vicinity of power plants.
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The Grainy head like-2 (Grhl2) transcription factor plays a major role in embryonic and cancer development. The role of Grhl2 has been intensively studied in various cancers but not for brain cancer. Hence, in this study, we provide a preliminary understanding on the role of Grhl2 that regulate the transition of astrocytoma cells. The human A172 astrocytoma cell line, a mesenchymal cell characterized by mild overexpression of Grhl2 transcription factor, was used in this study. At first, the Grhl2 stably overexpressing A172 clones into three types i.e., Grhl2+ (mild), Grhl2++ (moderate) and Grhl2+++ (high) based on mRNA and protein expression levels of Grhl2 were characterized. Phenotypic characteristics of vector and Grhl2+ cells were observed using phase contrast microscopy. Quantitative PCR (qPCR), Western blot and immunofluorescence were used to detect the level of mesenchymal markers (N-cadherin/vimentin) and also epithelial markers (E-cadherin/ ?- catenin) in vector and Grhl2+ cells. The migration and invasion characteristics of vector and Grhl2+ cells were determined by scratch assay and Boyden chamber assay. Further, the Grhl2+ cells were characterized to determine the effect of temozolomide chemotherapy drug which were widely used in treating brain cancer. As expected, in phase contrast image, we observed the mesenchymal characteristic of A172 cells becomes hybrid phenotype i.e., mixture of mesenchymal (spindle-like fibroblast morphology) and epithelial (cobblestone like appearance) cells upon Grhl2 mild expression (Grhl2+) when compared to vector cells. Further, we found that there was a significant upregulation of E-cadherin at both mRNA and protein levels in Grhl2+ cells when compared to vector cells. There was a significant upregulation of ?-catenin, N-cadherin and vimentin at mRNA levels, but there was no significant upregulation at the protein levels in Grhl2+ cells compared to the vector cells. The migration and invasion were diminished in Grhl2+ cells when compared to the vector control cells. We observed that the Grhl2+ were sensitive to the temozolomide compared to the vector cells. This infers that the Grhl2+ cells were unable to attain complete transition of mesenchymal to epithelial state, and hence we categorized the Grhl2+ cells as hybrid phenotype. The results provide a better understanding of the largely unknown function of Grhl2 in human astrocytoma cells as tumor progression or suppression.
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Congenital complete heart block (CCHB) has an incidence of one in 20,000 live births and carries a 20% risk of mortality. The hemodynamic instability due to bradycardia and asystole due to the increasing metabolic demands can be avoided by appropriate antenatal planning, timely delivery and initiation of medical treatment and early pacemaker insertion. In this report, we discuss the anaesthetic challenges of permanent epicardial pacemaker insertion with good outcomes in a 32?week gestational age 1380 grams neonate within a few hours of birth.
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Background: Necrotizing fasciitis refers to the rapidly progressive inflammation of the fascia, with secondary necrosis of subcutaneous tissues. Due to the high mortality, it is considered a surgical emergency, needing timely diagnosis and appropriate treatment with early debridement. The aim of the study was to analyse the clinical profile of patients with necrotizing fasciitis so as to determine the mortality and the risk factors associated with mortality and other poor outcomes.Methods: This retrospective cross-sectional study was conducted in a tertiary hospital in Kerala, from January 2016 through January 2018. 175 cases were identified through the ICD codes for necrotizing fasciitis and Fournier’s gangrene in the discharge and death registers; and data were obtained about these patients. The data were analyzed to assess the study objectives.Results: In this study mortality was found to be 22.7%. Diabetes mellitus was found to be the most common co-morbid disease and had a significant association with increased risk of amputation. Mixed growth (type I NF) was the most common microbiological isolate and Pseudomonas was the most common gram-negative isolate. 4 cases of MRSA were recorded. Klebsiella infection was found to have increased risk of undergoing limb amputation. 7.4% of the patients required amputation during hospital stay for infection control.Conclusions: Necrotizing fasciitis has a high mortality. Diabetes mellitus was found to be the most common co-morbid disease. Increased blood glucose and low serum albumin had a significant association with an increased risk of amputation. Proper control of these factors is essential to reduce mortality from this condition.
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Background: The objective of the study was to find out long term outcome of patients who underwent Frey’s procedure for chronic calcific pancreatitis.Methods: This is a prospective observational study from retrospectively collected data of all patients who underwent Frey’s procedure for chronic calcific pancreatitis in Institute of Surgical Gastroenterology, Rajiv Gandhi Government General Hospital, Chennai from January 2012 to December 2014. All patients who have completed at least 48 months after surgery were followed up and their long-term postoperative quality of life were analyzed.Results: Totally 48 patients underwent Frey’s procedure during this period. Eight patients lost follow up. Preoperatively all patients had pain score above six in numerical rating scale but after surgery only two patients in the long term required stronger opioids for pain relief. Exocrine deficiency was present in 24 (60%) patients preoperatively, out of which seven patients showed improvement, eight patients had worsened exocrine deficiency and weight loss. Post operatively there were six patients who developed exocrine deficiency. Endocrine deficiency was seen in 23 (57.5%) patients preoperatively and during follow up none showed improvement, with two (5%) patients developed endocrine deficiency. Seven patients showed worsened endocrine deficiency as documented by increasing insulin requirement. Quality of life analysis using SF 36 showed poor quality of life in patients with worsened exocrine deficiency.Conclusions: Frey’s procedure although in long term showed improved outcome in terms of pain free survival and overall quality of life, exocrine and endocrine deficiency persisted in most and worsened in some patients.
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Background: Human body consists of 206 bones; among which femur. The thigh bone is considered as the biggest and strongest bone of the body. The bone contains a femoral bicondylar angle which helps in maintaining the balance and certain movements of the body. Those movements are essential to stand upright and erect; therefore, helps in balancing the posture of the body. Bicondylar angle shows various gestures and characteristics essential for describing the necessary ailments of the human skeleton. Thus, the present study is designed with an aim to measure and compare the bicondylar angle of femur both in males and females in Udaipur, Rajasthan, India zone.Methods: Totally, 96 bones were studied- 48 males and 48 females’ bones in 2 years duration. The study was carried out in the Department of Anatomy of Geetanjali Medical College and Hospital and R.N.T. Medical College. The bicondylar angle was measured with a suitable apparatus comprising of compass, Digital Vernier Calliper, scale and protector (Figure 1) along with osteometric board. Bicondylar angle of male and female bone was calculated using SPSS software.Results: The study shows that the bicondylar angle of left femur was greater than right femur in both the genders, but their side differences was statistically insignificant (p>0.05).Conclusions: Hence, the bicondylar angle of female is larger than in comparison to males and these results can put emphasis/light on the orthopaedic clinicians and surgeons to know the etiology of osteometric diseases.
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In India, more than 72 million people have diabetes. Diabetic retinopathy (DR), a vision-threatening complication of people with diabetes, is an important cause of avoidable blindness. The delay in the detection of DR is due to lack of awareness and shortage of ophthalmologists trained in the management of DR. With this background, in 2015, we initiated a capacity-building program “Certificate Course in Evidence Based Management of Diabetic Retinopathy (CCDR)” with an objective to build the skills and core competencies of the physicians across India in the management of diabetes and DR. The program has completed four cycles and 578 physicians have been trained. The course elicited an excellent response, which reflects the much-felt need for skill improvement in DR diagnosis and management for physicians in India. This model demonstrates an innovative modality to address DR-related avoidable blindness in a resource-restraint country like India.
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Introduction: Rheumatoid arthritis (RA) is a chronic inflammatory disorder, involving joints and extra-articular manifestations. About 50% mortality in RA is due to cardiovascular disease. Cardiovascular events occur approximately a decade earlier in RA like that in diabetes mellitus. Aim: The aim of the study was to correlate and compare the association between disease severity and various clinical and cardiovascular manifestations in RA patients. Materials and Methods: This prospective cross-sectional study is carried out in known RA patients fulfilling the American College of Rheumatology criteria 2010 attending General Medicine and Rheumatology outpatient clinic of Tirunelveli Medical College Hospital between April 2017 and April 2018. They have been subjected to detail clinical and laboratory investigations and their cardiovascular manifestations are compared with their clinical profile and disease activity score. Results: In this study, 50 patients were included, with a mean age of 47.76 years and 72% of female patients. The mean clinical disease activity index (CDAI) score among them is 25.16 ± 10.4. The disease severity was high among our study group with 60% of cases occupying high CDAI score with no patients under remission. The most common electrocardiogram abnormality found in the study group was left axis deviation (30%) followed by nonspecific ST-T changes (24%). Mean carotid intima-media thickness (CIMT) was found to be increased in 68% of patients. Asymptomatic carotid plaque was present in 8% of patients. The most common echocardiographic abnormality is left ventricular (LV) diastolic dysfunction, which contributes 44% in our study group. Conclusion: Cardiovascular abnormalities such as LV diastolic and systolic dysfunction, premature atherosclerosis occur commonly in RA patients and positively correlate with CDAI score, disease duration, and treatment duration. All RA patients should be screened for chorionic villus sampling abnormalities through echocardiography and CIMT periodically
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Objective: The objective of this study was to evaluate the uptake and specificity of [11C]MPC-6827, a MT targeted PET ligand in prostate, glioblastoma and breast cancer cells. Methods: [11C]MPC-6827 was synthesized by reacting corresponding desmethyl precursors with [11C]CH3I in a GE-FX2MeI/FX2M radiochemistry module. In vitro binding of [11C]MPC-6827 was performed in breast cancer MDA-MB-231, glioblastoma (GBM) patient-derived tumor (GBM-PDX), GBM U251 and prostate cancer 3 (PC3) cell lines at 37 °C in quadruplicate at 5, 15, 30, 60, and 90 minute incubation time. The nonspecific bindings were determined by incubation with unlabeled microtubule targeting agents MPC-6827, HD-800, colchicine, paclitaxel and docetaxel (5.0 mM). Results: [11C]MPC-6827 provided the highest binding in the breast cancer cell, MDA-MB-231, among all the cells studied, with 90% specific binding. [11C]MPC-6827 binds to glioblastoma PDX and U251 cells with ~50% and 40% specific binding, whereas, prostate cancer cell line, PC3 cells showed 40% specific binding. [11C]MPC-6827 also exhibits binding to the taxane and colchicine binding sites of MTs, in MDA-MB-231 cells. Conclusion: These data indicate that [11C]MPC-6827 can be a promising PET radiotracer for preclinical imaging of the brain and peripheral cancers.
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@#Background: Published reports by the Social Welfare Department of Malaysia suggests that child abuse and neglect cases has been steadily increasing. There is a lack of basic data and qualitative study on child maltreatment in Malaysia. Objective: The aim is to describe the pattern and demographic features of all suspected child abuse and neglect (SCAN) cases seen in a single tertiary hospital in Malaysia over a period of five years. Methods: A retrospective descriptive review of children suspected of maltreatment, aged 0 to 18 years old who presented to the Hospital Serdang (HS), Selangor, Malaysia from January 2014 to December 2018 was done. A list of registered SCAN cases obtained from One Stop Crisis Centre (OSCC) HS census. Clinical information of patients was retrieved from the computerised database. Results: In all, there were a total of 391 SCAN cases over five years with almost a 3-fold increase in the number of cases from 2014 to 2018. Physical abuse was the most common (55%) seen followed by sexual abuse (34%) and neglect (10%). There were four deaths, all involving infants <1 year old who were physically abused by babysitters. The main perpetrator in sexual abuse were people known to the victim. Ninety-three percent of patients were neglected by their biological parents and more than 2/3rd of neglect cases occurred due to inadequate supervision. Discussion: Child maltreatment is an inevitable burden to our health system and infants are the most vulnerable group to sustain significant injuries leading to death and disabilities.
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Introduction: The increasing prevalence of ureteric stone is a matter of concern in this era and it may be linked to improvedquality of life. Medical expulsive therapy, including alpha-blockers, steroids, and calcium channel blockers, has been extensivelystudied for improving the rate of stone passage in patients who do not require immediate urologic intervention.Aim: The aim of this study is to compare the efficacy of tamsulosin and tadalafil in expulsive treatment for distal ureteralstones.Materials and Methods: This was a prospective comparative study included 120 adult patients (>18 years of age) presentingwith distal ureteric stones were randomized into 60 patients with tamsulosin 0.4 mg once daily (Group A) or 60 patients withtadalafil 10 mg once daily (Group B) treatment. Therapy was given for a maximum of 4 weeks.Results: About 85% of study patients had a size between 5 mm and 7 mm and 18 patients had size between 8 mm and 10 mm.There was no statistical difference noted in the pain duration and analgesic usage of both groups. In Group A, 67% of patientshad expulsion of stones; in Group B, 63% of patients had expulsion of stones. About 90% of patients in 40 cases of expelledstones are in <5 days in Group A and 89% of patients 38 cases of expelled stones are in <5 days in Group B. There was nostatistical difference noted between both groups.Conclusion: Tamsulosin and tadalafil have shown similar expulsion rate. Both of them simultaneously provides better paincontrol and significantly lower the needs for analgesia.
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Objective: To determine the antioxidant and anti-inflammatory activities of the solid powder extracted from the ethyl acetate fraction of the flower Hibiscus vitifolius L. Methods: The flower extract assessed for antioxidant activity using the 1,1–diphenyl-2-picryl-hydrazile (DPPH) radical scavenging assay and the reduced power assay was performed using the Ferric Reducing Capacity (FRC) assay. In vitro anti-inflammatory activity was assessed using human peripheral blood mononuclear cells (PBMC) induced by lipopolysaccharide (LPS) to test the production method of nitric oxide (NO). Results: The solid powder extracted from the ethyl acetate fraction of the flower Hibiscus vitifolius L showed good antioxidant activity in the scavenging DPPH radicals and the FRC assay compared to the standard sample. This powder sample also showed good anti-inflammatory activity in cell viability (LPS induced PBMC) assay and nitric oxide (NO) assay. Conclusion: These results suggest that the powder sample extracted from the ethyl acetate fraction of the flower Hibiscus vitifolius L has substantial antioxidant and anti-inflammatory activity.
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Objective Heart failure is a leading cause of death worldwide and in India, yet the qualitative data regarding heart failure care are limited. To fill this gap, we studied the facilitators and barriers of heart failure care in Kerala, India. Methods and results During January 2018, we conducted a qualitative study using in-depth, semi-structured interviews with 21 health-care providers and quality administrators from 8 hospitals in Kerala to understand the context, facilitators, and barriers of heart failure care. We developed a theoretical framework using iteratively developed codes from these data to identify 6 key themes of heart failure care in Kerala: (1) need for comprehensive patient and family education on heart failure; (2) gaps between guideline-directed clinical care for heart failure and clinical practice; (3) national hospital accreditation contributing to a culture of systematically improving quality and safety of in-hospital care; (4) limited system-level attention toward improving heart failure care compared with other cardiovascular conditions; (5) application of existing personnel and technology to improve heart failure care; and (6) longitudinal and recurrent costs as barriers for optimal heart failure care. Conclusions Key themes emerged regarding heart failure care in Kerala in the context of a health system that is increasingly emphasizing health-care quality and safety. Targeted in-hospital quality improvement interventions for heart failure should account for these themes to improve cardiovascular outcomes in the region.
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Abstract INTRODUCTION: The ability of Vitex trifolia and Vitex negundo essential oils to kill Aedes aegypti and Culex quinquefasciatus larvae was evaluated. METHODS: The larvae were treated with their respective essential oils at 50-125 ppm concentration. RESULTS: LC50 and LC90 for V. trifolia against Ae. aegypti and C. quinquefasciatus, and those for V. negundo against Ae. aegypti were 57.7+0.4, 77.9+0.9 ppm and 55.17+3.14, 78.28+2.23 ppm, and 50.86+0.9, 73.12+1.3 ppm, respectively. Eucalyptol and caryophyllene were the major components in Vitex trifolia and Vitex negundo essential oil, respectively. CONCLUSIONS: This study revealed potential larvicidal properties of essential oil from V. trifolia.