Cross Sectional Study of Depression in Patients following a Stroke: A Neurologists Perspective

Background: Stroke is one of the leading causes of mortality and morbidity in today’s world. With early intervention and improvements in critical care the mortality from stroke is decreasing. Today there are more chances of a patient surviving after a stroke than it was 2 decades ago. But this downward shift in mortality has caused increased prevalence of patients surviving with considerable neurodeficits and cognitive dysfunction. These patients are at increased risk of developing depression which may directly affect the recovery process. Yet the depression in post-stroke patient is rarely recognised and treated. Many a times such patients remain bed-ridden, neglected depressed and only a small number of these patients are treated for depression. Some of this has to do with the fact that there are not many randomised controlled trials dealing with this aspect. Gradually with increasing survival of the patients with stroke data is becoming available suggesting that the treatment of depression in post-stroke patient have a positive effect on recovery of these patients. We conducted this study to identify the prevalence and severity of depression in post stroke patients and to assess its relationship with demographic variables and stroke characteristics. Methods: This was a cross sectional study comprising of 52 patients selected on the basis of pre-defined inclusion criteria and was carried out in Department of Neurology of a tertiary care medical institute situated in an urban area. All patients attending follow up stroke OPDS having a history of stroke confirmed on imaging (Computed tomographic, MRI or MR angiography) were included in this study. Dependent variable of our study was depression while independent variables were demographic and clinical factors such as age, gender, marital status, financial status, residence status, education level and the clinical variables were stroke type, side and site of stroke. All the patients were interviewed using the preformed questionnaire specifically designed for this study. The data was tabulated and analysed. SPSS Statistics version 2.0 was used to analyze the collected data. Results: Forty four patients with stroke out of 52 (85%) met the criteria for depression. out of which 40 were males and 12 were females with a M: F ratio being 1:0.3. Demographic variables and stroke types (hemorrhagic versus thromboembolic) were not significantly associated with post stroke depression. A peculiar finding we encountered was infarcts in the middle cerebral artery territory were significantly associated with depression. Majority of the patients (87 %) had ischaemic stroke and most common location was found to be left hemisphere (60%). Most common territory was found to be left middle cerebral artery territory which was affected in 50% of the patients.81% patients were found to be having illness since more than 6 months. Depression was more common in male patients of more than 45 years of age. There was a significant association between the post stroke depression and left middle cerebral artery infarction. Conclusion: These results highlighted the need to investigate, diagnose and treat post-stroke depression. From a neurologist’s point of view it is important to recognize the symptoms of depression so that a psychiatric opinion can be sought.

Screening of Siddha Medicinal Plants for Anti Cancer Activity - A review.

India is a peninsula of herbal hub, in which Siddha system of medicine has flourished as an enlightment in the field of Medicine. Currently medicinal plants have become the paramount source of drug discovery in research for treating diverse form of diseases including Cancer. In this review Siddha classical literature and evidence based research data were emphasized to explore the Siddha medicinal plants with potent anticancer activity. This literature analysis based on both Siddha philosophy and modern parameters reveals that each medicinal plant has its own specific effects on specific type of Cancer.

Left ventricular hydatid cyst with myocardial infarction in a patient with severe rheumatic mitral stenosis.

Cardiac echinococcosis is rare, and the most serious of all hydatid infestations. We report a case of 30-year-old female who had a hydatid cyst, myocardial infarction and severe rheumatic mitral stenosis. Following mitral valvotomy, the hydatid cyst and the left ventricular aneurysm were totally excised under cardiopulmonary bypass. The patient was discharged on the post-operative day 15 with the advice to continue albendazole for 5 years.

Cranial computed tomography in partial motor seizures.

OBJECTIVE: To identify the pattern of intracranial structural lesions in developmentally normal children with partial motor seizures by computed tomography and to monitor the behavior of single ring enhancing lesion (SREL) after a period of time with or without treatment. METHODS: Consecutive developmentally normal children between one year and twelve years with partial motor seizures in a tertiary care referral Hospital. After clinical examination and appropriate investigation for tuberculosis and cysticercosis, CT scan was performed. In addition to anticonvulsants, children received antituberculous or anticysticercal therapy if indicated. Repeat CT was performed on children with SREL after 6 months. RESULTS: Computed tomography was abnormal in 102 (68%) children. Majority of the children (75) had SREL. The lesions were located in decreasing order of frequency in the parietal lobe (65), frontal lobe (7), occipital lobe (1), temporal lobe (1) and cerebellum (1). Repeat CT scan was performed on 50 of the 75 children with SREL. Among these, in 41 children who were only on antiepileptic therapy, the SREL had decreased in size in thirty-two whereas in the rest (9), there was no change in the size. CONCLUSION: Awareness of the existence of disappearing SREL lesions is essential to avoid unnecessary treatment with antituberculous or anticysticercal therapy and provides ample justification in treating with anticonvulsant drugs only.

Complete axillary conversion after neoadjuvant chemotherapy in locally advanced breast cancer: a step towards conserving axilla?

OBJECTIVES: This study was designed to assess the clinical, sonographic and histopathological response of axillary lymph node metastasis to neoadjuvant chemotherapy in patients with locally advanced breast cancer. MATERIAL AND METHODS: Forty patients with locally advanced breast cancer (LABC) with clinically palpable or sonographically detectable axillary nodes were studied. FNAC of the primary tumor and axillary nodes was done and patients were started on neoadjuvant chemotherapy. Axillary nodes were assessed clinically and sonographically for response after 3 cycles of chemotherapy. All patients underwent total mastectomy with axillary clearance and the lymph nodes in the specimen were examined for metastasis. RESULTS: 47% patients had complete clinical nodal response, while 19% showed complete sonographic response. Complete pathological nodal response was documented in 22% of patients. Ultrasonography was found to be more sensitive than clinical examination in assessing complete nodal response. 10% of the patients had complete pathological response of both primary tumor and axillary nodes. There was significant correlation between pathological response of primary tumor and lymph nodes (P=0.004). Patients with complete sonographic or clinical response were found to have no or minimal residual disease in axilla and hence axillary dissection may be avoided in them.

Feasibility of acute thrombolytic therapy for stroke.

BACKGROUND: Thrombolysis is an expensive medical intervention for ischemic stroke and hence there is a need to study the feasibility of thrombolysis in rural India. Aims: To asses the feasibility and limitations of providing thrombolytic therapy to acute ischemic stroke patients in a rural Indian set-up. MATERIAL AND METHODS: The first 64 consecutive patients registered under the Acute Stroke Registry in a university referral hospital with a rural catchment area were studied as per a detailed protocol and questionnaire. RESULTS: Of the 64 patients 44 were ischemic strokes, and 20 were hemorrhagic. Thirteen (29.55%) patients with ischemic stroke reached a center with CT scan facility within 3 hours, of whom only 7 (15.91%) were eligible to receive thrombolytic therapy as per the existing clinical and radiological criteria, but none received the therapy. Of the remaining 31 (70.45%) who arrived late, 11 (25%) had no clinical and radiological contraindications for thrombolysis, except the time factor. All the patients belonged to a low socioeconomic status and a rural background. CONCLUSION: Though a large proportion of ischemic stroke patients were eligible to receive thrombolytic therapy, the majority could not reach a center with adequate facilities within the recommended time window. More alarmingly, even for those patients who reached within the time window, no significant attempt was made to initiate thrombolysis. These data call not only for attention to improve existing patient transport facilities, but also for improving the awareness of efficacy and therapeutic window of thrombolysis in stroke, among the public as well as primary care doctors.

5-fluorouracil-Induced cardiotoxicity.

Cardiotoxicity due to antineoplastic agents such as doxorubicin, daunorubicin, cyclophosphamide, vincristin, vinblastin, cisplatin and busulfan is well known. However, 5-fluorouracil-induced cardiotoxicity is yet to be widely recognized by cardiologists. We report a patient who developed 5-fluorouracil-induced cardiotoxicity syndrome.

Role of operative flexible choledochoscopy in calculous biliary tract disease.

BACKGROUND: In India, no study is available regarding the use of operative choledochoscopy in the management of choledocholithiasis. ERCP facilities are not always available at many centres and usually require the expertise of a medical gastroenterologist. In contrast, operative choledochoscopy is a simpler procedure that can easily be learned and practised by many surgeons at the time of CBD exploration. AIMS: To study the role of the flexible choledochoscopy in the diagnosis and management of calculous biliary tract disorders. METHODS: Twenty four patients with choledocholithiasis underwent flexible choledochoscopy. Stones were removed either with Desjardin's forceps or by choledochoscopic instrumentation. Postoperative T-tube cholangiography was done to detect any retained stones. RESULTS: Flexible choledochoscopy was performed in a total of 24 patients. Choledochoscopy was done through a choledochotomy in 23 and through the cystic duct in one patient. The choledochoscope was used following conventional CBD exploration in 18 of the 23 patients. Complete clearance of stones was confirmed by choledochoscopy in 12 of the 18 patients and additional stones were seen in the remaining 6 patients. Fogarty balloon catheter and Dormia forceps were used to extract these stones. A CBD stricture was seen in 4 of these 18 patients and choledochoscopic biopsy was done in one of them. In 5 of the 23 patients, the choedochoscope was used as the initial exploring instrument. Impacted CBD stones were detected in 3 of the 5 patients, external compression of the CBD due to periampullary carcinoma in one and stones in both the ampulla and common hepatic duct in the last patient. Postoperative T-tube cholangiography was done in 10 patients and did not reveal any retained stones. Drainage procedures were carried out in 13 patients: 11 had choledochoduodenostomy and 2 had transduodenal sphincteroplasty. Choledochoscopy was a direct aid in choosing the operative procedure in 21 patients. CONCLUSIONS: Flexible choledochoscopy is the most effective method of CBD exploration and is essential in all patients with choledocholithiasis. No additional morbidity or mortality is caused by this procedure.

Hepatic artery mycotic aneurysm of tubercular aetiology.

Hepatic artery aneurysm caused by tuberculosis is extremely rare, the commonest being atherosclerosis and vasculitis. A 13 year boy admitted with suspected disseminated tuberculosis had a hepatic bruit. Patient died of aneurysmal rupture before antemortem etiological diagnosis could be established. Postmortem examination revealed widespread tubercular lesions in the chest and abdomen and hepatic artery aneurysm.

Bone changes in leprosy patients with disabilities/deformities (a clinico-radiological correlation).

One hundred and ten leprosy patients (96 males and 14 females, mean age 45.3 years) with disabilities/deformities were examined radiologically to evaluate bone changes and correlating them with clinical parameters. Most patients (98) had paucibacillary leprosy. The mean duration of leprosy was 7.4 years and that of deformity was 4.1 years. Ten patients presented with reaction. Seventy-five (68.2%) patients had received a full course of antileprosy treatment. The overall prevalence of bone changes was 87.3% (96 patients); specific, non-specific, osteoporotic and facial changes were seen in 44.5%, 75.5%, 38.2% and 9.1% of the patients respectively. Among the specific bone changes, primary periosteitis (28.2%) and "bone cysts" (22.7%) were the more common findings. Among the non-specific bone changes, terminal phalangeal absorption (48.2%), soft tissue changes (44.5%) and concentric absorption (32.7%) were more common. Specific bone changes showed a significant (P < 0.05) increase with lack of or incomplete antileprosy treatment. Non-specific bone changes showed significant correlation (P < 0.05) with increasing duration of disease, lack of or partial treatment and rising disability index. Osteoporotic changes showed a significant relationship with rising disability index.

Twin fetus in fetu.

Fetus in fetu is a rare cause of intra-abdominal mass. The presence of vertebral and skeletal axis differentiates it from a teratoma. We report an unusual case of two well developed fetuses in the retroperitoneal area of a neonate delivered at term.