Trends in Stroke Presentations before and during the COVID-19 Pandemic: A Meta-Analysis / 대한뇌졸중학회지

Background@#and Purpose There are reports of decline in the rates of acute emergency presentations during coronavirus disease 2019 (COVID-19) pandemic including stroke. We performed a meta-analysis of the impact of COVID-19 pandemic on rates of stroke presentations and on rates of reperfusion therapy. @*Methods@#Following the Meta-analysis Of Observational Studies in Epidemiology (MOOSE) guidelines, we systematically searched the literature for studies reporting changes in stroke presentations and treatment rates before and during the COVID-19 pandemic. Aggregated data were pooled using meta-analysis with random-effect models. @*Results@#We identified 37 observational studies (n=375,657). Pooled analysis showed decline in rates of all strokes (26.0%; 95% confidence interval [CI], 22.4 to 29.7) and its subtypes; ischemic (25.3%; 95% CI, 21.0 to 30.0), hemorrhagic (27.6%; 95% CI, 20.4 to 35.5), transient ischemic attacks (41.9%; 95% CI, 34.8 to 49.3), and stroke mimics (45.6%; 95% CI, 33.5 to 58.0) during months of pandemic compared with the pre-pandemic period. The decline was most evident for mild symptoms (40% mild vs. 25%–29% moderate/severe). Although rates of intravenous thrombolytic (IVT) and endovascular thrombectomy (EVT) decreased during pandemic, the likelihood of being treated with IVT and EVT did not differ between the two periods, both in primary and in comprehensive stroke centers (odds ratio [OR], 1.08; 95% CI, 0.94 to 1.24 and OR, 0.95; 95% CI, 0.83 to 1.09, respectively). @*Conclusions@#Rates of all strokes types decreased significantly during pandemic. It is of paramount importance that general population should be educated to seek medical care immediately for stroke-like symptoms during COVID-19 pandemic. Whether delay in initiation of secondary prevention would affect eventual stroke outcomes in the long run needs further study.

Variability in the therapeutic response of metformin treatment in patients with type 2 diabetes mellitus

Objective: To assess the glycemic response of metformin in patients with Type-2 Diabetes Mellitus [T2DM] as well as to see its association with reductions in BMI and GIT intolerance

Methods: This Quasi, Experimental study was conducted at Jinnah-Allama Iqbal Institute of Diabetes and Endocrinology [JAIDE] Jinnah Hospital, Lahore from 1st March 2016 to 30th September 2016. Newly diagnosed T2DM patients were given metformin for duration of three months and later on they were categorized into Responders and Non-Responders on the basis of HbA1c [A1C] reductions, which were estimated by Hemoglobin [A1C] analyzer [TD4611A TAIDoc Tech. Taiwan] through photometry. Similarly, baseline BMI and BMI after three months therapy with metformin was also recorded

Results: Among total of 200 patients, 40.5% of the patients were classified as Non-Responders whereas; 59.5% of the patients as Responders. The baseline BMI [26.09 kg/m2] was also decreased significantly after metformin therapy [25.40 kg/m2]. It was found that metformin reduced the A1C in all the patients. However, the glycemic control was much better in patients with higher baseline A1C [1.13% ± 0.08] as compared to lower baseline levels [0.61% ± 0.07]. Regarding GIT intolerance, 140 patients lacked the symptoms, out of which 60.7% were responders and 39.3% were non-responders

Conclusions: Metformin lead to improvement in glycemic control in 59.5% of newly diagnosed T2DM patients after taking metformin for three months but in 40.5% it did not which may be because of combined effects of various gene polymorphisms and their interaction with non-genetic factors. Metformin reduced the BMI in all the patients; however, BMI lowering activity of metformin was same regardless of its effect on HbA1C. Moreover, the signs and symptoms of GIT intolerance did not differ between the two groups

syndrome of diabetic amyotrophy: a preventable disaster?

Diabetic amyotrophy is a disabling syndrome that frequently has a difficult or delayed clinical recognition. It is characterised by lancinating pain followed by muscle weakness, usually in the hip and thigh. The disease predominantly occurs in elderly patients and causes significant morbidity. Although a detailed history and neurologic examinations are helpful, electrodiagnostic testing yields accurate diagnosis in most of the cases. Herein, we chronicle the case of a young patient who developed profound diabetic amyotrophy within five years after the onset of type 1 diabetes mellitus. Furthermore, this report highlights the preventive as well as therapeutic role of strict glycemic control, warranting population-based monitoring and education of patients for diabetic amyotrophy, especially in Pakistan

Thrombolysis in the treatment of acute stroke: is there a role for streptokinase when tissue plasminogen activator is not available?

Every year 350,000 people suffer an acute stroke in Pakistan. Treatment of acute stroke has not improved significantly despite the availability of intravenous thrombolysis with tissue plasminogen activator [tPA].The drug is expensive and is offered to a selected few. Streptokinase [SK], a low cost alternative thrombolytic agent, is widely available in Pakistan and is utilized to treat patients with acute coronary syndromes. Streptokinase was tested in acute stroke in the 1980's and found to be ineffective in ischemic stroke. This is likely due to trial design flaws, rather than the drug itself. Factors that may have contributed to poor outcomes include a prolonged treatment window, inclusion of patients with established infarction on CT scan, failure to treat excessive arterial pressures, a fixed dose of streptokinase and concomitant use of antithrombotic medications. Given the lack of therapeutic alternatives we believe that a properly designed trial in appropriate patient population utilizing stricter inclusion criteria, including early treatment with a lower dose of SK is warranted

Relationship of thyroid-stimulating hormone with metabolic syndrome in a sample of euthyroid Pakistani population

Background: Metabolic Syndrome is a group of factors that predispose to cardiovascular diseases. The prevalence of metabolic syndrome is rising rapidly. Recently, a few studies have suggested that lower thyroid function in the reference range may be associated with metabolic syndrome, but the issue remains unsettled. We aimed to elucidate the relationship between thyroid function and components of metabolic syndrome in a sample of euthyroid Pakistani population. Methods: This nalytical, cross-sectional study was conducted at the Department of Physiology, University of Health Sciences, Lahore, Pakistan, and extended over a period of 12 months. It included 100 subjects with metabolic syndrome in the study group and thirty subjects without metabolic syndrome in the control group with age ranging 45–55 years. Both groups had normal thyroid function. After a detailed history and clinical examination, fasting blood was analysed for glucose, triglycerides, high density lipoprotein-cholesterol along with thyroid-stimulating hormone [TSH] and free thyroxine. Results: Serum TSH was significantly higher in study group than in control group [p=0.040]. Serum free thyroxine values of study group were slightly but not significantly lower than those of control group. Serum TSH correlated significantly and positively with serum triglycerides in all subjects and with waist circumference and diastolic blood pressure in men. Serum TSH showed a positive and linear relationship with the number of components of metabolic syndrome [p=0.016] in all subjects. Conclusion: High-normal TSH is associated with metabolic syndrome and its components. There may be increased risk of cardiovascular diseases with high-normal TSH levels. Keywords: Thyroid Stimulating Hormone, Metabolic Syndrome, Euthyroid