Feasibility study of stroke surveillance: Data from Bangalore, India.

Background & objectives: Stroke is a leading cause of deaths, and disabilities in India. Reliable and good quality data on epidemiological characteristics of stroke are essential to plan, implement and evaluate stroke prevention and control programmes. A feasibility study was undertaken in Bangalore to examine the possibility of establishing stroke surveillance and to develop methodology for a larger programme. Methods: The study adapted WHO STEPs-STROKE methodology to collect data on hospitalized stroke events and fatal stroke events in the city of Bangalore. In STEP I, Information was collected from 1,174 stroke patients in three large hospitals and were followed till discharge and 28 days; outcome was measured as death or disability. Stroke cases fulfilling diagnostic criteria, evaluated by neurologists and CT/MRI confirmed cases were included. Brief information on major risk factors was collected from all stroke patients / family members and from medical records by trained research officers. In STEP II, death records of Bangalore Mahanagara Palike for 2004 (n=23,312) were analyzed to identify stroke related deaths. Results: Using WHO-STEPs approach, a methodology was developed for stroke surveillance in a geographically defined population. By STEP 1 method - 7 per cent of medical and 45 per cent of neurological admissions were due to stroke with a fatality rate of 9 per cent at hospital discharge and 20 per cent at 28 days. With a mean age of 54.5 (± 17.0) yr and male preponderance, nearly half had one or more risk factors. Weakness or paresis (92%) was the commonest presentation and ischaemic stroke was most frequent (73.8%). One third of total stroke patients were dependent at both discharge and 28 day follow up. By STEP II method the proportional mortality rate for Bangalore city was observed to be 6 per cent and more than 50 per cent of total stroke deaths had occurred in 10 major hospitals. Interpretation & conclusions: The present study has shown that stroke surveillance is possible and feasible. Institution based (hospitals and vital registry data) stroke surveillance supplemented with periodical population based information can provide comprehensive information on vital aspects of stroke like mortality, risk factors, disability and outcome. There is a need to develop stroke surveillance in a phased manner along with mechanisms to apply data for prevention and control programmes.

Hemothorax--a rare presentation of congenital strangulated diaphragmatic hernia.

We report the case of a 7 years old previously asymptomatic child who initially presented with respiratory distress because of massive left-sided hemothorax but was subsequently diagnosed to be having strangulated small intestine through a diaphragmatic rent on laparotomy. The case is being discussed in detail and the possible causes of hemothorax in such a scenario discussed.

A pilot survey on hand washing among some communities of West Bengal.

A cross-sectional observational study was carried out between April to May 2006 by interview method and observation technique with the objective to know the knowledge regarding hand washing in the community and it was done in the slum and nonslum urban areas and also one rural area. The result shows that in urban slum area 98% washed their hands with soap after defecation; Only 36%, 16% and 2% washed their hands with soap before meal, before serving food and before cooking respectively. However, it was observed that 69% used soap and water for hand washing after cleaning the child's faeces. In rural area 71% used soap and water after defecation while 26% used mud or ash. Only 13%, 1%, 1% and 5% used soap and water before meal, before serving food, before cooking and after cleaning the child's faeces. 82.35% of respondents in non slum area and 89% of respondents in rural area considered that diarrhoea and dysentery could be prevented by hand washing while they did not give importance to hand washing in prevention of diarrhoea over other methods like cleanliness, boiling and purification of water. ARI was much higher (25.72%) in rural area followed by slum area (13.77%) and non-slum area (3.87%). Out of 30 observations among 302 interview made on hand-washing only first step i.e. palm washing (transient rubbing the palm with soap) was followed by all the participants observed. Time taken for such hand-washing was only around five seconds (ideal 15-30 seconds) in urban slum and rural areas while in non slum area it varied between 7-10 seconds on an average. No one followed any other steps of hand-washing, recommended by IFH.

A study of epilepsy-related psychosis.

The association of epilepsy and psychosis is studied. Among the 500 patients of epilepsy evaluated, there were 12 patients, 8 males and 4 females with epilepsy-related psychosis. Their average age was 38 years. The interval between the age of onset of epilepsy and psychotic features was 9 years. Complex partial seizures were present in 7 patients and primary generalized tonic-clonic seizure was present in 1 patient. Four patients had post-ictal psychosis, 7 had acute interictal psychosis and 1 patient had chronic psychosis. The inter-ictal and chronic psychoses were schizophreniform whereas the post-ictal psychoses were not. EEG showed a temporal focus in 7 patients with complex partial seizures and an extra-temporal focus was identified in 4 out of the other 5 patients. Imaging (CT scan/MRI) revealed abnormalities in 10 patients. This study attempts to define the characteristics of psychoses occurring in epileptics.

Prevalence of photosensitivity--an Indian experience.

One thousand nine hundred and forty newly recruited entrants for training as pilots (Group A) underwent photic stimulation during EEG recording during the entrance examination to the flying stream. One hundred and sixty individuals (Group B) working on radars for prolonged periods were interviewed for eliciting complaints referable to photosensitivity and were subjected to EEG. EEGs in respect to 1000 cases (Group C) of known epilepsy were examined for the incidence of a photosensitive response. The study has revealed that 14 cases (0.72%) in group A had an abnormal response to photic stimulation out of which one case developed seizure during EEG recording. One case (0.62%) in group B and 30 cases (3%) in group C were detected to have photosensitivity. The maximum response was seen at 20 Hz stimulation. The prevalence of photosensitivity and its manifestations in these groups indicates that this condition is not uncommon.

Post-cardiorespiratory arrest beta-alpha coma: an unusual electroencephalographic phenomenon.

The presence of frontally-dominant alpha pattern in the EEG is common in patients with coma due to trauma, toxic-metabolic causes and following cardiorespiratory arrest. Diffuse beta activity following resuscitation after a cardiac arrest is not well recognized. We report a case of coma in a 3-year-old girl who had a cardiac arrest from which she was revived. Initial EEG showed diffuse beta activity, which later evolved to predominantly alpha activity. The possible mechanisms involved in the generation of such rhythms are discussed. Transition of EEG activity from faster to slower frequencies is suggested as an adverse prognostic factor in post-cardiorespiratory arrest coma.

Relevance of computerized electroencephalographic topography (brain mapping) in ischemic stroke.

BACKGROUND AND AIMS: Computerized electroencephalographic topography (CET) (brain mapping) is a non-invasive, spatially oriented procedure for depicting amplitude and frequency patterns by two-dimensional color-coded frequency and amplitude display of the electroencephalograph (EEG). MATERIAL AND METHODS: We prospectively studied the relationship between CT scan lesions, conventional EEG and brain mapping in 40 patients with ischemic stroke within 1 week of onset. EEG and brain mapping was done within 24 hours of doing CT scan. RESULTS: There were 32 males and 8 females and the mean age was 56 years (range 27-75 years). CET/EEG was normal in 2 patients with capsular infarct. Brain mapping showed abnormalities (most commonly low-frequency high-amplitude changes) in 95% of patients, whereas EEG abnormalities were seen in only 40%. Brain mapping abnormalities were appropriate to the side of the CT scan lesion in 20 (52.63%) patients and were present bilaterally n 18 (47.37%) patients. Brain mapping abnormalities were ipsilateral to the side of the CT lesion when the lesion was < 2 cm in diameter and they were bi-hemispherical when the CT lesion was > 2 cm in diameter. CONCLUSIONS: There was no correlation between motor deficits and brain map abnormalities.

Nadroparin plus aspirin versus aspirin alone in the treatment of acute ischemic stroke.

Low-molecular-weight-heparin (LMWH) has been widely used in the treatment of acute ischemic stroke but controlled trials are few. In this study, 40 patients with acute ischemic stroke of less than 24 hours duration were randomized to receive either aspirin (325 mg/day) alone or aspirin (325 mg/day) plus subcutaneous nadroparin 4100 units/day. At the end of 4 weeks, the morbidity and mortality were significantly less in the nadroparin group as compared to the aspirin group. There was no increased risk of clinically significant intracranial hemorrhage in either group. The combination of aspirin and LMWH deserves to be tested in larger studies.

Chasing hyponatraemia: unusual presentation.

Two females, in their sixth decade, presented with recurrent episodes of headache, vertigo, vomiting and altered sensorium. Both patients had persistent hyponatraemia as the only clue. Detailed investigations revealed a pituitary aetiology in both. One patient had a pituitary microadenoma while the other had an empty sella syndrome. The diagnosis and management is discussed and the relevant literature reviewed.

Cytogenetic study of primary amenorrhoea.

A study of chromosomal pattern was done in 60 cases of primary amenorrhoea of different age groups to determine the incidences of chromosomal abnormalities in them and to detect those cases of classical 45, X Turner's syndrome and Turner mosaics that do not bear the Turner stigmata. Buccal smears were examined for sex chromatin followed by karyotype using leucocyte culture method. Majority (63.3%) of cases were found chromosomally incompetent of which the major abnormality was 45, X/46, XX mosaicism (33.3%) followed by 45, X Turner's syndrome (26.6%). But only 43.7% of these Turner's syndrome had classical Turner stigmata. Two cases of complete testicular feminisation syndrome with male genotype (46,XY) and inguinal testis were also detected.

Albendazole therapy for neurocysticercosis.

Based on clinical evaluation and computed tomography (CT) of the brain, 30 cases of neurocysticercosis were diagnosed. Diagnosis was supported by presence of histopathologically proven subcutaneous cysticerci in 12 cases. Three primary neurological syndromes were established i.e. epilepsy in 22 cases, increased intracranial tension in 6 cases and meningoencephalitis in 2 cases. Albendazole was administered orally in a dose of 15 mg/kg bodyweight/day for 30 days without prophylactic steroids. Follow up CT study at 3 months and 12 months revealed complete regression of all lesions in 2 cases, partial regressions in 14 cases and change in morphology in 4 cases. Transient appearence of fresh subcutaneous cysticerci as a side effect of therapy was noted in 4 cases. Albendazole, though acting slow, is considered a suitable alternative to praziquantel in medical management of parenchymal neurocysticercosis.

Zinc supplementation in protein energy malnutrition.

A pair-matched controlled study was done with 30 children (15 males, 15 females) of mild to moderate PEM in test and equal number in control groups, aged 8-24 months old. At the beginning, in both test and control groups parents were advised to provide sufficient amount of home cooked foods so that the child received on an average 100-150 Kcal/kg/day of energy and 2-3 g/kg/day of protein. Vitamin supplements were provided to all children in both groups. In addition, the test group received a supplementation of 5.625 mg of elemental zinc daily orally while controls received a placebo. Evaluation at the end of 3 months showed that children in test group had a weight gain of 3.742 +/- 0.488 kg against 2.035 +/- 0.383 kg of the control group. Similarly, weight velocity was 5.752 +/- 0.818 g/kg/day in test group against 3.153 +/- 0.617 g/kg/day of the control group. These differences in weight gain and weight velocity were highly significant (p < 0.001). Serum zinc levels, initially and at the end of study were 87.5 +/- 9.6 micrograms/dl and 121.0 +/- 10.1 micrograms/dl, respectively in test group in comparison to 91.2 +/- 9.8 micrograms/dl and 91.0 +/- 10.1 micrograms/dl in controls. This difference was also highly significant (p < 0.001). The daily total calorie intake remained comparable in both groups. Our observations suggest that zinc supplementation during nutritional rehabilitation of mild to moderate PEM hastens the recovery.

Study of photodynamic reactions of p-nitroacetophenone using ESR and optical techniques.

The photosensitizing properties of p-nitroacetophenone (PNAP), a well-known radiosensitizer, have been studied in near UV region. The mechanism of PNAP photosensitization has been investigated by testing the efficiency of singlet oxygen production using photooxidation of 2,2,6,6-tetramethylpiperidine (TEMP) and photodegradation of guanosine. In both the cases, the enhancement effect of deuterated solvents has been observed. Results of these experiments suggest the significant role of type II mechanisms in PNAP photosensitization.