Stroke Characteristics as Predictors of New-onset Seizure in Patients with Acute Ischemic Stroke

Introduction: The current guidelines on diagnosis and management of new-onset seizures in stroke are not well defined, especially in the Indian setting. Our study aims at providing insight into the hospital prevalence risk of new-onset seizures following ischemic stroke and to correlate seizure risk with the characteristics of stroke and other clinical parameters. Methods: A total of 127 patients were analyzed for the study where we assessed the clinical severity and the imaging severity of stroke using the National Institute of Health Stroke Scale (NIHSS) score and Alberta Stroke Program Early CT (ASPECT) score, respectively. Seizure-related variables including semiology, timing, and details of antiepileptic drugs (AEDs) were assessed under the domain of early and late poststroke seizures (PSSs). All patients were followed for 6 months for the seizure recurrence and change in Barthel index. In statistical analysis, quantitative variables were compared using the independent t-test/Mann–Whitney U test, and qualitative variables were correlated using Chi-square test/Fisher’s exact test. Univariate and multivariate logistic regression was used to find out the significant risk factors of acute symptomatic seizure. Results: The mean age of the study population was 59.72 years (±14.77), with a male predominance (60.63%). About 78.74% of the cases had an NIHSS score more than or equal to 6.24% had posterior circulation strokes and the rest had anterior circulation strokes. A cortical location of infarct was observed in 62.2% of cases and a subcortical location in 61.4% of cases. The prevalence of early PSSs observed in our study was 10.6%. Of those, 80% had generalized seizures, 13.3% had focal seizures, and 6.67% had focal seizures with secondary generalizations. No patient in the study group had late-onset seizures. Total leukocyte count, serum protein levels, serum uric acid levels, and erythrocyte sedimentation rate (ESR) values were associated with early seizures (p<0.05). Patients with early seizures were found to have a longer hospital stay (8 vs 6 days with p<0.05). In the Trial of Org 10,172 in Acute Stroke Treatment (TOAST) etiological classification, an acute stroke of undetermined etiology was found to have a significant association with the occurrence of early seizure in both univariate and multivariate analysis [p = 0.030; odds ratio (OR) 4.735 (1.160–22.576)]. There was no difference in change in the Barthel index among the two groups. Conclusion: There was no recurrence of seizures in those who defaulted for AED and one patient had a seizure even on AED. Prophylactic AEDs in stroke patients based on stroke characteristics could not be ascertained, but the sample size was small. Knowing the fact that antiepileptics cause sedation and increase the chance of aspiration, continuing AEDs in patients who develop acute symptomatic seizures should be judged judiciously.

Autonomic Function Tests in Prehypertensive Young Adult Males of Uttarakhand Region.

Pre-hypertensives are at increased risk for rise in blood pressure and cardio vascular morbidities. Autonomic dysfunction is both a cause and effect of high blood pressure. Considering its serious prognosis the current study was undertaken with an aim to assess autonomic functions in pre-hypertensive young adult males. Male volunteers of 20-40 years were divided into normotensives (n=44) and clinically healthy pre-hypertensives (n=44). They were subjected to anthropometric measurements, Heart Rate variability (HRV) analysis along with Standard Isometric Handgrip Test (HGT) and Sinus arrhythmia test. Analysis showed a significant increase in sympathetic activity among prehypertensives characterized by lower rise in DBP (mmHg) in response to HGT: [11.27±3.76 mmHg vs 23.95±6.29 mmHg, (p<0.05)]. Parasympathetic activity was significantly decreased among prehypertensives (HFnu: 30.02±14.43 vs 41.62±14.91, p<0.05); E/I ratio: 1.20±0.10 vs 1.32±0.10, p<0.05). Sympathovagal balance showed prominent sympathetic activity (2.85±1.78 vs 1.75±0.98; (p<0.01) among prehypertensives. Salt intake among prehypertensives was significantly higher than normotensives (21.2±1.2 gm/day vs 9.0±0.5 gm/day: P<0.001). Conclusion: Autonomic dysfunction is evident in prehypertensives with an enhanced sympathetic activity, decreased parasympathetic activity and an altered sympathovagal balance in prehypertensives, salt intake was found on a higher side. Thus lifestyle changes in the form of balanced diet and moderate exercise may be advised to attenuate the risk progression of prehypertension to hypertension.

Effect of mobile usage on serum melatonin levels among medical students.

Exposure to extremely low frequency (ELF) electromagnetic radiations from mobile phones may affect the circadian rhythm of melatonin in mobile users. The study was designed with objective to evaluate the influence of mobile phone on circadian rhythm of melatonin and to find the association if any between the hours of mobile usage with serum melatonin levels. All the volunteers medical students using mobiles for > 2 hrs/day were included in high users group and volunteers who used mobile for ≤ 2 hrs where included in low users group. Both high and low users volunteers were sampled three times in the same day (Morning- 3-4 am, Noon 1-2 pm, Evening-5-6 pm) for estimation of serum melatonin levels. Comparsion of sernum melatonin levels in high users and low users were done by Mann Whitney “U” Test. Reduced morning melatonin levels (3-4 am) was observed in high users (> 2 hrs/day) i.e high users had a disturbed melatonin circadian rhythm.There was a negative correlation between melatonin secretion and hours of mobile usages.

Gender correlation of stress levels and sources of stress among first year students in a medical college.

Medical courses in India are very demanding for the students thus making career in medical education very stressful. The study was designed to determine the prevalence of stress levels in 100 first year medical students and to explore the sources of stress & it‘s relationship across the male and female students. Demographic information and Qualitative data from investigator tailored Medical Student Stress Questionnaire (MSSQ) by self rating under supervision of investigators were subjected to a thematic analysis. Stress perceived was more in males students (82.2%) as compared to females (61.8%) and their MSSQ index score was significantly different (U=985; P=0.02). Moderate to high academic stress was present among 79% of students more so in males with the academic domain score significantly different from that of females (U=883; P=0.007). Females perceived more stress in inter personal domain (12.7%) with the score significantly different from males (U=953.5; P=0.02). Group and Teaching stress was equally present in males and females.

Mobile usage and sleep patterns among medical students.

Exposure of humans to radio frequency electromagnetic field (EMF) both during receiving and transmitting the signals has amplified public and scientific debate about possible adverse effects on human health. The study was designed with the objective of assessing the extent of mobile phone use amongst medical students and finding correlation if any between the hours of usage of mobile to sleep pattern and quality. hundred medical students grouped as cases (n=57) (>2 hours/day of mobile usage) and control (n=43) (≤2 hours/day of mobile usage) were examined for their sleep quality & pattern by Pittsburg sleep Quality Index (PSQI). Differences between groups were examined with the Mann Whitney “U” test for proportions (Quantitative values) and with Student‘t’ test for continuous variables. The association of variables was analyzed by Spearman Rank’s correlation. Probability was set at <0.05 as significant. Sleep disturbance, latency and day dysfunction was more in cases especially females. A significant association of hours of usage and sleep indices were observed in both genders (males r=0.25; p=0.04, females r=0.31; p=0.009). Evening usage of mobile phone in cases showed a statistically significant negative association (–0.606; p=0.042) with Sleep quality (higher PSQI means sleep deprivation). Students using mobile for > 2 hours/day may cause sleep deprivation and day sleepiness affecting cognitive and learning abilities of medical students.

Effect of formalin vapours on pulmonary functions of medical students in anatomy dissection hall over a period of one year.

Formalin is extensively used for preservation of cadavers in department of Anatomy. However it is a noxious chemical which vaporises at normal room temperature in the air and may cause respiratory health problems among first year medical students. The study was planned to observe the effect of formalin vapours on lung function tests of first year medical students who are exposed routinely for 2 hrs every day for 6 days per week throughout the year. Following written informed consent clinically healthy 100 medical students between age group 18-23 yrs were subjected to pulmonary function testing by computerised spirometery. The dynamic lung function tests (FVC, FEV1, FEV1%, FEF25-75, PEFR) were measured on four occasions-basal (before exposure), 1 month, 6 months, 11 months of exposure to formalin vapours in anatomy dissection hall. The study revealed statistically significant (P<0.0001) decreases in FVC, FEV1%, FEF25-75, PEFR except FEV1 after 1 month of exposure to anatomy dissection hall. The decrease in all the parameters slowly reverted back towards normal basal values across 6 and 11 months and was statistically significant in all (P<0.0001) except FVC. Acute exposure to formalin vapours at anatomy dissection hall decreases the respiratory functions, however on long term exposure the body corrects the damage. Further studies are required to see the changes at cellular levels and the extent of damage to respiratory system.

Effect of Dolichos Biflorus on Blood Sugar and Lipids in Diabetic Rats.

Diabetes mellitus is a chronic disease characterized by hyperglycemia and dyslipidemia, which leads to severe morbid complications. In view of the effectiveness of conventional herbal adjutants the present study was taken to assess the anti-diabetic and anti-lipidemic effect of Dolichos biflorus. 32 healthy albino rats of either sex were randomly divided into 4 equal groups (I–IV) each having 8 rats. Group I, control rats received only vehicular fluid while Group II received only Dolichos biflorus for the experimental period of 30 days. Diabetes was induced in Group II and Group IV rats by single intravenous dose of STZ and confirmed on 3rd day with fasting blood sugar (FBS) more than 250 mg/dl. Group III diabetic rats, received vehicular fluid while Group IV diabetic rats received Dolichos biflorus in single dose of 300 mg/kg body weight/day intra-gastrically up to the experimental period of 30 days. FBS levels were assessed on 1st, 8th, 15th, 22nd and 30th day. On last day overnight fasted rats were sacrificed for drawing the sample for lipid profile from beating heart and harvested for pancreatic tissue histology. Data obtained showed that FBS levels were decreased significantly when Dolichos biflorus was given to diabetic rats from mean±SD values 362±63.36 to 118±38.55 with p value < 001.S cholesterol and S. triglyceride levels were also decreased significantly with P value < 001. It was concluded that Dolichos biflorus has anti-diabetic and anti-lipidemic effect at daily oral dose and can be used as an adjuvant for management of diabetes mellitus and its associated complications.

Clinical validation of aneroid sphygmomanometer.

Recent concerns about the mercury toxicity and its ill effects on the environment and health has led to widespread use of aneroid manometers. Present study was conducted to analyse whether this change would lead to any systematic shift in measured blood pressure or consistency of blood pressure measurement in clinical setting. The clinical accuracy of the Welch Allyn aneroid sphygmomanometer model 7670-04 was studied against the mercury sphygmomanometer on 83 volunteers from Dehradun. Two blood pressure reading of each study subject was recorded with pretested instruments (aneroid and mercury sphygmomanometer). Data analysis showed the difference of means between the reading of two devices against mean of the observer reading for both systolic (-3.62±4.88) and diastolic (-2.36±3.77) blood pressure were not statistically different. The corresponding values of the SBP and DBP from both the instruments showed significant correlation. Regression analysis of mercury versus aneroid showed regression line (Y = 9.52 + 0.95X for SBP, Y = 0.36 + 0.96X for DBP) significantly different from line of equality (P<0.001). The study has demonstrated that the aneroid device (model: 7670-04) achieved grade B performance according to the British Hypertensive Society criteria.

Effects of curcumin on the gastric emptying of albino rats.

Curcumin (diferuloylmethane), a polyphenol, is an active principle of the perennial herb Curcuma longa commonly known as turmeric. Turmeric (CURCUMA LONGA L.) is a medicinal plant extensively used in Ayurveda, Unani, and Siddha medicine as a home remedy for various diseases including biliary diseases, cough, hepatic diseases, wound healing. However studies on the effect of curcumin on the gastric emptying are nearly nonexistent. It is hypothesized that curcumin may have an effect on gastric emptying. For this reason the present study was aimed to study the effect of curcumin on gastric emptying. Rats were divided into 5 groups (Group I – Group V), based on the time interval between administration of curcumin/vehicular fluid to administration of barium sulphate (Group I – 1 hr, Group II – 8 hrs, Group III – 16 hrs, Group IV – 24 hrs, Group V – 48 hrs). Each group was further divided into two subgroups, Group A (control) and Group B (experimental), containing 6 rats each. Rats in experimental group were administered curcumin intragastrically, in the dose of 1 gm/kg body weight, suspended in normal saline (0.9% NaCl). The controls were given vehicular fluid intragastrically, in volume equal to the experimental animals. It was observed that there was a decrease in the gastric emptying in all the experimental groups.

Effect of gender on correlation of anaemia with body mass index in medical students.

: Nutritional anemia exists globally and cuts across all the sections of the population. Adolescent being formative years in life are more susceptible to nutritional anemia. Considerable changes in growth pattern, lifestyle, dietary habits & behavior are likely to influence the hemoglobin levels among male and females of high income group. Study was done to assess the level of anemia among medical students and it’s relation to Body mass index (BMI) among medical students. 200 healthy medical students at the Himalayan Institute of Medical Sciences belonging to both the sexes were taken in the study. Following consent anthropometry was conducted using standard protocol. Body Mass Index of >/= 18.5 kg/m2 is used to define undernutrition. Hemoglobin was estimated in gram %. Statistical analyses was done using mean .Standard deviation, Student’s t test, and was studied for effect of gender on correlation of anemia with BMI. 8% of the students of MBBS were found to be anemic (Hb <12 g%) with none of the boys having hemoglobin <12 g% .15.5% under nutrition was observed in the medical students with (25.75%) of girls having a BMI of <18.5 kg/m2. A negative association of hemoglobin was found with nutritional status (BMI) (r = –0.59; P = 0.24) in over weight and obese females students. Nutritional anemia and under nutrition exist among female medical students who are literate, and have free access to the nutritive diet in a good healthy environment.

Effects of vincristine on the bile flow in male albino rats.

Bile secretion is an important function served by the liver. The microtubular system integrity plays a key role in hepatic transport and excretion of several of bile constituents including phospholipids & cholesterol as well as detoxified xenobiotics. Furthermore, an alteration in bile secretion has been proposed as an important cause of enteritis, also a complication of microtubular inhibitors like Vincristine (VCR) that may occur following treatment as an anti cancer drug. The study aims to study the effects of microtubule inhibitor VCR on bile flow and bile composition in rats. For this purpose, male albino rats were studied. One group of five rats was infused with single IV dose of VCR (@1 mg/kg and the other received equal volume of IV vehicular fluid. For bile samples, animals were cannulated, bile flow examined at different time intervals before and after drug administration. Biliary composition studied at second hour post i/v administration. Single dose VCR treatment showed significant rise in the baseline excretion of bile in animals studied during first 2 hrs, although, there was a mild reduction in the biliary flow rate after few hours. Biliary total cholesterol was decreased and cation concentrations increased significantly in the second hour post VCR. The results indicate that the exposure of rats to VCR induces early alterations in biliary secretion. This study may prove useful for the purpose of understanding enteritis in patients undergoing chemotherapy.

Adiposity: Determinant of peak expiratory flow rate in young Indian adults male.

Background. Although several factors such as respiratory muscle strength, lung compliance, resistance to airflow, and even obesity affect the lung functions, the nature of relationship with markers of adiposity is not clear. We hypothesised that central pattern of fat distribution is a significant predictor of decreased peak expiratory flow rate (PEFR). The present study was designed with the aim to examine the effects of adiposity on PEFR in males. Methods. One hundred young healthy male volunteers were analysed in the study. They were classified into non-obese, and obese groups based on body mass index (BMI) (obese ≥30Kg/m2 and non-obese <30Kg/m2). The PEFR was measured by using Wright’s peak flow meter. Data was analysed using unpaired ‘t’ test for statistical significance of differences between the non-obese and the obese, stratified into age groups of 20 to 30 years and 30 to 40 years. A partial correlation adjusted to age, height and BMI followed by regression analysis was conducted using adiposity markers as a predictor of PEFR. Results. The model adjusted to age, height, weight and BMI revealed waist hip ratio (WHR) as the only parameter which shows significant variance in PEFR with a Pearson’s r=-0.59, F (1, 100)=12.23, p=0.04. The resulting linear regression equation is y=-388.72xWHR+850.68. Conclusions. Our findings suggest that obesity itself and especially the pattern of body fat distribution have independent effects on PEFR. These results suggest that abdominal adiposity, measured as WHR, is a better predictor of expiratory flow than weight or BMI.

A study on substance abuse among school going male adolescents of Doiwala Block, District Dehradun.

Adolescent boys are recognized as a vulnerable group to substance abuse. The present study has the objective to study the biosocial profile and habit pattern of substance abusers. The study was conducted on 511 male adolescents, students of 10 th to 12 th class from the four intermediate schools of the Doiwala block of Dehradun district. 46.9% students accepted substance abuse. In 75.5% cases, friends were providing the substances. 80.2% substance abusers expressed their desire to quit the habit. The study is indicative of need for developing a supportive environment involving both parents and teachers so that adolescent can decide and sustain with the right choices for healthy life.

Abdominal obesity and pulmonary functions in young Indian Adults : A prospective study.

Obesity is a global health hazard and has been linked to numerous metabolic complications such as dyslipidemia, type II diabetes, & cardio vascular diseases and is negatively associated to the pulmonary function. The mechanism for this association is still debated and the best marker of adiposity in relation to dynamic pulmonary function is still not clear. We assessed the association of respiratory parameters and body mass index (BMI), waist circumference (WC) and Waist Hip ratio (WHR) as the markers of relative and abdominal obesity adiposity respectively. Step wise linear regression analysis was used to find out the association of FVC and FEV1 (performed in standing) with over all and adiposity markers stratified by gender and adjusted to height and age. A random sample of volunteers (n=80) from general population in and around Dehradun, India of age group 20-40 years. In women the WC shows a higher negative association to respiratory parameters FVC and FEV1 {B (P value), R2 as – 0.381(0.017), 0.122 and – 0.373(0.019), 0.139} while all the adiposity markers showed a negative significant association. In men WC showed highly significant negative association with FVC and FEV1 {Beta (P value), R2 as – 0.502(0.001), 0.232 and – 0.428(0.006), 0.184} with higher R2 values as compared to other adiposity parameters. The result suggested that the abdominal obesity marker is an important and better predictor of pulmonary function than BMI and the investigators suggest the inclusion of it as a potential confounding factor when investigating the determinants of pulmonary function.

Hepatotoxic effects of vincristine: An experimental study on albino rats.

Vincristine (VCR) is an established drug of choice in treatment of some myelomas, lymphomas and leukemias. Hepatotoxicity is a lesser studied side effect of the drug. Samples of blood and other tissues were collected for morphological, biochemical and histopathological evaluation 2 and 24 hours after single intravenous administration of 1.0 mg/kg of VCR to male Albino Wistar rats. VCR produced weight loss; and elevated serum alkaline phosphatase (515.20±356.22, P<0.05), SGPT (192.00±102.62, P<0.05), and SGOT (574.20±292.16, P<0.05) even after 24 hours of drug administration. Though these changes were most severe during the first 2 hours of VCR administration, they also persisted till 24 hours, which may suggest a possibility of an enterohepatic circulation of the drug or its metabolites. This was complemented with morphological disruption in hepatocytes on light and electron microscopy including Scanning Electron Microscopy and Transmission Electron Microscopy.

Evaluation of dynamic function tests in normal obese individuals.

The study was undertaken to assess the dynamic pulmonary function tests in obese and non obese young adults of Gharwal (Uttrakhand, India) of 20–40 years age group, randomly selected form the employees of Himalayan institute of medical sciences, attendants of the patients at the hospital and also from the nearby community at Jolly grant, Dehradun. The volunteers representing mixed socioeconomic group were categorized into obese cases and non-obese controls as per the standard criteria for Body mass index (BMI). Dynamic pulmonary function tests were carried out with all the standard protocols. Statistical analysis comprised student’s “t” test and linear correlation analysis. The result indicated a significantly lower value of (FVC) forced vital capacity (2.89±0.29) and (FEV1) Forced expiratory volume in 1st sec (2.59±0.25) in obese females. The FVC and FEV1 in the females correlated negatively to the BMI (r = –0.376, P<0.05 and r = –0.359 and P<0.05) and were significant. Dynamic pulmonary function values in males showed a negative correlation but were not statistically significant. This concludes that obesity per se has less effect on the dynamic function tests in obese young adults except in females, but obese individuals presenting with greater morbidity may be more susceptible to altered dynamic pulmonary function test in this age group.