Comparative Analysis of Tenecteplase versus Alteplase in Acute Ischemic Stroke: A Multicentric Observational Study from Eastern India.

BACKGROUND: Tenecteplase is used as an alternative to alteplase and is considered noninferior for thrombolysis in acute ischemic stroke. OBJECTIVES: To compare the effectiveness and adverse effects of tenecteplase and alteplase in the real-world management of acute ischemic stroke. MATERIALS AND METHODS: In this retrospective observational study, we collected data from acute ischemic stroke patients admitted in six hospitals in West Bengal, India, and were thrombolysed with tenecteplase or alteplase between July 2021 and June 2022. Demographic data, baseline parameters, hospital course, and 3-month follow-up data were collected. The percentage of patients achieving a score of 0-2 in the modified Ranking scale at 3 months, rate of symptomatic intracranial hemorrhage, and all-cause mortality within 3 months were the main parameters of comparison between the two thrombolytic agents. RESULTS: A total of 162 patients were initially included in this study. Eight patients were excluded due to unavailability of follow-up data. Among the remaining patients, 71 patients received tenecteplase and 83 patients received alteplase. There was no statistically significant difference between tenecteplase and alteplase with respect to the percentage of patients achieving functional independence (modified Rankin scale score 0-2) at 3 months (53.5% vs. 60.2%, P = 0.706), rate of symptomatic intracranial hemorrhage (5.6% vs. 10.8%, P = 0.246), and all-cause mortality at 3 months (11.3% vs. 15.7%, P = 0.628). CONCLUSION: The effectiveness of tenecteplase is comparable to alteplase in the real-world management of acute ischemic stroke. Symptomatic intracranial hemorrhage and all-cause mortality rates are also similar in real-world practice.

Adherence to anti-hypertensive medications and its determinants: A study among hypertensive stroke patients in a tertiary care government hospital of West Bengal.

There is a paucity of antihypertensive drug adherence studies among stroke patients in West Bengal. With an aim to identify antihypertensive drug adherence and its determinants, this descriptive cross-sectional study was conducted for 2 months among a calculated sample of 133 study participants using predesigned and pretested schedule, the metric "Proportion of days covered (PDC)," and the Morisky, Green, and Levine (MGL) Scale. Data were compiled and analyzed using SPSS software (version 20.0). Adherence rates were 31.6% and 44.4% based on the MGL scale and PDC method, respectively. Higher adherence was significantly associated with increased age (P = 0.006), higher literacy (P = 0.013), increased interval between diagnosis of hypertension and present symptom (P = 0.001), a greater gap between antihypertensive treatment initiation and present symptom (P = 0.003), receiving advice on regular drug intake (P = 0.000), and registered medical practitioner prescribing the medication (P = 0.007).

Depression, Sexual Dysfunction, and Medical Comorbidities in Young Adults Having Nicotine Dependence.

BACKGROUND: Nicotine dependence, depression, diabetes mellitus, hypertension, and hypothyroidism are risk factors of sexual dysfunction. AIMS AND OBJECTIVES: The present study aims to find the prevalence of sexual dysfunction and the various sexual response cycle domains in individuals with nicotine dependence with and without comorbidities. MATERIALS AND METHODS: A total of 52 individuals attending the tobacco cessation clinic were included in the study. To assess the primary outcome, Fagerstrom test for nicotine dependence, Arizona Sexual Experiences Scale, and Hamilton's Depression Rating Scale 17had been administered after validation in local vernacular. RESULTS: In the sample, 32 (61.5%) were male and 20 (38.5) were female. The 17 participants (32.7%) met the criteria of low nicotine dependence, 5 (9.6%) participants met low to moderate, 11 participants (21.2%) had moderate dependence, and 19 (36.5%) participants met the criteria of high nicotine dependence. CONCLUSIONS: The nicotine dependence is directly related to sexual dysfunction, and it affects various stages of the sexual response cycle. One-quarter of individuals of nicotine dependence also met the threshold criteria of depression. The interventions as primary and primordial preventions with awareness building and health education may be a cost-effective measure to prevent tobacco-related deaths.

Diagnostic algorithm of Down syndrome by minor physical anomaly.

BACKGROUND: Down syndrome, most common chromosomal abnormality leading to intellectual disability is being diagnosed by Karyotyping. Due to cost constraints, parents couldn't afford to do Karyotyping which causes delay in individual and family interventions. INTRODUCTION: Down syndrome has characteristic morphological features. The minor physical anomaly (MPA) are insults which occur in utero during embryonic development mostly in first and early second trimester and persists throughout life. MATERIAL AND METHODS: 70 karyotyping confirmed cases of Down syndrome (DS), 70 other causes of intellectual disabilities (Other ID) and 70 age matched normal children and adolescents (Average) have been incorporated in the study. The Modified Waldrop's scale (Ismail's 41 item scale) have been applied. Demographic comparison and Decision tree algorithm approach have been analysed by SPSS 25 version. RESULTS AND DISCUSSION: The paternal age of childbirth, maternal age of childbirth, maternal age of marriage (P < 0.001), income (P = 0.026) variables are statistically significant in Down's syndrome group in comparison to other two groups whereas age and birth order are not statistically significant. DS group has more MPA (m = 17.04, SD = 5.462), than other ID (m = 5.93, SD = 2.628) and Average group (m = 1.59, SD = 1.378). Big sandal gap, high arched palate and epicanthus are most common three minor anomalies found in Down syndrome. Region wise scoring shows high significance (P < 0.001) in Global head, eyes, ears, mouth, hands and feet in Down syndrome group. The four anomalies; epicanthus, telecanthus, high-arched palate, and curved fifth finger) thus can be grouped as differentiating anomalies. When clinodactyly (item 27) and high arched palate (item 21) are present together or epicanthus (item 08) and telecanthus (item 09) present together sensitivity of diagnosing the case as Down syndrome is 0.945 with negative predictive value 0.979. CONCLUSION: The simian crease which is being considered as common physical anomaly is not specific for Down syndrome. The large scale study is required to extrapolate the above findings but surely it opens new avenue of research.

Assessing perceived stress in medical personnel: in search of an appropriate scale for the bengali population.

BACKGROUND: The occurrence of stress and stress related anxiety and depression in medical personnel are being increasingly reported in literature. The perceived stress scale (PSS) is the most widely used psychological instrument for measuring the perception of stress. It is needed to assess perceived stress in our population using appropriately translated version of PSS. The objectives of study were to prepare a Bengali version of PSS-10 and to establish its psychometric properties in the study population. MATERIALS AND METHODS: The study was conducted in a teaching hospital among medical students and interns (N=37). The translated Bengali version and the original English version of PSS-10 were separately handed over to the individual subjects. The scores were compared across different subgroups and psychometric properties of the translated version were assessed using SPSS 16. RESULTS: Internal consistency of PSS English (α=0.79) and Bengali (α=0.80) was satisfactory. Intra-rater reliability was adequate (κ>0.5) for most of the items, but showed an inadequate value (κ<0.5) for four items on the scale. After deleting these four items from the Bengali version, a new six-item PSS in Bengali was derived that showed good internal consistency (α=0.699). CONCLUSION: This new version needs to be validated in a larger study population. Perceived stress score using PSS-10 was considerably high in our study population, although there was no significant difference between the subgroups (male/female, intern/student).

Depression among stroke survivors: a community-based, prospective study from Kolkata, India.

OBJECTIVE: Post-stroke depression (PSD) is a disabling entity among stroke survivors (SS). Longitudinal studies on PSD, essential to determine its prognosis, are lacking from developing countries. This prospective study was undertaken to assess the prevalence, natural history, and correlates of depression among SS in an Indian community. METHODS: From a community based stroke registry, SS were assessed annually for cognition, disability, and depression using Bengali validated scales. PSD was diagnosed if score on geriatric depression scale was greater than or equal to 21. Complex sample strategy was considered when calculating prevalence of post stroke depression. An age- and sex-matched case-control study was undertaken to determine the odds of depression in SS. RESULTS: Prevalence of PSD was 36.98% (95% confidence interval [CI]: 31.89%-42.06%) among 241 patients assessed at baseline. About 17% developed depression annually and a similar proportion had spontaneous improvement. Peak rate of PSD was beyond 3 months and continued up to 18 months after stroke. Compared to the non-depressed group, PSD subjects were significantly older, had higher age at first stroke, less education, lower socioeconomic status, and greater cognitive impairment and disability. Education had a protective role. Mortality in PSD was nearly twice that in non-depressed patients, though not significant statistically (hazard ratio: 1.84; 95% CI: 0.90-3.77). Compared with controls, odds ratio of PSD was 19.95 (95% CI: 10.09-39.47). CONCLUSIONS: Approximately one-third of SS develop PSD, similar to developed countries. Prevalence remains stable annually. Delayed peak of PSD suggested later realization of underlying disability. Predictors of PSD have been described and higher literacy was protective in this study.

Determinants of quality of life in HIV-infected patients receiving highly active antiretroviral treatment at a medical college ART center in Kolkata, India.

Health-related quality of life (QOL) has become a high priority of long-term management of HIV-infected individuals. The newly diagnosed HIV cases were assessed to obtain sociodemographic and clinical findings. Eyesenk Personality Questionnaire (EPQ), World Health Organization Quality of Life Brief (WHOQOL-BREF) for HIV-infected patients, and Beck Depression Inventory (BDI) were used to get data regarding personality traits, QOL, and depression scores. A total of 175 patients were included in the study, 128 (73.1%) men and 47 (26.9%) women. Overall 56% of patients screened positive for depression. Presence of depression and high neuroticism score in the personality profile of HIV-infected patients are significantly associated with poorer QOL. High neuroticism score was a strong predictor of poorer QOL in psychological and spiritual domain. Management of HIV-infected patients therefore needs to address these psychological issues.

Domestic violence among ever married women of reproductive age group in a slum area of Kolkata.

BACKGROUND: Domestic violence has serious impact on women's health and well-being. A nationwide survey conducted in India observed that 37.2% of women experienced violence after marriage. OBJECTIVES: To assess the prevalence of domestic violence among the ever married women in reproductive age group and to find out the types of domestic violence and factors associated with it. MATERIALS AND METHODS: The study was a community based cross-sectional study, conducted in a slum area of Kolkata. RESULTS AND CONCLUSION: Overall prevalence of domestic violence was 54%, of which 41.9% suffered from both current and lifetime physical and psychological violence. Presence of property, higher per capita income and social support were protective factors against domestic violence, whereas alcohol addiction and multiple sex partners were the important contributory factors for it. The study recommended more social support, awareness and income generation for women in the slum areas.

Healthcare-seeking behavior of patients with epileptic seizure disorders attending a tertiary care hospital, kolkata.

INTRODUCTION: Neurological diseases are very important causes of prolonged morbidity and disability, leading to profound financial loss. Epilepsy is one of the most important neurological disorders Healthcare seeking by epilepsy patients is quite diverse and unique. AIMS AND OBJECTIVES: The study was conducted among the epilepsy patients, to assess their healthcare-seeking behavior and its determinants. MATERIALS AND METHODS: Three hundred and fifteen epilepsy patients, selected by systematic random sampling, in the neuromedicine outpatient department of a tertiary care hospital were interviewed with a predesigned, pretested, semi-structured proforma. RESULTS AND CONCLUSION: More than 90% sought healthcare just after the onset of a seizure. The majority opted for allopathic medicine and the causes for not seeking initial care from allopaths were ignorance, faith in another system, constraint of money, and so on. A significant association existed between rural residence and low social status of the patients with initial care seeking from someone other than allopaths. No association was found among sex, type of seizure, educational status of the patients, and care seeking. The mean treatment gap was 2.98 ± 10.49 months and the chief motivators were mostly the family members. Patients for anti epileptic drugs preferred neurologists in urban areas and general practitioners in rural areas. District care model of epilepsy was proposed in the recommendation.

A case of Klingsor Syndrome: when there is no longer psychosis.

The following case report describes an act of genital self mutilation. An employed, unmarried male suffering from schizophrenia paranoid type, autocastrated his genitalia during a period of illness when his psychotic symptoms were absent. Sufficient attention may not have been paid to his depressive symptomatology which may be primary as a core feature or secondary, in what can be called post-psychotic depression. The vulnerability of committing such an act increases when the person appears to be symptom-free and regaining insight. After a review of the available literature, it is considered that this case best fits the description for Klingsor Syndrome.

An outbreak of Koro among 19 workers in a jute mill in south Bengal.

Koro is a culture-bound syndrome that is characterized by the belief of retraction of genitals into the abdomen. It was initially reported in Asian countries, as having a usual acute and brief course. Two case clusters have been described in this article. Both occurred in the same jute mill in southern West Bengal among the workers. The case clusters depict unique socioeconomic factors and interesting health-seeking behavior toward koro. All the cases had a self-limiting course and reasonably good outcome. The case cluster yet again confirms that koro is not as rare as it is thought of and social and economic factors continue to play an important role in the etiology of the disease.

An interesting case of serotonin syndrome precipitated by escitalopram.

Serotonin syndrome is a known entity, which occurs with multiple drugs acting on serotonergic receptors. A 73-year-old lady presented with a history of agitation, altered sensorium, and autonomic hyperactivity after starting escitalopram on therapeutic dosage for her depressive syndrome who was on selegiline for her parkinsonism. This syndrome with therapeutic dose escitalopram warrants the careful and judicious use of the drug especially with other serotonergic drugs, so that this serious medical complication can be avoided.

Correlation between physical anomaly and behavioral abnormalities in Down syndrome.

OBJECTIVE: The minor physical anomaly (MPA) is believed to reflect abnormal development of the CNS. The aim is to find incidence of MPA and its behavioral correlates in Down syndrome and to compare these findings with the other causes of intellectual disability and normal population. MATERIALS AND METHODS: One-hundred and forty intellectually disabled people attending a tertiary care set-up and from various NGOs are included in the study. The age-matched group from normal population was also studied for comparison. MPA are assessed by using Modified Waldrop scale and behavioral abnormality by Diagnostic assessment scale for severely handicapped (DASH II scale). RESULTS: The Down syndrome group had significantly more MPA than other two groups and most of the MPA is situated in the global head region. There is strong correlation (P < 0.001) between the various grouped items of Modified Waldrop scale. Depression subscale is correlated with anomalies in the hands (P < 0.001), feet and Waldrop total items (P < 0.005). Mania item of DASH II scale is related with anomalies around the eyes (P < 0.001). Self-injurious behavior and total Waldrop score is negatively correlated with global head. CONCLUSION: Down syndrome group has significantly more MPA and a pattern of correlation between MPA and behavioral abnormalities exists which necessitates a large-scale study.

A study on cognitive status of 50 years and above aged non-demented women in a rural area of West Bengal.

The prevalence of ageing population is increasing not only in developed countries but also in developing world like India. Epidemiological reports about cognitive impairment or dementia in elderly people from developing countries are scarce. To study the cognitive status of women more than 50 years of age and to study the relationship of sociodemographic factors with cognitive status of the study subjects a descriptive epidemiological, community based cross-sectional survey was done involving 179 old women of 50 years and above in the rural field practice area of All India Institute of Hygiene and Public Health, Kolkata. The data were analysed using Epi-info 6.04, software packages. The mean age of the sample was 64.0 +/- 7.6 years. In the total sample, 53 subjects (29.6%) were in 50-59 years, 83 (43.4%) in 60-69 years, 34 (19%) in 70-79 years and 9 (5%) in women who were more than 80 years old. The cognitive defect was found to be 42.4% in elderly women .The variables like age > 70 years, widowhood, low per capita income, economic dependence, non-support from children, not staying with own children and having no satisfaction with life, were found to be significantly associated with cognitive defect. On (stepwise) multiple regression analysis these factors together contributed to 37% of cognitive impairment among these women. Prevalence of cognitive defect of more than 40% in the elderly women of this study emphasises the need for more attention and more social security measures for this neglected group.

A case of paroxetine-induced galactorrhoea with normal serum prolactin level.

The following case report highlights an interesting observation of paroxetine-induced galactorrhoea at therapeutic dosage and serum prolactin values of this patient comes out to be normal. This observation merits a systematic study to find the causal relationship of this unusual phenomenon and further explanation.

Cerebral malignancy presenting with post stroke depression.

The following case report highlights about a Glioblastoma presenting with features of post stroke depression. The neuropsychological findings though initially was normal but on subsequent follow up showed gross abnormalities. The imaging studies revealed the tumor, involving the right parietal and temporal lobes with midline shift and high vascularity. The patient exhibited rapid downhill course and died within 4 weeks of initial presentation.

A study of cluster behavioral abnormalities in Down syndrome.

BACKGROUND: The behavioral phenotype in Down syndrome follows a characteristic pattern. AIMS: To find the incidence of behavioral abnormalities in Down syndrome, to compare these findings with other causes of intellectual disability and normal population and to cluster these abnormalities. SETTINGS: One hundred forty mentally challenged people attending at tertiary care set up and from various non-governmental organizations were included in the study. Patients from both rural and urban set up participated in the study. The age-matched group from normal population was also studied for comparison. DESIGN: The study design is a cross-sectional survey done independently by four observers. MATERIALS AND METHODS: A semi-structured proforma for demographic profile has been used. The behavioral abnormalities are assessed by using DASH II (Diagnostic Assessment for the Severely Handicapped second modified version) scale. STATISTICAL ANALYSIS: Demographic comparison has been done by analysis of variance. Correlation matrix has been run to identify correlation between individual items. Principal component analysis has been used for grouping the behavioral pattern. RESULTS: Behavioral abnormalities as expected are more common in people having intellectual disability than the normal population. The Down syndrome group unlike other causes of intellectual disability shows higher scores in Stereotypy. Impulse control and Mania subscales. Factor analysis yields five characteristic factor structures, namely, hyperactive-impulsive, biological functions, affective, neurotic and organic-pervasive developmental disorder clusters. CONCLUSIONS: Contrary to the conventional belief of docile-fun and music loving prototype, individuals diagnosed with Down syndrome show clusters of behavioral abnormalities and management can vary depending on these target symptoms.

Insight in schizophrenia and its association with executive functions.

BACKGROUND: Lack of insight or awareness of illness is most frequently observed in patients with schizophrenia, and it influences treatment compliance. It has been hypothesized that the frontal dysfunction may explain poor insight in schizophrenia. AIM: The purposes of the study were to assess the degree of insight in schizophrenia and to examine the association, if any, between the degree of insight and executive functions in patients with schizophrenia. MATERIALS AND METHODS: In this pre-post study, 30 patients of both sexes diagnosed to have schizophrenia were assessed with the Scale to Assess Unawareness of Mental Disorder and Wisconsin Card Sorting Test (WCST). They were assessed once at the time of admission and then at the time of their discharge. RESULTS: The study revealed that 70% of the subjects possessed poor awareness of mental disorder. There was significant improvement of insight over time. The degree of insight was significantly associated with the performance on WCST 2(nd) assessment. WCST scores were able to explain 42% of the variance in insight. CONCLUSION: Majority of schizophrenic patients possess poor insight. This poor insight is significantly associated with poor executive function. Hence poor insight may have a cognitive etiology.