Association of Serum 25-hydroxyvitamin D in Carotid Intima-media Thickness: A Study from South India.

BACKGROUND: Abnormal carotid intima-media thickness (IMT) is a marker of carotid atherosclerosis which is a risk factor for cerebrovascular and cardiovascular diseases. Recent studies have found an association of 25-hydroxyvitamin D deficiency with abnormal carotid IMT. PURPOSE: The purpose of the study was to investigate the association of serum 25-hydroxyvitamin D levels with carotid IMT in Indian participants. MATERIALS AND METHODS: We prospectively recruited 300 participants at Yashoda Hospital, Hyderabad, during the study period between January 2012 and December 2014. All participants were assessed for fasting blood sugar, lipid profile, C-reactive protein (CRP), serum alkaline phosphatase, serum calcium, serum phosphorous, serum 25-hydroxyvitamin D levels, and carotid Doppler examination. RESULTS: Among the 300 participants, men were 190 (63.3%) and mean age was 51.9 ± 7.7 years with a range from 35 to 64 years. On risk factors evaluation, 105 (35%) were hypertensive, 79 (26.3%) diabetics, 63 (21%) smokers, and 56 (18.6%) were alcoholics. On evaluation of biochemical parameters, 81 (27%) had dyslipidemia, 120 (40%) had elevated CRP levels, 119 (39.6%) had 25-hydroxyvitamin D deficiency, mean alkaline phosphatase was 93.9 ± 14.9 IU/L, serum calcium (mg/dL) was 9.2 ± 2.3, and serum phosphorous 4.4 ± 1.2 mg/dL. On carotid imaging, 121 (40.3%) had abnormal IMT. After multivariate analysis, 25-hydroxyvitamin D deficiency (odds ratio [OR]: 2.14; 95% confidence interval [CI]: 1.29-3.55), dyslipidemia (OR: 2.53; 95% CI: 1.46-4.40), elevated CRP (OR: 2.27; 95% CI: 1.37-3.76), smoking (OR: 2.09; 95% CI: 1.16-3.77), and diabetes (OR: 1.84; 95% CI: 1.05-3.21) were independently associated with abnormal IMT. CONCLUSION: In our study, we established 25-hydroxyvitamin D deficiency as an independently associated with abnormal IMT in Indian participants.

Prevalence and risk factors of asymptomatic carotid artery stenosis in Indian population: An 8-year follow-up study.

BACKGROUND: Asymptomatic carotid artery stenosis (ACAS) is a marker for cerebrovascular disease, coronary atherosclerosis, and death. AIM: To investigate the prevalence of ACAS in the Indian population, and to correlate ACAS with other vascular risk factors. MATERIALS AND METHODS: We prospectively recruited 1500 individuals who were older than 40 years and asymptomatic for cerebrovascular disease between June 2003 and December 2014. Evaluation of vascular risk factors was done for all the participants. Color Doppler of bilateral carotid arteries was performed for all the participants. Carotid stenosis of 1-49% and ≥50% was considered to be mild and significant stenosis, respectively. RESULTS: There were 1016 (67.7%) men, with a mean age of 58.1 ± 10.6 years (age range: 40-98 years). The prevalence of significant carotid stenosis was 5.2%. After adjustment using multiple regression analysis, age >70 years (OR: 2.0; 95% CI: 1.48-2.74), hypertension (OR: 1.8; 95% CI: 1.11-2.96), diabetes (OR: 2.3; 95%CI: 1.45-3.89), smoking (OR: 3.6; 95% CI: 2.18-6.03), dyslipidemia (OR: 4.0; 95% CI: 2.52-6.63), history of migraine (OR: 3.6; 95% CI: 2.54-9.13), history of periodontitis (OR: 3.2; 95% CI: 1.90-5.68), and family history of stroke (OR: 7.1; 95% CI: 4.20-12.2) were significantly associated with >50% stenosis. Duration (>15 years) of hypertension (OR: 2.5; 95% CI: 1.33-6.43), diabetes (OR: 6.2; 95% CI: 3.41-11.3), and smoking (OR: 5.2; 95% CI: 2.20-12.1) markedly worsened the risk. During the 8-year follow up, 14 participants (1.4%) with mild stenosis and 3 participants (4.7%) with significant stenosis developed stroke. CONCLUSIONS: Our study suggests that 5.2% of asymptomatic individuals > 40 years of age harbor significant extracranial carotid artery disease. Presence of multiple vascular risk factors markedly increases the risk of carotid stenosis.

Association Between Chlamydia pneumoniae and Migraine: A Study from a Tertiary Center in India.

AIMS: To investigate the association between circulating Chlamydia pneumoniae (C pneumoniae) immunoglobulin G (IgG) antibody and migraine in Indian patients. METHODS: A total of 300 migraine patients and 150 age-matched and sex-matched controls were recruited from the Department of Neurology at Yashoda Hospital in Hyderabad, India, during the study period between August 2011 and July 2013. All patients and controls were assessed for the presence of the C pneumoniae IgG antibody and also C-reactive protein (CRP) as well as for depression, which was assessed by the Hamilton Depression Rating Scale (HDRS). RESULTS: Of the patients with migraine, 69% were female and the mean age ± standard deviation (SD) was 45.8 ± 4.8 years (range 18 to 62 years). The C pneumoniae IgG antibody was present in 151 of the patients (50.3%; P < .0001), CRP in 180 (60%; P < .0001), depression in 270 (90%; P < .0001), and history of sleep disturbances in 70 (23.3%; P < .0001); all measurements were significantly higher in migraine patients compared with controls. After adjustment for multiple logistic regression analyses, C pneumoniae IgG antibody positivity (odds ratio [OR] 2.6; 95% confidence interval [CI] = 1.3 to 3.7), CRP positivity (OR 6.2; 95% CI = 3.3 to 11.6), mild depression (OR 16.9; 95% CI = 6.5 to 39.4), and history of sleep disturbance (OR 2.1; 95% CI = 1.1 to 3.1) were independently associated with migraine. CONCLUSION: This study showed that the presence of C pneumoniae IgG antibody was independently associated with migraine in Indian patients.

Risk factors, clinical profile, and long-term outcome of 428 patients of cerebral sinus venous thrombosis: insights from Nizam's Institute Venous Stroke Registry, Hyderabad (India).

BACKGROUND: With the widespread use of neuroimaging and hematological workup, many of the previously held concepts about cerebral sinus venous thrombosis (CSVT) are changing. OBJECTIVE: The objective of this study was to investigate the risk factors, clinical profile, and outcome of the fully investigated cases of CSVT from a major university referral hospital in South India. MATERIALS AND METHODS: Consecutive patients of CSVT confirmed by definite neuroimaging criteria and fully investigated for prothrombotic states, between June 2002 and September 2010, were prospectively studied in the Venous Stroke Registry of Nizam's Institute of Medical Sciences, Hyderabad, South India. RESULTS: Of the 428 patients, 230 (53.7%) were men and the mean age was 31.3 years (range 8-65 years). Seizures were noted in 126 (29.4%) patients, stroke like presentation was found in 122 (28.5%) patients, and benign intracranial hypertension like presentation was found in 78 (18.2%) patients. Common risk factors were anemia in 79 (18.4%), hyperhomocysteinemia in 78 (18.2%), alcoholism in 67 (15.6%), oral contraceptive pill intake in 49 (11.4%), postpartum state in 42 (9.8%), anticardiolipin antibodies in 31 (7.2%), and protein S deficiency in 53 (12.3%) patients. Good outcome at 90 days (modified Rankin Scale £ 2) was observed in 273 (71.2%) of 383 patients available for follow-up. In-house mortality was noted in 33 (7.7%) and recurrence in 22 (5.1%) patients. CONCLUSIONS: Compared to the previous studies, prevalence of CSVT was higher in men. Anemia, hyperhomocysteinemia, alcoholism, oral contraceptive use, and postpartum state were the most common risk factors. Overall prognosis was good, but a small percentage of patients died or showed recurrence.

Use of thrombolytic therapy in cerebral venous sinus thrombosis with ulcerative colitis.

Cerebral venous thrombosis developing concurrently with active ulcerative colitis poses a therapeutic dilemma. We report the case of a 31-year-old woman who developed dural venous sinus thrombosis during the course of active ulcerative colitis in whom we accomplished clot lysis using intrasinus urokinase. The success of the procedure was assessed by improvement in the patient's neurological condition and resolution of imaging features without any bleeding complications. We also reviewed literature on various modalities of treatment of sinus venous thrombosis in patients with ulcerative colitis and outcome.

Outcome of Chlamydia pneumoniae associated acute ischemic stroke in elderly patients: a case-control study.

BACKGROUND: Limited data exists about the role of Chlamydia pneumoniae elderly patients with acute ischemic stroke. OBJECTIVE: To study the role of C. pneumoniae in elderly patients (age more than 65 years) with acute ischemic stroke and its impact on stroke out come. METHODS: We recruited 100 elderly patients with acute ischemic stroke and 100 age and sex matched controls over a period of 2 years. IgG and IgA anti C. pneumoniae antibodies were measured by microimmunofluorescence technique in patients and controls. Good outcome was defined as a Modified Rankin score (mRS) of ≤2. RESULTS: We found C. pneumoniae antibodies in 35% stroke patients and in 18% control subjects (p=0.01). Good out come at 90 days follow up was found in 20/35(57.1%) seropositive stroke patients compared to 37/65(56.9%) seronegative stroke patients (p=0.9). CONCLUSIONS: C. pneumoniae antibody positivity was independently associated with ischemic stroke in elderly patients and its presence does not alter the stroke outcome.

Seroprevalence of Chlamydia pneumoniae antibodies in stroke in young.

BACKGROUND: Younger patients, aged below 45 years, usually lack the conventional risk factors of stroke whereas infections, especially in developing countries, may play a role. There have been many reports in the last decade about the association of Chlamydia pneumoniae (C. pneumoniae) and atherosclerosis involving cerebral vessels. OBJECTIVE: To investigate the seroprevalence of C. pneumoniae IgG and IgA antibodies in patients aged below 45 years with acute ischemic stroke. METHODS: This study was done at a tertiary care hospital in South India between January 2004 and December 2006 where we recruited consecutive patients aged less than 45 years with acute ischemic stroke. Age and sex matched controls were recruited from the outpatient department with non stroke diagnosis. All stroke patients underwent CT (Computerized Tomography), MRI (Magnetic Resonance Image), MRA (Magnetic Resonance Angiography), Transthoracic Echocardiography and Carotid Doppler for stroke sub group diagnosis. We measured C. pneumoniae antibodies IgG and IgA by microimmunofluorescence technique in all patients and controls. RESULTS: A total of 120 patients and 120 controls were studied over a period of two years. We found C. pneumoniae antibodies in 29.1% (35/120) stroke patients and in 12.5% (15/120) control subjects (p=0.002). C. pneumoniae IgG antibodies were found in 27.5 % (33/120) of stroke patients and 12.5% (15/120) of controls (p=0.006). IgA antibodies were observed in 5% (6/120) of strokes and none in control group (p=0.03). After adjustment of all risk factors C. pneumoniae IgG seropositivity showed odds ratio of 2.6; 95% Confidence Interval 1.2-5.6. CONCLUSIONS: C. pneumoniae IgG antibodies were found to be associated with ischemic stroke in young.

Stroke burden and risk factors in developing countries with special reference to India.

Stroke is a major disabling health problem in developing countries like India. Stroke burden in India has been rising in the last few decades, in contrast to developed countries where it has plateaued or decreased. The average annual incidence rate of stroke in India currently is 145 per 100,000 population, which is higher than the western nations. Rapid socio-economic changes have led to changes in people's lifestyle, work related stress, altered food habits and the risk of developing hypertension, diabetes and hyperlipidaemia. This coupled with increased lifespan has resulted in increase in the incidence of stroke. Indians may also be genetically prone for stroke due to high prevalence of metabolic syndrome. In India 10% to 15% of strokes occur in people aged below 40 years. Up to 80% of strokes in India are ischaemic in nature, among which intracranial atherosclerosis is the most common mechanism. It is of utmost importance to create awareness among public about risk factors of stroke and their prevention in order to reduce the associated mortality and morbidity.

Antibodies to Chlamydia pneumoniae are associated with increased intima media thickness in asymptomatic Indian individuals.

Chlamydia pneumoniae has been found to be associated with cerebrovascular and cardiovascular diseases in seroepidemiologic studies. The aim of this study was to investigate whether this organism is associated with increased intima media thickness (IMT) of carotid arteries in asymptomatic individuals. Serum titer of antibodies to C pneumoniae antibodies IgA and IgG in 100 asymptomatic individuals older than 40 years was measured by microimmunofluorescence. These subjects also had their IMT measured by B-mode ultrasound in the common carotid artery on both sides. Comparison of baseline characteristics between the group with abnormal IMT (>0.08 cm) and group having normal IMT (