Stroke incidence, mortality, subtypes in rural and urban populations in five geographic areas of India (2018-2019): results from the National Stroke Registry Programme.

Background: Increasing stroke burden in India demands a long-term stroke surveillance framework. Earlier studies in India were urban-based, short term and provided limited data on stroke incidence and its outcomes. This gap is addressed by the establishment of five population-based stroke registries (PBSRs) of the National Stroke Registry Programme, India. This paper describes stroke incidence, mortality and age, sex, and subtypes distribution in the five PBSRs with urban and rural populations. Methods: First-ever incident stroke patients in age group ≥18 years, resident for at least one year in the defined geographic area, identified from health facilities were registered. Death records with stroke as the cause of death from the Civil Registration System (CRS) were included. Transient ischemic attack (TIA) was excluded. Three PBSRs (Cuttack, Tirunelveli, Cachar) included urban and rural populations. PBSRs in Kota and Varanasi were urban areas. The crude and age-standardized incidence rate (ASR) by age, sex, and residence (urban and rural), rate ratios of ASR, case fatality proportions and rates at day 28 after onset of stroke were calculated for years 2018-2019. Findings: A total of 13,820 registered first-ever stroke cases that included 985 death certificate-only cases (DCOs) were analysed. The pooled crude incidence rate was 138.1 per 100,000 population with an age-standardized incidence rate (ASR) of 103.4 (both sexes), 125.7 (males) and 80.8 (females). The risk of stroke among rural residents was one in seven (Cuttack), one in nine (Tirunelveli), and one in 15 (Cachar). Ischemic stroke was the most common type in all PBSRs. Age-standardized case fatality rates (ASCFR) per 100,000 population for pooled PBSRs was 30.0 (males) and 18.8 (females), and the rate ratio (M/F) ranged from 1.2 (Cuttack) to 2.0 (Cachar). Interpretation: Population-based registries have provided a comprehensive stroke surveillance platform to measure stroke burden and outcomes by age, sex, residence and subtype across India. The rural-urban pattern of stroke incidence and mortality shall guide health policy and programme planning to strengthen stroke prevention and treatment measures in India. Funding: The National Stroke Registry Programme is funded through the intramural funding of the Indian Council of Medical Research, Department of Health Research, Ministry of Health and Family Welfare, India.

Prescribing Patterns and Response to Antihyperglycemic Agents Among Novel Clusters of Type 2 Diabetes in Asian Indians.

Aim: To assess the prescribing patterns and response to different classes of antihyperglycemic agents in novel clusters of type 2 diabetes (T2D) described in India. Materials and Methods: We attempted to replicate the earlier described clusters of T2D, in 32,867 individuals with new-onset T2D (within 2 years of diagnosis) registered between October 2013 and December 2020 at 15 diabetes clinics located across India, by means of k-means clustering utilizing 6 clinically relevant variables. Individuals who had follow-up glycated hemoglobin (HbA1c) up to 2 years were included for the drug response analysis (n = 13,247). Results: Among the 32,867 participants included in the study, 20,779 (63.2%) were males. The average age at diagnosis was 45 years and mean HbA1c at baseline was 8.9%. The same four clusters described in India earlier were replicated. Forty percent of the study participants belonged to the mild age-related diabetes cluster, followed by insulin-resistant obese diabetes (27%), severe insulin-deficient diabetes (21%), and combined insulin-resistant and insulin-deficient diabetes (12%) clusters. The most frequently used antihyperglycemic agents were sulfonylureas, metformin, and dipeptidyl peptidase-4 inhibitors apart from insulin. While there were significant differences in HbA1c reduction between drugs across clusters, these were largely driven by differences in the baseline (pretreatment) HbA1c. Conclusions: In this new cohort, we were able to reliably replicate the four subtypes of T2D earlier described in Asian Indians. Prescribing patterns show limited usage of newer antihyperglycemic agents across all clusters. Randomized clinical trials are required to establish differential drug responses between clusters.

Clinical Characteristics and Management of Headache: A Real-Life Prospective, Observational Study From a Tertiary Care Center in Eastern India.

OBJECTIVE: To describe clinical profile and management pattern of headache in patients presenting to a tertiary care center.  Methods: In this observational study, demographics, radiological investigations, triggers, and treatment pattern in patients aged ≥ 14 years presenting with headache were recorded. Disability and severity of headache were assessed with Migraine Disability Assessment (MIDAS) score, Visual Analogue Scale (VAS), and Headache Impact Test (HIT-6) in case of migraineurs and VAS and HIT-6 for all other headache disorders. Patients were evaluated at baseline and after three and six months post-treatment. RESULTS: Out of 400 patients (60.25% females and 39.75% males), 277 (69.25%) had primary headache among whom 119 (42.96%) had migraine without aura. Stress, menstruation, fasting, and inadequate sleep were common triggers for migraine. Nausea, vomiting, photo-phonophobia and neck pain were the most common accompanying symptoms in patients with headache. Out of 106 (38.3%) patients with tension-type headache, 68.9% were episodic. In the migraine subset, 81% presented with moderate to severe disability at baseline, which changed to minimal to mild disability at three and six months post-treatment (p < 0.001). For abortive treatment, 130 (79.7%) patients were prescribed naproxen, domperidone, and sumatriptan. In 69 (42.3%) patients, valproic acid/divalproex was used for prophylaxis. Most common causes of secondary headaches (30.75%) were intracranial bleeds and cerebral venous sinus thrombosis. Most common abnormalities on computerized tomography were intracerebral hemorrhage, subarachnoid hemorrhage, sinusitis, and space-occupying lesions (SOLs). CONCLUSION: In our study, migraine was the most common etiology of headache. Headache was more common in females than males, and primary headache was more common than secondary headache. Sodium valproate was the commonly used prophylaxis in migraine.

Synthesis of Novel Diaziridinyl Quinone Isoxazole Hybrids and Evaluation of Their Anti-Cancer Activity as Potential Tubulin-Targeting Agents.

Two series of diaziridinyl quinone isoxazole derivatives were prepared and evaluated for their cytotoxic activity against MCF7, HeLa, BT549, A549 and HEK293 cell lines and interaction with tubulin. Compounds (6A-M: ) showed promising activity against all the 5 human cancer cell lines. Compounds 6A: , 6E: and 6 M: were potent [IC50 ranging between 2.21 µg to 2.87 µg] on ER-positive MCF7 cell line similar to the commercially available drug molecule Doxorubicin. The results from docking models are in consistent with the experimental values which demonstrated the favourable binding modes of compounds 6A-M: to the interface of α- and ß-tubulin dimer.

Synthesis of new kojic acid based unnatural α-amino acid derivatives.

An efficient method for the preparation of kojic acid based α-amino acid derivatives by alkylation of glycinate schiff base with bromokojic acids have been described. Using this method, mono as well as di alkylated kojic acid-amino acid conjugates have been prepared. This is the first synthesis of C-linked kojic acid-amino acid conjugate where kojic acid is directly linked to amino acid through a C-C bond.

Design and synthesis of novel isoxazole tethered quinone-amino Acid hybrids.

A new series of isoxazole tethered quinone-amino acid hybrids has been designed and synthesized involving 1,3-dipolar cycloaddition reaction followed by an oxidation reaction using cerium ammonium nitrate (CAN). Using this method, for the first time various isoxazole tethered quinone-phenyl alanine and quinone-alanine hybrids were synthesized from simple commercially available 4-bromobenzyl bromide, propargyl bromide, and 2,5-dimethoxybenzaldehyde in good yield.

Conformational switching caused by biphenyl substitution at the Calpha position: ethyl 2-benzyl-2-(formylamino)-3-phenylpropionate and ethyl 3-(1,1'-biphenyl-4-yl)-2-(formylamino)-2-(4-phenylbenzyl)propionate.

The title compounds, C19H21NO3 and C31H29NO3, are derivatives of alpha-aminoisobutyric acid, with benzyl and dibenzyl substitution. The pseudo-peptide formed by the N-formyl and ethyl ester substitution at the Calpha position switches from a trans-trans to a trans-cis configuration as a result of biphenyl substitution. The packing of the compounds is stabilized by N-H...O and C-H...O hydrogen bonds.

Ethyl 2-formamido-2-(4-iodobenzyl)-3-(4-iodophenyl)propionate and ethyl 2-(3-bromobenzyl)-3-(3-bromophenyl)-2-formamidopropionate.

The title compounds, C(19)H(19)I(2)NO(3) and C(19)H(19)Br(2)NO(3), are derivatives of alpha-aminoisobutyric acid with halogen substituents at the para and meta positions, respectively. The ethoxycarbonyl and formamide side chains attached to the C(alpha) atom of the molecule adopt extended and folded conformations, respectively. The crystal structures are stabilized by N-H.O, C-H.O, C-Br.O and C-I.O interactions.

Ethyl 6-acetylamino-6,7-dihydro-5H-dibenzo[a,c]cycloheptene-6-carboxylate.

The title compound, C(20)H(21)NO(3), is a derivative of Aib (alpha-aminoisobutyric acid) and is cyclized at the C(alpha) position by biphenyl rings. The seven-membered ring possesses C2 symmetry. The C(alpha) cyclization causes the backbone to assume a helical conformation in the crystal structure. The packing of the molecules is stabilized by intermolecular C-H.O, C-H.pi and N-H.O hydrogen bonds.

Synthesis of highly functionalised dibenzylglycine derivatives via the Suzuki-Miyaura coupling reaction.

Several alpha,alpha-dibenzylglycine (alpha-benzylphenylalanine) derivatives were prepared by alkylation of the ethyl isocyanoacetate with different benzyl bromide derivatives. Various aryl groups were introduced in the dibenzylglycine moiety via the Suzuki-Miyaura coupling reaction.