Edaravone - citicoline comparative study in acute ischemic stroke (ECCS-AIS).

BACKGROUND: Two new neuro-protective agents, Edaravone and Citicoline were recently found to be beneficial in acute ischemic stroke (AIS). But there is no study to compare these two agents on same protocol in AIS. This study was aimed to compare these two neuroprotective agents in AIS. METHODS: All patients of age more than 18 years who presented within 24 hours of acute ischemic stroke were randomly treated with Edaravone (group E), Citicoline (group C) or none (group N) with other standard treatment of AIS. Modified Rankin Scale (MRS) and National Institute of Health Stroke Scale (NIHSS) were recorded on admission and at 3 months. Analysis was done using Anova t test to find out significant difference in outcome at 3 months. P value of < or = 0.05 was labeled as significant. RESULTS: Mean MRS and NIHSS scores at 3 months were lowest in group E (p = 0.000), suggestive of better outcome in this group. After application of severity scale, 15 patients (68.1%) in group-E, 14 (58.3%) in group C and 18 (72%) in group N had moderate to severe stroke (NIHSS of more than 10). When the patients of moderate to severe stroke were analyzed separately at 3 months, patients in group E (mean 4.46 +/- 3.52) had significantly (p = 0.00) better outcome in comparison to group C (mean 10.28 +/- 7.93) and group N (mean 9.38 +/- 6.44). CONCLUSIONS: Edaravone was found to be associated with better neurological outcome at 3 months. Citicoline's role as a neuroprotective agent however remains controversial in acute ischaemic stroke.

Retrospective analysis of vivax malaria patients presenting to tertiary referral centre of Uttarakhand.

INTRODUCTION: despite the high prevalence of Plasmodium vivax (P vivax) malaria, research into its complications has lagged disproportionately as compared to Plasmodium falciparum (P falciparum) malaria. MATERIAL AND METHODS: the present retrospective observational study was conducted on cases with P vivax mono-infection presenting with severe malaria on the basis of one or more criteria as per the World Health Organization guidelines being used for severe falciparum malaria in children, as well as other manifestations been classified as complicated malaria, during an outbreak of malaria in a single tertiary referral hospital of north India. RESULTS: seventy-four patients of acute malaria presented during the outbreak, of which 50 cases with P vivax mono-infection were included for the study. Complicated malaria was diagnosed in 41/50 cases, with thrombocytopenia being the commonest manifestation. Other presentations of severe malaria in our patients were liver dysfunction (with or without jaundice) 31/50 cases, respiratory involvement 14/50 cases, renal impairment 11/50 cases, circulatory collapse (Shock) 8/50 cases, severe anaemia 3/50 cases and central nervous system (CNS) involvement 2/50 cases. CONCLUSION: the term "benign tertian malaria" no longer holds true for P vivax mono-infection. The authors wish to open a new front for researches on the possible genotypic abnormalities that the parasite or its carrier might have acquired over decades and has transformed into a species with the malignant potential of P falciparum.

Scrub typhus in Uttarakhand, India: a common rickettsial disease in an uncommon geographical region.

Scrub typhus is a commonly encountered rickettsial disease of the Indian subcontinent. Humans are infected accidentally and the case fatality can be significantly high if the disease is not identified in time. We report nine cases of scrub typhus from the Garhwal region of the newly created north Indian state of Uttarakhand, a region not previously known to harbour the vector. Entomological studies are needed to study the density of the vector and to institute vector control measures in order to prevent this relatively benign, yet potentially fatal, clinical entity from spiralling into a major public health issue.