Dinesh Sridhar, Lakshmi Ramamoorthy, Sunil K. Narayan, Deepak Amalnath, H. Lalthanthuami, Sachit Ganapathy, Unnikrishnan Puliyakkuth
Stroke is a medical emergency, the leading cause of death, and a significant cause of disability in developing countries. The primary goals of stroke management focus on reducing disability, which needs prompt treatment in time. Fever, sugar-hyperglycemia, and swallowing (FeSS) bundle are a promising nurse-led composite for reducing disability and death. The present study aims to assess the effect of FeSS bundle care on disability, functional dependency, and death among acute stroke patients. A randomized controlled trial was conducted among 104 acute stroke patients, who were admitted within the first 48 h of stroke symptoms and had no previous neurological deficits. Randomization was stratified based on gender and type of stroke. The intervention group received FeSS bundle care, which included nurse-led fever and sugar management for the first 72 h, and a swallowing assessment done within the first 24 h or before the first oral meal. A follow-up assessment was done after 90 days to assess the disability, functional dependency, and mortality status using a modified Rankin scale and Barthel index. No significant difference was noted in the 90-day disability and functional dependency between the groups. A reduction in mortality was noted in the intervention group. The risk ratio for mortality between groups was 2.143 (95% confidence interval: 0.953–4.820). Although no significant reduction in disability, there was a reduction in mortality in the intervention group. Hence, the study suggested the promotion of nurse-led intervention using the FeSS bundle in stroke units.
{"title":"Effectiveness of nurse-led fever, sugar-hyperglycemia, and swallowing bundle care on clinical outcome of patients with stroke at a tertiary care center: A randomized controlled trial","authors":"Dinesh Sridhar, Lakshmi Ramamoorthy, Sunil K. Narayan, Deepak Amalnath, H. Lalthanthuami, Sachit Ganapathy, Unnikrishnan Puliyakkuth","doi":"10.25259/jnrp_446_2023","DOIUrl":"https://doi.org/10.25259/jnrp_446_2023","url":null,"abstract":"\u0000\u0000Stroke is a medical emergency, the leading cause of death, and a significant cause of disability in developing countries. The primary goals of stroke management focus on reducing disability, which needs prompt treatment in time. Fever, sugar-hyperglycemia, and swallowing (FeSS) bundle are a promising nurse-led composite for reducing disability and death. The present study aims to assess the effect of FeSS bundle care on disability, functional dependency, and death among acute stroke patients.\u0000\u0000\u0000\u0000A randomized controlled trial was conducted among 104 acute stroke patients, who were admitted within the first 48 h of stroke symptoms and had no previous neurological deficits. Randomization was stratified based on gender and type of stroke. The intervention group received FeSS bundle care, which included nurse-led fever and sugar management for the first 72 h, and a swallowing assessment done within the first 24 h or before the first oral meal. A follow-up assessment was done after 90 days to assess the disability, functional dependency, and mortality status using a modified Rankin scale and Barthel index.\u0000\u0000\u0000\u0000No significant difference was noted in the 90-day disability and functional dependency between the groups. A reduction in mortality was noted in the intervention group. The risk ratio for mortality between groups was 2.143 (95% confidence interval: 0.953–4.820).\u0000\u0000\u0000\u0000Although no significant reduction in disability, there was a reduction in mortality in the intervention group. Hence, the study suggested the promotion of nurse-led intervention using the FeSS bundle in stroke units.\u0000","PeriodicalId":16443,"journal":{"name":"Journal of Neurosciences in Rural Practice","volume":null,"pages":null},"PeriodicalIF":1.4,"publicationDate":"2024-02-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139798121","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Rakesh Mishra, Vishal Chavda, L. Moscote-Salazar, O. Atallah, Saikat Das, Tariq Janjua, V. Maurya, Amit Agrawal
D-dimer levels are increased in stroke and cancer. Cancer patients are at a higher risk of stroke. However, the evidence is unclear if high D-dimer in stroke patients can suggest the diagnosis of concomitant cancer or the development of stroke in a cancer patient. The objective is to assess the evidence available on the baseline D-dimer level in stroke patients with and without cancer. We conducted the systematic review and meta-analysis using the Preferred Reporting Items for Systematic Reviews and Meta-analysis guidelines. We searched PUBMED, Cochrane, ScienceDirect, and Scopus for potentially eligible articles published till June 2023. All the review steps were iterative and done independently by two reviewers. The Newcastle-Ottawa scale tool was used to assess the quality of included studies for case control and cohort studies and the Agency for Healthcare Research and Quality tool for cross-sectional studies. The qualitative synthesis is presented narratively, and quantitative synthesis is shown in the forest plot using the random effects model. I2 of more than 60% was considered as high heterogeneity. The searches from all the databases yielded 495 articles. After the study selection process, six papers were found eligible for inclusion in the qualitative and quantitative synthesis. In the present systematic review, 2651 patients with ischemic infarcts are included of which 404 (13.97%) patients had active cancer while 2247 (86.02%) did not. The studies included were of high quality and low risk of bias. There were significantly higher baseline D-dimer levels in stroke patients with cancer than in non-cancer patients with a mean difference of 4.84 (3.07–6.60) P < 0.00001. D-dimer is a simple and relatively non-expensive biomarker that is increased to significant levels in stroke patients, who have cancer and therefore may be a tool to predict through screening for active or occult cancer in stroke patients.
{"title":"Systematic review and meta-analysis of studies comparing baseline D-dimer level in stroke patients with or without cancer: Strength of current evidence","authors":"Rakesh Mishra, Vishal Chavda, L. Moscote-Salazar, O. Atallah, Saikat Das, Tariq Janjua, V. Maurya, Amit Agrawal","doi":"10.25259/jnrp_379_2023","DOIUrl":"https://doi.org/10.25259/jnrp_379_2023","url":null,"abstract":"\u0000\u0000D-dimer levels are increased in stroke and cancer. Cancer patients are at a higher risk of stroke. However, the evidence is unclear if high D-dimer in stroke patients can suggest the diagnosis of concomitant cancer or the development of stroke in a cancer patient. The objective is to assess the evidence available on the baseline D-dimer level in stroke patients with and without cancer.\u0000\u0000\u0000\u0000We conducted the systematic review and meta-analysis using the Preferred Reporting Items for Systematic Reviews and Meta-analysis guidelines. We searched PUBMED, Cochrane, ScienceDirect, and Scopus for potentially eligible articles published till June 2023. All the review steps were iterative and done independently by two reviewers. The Newcastle-Ottawa scale tool was used to assess the quality of included studies for case control and cohort studies and the Agency for Healthcare Research and Quality tool for cross-sectional studies. The qualitative synthesis is presented narratively, and quantitative synthesis is shown in the forest plot using the random effects model. I2 of more than 60% was considered as high heterogeneity.\u0000\u0000\u0000\u0000The searches from all the databases yielded 495 articles. After the study selection process, six papers were found eligible for inclusion in the qualitative and quantitative synthesis. In the present systematic review, 2651 patients with ischemic infarcts are included of which 404 (13.97%) patients had active cancer while 2247 (86.02%) did not. The studies included were of high quality and low risk of bias. There were significantly higher baseline D-dimer levels in stroke patients with cancer than in non-cancer patients with a mean difference of 4.84 (3.07–6.60) P < 0.00001.\u0000\u0000\u0000\u0000D-dimer is a simple and relatively non-expensive biomarker that is increased to significant levels in stroke patients, who have cancer and therefore may be a tool to predict through screening for active or occult cancer in stroke patients.\u0000","PeriodicalId":16443,"journal":{"name":"Journal of Neurosciences in Rural Practice","volume":null,"pages":null},"PeriodicalIF":1.4,"publicationDate":"2024-02-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139863891","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Nourou Dine Adeniran Bankole, Y. Dokponou, R. de Koning, D. U. Dalle, Ö. Kesici, C. Egu, C. Ikwuegbuenyi, G. Adegboyega, S. Z. Yang Ooi, O. Dada, J. Erhabor, Emmanuel Mukambo, Tunde Olobatoke, B. Takoutsing, Soham Bandyopadhyay
Epilepsy is a common neurological condition in low- and middle-income countries (LMICs). This study aims to systematically review, analyze, evaluate, and synthesize information on the current state of medical and surgical management and outcomes of epilepsy in LMICs. Systematic searches were conducted on MEDLINE, EMBASE, World Health Organization Global Index Medicus, African Journals Online, WOS, and Scopus, covering the period from the inception of the databases to August 18th, 2021, focusing on studies reporting management and outcomes of epilepsy in LMICs. A total of 2298 unique studies were identified, of which, 48 were included (38035 cases). The mean age was 20.1 ± 19.26 years with a male predominance in 60.92% of cases. The type of seizure commonly reported in most of the studies was absence seizures (n = 8302, 21.82%); partial focal seizure (n = 3891, 10.23%); and generalized tonic-clonic seizures (n = 3545, 9.32%) which were the next most common types of seizures. Mesiotemporal epilepsy was less frequently reported (n = 87, 0.22%). Electroencephalogram was commonly used (n = 2516, 6.61%), followed by computed tomography scan (n = 1028, 2.70%), magnetic resonance imaging (n = 638, 1.67%), and video telemetry (n = 484, 1.27%) in the care of patients with seizures. Primary epilepsy was recorded in 582 patients (1.53%) whereas secondary epilepsy was present in 333 patients (0.87%). Carbamazepine was the most used anti-epileptic drug (n = 2121, 5.57%). Surgical treatment was required for 465 (1.22%) patients. In LMICs, epilepsy is underreported. There is still a lack of adequate tools for the diagnosis of primary or secondary epilepsy as well as adequate access to medical management of those reported.
{"title":"Epilepsy care and outcome in low- and middle-income countries: A scoping review","authors":"Nourou Dine Adeniran Bankole, Y. Dokponou, R. de Koning, D. U. Dalle, Ö. Kesici, C. Egu, C. Ikwuegbuenyi, G. Adegboyega, S. Z. Yang Ooi, O. Dada, J. Erhabor, Emmanuel Mukambo, Tunde Olobatoke, B. Takoutsing, Soham Bandyopadhyay","doi":"10.25259/jnrp_527_2023","DOIUrl":"https://doi.org/10.25259/jnrp_527_2023","url":null,"abstract":"\u0000\u0000Epilepsy is a common neurological condition in low- and middle-income countries (LMICs). This study aims to systematically review, analyze, evaluate, and synthesize information on the current state of medical and surgical management and outcomes of epilepsy in LMICs.\u0000\u0000\u0000\u0000Systematic searches were conducted on MEDLINE, EMBASE, World Health Organization Global Index Medicus, African Journals Online, WOS, and Scopus, covering the period from the inception of the databases to August 18th, 2021, focusing on studies reporting management and outcomes of epilepsy in LMICs.\u0000\u0000\u0000\u0000A total of 2298 unique studies were identified, of which, 48 were included (38035 cases). The mean age was 20.1 ± 19.26 years with a male predominance in 60.92% of cases. The type of seizure commonly reported in most of the studies was absence seizures (n = 8302, 21.82%); partial focal seizure (n = 3891, 10.23%); and generalized tonic-clonic seizures (n = 3545, 9.32%) which were the next most common types of seizures. Mesiotemporal epilepsy was less frequently reported (n = 87, 0.22%). Electroencephalogram was commonly used (n = 2516, 6.61%), followed by computed tomography scan (n = 1028, 2.70%), magnetic resonance imaging (n = 638, 1.67%), and video telemetry (n = 484, 1.27%) in the care of patients with seizures. Primary epilepsy was recorded in 582 patients (1.53%) whereas secondary epilepsy was present in 333 patients (0.87%). Carbamazepine was the most used anti-epileptic drug (n = 2121, 5.57%). Surgical treatment was required for 465 (1.22%) patients.\u0000\u0000\u0000\u0000In LMICs, epilepsy is underreported. There is still a lack of adequate tools for the diagnosis of primary or secondary epilepsy as well as adequate access to medical management of those reported.\u0000","PeriodicalId":16443,"journal":{"name":"Journal of Neurosciences in Rural Practice","volume":null,"pages":null},"PeriodicalIF":1.4,"publicationDate":"2024-02-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139804353","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Nourou Dine Adeniran Bankole, Y. Dokponou, R. de Koning, D. U. Dalle, Ö. Kesici, C. Egu, C. Ikwuegbuenyi, G. Adegboyega, S. Z. Yang Ooi, O. Dada, J. Erhabor, Emmanuel Mukambo, Tunde Olobatoke, B. Takoutsing, Soham Bandyopadhyay
Epilepsy is a common neurological condition in low- and middle-income countries (LMICs). This study aims to systematically review, analyze, evaluate, and synthesize information on the current state of medical and surgical management and outcomes of epilepsy in LMICs. Systematic searches were conducted on MEDLINE, EMBASE, World Health Organization Global Index Medicus, African Journals Online, WOS, and Scopus, covering the period from the inception of the databases to August 18th, 2021, focusing on studies reporting management and outcomes of epilepsy in LMICs. A total of 2298 unique studies were identified, of which, 48 were included (38035 cases). The mean age was 20.1 ± 19.26 years with a male predominance in 60.92% of cases. The type of seizure commonly reported in most of the studies was absence seizures (n = 8302, 21.82%); partial focal seizure (n = 3891, 10.23%); and generalized tonic-clonic seizures (n = 3545, 9.32%) which were the next most common types of seizures. Mesiotemporal epilepsy was less frequently reported (n = 87, 0.22%). Electroencephalogram was commonly used (n = 2516, 6.61%), followed by computed tomography scan (n = 1028, 2.70%), magnetic resonance imaging (n = 638, 1.67%), and video telemetry (n = 484, 1.27%) in the care of patients with seizures. Primary epilepsy was recorded in 582 patients (1.53%) whereas secondary epilepsy was present in 333 patients (0.87%). Carbamazepine was the most used anti-epileptic drug (n = 2121, 5.57%). Surgical treatment was required for 465 (1.22%) patients. In LMICs, epilepsy is underreported. There is still a lack of adequate tools for the diagnosis of primary or secondary epilepsy as well as adequate access to medical management of those reported.
{"title":"Epilepsy care and outcome in low- and middle-income countries: A scoping review","authors":"Nourou Dine Adeniran Bankole, Y. Dokponou, R. de Koning, D. U. Dalle, Ö. Kesici, C. Egu, C. Ikwuegbuenyi, G. Adegboyega, S. Z. Yang Ooi, O. Dada, J. Erhabor, Emmanuel Mukambo, Tunde Olobatoke, B. Takoutsing, Soham Bandyopadhyay","doi":"10.25259/jnrp_527_2023","DOIUrl":"https://doi.org/10.25259/jnrp_527_2023","url":null,"abstract":"\u0000\u0000Epilepsy is a common neurological condition in low- and middle-income countries (LMICs). This study aims to systematically review, analyze, evaluate, and synthesize information on the current state of medical and surgical management and outcomes of epilepsy in LMICs.\u0000\u0000\u0000\u0000Systematic searches were conducted on MEDLINE, EMBASE, World Health Organization Global Index Medicus, African Journals Online, WOS, and Scopus, covering the period from the inception of the databases to August 18th, 2021, focusing on studies reporting management and outcomes of epilepsy in LMICs.\u0000\u0000\u0000\u0000A total of 2298 unique studies were identified, of which, 48 were included (38035 cases). The mean age was 20.1 ± 19.26 years with a male predominance in 60.92% of cases. The type of seizure commonly reported in most of the studies was absence seizures (n = 8302, 21.82%); partial focal seizure (n = 3891, 10.23%); and generalized tonic-clonic seizures (n = 3545, 9.32%) which were the next most common types of seizures. Mesiotemporal epilepsy was less frequently reported (n = 87, 0.22%). Electroencephalogram was commonly used (n = 2516, 6.61%), followed by computed tomography scan (n = 1028, 2.70%), magnetic resonance imaging (n = 638, 1.67%), and video telemetry (n = 484, 1.27%) in the care of patients with seizures. Primary epilepsy was recorded in 582 patients (1.53%) whereas secondary epilepsy was present in 333 patients (0.87%). Carbamazepine was the most used anti-epileptic drug (n = 2121, 5.57%). Surgical treatment was required for 465 (1.22%) patients.\u0000\u0000\u0000\u0000In LMICs, epilepsy is underreported. There is still a lack of adequate tools for the diagnosis of primary or secondary epilepsy as well as adequate access to medical management of those reported.\u0000","PeriodicalId":16443,"journal":{"name":"Journal of Neurosciences in Rural Practice","volume":null,"pages":null},"PeriodicalIF":1.4,"publicationDate":"2024-02-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139863948","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Rakesh Mishra, Vishal Chavda, L. Moscote-Salazar, O. Atallah, Saikat Das, Tariq Janjua, V. Maurya, Amit Agrawal
D-dimer levels are increased in stroke and cancer. Cancer patients are at a higher risk of stroke. However, the evidence is unclear if high D-dimer in stroke patients can suggest the diagnosis of concomitant cancer or the development of stroke in a cancer patient. The objective is to assess the evidence available on the baseline D-dimer level in stroke patients with and without cancer. We conducted the systematic review and meta-analysis using the Preferred Reporting Items for Systematic Reviews and Meta-analysis guidelines. We searched PUBMED, Cochrane, ScienceDirect, and Scopus for potentially eligible articles published till June 2023. All the review steps were iterative and done independently by two reviewers. The Newcastle-Ottawa scale tool was used to assess the quality of included studies for case control and cohort studies and the Agency for Healthcare Research and Quality tool for cross-sectional studies. The qualitative synthesis is presented narratively, and quantitative synthesis is shown in the forest plot using the random effects model. I2 of more than 60% was considered as high heterogeneity. The searches from all the databases yielded 495 articles. After the study selection process, six papers were found eligible for inclusion in the qualitative and quantitative synthesis. In the present systematic review, 2651 patients with ischemic infarcts are included of which 404 (13.97%) patients had active cancer while 2247 (86.02%) did not. The studies included were of high quality and low risk of bias. There were significantly higher baseline D-dimer levels in stroke patients with cancer than in non-cancer patients with a mean difference of 4.84 (3.07–6.60) P < 0.00001. D-dimer is a simple and relatively non-expensive biomarker that is increased to significant levels in stroke patients, who have cancer and therefore may be a tool to predict through screening for active or occult cancer in stroke patients.
{"title":"Systematic review and meta-analysis of studies comparing baseline D-dimer level in stroke patients with or without cancer: Strength of current evidence","authors":"Rakesh Mishra, Vishal Chavda, L. Moscote-Salazar, O. Atallah, Saikat Das, Tariq Janjua, V. Maurya, Amit Agrawal","doi":"10.25259/jnrp_379_2023","DOIUrl":"https://doi.org/10.25259/jnrp_379_2023","url":null,"abstract":"\u0000\u0000D-dimer levels are increased in stroke and cancer. Cancer patients are at a higher risk of stroke. However, the evidence is unclear if high D-dimer in stroke patients can suggest the diagnosis of concomitant cancer or the development of stroke in a cancer patient. The objective is to assess the evidence available on the baseline D-dimer level in stroke patients with and without cancer.\u0000\u0000\u0000\u0000We conducted the systematic review and meta-analysis using the Preferred Reporting Items for Systematic Reviews and Meta-analysis guidelines. We searched PUBMED, Cochrane, ScienceDirect, and Scopus for potentially eligible articles published till June 2023. All the review steps were iterative and done independently by two reviewers. The Newcastle-Ottawa scale tool was used to assess the quality of included studies for case control and cohort studies and the Agency for Healthcare Research and Quality tool for cross-sectional studies. The qualitative synthesis is presented narratively, and quantitative synthesis is shown in the forest plot using the random effects model. I2 of more than 60% was considered as high heterogeneity.\u0000\u0000\u0000\u0000The searches from all the databases yielded 495 articles. After the study selection process, six papers were found eligible for inclusion in the qualitative and quantitative synthesis. In the present systematic review, 2651 patients with ischemic infarcts are included of which 404 (13.97%) patients had active cancer while 2247 (86.02%) did not. The studies included were of high quality and low risk of bias. There were significantly higher baseline D-dimer levels in stroke patients with cancer than in non-cancer patients with a mean difference of 4.84 (3.07–6.60) P < 0.00001.\u0000\u0000\u0000\u0000D-dimer is a simple and relatively non-expensive biomarker that is increased to significant levels in stroke patients, who have cancer and therefore may be a tool to predict through screening for active or occult cancer in stroke patients.\u0000","PeriodicalId":16443,"journal":{"name":"Journal of Neurosciences in Rural Practice","volume":null,"pages":null},"PeriodicalIF":1.4,"publicationDate":"2024-02-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139803930","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Deb Kumar Boruah, Rebecca Marak, Dhrubajyoti Bhuyan, H. Mazumdar, S. Patgiri
Liver cirrhosis patients commonly progress to minimal hepatic encephalopathy (MHE) with cognitive impairment and raised blood ammonia and proinflammatory cytokines levels. This study aims to identify the subjects of MHE in patients with liver cirrhosis by hydrogen 1 magnetic resonance (1H-MR) spectroscopy of the brain, serum proinflammatory cytokines, and neuropsychiatric tests. This prospective was carried out on 100 patients of liver cirrhosis without overt hepatic encephalopathy (HE) and compared with 100 healthy controls in a tertiary care hospital in Northeast India between September 2017 and October 2019. The psychometric hepatic encephalopathy score (PHES) neuropsychological tests, cranial MRIwith 1H-MR spectroscopy, and estimation of serum interleukin 6 (IL-6) and tumor necrosis factor-alpha (TNF-α) were done. The PHES scores and serum proinflammatory markers levels were correlated with the conventional and 1H-MR spectroscopy findings of the brain. The mean PHES score in the case group was −7.58±3.43 (standard deviation [SD]) and the control group was −3.41 ± 3.87 (SD). Patients with Child-Pugh class A (n = 8) had a PHES score of −8.7 ± 2.5 (SD), class B (n = 42) −7.62 ± 3.7 (SD), and class C (n = 50) had a score of −7.36 ± 3.3 (SD). The mean value of IL-6 and TNF-α in the case group was 219 ± 180 (SD) pg/mL and 99 ± 118 (SD) pg/mL and the control group was 67.4 ± 77 (SD) pg/mL and 57.5 ± 76 (SD) pg/mL. Globus pallidus T1-weighted hyperintensities on the visibility scale with a visibility score of 0 were observed in 39 cases, a score of 1 in 38 cases, and a score of 2 in 23 cases. Increased glutamate/glutamine/creatine (Glx/Cr) ratio was identified in the case group on MR spectroscopy as compared to the control (0.95 ± 0.24 vs. 0.31 ± 0.19, P < 0.0005), a decrease of myoinositol/creatine (mI/Cr) ratio (0.11 ± 0.13 vs. 0.30 ± 0.12, P < 0.0005), and increase choline/creatine (Cho/Cr) ratio (0.69 ± 0.26 vs. 0.61 ± 0.20, P < 0.0005). There was a statistically significant difference in Glx/Cr, mI/Cr and Cho/Cr ratio between the case and control groups with P < 0.0005. Predicting the development of MHE in established cases of liver cirrhosis using non-invasive modalities like PHES, IL-6, TNF-α levels, and 1H-MR spectroscopy plays an important role in further progression to overt HE and coma.
{"title":"Importance of 1H-MR spectroscopy of the brain to identify the minimal hepatic encephalopathy in different patients with liver cirrhosis: A prospective study","authors":"Deb Kumar Boruah, Rebecca Marak, Dhrubajyoti Bhuyan, H. Mazumdar, S. Patgiri","doi":"10.25259/jnrp_460_2023","DOIUrl":"https://doi.org/10.25259/jnrp_460_2023","url":null,"abstract":"\u0000\u0000Liver cirrhosis patients commonly progress to minimal hepatic encephalopathy (MHE) with cognitive impairment and raised blood ammonia and proinflammatory cytokines levels. This study aims to identify the subjects of MHE in patients with liver cirrhosis by hydrogen 1 magnetic resonance (1H-MR) spectroscopy of the brain, serum proinflammatory cytokines, and neuropsychiatric tests.\u0000\u0000\u0000\u0000This prospective was carried out on 100 patients of liver cirrhosis without overt hepatic encephalopathy (HE) and compared with 100 healthy controls in a tertiary care hospital in Northeast India between September 2017 and October 2019. The psychometric hepatic encephalopathy score (PHES) neuropsychological tests, cranial MRIwith 1H-MR spectroscopy, and estimation of serum interleukin 6 (IL-6) and tumor necrosis factor-alpha (TNF-α) were done. The PHES scores and serum proinflammatory markers levels were correlated with the conventional and 1H-MR spectroscopy findings of the brain.\u0000\u0000\u0000\u0000The mean PHES score in the case group was −7.58±3.43 (standard deviation [SD]) and the control group was −3.41 ± 3.87 (SD). Patients with Child-Pugh class A (n = 8) had a PHES score of −8.7 ± 2.5 (SD), class B (n = 42) −7.62 ± 3.7 (SD), and class C (n = 50) had a score of −7.36 ± 3.3 (SD). The mean value of IL-6 and TNF-α in the case group was 219 ± 180 (SD) pg/mL and 99 ± 118 (SD) pg/mL and the control group was 67.4 ± 77 (SD) pg/mL and 57.5 ± 76 (SD) pg/mL. Globus pallidus T1-weighted hyperintensities on the visibility scale with a visibility score of 0 were observed in 39 cases, a score of 1 in 38 cases, and a score of 2 in 23 cases. Increased glutamate/glutamine/creatine (Glx/Cr) ratio was identified in the case group on MR spectroscopy as compared to the control (0.95 ± 0.24 vs. 0.31 ± 0.19, P < 0.0005), a decrease of myoinositol/creatine (mI/Cr) ratio (0.11 ± 0.13 vs. 0.30 ± 0.12, P < 0.0005), and increase choline/creatine (Cho/Cr) ratio (0.69 ± 0.26 vs. 0.61 ± 0.20, P < 0.0005). There was a statistically significant difference in Glx/Cr, mI/Cr and Cho/Cr ratio between the case and control groups with P < 0.0005.\u0000\u0000\u0000\u0000Predicting the development of MHE in established cases of liver cirrhosis using non-invasive modalities like PHES, IL-6, TNF-α levels, and 1H-MR spectroscopy plays an important role in further progression to overt HE and coma.\u0000","PeriodicalId":16443,"journal":{"name":"Journal of Neurosciences in Rural Practice","volume":null,"pages":null},"PeriodicalIF":1.4,"publicationDate":"2024-01-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139526582","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Rajitha Pavalur, P. Nattala, Arun Kandasamy, Dhaval P. Shukla
Driving under the influence of alcohol is one of the leading causes of road traffic accidents in India. Individuals with acute injuries often present to emergency hospital services. Carrying out brief interventions in the emergency can prevent further injury and even progression to severe patterns of drinking. However, there are no known studies from India examining the effectiveness of such interventions in emergency settings. Against this background, the objective of this randomized controlled trial was to evaluate the effectiveness of a nurse-led Brief Focused Intervention (BFI) in comparison with the minimal intervention for patients with mild Traumatic Brain Injury (TBI) reporting to the emergency and casualty services of a tertiary hospital in Bengaluru, South India, who screened positive for alcohol use. The BFI comprised a video portraying the effects of alcohol on the brain and muscles and brief advice on how to reduce or avoid alcohol use. Subjects (N = 90) were randomly allocated to two groups: BFI (n = 45) or Minimal Intervention Group (MIG) (n = 45). Standardized tools were used to assess both groups on specific outcomes for up to six months following discharge from the emergency and casualty services. At the end of six months, complete data wasavailable for 73 patients. Participants’ (N = 73) mean age was 35 years (standard deviation [SD]-11). Over the six-month follow-up, the BFI group reported significantly lesser quantity of alcohol consumption (Alcohol Use Disorder Identification Test [AUDIT] Score – 5.03, SD 4.09, 95% confidence interval [CI] = 3.70, 6.35) compared to MIG (AUDIT Score – 9.76, SD 2.96, 95% CI = 8.73, 10.80), and fewer alcohol use-related problems in BFI group (Mean – 4.18, SD 3.21, 95% CI = 3.14, 5.22) compared to MIG (Mean – 5.88, SD 2.59, 95% CI = 4.98, 6.79). Results of logistic regression showed that being in MIG as well as baseline hazardous use of alcohol were associated with unfavorable outcomes at the end of six months follow-up. Findings provide the first known evidence from India for the effectiveness of nurse-led BFI in the emergency and casualty services in improving post-discharge outcomes for patients with alcohol use-related mild TBI. While the findings of the study are statistically significant, these findings also have significant clinical relevance, as they have shown that the BFI improved clinical outcomes. Thus, brief interventions should be implemented for these patients whenever possible in the Emergency setting.
{"title":"A randomized controlled trial of nurse-led Brief Focused Intervention for patients with alcohol use-related mild traumatic brain injury in the emergency and casualty services of a tertiary hospital","authors":"Rajitha Pavalur, P. Nattala, Arun Kandasamy, Dhaval P. Shukla","doi":"10.25259/jnrp_381_2023","DOIUrl":"https://doi.org/10.25259/jnrp_381_2023","url":null,"abstract":"\u0000\u0000Driving under the influence of alcohol is one of the leading causes of road traffic accidents in India. Individuals with acute injuries often present to emergency hospital services. Carrying out brief interventions in the emergency can prevent further injury and even progression to severe patterns of drinking. However, there are no known studies from India examining the effectiveness of such interventions in emergency settings. Against this background, the objective of this randomized controlled trial was to evaluate the effectiveness of a nurse-led Brief Focused Intervention (BFI) in comparison with the minimal intervention for patients with mild Traumatic Brain Injury (TBI) reporting to the emergency and casualty services of a tertiary hospital in Bengaluru, South India, who screened positive for alcohol use.\u0000\u0000\u0000\u0000The BFI comprised a video portraying the effects of alcohol on the brain and muscles and brief advice on how to reduce or avoid alcohol use. Subjects (N = 90) were randomly allocated to two groups: BFI (n = 45) or Minimal Intervention Group (MIG) (n = 45). Standardized tools were used to assess both groups on specific outcomes for up to six months following discharge from the emergency and casualty services. At the end of six months, complete data wasavailable for 73 patients.\u0000\u0000\u0000\u0000Participants’ (N = 73) mean age was 35 years (standard deviation [SD]-11). Over the six-month follow-up, the BFI group reported significantly lesser quantity of alcohol consumption (Alcohol Use Disorder Identification Test [AUDIT] Score – 5.03, SD 4.09, 95% confidence interval [CI] = 3.70, 6.35) compared to MIG (AUDIT Score – 9.76, SD 2.96, 95% CI = 8.73, 10.80), and fewer alcohol use-related problems in BFI group (Mean – 4.18, SD 3.21, 95% CI = 3.14, 5.22) compared to MIG (Mean – 5.88, SD 2.59, 95% CI = 4.98, 6.79). Results of logistic regression showed that being in MIG as well as baseline hazardous use of alcohol were associated with unfavorable outcomes at the end of six months follow-up.\u0000\u0000\u0000\u0000Findings provide the first known evidence from India for the effectiveness of nurse-led BFI in the emergency and casualty services in improving post-discharge outcomes for patients with alcohol use-related mild TBI. While the findings of the study are statistically significant, these findings also have significant clinical relevance, as they have shown that the BFI improved clinical outcomes. Thus, brief interventions should be implemented for these patients whenever possible in the Emergency setting.\u0000","PeriodicalId":16443,"journal":{"name":"Journal of Neurosciences in Rural Practice","volume":null,"pages":null},"PeriodicalIF":1.4,"publicationDate":"2024-01-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139614612","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Cytotoxic lesion of corpus callosum secondary to phenytoin toxicity","authors":"Akhil Sahib, Amrita Gotur","doi":"10.25259/jnrp_468_2023","DOIUrl":"https://doi.org/10.25259/jnrp_468_2023","url":null,"abstract":"","PeriodicalId":16443,"journal":{"name":"Journal of Neurosciences in Rural Practice","volume":null,"pages":null},"PeriodicalIF":1.4,"publicationDate":"2024-01-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139616890","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Tumefactive perivascular space of the anterior temporal lobe","authors":"Amit Agarwal, P. Vibhute","doi":"10.25259/jnrp_343_2023","DOIUrl":"https://doi.org/10.25259/jnrp_343_2023","url":null,"abstract":"","PeriodicalId":16443,"journal":{"name":"Journal of Neurosciences in Rural Practice","volume":null,"pages":null},"PeriodicalIF":1.4,"publicationDate":"2024-01-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139617842","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pooja Rai, Jonas S. Sundarakumar, Nimisha Basavaraju, R. Kommaddi, T. Issac
Several genetic factors have been associated with cognitive decline in aging. Apolipoprotein E (ApoE) ε4 has been widely studied in the risk for pathological cognitive decline, including dementia. However, the association between ApoE ε4 and cognitive functioning in the healthy aging Indian population has been understudied, and the results are ambiguous. This study aims to examine the role of the ApoE genotype with attentional function in aging adults (≥45 years) in a rural Indian population. Cross-sectional (baseline) data (n = 2100) was utilized from an ongoing longitudinal cohort study on aging (Srinivaspura Aging, Neurosenescence, and Cognition study). Participants hailed from villages of Srinivaspura in Karnataka, southern India. Participants were categorized based on ApoE-ε4 status into three categories: No ε4, heterozygous ε4, and homozygous ε4. Attentional function was assessed using the auditory and visual attention subtests from a computerized neurocognitive test battery. Linear regression was performed adjusting for age, gender, and education. In model 1 (unadjusted), we did not find an association between ApoE and attention function. In the partially adjusted model 2 (adjusting for age), ApoE ε4 with age was significantly associated with the attention function. Further, with increasing age, there was a decline in attention among homozygous ε4 individuals. Model 3 (model 2 + gender) found that ApoE ε4, age, and gender explained a significant variance in attention function. In addition, with increasing age, males had poor attention in the homozygous as compared to heterozygous group. Model 4 (model 3+ education) explained a significant variance in attention and also revealed that with increasing age, attention declined in the illiterate and low literacy groups in both homozygous and heterozygous groups among both genders. Although ApoE ε4 alone was not associated, it interacted with age, gender, and education to affect attention function in this rural Indian population. Longitudinal cognitive monitoring will yield insights into understanding whether the ApoE ε4 genotype influences the rate of cognitive decline in this rural, aging population.
有几种遗传因素与老年认知能力下降有关。载脂蛋白 E（载脂蛋白 E）ε4 与包括痴呆症在内的病理认知能力衰退风险的关系已被广泛研究。本研究旨在研究印度农村人口中的载脂蛋白 E 基因型与老年人（≥45 岁）的注意力功能之间的关系。横断面（基线）数据（n = 2100）来自一项正在进行的老龄化纵向队列研究（Srinivaspura Aging, Neurosenescence, and Cognition study）。参与者来自印度南部卡纳塔克邦斯里尼瓦斯普拉的村庄。根据载脂蛋白E-ε4的状态将参与者分为三类：无ε4、杂合子ε4和同合子ε4。注意力功能通过计算机化神经认知测试中的听觉和视觉注意力子测试进行评估。在模型1（未调整）中，我们没有发现载脂蛋白E与注意力功能之间的关系。在部分调整后的模型 2（调整年龄）中，载脂蛋白E ε4与年龄的关系与注意力功能显著相关。此外，随着年龄的增长，同卵ε4个体的注意力下降。模型 3（模型 2 + 性别）发现，载脂蛋白 E ε4、年龄和性别解释了注意力功能的显著差异。此外，随着年龄的增长，与杂合子组相比，同合子组男性的注意力较差。模型4（模型3+教育程度）解释了注意力的显著差异，还显示随着年龄的增长，在同卵和杂合子组中，文盲和低文化程度组的男女注意力都有所下降。对认知能力的纵向监测将有助于了解载脂蛋白E ε4基因型是否会影响这一农村老龄人口的认知能力衰退速度。
{"title":"Association between ApoE ε4 genotype and attentional function in non-demented, middle-aged, and older adults from rural India","authors":"Pooja Rai, Jonas S. Sundarakumar, Nimisha Basavaraju, R. Kommaddi, T. Issac","doi":"10.25259/jnrp_272_2023","DOIUrl":"https://doi.org/10.25259/jnrp_272_2023","url":null,"abstract":"\u0000\u0000Several genetic factors have been associated with cognitive decline in aging. Apolipoprotein E (ApoE) ε4 has been widely studied in the risk for pathological cognitive decline, including dementia. However, the association between ApoE ε4 and cognitive functioning in the healthy aging Indian population has been understudied, and the results are ambiguous.\u0000\u0000\u0000\u0000This study aims to examine the role of the ApoE genotype with attentional function in aging adults (≥45 years) in a rural Indian population. Cross-sectional (baseline) data (n = 2100) was utilized from an ongoing longitudinal cohort study on aging (Srinivaspura Aging, Neurosenescence, and Cognition study). Participants hailed from villages of Srinivaspura in Karnataka, southern India. Participants were categorized based on ApoE-ε4 status into three categories: No ε4, heterozygous ε4, and homozygous ε4. Attentional function was assessed using the auditory and visual attention subtests from a computerized neurocognitive test battery. Linear regression was performed adjusting for age, gender, and education.\u0000\u0000\u0000\u0000In model 1 (unadjusted), we did not find an association between ApoE and attention function. In the partially adjusted model 2 (adjusting for age), ApoE ε4 with age was significantly associated with the attention function. Further, with increasing age, there was a decline in attention among homozygous ε4 individuals. Model 3 (model 2 + gender) found that ApoE ε4, age, and gender explained a significant variance in attention function. In addition, with increasing age, males had poor attention in the homozygous as compared to heterozygous group. Model 4 (model 3+ education) explained a significant variance in attention and also revealed that with increasing age, attention declined in the illiterate and low literacy groups in both homozygous and heterozygous groups among both genders.\u0000\u0000\u0000\u0000Although ApoE ε4 alone was not associated, it interacted with age, gender, and education to affect attention function in this rural Indian population. Longitudinal cognitive monitoring will yield insights into understanding whether the ApoE ε4 genotype influences the rate of cognitive decline in this rural, aging population.\u0000","PeriodicalId":16443,"journal":{"name":"Journal of Neurosciences in Rural Practice","volume":null,"pages":null},"PeriodicalIF":1.4,"publicationDate":"2024-01-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139442830","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
京公网安备 11010802042870号
京ICP备2023020795号-1
扫码关注我们
求助内容：
应助结果提醒方式：