A study of stress hyperglycemia and its relationship with the neurological outcome in patients presenting with acute ischemic stroke

2016-07-23T04-22-34Z
Source: International Journal of Advances in Medicine
Siva Ranganathan Green, Lokesh S., Tony Kadavanu Mathew, Jayasingh K., Ragupathy S..
Background: Cerebrovascular accident (CVA) continues to be the most common neurological disease in the developed and developing countries. It also stands as the 3rd more common cause of death after cardiovascular disease and cancer. Stroke related burden keeps rising among the patients, their relatives and treating consultants. The neurological outcome depends on various modifiable and non-modifiable risk factors. Among the modifiable risk factors, admission (stress) hyperglycemia has a deleterious effect on the neurological outcome. It is well known by various studies that diabetic patients have more severe outcome and neurological disability after acute stroke than the non-diabetic patients. Now stress hyperglycemia is also becoming a second serious marker to affect the neurological outcome of these stroke patients. The aim was to study the blood sugar level and it`s correlation with the neurological outcome among the acute ischemic stroke patients on admission and at third month of follow-up. Methods: It is a prospective and comparative study done in a tertiary care hospital. Adult patients (> 40 years) presenting with acute ischemic stroke were neurologically stratified based on National Institutes of Health Stroke Scale (NIHSS) and admission blood sugars were noted. They were subdivided into 3 groups. Group 1 consisting of 31 normoglycemic patients, group 2 consisting of 32 stress hyperglycemic patients and group 3 consisting of 40 Type 2 diabetes mellitus (T2DM) patients. They were again reassessed after 3 months with FBS, PPBS and neurological recovery by NHISS. Chi- square test / fischer exact test was used to compare between 3 groups. A p-value of


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Screening based on incidence of severe retinopathy of prematurity in a tertiary care center in India: are Indian infants different?

2016-07-23T03-57-49Z
Source: International Journal of Contemporary Pediatrics
Umamaheswari Balakrishnan, Shafi Jan Mohammad Shaik, Nivetha Manian*, Muthayya Muthukumar, Mary Thomas, Prakash Amboiram, Binu Ninan, Ashok Chandrasekaran, Saravanan Ramaswamy.
Background: Incidence of retinopathy of prematurity (ROP) and screening criteria among the preterm infants varies widely. The incidence of ROP and severe ROP in different Birth Weight (BW) and Gestational Age (GA) groups were studied. The aim of the study was to review the existing screening criteria for ROP based on the highest birth weight and or gestational age of infants who developed severe ROP. Methods: This is a retrospective descriptive study of neonates with GA of ≤ 34 weeks and/or BW of ≤ 1750 gm screened for ROP by experienced ophthalmologist from January, 2011 to December, 2015. End point was either complete vascularisation or need for laser therapy as per ETROP guidelines. Severe ROP was defined as ROP needing treatment. Highest BW and or GA of infants who developed severe ROP were taken as cut off points for revising the existing screening criteria for ROP. Results: Among 1366 infants included in this study, 252 (18.4%) and 86 (6.2%) developed ROP and severe ROP, respectively. Mean GA was 29.2±1.4 weeks and 28.7±2.3 among infants with ROP and severe ROP, respectively. Stratified analysis showed a significant increase in the incidence of ROP with decreasing BW and GA (p


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Society of Anesthesia and Sleep Medicine Guidelines on Preoperative Screening and Assessment of Adult Patients With Obstructive Sleep Apnea

The purpose of the Society of Anesthesia and Sleep Medicine guideline on preoperative screening and assessment of adult patients with obstructive sleep apnea (OSA) is to present recommendations based on the available clinical evidence on the topic where possible. As very few well-performed randomized studies in this field of perioperative care are available, most of the recommendations were developed by experts in the field through consensus processes involving utilization of evidence grading to indicate the level of evidence upon which recommendations were based. This guideline may not be appropriate for all clinical situations and all patients. The decision whether to follow these recommendations must be made by a responsible physician on an individual basis. Protocols should be developed by individual institutions taking into account the patients' conditions, extent of interventions and available resources. This practice guideline is not intended to define standards of care or represent absolute requirements for patient care. The adherence to these guidelines cannot in any way guarantee successful outcomes and is rather meant to help individuals and institutions formulate plans to better deal with the challenges posed by perioperative patients with OSA. These recommendations reflect the current state of knowledge and its interpretation by a group of experts in the field at the time of publication. While these guidelines will be periodically updated, new information that becomes available between updates should be taken into account. Deviations in practice from guidelines may be justifiable and such deviations should not be interpreted as a basis for claims of negligence.

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Mechanisms of the Immunological Effects of Volatile Anesthetics: A Review

Volatile anesthetics (VAs) have been in clinical use for a very long time. Their mechanism of action is yet to be fully delineated, but multiple ion channels have been reported as targets for VAs (canonical VA targets). It is increasingly recognized that VAs also manifest effects outside the central nervous system, including on immune cells. However, the literature related to how VAs affect the behavior of immune cells is very limited, but it is of interest that some canonical VA targets are reportedly expressed in immune cells. Here, we review the current literature and describe canonical VA targets expressed in leukocytes and their known roles. In addition, we introduce adhesion molecules called β2 integrins as noncanonical VA targets in leukocytes. Finally, we propose a model for how VAs affect the function of neutrophils, macrophages, and natural killer cells via concerted effects on multiple targets as examples.

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Adjustments of the amplitude mapping function: Sensitivity of cochlear implant users and effects on subjective preference and speech recognition

10.1080/14992027.2016.1202454<br/>Femke L. Theelen–van den Hoek

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Evaluation of training program on knowledge of stroke among anganwadi workers in Chintamani taluk of Karnataka state, India

2016-07-23T03-16-18Z
Source: International Journal of Community Medicine and Public Health
Suman G., Lalitha K., Aravind B.A., Mahendra J.V., Arjunan I., Shivaraj N.S., Pruthvish S..
Background: Established population based disease registry provides data on incidence, risk factors, determinants and trends of the disease. Population based rural stroke registry was started on a pilot basis with an objective to evaluate the feasibility of establishing population-based stroke registry in Chintamani taluk of Karnataka state, India. Training of health care personnel was undertaken to facilitate reporting of case. The objective of the present communication is to evaluate the training conducted for anganwadi workers by trained investigators in 2012. Methods: Training was conducted using a validated training manual. Among the existing 438 anganwadi workers in the taluk, 405 (92.4%) attended the training. Pre and post-test questionnaire was administered before and after the training session to assess the improvement in the knowledge of stroke. Results: Only 362 (89.38%) with both pre and post-test answered were included for analysis. Overall there was statistical significant improvement in knowledge of anganwadi workers on symptoms, risk factors and prevention of stroke. Regarding Knowledge on symptoms of Stroke, 85 (95.5%) who scored poor, 81 (98.8%) who scored average in pre-test improved to good in post test. It was observed that 94 (100%) and 120 (94.4%) of the workers who scored poor regarding knowledge on prevention and risk factors of stroke respectively improved to good in the post-test. Conclusions: This endeavor substantiates the fact that anganwadi workers can be trained to identify suspects.


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Comparison of 2 Zero-Profile Implants in the Treatment of Single-Level Cervical Spondylotic Myelopathy: A Preliminary Clinical Study of Cervical Disc Arthroplasty versus Fusion.

Comparison of 2 Zero-Profile Implants in the Treatment of Single-Level Cervical Spondylotic Myelopathy: A Preliminary Clinical Study of Cervical Disc Arthroplasty versus Fusion.

PLoS One. 2016;11(7):e0159761

Authors: Shi S, Zheng S, Li XF, Yang LL, Liu ZD, Yuan W

Abstract
OBJECTIVES: Cervical disc arthroplasty (CDA) with Discover prosthesis or anterior cervical discectomy and fusion (ACDF) with Zero-P cage has been widely used in the treatment of cervical spondylotic myelopathy (CSM). However, little is known about the comparison of the 2 zero-profile implants in the treatment of single-level CSM. The aim was to compare the clinical outcomes and radiographic parameters of CDA with Discover prosthesis and ACDF with Zero-P cage for the treatment of single-level CSM.
METHODS: A total of 128 consecutive patients who underwent 1-level CDA with Discover prosthesis or ACDF with Zero-P cage for single-level CSM between September 2009 and December 2012 were included in this study. Clinical outcomes were evaluated using the Japanese Orthopaedic Association (JOA) score and Neck Disability Index (NDI). For radiographic assessment, the overall sagittal alignment (OSA), functional spinal unit (FSU) angle, and range of motion (ROM) at the index and adjacent levels were measured before and after surgery. Additionally, the complications were also recorded.
RESULTS: Both treatments significantly improved all clinical parameters (P < 0.05), without statistically relevant differences between the 2 groups. The OSA and FSU angle increased significantly in both groups (P <0.05). Compared with Zero-P group, ROMs at the index levels were well maintained in the Discover group (P < 0.05). However, there were no statistical differences in the ROMs of adjacent levels between the 2 groups (P > 0.05). Besides, no significant differences existed in dysphagia, subsidence, or adjacent disc degeneration between the 2 groups (P > 0.05). However, significant differences occurred in prosthesis migration in CDA group.
CONCLUSIONS: The results of this study showed that clinical outcomes and radiographic parameters were satisfactory and comparable with the 2 techniques. However, more attention to prosthesis migration of artificial cervical disc should be paid in the postoperative early-term follow-up.

PMID: 27441736 [PubMed - as supplied by publisher]

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