Hyperhomocysteinaemia And Vitamin B12 Deficiency In Ischaemic Strokes In India

Hyperhomocysteinemia is a recognised risk factor for stroke and ischemic heart disease (HID). Vit B12 Folate and pyridoxine deficiency are important causes of raised serum homocysteine. As a vegetarian diet is very poor in Vit B12 we sought to study the incidence of hyperhomocysteinaemia in our stroke populating and to measure Vit B12 and folate in these cases. Consecutive cases of ischaemic stroke, either arterial or venous, admitted over a period of 2 1/2 years were studied. Embolic strokes and those on vitamin supplements were excluded. cases were divided into vegetarian (including those taking milk and / Or eggs), those who took non-vegetarian 4 or less times a month, and frequent non-vegetarians taking 5 or more times a month. Serum total homocysteine, serum B12 and folate levels were studied along with all other routine parameters. For comparison we examined 101 controls without HID, stroke, peripheral vascular disease, rental failure or recent vitamin intake. With the international norm for homocysteine given as 5-15 umol/litre (1)we called serum homocysteine 16 umol/litre or more as raised. There were 147 cases of ischcmic stroke :119 arterial and 28 venous infarcts. In the arterial strokes 99 of 119 cases (83.19%) had raised serum Homocysteine including 25 of 27 (92.5%) of those with arterial stroke before age 45. Of 28 cases with venous infarct 21 (75%) had raised homocysteine (HCY). Hyperhomocysteinemia was the commonest risk factor for stroke in our populations. Out of the total 147 cases the exact dietary intake was not known for ten cases., 58 were vegetarians, 54 were occasional non vegetarians (NV) and 25 were frequent NV. In the 58 vegetarians, 55 had serum HCY> 16 umol/1 (94.8%) and of those vegetarians with HCY> 16, serum B12 <200pg/ml was seen in 44 (75.8%) and between 200-300 pg/ml in five (8.6%). Of the 54 occasional NV, 46 had HCY>16umo/1 (85.2%) Of those with HCY >16, serum B12 level of <200 pg/ ml was seen in 28 (51.85% occ. NV) and the level was 200-300 pg/ml in 12 patients (22.2%) . Of the 25 frequent NV 11 had increased HCY (44%), none had serum B12 <200 pg/ml and six had serum B12 between 200-300 pg/ml (24%). MCV (means corpuscular volume) was greater than 95fL in 51% of vegetarians, 4606% of occasional non- vegetarians and 6% of frequent NV. Low serum folate (<3 mg/ml) was uncommon and found in3 vegetarians, 3 occasional NV and 2 frequent NV and each time with B12 deficiency. In 101 controls homocysteine was raised in 52 (51.5%) including 86.6% of vegetarians and 17.1% frequent NV. Serum B12 <200 pg/ml was present in39 (38.6%). This included 56.6% of vegetarians and 5.7% of frequent NV. Raised serum homocysteine is common in India and is a major risk factor for strokes and this is mainly due to Vit B12 deficiency. The important predisposing factor is a vegetarians diet. A regular supplement, or fortification of food with vit. B12 (with or without folate) could be a very worthwhile preventive measure in this country

PLUTO plus : Near-Complete Modeling of Affine Transformations for Parallelism and Locality

Affine transformations have proven to be very powerful for loop restructuring due to their ability to model a very wide range of transformations. A single multi-dimensional affine function can represent a long and complex sequence of simpler transformations. Existing affine transformation frameworks like the Pluto algorithm, that include a cost function for modern multicore architectures where coarse-grained parallelism and locality are crucial, consider only a sub-space of transformations to avoid a combinatorial explosion in finding the transformations. The ensuing practical tradeoffs lead to the exclusion of certain useful transformations, in particular, transformation compositions involving loop reversals and loop skewing by negative factors. In this paper, we propose an approach to address this limitation by modeling a much larger space of affine transformations in conjunction with the Pluto algorithm's cost function. We perform an experimental evaluation of both, the effect on compilation time, and performance of generated codes. The evaluation shows that our new framework, Pluto+, provides no degradation in performance in any of the Polybench benchmarks. For Lattice Boltzmann Method (LBM) codes with periodic boundary conditions, it provides a mean speedup of 1.33x over Pluto. We also show that Pluto+ does not increase compile times significantly. Experimental results on Polybench show that Pluto+ increases overall polyhedral source-to-source optimization time only by 15%. In cases where it improves execution time significantly, it increased polyhedral optimization time only by 2.04x

Practice patterns and outcomes after stroke across countries at different economic levels (INTERSTROKE):an international observational study

Background: Stroke disproportionately affects people in low-income and middle-income countries. Although improvements in stroke care and outcomes have been reported in high-income countries, little is known about practice and outcomes in low and middle-income countries. We aimed to compare patterns of care available and their association with patient outcomes across countries at different economic levels. Methods: We studied the patterns and effect of practice variations (ie, treatments used and access to services) among participants in the INTERSTROKE study, an international observational study that enrolled 13 447 stroke patients from 142 clinical sites in 32 countries between Jan 11, 2007, and Aug 8, 2015. We supplemented patient data with a questionnaire about health-care and stroke service facilities at all participating hospitals. Using univariate and multivariate regression analyses to account for patient casemix and service clustering, we estimated the association between services available, treatments given, and patient outcomes (death or dependency) at 1 month. Findings: We obtained full information for 12 342 (92%) of 13 447 INTERSTROKE patients, from 108 hospitals in 28 countries; 2576 from 38 hospitals in ten high-income countries and 9766 from 70 hospitals in 18 low and middle-income countries. Patients in low-income and middle-income countries more often had severe strokes, intracerebral haemorrhage, poorer access to services, and used fewer investigations and treatments (p<0·0001) than those in high-income countries, although only differences in patient characteristics explained the poorer clinical outcomes in low and middle-income countries. However across all countries, irrespective of economic level, access to a stroke unit was associated with improved use of investigations and treatments, access to other rehabilitation services, and improved survival without severe dependency (odds ratio [OR] 1·29; 95% CI 1·14–1·44; all p<0·0001), which was independent of patient casemix characteristics and other measures of care. Use of acute antiplatelet treatment was associated with improved survival (1·39; 1·12–1·72) irrespective of other patient and service characteristics. Interpretation: Evidence-based treatments, diagnostics, and stroke units were less commonly available or used in low and middle-income countries. Access to stroke units and appropriate use of antiplatelet treatment were associated with improved recovery. Improved care and facilities in low-income and middle-income countries are essential to improve outcomes