Effects of antiplatelet therapy on stroke risk by brain imaging features of intracerebral haemorrhage and cerebral small vessel diseases: subgroup analyses of the RESTART randomised, open-label trial

Background Findings from the RESTART trial suggest that starting antiplatelet therapy might reduce the risk of recurrent symptomatic intracerebral haemorrhage compared with avoiding antiplatelet therapy. Brain imaging features of intracerebral haemorrhage and cerebral small vessel diseases (such as cerebral microbleeds) are associated with greater risks of recurrent intracerebral haemorrhage. We did subgroup analyses of the RESTART trial to explore whether these brain imaging features modify the effects of antiplatelet therapy

Effects of antiplatelet therapy after stroke due to intracerebral haemorrhage (RESTART): a randomised, open-label trial

Background: Antiplatelet therapy reduces the risk of major vascular events for people with occlusive vascular disease, although it might increase the risk of intracranial haemorrhage. Patients surviving the commonest subtype of intracranial haemorrhage, intracerebral haemorrhage, are at risk of both haemorrhagic and occlusive vascular events, but whether antiplatelet therapy can be used safely is unclear. We aimed to estimate the relative and absolute effects of antiplatelet therapy on recurrent intracerebral haemorrhage and whether this risk might exceed any reduction of occlusive vascular events. Methods: The REstart or STop Antithrombotics Randomised Trial (RESTART) was a prospective, randomised, open-label, blinded endpoint, parallel-group trial at 122 hospitals in the UK. We recruited adults (≥18 years) who were taking antithrombotic (antiplatelet or anticoagulant) therapy for the prevention of occlusive vascular disease when they developed intracerebral haemorrhage, discontinued antithrombotic therapy, and survived for 24 h. Computerised randomisation incorporating minimisation allocated participants (1:1) to start or avoid antiplatelet therapy. We followed participants for the primary outcome (recurrent symptomatic intracerebral haemorrhage) for up to 5 years. We analysed data from all randomised participants using Cox proportional hazards regression, adjusted for minimisation covariates. This trial is registered with ISRCTN (number ISRCTN71907627). Findings: Between May 22, 2013, and May 31, 2018, 537 participants were recruited a median of 76 days (IQR 29–146) after intracerebral haemorrhage onset: 268 were assigned to start and 269 (one withdrew) to avoid antiplatelet therapy. Participants were followed for a median of 2·0 years (IQR [1·0– 3·0]; completeness 99·3%). 12 (4%) of 268 participants allocated to antiplatelet therapy had recurrence of intracerebral haemorrhage compared with 23 (9%) of 268 participants allocated to avoid antiplatelet therapy (adjusted hazard ratio 0·51 [95% CI 0·25–1·03]; p=0·060). 18 (7%) participants allocated to antiplatelet therapy experienced major haemorrhagic events compared with 25 (9%) participants allocated to avoid antiplatelet therapy (0·71 [0·39–1·30]; p=0·27), and 39 [15%] participants allocated to antiplatelet therapy had major occlusive vascular events compared with 38 [14%] allocated to avoid antiplatelet therapy (1·02 [0·65–1·60]; p=0·92). Interpretation: These results exclude all but a very modest increase in the risk of recurrent intracerebral haemorrhage with antiplatelet therapy for patients on antithrombotic therapy for the prevention of occlusive vascular disease when they developed intracerebral haemorrhage. The risk of recurrent intracerebral haemorrhage is probably too small to exceed the established benefits of antiplatelet therapy for secondary prevention

Effects of antiplatelet therapy after stroke due to intracerebral haemorrhage (RESTART): a randomised, open-label trial

Background: Antiplatelet therapy reduces the risk of major vascular events for people with occlusive vascular disease, although it might increase the risk of intracranial haemorrhage. Patients surviving the commonest subtype of intracranial haemorrhage, intracerebral haemorrhage, are at risk of both haemorrhagic and occlusive vascular events, but whether antiplatelet therapy can be used safely is unclear. We aimed to estimate the relative and absolute effects of antiplatelet therapy on recurrent intracerebral haemorrhage and whether this risk might exceed any reduction of occlusive vascular events. Methods: The REstart or STop Antithrombotics Randomised Trial (RESTART) was a prospective, randomised, open-label, blinded endpoint, parallel-group trial at 122 hospitals in the UK. We recruited adults (≥18 years) who were taking antithrombotic (antiplatelet or anticoagulant) therapy for the prevention of occlusive vascular disease when they developed intracerebral haemorrhage, discontinued antithrombotic therapy, and survived for 24 h. Computerised randomisation incorporating minimisation allocated participants (1:1) to start or avoid antiplatelet therapy. We followed participants for the primary outcome (recurrent symptomatic intracerebral haemorrhage) for up to 5 years. We analysed data from all randomised participants using Cox proportional hazards regression, adjusted for minimisation covariates. This trial is registered with ISRCTN (number ISRCTN71907627). Findings: Between May 22, 2013, and May 31, 2018, 537 participants were recruited a median of 76 days (IQR 29–146) after intracerebral haemorrhage onset: 268 were assigned to start and 269 (one withdrew) to avoid antiplatelet therapy. Participants were followed for a median of 2·0 years (IQR [1·0– 3·0]; completeness 99·3%). 12 (4%) of 268 participants allocated to antiplatelet therapy had recurrence of intracerebral haemorrhage compared with 23 (9%) of 268 participants allocated to avoid antiplatelet therapy (adjusted hazard ratio 0·51 [95% CI 0·25–1·03]; p=0·060). 18 (7%) participants allocated to antiplatelet therapy experienced major haemorrhagic events compared with 25 (9%) participants allocated to avoid antiplatelet therapy (0·71 [0·39–1·30]; p=0·27), and 39 [15%] participants allocated to antiplatelet therapy had major occlusive vascular events compared with 38 [14%] allocated to avoid antiplatelet therapy (1·02 [0·65–1·60]; p=0·92). Interpretation: These results exclude all but a very modest increase in the risk of recurrent intracerebral haemorrhage with antiplatelet therapy for patients on antithrombotic therapy for the prevention of occlusive vascular disease when they developed intracerebral haemorrhage. The risk of recurrent intracerebral haemorrhage is probably too small to exceed the established benefits of antiplatelet therapy for secondary prevention

Impact of COVID-19 on cardiovascular testing in the United States versus the rest of the world

Objectives: This study sought to quantify and compare the decline in volumes of cardiovascular procedures between the United States and non-US institutions during the early phase of the coronavirus disease-2019 (COVID-19) pandemic. Background: The COVID-19 pandemic has disrupted the care of many non-COVID-19 illnesses. Reductions in diagnostic cardiovascular testing around the world have led to concerns over the implications of reduced testing for cardiovascular disease (CVD) morbidity and mortality. Methods: Data were submitted to the INCAPS-COVID (International Atomic Energy Agency Non-Invasive Cardiology Protocols Study of COVID-19), a multinational registry comprising 909 institutions in 108 countries (including 155 facilities in 40 U.S. states), assessing the impact of the COVID-19 pandemic on volumes of diagnostic cardiovascular procedures. Data were obtained for April 2020 and compared with volumes of baseline procedures from March 2019. We compared laboratory characteristics, practices, and procedure volumes between U.S. and non-U.S. facilities and between U.S. geographic regions and identified factors associated with volume reduction in the United States. Results: Reductions in the volumes of procedures in the United States were similar to those in non-U.S. facilities (68% vs. 63%, respectively; p = 0.237), although U.S. facilities reported greater reductions in invasive coronary angiography (69% vs. 53%, respectively; p < 0.001). Significantly more U.S. facilities reported increased use of telehealth and patient screening measures than non-U.S. facilities, such as temperature checks, symptom screenings, and COVID-19 testing. Reductions in volumes of procedures differed between U.S. regions, with larger declines observed in the Northeast (76%) and Midwest (74%) than in the South (62%) and West (44%). Prevalence of COVID-19, staff redeployments, outpatient centers, and urban centers were associated with greater reductions in volume in U.S. facilities in a multivariable analysis. Conclusions: We observed marked reductions in U.S. cardiovascular testing in the early phase of the pandemic and significant variability between U.S. regions. The association between reductions of volumes and COVID-19 prevalence in the United States highlighted the need for proactive efforts to maintain access to cardiovascular testing in areas most affected by outbreaks of COVID-19 infection

Breast cancer management pathways during the COVID-19 pandemic: outcomes from the UK ‘Alert Level 4’ phase of the B-MaP-C study

Abstract: Background: The B-MaP-C study aimed to determine alterations to breast cancer (BC) management during the peak transmission period of the UK COVID-19 pandemic and the potential impact of these treatment decisions. Methods: This was a national cohort study of patients with early BC undergoing multidisciplinary team (MDT)-guided treatment recommendations during the pandemic, designated ‘standard’ or ‘COVID-altered’, in the preoperative, operative and post-operative setting. Findings: Of 3776 patients (from 64 UK units) in the study, 2246 (59%) had ‘COVID-altered’ management. ‘Bridging’ endocrine therapy was used (n = 951) where theatre capacity was reduced. There was increasing access to COVID-19 low-risk theatres during the study period (59%). In line with national guidance, immediate breast reconstruction was avoided (n = 299). Where adjuvant chemotherapy was omitted (n = 81), the median benefit was only 3% (IQR 2–9%) using ‘NHS Predict’. There was the rapid adoption of new evidence-based hypofractionated radiotherapy (n = 781, from 46 units). Only 14 patients (1%) tested positive for SARS-CoV-2 during their treatment journey. Conclusions: The majority of ‘COVID-altered’ management decisions were largely in line with pre-COVID evidence-based guidelines, implying that breast cancer survival outcomes are unlikely to be negatively impacted by the pandemic. However, in this study, the potential impact of delays to BC presentation or diagnosis remains unknown

Effects of antiplatelet therapy after stroke due to intracerebral haemorrhage (RESTART): a randomised, open-label trial

BACKGROUND: Antiplatelet therapy reduces the risk of major vascular events for people with occlusive vascular disease, although it might increase the risk of intracranial haemorrhage. Patients surviving the commonest subtype of intracranial haemorrhage, intracerebral haemorrhage, are at risk of both haemorrhagic and occlusive vascular events, but whether antiplatelet therapy can be used safely is unclear. We aimed to estimate the relative and absolute effects of antiplatelet therapy on recurrent intracerebral haemorrhage and whether this risk might exceed any reduction of occlusive vascular events. METHODS: The REstart or STop Antithrombotics Randomised Trial (RESTART) was a prospective, randomised, open-label, blinded endpoint, parallel-group trial at 122 hospitals in the UK. We recruited adults (≥18 years) who were taking antithrombotic (antiplatelet or anticoagulant) therapy for the prevention of occlusive vascular disease when they developed intracerebral haemorrhage, discontinued antithrombotic therapy, and survived for 24 h. Computerised randomisation incorporating minimisation allocated participants (1:1) to start or avoid antiplatelet therapy. We followed participants for the primary outcome (recurrent symptomatic intracerebral haemorrhage) for up to 5 years. We analysed data from all randomised participants using Cox proportional hazards regression, adjusted for minimisation covariates. This trial is registered with ISRCTN (number ISRCTN71907627). FINDINGS: Between May 22, 2013, and May 31, 2018, 537 participants were recruited a median of 76 days (IQR 29-146) after intracerebral haemorrhage onset: 268 were assigned to start and 269 (one withdrew) to avoid antiplatelet therapy. Participants were followed for a median of 2·0 years (IQR [1·0- 3·0]; completeness 99·3%). 12 (4%) of 268 participants allocated to antiplatelet therapy had recurrence of intracerebral haemorrhage compared with 23 (9%) of 268 participants allocated to avoid antiplatelet therapy (adjusted hazard ratio 0·51 [95% CI 0·25-1·03]; p=0·060). 18 (7%) participants allocated to antiplatelet therapy experienced major haemorrhagic events compared with 25 (9%) participants allocated to avoid antiplatelet therapy (0·71 [0·39-1·30]; p=0·27), and 39 [15%] participants allocated to antiplatelet therapy had major occlusive vascular events compared with 38 [14%] allocated to avoid antiplatelet therapy (1·02 [0·65-1·60]; p=0·92). INTERPRETATION: These results exclude all but a very modest increase in the risk of recurrent intracerebral haemorrhage with antiplatelet therapy for patients on antithrombotic therapy for the prevention of occlusive vascular disease when they developed intracerebral haemorrhage. The risk of recurrent intracerebral haemorrhage is probably too small to exceed the established benefits of antiplatelet therapy for secondary prevention. FUNDING: British Heart Foundation

Identification and Characterization of Bacterial Isolates and their Role in the Degradation of Neonicotinoid Insecticide Thiamethoxam

Thiamethoxam (THIA) degrading bacterial colonies were isolated from soil obtained from different ecosystems such as cotton, cabbage and paddy tolerating high concentrations of the insecticide followed by enrichment technique. Eight colonies were isolated and were morphologically and biochemically tested. Among eight bacterial isolates, three isolates named as THIA-3, THIA-4 and THIA-7 were found to be superior and recorded maximum growth in the medium supplemented with thiamethoxam as sole carbon source. Highest dissipation of thiamethoxam was recorded in the artificial medium inoculated with THIA-3 (94.72 %) followed by THIA-4 (90.78 %) and THIA-7 (82.06 %) compared to 53.85 percent in the control. In the thiamethoxam bioremediation study by using sterilized soil, half-life of thiamethoxam was reduced to 7.60 days in THIA-3 inoculation followed by THIA-4 (8.75 days) and THIA-7 (10.52 days) compared to 17.91 days in the control. The bacterial isolates viz., THIA-3, THIA-4 and THIA-7 were later identified as Acinetobacter sp., Enterobacter sp. and Bacillus sp., respectively through molecular characterization by 16S rRNA gene sequencing. These results highlight the potential of bacterial cultures to be used in the cleanup of pesticide contaminated sites in the environment

Circumstances and Consequences of Falls in Community-Living Elderly in North Bangalore Karnataka

Background: Falls are one of the causes of injuries and non-communicable diseases associated with old age. Falls lead to 20-30% of mild to severe injuries and are underlying cause of 10-15% of all emergency departments. Knowledge of the circumstances and consequences of falls is important for understanding the etiology and prevention of falls. Material and Methods: A community based cross sectional study was conducted for a period of one year. Complete enumerations of all the elderly were undertaken by house-to-house visit and a sample of 416 elderly was taken by simple random sampling. A pretested semistructured questionnaire was administered. Data was analyzed using SPSS version 17.Results: Prevalence of falls was 29.8 %, about 82.3% of the old had a single episode of fall, 17.7% had recurrent falls in a year. The fall rate was higher 65.7% among old, 26.3% in young old and 20.0% in very old, outdoor falls constituted 57.2%, indoor falls 42.8%. About 81.4% had one or the other form of injury. Injury rate was 82% in females and 80% in males. Statistically significant higher fall rate of 47.8% falls was seen with elderly who had fear of falling than those without fear of fall with 11.8%. Bruises, internal injuries were commonest (48.5%) and (13.8%) of injuries resulted in fractures.18.4% had difficulty in carrying out activities of daily living, deformity was observed in 12.6%, and residual disability in 10.6% of the elderly. Conclusion: The morbidity due to falls includes injuries, fractures, restricted mobility. The results of this study reflect on the circumstances observed in the indoor and outdoor falls like falls on the footpath, in the bathroom, while using stairs etc. The consequences like bruises and internal injuries followed by sprains, cuts and fractures have been observed. The study suggests possible ways of preventing falls

Prevalence and Determinants of Smoking and Smokeless Tobacco in the Rural Population of Karnataka, India

Background: Tobacco is known as a major cause of various preventable non-communicable diseases and kills half of all its users. With a greater prevalence in the rural community compared to the urban, this global health burden is substantially malignant. This study aimed to bridge the gap in the lack of adequate statistical information pertaining to prevalence and determinants of smoking and smokeless tobacco use in the rural population of Karnataka. Subjects and Method: This randomized community interventional study was conducted in primary health center areas of Karnataka, India. A total of 4,576 persons were interviewed (2,087 males and 2,489 females). Subjects ?30 years of age and residents for a minimum of six months were included. Mentally challenged, bedridden or differently abled subjects were excluded. The study employed a validated questionnaire adapted from the WHO STEPS questionnaire concerning demographical information, behavioral, physical, and biochemical measurements. Besides tobacco, informa-tion on use of beedis, cigarettes, and smokeless tobacco products (snuff, chewing tobacco) were also elicited. Data analysis of socio-demographic characteristics (age, educational/ marital/ occupational status) was carried out only for the participants with a current smoking habit. Data were analyzed using SPSS Version 18.0. Results: The overall prevalence rate of current smoking and smokeless tobacco habit in the study population was 54.8% (95%CI= 53.40 to 56.20) and the prevalence rate of ever/past users was 39.7% (95%CI= 38.26 to 41.10). Genderwise analysis predicted a higher prevalence of males currently smoking, and among them, most were 50 to 59 years of age (43.3%), illiterate (42.7%), widowed/ separated (39.8%), unskilled (44%), and semi-skilled workers (30%). Conclusion: Both genders participate in tobacco use, prevalence of smoking was higher among men and consumption of smokeless tobacco was higher among women. Subjects aged 50-59 years, illiterate, divorced/widowed/separated and, involved in unskilled or semi-skilled labor exhibited greater prevalence of tobacco habit compared to other determinants. Keywords: noncommunicable diseases, global health, tobacco use, tobacco smoking, smokeless tobacco. Correspondence: Dinesh Rajaram, Associate Professor. Department of Community Medicine, M.S. Ramaiah Medical college and Hospital, Bengaluru 560054, Karnataka, India. Email id.: [email protected]. Mobile: +919980336893. Journal of Epidemiology and Public Health (2023), 08(01): 15-24 https://doi.org/10.26911/jepublichealth.2023.08.01.02

First record of marine phytoplankton, <i>Picochlorum maculatum</i> in the Southeastern coast of India

791-796The marine phytoplankton Picochlorum maculatum (Chlorophyta:Trebouxiophyceae) is recorded for the first time in the Southeastern coast of India. In this study, marine phytoplankton were collected at Muthukkuda mangrove waters, Tamil Nadu, Southeast coast of India which was then isolated, purified and identified with rDNA sequencing. Recurrence component analysis of marine phytoplankton P. maculatum indicated that the peptides were composed of Beta structure, comprising alpha-helix, extended strand and random coil. The number of amino acids and chemical properties from the marine microalgae P. maculatum are calculated and having composition of Neutral (82.69%), Acidic (10.72%) and Basic (6.57%) amino acids. This species may be introduced by way of shipping and other transport mechanisms where organisms are inadvertently moved out of their home range, e.g., ballast water exchange