Lymphatic filariasis in migrant population in non-endemic states - Need to cover by Mass Drug Administration (MDA)

Background: Lymphatic filariasis (LF) is targeted by WHO for global elimination as a public health problem by year2020. GoI is signatory to WHO resolution and envisaged elimination by instituting annual mass drug administration (MDA) in all endemic districts under NVBDCP by year 2015.With rapid industrialization and urbanization, large number of landless farmer, unskilled/skilled labour migrate either singly or with entire family members to other states (which may be non-endemic for LF) in search of employment. These migrants from endemic states escape MDA beings migrated to non-endemic states. Aims and Objectives: To find out prevalence of LF and MF density among migrant staying in non-endemic states and assess needs to institute MDA in such migrants. Material & Methods: This study was a cross sectional epidemiological study carried out in migrant population staying at/near the construction site covering the population of 1640. However, only 1092 person participated in the study. Result: A total of 1092 people agreed to participate in the study, out of which, 22 were found MF positive and 4 presented with clinical signs of LF. The study found MF prevalence of 2.01% with average MF density of 3.90. Conclusion: Endemicity (2.01%) of MF among migratory population more than national average (0.45%), which is capable of continuing transmission (>1%) in population at risk living in non-endemic states where MDA is not administered.&nbsp

Antithrombotic treatment for secondary prevention of stroke and other thromboembolic events in patients with stroke or transient ischemic attack and non-valvular atrial fibrillation : A European Stroke Organisation guideline

Patients with ischemic stroke or transient ischemic attack and non-valvular atrial fibrillation have a high risk of recurrent stroke and other vascular events. The aim of this guideline is to provide recommendations on antithrombotic medication for secondary prevention of stroke and other vascular outcomes in these patients. The working group identified questions and outcomes, graded evidence, and developed recommendations according to the Grading of Recommendations Assessment, Development, and Evaluation approach and the European Stroke Organisation (ESO) standard operating procedure for guidelines. The guideline was reviewed and approved by the ESO guideline board and the ESO executive committee. In patients with atrial fibrillation and previous stroke or transient ischemic attack, oral anticoagulants reduce the risk of recurrence over antiplatelets or no antithrombotic treatment. Non-vitamin K antagonist oral anticoagulants are preferred over vitamin K antagonists because they have a lower risk of major bleeding and death. Recommendations are weak regarding timing of treatment, (re-)starting oral anticoagulants in patients with previous intracerebral haemorrhage, and treatment in specific patient subgroups of those of older age, with cognitive impairment, renal failure or small vessel disease, because of a lack of strong evidence. In conclusion, for patients with atrial fibrillation and ischemic stroke or transient ischemic attack, non-vitamin K antagonist oral anticoagulants are the preferred treatment for secondary prevention of recurrent stroke or thromboembolism. Further research is required to determine the best timing for initiating oral anticoagulants after an acute ischemic stroke, whether or not oral anticoagulants should be (re)started in patients with a history of intracerebral haemorrhage, and the best secondary preventive treatment in specific subgroups.Peer reviewe

European Stroke Organization and European Society for Swallowing Disorders guideline for the diagnosis and treatment of post-stroke dysphagia

Post-stroke dysphagia (PSD) is present in more than 50% of acute stroke patients, increases the risk of complications, in particular aspiration pneumonia, malnutrition and dehydration, and is linked to poor outcome and mortality. The aim of this guideline is to assist all members of the multidisciplinary team in their management of patients with PSD. These guidelines were developed based on the European Stroke Organisation (ESO) standard operating procedure and followed the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) approach. An interdisciplinary working group identified 20 relevant questions, performed systematic reviews and meta-analyses of the literature, assessed the quality of the available evidence and wrote evidence-based recommendations. Expert opinion was provided if not enough evidence was available to provide recommendations based on the GRADE approach. We found moderate quality of evidence to recommend dysphagia screening in all stroke patients to prevent post-stroke pneumonia and to early mortality and low quality of evidence to suggest dysphagia assessment in stroke patients having been identified at being at risk of PSD. We found low to moderate quality of evidence for a variety of treatment options to improve swallowing physiology and swallowing safety. These options include dietary interventions, behavioural swallowing treatment including acupuncture, nutritional interventions, oral health care, different pharmacological agents and different types of neurostimulation treatment. Some of the studied interventions also had an impact on other clinical endpoints such as feedings status or pneumonia. Overall, further randomized trials are needed to improve the quality of evidence for the treatment of PSD

Sex differences in outcome after carotid revascularization in symptomatic and asymptomatic carotid artery stenosis

Objective: Sex differences regarding the safety and efficacy of carotid revascularization in carotid artery stenosis have been addressed in several studies with conflicting results. Moreover, women are underrepresented in clinical trials leading to limited conclusions regarding the safety and efficacy of acute stroke treatments. Methods: A systematic review and meta-analysis was performed by literature search including 4 databases from January 1985 to December 2021. Sex differences in the efficacy and safety of revascularization procedures, including carotid endarterectomy (CEA) and carotid artery stenting (CAS), for symptomatic and asymptomatic carotid artery stenoses were analyzed. Results: Regarding carotid endarterectomy (CEA) in symptomatic carotid artery stenosis, the stroke risk in men (3.6%) and women (3.9%) based on 99,495 patients (30 studies) did not differ (p=0.16). There was also no difference in the stroke risk by different time frames up to 10 years. Compared with men, women treated with CEA had a significantly higher stroke or death rate at 4 months (2 studies, 2565; 7.2% vs 5.0%; OR 1.49, 95% CI 1.04-2.12; I2=0%; p=0.03), and a significantly higher rate of restenosis (1 study, 615; 17.2% vs. 6.7%; OR 2.81,95% CI 1.66-4.75; p=0.0001). For carotid stenting (CAS) in symptomatic artery stenosis data showed a non-significant tendency toward higher peri-procedural stroke in women. Whereas, for asymptomatic carotid artery stenosis, data based on 332,344 patients showed that women compared to men after CEA had similar rates of stroke, stroke or death and the composite outcome stroke/death/myocardial infarction. The rate of restenosis at 1 year was significantly higher in women compared to men (1 study, 372 patients; 10.8% vs 3.2%; OR 3.71, 95% CI 1.49-9.2; p=0.005). Furthermore, carotid stenting in asymptomatic patients was associated with low risk of a postprocedural stroke in both sexes, but a significantly higher risk of in-hospital myocardial infarction in women than men (8445 patients, 1.2% vs. 0.6%, OR 2.01, 95%CI 1.23-3.28, I2=0%, p=0.005). Conclusions: A few sex-differences in short term outcomes after carotid revascularization for symptomatic and asymptomatic carotid artery stenosis were found, although there were no significant differences in the overall stroke. This indicates a need for larger multicenter prospective studies to evaluate these sex-specific differences. More women, including those aged over 80 years, need to be enrolled in RCTs, to better understand if sex differences exist and to tailor carotid revascularization accordingly

European Stroke Organisation guidelines on stroke in women: Management of menopause, pregnancy and postpartum

Pregnancy, postpartum and menopause are regarded as periods women are more vulnerable to ischaemic events. There are conflicting results regarding stroke risk and hormone replacement therapy (HRT) during menopause. Stroke in pregnancy is generally increasing with serious consequences for mother and child; therefore, recommendations for acute treatment with intravenous thrombolysis (IVT) and/or mechanical thrombectomy (MT) are needed. The aim of this guideline is to support and guide clinicians in treatment decisions in stroke in women. Following the “Grading of Recommendations and Assessment, Development and Evaluation (GRADE)” approach, the guidelines were developed according to the European Stroke Organisation (ESO) Standard Operating Procedure. Systematic reviews and metanalyses were performed. Based on available evidence, recommendations were provided. Where there was a lack of evidence, an expert consensus statement was given. Low quality of evidence was found to suggest against the use of HRT to reduce the risk of stroke (ischaemic and haemorrhagic) in postmenopausal women. No data was available on the outcome of women with stroke when treated with HRT. No sufficient evidence was found to provide recommendations for treatment with IVT or MT during pregnancy, postpartum and menstruation. The majority of members suggested that pregnant women can be treated with IVT after assessing the benefit/risk profile on an individual basis, all members suggested treatment with IVT during postpartum and menstruation. All members suggested treatment with MT during pregnancy. The guidelines highlight the need to identify evidence for stroke prevention and acute treatment in women in more vulnerable periods of their lifetime to generate reliable data for future guidelines

Effect of <i style="">Withania somnifera</i> Dunal in ethanol-induced anxiolysis and withdrawal anxiety in rats

470-475Withania somnifera (WS) or its psychotropic preparation is known to play a critical role in morphine, alcohol and benzodiazepines addiction. This study investigates the role of WS in acute ethanol and withdrawal from chronic ethanol consumption using elevated plus maze paradigm in rats. Acute administration of ethanol (1.5-2 g/kg, ip) triggered anxiolytic effect and withdrawal from prolonged ethanol (9% v/v ethanol, 15 days) consumption elicited enhanced behavioral despair (anxiety). Acute administration of WS (50 mg/kg, oral) potentiated the anxiolytic action of subeffective dose of ethanol (0.5 or 1 g/kg, ip). Moreover, the ethanol withdrawal anxiety was markedly antagonized in dose dependent manner by WS at 200 and 500 mg/kg or higher dose of ethanol (2.5 g/kg). However, co-administration of subeffective doses of WS (50 mg/kg, oral) and ethanol also attenuated withdrawal-induced anxiety due to chronic ethanol (9% v/v ethanol, 15 days) consumption. The results suggest the protective effect of WS in the management of ethanol withdrawal reactions

Comparison of high resolution ultrasonography with clinical findings in patients with ankle pain

Cel: Celem pracy była analiza dokładności diagnostycznej ultrasonografii wysokiej rozdzielczości w ocenie bolesnego stawu skokowego w porównaniu z wynikami badania klinicznego. Materiał i metody: Prospektywnym badaniem objęto 136 chorych z bólem stawu skokowego w wywiadzie, skierowanych do Zakładu Radiodiagnostyki i Diagnostyki Obrazowej w celu wykonania badania ultrasonograficznego. Analiza statystyczna: Wyniki badania ultrasonograficznego i klinicznego porównano za pomocą testu McNemara. Wyniki: Oceniono 136 chorych z łącznie 218 patologiami stawu skokowego. W tej grupie 178 patologii podejrzewano klinicznie, a 206 rozpoznano w badaniu ultrasonograficznym. Różnica była istotna statystycznie (wartość p = 0,000). Wnioski: Ultrasonografia to znakomite narzędzie do oceny chorych zgłaszających się z bólem stawu skokowego, szczególnie w przypadkach nieprawidłowości dotyczących więzadeł bocznych, patologii ścięgien, wysięku oraz innych zmian. Może stanowić badanie pierwszego rzutu ze względu na możliwość szybkiej, dynamicznej i niedrogiej oceny stawu. Jednak metoda ta ma ograniczenia w obrazowaniu uszkodzeń więzadła skokowo-strzałkowego tylnego, nieprawidłowości szpiku kostnego oraz głęboko umiejscowionych patologii, w których przypadku należy wykonać badanie rezonansem magnetycznym.Aim: The aim of this study was to investigate the diagnostic accuracy of high resolution ultrasonography for the assessment of painful ankle joint as compared with the clinical findings. Material and Methods: A prospective study was conducted on 136 patients having history of ankle pain and referred to the Department of Radiodiagnosis and Imaging for ultrasonography. Statistical analysis: Comparison of ultrasonography findings and clinical findings was done using McNemar Test. Results: 136 patients with 218 pathologies of the ankle joint were analyzed. Of these, 178 pathologies were clinically suspected, but 206 were diagnosed with ultrasonography. This difference was statistically significant (p value = 0.000). Conclusion: Ultrasonography is an excellent tool for evaluating patients with ankle pain, especially in cases of lateral ligament pathologies, tendinous pathologies, joint effusion, and miscellaneous pathologies. It can be used as the primary imaging investigation because it allows a rapid, dynamic, and cost-effective examination of the ankle joint. However, ultrasonography has limitations when using it to evaluate a suspected posterior talofibular ligament injury, marrow abnormalities, and deep seated pathologies, for which MRI should be incorporated for a diagnosis