Implications of Female sex on Stroke risk factors, care, outcome and rehabilitation: an Asian perspective

Background: Stroke affects 16.9 million people annually and the greatest burden of stroke is in low- and middle-income countries, where 69% of all strokes occur. Stroke risk factors, mortality and outcomes differ in developing countries as compared to the developed world. We performed a literature review of 28 articles pertaining to epidemiology of stroke in Asian women, stroke risk factors, gender-related differences, and stroke outcomes. Summary: Asian women differ from women worldwide due to differences in stroke awareness, risk factor profile, stroke subtypes, and social issues that impact stroke care. While Asian men have a higher incidence of stroke as compared to women overall, the long- and short-term outcomes in Asian women tend to be poorer. Both conventional and gender-specific risk factors contribute to stroke risk. Oral contraceptive use and addictions such as tobacco and alcohol are less prevalent among Asian women due to socio cultural differences. There is however, a much higher preponderance of pregnancy-related stroke and cardio-embolic stroke secondary to rheumatic heart disease and heavy use of chewing tobacco. The overall outcome is poor due to poor access to health care and lack of resources. Key Messages: Our review exposed the gaps in our knowledge about stroke risk factors and differences in stroke care provided to Asian women. While there are sociocultural barriers that impede the provision of immediate care to these stroke patients, much needs to be done by way of prevention of recurrent stroke and treatment of risk factors

Environmental Ethics: Ancient Traditions and Contemporary Dilemmas: A Hindu Perspective

According to an ancient Hindu myth the goddess Earth was once imprisoned at the bottom of the ocean, in the nether world, by a demon who had laid waste to the earth, causing havoc to the order of things. To rescue her from the demon, Lord Vishnu incarnated as a boar, as Varaha Avatar. He fought and killed the demon and released the goddess Earth by carrying her on his tusk to float free once more on the cosmic waters

Clobazam monotherapy in drug naı̈ve adult patients with epilepsy

AbstractPurpose: Evaluation of the efficacy and side effects profile of Clobazam in a 24-week open-labelled trial involving 26 cases of drug naı̈ve adult patients with epilepsy.Methods: The study was an open labelled unicentre trial in which only drug naı̈ve cases with epilepsy were included. A total of 26 cases were recruited. One case was dropped because he did not complete the desired follow up. Seizure type and frequency were recorded and follow up was done at 4, 8, 12, 18 and 24 weeks after initiation of therapy. The change in seizure severity, the dose of Clobazam required and development of side effects were recorded.Results: The seizure types included GTCS (n=16), complex partial seizures (n=4), focal motor seizures with secondary generalisation (n=3) and juvenile myoclonic epilepsy (n=2). Out of 25 patients, 16 (64%) became seizure free, while five (20%) had >50% reduction in their seizure frequency. Thus, these 21 patients (84%) were considered to be well controlled. The commonest side effect seen was sedation, which was noted in 4 of the 25 patients (16%). However, in none of these four patients sedation was significant enough to warrant stoppage of therapy. Weight gain, gait ataxia, loss of short-term memory and breakthrough seizures were noted in one patient each.Conclusions: The efficacy of Clobazam coupled with the lack of significant side effects noted in our study makes it merit consideration as monotherapy in adult patients with epilepsy

Corticosteroids for chronic inflammatory demyelinating polyradiculoneuropathy

Background: Chronic inflammatory demyelinating polyradiculoneuropathy (CIDP) is a progressive or relapsing and remitting paralysing illness, probably due to an autoimmune response, which should benefit from corticosteroid treatment. Non-randomised studies suggest that corticosteroids are beneficial. Two commonly used corticosteroids are prednisone and prednisolone. Both are usually given as oral tablets. Prednisone is converted into prednisolone in the liver so that the effect of the two drugs is usually the same. Another corticosteroid, dexamethasone, is more potent and is used in smaller doses. The review was first published in 2001 and last updated in 2015; we undertook this update to identify any new evidence. Objectives: To assess the effects of corticosteroid treatment for CIDP compared to placebo or no treatment, and to compare the effects of different corticosteroid regimens. Search methods: On 8 November 2016, we searched the Cochrane Neuromuscular Specialised Register, Cochrane Central Register of Controlled Trials, MEDLINE, and Embase for randomised trials of corticosteroids for CIDP. We searched clinical trials registries for ongoing trials. Selection criteria: We included randomised controlled trials (RCTs) or quasi-RCTs of treatment with any corticosteroid or adrenocorticotrophic hormone for CIDP, diagnosed by an internationally accepted definition. Data collection and analysis: Two authors extracted data from included studies and assessed the risk of bias independently. The intended primary outcome was change in disability, with change in impairment after 12 weeks and side effects as secondary outcomes. We assessed strength of evidence using the GRADE approach. Main results: One non-blinded RCT comparing prednisone with no treatment in 35 eligible participants did not measure the primary outcome for this systematic review. The trial had a high risk of bias. Neuropathy Impairment Scale scores after 12 weeks improved in 12 of 19 participants randomised to prednisone, compared with five of 16 participants randomised to no treatment (risk ratio (RR) for improvement 2.02 (95% confidence interval (CI) 0.90 to 4.52; very low-quality evidence). The trial did not report side effects in detail, but one prednisone-treated participant died. A double-blind RCT comparing daily standard-dose oral prednisolone with monthly high-dose oral dexamethasone in 40 participants reported none of the prespecified outcomes for this review. The trial had a low risk of bias, but the quality of evidence was limited as it came from a single small study. There was little or no difference in number of participants who achieved remission (RR 1.11; 95% CI 0.50 to 2.45 in favour of monthly dexamethasone; moderate-quality evidence), or change in disability or impairment after one year (low-quality evidence). Change of grip strength or Medical Research Council (MRC) scores demonstrated little or no difference between groups (moderate-quality to low-quality evidence). Eight of 16 people in the prednisolone group and seven of 24 people in the dexamethasone group deteriorated. Side effects were similar with each regimen, except that sleeplessness was less common with monthly dexamethasone (low-quality evidence) as was moon facies (moon-shaped appearance of the face) (moderate-quality evidence). Experience from large non-randomised studies suggests that corticosteroids are beneficial, but long-term use causes serious side effects. Authors' conclusions: We are very uncertain about the effects of oral prednisone compared with no treatment, because the quality of evidence from the only RCT that exists is very low. Nevertheless, corticosteroids are commonly used in practice, supported by very low-quality evidence from observational studies. We also know from observational studies that corticosteroids carry the long-term risk of serious side effects. The efficacy of high-dose monthly oral dexamethasone is probably little different from that of daily standard-dose oral prednisolone. Most side effects occurred with similar frequencies in both groups, but with high-dose monthly oral dexamethasone moon facies is probably less common and sleeplessness may be less common than with oral prednisolone. We need further research to identify factors that predict response

PRE-ANALYTICAL VARIABLES IN CLINICAL CHEMISTRY: TRAINING MEDICAL UNDERGRADUATES THROUGH CASE BASED DISCUSSION

Background: Pre-analytical variables in clinical chemistry are factors prior to the biochemical analysis of samples affecting laboratory test results accounting for 32-75% of errors leading to misdiagnosis, decreased quality of medical care services and wastage of monetary resources. Aim: To educate first year medical undergraduates about pre-analytical variables through case based discussion and lecture method of teaching and assess the gain in knowledge by these methods. Methods and material: Two batches of medical students namely A (N=50) and B (N=52) were assessed for their background knowledge on the topic using an MCQ based questionnaire (pre-test). Batch A and B were taught through didactic lecture and case based discussion respectively. Post-test questionnaire was conducted to test the gain in knowledge of both batches. Delayed post-test was conducted after 2 weeks to assess retention of knowledge amongst students. Results: Pre-test scores of Batch A and B were not significantly different indicating that both batches had similar background knowledge of topic. Post-test scores vs. pre-test scores were significantly higher in both batches implying that both batches benefitted from their respective teaching sessions. But post-test score of Batch B was significantly higher than that of Batch A indicating higher gain of knowledge through case based discussion. Delayed post-test score was also significantly higher in Batch B vs. A implying better retention of knowledge through case based discussions. Conclusion: Topic ˜Pre-analytical variables in clinical chemistry must be included in undergraduate medical curriculum. Case based discussion could be an effective module for teaching the same. Key words: Case based discussion; Didactic lecture; Medical students; Medical education; Pre-analytical variables

PRE-ANALYTICAL VARIABLES IN CLINICAL CHEMISTRY: TRAINING MEDICAL UNDERGRADUATES THROUGH CASE BASED DISCUSSION

Background: Pre-analytical variables in clinical chemistry are factors prior to the biochemical analysis of samples affecting laboratory test results accounting for 32-75% of errors leading to misdiagnosis, decreased quality of medical care services and wastage of monetary resources. Aim: To educate first year medical undergraduates about pre-analytical variables through case based discussion and lecture method of teaching and assess the gain in knowledge by these methods. Methods and material: Two batches of medical students namely A (N=50) and B (N=52) were assessed for their background knowledge on the topic using an MCQ based questionnaire (pre-test). Batch A and B were taught through didactic lecture and case based discussion respectively. Post-test questionnaire was conducted to test the gain in knowledge of both batches. Delayed post-test was conducted after 2 weeks to assess retention of knowledge amongst students. Results: Pre-test scores of Batch A and B were not significantly different indicating that both batches had similar background knowledge of topic. Post-test scores vs. pre-test scores were significantly higher in both batches implying that both batches benefitted from their respective teaching sessions. But post-test score of Batch B was significantly higher than that of Batch A indicating higher gain of knowledge through case based discussion. Delayed post-test score was also significantly higher in Batch B vs. A implying better retention of knowledge through case based discussions. Conclusion: Topic ˜Pre-analytical variables in clinical chemistry must be included in undergraduate medical curriculum. Case based discussion could be an effective module for teaching the same. Key words: Case based discussion; Didactic lecture; Medical students; Medical education; Pre-analytical variables