Clinical Profile, Neuroimaging Evaluation and Treatment Outcome of Acute Ischemic Stroke Patients.

Clinical symptoms and signs of focal (at times global) disturbance of cerebral function, lasting for more than 24 hours or leading to death with no apparent cause other than that of vascular origin” Recent data has shown that about 87% of strokes are ischemic and 13% is due to hemorrhage (intracerebral or subarachnoid) Stroke is a huge public health concern because of its high morbidity and disability. It is the second commonest cause of mortality and the most common cause of morbidity. The prevalence rate of stroke in India is 545 per 100,000 [3]. Recent studies showed that the age-adjusted annual incidence rate in India is 105/100,000 in the urban community and 262/100,000 in a rural community. Incidence of stroke in United States is 200 / 100000 population. It is age related, relatively uncommon before the age of 50 but doubling every decade after the age of 55. It is more common in men. Most acute stroke fatalities occur in the first 30 days after onset. 8 to 12% of ischemic strokes result in death within 30 days. The Clinical features of the ischemic stroke depend upon the extent and severity of involvement of specific arteries. Time and Mode of onset of the stroke might help us to determine the aetiology. A large number of risk factors for stroke have been described, areflection of the heterogeneity of the disease. Only 2% of ischemic strokes enter into the medical attention with in the golden time window i.e. three hours of onset of stroke. Neuroimaging, especially CT Scan Brain and MRI Brain helps to confirm the ischemic strokes, rule out the stroke mimics, find out the involved arterial territory and the extent & pattern of involvement. Another novelty is that stroke is no more considered as unavoidable and untreatable. There is now a clear consensus that stroke is an emergency and that specialized units and teams will improve the outcome and may lower the costs. The role of heparin in the management of acute ischemic stroke is still controversial. Many studies continue to show no proven benefits. In this study, the clinical profile, risk factors, neuroimaging assessment of infarcts and treatment outcome of the patients with acute ischemic strokes were analyzed. The maximum number of patients was in the age group between 51 and 60 years. (36.94%). Our population developed ischemic stroke one to two decades earlier than the western population. Males (55.9%) were more affected than Females (44.1%). Males predominated in the age group between 41 and 60 years (64.7%), while females predominated in the age group between 51 and 70 years (67.7%). Common risk factors were hypertension (65.71%), hyperlipidemia (62.21%), diabetes mellitus (44.08%), smoking (44.28%) and alcoholism (40.04%). Modification of lifestyle and proper management of these modifiable risk factors might play a major role in the primary and secondary prevention of ischemic stroke. Left hemiparesis (55.46%) was more common, Aphasia was seen in 29.8% and Dysarthria in 39.7% of patients. More number of patients (56.53%) had noted the stroke on awakening. Only 4.4% of patients reached the hospital with in three hours. CT scan Brain was done only in 2.45% of patients with in three hours. This exemplifies the need of Stroke awareness among the public so that the patients can reach the hospital with in the therapeutic window

Therapeutic mitigation of measles-like immune amnesia and exacerbated disease after prior respiratory virus infections in ferrets

Abstract Measles cases have surged pre-COVID-19 and the pandemic has aggravated the problem. Most measles-associated morbidity and mortality arises from destruction of pre-existing immune memory by measles virus (MeV), a paramyxovirus of the morbillivirus genus. Therapeutic measles vaccination lacks efficacy, but little is known about preserving immune memory through antivirals and the effect of respiratory disease history on measles severity. We use a canine distemper virus (CDV)-ferret model as surrogate for measles and employ an orally efficacious paramyxovirus polymerase inhibitor to address these questions. A receptor tropism-intact recombinant CDV with low lethality reveals an 8-day advantage of antiviral treatment versus therapeutic vaccination in maintaining immune memory. Infection of female ferrets with influenza A virus (IAV) A/CA/07/2009 (H1N1) or respiratory syncytial virus (RSV) four weeks pre-CDV causes fatal hemorrhagic pneumonia with lung onslaught by commensal bacteria. RNAseq identifies CDV-induced overexpression of trefoil factor (TFF) peptides in the respiratory tract, which is absent in animals pre-infected with IAV. Severe outcomes of consecutive IAV/CDV infections are mitigated by oral antivirals even when initiated late. These findings validate the morbillivirus immune amnesia hypothesis, define measles treatment paradigms, and identify priming of the TFF axis through prior respiratory infections as risk factor for exacerbated morbillivirus disease