Distribution of aetiological types of stroke among the diabetic adults admitted with stroke in a referral hospital: an observational study

Background: Stroke is one of the most devastating disorders worldwide, in terms of morbidity and mortality. Association of comorbid conditions increase severity and chances of unfavourable outcome in stroke patients. Diabetes is one of the vital comorbidity risk factors reported to be associated with occurrence, poor outcome in stroke patients. An increased incidence of stroke has been reported in advanced age among diabetic patients. The aim of this study was to determine the relative distribution of aetiological types of stroke among the stroke patients having diabetes.Methods: All adults (18-65) admitted in medicine indoor of Midnapore medical college and hospital with a provisional diagnosis of stroke having random blood glucose level ≥200 mg/dl and/or h/o diabetes were enrolled and screened for different etiological factors e.g., hypertension, dyslipidemia. Age group and gender wise distribution pattern were also obtained.Results: A total 384 subjects were included in the study. Hypertension was found to be most common (75%) comorbid condition among participants, followed by dyslipidemia (56%). 77.9% of subjects presented with random glucose level of >200 mg/dl.Conclusions: stroke of either types is very much prevalent among diabetes. Uncontrolled diabetes along with hypertension and dyslipidemia increases the chance many times. Early detection and prompt therapeutic intervention may reduce the mortality rate overall

A comparative study on sedative and cardiorespiratory effects of clonidine and dexmedetomidine added to ropivacaine in supraclavicular brachial plexus block in upper extremity surgery

Background: Supraclavicular brachial plexus block is widely used peripheral nerve block technique used for surgery of the upper extremity. Several drugs have been used with local anesthetic as adjuvants for rapid, dense, and prolonged analgesia. Aims and Objectives: The aims and objectives of the study are to compare the degree of sedation and cardiorespiratory effects of clonidine and dexmedetomidine added to ropivacaine in supraclavicular brachial plexus block. Materials and Methods: A double-blinded comparative study was done on eighty patients who were randomly allocated equally into two groups and received clonidine and dexmedetomidine added to ropivacaine 0.5%. Intraoperative degree of sedation and cardiorespiratory parameters were monitored in regular intervals and compared to find difference. Results: Heart rate was consistently lower with dexmedetomidine. Systolic, diastolic, and mean arterial pressures (MAPs) were comparable in both groups at all time points except at 45 min when diastolic and MAP were lower with dexmedetomidine and it was statistically significant. Sedation score in Group D was higher except at 5 min and difference was statistically significant. All patients in both groups were sedated and easily arousable. There was statistically significant difference in peroperative oxygen saturation between the groups although it was clinically not significant. Conclusion: There was more hemodynamic effect of dexmedetomidine than clonidine but these effects can be managed by medication easily. In addition to this, it was found that dexmedetomidine provides conscious sedation without any respiratory depression. Comparing the risk and benefit dexmedetomidine can be used with local anesthetic in supraclavicular brachial plexus block in upper extremity surgery

Imaging of Knee Joint Pathologies: A Comparative Study of Ultrasound and Magnetic Resonance Imaging

Background: Magnetic resonance imaging (MRI) has been accepted as the best non-invasive imaging modality for the evaluation of knee joint pathology but the advantages of ultrasound (US) over magnetic resonance imaging (MRI) are that the ultrasound is readily available, cheap and offers real-time imaging. Aim: To assess the accuracy of ultrasound in diagnosing knee joint pathologies using MRI as a reference. Materials And Methods: 50 patients were evaluated prospectively over a period of 1.5 years by USG followed by MRI of the affected knee. Accuracy of USG was calculated with MRI as reference. Results: In our study, the majority of patients were in age group 21-30 years. Perfect agreement was noted between ultrasound and MRI for detecting Baker’s cyst. Near perfect agreement was noted between ultrasound and MRI for detecting joint effusion, soft tissue edema and osteophytes. Substantial agreement was noted between ultrasound and MRI for Collateral ligaments tear and Meniscal injuries. Moderate agreement was noted between ultrasound and MRI for PCL tear. Fair agreement was noted between ultrasound and MRI for ACL tear. Conclusion: Knee USG has high accuracy in diagnosing pathologies like knee joint effusion, synovitis, popliteal/baker’s cysts, soft tissue edema/cellulitis, arthritic changes, collateral ligament and meniscal tears. Keywords: Knee joint pathologies, Ultrasound, MRI, Ligament

Wernicke’s encephalopathy precipitated by neuromyelitis optica spectrum disorder and Graves’ disease: A tale of clinical and radiological dilemmas

Background Neuromyelitis optica spectrum disorder (NMOSD), an autoimmune astrocytopathy, may share common clinico-radiological features with Wernicke's encephalopathy (WE). A variant of NMOSD, known as area postrema syndrome (APS), that presents with intractable hiccups and associated vomiting, might lead to the depletion of nutrients if not detected and treated early. Autoimmune thyroid disorders (i.e., Graves’ disease) may be associated with NMOSD. Rarely, thyrotoxicosis can give rise to thiamine depletion and WE. Case presentation Here, we present a case of untreated hyperthyroidism in an Indian female who presented with thyrotoxicosis and later developed WE, possibly also contributed by NMOSD (APS)-induced recurrent vomiting. The patient recovered with antithyroid drugs, parenteral thiamine, and immunomodulatory therapy. The possible pathogenic mechanisms have been discussed. Conclusion Our case establishes the importance of considering NMOSD variants in metabolic encephalopathy, especially if neuroimaging is suggestive and in the backdrop of another autoimmune disorder

Photoactivatable prodrugs of antimelanoma agent Vemurafenib

In this study, we report on novel photoactivatable caged prodrugs of vemurafenib. This kinase inhibitor was the first approved drug for the personalized treatment of BRAF-mutated melanoma and showed impressive results in clinical studies. However, the occurrence of severe side effects and drug resistance illustrates the urgent need for innovative therapeutic approaches. To conquer these limitations, we implemented photoremovable protecting groups into vemurafenib. In general, this caging concept provides spatial and temporal control over the activation of molecules triggered by ultraviolet light. Thus, higher inhibitor concentrations in tumor tissues might be reached with less systemic effects. Our study describes the first development of caged vemurafenib prodrugs useful as pharmacological tools. We investigated their photochemical characteristics and photoactivation. <i>In vitro</i> evaluation proved the intended loss-of-function and the light-dependent recovery of efficacy in kinase and cellular assays. The reported vemurafenib photo prodrugs represent a powerful biological tool for novel pharmacological approaches in cancer research