POST STROKE DEPRESSION AND ANXIETY: PREVALANCE AND CORRELATES

Objectives: The objective of the study is to evaluate the prevalence of depression and anxiety in post-stroke patients and identify its predictors. Materials and Methods: This study was conducted for a period of 6 months among 81 patients admitted with stroke in SSIMS and RC, Davangere. The information compiled from patient data collection form was assessed for comorbid conditions and type of stroke. Assessment for depression and anxiety was conducted using Hamilton D (HAM-D) and HAM-A scale and information of location of lesion was obtained from patient’s neuroimaging results. Quality of life (QOL) of post-stroke was assessed using stroke and aphasia QOL (SAQOL) questionnaire. Follow-up was conducted for patients who were diagnosed with depression and anxiety within 1 to 3 months. Results: Depression was more prevalent as compared to anxiety in post-stroke patients and was predominant in males and between the ages 61 and 70 years. Hypertension and diabetes were found to be a major comorbid conditions in such patients. Factors contributing to increased risk of depression and anxiety after stroke include age, sex, comorbidities, lesion location, and type of stroke. Post-stroke depression (PSD) and anxiety showed statistically significant association with left-sided lesion. Conclusion: PSD and anxiety are a relatively common complications and can result in poor QOL in stroke patients. Early detection of depression and anxiety symptoms may assist functional recovery and improve QOL in stroke patients. Careful evaluation of PSD and post-stroke anxiety should be integrated into clinical care of stroke patients

Basic science232. Certolizumab pegol prevents pro-inflammatory alterations in endothelial cell function

Background: Cardiovascular disease is a major comorbidity of rheumatoid arthritis (RA) and a leading cause of death. Chronic systemic inflammation involving tumour necrosis factor alpha (TNF) could contribute to endothelial activation and atherogenesis. A number of anti-TNF therapies are in current use for the treatment of RA, including certolizumab pegol (CZP), (Cimzia ®; UCB, Belgium). Anti-TNF therapy has been associated with reduced clinical cardiovascular disease risk and ameliorated vascular function in RA patients. However, the specific effects of TNF inhibitors on endothelial cell function are largely unknown. Our aim was to investigate the mechanisms underpinning CZP effects on TNF-activated human endothelial cells. Methods: Human aortic endothelial cells (HAoECs) were cultured in vitro and exposed to a) TNF alone, b) TNF plus CZP, or c) neither agent. Microarray analysis was used to examine the transcriptional profile of cells treated for 6 hrs and quantitative polymerase chain reaction (qPCR) analysed gene expression at 1, 3, 6 and 24 hrs. NF-κB localization and IκB degradation were investigated using immunocytochemistry, high content analysis and western blotting. Flow cytometry was conducted to detect microparticle release from HAoECs. Results: Transcriptional profiling revealed that while TNF alone had strong effects on endothelial gene expression, TNF and CZP in combination produced a global gene expression pattern similar to untreated control. The two most highly up-regulated genes in response to TNF treatment were adhesion molecules E-selectin and VCAM-1 (q 0.2 compared to control; p > 0.05 compared to TNF alone). The NF-κB pathway was confirmed as a downstream target of TNF-induced HAoEC activation, via nuclear translocation of NF-κB and degradation of IκB, effects which were abolished by treatment with CZP. In addition, flow cytometry detected an increased production of endothelial microparticles in TNF-activated HAoECs, which was prevented by treatment with CZP. Conclusions: We have found at a cellular level that a clinically available TNF inhibitor, CZP reduces the expression of adhesion molecule expression, and prevents TNF-induced activation of the NF-κB pathway. Furthermore, CZP prevents the production of microparticles by activated endothelial cells. This could be central to the prevention of inflammatory environments underlying these conditions and measurement of microparticles has potential as a novel prognostic marker for future cardiovascular events in this patient group. Disclosure statement: Y.A. received a research grant from UCB. I.B. received a research grant from UCB. S.H. received a research grant from UCB. All other authors have declared no conflicts of interes