Intravenous Thrombolytic Therapies in The Management of Unknown Onset and Wakeup Strokes: A Scoping Review

ABSTRACT Background: The efficacy and safety of intravenous recombinant tissue plasminogen activator (IV rt-PA) for the management of unknown time onset stroke (UTOS) and wake-up stroke (WUS) are in a debate. Objective:The objective of this review is to discuss the UTOS and its management with intravenous thrombolytic therapies. Data Sources: Databases searched included PubMed and Cochrane electronic databases and manual search. Study Selection and Data Extraction: 45 articles of potential relevance were selected. Results: 14 relevant papers were included. Most of studies including recent trials using Magnetic resonance imaging diffusion-weighted imaging fluid-attenuated inversion recovery (MRIDWI FLAIR) mismatch or Computed tomography perfusion (CTP) based selection showed favorable outcome modified Rankin scale (mRS) of 0 to 2 at 90 days in range of 44.6% to 53%. While Symptomatic intracranial hemorrhage (SIH) was observed in 1.3% to3.6%. Patients selected with significant ischemic penumbra using visual assessment of MRI DWI perfusion weighted images (PWI) mismatch did not showed a significant benefit in clinical outcome. OR: 1.2; 95%CI 0.63-2.27, p = 0.5. While use of RAPID software for automated penumbral image processing with median time from last seen well 9.9 hours showed favorable outcome in IV rt-PA group with no significant difference in in mortality.(OR, 1.44; 95% CI, 1.01 to 2.06; P=0.04). Conclusions: The penumbral mismatch in UTOS is a cogent method to recognize the patients for thrombolytic therapy without significant risk, but the appropriate neuroimaging criteria to maximize the efficacy and minimize hemorrhagic complications of thrombolytic treatment still has to be fully defined

Efficacy of memantine on cognitive functions of patients with moderate vascular dementia

Introduction: Vascular dementia is a common condition for which there is no effective approved pharmacological treatment available. Absence of effective treatment creates a difficult situation for those suffering from the disease, their caregivers, and healthcare providers. The objective of this study is todetermine the Efficacy of Memantine on cognitive functions in patients with Moderate vascular dementia. Material and methods: This Case series study was carried out inthe Neurology Section of department of Medicine Ziauddin University and Hospitals North Nazimabad campus, Karachifrom 12th March 2010 to 11th March 2011.90 patients were included, who fulfilled the inclusion criteria after taking an informed consent. The SPSS version 11 was applied to the data. Results: There were 55 (59.1%) males and 38 (40.9%) females. Mean ± standard deviation age 69.7 ± 6.6 years, mean duration of symptoms was 1.76 ± 1.1 years. Baseline minimental examination score was 15.14 ± 3.1. Minimental score after 24 weeks of drug therapy was 17.14 ± 4.1. Efficiency was found in 62 (66.7%) patients. Conclusion: Memantine produced only a small benefit in cognition (of uncertain clinical significance) in patients with moderate vascular dementia. Data is insufficient to support widespread use of this drug in vascular dementia. Individual patient analysis is needed to identify subgroups of patients with vascular dementia who might benefit

Association of blood donation related fears with donors’ characteristics and their impact on future donation

Background: To find the association of blood donation related fears with the donors’ characteristics like age, education level and previous donation history and to find their impact on future donation. Methods: It was a cross-sectional study carried out at a tertiary care hospital in Lahore, Pakistan, from June to December 2022. A self-designed questionnaire addressing five types of fears was filled from 700 blood donors through interview after taking informed consent. Data was analyzed by using IBM-SPSS V23. Results: Among 700 participants, 91.1% were male with mean age ±SD of 28.9±7.1years and 8.9% were female with mean age of 24.5±3.7years. For previous donation experience, the cohort was divided into five subgroups in which 19.7% had never donated blood and 11.3% had six or more donations. Fears were significantly reduced among donors with frequent donations compared to those with reduced donations. However, 4-5% had some retained fears. Reduced fears were observed in donors with higher education except for the fear of needle. Fears of having blood drawn/seeing blood and fear of fainting were more in younger donors. Out of 5.71% donors who were not willing for voluntary blood donation in future, 95% had fears. Conclusions: Frequent blood donations, higher education level and age more than 30 years were associated with reduced blood donation associated fears among blood donors. The presence of fears has negative relation with willingness for future blood donations

Bronchogenic Cyst in a 13 month Old Child

Background Persistent cough ,stridor and respiratory distress are most common symptoms encountered by paediatrician in their daily practices.Although bronchogenic cyst is rare cause of persistent cough but should always be kept in differential diagnosis of respiratory sypmptoms nonresponding to antibiotics and bronchodilators. Case presentation 13 month old baby had history of frequent visits at hospital and treated as case of pneumonia and hyperreactive airway disease.Chest X-ray revealed cystic mass in mediastinum with CT chest confirmed bronchogenic cyst for which patient underwent surgical excision.Histopathology report revealed bronchogenic cyst .After surgical excision patient got stable with stridor got settled. Conclusion Case is being reported to create awareness related to bronchogenic cyst as cause of persistent cough and respiratory distres

Bronchogenic Cyst in a 13 month Old Child

Background Persistent cough ,stridor and respiratory distress are most common symptoms encountered by paediatrician in their daily practices.Although bronchogenic cyst is rare cause of persistent cough but should always be kept in differential diagnosis of respiratory sypmptoms nonresponding to antibiotics and bronchodilators. Case presentation 13 month old baby had history of frequent visits at hospital and treated as case of pneumonia and hyperreactive airway disease.Chest X-ray revealed cystic mass in mediastinum with CT chest confirmed bronchogenic cyst for which patient underwent surgical excision.Histopathology report revealed bronchogenic cyst .After surgical excision patient got stable with stridor got settled. Conclusion Case is being reported to create awareness related to bronchogenic cyst as cause of persistent cough and respiratory distres

Latent iron deficiency in non-anemic children under five years of age

Background: The most common nutritional deficiency in world is iron deficiency. The iron deficiency is the most common cause of anemia due to nutritional deficiency and is seen most commonly in children under five years of age. Objective: To determine the frequency of iron deficiency in non-anemic children under five years of age. Methods: A descriptive cross-sectional survey was conducted in pediatrics department of –removed for blind review---from August 2020 to February 2021. A total of 145 non-anemic children, ages 2-59 months were enrolled through non-probability consecutive sampling in this study. The complete blood count and C-reactive protein were sent for laboratory tests to rule out infection/inflammation. In children with normal hematocrit (30-40%) and CRP (≤ 6), serum ferritin levels were sent. Those children in whom serum ferritin levels were ≤12ng/ml was regarded as cases of latent iron deficiency. SPSS version 23 was used for data entry and analysis. Age and gender for effect modifiers were controlled by stratification. The chi square test was used for post stratification. The value of p ≤ 0.05 was considered significant. Results: The mean age of the patients was 3.20±5.41 years. Among all children, 69 (47.6%) were boys and remaining 76 (52.4%) were girls. Out of 145 children, 62 (42.8%) were iron deficient whereas 83 (57.2%) were non-iron deficient. The male to female ratio of iron deficiency was 1:1.3. The prevalence of iron deficiency among infants was 46%, followed by toddlers 42% and preschoolers 41%. The mean serum ferritin level was 22.96±2.21 ng/ml. The mean hematocrit was 33.84±2.68. The statistical analysis showed that there was an insignificant association between iron deficiency and age groups of children (p ≥ 0.5). Conclusion: The study concluded that the iron deficiency in children is very common, especially in infants. Screening of iron deficiency in children under five years of age seems to be a very important task for better child care. Key words: Anemia, Iron-Deficiency; Child, Preschool; Malnutrition

Relationship Between Glycated Haemoglobin and Carotid Atherosclerotic Disease Among Patients with Acute Ischaemic Stroke

Objectives: This study aimed to determine the relationship between glycaemic control and carotid atherosclerotic disease among patients with acute ischaemic stroke (AIS). Methods: This retrospective cross-sectional study took place in the Neurology Department of King Fahad Hospital of University, Khobar, Saudi Arabia, from April to October 2017. Data were collected from the medical records of 244 patients with a diagnosis of AIS confirmed by computed tomography. Doppler ultrasounds of the carotid artery were performed to determine the presence of increased carotid intima media thickness (CIMT) and plaques. Results: Significantly higher mean glycated haemoglobin (HbA1c) levels were noted in cases with high CIMT values (P = 0.002), but not in cases with carotid plaques (P = 0.360). In addition, there was a significant association between diabetes mellitus (DM) and high CIMT (P = 0.045), but not with carotid plaques (P = 0.075). Finally, while dyslipidaemia and age were independently correlated with high CIMT values (P = 0.034 and 0.050 each). Conclusion: High HbA1c levels were associated with high CIMT values, but not with carotid plaques. Therefore, HbA1c levels may be useful as an indirect marker of the initial stages of carotid artery atherosclerosis. Keywords: Glycated Hemoglobin A1c; Diabetes Mellitus; Carotid Intima-Media Thickness; Atherosclerotic Plaque; Stroke

Artificial intelligence-reported chest X-ray findings of culture-confirmed pulmonary tuberculosis in people with and without diabetes

Objectives: We applied computer-aided detection (CAD) software for chest X-ray (CXR) analysis to determine if diabetes affects the radiographic presentation of tuberculosis. Methods: From March 2017-July 2018, we consecutively enrolled adults being evaluated for pulmonary tuberculosis in Karachi, Pakistan. Participants had same-day CXR, two sputum mycobacterial cultures, and random blood glucose measurement. We identified diabetes through self-report or glucose >11.1mMol/L. We included participants with culture-confirmed tuberculosis for this analysis. We used linear regression to estimate associations between CAD-reported tuberculosis abnormality score (range 0.00 to 1.00) and diabetes, adjusting for age, body mass index, sputum smear-status, and prior tuberculosis. We also compared radiographic abnormalities between participants with and without diabetes. Results: 63/272 (23%) of included participants had diabetes. After adjustment, diabetes was associated with higher CAD tuberculosis abnormality scores (p < 0.001). Diabetes was not associated with frequency of CAD-reported radiographic abnormalities apart from cavitary disease; participants with diabetes were more likely to have cavitary disease (74.6% vs 61.2% p = 0.07), particularly non-upper zone cavitary disease (17% vs 7.8%, p = 0.09). Conclusions: CAD analysis of CXR suggests diabetes is associated with more extensive radiographic abnormalities and with greater likelihood of cavities outside upper lung zones

Prospective Matched Case-Control Study of Over-Early P100 Wave Latency in Migraine with Aura

A sizable portion of the world’s population suffers from migraines with aura. The purpose of this research is to describe the findings of a case-control study that was carried out to gain a better understanding of how migraine with aura manifests. The research looked at the P100 delay of the visual-evoked potential in both eyes of 92 healthy people and 44 patients who suffered from migraines with visual aura. All of the participants in the study were recruited from King Fahad University Hospital in Saudi Arabia. Both sets of people had the same ancestry and originated from the same location. Patients who suffered from migraines with aura exhibited a significantly shorter P100 delay in both eyes compared to healthy controls (p = 0.001), which is evidence that their early visual processing was distinct. In order to arrive at these findings, we compared people who suffer from migraines with aura to people who do not suffer from migraines and used them as subjects. These findings contribute to the ongoing attempts to bring the disease under control and provide vitally significant new information regarding the functioning of headaches with auras. The primary focus of study in the future should be on determining the nature of the connection between issues with early visual processing and headaches with aura