European Journal of Cardiovascular Medicine

Objectives: The aim of current study is to evaluate relation between body mass index (BMI) and in-hospital outcome in patients undergoing percutaneous coronary intervention (PCI). Background: Relation between body mass indexes (BMI) with percutaneous coronary intervention (PCI) has shown in different studies. Recent studies suggested a paradox relation between different BMI values and outcome in certain patients. Methods: In this prospective study, 1134 patients (81.7% male, 18.3% female with mean age of58.18±11.16 years) whom undergone PCI between January 2011 and December 2011 were chosen and their BMI and disease outcome was studied. Classification of BMI was: healthy weight (18.5 to24.9 kg/m2), overweight (25 to 29.9 kg/m2), moderate obesity (30 to 34.9 kg/m2) and severe obesity (over 35 kg/m2). Baseline patient characteristics and in-hospital outcome were compared among BMI categories. Results: Major adverse cardiac events (MACE) were significantly higher in patients with overweight and moderate obesity than two other groups. There was no difference in mortality, reinfarction, revascularisation, stroke and bleeding events among the 4 groups. Being overweight is an independent factor associated to in-hospital MACE (odds ratio [OR] 0.37, 95% confidence interval [CI] 0.17 to 0.73, p=0.01) and mortality rate (OR 0.20, 95%CI 0.04 to 0.85, p=0.03). Conclusion: BMI overall is not correlated to in-hospital MACE and mortality; however, overweight patients are at reduced risk for MACE and mortality.

Background: Left atrial enlargement (LAE) has been proven to be significantly related to stroke and cardiovascular diseases. Previous studies have shown a link between Left atrial enlargement (LAE) with the increase in the risk of stroke and cardiovascular diseases (CVD). Bangladeshi data is lacking on the exact prevalence of LAE. Aims and Objectives: To study the prevalence of LAE and its associated risk factors. Materials and Methods: Hundred patients having were studied in the Department of Vascular Surgery, Bangabandu Sheikh Mujib Medical University (BSMMU), and Dhaka, Bangladesh from January 2020 to December 2020. After a complete physical examination, echocardiogram was performed in all the patients. In present study LAE is defined if the LA diameter is more than 4.0 cm in men and 3.8 cm in women. We performed multivariable logistic regression analysis to identify risk factors for LAE. Results: Prevalence of LAE was 8%. The prevalence of LAE was higher in men (9.37%). On multivariable logistic regression analysis advancing age (OD;1.034), increased systolic blood pressure (SBP) (OR: 2.862), increased diastolic blood pressure (DBP) (OR: 1.32), abnormally high BMI (OR: 3.721), increased prevalence of diabetes (OR: 1.245), increased left ventricular myocardial index (LVMI) (OR: 1.023), and decreased left ventricular ejection fraction (LVEF), decreased heart rate (HR), and decreased estimated glomerular filtration rate (eGFR) were found to be the major risk factors of LAE. Conclusion: A significant number of patients had LAE. Among the risk factors advancing age, increased SBP, increased BMI, presence of diabetes mellitus, increased LVMI, decreased eGFR, decreased LVEF, and decreased HR were more common.

Background: Chronic kidney disease (CKD) is a long-term condition characterized by a gradual loss of kidney functions, usually accompanied by other comorbidities including cardiovascular diseases (hypertension, heart failure and stroke) and diabetes mellitus. Epidemiological and clinical observations have shown that polypharmacy may increase the probability of adverse drug reactions (ADRs), possibly through a higher risk of drug-drug interactions (DDIs). Renal impairment may further worsen this scenario by affecting the physiological and biochemical pathways underlying pharmacokinetics and ultimately modifying the pharmacodynamic responses

Introduction: Prostate cancer is a disease of men. An early observation reports that more than 65% of all prostate cancers are diagnosed in men over the age of 65. Current advances in molecular techniques have provided new tools facilitating the discovery of new biomarkers for prostate cancer. High levels of leptin have been significantly correlated with testosterone and Prostate specific antigen values in subjects with Prostate Cancer compared with subjects in the control group. Adiponectin is the most abundant circulating adipokine and accounts for 0.05% of the total plasma proteins. As a consequence of these observations, and its inhibitory role on the growth of breast and endometrial Cancer cells ,it can be labelled as an Anti-Cancer Adipokine. Interleukin (IL)-6 is a pro-inflammatory cytokine that is expressed in prostate tumors and in the stromal tumor micro-environment. It is known to regulate proliferation, apoptosis, angiogenesis, and differentiation. Material and Methods: This Observational study was conducted among 120 Males, aged above 50 years, out of which 60 were prostate cancer patients and 60 were Healthy controls, who attended the O.P at Dr. VRK Women's Medical College, Teaching Hospital and Research Centre. Men were excluded at baseline, if they had a history of myocardial infarction, stroke, transient ischemic attack, unstable angina, cancer or current renal or liver disease, peptic ulcer, gout, or use of platelet-active agents, vitamin A, or β-carotene supplements. Serum samples of men with prostate cancer based on high prostate specific antigen (PSA),biopsy and/or abnormal DRE  and those of healthy controls were collected after an overnight fast and analysed on the same day. Serum PSA and IL-6 levels were estimated using ELISA. Plasma adiponectin and leptin concentrations were measured by competitive RIA.  Results: In our study, 60 Males were Cases of Prostate Cancer and 60 were Healthy Control group. The age of the patients was almost similar in both Cases of Prostate Cancer (66.23±7.25) and Control group (61.01 ± 7.81). The PSA (ng/ml) level was significantly (<0.001) higher in PCa patients (7.12±0.80) as compared to control group (0.93±0.84). Similarly, the Interleukin-6 level was significantly (<0.001) higher in PCa patients (9.71±0.75) as compared to control group (5.9±0.61). In our study, Leptin (ng/mL) level of Prostate cancer group was 13.31±0.84 which was higher when compared to control group where it was 7.52±0.74. Adiponectin (µg/mL) Levels of Prostate cancer group were 11.72±2.34 which was lower compared to control group where it was 16.25 ±2.73. Conclusion These data further support a relationship between elevated IL-6 and prostate cancer disease prognosis. IL-6 correlates with rising PSA levels and extent of disease, and thus can be used in conjunction with other disease indicators. The multifaceted role of adiponectin in regulating several hallmark pathways that drive cancer growth suppression has been proposed in various studies. Adiponectin is an adipose tissue-derived polypeptide hormone, that in addition, to its anti-diabetic and anti-atherogenic effects also exerts anti-angiogenic properties and therefore it can be used as a target for anti Cancer therapy. On the other hand, leptin would affect PCa growth by means of factors related with obesity such as testosterone and could influence cell differentiation and Prostate Cancer progession.

Background: Non-communicable diseases (NCDs) are the leading cause of death worldwide, with hypertension being the leading risk factor. Ischemic heart disease and stroke are the leading causes of Disability Adjusted Life years (DALYs) in people aged 50 and older, and high systolic blood pressure is responsible for 19.2% of all deaths worldwide. The global NCD priority is to reduce hypertension prevalence by 25% by 2025. Strategies such as early detection, treatment, and control, cost sharing, and benefit designs can help reduce unfavourable health outcomes associated with hypertension. Objectives: The current study is a Community Interventional Trial for Hypertension Control in Rural Maharashtra, India to determine if a community-based intervention delivered to community and healthcare workers in a rural area can be effective in controlling hypertension and if any beneficial effects can be sustained in the long term. Materials & Methods: The study was conducted in the Coverage area of two Primary Health Centers in Palghar District of Maharashtra from Jan 2018 to Dec 2022. It was a Cluster randomized controlled trial with 1850 people in each Sub-center. Comprehensive community-based intervention was implemented in one Subcenter under Primary Health Centre of Kaman and second subcenter in the Primary Health Centre of Satpati in rural area of Maharashtraand its effect was assessed. Results: The baseline characteristics of the study population were similar in both sub-centres. Recommended Physical activity was less in both subcentres, with most of the participants consuming 2000-2499 Kcal/Day. Overweight was higher in Kaman, while central obesity was higher in both PHCs. The prevalence of known cases of both Diabetes Mellitus and Hypertension was 3.4% in Kaman, while Suspected Hypertension cases was higher in Kaman. In Kaman there were 27.5% of confirmed cases of hypertension and after intervention it has reduced to 17.5%. There was a decrease of 10%. In Satpati there were 25.2% of confirmed cases of hypertension and after intervention it has reduced to 21.6%. There was a decrease of 3.6%. Conclusion: A high number of cases of Hypertension is found in rural population. 27.5% of the participants were newly diagnosed with Hypertension. Screening and early detection and treatment of Hypertension is highly needed in rural areas. Community-based intervention is equally important to focus on prevention, promotion, and enable lifestyle changes to prevent and control Hypertension and avoid risk factors.

Background:This study aimed to compare the efficacy and safety of ibuprofen gargle with lignocaine gargle given 30 minutes before surgery in preventing postoperative sore throat (POST) after endotracheal intubation for 24 hours postoperatively.Methods: Eighty ASA I–II patients undergoing elective surgery under general anaesthesia were enrolled in this prospective, randomised, observational study. Patients were allocated into 40 subjects each: Group –L and Group - I; Group-L received lignocaine viscous 2 % solution at 5mg/kg, and Group-I received crushed tab Ibuprofen 400mg diluted in 20ml of water.  Patients were asked to gargle for thirty seconds, thirty minutes before shifting to the operation theatre. Results: There was no statistically significant difference in the occurrence or severity of POST between the two groups for up to 24 hours after the surgery.Conclusions: Preoperative gargling with ibuprofen solution effectively reduces the incidence and severity of POST compared to lignocaine gargle.

Conclusion: Serum homocysteine, vitamin B12and folic acid are easily available investigations which may predict the severity and outcome of patient s    of acute ischemic stroke.

Background: The factors that determine acute exacerbations and hospitalization in COPD patients are poorly understood. Factors that have been studied as predictors of mortality and other outcomes include FEV1, blood gases, co-morbidity, chronic mucus hypersecretion (CMH), muscle weakness, poor nutritional status, low BMI, socioeconomic status and support, number of previous physician visits or hospital admissions, influenza vaccination, pneumococcal vaccination, pulmonary rehabilitation, inhaled corticosteroids and long-term oxygen therapy. Hyperglycaemia is associated with poor outcomes from pneumonia, myocardial infarction and stroke, but the effect of blood glucose on outcomes from acute exacerbations of chronic obstructive pulmonary disease (AECOPD) has not been established. Recent UK guidelines do not comment on measurement or control of blood glucose in AECOPD. A study was therefore undertaken to determine the relationship between blood glucose concentrations, length of stay in hospital, and mortality in patients admitted with AECOPD. Materials and methods: This study was a prospective study in a tertiary care hospital over a period of 48 months. During the initial 24 months, the patients were recruited in the study and for the next 24 months all these patients were followed up systematically for stability of the disease or any adverse impact. Patients who had acute exacerbation of COPD during the initial entry period of 24 months were included in the study. The inclusion criteria were: (i) patients with a principal diagnosis of AECOPD; (ii) age over 50 years; (iii) current smokers or ex‑smokers with a history of smoking equivalent to at least 20 pack‑years; and (iv) surviving patients with stable COPD status on discharge.  Result: Of 115 COPD patients admitted for AECOPD, 54% had one or more readmission, and another 45% had two or more readmissions over a period of 2 years. There was a high prevalence of current or ex‑heavy smokers, associated co‑morbidity, underweight patients, low vaccination prevalence and use of domiciliary oxygen therapy among COPD patients. A total of 12% mortality was observed in the present study. Immediate failure rates after first exacerbation was observed to be 34.8%. Multivariate analysis showed that duration >20 years (OR = 0.43; 95% CI: 0.15‑0.91), use of Tiotropium (OR = 3.33; 95% CI: 2.16‑6.74) and use of co‑amoxiclav during first admission (OR = 3.48; 95% CI: 2.28‑6.84) were significantly associated with higher immediate failure rates.  Conclusion: it has been shown that half of all chronic obstructive pulmonary disease patients hospitalised with acute exacerbations died within 3 yrs. These findings may help clinicians with important information about the probable short- and long-term survival of these patients. Thus, low levels of serum albumin strongly predict poorer long-term outcome, and longer duration of disease and longer time elapsed since first hospitalisation appear as new mortality related independent factors. The authors believe that the current findings will provide clinicians with new insights, allowing them to implement more individualised treatment strategies by better predicting the life expectancy of chronic obstructive pulmonary disease patients.

Background: Stroke rank high among the leading causes of death and permanent disability in India. Due to shifting demographics and rising rates of important modifiable risk factors. The purpose of this study was to compare the blood sugar levels of people with and without diabetes in the early stages of ischemic stroke. Material and Methods:  40 patients who had been admitted to the Department of General Medicine, Sri Venkateswaraa Medical College Hospital & Research Centre, Puducherry, India for the diagnosis of acute ischemic stroke between the April 2022 to March 2023 were included in this study. The Patients were on the basis of the inclusion and exclusion criteria. Results: In our analysis of 40 patients, the majority of them were male, indicating a male preponderance, which is prevalent in most investigations. Twenty-eight of the forty patients had hypertension, 34 had diabetes, three had a history of myocardial infarction, and one female patient had atrial fibrillation. The majority of the patients (15) were between the ages of 51 and 60, with 11 between the ages of 27.5 and 12.5% between the ages of 40 and 50. Conclusion: Ischemic stroke severity, magnitude, and outcome are linearly related to admission day hyperglycemia. Diabetes and stress hyperglycemics have greater severe strokes and worse functional outcomes and higher death. Admission day glucose levels predict ischemic stroke outcomes.

Introduction: Cerebral cardiac syndrome (CCS) refers to cardiac dysfunction after brain injury.  Byer and colleagues   first   reported Cerebral cardiac syndrome in 1946. It is an interplay between brain and heart and is also known as neuro cardiogenic syndrome or stroke heart syndrome. CCS refers to cardiac complications that occur after stroke including arrhythmias, myocardial damage, and cardiac dysfunction. Ischemic stroke is   strongly   evidenced to induce CCS with prevalence of 4-19%. ECG changes   are reported in 65 -69% of ischemic stroke patients. Most of these ECG changes are seen early after stroke within the first 3 days. CCS is   worsening of premorbid cardiac conditions or new onset cardiac injury in stroke patients.   Materials and methods: This is a cross sectional study conducted in the Department of Neurology at Dr.Pinnamaneni Siddhartha Institute of Medical Sciences &Research Foundation, Chinnavutapalli, Vijayawada, Andhra Pradesh from July 2022 to June 2023 with a sample size of 51 patients. Patients of acute ischemic stroke within 72 hours with no previous cardiac disease. Data regarding age, sex, stroke territory, NIHSS score, 2d echo and ECG findings, blood investigations like prothrombin time and neutrophil count were analyzed. Results: A total of 51 ischemic stroke patients were included in this study; 49 patients with arterial infarcts and 2 with venous infarcts. Out of 51 ischemic stroke patients, 23 developed CCS accounting to an incidence of 45%. In 38 patients with   anterior circulation strokes, 39% (14) developed CCS. In 11 patients with posterior circulation strokes, 54% (6) patients developed CCS. ECG findings were recorded within 72 hours of acute stroke. Anterior circulation strokes: In strokes involving anterior circulation, 80% had ECG changes. T waves inversions accounted to 60% and T wave elevations to 20%, T wave inversion with co-existing ST elevation, ST depression and pathological Q waves were accounted for 6.6% each. Conclusion: Our study shows that ECG changes, NIHSS score, sex, prothrombin time, neutrophil count are independent risk factors for CCS correlating with the previous studies. However, our sample had more of posterior circulation strokes presenting with CCS rather than anterior circulation as reported by various studies. Dual role of neutrophils need to be further studied for targeted therapies to improve functional outcomes post stroke.

Introduction: Stroke is one of the most important non communicable diseases causing death. Stroke or CerebroVascular Accident (CVA) is “abrupt onset of a neurologic deficit that is attributable to a focal vascular cause Therefore, the role of lipid profile at the aspect of stroke status and risk assessment also needs to be further discussed. In order to analyse the above issues, our study investigated the association between stroke patients and their lipid profile. Material and Methods: This study included 100 patient admitted in the ward and fulfilling the inclusion criteria. The study consists of history taking, clinical examination and biochemical assay. Study subjects were selected after obtaining consent. Patient were managed according to standard guidelines. Results: Incidence of stroke was greater in males around 71%. The total serum cholesterol concentration was ≥200mg/dl in 62% of our patients. The HDL-C was <60 mg/dl in 87% of patients in our study and among them 43% had <40mg/dl. The VLDL-C was ≥30 in 46% of stroke patients in our study. Apart from dyslipidemia, hypertension was the most significant risk factor (54%) in our study. Conclusion: Dyslipidemia is a tip of iceberg. Lipid profile screening in patients with risk factors like Hypertension, DM, elder people with family history of atherosclerosis diseases etc., can help to provide primary preventive measures. Dyslipidemia, if properly treated being a modifiable risk factor for ischemic stroke, decreases the incidence of stroke due to dyslipidemia. This leads to decreased morbidity and mortality leading to a healthier society.

Introduction: OPCAB was designed to reduce complications resulting from cardiopulmonary bypass like stroke, renal complications and myocardial ischemia and to reduce hospital stay, reduce morbidity and mortality. It includes various anatomical distortions of heart using stabilizers and suspensions which needs extensive monitoring techniques. To improve its efficiency neurological monitoring like NIRS and PA cannulation could play a significant role in further reducing such complications. Mixed venous oxygen saturation (SvO2) remains the accepted standard during anesthesia to evaluate the balance of oxygen delivery and consumption, especially during cardiac surgery. Monitoring the ScvO2-SvO2 with conventional PAC gives indirect evidence of myocardial ischemia, after excluding other causes of ischemia in lower body. Materials and Methods:  In this single centred prospective interventional study, 60 patients undergoing elective off pump CABG between March 2018 to March 2020 were taken. Institutional ethical and scientific committee approval was taken (UNMICRC/ANESTH/2017/09) and written informed consent from patients was obtained. Results:  Total 360 patients were enrolled in the study for comparative analysis of regional cerebral oxygen saturation (rScO2), central venous oxygen saturation (ScvO2) and mixed venous oxygen saturation (SvO2) in off pump CABG. Table 1 shows general characteristics of patients. Mean ejection fraction was 45.92 ± 9.23%. Fifty patients had triple vessel disease and 10 had double vessel disease for which 60, 53 and 49 patients had undergone Left anterior descending (LAD), Obtuse marginal (OM) or Diagonal (DG) and Posterior descending artery (PDA) or Right coronary artery (RCA) grafting respectively. Conclusion:  Positioning of the heart for distal anastomoses at lateral and posterior wall was associated with more hemodynamic alteration and increased in inotropic and vasopressor requirement and significant decreased in rScO2, ScvO2 and SvO2. There was significant positive correlation on measured gradient between ScvO2 & SvO2 and rScO2 & SvO2 and rScO2 & ScvO2. ΔrScO2 was found to be highest as compared to ΔSvO2 followed by ΔScvO2.

Introduction: World Health Organization clinically defines a stroke as ‘the rapid development of clinical signs and symptoms of a focal neurological disturbance lasting more than 24 hours or leading to death with no apparent cause other than vascular origin’. Hypomagnesaemia leads to neuromuscular hyperirritability, tremors, increased vascular resistance, coronary vasospasm and hypertension. Hypomagnesaemia triggers vasoconstriction enhancing vascular endothelial injury and hence leads to atherosclerosis. Subjects and Methods: It was a case control study, undertaken in the Department of Medicine in S Nijalingappa medical college and HSK Hospital during the period of July 2021–December 2022. 30 patients with acute ischemic cerebral stroke fulfilling the inclusion criteria were selected. 2 ml venous sample for serum magnesium level was taken within 24 hours. Magnesium levels in patients after acute cerebral ischemic stroke were documented in patients, receiving standard management protocol of ischemic stroke. The correlation co-efficient of Hypomagnesaemia with modified Rankin Scale Score was calculated. Results: The mean age of patients was 45-80 years, 36 (60 %) patients were male and 24 (40 %) were females and there was male preponderance. The mean serum magnesium levels were measured. The present study observed a statistically significant correlation between modified Rankin Scale score measured at three months and serum magnesium level. Conclusion: It was concluded through the results of this study that Hypomagnesaemia in the body can cause more severe ischemic stroke.

Background: Cardiovascular disease (CVD) has become a major public health problem and leading cause of mortality in developing countries. Cardiovascular risk assessment approach is feasible and cost-effective tool, which helps to identify those at high risk for developing CVDs. so that immediate preventive measures or action can be taken to reduce the risk. Aim: The present study was conducted to assess the CVD (myocardial infarction or stroke) risk by utilizing the WHO/ISH risk charts (non-cholesterol based/ noninvasive chart) in a tribal population of Nasik, India. Methods: This was a cross-sectional community-based study conducted in the rural health training center of the tertiary Healthcare Institute Nashik on 110 participants. The WHO/ISH risk prediction chart for South-East Asia Region D (SEAR D) was used for calculating the 10-year cardiovascular risk. Results: Among total 110 study participants, 83 (75.5%) were in the mild-risk (<10%) category. The 10-year risk of myocardial infarction and stroke is comparable among both sexes (Male- 24.4%, female – 25%), type of occupation (Farmer 24.4%, Non-farmer group – 24.6%), and educational status (Up to secondary level – 25%, above secondary education – 23.3%). Risk factors such as advancing age, three generation family, Tobacco addiction, Family History of Diabetes, Stress, high blood pressure (Both SBP & DBP) and raised random blood sugar level were found to be significantly associated with increased risk of the major cardiovascular event. Conclusion: WHO/ISH chart is a best useful tool in identifying CVD risk. This can further help in planning and implementing targeted interventions amongst identified high risk population in tribal population.

Introduction: The World Health Organization (WHO) definition of stroke is: “rapidly developing clinical signs of focal (or global) disturbance of cerebral function, with symptoms lasting 24 hours or longer or leading to death, with no apparent cause other than of vascular origin”. The pathological background for stroke may either be Thrombotic or hemorrhagic disturbances of the cerebral blood circulation. Thrombotic cerebral infarction results from the atherosclerotic obstruction of large cervical and cerebral arteries, with ischemia in all or part of the territory of the occluded artery. Hyperhomocysteinemia has been emerging as an independent risk factor for atherosclerosis. Several workers opined that moderately elevated plasma Homocysteine (Hcy) concentration might be an independent risk factor for cerebrovascular disease including stroke and transient ischaemic attack. Material and Methods: The study is a hospital based observational study was conducted in the Department of General Medicine at ACSR Government Medical College, Nellore from Dec 2022 to October 2023. 31 patients with thrombotic stroke(cases) and 31 subjects without thrombotic stroke (controls) and other comorbid conditions that affect serum homocysteine were included in the study. Venous blood samples were collected in tubes containing disodium EDTA. Homocysteine assay is based on the measurement of co-substrate conversion product. Results: In the present study, the mean age ± SD of cases was 55.03±14.51. The mean age of males was 51.68±13.45 and the mean age of females was 60.33±15.11. The mean age in control group was 51.22±13.77. The mean serum homocysteine level in the present study, in cases was 25.98±11.95. The mean homocysteine level in males was 7.83±14.29. The mean in females was 23.05±5.67. The mean homocysteine level in control group was 7.19±3.51. Mean homocysteine level of cerebral ischemic stroke females was 14.86 ± 5.34. The mean homocysteine level in controls was 7.428 ± 4.091. The mean homocysteine level in controls was 12.30± 4.68. The mean cholesterol of the cases was167.67±40.68. The mean LDL in the study was 89.74±27.38. The mean HDL was 38.48±10.92. Conclusions: Serum homocysteine levels were significantly higher in those paients with stroke when compared to those without stroke. Apparently, Serum homocysteine level is an independent risk factor for thrombotic stroke.

Background: As we all know that Stroke is becoming an important cause of disability and premature death in low-income and middle-income countries like India, affecting largely the poorer sections of the society driven by demographic changes and enhanced by the increasing prevalence of the key modifiable risk factors which impoverish their families further. Therefore, our study was planned to evaluate the risk factors and their prognostic value in patients of ischemic stroke in our setup? Research Question: What are the risk factors and their prognostic value in the patients of ischemic stroke?The setting of the study was at department of General Medicine, Government General Hospital, Government Medical College, Machilipatnam, Andhra Pradesh. A one-year observational study was conducted during the period from October 2022 to September 2023 on about 100 Ischemic Stroke cases admitted during the above period in the department of General Medicineby studying their socio-demographic profiles, associated risk factors, assessment of the degree of severity in association with risk factors, clinical course and outcome, etc. Results: Among the total study subjects 61% were male and 39% were female and it was observed that the distribution of the disease was more as age advances and it was also noticed that the severity of the disease was more among males when compared to females. Among all the study subjects 55% had hypertension followed by 45% had diabetes mellitus, 34% had history of smoking, 26% had history of regular alcohol intake, 23% had dyslipidemia, 13% had heart disease, 6% had hypercoagulable states,10% had history of TIA, 6% had history of migraine, 3% had history of OC pills usage and 2% had family history of stroke. Hypertension, Diabetes and smoking were the common risk factors present in the majority of the study subjects. Regarding the outcome of the disease the disability and mortality was more among the study subjects who had hypertension and diabetes when compared to non-hypertensive and non-diabetic study subjects significantly(P<0.001).

Aims and objectives:The current study aims to find the correlation of serum CRPlevel with disease morbidity & clinical recovery in patients with acute ischemic stroke Materials and methods: A prospective observational study was conducted in 80 radiologically confirmed cases of acute ischemic stroke admitted in medicine wards at Dr Baba Saheb Ambedkar Hospital,Rohini,New Delhi. Patients were subjected to detailed neurological examination and blood samples were obtained from patients who fulfilled the inclusion and exclusion criteria and blood was send to laboratory for the measurement of serum CRP levels. Results: In this study group, the serum CRP levels on admission were predictive of stroke severity(positively correlated with NIHSS (P = 0.001) as well as outcome(positively correlated with MRS(P =0.001) Conclusion: The serum CRP level on admission can be used to predict severity and outcome in acute ischemic stroke

Background: Diabetes mellitus, characterized by elevated blood glucose levels, poses a significant global health challenge. Type 2 diabetes accounts for the majority of cases and is associated with factors such as obesity, physical inactivity, and poor dietary habits. The global burden of diabetes is substantial, contributing to major complications like blindness, kidney failure, heart attacks, stroke, and lower limb amputation.  Methodology: This study investigates cardiovascular complications in 209 adult diabetic cases with a disease duration exceeding 5 years. The research, conducted at a tertiary care teaching hospital, includes a detailed clinical examination, relevant investigations, and categorization based on disease severity, control status, and treatment type. Various parameters, including fasting blood sugar, postprandial blood sugar, urine examinations, serum cholesterol levels, and hypertension classification, were assessed. Results: The study reveals that 112 cases (53.6%) exhibited cardiovascular complications, with ischemic heart disease (IHD) being the most prevalent (39.7%). The majority of patients were in the 51-60 age group, and 75.6% were male. Poor glycemic control was evident in 79.9% of cases, while 23.9% had severe diabetes. Hypertension and retinopathy were present in 30.1% and 35.8% of cases, respectively. IHD was more prevalent in males (56.6%) and the 51-60 age group. Discussion: The study establishes associations between different complications, emphasizing the frequent coexistence of various cardiovascular issues in diabetes. It explores the distribution of IHD among diabetics, with a peak in the 51-60 age group and a higher incidence in males. The severity of diabetes did not significantly influence IHD incidence. Good glycemic control demonstrated a protective effect against complications. Conclusion: This comprehensive study underscores the substantial impact of cardiovascular complications in diabetes mellitus. It highlights the importance of glycemic control, lifestyle modifications, and weight management in reducing the incidence and severity of complications.

Background: Dyke-Davidoff-Masson syndrome is a rare condition resulting from brain injury due to a multitude of causes; especially in early life. Characteristics include cerebral hemiatrophy/hypoplasia, contralateral hemiparesis, seizures, and compensatory osseous hypertrophy. Case presentation: We present a case of a 14-year-old girl who initially presented with left sided hemiparesis. Computed tomography (CT) showed evidence of right cerebral atrophy. Workup for paediatric stroke was negative. Upon further evaluation by Neuroradiology, features suggesting Dyke-Davidoff-Masson syndrome were confirmed. Patient has been under Neurology follow up since. Conclusions: Due to its rarity, Dyke-Davidoff-Masson syndrome may easily be missed by the majority of treating clinicians. Knowledge of its features on imaging enables timely and accurate diagnosis – allowing appropriate management.

Introduction: Acute stroke is defined as an abrupt onset of a neurologic deficit that is attributable to a focal vascular cause which may be either ischemic or hemorrhagic in nature. Acute ischemic stroke, most common of the two types, results from prolonged cerebral ischemia leading to cerebral neuronal death. Ischemia Modified Albumin (IMA) is the only ischemic marker which has been approved by Food and Drug Administration(FDA) of United States(US) for early diagnosis of myocardial ischemia. Serum IMA levels and IMA to Albumin ratio(IMAR) were shown to increase in several diseases such as myocardial ischemia, acute stroke, muscle ischemia and bowel ischemia. Aim and Objectives: The aim of the study is to know whether Ischemia Modified Albumin (IMA) level is elevated in acute stroke patients and to compare the IMA levels and IMA to albumin ratio (IMAR) in acute stroke patients with healthy controls. Materials and Methods: Data required for the study were extracted from confirmed cases of Acute stroke (Diagnosed clinically and radiologically) patients attending Emergency and Intensive Care Unit of Neurology Department, GGH, Guntur and age matched normal healthy persons taken as controls. Biochemical parameters for the study were Ischemia Modified Albumin (IMA) estimated by Albumin Cobalt binding method and serum Albumin estimated by Bromo Cresol Green Dye binding method done on Beckman Coulter, Au 480 fully automated biochemistry analyzer. Ischemia Modified Albumin to Albumin Ratio(IMAR) was calculated from the results of both test and control groups. Results: IMA values of acute stroke patients were significantly higher than the control group (P Value <0.001). Mean serum albumin value of control group was higher than that of acute stroke patients. Negative Correlation was seen in Stroke patients between Serum Albumin and IMA (r = - 0.876). Mean IMA to Albumin Ratio(IMAR) of acute stroke patients were significantly higher than the control group (P Value <0.001). Conclusion: Ischemia Modified Albumin(IMA)would be a novel biomarker to support the clinical diagnosis of acute stroke. n this study mean IMA values of Acute Stroke patients were significantly higher than the control group. An arbitrary cut-off of 105.17 U/ml of IMA was chosen based on the ROC Curve analysis in the diagnosis of Acute Stroke patients. Further large scale studies are needed to choose clinically appropriate cut–off for serum IMA levels.

Background:   End-stage renal disease (ESRD) necessitates maintenance hemodialysis, posing significant healthcare challenges, including high hospitalization and mortality rates. This study aimed to analyze the outcomes of hospitalization in ESRD patients undergoing maintenance hemodialysis in a tertiary care center. Methods:    A prospective observational study was conducted on 130 patients, focusing on demographics, clinical characteristics, comorbidities, hospitalization causes, and outcomes. Results:    The majority of patients were males (66.9%), with the most prevalent age group being 41-50 years (32.3%). Hypertension (87.7%) and diabetes mellitus (28.5%) were the most common comorbidities. Cardiac abnormalities significantly influenced hospitalization rates (p<0.0001), and acute pulmonary edema was the leading cause of hospitalization (31.4%). The overall mortality rate was 6.2%, with acute pulmonary edema, acute hemorrhagic stroke, and uremic encephalopathy being the primary causes of death. Patients under three times weekly maintenance hemodialysis showed higher hospitalization rates compared to those receiving twice-weekly sessions (p=0.004). Conclusion: The study highlights the critical role of comorbid conditions management and the need for individualized care strategies to mitigate hospitalization and improve outcomes in ESRD patients on maintenance hemodialysis

Introduction : Tuberculosis (TB) is the most prevalent infectious disease which is brought by the mycobacterium tuberculosis. In addition to the lung tissue, TB also affects the bone marrow. Significant haematological and coagulation abnormalities are associated with TB. Therefore the diagnosis, prognosis, and therapeutic response can also be indicated by these haematological and coagulation markers. These coagulation abnormalities can lead to stroke and DIC leading to increased mortality. Aims To evaluate the haematological and coagulation parameters in pulmonary tuberculosis patients. Methods and Materials: In this study a total of 50 patients with confirmed tuberculosis were chosen using purposive sampling. Four millilitres of venous blood were drawn while taking the necessary aseptic precaution. Sysmex XN 1000 6-part haematology analyser was used to perform hematologicalanalysis on two millilitres of ethylenediamine tetra acetic acid (EDTA)vacutainer tubes. Rest two millilitres of blood
in sodium citrate vacutainer tube was used to perform coagulation parameters analysis on ACL elite pro coagulation analyser for measurement of D dimer and fibrinogen. Results Hemoglobin and other blood indices were marginally lower in both sexes
compared to healthy controls. Patients with tuberculosis show significantly greater levels of white blood cells (WBC), platelets, D-dimer, and fibrinogen when compared to healthy controls. P-value < 0.05 indicated that these increases were statistically
significant.

Background: Stroke poses a significant societal burden, contributing to global mortality and disability. Second only to ischemic heart disease, stroke exhibits the highest mortality rates. Preventive measures involve addressing modifiable risk factors such as diabetes, hypertension, heart disease, obesity, atrial fibrillation, smoking, and alcoholism. This study aims to assess the demographic profile and associated risk factors among stroke patients younger than 45years admitted to PGIMER & Capital Hospital, Bhubaneswar, Odisha.

Methods: Conducted between October 2022, and October 2023, this single-center, cross-sectional observational study enrolled 52 stroke patients at PGIMER & Capital Hospital, Bhubaneswar, Odisha. Data analysis was performed using SPSS version 20.

Results: Of the 52 patients, 34 (65%) were male, and 18 (35%) were female, with a mean age of 32.57 ± 9.6 years. Ischemic stroke occurred in 39 (75 %) patients, while hemorrhagic stroke was observed in 13 (25 %). The middle cerebral artery territory was the most commonly affected in ischemic stroke (22, 42.30%), whereas intracerebral hemorrhage occurred in 11 (78.57%) cases. Smoking and hypertension were prevalent in 51.92% and 51.92 % of ischemic stroke cases, respectively, while hemorrhagic stroke cases showed rates of 23.07 % and 21.15%, respectively. Physical inactivity (50%), alcohol consumption (40.38%), central obesity (46.15%), and dyslipidemia (30.76%) were more frequently associated with ischemic stroke, while significant alcohol consumption (15.38%) was more linked to hemorrhagic stroke.

Conclusions: Stroke predominantly affected males and increasing age groups, with ischemic stroke being more common than hemorrhagic stroke. The most prevalent risk factors for stroke in young patients were smoking, hypertension and central obesity

Background: - Trunk muscles are imperative in supporting the body in sustained antigravity poses such as sitting and standing. It also serves as a stabilizing agent for the upper limb during the execution of voluntary movements. Very few studies are published that support the role of Proprioceptive Neuromuscular Facilitation (PNF) and Manual Perturbation (MP) exercises in the facilitation of trunk control and enhancing the lower extremity functions and mobility among the sub-acute stroke patients. Thus, through this study, an attempt was made to examine and compare the effects of the MP exercises and PNF exercises on the trunk control mechanism and lower extremity functions among sub-acute stroke survivors. Methodology/ Subject Selection: A double-blinded randomized clinical trial was carried out by recruiting 30 subjects from both genders in the subacute phase attained stroke survivors with a history of first ever stroke, who’s age ranged between 50 to 70, who can able to walk with or without support. All the study participants were informed in detail about the study protocols and written consent was taken before the recruitment for this study. All the study subjects were randomly allotted into 2 groups, i.e., MP and PNF, and received interventions for a total of 8 weeks. Before the interventions, trunk stability was measured by the Trunk Impairment Scale (TIS), Lower Extremity Stability and mobility function were measured by the Dynamic Gait Index (DGI), timed up and go (TUG) test, and Gait parameters (Cadence, Affected and Non-Affected Side Step Length and Stride Length).  Results: A paired t-test was used to compare differences between pre-and post-intervention, and independent t-tests were used to compare the groups. Both the groups showed improved trunk Stability and lower Extremity function for the affected limb step length (A-LSL) and Unaffected Limb Step Length (UA-LSL) components. No statistically significant difference was found between the two groups at the post-intervention level.  Conclusion: The MP and PNF are equally efficient in improving trunk stability and lower extremity functions except the TUG & unaffected side step length. Thus, if both approaches are used instantaneously, a better result can be obtained in a shorter duration. Indexed Keywords: Stroke, Trunk Control, Lower Extremity Function, Manual perturbation, Proprioceptive Neuromuscular Facilitation.

Introduction: Cerebrovascular accidents (CVAs), commonly known as strokes, represent a significant public health concern worldwide due to their high morbidity and mortality rates. They result from the sudden interruption of blood flow to a part of the brain, leading to neurological deficits that can range from mild to severe. Ischemic strokes, caused by the blockage of blood vessels supplying the brain, account for the majority of cases, while hemorrhagic strokes, caused by the rupture of blood vessels, constitute a smaller but equally critical subset. Among the various biomarkers studied in the context of strokes, plasma fibrinogen levels have garnered considerable attention. Elevated levels of fibrinogen are associated with increased thrombotic potential, potentially contributing to the pathophysiology of ischemic strokes. Materials And Methods: This is a hospital based Prospective analytical study was conducted in Department of General Medicine at Sapthagiri Institute of Medical Sciences and Research Centre, Bengaluru, Karnataka over a period of 1 year. Total 50 adult patients who are getting admitted in medical wards and acute medical care with first episode of stroke and full filling the Inclusion and exclusion criteria. Plasma Fibrinogen level estimation will be carried between 24-72 hours after onset of Cerebro Vascular accidents. After completion of selection of patients, written consent is taken from the patients or their attender’s, detailed history was taken, Physical examination was done, subjects are investigated with routine blood tests like CBC, Blood Urea, Serum creatinine, Random blood sugar, CRP, urine Routine Microscopy, ECG, carotid doppler, Lipid profile, CT BRAIN, MRI BRAIN done in selected cases. Results: In the present study, Ischemic stroke is seen in 68% of patients and Hemorrhagic stroke in 32% of patients. It shows that ischemic stroke is more common than hemorrhagic stroke. Out of 34 patients of ischemic stroke,22(65%) showed their plasma fibrinogen levels ≥350 mg/dl4. Of them, 2 patients showed higher plasma fibrinogen levels between 450-549 mg/dl. Normal plasma fibrinogen levels are seen in 12 patients (35%). Higher fibrinogen levels are seen in 9 out of 16 patients (56%) in haemorrhagic stroke group. 7 patients showed normal fibrinogen level. Out of 50 patients, 7 patients expired and 43 patients survived. Among deceased 7 patients, 4 patients had ischemic stroke and 3 patients had hemorrhagic stroke. Conclusions: Stroke due to ischemia (68%) is more common than stroke due to haemorrhage (32%). Elevated fibrinogen level is one of the independent risk factors for stroke. Fibrinogen levels are slightly higher in ischemic stroke individuals compared to hemorrhagic stroke but not statistically significant. All non survivors have higher fibrinogen levels.

Background: The adrenal glucocorticoid stress response in humans causes catabolism, increasing blood glucose and heart rate, and possibly potentiates ischemic damage to neurons. These effects could induce secondary brain damage in acute stroke. Materials and methods: In this prospective observational study, 60 patients with acute ischemic stroke were evaluated. Cardioembolic and lacunar strokes were excluded. In the first 24 hours of admission, serum cortisol level, national institutes of health stroke scale (NIHSS), diabetes and hypertension were assessed to determine their value to predict mortality within 90 days.  Result: Mean age was observed in the current series was 74.14 ± 14.58 years. There were 32 (53.3%) male and 28 (46.7%) female. Scandinavian Stroke Scale (SSS) was observed to be 34 (21-47) on admission. History of hypertension, History of stroke, Diabetes mellitus and Atrial fibrillation was observed in 35 (58.3%), 10 (16.7%), 22(36.7%) and 9 (15%) respectively. In univariate logistic regression analysis of the relations to 7 days of mortality, s-cortisol, SSS on admission, and pulse rate reached a significance level. S-cortisol level was higher in patients with insular involvement, 635 nmol/l, in comparison to patients without insular involvement, 589 nmol/l.   Conclusion: Among the patients with acute ischemic stroke, high serum cortisol levels at the time of admission. Clinical severity which is assessed by National Institute of Health Stroke Scale and Poor prognosis and functional outcome after 15 days which is assessed by Modified Rankin Scale

Introduction:   Chronic kidney disease (CKD) significantly elevates the risk of cardiovascular disease (CVD), which is the leading cause of morbidity and mortality in CKD patients. Understanding the cardiovascular outcomes in this population is crucial for developing effective prevention and management strategies. Objective: This study aims to evaluate the incidence and determinants of cardiovascular events in patients with CKD at the Department of Cardiology, Hi-Tech Medical College & Hospital, Bhubaneswar, India, over a period from June 2018 to December 2023. Method: An observational cohort study was conducted with a sample size of 68 CKD patients. Data were collected on traditional and non-traditional cardiovascular risk factors, and patients were followed to document major cardiovascular events such as myocardial infarction, stroke, and heart failure. Statistical analyses included the calculation of incidence rates and multivariate regression to identify independent predictors of cardiovascular outcomes. Results: During the study period, 23.5% of the patients experienced a major cardiovascular event. The incidence rates of myocardial infarction, stroke, and heart failure were 10.3%, 5.9%, and 7.3%, respectively. Significant predictors of cardiovascular events included hypertension (p < 0.01), dyslipidemia (p < 0.05), and elevated levels of inflammatory markers (p < 0.01). CKD progression was also strongly associated with increased cardiovascular risk (p < 0.01). Conclusions: The findings highlight a high incidence of cardiovascular events among CKD patients and underscore the importance of comprehensive cardiovascular risk management in this population. Early identification and intervention for modifiable risk factors are essential to improve cardiovascular outcomes in CKD patients

Introduction: Stroke, a rapid onset cerebral deficit, is a leading cause of disability and mortality. Electrolyte imbalances, particularly hyponatremia, are common in stroke patients and linked to poor outcomes. Differentiating between conditions like SIADH and CSWS is crucial for effective treatment. This study aimed to evaluate serum sodium levels and investigates hyponatremia causes in newly diagnosed stroke patients. Materials & Methods: A total of 210 stroke patients were studied over six months using consecutive sampling. Patients over 18 years old admitted within 48 hours of stroke onset, diagnosed via CT or MRI, were included. Data, including demographics, clinical history, and laboratory measurements, were collected after informed consent. Various parameters including urinary sodium, serum osmolality, serum uric acid, serum sodium, urine specific gravity, blood glucose, blood urea, and blood urea nitrogen were measured. Results: Most stroke patients were aged between 56 and 75, with ischemic strokes being the most common (70.5%). A significant portion of patients had hyponatremia (40.0%), with SIADH being more prevalent (64.3%) than CSWS (35.7%). Mortality rate among hyponatremic patients (42.9%) was higher compared to those without hyponatremia (18.3%). However, there was no significant difference in mortality rate between SIADH (42.6%) and CSWS patients (43.3%, p=0.94). Conclusion: Maintaining electrolyte balance, especially sodium levels, upon patient arrival is crucial due to its potential adverse effects. Hyponatremia, common in stroke patients, can worsen consciousness levels and neurological symptoms, necessitating careful assessment of its severity for effective management.

Introduction: A change in the heart's electrical rhythm is known as a cardiac arrhythmia. This is mostly a sign of a structural heart illness; however, it can also happen when a healthy heart has aberrant conduction, depolarization, or an electrolyte change. Aims: To assess the effectiveness of dabigatran versus warfarin in patients of non-valvular atrial fibrillation in clinical practice in a tertiary care hospital of west Bengal, India Materials and method: Present study was conducted in the department of pharmacology and department of cardiology in a tertiary care hospital from January 2018 to April 2019. A total of 150 patients with newly diagnosed non valvular atrial fibrillation, between 26-90 years were included in the study. Result: In group-A, 45(60.8%) patients had hypertension, 34 (45.9%) patients had diabetes mellitus, 3(4.05%) patients had hyperthyroidism and 46 (62.2%) patients had old stroke/TIA. In group-B, 29 (38.2%) patients had hypertension, 29(38.2%) patients had diabetes mellitus, 4 (5.26%) patients had hyperthyroidism and 41 (53.94%) patients had old stroke/TIA. In group-A, 36 (48.6%) patients had paroxysmal and 38 (51.4%) patients had persistent atrial fibrillation. In group-B, 24 (31.6%) patients had paroxysmal and 51 (67.1%) patients had persistent atrial fibrillation. Conclusion: Dabigatran 110 mg twice daily dose is non-inferior to warfarin INR adjusted dose regarding effectiveness and safety profile in non-valvular atrial fibrillation patients in Indian perspective. The incidence of dyspepsia is significantly high with dabigatran. there is no other significant difference in other adverse drug reactions.

Background: Psoriasis is a chronic inflammatory disease associated with an increased risk of cardiovascular diseases (CVD) due to systemic inflammation and metabolic dysregulation. Objective: This study investigates the association between psoriasis and cardiovascular diseases in patients attending Hamdard Institute of Medical Sciences and Research, New Delhi. Methods: A prospective observational study was conducted from January 2023 to May 2024. A sample of 65 psoriasis patients was assessed for cardiovascular risk factors, including hypertension, dyslipidemia, obesity, and metabolic syndrome. Detailed clinical evaluations, blood tests, and ECG were performed. The prevalence of CVD risk factors and the correlation with psoriasis severity were statistically analyzed. Results: Out of the 65 patients (mean age 43.7 years, 60% male), 45 (69%) showed at least one cardiovascular risk factor. Hypertension was observed in 40% of the patients, dyslipidemia in 35%, and metabolic syndrome in 30%. Psoriasis severity (PASI score) was positively correlated with the presence of multiple CVD risk factors (p<0.05). Furthermore, 12% of the patients had a history of cardiovascular events such as myocardial infarction or stroke. The findings indicated a higher prevalence of cardiovascular risk factors in moderate-to-severe psoriasis cases than in mild cases. Conclusions: Psoriasis patients, especially those with severe forms, exhibit a significantly increased risk of cardiovascular diseases. Early cardiovascular screening and management should be integral to psoriasis care to mitigate this risk.

Introduction: Coronary artery disease (CAD) remains a major global health concern, with left main coronary artery (LMCA) disease posing high risks due to the large myocardial area it supplies. Despite coronary artery bypass grafting (CABG) being the preferred revascularization strategy for unprotected left main coronary artery (ULMCA) disease, percutaneous coronary intervention (PCI) with drug-eluting stents (DES) has emerged as a viable alternative. However, data on ULMCA PCI outcomes in the Indian subcontinent are scarce. Materials and Methods: This single-center, retrospective study evaluated 253 patients who underwent ULMCA PCI using DES between January 2018 and June 2023 in Central India. Clinical, angiographic, and procedural data were analyzed with a median follow-up of 753.5 days. Comparative analyses were conducted based on SYNTAX scores and imaging-guided versus non-imaging-guided interventions. Results: The cohort's mean age was 61.3 years, with a predominantly male population (77.5%). Imaging guidance was employed in 30.4% of cases. The composite outcome (cardiovascular death, myocardial infarction, stroke) occurred in 11.6% of patients. Higher age and hypertension were identified as significant predictors of adverse outcomes. Conclusion: In this study, PCI for unprotected left main coronary artery (ULMCA) disease using drug-eluting stents (DES) demonstrated favorable short- and mid-term outcomes in an Indian cohort, even in a resource-limited setting. While procedural success was high, factors such as SYNTAX score and patient comorbidities such as age >60 yrs, hypertension significantly influenced outcomes. Imaging- guided interventions, though not altering mortality rates, appeared to enhance procedural safety. These findings support the feasibility of PCI as an alternative to surgery in select high-risk patients, emphasizing the need for further research to refine risk stratification and optimize intervention strategies.

Background: "Stroke" is a generic term meaning sudden onset of a neurologic event and is also called cerebrovascular accident or "brain attack". It is one of the leading causes of death globally and is a significant cause of long-term disability. Magnetic resonance imaging (MRI) provides critical information in acute stroke that can be used to confirm the diagnosis and direct both acute therapeutic interventions and long-term treatment decisions. MRI can identify regions of hemorrhage, active ischemia, and vessel occlusion. This has made SWI a powerful technique in the evaluation of stroke patients. Materials and Methods: This is a Cross-sectional study was done in the Radiology Department, Subbaiah Institute of Medical Sciences over the period of 1 year. All clinically suspected patients with a neurological deficit (signs and symptoms like dysphasia/aphasia, hemiparalysis/hemiparesis, ataxia, convulsions) were referred by a neurologist, physicians for MRI brain in medical college and general hospital. Results: In this study, out of the 125patients, 115 patients (92%) had infarcts in the arterial territory, and 10 patients (8%) had venous infarcts. Hemorrhage was detected in 42 patients (33.6%), of which 33 cases were arterial infarcts and 9 were venous infarcts. Hemorrhage was seen in 27(35%) out of 77 male patients and 15 (31.2%) out of 48 female patients. Hypointense blooming was not seen in 83 patients (66.4%) in this study. Occlusion in TOF-MRA was seen in 25(21.7%) patients out of 115 patients. Susceptibility vessel sign is seen in 20 patients out of 25 patients showing occlusion in TOF-MRA. Loss of flow void on T2 indicating thrombus in the vessel was seen in 5 patients. Conclusion Susceptibility weighted imaging is superior than conventional MR imaging in the detection of haemorrhagic transformation of infarct. SWI can also detect the thromboemboli in the vessels by susceptibility vessel sign. SWI indicates the need for doing perfusion MRI to detect penumbra in cases of DWI-SWI mismatch

Background: CTO PCI can provide significant clinical benefits, yet there is limited information on its safety in unselected patient populations. Objective:The aim of this study is to describe short term outcomes of chronic total occlusion (CTO) percutaneous coronary intervention (PCI) in a tertiary care hospital in southern India. Methods: We analysed the frequency of short-term clinical outcomes of CTO PCI between Jan 1, 2023, and Dec 31, 2023. Results: During the study period, total of 212 patients (men 178(84%) were treated with PCI for CTO. Out of these, 159 patients (75%) had successful PCI and was unsuccessful in 53 patients (25%).In a total sample of 212 individuals, 26 (12.3%) experienced coronary dissection, while 13 (6.1%) had coronary perforation. Cardiac tamponade requiring urgent intervention occurred in 9 patients (4.2%), and 7 patients (3.3%) needed urgent revascularization. Additionally, 4 patients (1.9%) suffered a stroke after the procedure, and 2 patients (0.9%) died. Compared to successful procedures, unsuccessful ones showed significantly higher rates of coronary dissection (34% vs. 5%, p < 0.0001), perforation (17% vs. 2.5%, p < 0.0001), and tamponade (9.4% vs. 2.5%, p = 0.031). However, no significant differences between unsuccessful and successful PCI were observed in terms of death (0% vs. 1.3%, p = 0.412), peri-procedural MI (0% vs. 1.9%, p = 0.314), urgent revascularization (1.9% vs. 3.8%, p = 0.506), or stroke (3.8% vs. 1.8%, p = 0.244). Conclusion: In the present study, failed CTO interventions are associated with a higher incidence of complications such as coronary dissection, coronary perforation, and cardiac tamponade compared to successful CTO interventions. Although periprocedural MI, death, and urgent revascularization occurred more frequently in successful attempts, the differences are not statistically significant.

Introduction- In India stroke stands as a threat, to life affect 1 in every 1000 individuals. Due to lack of awareness among the public, about the symptoms and risks of stroke prompt administration of rtPA treatment gets delayed frequently. Aim and Objectives- The aim is to assess how well the general public recognizes the signs of a stroke and its risk factors and treatment options based on age and gender differences and to provide education to those, with understanding to encourage intervention. Methodology- This was a cross-sectional survey; five hundred subjects aged 18-80 were recruited from patients attending health care in Ahmedabad city using stroke awareness questionnaire. Participants were educated about stroke warning signs, risk factors, and actions after inquiring the required responses and obtaining informed consent. Results- Of the sample 49% males and 51% females participated, and average age was 22 years. The knowledge of stroke warning signs and treatment response was better among females. However, age did not make any significant difference (p=0.06). Gender and age did not significantly regard awareness of risk factors. However, there were significant relationships between awareness of warning signs and treatment action, as well as between awareness of risk factors and treatment awareness. Discussion- Even though 95% of respondents understand the word "stroke," only 25% were able to identify warning signs; awareness was higher among females. This calls for directed education about the improvement of the ability to identify when the symptoms appear in an effort to eliminate the time that these patients wait before they receive treatment. This study proposes to evaluate the level of stroke signs, risk factors and methods available to treat heart stroke within the society targeting the existing gaps on educational needs.

Hypertension, or high blood pressure, is a chronic health condition affecting over 1.13 billion individuals globally and a significant contributor to cardiovascular diseases, kidney failure, and strokes. Known as the “silent killer” due to its often-asymptomatic progression, hypertension poses extensive public health challenges worldwide. It results from a complex interaction of non-modifiable factors, such as age, sex, and genetic predisposition, alongside modifiable lifestyle factors, including diet, physical inactivity, obesity, stress, and socio-economic determinants. The prevalence of hypertension has notably increased in recent years, particularly in low- and middle-income countries (LMICs), where urbanization, dietary shifts, and sedentary behaviours exacerbate the risk. This systematic review provides a detailed analysis of these key risk factors, highlighting the genetic, environmental, lifestyle, and socio-economic factors that contribute to hypertension and emphasizing the necessity of multi-level interventions involving clinical care, public health policies, and lifestyle changes to effectively address this global health issue.

Introduction: Intra cerebral hemorrhage (ICH) is the most devastating form of stroke, with high mortality and severe disability among survivors. Non contrast computed tomography (CT) is the most commonly available tool for the diagnosis of intracranial hemorrhage. he aim of the study is to document the location and volume of intra cerebral hemorrhage, presence of subarachnoid /ventricular extension various types of brain herniations. The relation of extent of damage to patient management and outcome was analyzed. Materials and Methods: This prospective study was carried out on 54 patients with spontaneous intracerebral hemorrhage (SICH) over a period of 18 months (April 2023 - September 2024). Non contrast CT was performed using sixteen slice Multidetector Computed Tomography scanner (GE Revolution ACT 50 slice CT scanner).Contrast CT, follow up CT and additional radiological tests were performed as and when required. Results: In our study out of 54 patients, SICH was higher among males, with hypertension as the most important risk factor and most of the patients are with volume of bleed less than 30mL (59%). Intraventricular extension was seen in 25 patients. Supratentorial location of hemorrhage (81%) was more common compared with infratentorial location (19%) with the most common site being basal ganglia (37%). 48 patients were treated medically and six patients underwent surgery. Of the 48 patients treated medically, 9 were in infratentorial location with 4 in cerebellum and 5 in brain stem and all these patients had fatal outcome, remaining 39 patients treated medically for the supratentorial ICH, 23 patients survived. Among these patients, 22 patients had ICH volume of less than 30 mL (95%). Of 16 patients with intracerebral hemorrhage volume of ≥ 60 mL, mortality was seen in 87.5% (14 of 16 patients). Of the six patients treated surgically for supratentorial bleeds, survival rate was 66.67% (4 of 6 patients) and all the survived patients had volume of bleed more than 30 mL. Interpretation and conclusion: Based on the findings we conclude that SICH volume involving more than 60 mL, infratentorial location and intraventricular extension are predictors for poor outcomes. Patients with ICH volume of less than 30 mL have a good prognosis and patients with ICH volume ofmore than 30 mL may be considered as patients suitable for surgery.

Objective: To assess the relationship between levels of CRP, IL-6, and fibrinogen with the incidence of cardiovascular events with known cardiovascular risk factors. Methodology:  This prospective cohort study aimed to investigate the predictive role of inflammatory biomarkers (C-reactive protein [CRP], interleukin-6 [IL-6], and fibrinogen) in forecasting cardiovascular events. The study included 500 participants aged 40 to 75 years with at least one cardiovascular risk factor, such as hypertension, diabetes, hyperlipidaemia, or smoking history. Baseline blood samples were collected to measure CRP, IL-6, and fibrinogen levels, and participants were followed for 5 years. Cardiovascular events, including myocardial infarction, stroke, and sudden cardiac death, were recorded during the follow-up period. Results: The study found that elevated levels of CRP, IL-6, and fibrinogen were significantly associated with an increased incidence of cardiovascular events. Participants in the highest quartiles of these biomarkers had notably higher event rates compared to those in the lowest quartiles (p = 0.03 for CRP, p = 0.04 for IL-6, and p = 0.02 for fibrinogen). Cox proportional hazards regression analysis revealed that each unit increase in CRP, IL-6, and fibrinogen corresponded to a 45%, 23%, and 31% higher hazard of experiencing a cardiovascular event, respectively (p ≤ 0.05 for all biomarkers). Conclusion: This study highlights the significant role of inflammatory biomarkers in predicting cardiovascular events, especially in individuals with established cardiovascular risk factors. Elevated levels of CRP, IL-6, and fibrinogen were found to be strong predictors of adverse cardiovascular outcomes, suggesting that these biomarkers may improve cardiovascular risk stratification and help identify high-risk individuals for early intervention. Further research is needed to explore their potential integration into clinical practice for more effective prevention strategies

Introduction: Stroke is defined as an "acute neurologic dysfunction of vascular origin with sudden (within seconds) or at least rapid (within hours) occurrence of symptoms and signs corresponding to the involvement of focal areas in the brain". The two main types of strokes are ischemic and hemorrhagic which are due to a number of different pathological mechanisms. Hemorrhagic stroke occurs when blood from a ruptured blood vessel compresses and damages normal functioning brain tissue. In an ischemic stroke, a blocked artery prevents blood carrying oxygen and other nutrients from reaching a portion of the brain, leading to dysfunction and death of that brain tissue. Material and Methods: This is a Prospective, Observational and Single center conducted in the Department of Biochemistry and Neurology, Index Medical College Hospital & Research Center. In this study, total 220 subjects were included; of which 110 newly diagnosed ischemic stroke patients of either sex, who clinically diagnosed in the department of Neurology and 110 newly diagnosed hemorrhagic stroke. After clinical examination and confirmed diagnosis by Physician, 220 patients of either sex, who meet the inclusion and exclusion criteria selected for the study from January 2022 to July 2024. Results: Ischemic Stroke: Thiol group levels are higher, with a mean of 332.35 ± 31.64 mmol/L. Hemorrhagic Stroke: Thiol group levels are lower, with a mean of 318.12 ± 28.55 mmol/L. The higher levels of thiol groups in ischemic stroke may indicate a greater presence of these important antioxidants, which can help protect against oxidative damage. In contrast, the lower levels in hemorrhagic stroke might suggest a reduced capacity for antioxidant defense in that condition. mRS Outcomes The majority of patients in both groups had favorable outcomes (mRS < 2), with ischemic stroke showing a slightly higher percentage (64.5%) compared to hemorrhagic stroke (60%). The proportion of patients with unfavorable outcomes (mRS 2-5) is relatively similar between the two groups, with ischemic stroke at 34.5% and hemorrhagic stroke at 39.0%. Conclusion: In conclusion, we determined that diabetes mellitus brings an additive oxidative stress load to acute ischemic stroke patients. These patients need to be managed carefully with regard to their poor prognosis. We consider that high TAC levels in diabetic stroke patients render the antioxidant supplementation useless at least for the acute-phase (24 hours) treatment of stroke. Oxidative stress and TAC in the later periods of acute ischemic stroke need to be explored in further studies.

Aim and Objective: To describe the epidemiology, clinical-serological profile, and outcome of primary APS in a South Indian tertiary care center. Material and methods: This retrospective study, conducted in the Clinical Immunology and Rheumatology Department at SRMC/SRIHER Chennai from 2018 to 2024, included 40 patients with the primary anti-phospholipid syndrome (PAPS) as defined by the modified Sapporo criteria. Patients with conditions like protein C or S deficiency, hyperhomocysteinemia, Factor V Leiden mutation, or other autoimmune diseases were excluded. Data on demographics, clinical presentation, lab results, and treatment outcomes were gathered. Anticardiolipin (aCL) and anti-β-2 glycoprotein I (β-2GPI) antibodies (IgG and IgM) were measured by ELISA, with positivity cut-offs of 12 GPL-U/ml for aCL and 20 GPL-U/ml for β-2GPI. Lupus anticoagulant (LAC) was assessed using the diluted Russell Viper Venom Test (dRVVT), with a normalized ratio >1.2 indicating positivity. This approach ensured standardized PAPS diagnosis and characterization in the study cohort. Result: In this study of 40 primary anti-phospholipid syndrome (PAPS) patients, 82.5% were female, with an average diagnostic age of 35.9 years (range 16–65). Venous thrombosis was the most frequent presentation, seen in 60% of cases, followed by arterial thrombosis (37.5%) and mixed thrombosis (22.5%), while 12.5% had obstetric complications. Deep vein thrombosis (DVT) and ischemic stroke were the most prevalent venous and arterial events, at 47.5% and 27.5%, respectively. Diagnostic testing revealed lupus anticoagulant (LAC) in 55% of patients, anti-β-2 glycoprotein I (β-2GPI) in 47.5%, and anticardiolipin (aCL) antibodies in 37.5%; 20% were positive for all three antibodies. Non-thrombotic manifestations included thrombocytopenia (27.5%) and hemolytic anemia (22.5%). Catastrophic anti-phospholipid syndrome (CAPS) affected 12.5% of patients, with one fatality, while 12.5% experienced thrombosis recurrence. Conclusion: Data on primary anti-phospholipid syndrome (PAPS) alone is limited, as most studies combine primary and secondary APS cases. Our study uniquely focuses on PAPS, including cases with catastrophic APS (CAPS), where triple-positive APS antibodies were more prevalent. Venous thrombosis was the most common presentation, with LAC as the leading antibody, followed by β2GPI and aCL, while thrombotic microangiopathy (TMA), frequently observed in our study, is rarely reported elsewhere.

Background- A number of patients living with uncontrolled blood pressure remains a challenging problem all over the world. Hypertension is responsible for 57% of all stroke deaths and 24% of coronary heart disease death in India. Therefore, it is important to know the prevalence of uncontrolled blood pressure in patients with hypertension. Aims- To Assess adequacy of blood pressure control in patients with hypertension attending medicine OPD & other medical clinics of hospital. Materials and methods- This was an observational prospective study which was conducted in the Department of Internal Medicine, Maulana Azad Medical College and Lok Nayak Hospital, located in New Delhi, India. A total of 100 diagnosed cases of hypertension fulfilling inclusion and exclusion criteria were evaluated in this study. Risk factors like adherence, no of antihypertensive medications, reduced salt intake, knowledge about hypertension, hyperlipidemia, diabetes mellitus, demographic and socioeconomic characteristics, cardiovascular disease, smoking, alcohol, physical activity and obesity were assessed. Results- The mean age of the patients was 50.48 (±12.01) years. As compared to patients with controlled BP, those with uncontrolled BP had significantly more number of females (77.4% vs. 52.2) then to males (22.6% vs. 47.8%) (P=0.01). age, Educational standard, residency, occupations, did not show a significant association with control of hypertension in our study. Socioeconomic status as a factor showed a significant association with control of hypertension. As compared to patients with controlled BP to those with in uncontrolled BP, uncontrolled BP was more common in patients with heart disease, diabetes mellitus and respiratory disease.  (12.9% vs 0.0%, P<0.01). 14% patients used tobacco in the form of smoking; 5% were current alcoholic. In the index study, 66% patients were on salt restricted diet and 73% of the patients were adhere to antihypertensive medications. Whereas patients on dual and single antihypertensive were more in controlled group 58.0% and 14.5 % respectively (P<0.01). In uncontrolled group, there were significantly more patients (77.4%) who had inadequate knowledge about HTN control vs.(23.2%) in controlled BP group, (P<0.001. Among the hypertensives, 40% subjects were physically active. BMI as a factor showed a significant association with control of BP in our study. Mean cholesterol level in uncontrolled BP group was significantly higher than controlled BP group (184.13 vs. 137.68, P≤0.01). Mean triglycerides level in uncontrolled BP group was significantly higher 157.68 (±55.98) vs. 126.29 (±38.47) in controlled group (P≤0.01). Conclusion- The present study compares parameters such salt restriction diet and adherence to antihypertensive medications in uncontrolled and controlled hypertension patients in India, which provides valuable information for researchers and authorities, who are responsible for the planning of health services. There are a limited number of researches on BP control status of hypertensive in India. So, this study will provide information about risk factors responsible for uncontrolled blood pressure in patients with hypertension. Our findings have significant public health implications that emphasize the urgency of increased awareness about blood pressure control

Venous thrombosis is uncommon cause of stroke as compared to arterial occlusions, but it is an important consideration because of its potential morbidity and increasing incidence especially in current covid era. Historically comparatively low incidence of cerebral venous thrombosis {CVT} is approximately at 0.2 to 0.5 per 100000 per year while the mortality of CVT probably varied between 20%-50%. Standard medical management for CVT is hydration and systemic anticoagulation with heparin at therapeutic dosage, even in patients with an intracranial hemorrhage (ICH) i.e., Venous hemorrhagic infarct at baseline along with watchful monitoring for seizures & raised Intracranial Tension (ICT) and fundoscopy to monitor Papilledema. There are few cases that do not respond to standard of care with medical management & with progressive CVT leading to poor outcomes with resultant ischemic and hemorrhagic stroke, cerebral edema, mass effect and death.  Endovascular options has been in vogue in recent decade, including intra-venous application of thrombolytic agents and/or mechanical thrombectomy for patients with Major venous sinus thrombosis without large hematoma & significant  midline shift that necessitates emergency decompressive craniotomy  and those with Altered Sensorium (Glasgow Coma scale < 10)/ Refractory to anticoagulation with progressive disease or neurologic deterioration (deterioration on Glasgow Coma Scale ) refractory to anti- coagulation therapy or with new deterioration of symptoms or worsening of ICH or Haemorrage despite standard medical management. We present our unique experience of venous stroke patients in covid era that underwent endovascular salvage for major cortical venous sinus thrombosis & technical note on direct jugular vein accesses intervention utilizing peripheral hardware.

Background: Electrocardiographic (ECG) changes are reported frequently after acute strokes. It seems that cardiovascular effects of strokes are modulated by concomitant or pre-existent cardiac diseases, and are also related to the type of cerebrovascular disease and its localization. We aimed to determine the pattern of ECG changes associated with pathophysiologic categories of acute stroke among patients with/ without cardiovascular disease and to determine if specific ECG changes are related to the location of the lesion. Every year, more than half a million people in the world suffer from acute cerebrovascular events, including ischemic stroke, intracerebral and subarachnoid hemorrhage.  Materials and methods: This is a Prospective and observational study conducted in the Department of Medicine, Tertiary Care Teaching Hospital over a period of 1.5 years. Selection of study subjects - After admission, based on clinical history and Physical Examination, a presumptive diagnosis is made and later the patient will be subjected to Serial ECGs after informed consent. Patients admitted in the NICU and various medical wards within 24 hours after the onset of neurological deficit. Patients who developed stroke during their stay in hospital. Result: We have recruited 90 stroke patients, most of them were males. Major type was ischemic stroke. In total 62 (68.89%) stroke patients had some form of ECG change. Majority i.e. 35 (38.89%) patients had QTc prolongation followed by 32 (35.56%) patients had T wave changes. QTc prolongation and Atrial fibrillation were significantly more among hemorrhagic stroke patients (p<0.05) and T wave changes and ST changes (elevation or depression) were significantly more among ischemic stroke patients (p<0.05). Conclusion: PWDis and PTFV1 are independent predictors of PAF in patients with acute ischemic stroke. These simple and easily accessible predictors that can be detected via surface ECG may be used as a guide to identify patients who require longer rhythm monitoring to better detect occult PAF, thereby preventing recurrent strokes.

Introduction: The International Diabetes Federation (IDF) estimated that the number of individuals living with Diabetes would increase from approximately 65 million in 2013 to 100 million by 2035. Despite the increasing burden of Non-Communicable Diseases, both research and the allocation of resources to combat Non-Communicable Diseases remain limited¹. The NCDs like Diabetes, Hypertension, Obesity, CVS etc. are estimated to account for around 60% of all deaths. NCDs cause considerable loss in potentially productive years of life. Losses due to premature deaths related to heart diseases, stroke and Diabetes are also projected to increase over the years. Individuals with Non-Communicable Diseases also have a higher risk of increased health expenditure, and a substantial proportion of households face catastrophic health expenditure and subsequent impoverishment due to NCD related expenses.² Objectives of the study: 1. To assess the prevalence of Non-Communicable Diseases (Hypertension, Diabetes Mellitus and Obesity) among the adult population of Kokrajhar District. 2. To assess the prevalence of risk factors of common non-communicable diseases in adult population of Kokrajhar District. Methodology: Study Type: Community-based, Descriptive Cross-sectional study. Study Population: Adult Population of 18 –59 years of age. Study Area:  Villages under Titaguri area which is one of  the  field  practice  areas and Family adoption areas  of  the  Department  of Community    Medicine,   Kokrajhar Medical  College. Study Duration: July 2024 to September 2024.  Sample Size calculation: The sample size was calculated by the formula N = 4pq/l2, where p represents prevalence of diabetes which was 15.5% (Thakur J, Jeet G, et al. (2019) non-communicable diseases risk factors and their determinants: A cross-sectional state-wide STEPS survey, Haryana, North India. PLoS ONE 14(11): e0208872. https://doi.org/10.1371/journal.pone.0208872). ‘l’ is allowable error, taken as 5% of p. Therefore, a sample size of 210 was taken. Ethical Clearance: Ethical clearance had been obtained from the Institutional Ethical Committee of Kokrajhar Medical College and Hospital, Kokrajhar, Assam. Inclusion Criteria: Permanent residents of Kokrajhar District (residing for more than 6 months) Exclusion Criteria: 1) Pregnant lady, 2) Those with known psychiatric illness, 3) Individuals having serious morbidity, Consent: Informed consent was taken from all the participants before data collection and confidentiality was maintained. Data collection: Information regarding risk factors of NCDs were collected by using Pre tested per-designed questionnaire. Non-stretchable    measuring    tape, digital weighing scale, portable stadiometer, digital BP apparatus were   used to measure waist and hip circumference, weight, height, and blood pressure, respectively. Data analysis–Data has been entered in MS excel sheet. Qualitative data were expressed in proportions.  Mean and standard deviation were used for quantitative data.  Suitable tests    of    significance    has been      applied    wherever necessary.

Background and Objectives: Embolic stroke is a leading cause of cerebrovascular events, characterized by sudden focal neurologic deficits. Most cases arise from fragments of thrombi in the heart, with other sources including intra-arterial thrombi and atheromatous plaques. Cardioembolic strokes account for about 15% of all strokes and are considered preventable. Methodology: We evaluated 40 patients with cardioembolic stroke through clinical history, physical examination, and necessary investigations. Results: Of the 40 patients, 36 were male, all presented with hemiparesis. Rheumatic valvular heart disease was identified in 22 cases, and 19 patients had atrial fibrillation, with the middle cerebral artery affected in 62.5%. Conclusions: Most strokes occurred during the day, with hemiplegia as the primary symptom. Rheumatic heart disease was a significant factor, particularly in cases of multivalvular involvement. Atrial fibrillation was prevalent, and the middle cerebral artery was the most commonly involved artery.

Background:  Tenecteplase has higher fibrin specificity and greater resistance to inactivation by its endogenous inhibitor (PAI-1) compared to native t-PA. The objective of this study was to assess the outcome of intravenous thrombolysis (IVT) with Tenecteplase (TNK) in patients with Middle Cerebral Artery (MCA) ischemic stroke. Methods: A prospective observational study was conducted in a South Indian multi-specialty tertiary care hospital from April 2019 to March 2020. We have observed that 42 MCA ischemic stroke patients underwent IVT with TNK (0.25 mg/kg) within four and half hours of onset of symptoms. All were followed up for 3 months, to assess the response to therapy and clinical outcomes. Results: Among the study population, the majority of the patients (71%) were from ≥55 years of age group and 33 (77%) were male; 62% had a history of hypertension and 52% were diabetics. Slurred speech was the most common (47.8%) presenting symptom and Right hemiparesis was the most common (54.8%) neurological sign. There is a significant reduction (P<0.001) in NIHSS score was observed with a mean score of 3.38 after 24 hours of IVT with TNK and in the modified Rankin Scale (mRS) score (mean score: 1.61; P<0.001) at 3 months follow up. Two (4.7%) patients have developed hemorrhagic transformation; among them, one (2.3%) had an NIHSS score of more than 13 at arrival. Conclusion: Intravenous thrombolysis (IVT) with Tenecteplase (TNK) 0.25 mg/kg is safe with less chance of symptomatic intracranial hemorrhage and has good functional outcomes.

Introduction Coronary artery bypass grafting (CABG) is a highly successful surgical treatment for the relief of angina and prolongs life in patients with coronary artery disease (CAD). Preoperative renal dysfunction is a significant risk factor that influences the outcome in patients undergoing CABG surgery. Mild renal dysfunction is an adverse prognostic indicator in patients with coronary artery disease. Several studies showed that patients with mild renal dysfunction have an increased risk of dying within 30 days after coronary surgery. Patients with renal dysfunction who require CABG represent a complex group of patients with accelerated atherosclerosis and advanced cardiovascular disease. Methods And Materials This is a prospective study was conducted in the Department of Cardiothoracic and vascular surgery, Yashoda Hospital, Secunderabad. OPCAB was performed with the Octopus-Evolution tissue stabilizer system device for target coronary artery stabilization. A mean systemic arterial pressure was maintained around 65 to 70 mmHg throughout the procedure. An intracoronary shunt  was used in all target coronaries greater than 1.25mm in diameter during construction of distal anastomosis. Humidified carbon dioxide blower /mister was used to disperse the blood from the anastomotic site while constructing the distal anastomoses Results The mean age in mild group was 59.05±7.60 and 56.37±9.06 in normal group, p=0.15. In mild group 16 (40.00) were females and 24 (60.00) were males whereas 10(25.00) were females and 30 (75.00) were males in normal group, p=0.15(figure 2). Preoperative variables such as BMI>30 (p=0.30), Smoking (p=1.00), Hypertension (p=0.33), Diabetes mellitus (p=0.57), Hyperlipidaemia (p=0.63), COPD (p=0.80), preoperative MI (p=0.81) were compared between the mild and normal groups and none of the baseline variables were significant between the groups Conclusions There was no significant difference in the patients undergoing off-pump CABG with normal renal function and mild renal dysfunction in terms of short-term mortality, myocardial infarction, stroke, or renal failure requiring dialysis. Off-pump CABG is more reno-protective for patients with normal renal function but for patients with mild renal dysfunction may need preoperative assessment of renal function by GFR in addition to serum creatinine levels to stratify the risk for postoperative renal dysfunction and to optimize measures for renal preservation during surgical myocardial revascularization

Background: Atherosclerotic cardiovascular disease (ASCVD) remains a leading cause of morbidity and mortality globally. Serum lipid profiles play a crucial role in ASCVD risk assessment, but the predictive value of traditional and non-traditional lipid markers requires further investigation. Objectives: This study aims to determine the relationship between serum lipid profiles (total cholesterol, LDL-C, HDL-C, triglycerides) and ASCVD risk. Secondary objectives include analyzing lipid ratios (TC/HDL-C, LDL-C/HDL-C) as predictors, evaluating the role of non-traditional lipid markers, and identifying demographic and lifestyle factors influencing lipid profiles and ASCVD risk. Methods: This observational study included 100 adults (30–70 years) without pre-existing ASCVD, recruited from a single-center healthcare facility. Baseline demographic, lifestyle, and biochemical parameters were recorded. Lipid profiles, lipoprotein(a), apolipoproteins, fasting glucose, and HbA1c were assessed. Participants were followed for six weeks to monitor incident ASCVD events. Data were analyzed using SPSS and R software, with logistic regression applied for risk assessment. Results: The mean ASCVD risk score was 10.3 ± 4.7%. Elevated LDL-C (132.5 ± 21.6 mg/dL) and unfavorable lipid ratios correlated with higher ASCVD risk. Incident ASCVD events occurred in 15% of participants, including myocardial infarction (7%), stroke (4%), and peripheral arterial disease (4%). Lipoprotein(a) and apolipoproteins showed potential value in risk stratification. Conclusion: Dyslipidemia and unfavorable lipid ratios significantly predict ASCVD risk. Non-traditional lipid markers may enhance risk assessment. Routine lipid monitoring and targeted interventions are essential for early prevention.

Background: Postoperative acute kidney injury (AKI) remains a significant complication in high-risk surgical patients, contributing to increased morbidity, prolonged hospital stays, and higher mortality rates. Fluid management during the perioperative period plays a critical role in maintaining renal perfusion and preventing ischemic kidney injury. Goal-Directed Fluid Therapy (GDFT), an individualized approach using hemodynamic monitoring to optimize fluid administration, has been proposed as a strategy to improve renal perfusion and organ function in surgical patients. However, its impact on postoperative renal function, particularly in high-risk populations, remains a subject of ongoing investigation. This study aims to evaluate the effectiveness of perioperative GDFT in preserving renal function and reducing the incidence of postoperative AKI in high-risk surgical patients. Objective: To assess the impact of perioperative Goal-Directed Fluid Therapy (GDFT) on postoperative renal function, determine its role in reducing AKI incidence, and compare it with standard fluid management protocols in high-risk surgical patients. Methods: This prospective observational study was conducted over six months in the surgical and critical care units of a tertiary care hospital, enrolling 50 high-risk surgical patients undergoing major non-cardiac surgery. Patients were divided into two groups based on intraoperative fluid management strategy: •GDFT Group: Patients managed using non-invasive hemodynamic monitoring (stroke volume variation, cardiac output, dynamic fluid responsiveness) to guide fluid administration. •Standard Fluid Therapy (SFT) Group: Patients managed using a fixed, weight-based fluid administration approach. Preoperative renal function was assessed using serum creatinine, estimated glomerular filtration rate (eGFR), and urine output. Postoperative renal function was evaluated using Acute Kidney Injury Network (AKIN) criteria, comparing serum creatinine changes, urine output, and AKI incidence between the two groups at 24 hours and 72 hours postoperatively. Secondary outcomes included length of hospital stay, need for renal replacement therapy (RRT), and overall morbidity and mortality rates. Results: The incidence of postoperative AKI was significantly lower in the GDFT group (12%) compared to the SFT group (32%) (p < 0.05). Patients in the GDFT group maintained better renal function, as indicated by lower serum creatinine elevation (mean increase of 0.2 ± 0.1 mg/dL vs. 0.5 ± 0.2 mg/dL in SFT, p < 0.05) and higher urine output (mean 1.2 ± 0.4 mL/kg/hr vs. 0.7 ± 0.3 mL/kg/hr, p < 0.05). The requirement for renal replacement therapy (RRT) was lower in the GDFT group (4%) compared to the SFT group (12%), although this difference was not statistically significant. Additionally, the length of ICU stay, and total hospital stay were significantly shorter in the GDFT group, suggesting an overall improved recovery trajectory. Conclusion: The findings of this study suggest that perioperative Goal-Directed Fluid Therapy (GDFT) is associated with improved renal function, reduced incidence of postoperative AKI, and shorter hospital stays in high-risk surgical patients. The use of dynamic hemodynamic monitoring for individualized fluid administration appears to be superior to standard fixed-volume resuscitation strategies, potentially leading to better renal perfusion and organ protection. These results support the implementation of GDFT protocols in high-risk surgical populations to improve postoperative outcomes. Further multi-center trials with larger patient cohorts are needed to establish standardized GDFT guidelines for optimizing perioperative renal protection strategies.

Background: Cerebrovascular accidents (CVAs), also called as strokes, considered as second leading cause of death and disability globally. The pathological mechanism of stroke may be either ischemic and hemorrhagic disturbances of the cerebral blood circulation. Hypercholesterolemia is also a known risk factor for stroke. Aim: This study aimed to assess the lipid profile of stroke patients and to compare the lipid profile of hemorrhagic stroke and ischemic stroke in patients admitted to Akash hospital, Devanahalli, Bengaluru rural, Karnataka, India. Materials and methods: This cross-sectional observational study conducted in Department of General Medicine, Akash Institute of Medical Sciences and Research Centre (AIMSRC), Karnataka, India. In this, a total of 112 patients with new onset ischemic and hemorrhagic stroke, confirmed by CT/MRI and presented within 24 hours of onset of stroke admitted in Akash hospital. Blood samples were collected, centrifuged to obtain serum sample. The obtained serum was used for biochemical analysis of total cholesterol (cholesterol oxidase/peroxidase), triglycerides (glycerol phosphate oxidase/peroxidase), HDL-C (HDL-C- Direct) were estimated by using Cobas C111 Biochemistry fully auto analyzer. LDL-C and VLDL-C were calculated by Frieldwald’s formula. Detailed history, physical and clinical examination was done for all the study subjects. Results: In this study, males were 63 (56.2%) and females were 49 (43.8%). 68 (60.7%) cases were above 60 years of age, 28 (25%) were 51-60 years of age, Among the comorbidities, hypertension 42 (37.5%) emerges as the most prevalent. In this study, 88 (78.6%) cases were with infarcts and 24 (21.4%) cases were hemorrhagic. Majority of subjects were non-smokers 58 (51.8%) and smokers were 54 (48.2%). In this study, lipid profile parameters were compared between hemorrhage and infarcts. Serum cholesterol (196.88±21.40) levels were significantly increased in haemorrhagic stroke compared with infarcts. Lipid profile parameters were compared between smokers and non-smokers, significant differences were observed in LDL (smokers 94.4±20.3 mg/dL vs non-smoker 104.96±22.9 mg/dL). Similarly, lipid profile parameters were compared between diabetic and non-diabetic subjects, significant increase was observed in total cholesterol (diabetic 192.8±31.4 mg/dL vs non-diabetic 178.8±30.0 mg/dL), Triglycerides (diabetics 132.6±18.6 mg/dL vs non-diabetic 121.9±36.0 mg/dL). Conclusion: In a comparison of lipid profiles between patients with hemorrhagic stroke and ischemic stroke, statistically significant differences were observed as raised total cholesterol levels. In comparison of lipid profiles between smokers and non-smoker significant differences were observed in increased LDL among non-smokers. Decreased HDL was seen in all the stroke patients. In the comparison of lipid profiles between Diabetic and non-diabetic stroke patients, increased total cholesterol and triglyceride levels among the diabetic group.

Background: William Cole introduced the term "stroke" in 1689.1 A stroke is a neurological injury resulting from a sudden localized interruption in the central nervous system. This interruption can arise from intracerebral bleeding, subarachnoid haemorrhage, or cerebral infarction.2 The World Health Organization characterizes a stroke as a rapid onset of clinical symptoms due to a specific disruption in cerebral function.  Objectives: • To find the serum levels of vitamin D in patients with acute stroke and without stroke. • To find out the association between vitamin D and acute ischaemic stroke. Material & Methods: Study Design: Observational Case-Control study.   Study area:  The study was conducted in a Teaching hospital AIMSR & District headquarters hospital, Chittoor. Study Period: 1 year.   Study population: This study included a total of 120 subjects out of which 60 are cases (acute ischaemic stroke) and 60 are controls. Sample size: The study consisted of a total of 120 cases. Results: Among the cases, 28 participants (46.7%) were classified as deficient in vitamin D, 27 participants (45%) were classified as insufficient, and 5 participants (8.3%) were classified as having sufficient levels of vitamin D. The p-value associated with serum vitamin D levels was less than 0.001, indicating a significant difference in the distribution of vitamin D levels between cases and controls. Conclusion: In conclusion, this study found significant differences in serum vitamin D levels and other risk factors, such as hypertension, diabetes, TLC, and FBS, between acute ischemic stroke patients and healthy controls. Lower vitamin D levels in stroke cases suggest a potential link between vitamin D deficiency and increased stroke risk, highlighting its role as a modifiable risk factor.

Background: Ischemic stroke is a major cause of morbidity and mortality worldwide, with a strong association with atherosclerosis and dyslipidemia. Carotid artery plaque formation is a critical factor in stroke pathophysiology, and its evaluation through Doppler ultrasound provides valuable insights into disease progression. This study aims to assess the relationship between ischemic stroke, lipid profile, and carotid artery plaque characteristics. Materials and Methods: A total of 100 ischemic stroke patients, aged 45–75 years, were included in this hospital-based cross-sectional study. Patients underwent lipid profile analysis, including total cholesterol (TC), low-density lipoprotein (LDL), high-density lipoprotein (HDL), and triglycerides (TG). Carotid Doppler ultrasound was performed to assess plaque presence, morphology, and degree of stenosis. Statistical analysis was conducted to determine correlations between lipid parameters and carotid plaque severity. Results: Among the patients, 70% had hyperlipidemia, with a mean LDL level of 150 ± 20 mg/dL and HDL of 38 ± 5 mg/dL. Carotid artery plaques were detected in 65% of cases, with 40% exhibiting significant stenosis (>50%). A strong positive correlation (r = 0.72, p < 0.01) was observed between LDL levels and plaque severity. Patients with TC > 200 mg/dL had a 3.5-fold increased risk of severe carotid plaque formation. Conclusion: The study highlights a significant association between dyslipidemia and carotid artery plaque formation in ischemic stroke patients. Routine lipid monitoring and carotid Doppler evaluation can aid in early detection and risk stratification, potentially reducing stroke recurrence through targeted lipid-lowering therapies.

Background: Rapid assessment of stroke severity is critical in emergency settings to guide timely management. The National Institutes of Health Stroke Scale (NIHSS) is widely used, but its diagnostic limitations—particularly in detecting non-dominant hemisphere syndromes and aphasia—warrant evaluation against alternative tools such as the Scandinavian Stroke Scale (SSS). Objectives: To compare the diagnostic accuracy of the NIHSS and SSS in assessing early stroke severity among adult patients presenting to the emergency medicine department, using CT brain imaging as the reference standard. Methods: This cross-sectional analytical study was conducted at the Emergency Medicine Department of Bharati Hospital, Pune, over a one-year period (January 2024–January 2025). Adults (≥18 years) with suspected ischemic stroke were assessed using both NIHSS and SSS at presentation. Stroke severity was categorized into mild, moderate, and severe for each scale. CT imaging served as the reference standard. Sensitivity, specificity, and positive predictive value (PPV) were calculated for each scale. Results: A total of 306 patients were included. The NIHSS classified 39.5% as mild, 40.5% moderate, and 19.9% severe, while SSS categorized 38.2% as mild, 40.8% moderate, and 20.9% severe. Cohen’s Kappa between the two scales was 0.567, indicating moderate agreement. In patients with classifiable CT findings (n = 13), SSS showed higher sensitivity (62.5%) and PPV (83.3%) compared to NIHSS (sensitivity 37.5%, PPV 75.0%). Both tools had equal specificity (80.0%). Conclusions: While NIHSS and SSS are both effective in early stroke severity assessment, the SSS demonstrated greater sensitivity and predictive value when compared to CT imaging. These findings suggest that SSS may offer a more sensitive alternative for early stroke triage in emergency settings

Background: Stroke is the leading cause of physical impairment and the leading cause of mortality in the developed world, after ischemic heart disease and cancer. In wealthy nations, stroke is the third most prevalent cause of death. Objective: To study serum HDL level in patient with cerebrovascular accident and to compare the level of serum HDL level between two categories of stroke. Materials and Methods: The study was conducted on 100 patients of cerebrovascular accident admitted in King George Hospital, Andhra Medical College, Visakhapatnam. in both male and female ward & intensive medical care unit between October 2022 to September 2023. Result: The Mean value of HDL of Haemorrhagic stroke (39.36) was higher when compared to the Mean Ischemic Stroke (32.36), which is statistically significant with p value <0.05. The mean values of Total Cholesterol (161.22), Triglycerides (159.56), VLDL (31.90) and LDL (96.96) of ischemic stroke were higher than Haemorrhagic Stroke, whose mean values of Total Cholesterol (159.56),Triglycerides (157.14),VLDL (31.46 )and LDL( 88.88). The mean Systolic (161.28) and Diastolic BP (97.84) of Haemorrhagic stroke was higher than Ischemic stroke mean Systolic BP (135.60) and Diastolic BP (81.48) and the P value was <0.05, which is statistically significant. The mean age of Haemorrhagic stroke (58.08 ) was higher than mean ischemic Stroke (53.02) and the P value was <0.05, which is statistically significant. The mean random blood sugar of ischemic stroke (150.58) was higher than Haemorrhagic Stroke (133.72). Conclusion: HDL is used as an early predictor of atherosclerosis and ischemic stroke. By measuring the HDL earlier, early intervention measures by pharmaceutical means or by dietary means can be done to increase the HDL level to decrease the morbidity and mortality of stroke.

Background: Chronic Total Occlusions (CTOs) represent a complete blockage of a coronary artery persisting for more than three months. These lesions are common in patients with chronic stable angina but may also occur in those with non-ST elevation myocardial infarction (NSTEMI) and unstable angina (UA). Historically considered complex with high procedural risks, CTO interventions have seen significant advancements in safety and success rates due to improvements in technology and operator expertise. Successful revascularization has been shown to improve myocardial perfusion, alleviate symptoms, and enhance overall cardiovascular outcomes.

Aims and Objectives:

1. To study the clinical and angiographic profile of patients undergoing CTO angioplasty at a tertiary care center.
2. To assess the immediate procedural outcomes and complication profile in this cohort.

Methods: This was a record-based descriptive study conducted in the Department of Cardiology, Government Medical College, Alappuzha. Data were collected from the CTO registry for a 2-year period (November 2022 to November 2024). Patients aged ≥18 years with angiographically confirmed CTO (duration >3 months) who underwent percutaneous coronary intervention (PCI) were included. Those with severe comorbidities, uncontrolled systemic conditions, or inability to provide consent were excluded. Data were extracted on demographics, comorbidities, clinical symptoms, angiographic features, procedural success, and complications, and were entered into a master chart for descriptive statistical analysis. Results: A total of 220 patients underwent CTO angioplasty during the study period. Most patients were elderly, with 66.36% aged >60 years. Males constituted 84.09% of the cohort. Hypertension (76.36%), type 2 diabetes mellitus (86.36%), and smoking (67.27%) were the most common risk factors. Prior PCI was seen in 50.90% and previous CABG in 15.45%. The predominant presenting symptoms were dyspnea on exertion (83.18%), easy fatigability (79.09%), and effort angina (71.36%), with most in NYHA Class II. The most common clinical presentation was UA/NSTEMI (55.45%), followed by chronic stable angina (37.27%) and STEMI (7.27%). Angiographically, double vessel disease was most frequent (69.54%), and the LAD was the most commonly involved CTO vessel (52.72%), followed by LCX (39.54%) and RCA (38.18%). Procedural success was achieved in 82.72% of cases. The most frequent complication was coronary perforation (15.45%), followed by nonfatal myocardial infarctions (10.45%), arrhythmias (8.18%), and no-flow/slow-flow phenomena (8.18%). Stroke and acute kidney injury were rare (1.36% and 0.91%, respectively). All-cause and cardiac-specific mortality were low at 0.91%. No patients required emergency CABG. Conclusion: CTO angioplasty, once considered a high-risk and low-success intervention, is now feasible and effective with a high procedural success rate and low mortality. Despite the complexity of cases and comorbid burden, the outcomes reflect improved technical capabilities and procedural safety. Early recognition, appropriate case selection, and expertise are crucial for favorable outcomes.

Background: This case report examines the diagnostic challenges and management of a young female patient who presented with hemorrhagic stroke, later determined to be due to renal artery stenosis likely caused by fibromuscular dysplasia. FMD is a hyperplastic arterial disorder primarily affecting medium-sized and small arteries, though larger arteries can also be involved. It is more common in young females and typically targets the renal and carotid/vertebral arteries but can also affect other arteries. While FMD usually presents as renovascular hypertension, it can also manifest as a stroke in young adults. Case Description A 27-year-old female presented with an acute hemorrhagic stroke. Upon admission to Divisional Railway Hospital, Kharagpur, South Eastern Railway, extensive diagnostic evaluation was conducted. Imaging studies confirmed the presence of hemorrhagic stroke. Given her young age and atypical presentation, further investigations were necessary. Angiographic studies revealed abnormalities consistent with fibromuscular dysplasia, characterized by the string of beads appearance in the renal arteries. The renal artery stenosis, likely due to FMD, was a significant factor contributing to her stroke. Her management involved acute stroke treatment, long-term blood pressure control and regular monitoring. Conclusion This case highlights the importance of considering FMD in the differential diagnosis of young stroke patients, especially in the absence of traditional risk factors. Early recognition and timely treatment of FMD can significantly improve the patient quality of life and ensure favorable long-term prognosis. The case illustrates the need for thorough investigation and high index of clinical suspicion in diagnosing and managing such conditions.

Stroke is a leading cause of morbidity and mortality globally. Alterations in serum magnesium (Mg) and potassium (K) levels play a significant role in the prognosis of acute ischemic stroke (AIS). This study aimed to evaluate serum Mg and K levels as prognostic markers in AIS patients. Materials and Methods: This hospital-based prospective study included 90 AIS patients admitted to the Department of Medicine, GMSH, Chandigarh, over six months. Detailed demographic and clinical data were recorded, and serum Mg and K levels were analyzed. Neurological severity was assessed using the National Institutes of Health Stroke Scale (NIHSS). Statistical significance was evaluated for various parameters, including comorbidities such as diabetes mellitus (DM), hypertension, and coronary artery disease (CAD). Results: Serum Mg levels ≤1.7 mg/dl were associated with higher NIHSS scores at admission, day 5, one month, and three months, indicating worse prognosis (p < 0.05). The mean serum K level was 4.02 ± 0.56 mg/dl. Lower K levels (<3.5 mg/dl) were observed in patients with higher NIHSS scores at one month (p < 0.05), although no significant correlation was found with other clinical outcomes. The mean serum Mg level was 1.98 ± 0.31 mg/dl, significantly lower in patients with DM, CAD, and hypertension compared to those without these conditions. Conclusion: Serum Mg levels were significantly associated with higher NIHSS scores and the presence of comorbidities such as DM, CAD, and hypertension, highlighting their potential role as prognostic markers in AIS. Serum K levels showed limited prognostic value, with significance observed only at one-month NIHSS scores.

Ischemic stroke is a neurological emergency which reveals complex and unexpected etiologies infrequently. Embolic strokes represent a major subset of ischemic strokes and are often linked to cardiac or large vessel sources. In one-quarter to one-third of ischemic strokes, the cause may remain elusive despite comprehensive workup, and are classified as cryptogenic stroke. Emerging evidence suggests that systemic and non-cardiogenic conditions, such as malignancy-induced hypercoagulability can act as rare yet important risk factors for ischemic stroke, particularly embolic subtype. We present a case series highlighting two rare but clinically significant etiologies of ischemic stroke, namely malignancy and adenomyosis, in four patients. In addition to ischemic stroke, these patients also exhibited extreme prothrombotic tendency in varied forms such as myocardial infarction, nonbacterial thrombotic endocarditis, pulmonary and venous thromboembolism. This report also aims to highlight adenomyosis as a less-explored cause of ischemic stroke in the young.

Background: Transcatheter aortic valve replacement (TAVR) has emerged as a proven therapy in high- and intermediate-risk patients with severe aortic stenosis. Yet, its application among low-risk populations is still under investigation, especially in countries with limited resources. The present study is conducted to evaluate the procedural and long-term efficacy of TAVR in low-risk patients at a tertiary care facility in Northern India. Methods: An intention-to-treat prospective observational study was performed at Rajshree Medical College and Hospital, Bareilly, Uttar Pradesh, among 84 low-risk patients undergoing TAVR from January 2020 to December 2022. Patients were assessed for a median duration of 28 months. Primary endpoints were procedural success, survival, and improvement in New York Heart Association (NYHA) functional class. Secondary endpoints were stroke, pacemaker implantation, rehospitalization, and structural valve deterioration. Results: The procedural success rate was 98.8% without in-hospital mortality. Overall survival at 3-year follow-up was 94.0%. There was significant functional capacity improvement, with 88% of patients in NYHA Class I or II versus 75.8% of patients in Class III or IV at baseline. Stroke developed in 2.4% of patients and new pacemaker implantation in 4.8%. No structural valve deterioration occurred during follow-up. Conclusion: TAVR in well-screened low-risk patients shows outstanding safety and long-term clinical success, validating its increasing application as a first-line treatment for severe aortic stenosis. These results are consistent with global data and promote wider consideration of TAVR in low-risk populations, particularly in developing healthcare systems.

Background: An exploratory analysis of data showed that the chance of atherosclerosis was more than 10 times higher in the 40– 49 years age group than in the younger group, and that this chance was even higher in people aged 50 years or over.6 Atherosclerotic vascular disease begins in childhood and progresses over decades.7 Symptomatic, clinical cardiovascular disease (CVD) events generally occur when atherosclerosis progresses to flow limiting disease that causes ischemia, or when a thrombus forms on an existing plaque as a result of rupture or erosion Material and methods: This was an observational study. The present study was carried out on 120 individuals in the department of Radio-diagnosis. Inclusion criteria were -Age criteria for study are 40 years and above both sexes and all patients and volunteers, otherwise asymptomatic (No known H/O CVA, STROKE, IHD, MI) above 40 years of age. Results: Smoking was found to be the most powerful risk factor in males responsible for development of atherosclerotic plaque in carotid arteries.

Following risk factors are overlapping.

• Only Hypertensive = Non-diabetic, non-smoker and non-alcoholic.
• Only Diabetic = Normotensive, non-smoker and non-alcoholic.
• Only Smoker = Normotensive , non-diabetic and non-alcoholic.

Conclusion: Considering individual risk factors in asymptomatic individuals, hypertension was found to be the most powerful risk factor in males as well as females responsible for development of plaque in carotid arteries..

Background: This cross-sectional study investigated the clinical profile, risk factors, etiology, and prognosis of Cerebrovascular Accident (CVA) patients in Ahmedabad, Gujarat, India. Conducted at Smt. Shardaben General Hospital from August 2023 to July 2024, the study prospectively enrolled 100 adult patients (aged ≥18 years) hospitalized with suspected new-onset stroke and confirmed by CT or MRI brain. Data were collected via a predefined proforma, including detailed medical history, clinical examination (with NIHSS scoring), and radiological findings. Statistical analysis involved Student's t-tests and Chi-Squared tests to compare continuous and categorical data, respectively, with significance set at p<0.05. Results : Among the 100 participants (57 male, 43 female; mean age 62.1 years), 91% had ischemic stroke and 9% had hemorrhagic stroke. Weakness of limbs was the most common symptom (92%), but change/loss of consciousness and speech, and headache were significantly more prevalent in hemorrhagic stroke (p<0.05). Hemorrhagic stroke patients also presented with significantly higher blood pressure, lower Glasgow Coma Scale (GCS) scores, and higher NIHSS scores (p<0.05). Hypertension was the most common risk factor (51% overall), observed in 8 out of 9 hemorrhagic CVA patients. Prognosis, assessed by the modified Rankin Scale (mRS), indicated that the majority of patients (91%) experienced moderate to severe disability (mRS scores 3-5), highlighting the significant burden of CVA.

Background: Stroke is a condition that results in high mortality rates and severe disabilities. Stroke is expected to be the second most important cause of mortality worldwide by 2020.  Most stroke survivors can and do experience improvements in their functional abilities, but the amount, rate, timing, pattern, type, and ultimate outcome of the improvements differ across patients and situations. Stroke severity and patient age are the main predictors of stroke outcome in the acute phase. Additional important predictors include functional status prior to stroke, presence of comorbid medical conditions, etiologies and the vascular territories affected. Materials and Methods: This single centre, descriptive, case–control study was carried out on inpatients admitted to department of General Medicine, SRI CHAMUNDESHWARI MEDICAL COLLEGE HOSPITAL AND RESEARCH INSTITUTE, Channapatna for a period of 4 months from December 2024 to March 2025.All the patients of both genders ≥18 years of age were included in the study. Results: Comparison between individuals with diabetes and without diabetes with stroke: values are presented as mean ± SD. BMI, body mass index; BSF, blood sugar fasting; DBP, diastolic blood pressure; HbA1c, glycated haemoglobin; HDL-C, high-density lipoprotein cholesterol; LDL-C, low-density lipoprotein cholesterol; SBP, systolic blood pressure; TC, total cholesterol; TGL-C, triglyceride Conclusion: Severity of stroke correlates with the glycaemic status of the patients in diabetics and non-diabetics. Hyperglycaemia, an important risk factor in non-diabetic patients after acute stroke is a stress response reflecting more severe neurological damage. Management of hyperglycaemia in patients with diabetes and non-diabetes is an important aspect of the emergency management of stroke.

Background: Stroke remains one of the foremost causes of mortality and long-term disability worldwide, with hypertension serving as the most significant modifiable risk factor. Carotid artery intima-media thickness (CIMT) is a validated non-invasive marker of subclinical atherosclerosis and has shown potential in predicting future cerebrovascular events. Methods: A hospital-based case-control study was conducted at a tertiary care center in Kanpur, North India, involving 200 hypertensive patients—100 with acute stroke (cases) and 100 without stroke (controls). CIMT was measured using B-mode ultrasonography. Statistical analyses were performed using SPSS version 26, and a p-value <0.05 was considered significant. Results: CIMT was significantly higher in ischemic stroke patients (1.03 ± 0.11 mm) compared to haemorrhagic stroke patients (0.98 ± 0.13 mm; p = 0.040). Elevated CIMT (>0.9 mm) was strongly associated with dyslipidaemia—total cholesterol (p = 0.0022), triglycerides (p = 0.018), LDL (p = 0.024)—as well as diabetic markers such as fasting blood glucose (p = 0.015), postprandial glucose (p = 0.004), and HbA1c >10% (p = 0.022). Longer duration of hypertension (>10 years) and higher blood pressure stages were also significantly linked with increased CIMT values. Conclusion: CIMT is a reliable early indicator of atherosclerotic vascular changes in hypertensive patients, especially those with coexisting diabetes and dyslipidaemia.

Introduction: Stroke can be due to ischemia or hemorrhage. 80% of strokes are due to an ischemic event. Out of these, 20% are posterior circulation stroke. Posterior circulation is more prone to atherosclerosis like systemic arteries compared to the intracranial part of anterior circulation. Material & Methods: This study was carried out in patients who presented with signs and symptoms of PC stroke to the medicine and neurology department of king George hospital, Andhra medical college, Vishakhapatnam. The study was conducted during the time period of November 2019 to October 2020. The stroke events were classified according to the Trial of Org 10172 in Acute Stroke Treatment (TOAST) classification. Results: Males were commonly affected than female. The most common age group was between 40-60 years. The most common risk factor for PC stroke in our population was hypertension, followed by smoking and diabetes. The most common clinical presentation was vertigo, followed by ataxia and motor weakness. Distal territory involvement was most common in our study, followed by proximal and middle vascular territories. In posterior circulation, stroke ischemic was more common than hemorrhagic. The common isolated site of involvement in posterior circulation ischemic stroke was the cerebellum followed by the occipital lobe, and the most common site of bleed in PC stroke was the cerebellum. Study found a higher percentage of large artery disease, followed by cardio embolism as a cause of posterior circulation stroke. Conclusions: Our study demonstrated the occurrence of posterior circulation stroke in a relatively younger age group compared to case series from the Western world. We found a higher percentage of large artery disease as a cause of posterior circulation stroke with distal territory involvement.

Hypertension is one of the most important risk factors for cardiovascular diseases (CVD), particularly ischemic heart disease and stroke (sequelae of hypertension). By compromising endothelial function and encouraging atherosclerosis, inflammatory markers like C-reactive protein (CRP), interleukins (ILs), and tumour necrosis factor-alpha (TNF-α) have been associated with a poor prognosis in individuals with hypertension in CVD studies. A straightforward, affordable, and generally available haematological measure, the neutrophil-to-lymphocyte ratio (NLR) has garnered increasing attention in recent years. Neutrophils and lymphocytes make up NLR, which represents a balance between immunological responses and inflammation. While lymphocytes play a significant role in controlling immunological responses, neutrophils are crucial for the acute inflammatory response. There is no study available about Neutrophil to lymphocyte ration in newly detected hypertension patient. In addition to this correlation of NL Ratio is never studied with Staging of Hypertension hence this is an area of interest. Material and Methods: The present cross-sectional study was conducted from May 2023 to November 2024 in the Department of General Medicine, School of Medical Sciences & Research, Sharda Hospital, Greater Noida, Uttar Pradesh among 100 newly detected hypertensive patients as per inclusion and exclusion criteria, with Age & Sex matched 100 controls.  Results: Of the individuals in the case and control groups, 56% and 4%, respectively, had left ventricular hypertrophy (LVH) was seen amongst 56% of cases and 4% of controls which was statistically significant with p-value <0.01 when the chi square test was used. The case group had higher mean neutrophil %, lymphocyte %, and NLR than the control group. Mean NLR in stage 1 and stage 2 hypertension showed statistically significant increase in value as the BP rises. Hence mean NLR was significantly more in stage 2 hypertension as compared to stage 1 hypertension as p-value=0.007. The Pearson correlation test revealed a substantial positive link between NLR and hypertension staging (r=0.44, p<0.01), meaning that when NLR increases, so do SBP and DBP.  Conclusion: Our study demonstrated a rise in NLR levels as the severity of hypertension increases. Our findings suggest that neutrophils and lymphocytes may be implicated in inflammation, which may be a significant factor in the development of hypertension. These results could be helpful in elucidating the pathophysiological process of hypertension and in the creation of novel treatment strategies that target low-grade inflammation in order to manage hypertension and hypertensive damage.