Indian Pediatr. 2007 Sep;44(9):702-4.
Mohite A, Prasad V, Rajam L, Madhusudana SN.
Department of Pediatrics, Amrita Institute of Medical Sciences and Research Center, Kochi, Kerala, India.
A 12-year-old boy presented with fever and sore throat of 6 days duration followed by vomiting and altered sensorium. He had received 4 doses of antirabies vaccine following a dog bite 4 weeks back. Rabies immunoglobulin was not given. History of hydrophobia and aerophobia were strikingly absent. The possibilities of rabies encephalitis and vaccine induced acute disseminated encephalomyelitis (ADEM) were considered. MRI brain showed exclusive grey matter changes characteristic of rabies. The diagnosis was further confirmed by serological tests.
PMID: 17921563 [PubMed - indexed for MEDLINE]
Thursday, 25 February 2010
Solid-Phase Peptide Synthesis of Endothelin Receptor Antagonists on Novel Flexible, Styrene-Acryloyloxyhydroxypropyl Methacrylate-Tripropyleneglycol Diacrylate [SAT] Resin
J Comb Chem. 2010 Feb 22. [Epub ahead of print]
Siyad MA, Nair AS, Kumar GS.
Chemical Biology, Molecular Medicine Division, Rajiv Gandhi Centre for Biotechnology, Poojappura, Thiruvananthapuram-695 014, Kerala, India.
Novel cross-linked polymeric support by the copolymerization of styrene and 3-(acryloyloxy)-2-hydroxypropyl methacrylate with Tri(propyleneglycol) diacryalte (SAT) for solid-phase peptide synthesis is presented here. The synthesis of SAT is based on the cross-linking of 3-(acryloyloxy)-2-hydroxypropyl methacrylate with styrene by free-radical suspension polymerization, consisting of an ester and a secondary hydroxyl group. An additional cross-linker tri(propyleneglycol) diacryalte provides a hydrophilic environment throughout the resin, which will enhance the physicochemical properties of the resin toward organic synthesis. The resins were synthesized in various cross-linking densities to check the swelling property, mechanical stability, and functional loading capacity. The resin was characterized by the IR, (13)C NMR, and SEM techniques. The extent of swelling properties of the polymer of different cross-linking densities were studied and compared with Merrifield resin and TentaGel. To demonstrate the efficiency of SAT support was proved by synthesizing the challenging peptide sequence of acyl carrier protein (ACP) and compared with commercially available Merrifield resin. It was further tested by synthesizing endothelial receptor antagonist peptides using SAT resin and compared with commercially available TentaGel resin. The standard Fmoc strategy was adopted for peptide synthesis and was characterized by MALDI-TOF MS and analyzed the purity of peptides by HPLC.
PMID: 20175557 [PubMed - as supplied by publisher]
Siyad MA, Nair AS, Kumar GS.
Chemical Biology, Molecular Medicine Division, Rajiv Gandhi Centre for Biotechnology, Poojappura, Thiruvananthapuram-695 014, Kerala, India.
Novel cross-linked polymeric support by the copolymerization of styrene and 3-(acryloyloxy)-2-hydroxypropyl methacrylate with Tri(propyleneglycol) diacryalte (SAT) for solid-phase peptide synthesis is presented here. The synthesis of SAT is based on the cross-linking of 3-(acryloyloxy)-2-hydroxypropyl methacrylate with styrene by free-radical suspension polymerization, consisting of an ester and a secondary hydroxyl group. An additional cross-linker tri(propyleneglycol) diacryalte provides a hydrophilic environment throughout the resin, which will enhance the physicochemical properties of the resin toward organic synthesis. The resins were synthesized in various cross-linking densities to check the swelling property, mechanical stability, and functional loading capacity. The resin was characterized by the IR, (13)C NMR, and SEM techniques. The extent of swelling properties of the polymer of different cross-linking densities were studied and compared with Merrifield resin and TentaGel. To demonstrate the efficiency of SAT support was proved by synthesizing the challenging peptide sequence of acyl carrier protein (ACP) and compared with commercially available Merrifield resin. It was further tested by synthesizing endothelial receptor antagonist peptides using SAT resin and compared with commercially available TentaGel resin. The standard Fmoc strategy was adopted for peptide synthesis and was characterized by MALDI-TOF MS and analyzed the purity of peptides by HPLC.
PMID: 20175557 [PubMed - as supplied by publisher]
Wednesday, 24 February 2010
Self-assembled cylindrical and vesicular molecular templates for polyaniline nanofibers and nanotapes
J Phys Chem B. 2009 Aug 27;113(34):11614-24.
Anilkumar P, Jayakannan M.
Chemical Sciences and Technology Division, National Institute for Interdisciplinary Science and Technology, Thiruvananthapuram-695019, Kerala, India.
We report a soft template approach based on a custom-designed novel surfactant-cum-dopant for size and shape tuning of polyaniline nanomaterials such as nanofibers and nanotapes via emulsion and dispersion polymerization routes. A new amphiphilic 4-(3-dodecyl-8-enylphenyloxy) butane sulfonic acid was synthesized by ring-opening of butanesultone with renewable resource cardanol. The new amphiphilic dopant forms spherical micelles in water and its critical micelle concentration was determined by dye encapsulation and surface tension methods. In the emulsion route, the amphiphilic dopant complexed with aniline to produce cylindrical micellar aggregates that template exclusively for polyaniline nanofibers. The dispersion of aniline+dopant in water/toluene solvent mixture produces vesicles that selectively template for polyaniline nanotapes. The mechanism of the polyaniline nanomaterials formation was investigated by dynamic light scattering (DLS) and high-resolution transmission electron microscopy (HR-TEM). DLS of the polymerization templates in water proved the presence of micrometer range aggregates, and TEM images confirmed the shape of the cylindrical and vesicular templates. The polyaniline nanomaterials were found soluble in water and polar organic solvents for structural characterization and composition analysis by 1H NMR spectroscopy. Absorbance spectra of the nanomaterials showed free carrier tail above 900 nm in the near IR region for the delocalization of electrons in the polaron band corresponding to expanded conformation of polyaniline chains. Wide angle X-ray diffraction showed two new peaks at low angle region with d-spacing of 26.5 and 13.6 A corresponding to lamellar ordering of polyaniline chains followed by interdigitations of the amphiphilic dopant in the nanomaterials.
PMID: 19642663 [PubMed - indexed for MEDLINE]
Anilkumar P, Jayakannan M.
Chemical Sciences and Technology Division, National Institute for Interdisciplinary Science and Technology, Thiruvananthapuram-695019, Kerala, India.
We report a soft template approach based on a custom-designed novel surfactant-cum-dopant for size and shape tuning of polyaniline nanomaterials such as nanofibers and nanotapes via emulsion and dispersion polymerization routes. A new amphiphilic 4-(3-dodecyl-8-enylphenyloxy) butane sulfonic acid was synthesized by ring-opening of butanesultone with renewable resource cardanol. The new amphiphilic dopant forms spherical micelles in water and its critical micelle concentration was determined by dye encapsulation and surface tension methods. In the emulsion route, the amphiphilic dopant complexed with aniline to produce cylindrical micellar aggregates that template exclusively for polyaniline nanofibers. The dispersion of aniline+dopant in water/toluene solvent mixture produces vesicles that selectively template for polyaniline nanotapes. The mechanism of the polyaniline nanomaterials formation was investigated by dynamic light scattering (DLS) and high-resolution transmission electron microscopy (HR-TEM). DLS of the polymerization templates in water proved the presence of micrometer range aggregates, and TEM images confirmed the shape of the cylindrical and vesicular templates. The polyaniline nanomaterials were found soluble in water and polar organic solvents for structural characterization and composition analysis by 1H NMR spectroscopy. Absorbance spectra of the nanomaterials showed free carrier tail above 900 nm in the near IR region for the delocalization of electrons in the polaron band corresponding to expanded conformation of polyaniline chains. Wide angle X-ray diffraction showed two new peaks at low angle region with d-spacing of 26.5 and 13.6 A corresponding to lamellar ordering of polyaniline chains followed by interdigitations of the amphiphilic dopant in the nanomaterials.
PMID: 19642663 [PubMed - indexed for MEDLINE]
Risk factor profile for chronic non-communicable diseases: Results of a community-based study in Kerala, India
Indian J Med Res. 2010 Jan;131:53-63.
Thankappan KR, Shah B, Mathur P, Sarma PS, Srinivas G, Mini GK, Daivadanam M, Soman B, Vasan RS.
Achutha Menon Centre for Health Science Studies,Thiruvananthapuram.
BACKGROUND & OBJECTIVES: Kerala State is a harbinger of what will happen in future to the rest of India in chronic non-communicable diseases (NCD). We assessed: (i) the burden of NCD risk factors; (ii) estimated the relations of behavioural risk factors to socio-demographic correlates, anthropometric risk factors with behavioural risk factors; (iii) evaluated if socio-demographic, behavioural and anthropometric risk factors predicted biochemical risk factors; and (iv) estimated awareness, treatment and adequacy of control of hypertension and diabetes, in Kerala state. METHODS: A total of 7449 individuals (51% women) stratified by age group, sex and place of residence were selected and information on behavioural risk factors; tobacco use, diet, physical activity, alcohol use, measured anthropometry, blood pressure was collected. Fasting blood samples were analysed for blood glucose, total cholesterol, high density lipoprotein cholesterol and triglycerides in a sample subset.Using multiple logistic regression models the associations between socio-demographic and anthropometric variables with biochemical risk factors were estimated. RESULTS: The burden of NCD risk factors was high in our sample. Prevalence of behavioural and each of the biochemical risk factors increased with age, adjusting for other factors including sex and the place of residence. The odds ratios relating anthropometric variables to biochemical variables were modest, suggesting that anthropometric variables may not be useful surrogates for biochemical risk factors for population screening purposes. INTERPRETATION & CONCLUSIONS: In this large study of community-based sample in Kerala, high burden of NCD risk factors was observed, comparable to that in the United States. These data may serve to propel multisectoral efforts to lower the community burden of NCD risk factors in India in general, and in Kerala, in particular.
PMID: 20167974 [PubMed - in process]
Thankappan KR, Shah B, Mathur P, Sarma PS, Srinivas G, Mini GK, Daivadanam M, Soman B, Vasan RS.
Achutha Menon Centre for Health Science Studies,Thiruvananthapuram.
BACKGROUND & OBJECTIVES: Kerala State is a harbinger of what will happen in future to the rest of India in chronic non-communicable diseases (NCD). We assessed: (i) the burden of NCD risk factors; (ii) estimated the relations of behavioural risk factors to socio-demographic correlates, anthropometric risk factors with behavioural risk factors; (iii) evaluated if socio-demographic, behavioural and anthropometric risk factors predicted biochemical risk factors; and (iv) estimated awareness, treatment and adequacy of control of hypertension and diabetes, in Kerala state. METHODS: A total of 7449 individuals (51% women) stratified by age group, sex and place of residence were selected and information on behavioural risk factors; tobacco use, diet, physical activity, alcohol use, measured anthropometry, blood pressure was collected. Fasting blood samples were analysed for blood glucose, total cholesterol, high density lipoprotein cholesterol and triglycerides in a sample subset.Using multiple logistic regression models the associations between socio-demographic and anthropometric variables with biochemical risk factors were estimated. RESULTS: The burden of NCD risk factors was high in our sample. Prevalence of behavioural and each of the biochemical risk factors increased with age, adjusting for other factors including sex and the place of residence. The odds ratios relating anthropometric variables to biochemical variables were modest, suggesting that anthropometric variables may not be useful surrogates for biochemical risk factors for population screening purposes. INTERPRETATION & CONCLUSIONS: In this large study of community-based sample in Kerala, high burden of NCD risk factors was observed, comparable to that in the United States. These data may serve to propel multisectoral efforts to lower the community burden of NCD risk factors in India in general, and in Kerala, in particular.
PMID: 20167974 [PubMed - in process]
Clinical profile and etiology of diabetes mellitus with onset at less than 6 months of age
Kaohsiung J Med Sci. 2009 Dec;25(12):656-62.
Valamparampil JJ, Chirakkarot S, Savida P, Omana S.
Department of Pediatrics, Institute of Child Health, Government Medical College, Kottayam, Kerala, India.
The aim of this study was to determine the clinical profile and etiology of diabetes mellitus (DM) with onset at < 6 months of age. All children aged < 6 months diagnosed with DM at a tertiary referral center between 2005 and 2008 were included in the study. Three cases of DM with onset at < 6 months of age were identified. All patients were female and of the same ethnic origin, with nonconsanguineous parents. Intrauterine growth retardation was noted in all three patients, and diabetic ketoacidosis and hypertriglyceridemia in two of the three. Blood samples from all three patients and their parents were analyzed for mutations in the KCNJ11 gene (inwardly-rectifying potassium channel, subfamily J, member 11 gene; OMIM 600937). A heterozygous de novo mutation in the KCNJ11 gene was detected in one patient, which confirmed the diagnosis of permanent neonatal DM. Neither C-peptide secretion nor circulating islet cell antibodies were detected in any patient during diagnosis, but C-peptide elevation was detected in the patient with permanent neonatal DM after treatment with sulfonylurea. One infant had clinical and immunological evidence of congenital cytomegalovirus infection while the diabetes in another case was postulated to be syndromic. DM within the first 6 months of life is a rare condition with various etiologies. The high prevalence of Kir6.2 mutations in neonatal diabetes means that all children < 6 months of age diagnosed with diabetes should be tested for Kir6.2 mutations at diagnosis.
PMID: 19951851 [PubMed - indexed for MEDLINE]
Valamparampil JJ, Chirakkarot S, Savida P, Omana S.
Department of Pediatrics, Institute of Child Health, Government Medical College, Kottayam, Kerala, India.
The aim of this study was to determine the clinical profile and etiology of diabetes mellitus (DM) with onset at < 6 months of age. All children aged < 6 months diagnosed with DM at a tertiary referral center between 2005 and 2008 were included in the study. Three cases of DM with onset at < 6 months of age were identified. All patients were female and of the same ethnic origin, with nonconsanguineous parents. Intrauterine growth retardation was noted in all three patients, and diabetic ketoacidosis and hypertriglyceridemia in two of the three. Blood samples from all three patients and their parents were analyzed for mutations in the KCNJ11 gene (inwardly-rectifying potassium channel, subfamily J, member 11 gene; OMIM 600937). A heterozygous de novo mutation in the KCNJ11 gene was detected in one patient, which confirmed the diagnosis of permanent neonatal DM. Neither C-peptide secretion nor circulating islet cell antibodies were detected in any patient during diagnosis, but C-peptide elevation was detected in the patient with permanent neonatal DM after treatment with sulfonylurea. One infant had clinical and immunological evidence of congenital cytomegalovirus infection while the diabetes in another case was postulated to be syndromic. DM within the first 6 months of life is a rare condition with various etiologies. The high prevalence of Kir6.2 mutations in neonatal diabetes means that all children < 6 months of age diagnosed with diabetes should be tested for Kir6.2 mutations at diagnosis.
PMID: 19951851 [PubMed - indexed for MEDLINE]
Analyzing sociodemographic factors amongst blood donors
J Emerg Trauma Shock. 2010 Jan;3(1):21-5.
Shenga N, Thankappan K, Kartha C, Pal R.
IIDD Cell, Government of Sikkim, Sikkim, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, Kerala, India.
INTRODUCTION: Blood transfusion is a fundamental and requisite part of any National Health Service for optimum management of emergency conditions like severe trauma shock and resuscitation with the optimum stock of its different components. The objective of the present study was to analyze the factors of knowledge of prospective blood donors that may influence their perception and awareness about blood donation. MATERIALS AND METHODS: This population-based cross-sectional study was conducted at Gangtok in the state of Sikkim, India, on 300 subjects of the adult population selected by two-stage cluster sampling. The main outcome variables were the socioeconomic and demographic variables of knowledge of blood donation. By interview technique, using the pre-tested structured close-ended questionnaire, the principal investigator collected the data. RESULTS: In our study population, 46% of the study population was found to have a high knowledge score. The knowledge about blood donation was found to be statistically significant with the occupational status and the education levels, both in the bivariate and in the multivariate analyses. Knowledge about blood donation was not significantly related to age, sex, marital status, religion, community status and per capita monthly family income. CONCLUSION: The study suggested that the perceptions toward voluntary blood donation could be influenced to a large extent by sociodemographic variables of knowledge among the general population.
PMID: 20165717 [PubMed - in process]
Shenga N, Thankappan K, Kartha C, Pal R.
IIDD Cell, Government of Sikkim, Sikkim, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, Kerala, India.
INTRODUCTION: Blood transfusion is a fundamental and requisite part of any National Health Service for optimum management of emergency conditions like severe trauma shock and resuscitation with the optimum stock of its different components. The objective of the present study was to analyze the factors of knowledge of prospective blood donors that may influence their perception and awareness about blood donation. MATERIALS AND METHODS: This population-based cross-sectional study was conducted at Gangtok in the state of Sikkim, India, on 300 subjects of the adult population selected by two-stage cluster sampling. The main outcome variables were the socioeconomic and demographic variables of knowledge of blood donation. By interview technique, using the pre-tested structured close-ended questionnaire, the principal investigator collected the data. RESULTS: In our study population, 46% of the study population was found to have a high knowledge score. The knowledge about blood donation was found to be statistically significant with the occupational status and the education levels, both in the bivariate and in the multivariate analyses. Knowledge about blood donation was not significantly related to age, sex, marital status, religion, community status and per capita monthly family income. CONCLUSION: The study suggested that the perceptions toward voluntary blood donation could be influenced to a large extent by sociodemographic variables of knowledge among the general population.
PMID: 20165717 [PubMed - in process]
Thursday, 18 February 2010
Employment outcome and satisfaction after anterior temporal lobectomy for refractory epilepsy: a developing country's perspective
Epilepsy Behav. 2009 Nov;16(3):495-500. Epub 2009 Sep 26.
George L, Iyer RS, James R, Sankara Sarma P, Radhakrishnan K.
R. Madhavan Nair Center for Comprehensive Epilepsy Care, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, Kerala, India.
We examined employment outcome and its determinants in 172 south Indian patients who had undergone anterior temporal lobectomy (ATL) for medically refractory epilepsy. Despite seizure-free outcome in the majority, a significant change in post-ATL employment status occurred only in those involved in skilled jobs. Although factors such as younger age at surgery, shorter duration of epilepsy, longer post-ATL follow-up duration, and lower income were associated with favorable employment outcome in univariate analysis, only shorter duration of epilepsy was independently predictive in the multivariate model. A majority of homemakers appreciated marked improvement in their own day-to-day activities. Our patients did not express their desire to work as a principal aim of epilepsy surgery. To enhance occupational attainment, patients require, before epilepsy surgery, occupational assessment to identify their individual abilities and limitations and counseling in formulating realistic goals. After surgery, they require continued support in vocational training and job seeking.
PMID: 19783220 [PubMed - indexed for MEDLINE]
George L, Iyer RS, James R, Sankara Sarma P, Radhakrishnan K.
R. Madhavan Nair Center for Comprehensive Epilepsy Care, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, Kerala, India.
We examined employment outcome and its determinants in 172 south Indian patients who had undergone anterior temporal lobectomy (ATL) for medically refractory epilepsy. Despite seizure-free outcome in the majority, a significant change in post-ATL employment status occurred only in those involved in skilled jobs. Although factors such as younger age at surgery, shorter duration of epilepsy, longer post-ATL follow-up duration, and lower income were associated with favorable employment outcome in univariate analysis, only shorter duration of epilepsy was independently predictive in the multivariate model. A majority of homemakers appreciated marked improvement in their own day-to-day activities. Our patients did not express their desire to work as a principal aim of epilepsy surgery. To enhance occupational attainment, patients require, before epilepsy surgery, occupational assessment to identify their individual abilities and limitations and counseling in formulating realistic goals. After surgery, they require continued support in vocational training and job seeking.
PMID: 19783220 [PubMed - indexed for MEDLINE]
Thursday, 11 February 2010
Marine mycoflora in backwater ecosystem of Kerala, India
J Environ Biol. 2009 Sep;30(5):647-9.
Nambiar GR, Raveendran K.
Department of Post Graduate Studies and Research in Botany, Sir Syed College, Taliparamba, Kerala-670 142, India. grn_149@rediffmail.com
Back water system of Kerala is well known for its fertility. Fungi play a vital role in detritus decomposition, nutrient cycling and energy flow in marine food web including backwater ecosystem. Present investigation on the diversity of marine fungi from two back waters of Kerala resulted in the isolation of 20 marine fungi. These include 11 Ascomycetes, 1 Basidiomycete and 8 Mitosporic fungi. In terms of percent frequency of occurrence the most common species obtained were Aniptodera chesapeakensis, Verruculina enalia, Savoryella lignicola and Clavatospora bulbosa. Ascochyta sp. was represented by only a single isolate.
PMID: 20136041 [PubMed - in process]
Nambiar GR, Raveendran K.
Department of Post Graduate Studies and Research in Botany, Sir Syed College, Taliparamba, Kerala-670 142, India. grn_149@rediffmail.com
Back water system of Kerala is well known for its fertility. Fungi play a vital role in detritus decomposition, nutrient cycling and energy flow in marine food web including backwater ecosystem. Present investigation on the diversity of marine fungi from two back waters of Kerala resulted in the isolation of 20 marine fungi. These include 11 Ascomycetes, 1 Basidiomycete and 8 Mitosporic fungi. In terms of percent frequency of occurrence the most common species obtained were Aniptodera chesapeakensis, Verruculina enalia, Savoryella lignicola and Clavatospora bulbosa. Ascochyta sp. was represented by only a single isolate.
PMID: 20136041 [PubMed - in process]
Water quality assessment of open wells in and around Chavara industrial area, Quilon, Kerala
J Environ Biol. 2009 Sep;30(5):701-4.
Shaji C, Nimi H, Bindu L.
Department of Botany, Sree Narayana College, Quilon, Kerala-691 001, India. shajchellappan@gmail.com
Water quality of four open wells representing four localities around the Kerala Minerals and Metals Ltd industrial area, Chavara, Quilon district was studied fora period of six months from December, 2006 to May 2007 to assess the suitability of the well waters for domestic purposes. The well waters exhibited high BOD (average values from 12.87-15.96 mg l(-1)), COD (666.67-796.67 mg l(-1)), TDS (500-1466.67mg l(-1)), total hardness (110-835 mg l(-1)), nitrate (1.12-4.97 mg l(-1)), calcium (30.59-271.22 mg l(-1)), phosphate (0.19-0.48 mg l(-1)) and free CO2 (49.13-102.47 mg l(-1)) and low dissolved oxygen (2.63-3.13 mg l(-1)). Heavy metal analysis revealed that the third and fourth wells are free from heavy metal pollution. Coliform test showed bacterial contamination in all the wells. The values of BOD, COD, TDS and phosphate exceeded the maximum permissible limits and the dissolved oxygen was much lower than the desirable limit in all the well waters. Hence all the four well waters are found unsuitable for domestic purposes as it is confirmed by water quality index. The use of waters of open wells in and around the industrial area may cause health hazards to nearby inhabitants.
PMID: 20136051 [PubMed - in process]
Shaji C, Nimi H, Bindu L.
Department of Botany, Sree Narayana College, Quilon, Kerala-691 001, India. shajchellappan@gmail.com
Water quality of four open wells representing four localities around the Kerala Minerals and Metals Ltd industrial area, Chavara, Quilon district was studied fora period of six months from December, 2006 to May 2007 to assess the suitability of the well waters for domestic purposes. The well waters exhibited high BOD (average values from 12.87-15.96 mg l(-1)), COD (666.67-796.67 mg l(-1)), TDS (500-1466.67mg l(-1)), total hardness (110-835 mg l(-1)), nitrate (1.12-4.97 mg l(-1)), calcium (30.59-271.22 mg l(-1)), phosphate (0.19-0.48 mg l(-1)) and free CO2 (49.13-102.47 mg l(-1)) and low dissolved oxygen (2.63-3.13 mg l(-1)). Heavy metal analysis revealed that the third and fourth wells are free from heavy metal pollution. Coliform test showed bacterial contamination in all the wells. The values of BOD, COD, TDS and phosphate exceeded the maximum permissible limits and the dissolved oxygen was much lower than the desirable limit in all the well waters. Hence all the four well waters are found unsuitable for domestic purposes as it is confirmed by water quality index. The use of waters of open wells in and around the industrial area may cause health hazards to nearby inhabitants.
PMID: 20136051 [PubMed - in process]
Does intravenous rtPA benefit patients in the absence of CT angiographically visible intracranial occlusion?
Neurol India. 2009 November-December;57(6):739-743
Sylaja PN, Dzialowski I, Puetz V, Eliasziw M, Hill MD, Krol A, O'Reilly C, Demchuk AM.
Department of Clinical Neurosciences, Calgary Stroke Program, Calgary, Alberta; Ananthapuri Hospitals and Research Institute, Kerala, India
Background : In patients with acute stroke receiving intravenous tissue plasminogen activator (tPA), we postulated that the presence of intracranial occlusion on CT angiography (CTA) modifies the benefit of thrombolysis. Materials and Methods : Using a retrospective cohort design, we identified patients with acute ischemic stroke in our CTA database between May 2002 and August 2007. All the patients had a CTA within 12 h of onset, a premorbid modified Rankin scale (mRS) #1, and a baseline National Institute of Health Stroke Scale score(NIHSS)f $6. The primary outcome was early effectiveness of tPA defined as an NIHSS score of #2 at 24 h or a 4-point NIHSS improvement at 24 h. Secondary outcome included mRS #1 at 90 days. The relationship between intracranial occlusion on CTA and benefit of tPA was assessed using a test for interaction. Results : A total of 287 patients met the criteria [occlusion present N =168; (98 with tPA; 70 without tPA) and occlusion absent N = 119; (52 with tPA; 67 without tPA)]. Those with intracranial occlusion were likely to have more severe strokes (NIHSS $15; P < 0.001) and abnormal brain imaging (ASPECTS #7; P < 0.001). For outcome of 4-point NIHSS score improvement at 24 h, benefit from tPA was observed only among patients with a visible occlusion (absolute difference in favor of tPA: 20.4% vs. 0.7%; P = 0.06). Conclusion : In patients with acute ischemic stroke, thrombolysis produced a better early clinical response among patients with intracranial occlusion, which needs to be confirmed in stroke thrombolysis trials.
PMID: 20139502 [PubMed - as supplied by publisher]
Sylaja PN, Dzialowski I, Puetz V, Eliasziw M, Hill MD, Krol A, O'Reilly C, Demchuk AM.
Department of Clinical Neurosciences, Calgary Stroke Program, Calgary, Alberta; Ananthapuri Hospitals and Research Institute, Kerala, India
Background : In patients with acute stroke receiving intravenous tissue plasminogen activator (tPA), we postulated that the presence of intracranial occlusion on CT angiography (CTA) modifies the benefit of thrombolysis. Materials and Methods : Using a retrospective cohort design, we identified patients with acute ischemic stroke in our CTA database between May 2002 and August 2007. All the patients had a CTA within 12 h of onset, a premorbid modified Rankin scale (mRS) #1, and a baseline National Institute of Health Stroke Scale score(NIHSS)f $6. The primary outcome was early effectiveness of tPA defined as an NIHSS score of #2 at 24 h or a 4-point NIHSS improvement at 24 h. Secondary outcome included mRS #1 at 90 days. The relationship between intracranial occlusion on CTA and benefit of tPA was assessed using a test for interaction. Results : A total of 287 patients met the criteria [occlusion present N =168; (98 with tPA; 70 without tPA) and occlusion absent N = 119; (52 with tPA; 67 without tPA)]. Those with intracranial occlusion were likely to have more severe strokes (NIHSS $15; P < 0.001) and abnormal brain imaging (ASPECTS #7; P < 0.001). For outcome of 4-point NIHSS score improvement at 24 h, benefit from tPA was observed only among patients with a visible occlusion (absolute difference in favor of tPA: 20.4% vs. 0.7%; P = 0.06). Conclusion : In patients with acute ischemic stroke, thrombolysis produced a better early clinical response among patients with intracranial occlusion, which needs to be confirmed in stroke thrombolysis trials.
PMID: 20139502 [PubMed - as supplied by publisher]
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