Is Prevalence of Hypertension Increasing in First-Ever Stroke Patients?: A Hospital-Based Cross-Sectional Study

Prevalence of Triggering Factors in Acute Stroke: Hospital-based Observational Cross-sectional Study

Essential Workflow and Performance Measures for Optimizing Acute Ischemic Stroke Treatment in India.

American Journal of HematologyVolume 70, Issue 3 p. 266-267 Letters and CorrespondenceFree Access Autosomal non-dominant hereditary spherocytosis: Does it occur in India? Akhilesh S. Karan, Akhilesh S. Karan Department of Haematology, All-India Institute of Medical Sciences, New Delhi, IndiaSearch for more papers by this authorRenu Saxena, Renu Saxena Department of Haematology, All-India Institute of Medical Sciences, New Delhi, IndiaSearch for more papers by this authorV.P. Choudhry, V.P. Choudhry Department of Haematology, All-India Institute of Medical Sciences, New Delhi, IndiaSearch for more papers by this author Akhilesh S. Karan, Akhilesh S. Karan Department of Haematology, All-India Institute of Medical Sciences, New Delhi, IndiaSearch for more papers by this authorRenu Saxena, Renu Saxena Department of Haematology, All-India Institute of Medical Sciences, New Delhi, IndiaSearch for more papers by this authorV.P. Choudhry, V.P. Choudhry Department of Haematology, All-India Institute of Medical Sciences, New Delhi, IndiaSearch for more papers by this author First published: 27 June 2002 https://doi.org/10.1002/ajh.10122Citations: 2AboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat Citing Literature Volume70, Issue3July 2002Pages 266-267 ReferencesRelatedInformation

BackgroundGlobally, stroke appears as a major cause of preventable deaths and disabilities. In Ethiopia, the intra-hospital mortality of stroke is significant; however, epidemiologic data are scarce whether there is a difference in the overall survival time between hypertensive and non-hypertensive adult stroke patients admitted in specialized hospitals. This study was intended to determine the survival of stroke patients according to their hypertension status admitted in Ayder Comprehensive Specialized Hospital, Northern Ethiopia from March 1, 2012, to February 28, 2019.Methods and FindingsA hospital-based retrospective cohort study was conducted among all cohorts of confirmed first-ever stroke patients admitted in Ayder Comprehensive Specialized Hospital, Northern Ethiopia. Kaplan–Meier survival analysis was applied to estimate the survival probability of hypertensive and non-hypertensive first-ever stroke patients. Cox proportional hazards regression model was used to determine the adjusted hazard ratio of death for each main baseline predictor variable with 95% CI, and P-value <0.05 was used to declare statistical significance. The assumptions of the Cox proportional hazards regression model assessed by the global test, Schoenfeld residuals. There were 503 (323 were hypertensive, 180 Non-hypertensive) confirmed first, ever adult stroke patients, the overall median age of the patients was 65 years, IQR (53–75) years. Seventy-five (14.9%) of them were dead, with a median survival time of 48 days and 428 (85.1%) of them were censored. At any particular point in time, the hazard of death among hypertensive patients was two times higher than non-hypertensive patients, but this was not found to be a statistically significant (adjusted HR=2.13: 95% CI 0.66–6.81). Glasgow Coma Scale 3–8 at admission (adjusted HR=10.12; 95% CI 2.58–40.68), presence of stroke complications (adjusted HR=7.23; 95% CI 1.86–28.26) and borderline high total cholesterol level (adjusted HR=3.57; 95% CI 1.15–11.1) were the only independent predictors of intra-hospital patient mortality.ConclusionThe overall survival time difference between hypertensive and non-hypertensive first-ever adult stroke patients was not statistically significant. Early identification and treatment of stroke complications, co-morbidities along strict follow-up of comatose patients may improve the intra-hospital survival of stroke patients, and we also recommend community-based studies using a large sample size.

Objective: To compare the outcomes of non-traumatic hemorrhagic stroke (HS) patients transferred to a large Comprehensive Stroke Center (CSC) as compared to patients directly admitted through the CSC9s ED. Background Many stroke patients are transferred from community hospitals to CSCs. However, outcomes of these patients are infrequently studied separately. Even fewer data are available regarding HS patients, who generally require transfer more often than ischemic stroke patients. Design/Methods: Retrospective review of consecutively treated HS patients between 7/2006-12/2010 admitted through the CSC9s ED or transferred from outside hospitals (including intracerebral and subarachnoid hemorrhage patients). Outcome measures included discharge destination (expired patients and patients discharged to acute care hospitals and hospice were excluded from analysis), length of stay (LOS), and mortality. Results: 275 HS patients were transferred and 267 admitted through the ED. Transferred patients were younger (60.8yr vs. 67.5yr for ED patients), and had a longer LOS (12.1d vs. 8.4d for ED patients). Mortality was not significantly different (19.6% vs. 22.5% for ED patients, p=0.42). Logistic regression controlling for stroke severity and patient demographics showed no significant association between transfer status and discharge destination (home with or without care vs. skilled nursing facility or inpatient rehabilitation; p=0.89). Conclusions: At a large CSC, transferred HS patients demonstrate similar outcomes to non-transferred patients, despite a longer LOS. These data suggest that transfer of HS patients is safe and potentially effective in this patient population. Disclosure: Dr. Tong has received personal compensation for activities with Genentech, Inc. as a speaker. Dr. Grosvenor has nothing to disclose. Dr. Bedenk has nothing to disclose. Dr. Thomas has nothing to disclose. Dr. Rose has received personal compensation for activities with Boehringer Ingelheim as a speaker. Dr. Barazangi has received personal compensation for activities with Genentech Inc.

Objective: Stroke is a major cause of morbidity and mortality worldwide resulting from either an ischemic insult or rupture of a blood vessel in the brain. It not only leads to significant physical disability but also imposes emotional and economic burdens on patients and their families. Assessing the lipid profile in stroke patients is crucial, especially in ischemic stroke, where dyslipidemia plays a key role in atherosclerosis development. Elevated low-density lipoprotein (LDL) and triglycerides (TG) are important modifiable risk factors, and managing these can reduce the incidence and recurrence of strokes. Comprehensive lipid management should be a core component of stroke prevention and treatment strategies. Methods: This was a cross-sectional study in which 80 adult stroke patients (40 ischemic and 40 hemorrhagic strokes) were included on the basis of a predefined inclusion and exclusion criteria. The diagnosis of stroke was made on the basis of imaging and neurological examination. A comprehensive medical history, physical measurements (including body mass index), and lipid profiles (total cholesterol [TC], LDL, High-density lipoprotein [HDL], and TG) were recorded for all participants. Blood samples were taken after overnight fasting to ensure accuracy. Statistical analysis using SPSS version 21.0 compared lipid levels between the groups. An unpaired t-test and Chi-square test were used, with significance defined as a p&lt;0.05. Results: There was a significant difference in lipid profiles between ischemic and hemorrhagic stroke patients. Ischemic stroke patients had markedly higher levels of LDL with a mean of 129.84±36.54 mg/dL compared to 106.32±26.68 mg/dL in hemorrhagic stroke patients (p=0.0015). TC levels were also significantly elevated in ischemic stroke patients, averaging 236.22±56.26 mg/dL versus 196.48±46.24 mg/dL in hemorrhagic stroke patients (p=0.0009). Total TG were higher in ischemic stroke patients (158.54±44.68 mg/dL) compared to hemorrhagic stroke patients (128.62±39.16 mg/dL, p=0.0021). HDL levels were slightly lower in ischemic stroke patients (34.54±8.26 mg/dL) compared to hemorrhagic stroke patients (38.12±9.12 mg/dL), although this difference was not statistically significant (p=0.0696). Conclusion: There were significant differences in lipid profiles between ischemic and hemorrhagic stroke patients. Ischemic stroke patients had higher levels of LDL, TC, and TG, indicating a stronger association with dyslipidemia and atherosclerosis. These findings highlight the importance of aggressive lipid management in ischemic stroke patients to reduce recurrence risk and improve outcomes.

To examine the relation between the quality of physicians and migration among alumni of All India Institute of Medical Sciences (AIIMS), New Delhi, India over the period 1989-2000. In a retrospective cohort study, data on graduates of AIIMS were collected from entrance exam qualifier lists, the AIIMS alumni directory, convocation records, the American Medical Association and informal alumni networks. The data were analysed by use of 2x2 contingency tables and logistic regression models. Nearly 54% of AIIMS graduates during 1989-2000 now reside outside India. Students admitted under the general category are twice as likely to reside abroad (95% confidence interval: 1.53-2.99) as students admitted under the affirmative-action category. Recipients of multiple academic awards were 35% more likely to emigrate than non-recipients of awards (95% confidence interval: 1.04-1.76). Multivariate analyses do not change these basic conclusions. Graduates from higher quality institutions account for a disproportionately large share of emigrating physicians. Even within high-end institutions, such as AIIMS, better physicians are more likely to emigrate. Interventions should focus on the highly trained individuals in the top institutions that contribute disproportionately to the loss of human resources for health. Our findings suggest that affirmative-action programmes may have an unintended benefit in that they may help retain a subset of such personnel.

Aim: The aim of this study was compare between haemorrhagic stroke (HS) and ischaemic stroke (IS) stroke in relation to risk factors and clinical presentation among stroke patients admitted to a tertiary teaching hospital over a 5-year period. Materials and Methods: This was a retrospective, cross-sectional, hospital-based study. We reviewed the medical files of patients admitted with the diagnosis of stroke at Ibn Sina Teaching Hospital, from January 2011 to December 2015 to compare between HS and IS patients. Results: From a total of 1678 stroke patients, IS constituted 81.2% of them and 18.8% were HS, males were 57.7% and females 42.3%. HS patients were significantly younger than IS patients, (odds ratio [OR] 0.4; 95% confidence interval [CI] 0.31–0.51, P= 0.000), and there was no significant difference in gender (males 61.6% vs. 56.8%, P = 0.12). Hypertension and smoking were significantly higher among HS than IS patients (OR 5.51; 95% CI 3.98–7.62, P &lt; 0.0001) and (OR 1.84; 95% CI, 1.37–2.46, P= 0.003), respectively, whereas diabetes mellitus (OR, 0.75 95% CI, 0.58–0.96, P= 0.024), transient ischaemic attacks (TIA) (OR, 0.23; 95% CI 0.14–0.38, P &lt; 0.0001), hyperlipidaemia (OR, 0.35; 95% CI 0.19–0.66, P = 0.007) and family history of stroke (OR, 0.64; 0.42–0.97, P= 0.033) were significantly higher in IS than HS patients. Sudden onset of stroke attack and impaired consciousness including coma was significantly more frequent in HS than IS patients (98.7% vs. 86.8%, P= 0.000) and (77.5% vs. 34.2%, P = 0.000), respectively. In-hospital fatality was higher among HS than IS victims (46.3% vs. 26.5%, P = 0.000). Conclusion: Younger age, hypertension and smoking were higher in HS than IS patients, and increasing age, diabetes, TIA, hyperlipidaemia and family stroke history were higher in IS patients, sex did not favour any type, HS was more presented with impaired consciousness and had a higher in-hospital fatality than IS.

Medical profession has proved its versatility in the adoption of many strategies to deal with the impact of COVID-19. All India Institute of Medical Sciences (AIIMS), New Delhi, India is a large public funded medical school and general hospital in North India. Psychiatry department is one of the 42 departments at AIIMS. COVID-19 has impacted all the functions of the department: clinical care, teaching and training, research and other roles. In this communication, we report the strategies, simple yet effective improvisations to meet the challenges of COVID-19 so as to continue the basic functions of the discipline. This could serve as a model for continued functioning of a tertiary care teaching medical facility in a pandemic situation.

In 2018, the Government of India approved the establishment of the New All India Institute of Medical Sciences (AIIMS) in Thoppur, Madurai, Tamil Nadu, India. As the most important amenity for continuing primary care and rescue response is a healthcare facility, a secure electricity supply becomes an imperative necessity. Hence, as the energy supplier for the new AIIMS, Madurai, this paper proposes a microgrid combined with the utility grid. The microgrid consists of a 4-MW photovoltaic system, a 1.8-MW wind-turbine energy-conversion system, a backup diesel generator capable of meeting the forecasted maximum demand and a 1-MW battery energy-storage system. The AIIMS Microgrid will have a service providing a capacity of 20 MVA following integration with the utility grid. The proposed microgrid would be the first attempt at healthcare facilities in India since its first day of work to ensure the availability of electricity. It would have a 9.8% return on investment, a 13.6% internal rate of return and a payback period of 6.75 years once it is operational, as well as an attractive levelized cost of energy (LCOE) of USD 0.07547/kWh. It would provide an environmentally friendly atmosphere by avoiding an annual emission of 6 261 132 kg of carbon dioxide, 27 362 kg of sulphur dioxide and 12 838 kg of nitrogen oxides as compared to power supplied entirely from the utility grid.

Pentazocine was introduced in 1967 as a "non-narcotic, nonaddicting" analgesic. However, the abuse potential of this medication was soon recognized, and cutaneous and muscular complications of pentazocine abuse have been reported. Demographic and clinical data on 10 patients with pentazocine-induced ulcers attending the Dermatology Outpatient Department of the All India Institute of Medical Sciences (AIIMS), New Delhi, India between November 2000 and October 2002 have been compiled. Ten patients with pentazocine-induced ulcers were seen at AIIMS between November 2000 and October 2002, six of whom were female. The average age of these patients was 32 years. The duration of the complaints ranged from 10 days to 7 years (average 17.5 months). Nine of the 10 patients had past history of painful medical conditions for which they had received pentazocine injections. All the patients presented with deep ulcers and sinuses over the accessible sites. The margins of these ulcers were hyperpigmented and indurated. Six patients had scars along the superficial vein access sites. Three patients had puffy-hand syndrome, while two had muscle contractures. No underlying psychiatric disorders were found in any of these patients. Urine screening for pentazocine was positive in two patients. Antinuclear antibody (ANA), antineutrophil cytoplasmic antibody (ANCA) and antibody against DNA (antidsDNA) tests and screening for infections such as human immunodeficiency virus (HIV), hepatitis B virus (HBV) and hepatitis C virus (HCV) were negative in all patients. Pentazocine abuse can be suspected from cutaneous findings, even when the patient does not volunteer a history of self-medication. Recognition of the condition will prevent misdirected investigations and treatment. The patient should be encouraged to seek treatment for drug dependence.

Drug misuse in India: Where do we stand & where to go from here?

BackgroundGlobally, there has been an exponential rise in smartphone use and selfie taking among youth. To make selfies exciting, dangerous selfies are often taken that may lead to catastrophic consequences, including death. This study aims to estimate the prevalence of dangerous selfies and to determine the factors associated with dangerous selfies among medical and nursing students in India.MethodsThe study was conducted at the All India Institute of Medical Sciences (AIIMS), Bhubaneswar, India, in April–August 2018. The inclusion criteria were students enrolled in the Bachelor of Medicine and Bachelor of Surgery (MBBS) and nursing courses of AIIMS, Bhubaneswar. Students who did not use smartphones were excluded from the study. The interview schedule and Selfitis Behaviour Scale (SBS) were used to collect information on sociodemographic variables, smartphone use and variables related to selfies and dangerous selfies. Forward stepwise logistic regression was undertaken with the probability of entry and removal as 0.05 and 0.10, respectively.ResultsOf 633 eligible participants, 595 were included in the study. The mean (SD) age of the participants was 21.2 (1.6) years. More than half (56.8%) of the participants were female, 384 (64.5%) were medical students and 211 (35.5%) were nursing students. Nearly two-thirds of the participants (70.6%) preferred to take selfie. One hundred thirty three (40.3%) of the participants posted selfies on social media daily. The prevalence of dangerous selfies was 8.74% (95% CI: 6.73–11.28). Eight injury episodes while taking selfies were reported by seven (1.2%) participants. Being male (AOR 4.96, 95% CI 2.53–9.74), posting selfies on social media daily (AOR 3.33, 95% CI 1.71–6.47) and an SBS score > 75 (AOR 4.97, 95% CI 1.43–17.28) were independent predictors of dangerous selfies.ConclusionNearly one in ten medical and nursing students reported having taken a dangerous selfie, and one in one hundred reported having been injured while attempting to take a selfie. Being male, posting selfies on social media daily and an SBS score > 75 were independent predictors of dangerous selfies. Further research is required to identify the community burden of dangerous selfies and to develop strategies to prevent selfie-related fatalities among youths.

Introduction: Pulmonary Tuberculosis (PTB) remains a major global health burden, particularly in developing countries. Even after microbiological cure, a significant proportion of patients develop post-tuberculosis (post-PTB) lung sequelae, which may predispose them to Pulmonary Hypertension (PH), a condition associated with increased morbidity and mortality. Aim: To determine the prevalence and severity of pulmonary hypertension in patients with post-tuberculosis lung sequelae. Materials and Methods: This hospital-based cross-sectional study was conducted at BJ Government Medical College (GMC) and Sassoon Hospital, Pune, Maharashtra, India, from October 2022 to March 2023. A total of 70 patients with posttuberculosis lung sequelae were included. Clinical profile, chest radiographic findings, Electrocardiographic (ECG) changes, and echocardiographic parameters, including Right Ventricular Systolic Pressure (RVSP), Tricuspid Regurgitation Velocity (TRV), were assessed. Data were analysed using descriptive statistics. Results: There were 55 males and 15 females. The majority of patients were middle-aged males with a high proportion of smokers. PH was detected in 29 (41.43%) patients. Mild, moderate, and severe PH were observed in 4 (5.71%), 17 (24.29%), and 8 (11.43%) patients, respectively. The mean RVSP was 39.86±17.74 mmHg and the mean TRV was 2.75±0.58 m/s in patients with extensive radiological lung involvement. Conclusion: The present study highlights a high prevalence (41.43%) of PH among post-PTB patients. Echocardiographic screening revealed elevated RVSP in patients with PH, and TRV was elevated in a significant proportion of cases. Thus, PTB patients require long-term follow-up to diagnose and treat functional impairment after cure.

Background:Tattooing has become increasingly popular, particularly among young people. However, little is known about the tattoo practices in North-East India.Objectives:The primary objective of this study was to know the reasons and motivations of tattoo application and tattoo removal in individuals asking for tattoo removal. The secondary objective was to identify the demography, methods and safety of tattoo practices in these tattooed individuals.Materials and Methods:A hospital-based cross-sectional study was carried out in 212 consecutive individuals seeking tattoo removal. Chi-square and Fisher's exact tests were performed for intergroup comparisons.Results:There were 178 (84%) males and 34 (16%) females. The mean ± standard deviation (SD) age of individuals seeking tattoo removal was 21.8 ± 4 years. The mean ± SD age of doing tattoo was 15.8 ± 3 years. Most individuals possessed an amateur tattoo (94.3%), 4.2% a professional one and 1.4% had a combination. Sewing needle was the most common instrument used for making tattoos in 51.4%. The individuals made their tattoos in an unsterile manner in 49.1%. The most common reason for doing tattoo was for fashion in 87.7%. The participants wanted tattoo removal to qualify for jobs, especially in armed forces in 49.5% and due to regret in 21.7%. Black was the most preferred colour in 37.3% followed by green in 28.3%. The fabric ink was the choice of ink in maximum number of individuals, i.e. 93.9%.Limitations:It was a hospital-based study done only on individuals seeking tattoo removal. It needs caution to generalise the findings in population. In addition, there may be recall bias in the participants.Conclusion:The tattoo was done mostly below 18 years of age in a crude unsterile way. The individuals had poor risk perceptions about various infections and complications of tattooing. There is an urgent need to caution and educate the youngsters and school-going children about safe tattooing and consequences of tattooing.