Publications by authors named "Arvind Sharma"

120 Publications

Glial Cells Response in Stroke.

Cell Mol Neurobiol 2022 Jan 23. Epub 2022 Jan 23.

Department of Pharmacology and Toxicology, National Institute of Pharmaceutical Education and Research (NIPER), Ahmedabad, Gandhinagar, Gujarat, 382355, India.

As the second-leading cause of death, stroke faces several challenges in terms of treatment because of the limited therapeutic interventions available. Previous studies primarily focused on metabolic and blood flow properties as a target for treating stroke, including recombinant tissue plasminogen activator and mechanical thrombectomy, which are the only USFDA approved therapies. These interventions have the limitation of a narrow therapeutic time window, the possibility of hemorrhagic complications, and the expertise required for performing these interventions. Thus, it is important to identify the contributing factors that exacerbate the ischemic outcome and to develop therapies targeting them for regulating cellular homeostasis, mainly neuronal survival and regeneration. Glial cells, primarily microglia, astrocytes, and oligodendrocytes, have been shown to have a crucial role in the prognosis of ischemic brain injury, contributing to inflammatory responses. They play a dual role in both the onset as well as resolution of the inflammatory responses. Understanding the different mechanisms driving these effects can aid in the development of therapeutic targets and further mitigate the damage caused. In this review, we summarize the functions of various glial cells and their contribution to stroke pathology. The review highlights the therapeutic options currently being explored and developed that primarily target glial cells and can be used as neuroprotective agents for the treatment of ischemic stroke.
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http://dx.doi.org/10.1007/s10571-021-01183-3DOI Listing
January 2022

Clinical Features and Outcome of Stroke with COVID-19. COVID-19 Stroke Study Group (CSSG), India.

Ann Indian Acad Neurol 2021 Sep-Oct;24(5):668-685. Epub 2021 Aug 30.

Department of Neurology, Ramesh Hospitals Guntur, Andhra Pradesh, India.

Background And Purpose: Occurrence of stroke has been reported among patients with COVID-19. The present study compares clinical features and outcomes of stroke patients with and without COVID-19.

Methods: The COVID-19 Stroke Study Group (CSSG) is a multicentric study in 18 sites across India to observe and compare the clinical characteristics of patients with stroke admitted during the current pandemic period and a similar epoch in 2019. The present study reports patients of stroke with and without COVID-19 (CoVS and non-CoVS, respectively) seen between February 2020 and July 2020. Demographic, clinical, treatment, and outcome details of patients were collected.

Results: The mean age and gender were comparable between the two groups. CoVS patients had higher stroke severity and extent of cerebral involvement on imaging. In-hospital complications and death were higher among CoVS patients (53.06% vs. 17.51%; < 0.001) and (42.31% vs. 7.6%; < 0.001), respectively. At 3 months, higher mortality was observed among CoVS patients (67.65% vs. 13.43%; < 0.001) and good outcome (modified Rankin score [mRS]: 0-2) was seen more often in non-CoVS patients (68.86% vs. 33.33%; < 0.001). The presence of COVID-19 and baseline stroke severity were independent predictors of mortality.

Conclusions: CoVS is associated with higher severity, poor outcome, and increased mortality. Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and baseline stroke severity are independent predictors of mortality.
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http://dx.doi.org/10.4103/aian.AIAN_122_21DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8680894PMC
August 2021

The epitope arrangement on flavivirus particles contributes to Mab C10's extraordinary neutralization breadth across Zika and dengue viruses.

Cell 2021 12 30;184(25):6052-6066.e18. Epub 2021 Nov 30.

Institut Pasteur, Université de Paris, CNRS UMR3569, Unité de Virologie Structurale, 75015 Paris, France. Electronic address:

The human monoclonal antibody C10 exhibits extraordinary cross-reactivity, potently neutralizing Zika virus (ZIKV) and the four serotypes of dengue virus (DENV1-DENV4). Here we describe a comparative structure-function analysis of C10 bound to the envelope (E) protein dimers of the five viruses it neutralizes. We demonstrate that the C10 Fab has high affinity for ZIKV and DENV1 but not for DENV2, DENV3, and DENV4. We further show that the C10 interaction with the latter viruses requires an E protein conformational landscape that limits binding to only one of the three independent epitopes per virion. This limited affinity is nevertheless counterbalanced by the particle's icosahedral organization, which allows two different dimers to be reached by both Fab arms of a C10 immunoglobulin. The epitopes' geometric distribution thus confers C10 its exceptional neutralization breadth. Our results highlight the importance not only of paratope/epitope complementarity but also the topological distribution for epitope-focused vaccine design.
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http://dx.doi.org/10.1016/j.cell.2021.11.010DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8724787PMC
December 2021

Brachial Plexus Injury due to Central-line Insertion during Kypho-scoliosis Deformity Correction.

J Orthop Case Rep 2021 Jul;11(7):41-44

Department of Orthopaedics and Spine Surgery, Zydus Hospitals and Healthcare Research Pvt. Ltd., Thaltej, Ahmedabad, Gujarat, India.

Introduction: Internal Jugular Venous (IJV) cannulation or central-line insertion is frequently performed during kyphoscoliosis deformity correction surgery or spine surgery with high risk. This helps monitor central venous pressure and administer medicines when required. Although many complications of IJV cannulation have been reported in the literature, its effect on brachial plexus is not known. The objective of this paper was to report a rare complication of IJV during scoliosis surgery.

Case Presentation: We reported a case of 27-year-old male who was operated for severe kyphoscoliosis correction where preoperatively IJV cannulation was done. Repeated attempts were done during IJV cannula insertion due to altered anatomy. Eventually, cannula insertion was done using ultrasound modality and surgery for correction was done. Postoperatively patient developed right upper extremity weakness and sensory loss although the clinical result of kyphoscoliosis correction was acceptable. EMG-NCV study proved it brachial plexus injury. The patient was treated with intravenous steroid and physiotherapy. The patient recovered completely within 6 months of surgery.

Conclusion: We reported a case of kyphoscoliosis deformity corrective surgery where IJV cannulation led to brachial plexus injury and was eventually recovered with medications and physiotherapy.
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http://dx.doi.org/10.13107/jocr.2021.v11.i07.2308DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8576778PMC
July 2021

BOX engineering to mitigate negative differential resistance in MFIS negative capacitance FDSOI FET: an analog perspective.

Nanotechnology 2021 Dec 2;33(8). Epub 2021 Dec 2.

Department of Electronics and Communication Engineering, IIT Roorkee, Roorkee, India.

Till date, the existing understanding of negative differential resistance (NDR) is obtained from metal-ferro-metal-insulator-semiconductor (MFMIS) FET, and it has been utilized for both MFMIS and metal-ferro-insulator-semiconductor (MFIS) based NCFETs. However, in MFIS architecture, the ferroelectric capacitance () is not a lumped capacitance. Therefore, for MFIS negative capacitance (NC) devices, the physical explanation which governs the NDR mechanism needs to be addressed. In this work, for the first time, we present the first principle explanation of the NDR effect in MFIS NC FDSOI. We found that the output current variation with the drain to source voltage (), (i.e.) primarily depends upon two parameters: (a)dependent inversion charge gradient (); (b)sensitive electron velocity (), and the combined effect of these two dependencies results in NDR. Further, to mitigate the NDR effect, we proposed the BOX engineered NC FDSOI FET, in which the buried oxide (BOX) layer is subdivided into the ferroelectric (FE) layer and the SiOlayer. In doing so, the inversion charge in the channel is enhanced by the BOX engineered FE layer, which in turn mitigates the NDR and a nearly zerowith a minimal positive slope has been obtained. Through well-calibrated TCAD simulations, by utilizing the obtained positive, we also designed aindependent constant current mirror which is an essential part of analog circuits. Furthermore, we discussed the impact of the FE parameter (remanent polarization and coercive field) variation on the device performances. We have also compared the acquired results with existing literature on NC-based devices, which justifies that our proposed structure exhibits complete diminution of NDR, thus enabling its use in analog circuit design.
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http://dx.doi.org/10.1088/1361-6528/ac328aDOI Listing
December 2021

Prevalence and predictors of Potentially Inappropriate Psychotropic Medication in older adults with psychiatric illness.

Asian J Psychiatr 2021 Dec 1;66:102872. Epub 2021 Oct 1.

Multi-Disciplinary Research Unit, Guru Gobind Singh Medical College and Hospital, Faridkot, India. Electronic address:

Background: There is limited information available on the use of Potentially Inappropriate Psychotropic (PIP) medication in older adults having a psychiatric illness.

Objective: To determine the prevalence of and predictors of prescribing PIP medications in older adults with psychiatric illness.

Methods: A cross-sectional study was carried out at a tertiary care hospital on 456 patients of either sex, with a median age of 65 years attending the psychiatry outpatient department. Evaluation of PIP medication was done using Beers criteria 2019 and Screening tool of Older Persons Potentially Inappropriate Medication (STOPP) criteria 2015. Bivariate logistic regression was used to find out the predictors of PIP prescribing.

Results: Results of the study reflect that a staggering number of older adults, (more than 91% and 73%) out of a total of 456 patients were prescribed with at least one PIP medication identified by Beers criteria and STOPP criteria, respectively. Long-acting benzodiazepine (LABZD) like clonazepam was identified as one of the most commonly prescribed PIP medications by both sets of criteria. Further analysis revealed that older adults from rural background (Odds Ratio (OR) 2.60, 95% Confidence Interval (CI) 1.20-5.65; P = 0.015), Tricyclic Antidepressant (TCA) (OR 0.30, 95% CI 0.12-0.75; P = 0.010), LABZD (OR 33.72, 95% CI 11.27-100.85; P = < 0.001), atypical antipsychotics (OR 22.35, 95% CI 5.31-93.99; P = < 0.001) use were most common predictors for PIP medication prescribing.

Conclusion: The study suggests that the Beer criteria detects more PIP medication than the STOPP criteria.
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http://dx.doi.org/10.1016/j.ajp.2021.102872DOI Listing
December 2021

Antibody response after first and second-dose of ChAdOx1-nCOV (Covishield®) and BBV-152 (Covaxin®) among health care workers in India: The final results of cross-sectional coronavirus vaccine-induced antibody titre (COVAT) study.

Vaccine 2021 10 24;39(44):6492-6509. Epub 2021 Sep 24.

Associate Professor, Dept. of Community Medicine, Mahatma Gandhi Medical College & Hospital, Jaipur, Rajasthan, India.

Background: We assessed the humoral immune response of both ChAdOx1-nCOV (Covishield) and BBV-152 (Covaxin) vaccines in Indian health care workers (HCW).

Methods: A Pan-India, Cross-sectional, Coronavirus Vaccine-induced Antibody Titre (COVAT) study was conducted that measured SARS-CoV-2 anti-spike binding antibody quantitatively, 21 days or more after the first and second dose of two vaccines in both severe acute respiratory syndrome (SARS-CoV-2) naïve and recovered HCW. Primary aim was to analyze antibody response (seropositivity rate, Geometric Mean Titre [GMT] and 95% Confidence Interval [CI]) following each dose of both vaccines and its correlation to age, sex, blood group, body mass index (BMI) and comorbidities. Here we report the results of anti-spike antibody response after first and two completed doses.

Results: Among the 515 HCW (305 Male, 210 Female) who took two doses of both vaccines, 95.0% showed seropositivity to anti-spike antibody. However, both seropositivity rate and GMT (95% CI) of anti-spike antibody was significantly higher in Covishield vs. Covaxin recipients (98.1 vs. 80.0%; 129.3 vs. 48.3 AU/mL; both p < 0.001). This difference persisted in 457 SARS-CoV-2 naïve and propensity-matched (age, sex and BMI) analysis of 116 participants. Age > 60-years, males, people with any comorbidities, and history of hypertension (HTN) had a significantly less anti-spike antibody GMT compared to age ≤ 60 years, females, no comorbidities and no HTN respectively, after the completion of two doses of either vaccine. Gender, presence of comorbidities, and vaccine type were independent predictors of antibody seropositivity rate and anti-spike antibody titre levels in multiple logistic and log transformed linear regression analysis. Both vaccine recipients had similar solicited mild to moderate adverse events and none had severe or unsolicited side effects.

Conclusions: Both vaccines elicited good immune response after two doses, although seropositivity rates and GMT of anti-spike antibody titre was significantly higher in Covishield compared to Covaxin recipients.
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http://dx.doi.org/10.1016/j.vaccine.2021.09.055DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8461292PMC
October 2021

Association of SARS CoV-2 Cycle Threshold (Ct) with Outcomes in COVID-19: Hospital-Based Study.

J Assoc Physicians India 2021 07;69(7):20-23

Academic Research Development Unit, Rajasthan University of Health Sciences, Jaipur, Rajasthan.

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July 2021

The Role of Religiosity and Guilt in Symptomatology and Outcome of Obsessive Compulsive Disorder.

Psychopharmacol Bull 2021 06;51(3):38-49

Rakesh, MD, Arvind, MD, Dutt, MD, Mamta, PhD, Bhavneesh, MD, Kavita, MD, Navneet, MBBS, Shrutika, MD, Priyanka, MD, Arun, MD, Harkamal, MD, Jagdeep, MD, Department of Psychiatry, Guru Gobind Singh Medical College and Hospital, Baba Farid University of Health Sciences, Punjab, India.

Importance: Religiosity and guilt are commonly featured in obsessive-compulsive disorders (OCD). The role of religiosity and guilt in OCD has been frequently studied in the literature and suggested that greater religiosity/spirituality, paranormal beliefs, and magical ideation have often been associated with enhanced obsessive-compulsive behavior. India being a multi-religious country, it is particularly notable that a research was required to assess the role of religiosity and guilt in symptomatology and outcome in OCD, a condition in which religious themes are often present. It has also been documented that the fear of guilt for doing something irresponsibly may lead to OCD symptoms.

Objective: The study aimed to seek the role of religiosity and guilt in symptomatology and outcome of OCD. This study also aimed to assess the pattern of symptomatology of patients with OCD and the relation between religiosity and guilt.

Settings And Design: This was a single-centered, prospective study for one year with six months follow-up.

Methods And Material: Fifty OCD subjects of either gender, aged between 18 years and 45 years were included in this study and were assessed using Yale-Brown Obsessive Compulsive Scale, Belief into Action Scale, and The Guilt Inventory instruments for the measurement of OCD severity, religiosity, and guilt, respectively. All the recorded data were analyzed using IBM SPSS version 20.1.

Results: At baseline, OCD severity was positively correlated with religiosity and guilt, while after 6-month follow-up, OCD severity was negatively correlated with religiosity and positively correlated with guilt.

Conclusion: Religiosity and guilt have significant effect on the symptomatology and outcome of OCD.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8374933PMC
June 2021

Clinical profile and outcome of non-COVID strokes during pandemic and the pre pandemic period: COVID-Stroke Study Group (CSSG) India.

J Neurol Sci 2021 09 16;428:117583. Epub 2021 Jul 16.

Department of Neuroimaging and Interventional Neuroradiology, All India Institute of Medical Sciences (AIIMS), New Delhi, India.

Background: As the health systems around the world struggled to meet the challenges of COVID-19 pandemic, care of many non-COVID emergencies was affected.

Aims: The present study examined differences in the diagnosis, evaluation and management of stroke patients during a defined period in the ongoing pandemic in 2020 when compared to a similar epoch in year 2019.

Methods: The COVID stroke study group (CSSG) India, included 18 stroke centres spread across the country. Data was collected prospectively between February and July 2020 and retrospectively for the same period in 2019. Details of demographics, stroke evaluation, treatment, in-hospital and three months outcomes were collected and compared between these two time points.

Results: A total of 2549 patients were seen in both study periods; 1237 patients (48.53%) in 2019 and 1312 (51.47%) in 2020. Although the overall number of stroke patients and rates of thrombolysis were comparable, a significant decline was observed in the month of April 2020, during the initial period of the pandemic and lockdown. Endovascular treatment reduced significantly and longer door to needle and CT to needle times were observed in 2020. Although mortality was higher in 2020, proportion of patients with good outcome were similar in both the study periods.

Conclusions: Although stroke admissions and rates of thrombolysis were comparable, some work flow metrics were delayed, endovascular stroke treatment rates declined and mortality was higher during the pandemic study period. Reorganization of stroke treatment pathways during the pandemic has likely improved the stroke care delivery across the globe.
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http://dx.doi.org/10.1016/j.jns.2021.117583DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8282445PMC
September 2021

The mucormycosis epidemic within COVID-19 pandemic- lessons from India.

Brain Behav Immun 2021 10 8;97:4-5. Epub 2021 Aug 8.

Department of Medicine, National University Hospital and Yong Loo Lin School of Medicine, National University of Singapore, Singapore. Electronic address:

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http://dx.doi.org/10.1016/j.bbi.2021.08.005DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8349392PMC
October 2021

RNAi by Soaking Pupae in dsRNA.

Insects 2021 Jul 13;12(7). Epub 2021 Jul 13.

Department of Biochemistry and Molecular Biology, University of Nevada, Reno, NV 89557, USA.

RNA-interference (RNAi) is a standard technique for functional genomics in adult mosquitoes. However, RNAi in immature, aquatic mosquito stages has been challenging. Several studies have shown successful larval RNAi, usually in combination with a carrier molecule. Except for one study in malaria mosquito, , none of the previous studies has explored RNAi in mosquito pupae. Even in the study that used RNAi in pupae, double stranded RNA (dsRNA) was introduced by microinjection. Here, we describe a successful method by soaking pupae in water containing dsRNA without any carrier or osmotic challenge. The knockdown persisted into adulthood. We expect that this simple procedure will be useful in the functional analysis of genes that highly express in pupae or newly emerged adults.
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http://dx.doi.org/10.3390/insects12070634DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8307132PMC
July 2021

Efficacy of IVRS-based mHealth intervention in reducing cardiovascular risk in metabolic syndrome: A cluster randomized trial.

Diabetes Metab Syndr 2021 Sep-Oct;15(5):102182. Epub 2021 Jun 21.

Academic Research Development Unit, Rajasthan University of Health Sciences, 302033, Jaipur, India.

Aims: Efficacy of mobile-phone based intervention for reducing cardiovascular risk in metabolic syndrome (MetSyn).

Methods: We screened adults 20-60 years in 10 villages in India for MetSyn using stratified cluster sampling. Lifestyle and biochemical risk factors were assessed. International Harmonized Criteria were used for diagnosis. Villages were randomized with 5 each in control and intervention groups. Interactive voice response system (IVRS) in Hindi was developed. In intervention clusters two messages for promotion of healthy lifestyle and medical treatment were broadcast daily over 12-months and risk factors reassessed.

Results: 1012/1200(84%) persons were screened and MetSyn diagnosed in 286(28.3%). Villages were divided into 5 control(n = 136) and 5 intervention(n = 147) clusters. Baseline characteristics in both clusters were similar. Acceptability of intervention was >60% in 80% participants. At 12 months, significantly greater participants in intervention vs control clusters had healthier lifestyle (healthy diet 28.8vs14.7%, physical activity 25.9vs13.1%, tobacco 13.7vs32.5%), anthropometry (waist circumference 85.7 ± 6.3vs88.6 ± 14.0 cm, body mass index 21.9 ± 2.8vs23.1 ± 2.9 kg/m), systolic BP 123.6 ± 7.7vs128.6 ± 14.1 mmHg, fasting glucose 95.6 ± 19.4vs109.4 ± 43.7 mg/dl, cholesterol 175.5 ± 36.5vs186.4 ± 43.3 mg/dl, and triglycerides 147.6 ± 48.3vs159.5 ± 60.7 mg/dl (p < 0.01). Prevalence of metabolic syndrome declined in intervention group by 22.3%vs3.9%, p < 0.001).

Conclusion: An interactive voice response system based technology significantly reduced multiple cardiovascular risk factors and prevalence of metabolic syndrome.
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http://dx.doi.org/10.1016/j.dsx.2021.06.019DOI Listing
January 2022

Mucormycosis and COVID-19: An epidemic within a pandemic in India.

Mycoses 2021 Oct 24;64(10):1253-1260. Epub 2021 Jul 24.

Division of Neurology, Department of Medicine, National University Hospital and Yong Loo Lin School of Medicine, National University of Singapore, Singapore.

Importance: Coronavirus disease (COVID-19) causes an immunosuppressed state and increases risk of secondary infections like mucormycosis. We evaluated clinical features, predisposing factors, diagnosis and outcomes for mucormycosis among patients with COVID-19 infection.

Methods: This prospective, observational, multi-centre study included 47 consecutive patients with mucormycosis, diagnosed during their course of COVID-19 illness, between January 3 and March 27, 2021. Data regarding demography, underlying medical conditions, COVID-19 illness and treatment were collected. Clinical presentations of mucormycosis, imaging and biochemical characteristics and outcome were recorded.

Results: Of the 2567 COVID-19 patients admitted to 3 tertiary centres, 47 (1.8%) were diagnosed with mucormycosis. Mean age was 55 ± 12.8years, and majority suffered from diabetes mellitus (n = 36, 76.6%). Most were not COVID-19 vaccinated (n = 31, 66.0%) and majority (n = 43, 91.5%) had developed moderate-to-severe pneumonia, while 20 (42.6%) required invasive ventilation. All patients had received corticosteroids and broad-spectrum antibiotics while most (n = 37, 78.7%) received at least one anti-viral medication. Mean time elapsed from COVID-19 diagnosis to mucormycosis was 12.1 ± 4.6days. Eleven (23.4%) subjects succumbed to their disease, mostly (n = 8, 72.7%) within 7 days of diagnosis. Among the patients who died, 10 (90.9%) had pre-existing diabetes mellitus, only 2 (18.2%) had received just one vaccine dose and all developed moderate-to-severe pneumonia, requiring oxygen supplementation and mechanical ventilation.

Conclusions: Mucormycosis can occur among COVID-19 patients, especially with poor glycaemic control, widespread and injudicious use of corticosteroids and broad-spectrum antibiotics, and invasive ventilation. Owing to the high mortality, high index of suspicion is required to ensure timely diagnosis and appropriate treatment in high-risk populations.
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http://dx.doi.org/10.1111/myc.13353DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8446956PMC
October 2021

INSTRuCT: Protocol, Infrastructure, and Governance.

Stroke 2021 10 25;52(10):e574-e580. Epub 2021 Jun 25.

Department of Neurology, All India Institute of Medical Sciences, New Delhi, India (M.V.S., R.B.).

Background And Purpose: Very few large scale multicentric stroke clinical trials have been done in India. The Indian Council of Medical Research funded INSTRuCT (Indian Stroke Clinical Trial Network) as a task force project with the objectives to establish a state-of-the-art stroke clinical trial network and to conduct pharmacological and nonpharmacological stroke clinical trials relevant to the nation and globally. The purpose of the article is to enumerate the structure of multicentric stroke network, with emphasis on its scope, challenges and expectations in India.

Methods: Multiple expert group meetings were conducted by Indian Council of Medical Research to understand the scope of network to perform stroke clinical trials in the country. Established stroke centers with annual volume of 200 patients with stroke with prior experience of conducting clinical trials were included. Central coordinating center, standard operating procedures, data and safety monitoring board were formed.

Discussion: In first phase, 2 trials were initiated namely, SPRINT (Secondary Prevention by Structured Semi-Interactive Stroke Prevention Package in India) and Ayurveda treatment in the rehabilitation of patients with ischemic stroke in India (RESTORE [Rehabilitation of Ischemic stroke Patients in India: A Randomized controlled trial]). In second phase, 4 trials have been approved. SPRINT trial was the first to be initiated. SPRINT trial randomized first patient on April 28, 2018; recruited 3048 patients with an average of 128.5 per month so far. The first follow-up was completed on May 27, 2019. RESTORE trial randomized first patient on May 22, 2019; recruited 49 patients with an average of 3.7 per month so far. The first follow-up was completed on August 30, 2019.

Conclusions: In next 5 years, INSTRuCT will be able to complete high-quality large scale stroke trials which are relevant globally.

Registration: URL: http://www.ctri.nic.in/; Unique Identifier: CTRI/2017/05/008507.
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http://dx.doi.org/10.1161/STROKEAHA.120.033149DOI Listing
October 2021

Prevalence and follow-up of subclinical rheumatic heart disease among asymptomatic school children in a north-western district of India based on the World Heart Federation echocardiographic criteria.

Echocardiography 2021 07 28;38(7):1173-1178. Epub 2021 May 28.

Cardiovascular Medicine, University of Alabama at Birmingham, Birmingham, AL, USA.

Background: The present study is based on the World Heart Federation (WHF) echocardiographic criteria to assess the prevalence of subclinical rheumatic heart disease (RHD) and elucidate evolution of the disease when the cases were placed on appropriate antibiotic prophylaxis and regular follow-up. The prevalence of subclinical RHD reported by previous active surveillance studies among asymptomatic school children is not comparable to our study because of major differences in screening methods.

Methods: A random inclusion strategy was adopted to recruit urban and rural school children of Bikaner district in the state of Rajasthan, India. The diagnosis of RHD was based on the echocardiographic criteria proposed by the WHF. All studies were reported on-site by a single experienced cardiologist and the digitally preserved studies were reported by a second cardiologist off-site. The final diagnosis was made by consensus. The second echocardiogram was performed for cases diagnosed with RHD after two years from start of study to document early evolution of the disease with ongoing antibiotic prophylaxis.

Results: A high prevalence of subclinical RHD was observed in the study population. Pathological mitral and/or aortic valve regurgitation was the commonest lesion, and a significant proportion of cases improved while on regular antibiotic prophylaxis. No case showed fixity of leaflets/ stenosis.

Conclusion: The prevalence of subclinical RHD is high in the study population, and the disease seems to regress over time in the presence of appropriate antibiotic prophylaxis.
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http://dx.doi.org/10.1111/echo.15035DOI Listing
July 2021

Genetic Manipulation of Ticks: A Paradigm Shift in Tick and Tick-Borne Diseases Research.

Front Cell Infect Microbiol 2021 10;11:678037. Epub 2021 May 10.

Department of Biochemistry and Molecular Biology, The University of Nevada, Reno, NV, United States.

Ticks are obligate hematophagous arthropods that are distributed worldwide and are one of the most important vectors of pathogens affecting humans and animals. Despite the growing burden of tick-borne diseases, research on ticks has lagged behind other arthropod vectors, such as mosquitoes. This is largely because of challenges in applying functional genomics and genetic tools to the idiosyncrasies unique to tick biology, particularly techniques for stable genetic transformations. CRISPR-Cas9 is transforming non-model organism research; however, successful germline editing has yet to be accomplished in ticks. Here, we review the ancillary methods needed for transgenic tick development and the use of CRISPR/Cas9, the most promising gene-editing approach, for tick genetic transformation.
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http://dx.doi.org/10.3389/fcimb.2021.678037DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8141593PMC
July 2021

A comparative study on the safety and efficacy of naltrexone versus baclofen versus acamprosate in the management of alcohol dependence.

Indian J Psychiatry 2020 Nov-Dec;62(6):650-658. Epub 2020 Dec 12.

Department of Psychiatry, Guru Gobind Singh Medical College and Hospital, Faridkot, Punjab, India.

Background: The efficacy of naltrexone, baclofen, and acamprosate in the treatment of alcohol dependence has been successfully established over the past several years. The knowledge about their relative efficacies can facilitate in developing relapse prevention strategies that would give rise to a greater personal and socioeconomic benefits.

Aims And Objective: To assess and compare the safety and efficacy profile of naltrexone, baclofen, and acamprosate in the treatment of alcohol dependence. In addition to this, the pattern of relapse and attitude of patients toward the treatment were also assessed.

Materials And Methods: This was a prospective study carried out at a tertiary care center. It comprised of thirty alcohol-dependent patients each assigned to naltrexone, baclofen, and acamprosate group after detoxification. The patients were assessed for craving, relapse risk, and medication adherence using the respective scales and questionnaires.

Results: In terms of Obsessive Compulsive Drinking Scale score decline, the decline seen in the naltrexone group (26.72 ± 13.05) was maximum, followed by baclofen and acamprosate. In terms of decreasing Advance Warning of Relapse (AWARE) questionnaire score, again naltrexone was most effective, with the maximum decline in AWARE score (64.72 ± 45.65), followed by baclofen and acamprosate. The attitude toward treatment with all the three medications was positive, as per the Hogan Drug Attitude Inventory score.

Conclusion: Naltrexone was most effective in decreasing craving and drinking behavior. Baclofen showed best tolerability in terms of liver function tests and least number of side effects reported. Naltrexone group reported the least number of relapses but maximum number of side effects. Acamprosate group had the maximum dropout rate.
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http://dx.doi.org/10.4103/psychiatry.IndianJPsychiatry_201_19DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8052868PMC
December 2020

Targeting "diabetic" coronary artery disease merging the properties of sirolimus coated balloon with sirolimus eluting stent.

Minerva Cardiol Angiol 2021 Oct 7;69(5):525-532. Epub 2021 Apr 7.

Department of Cardiology, IRCCS San Donato Polyclinic, Milan, Italy.

Background: Patients with diabetes mellitus (DM) represents a challenging subset of population as they experience worse outcomes after percutaneous coronary intervention than patients without diabetes. We evaluated the 2-year efficacy and safety profile of the Abluminus DES+ in patients with diabetes within the population enrolled in the large multicenter en-ABL e-registry.

Methods: Multicenter, prospective, all-comers registry performed in 31 centers in India. We analyze patients according to the diagnosis of DM and insulin dependency (ID or Non-ID): non-DM (1641 patients), NIDDM (721 patients), IDDM (138 patients). The primary endpoint was a composite of device-oriented major adverse cardiac events (MACE): cardiac death, target vessel-related myocardial infarction (MI), and ischemia-driven target lesion revascularization (TLR)/ target vessel revascularization (TVR) at 2-year. Stent thrombosis (ST) at any time point was also recorded.

Results: The MACE rate at 2-year follow-up was 3.0% in the overall population with DM patients showing a higher rate of primary endpoint compared to non-DM (4.4% vs. 2.4%, P=0.025). Rate of cardiac death was actually low and consistent between the 2 groups (1.7% vs. 0.9%, P=0.100). At 2-year follow-up, the rate of ST was 0.9% in DM patients versus 0.5% in non-DM, P=0.213.

Conclusions: At 2-year follow-up, the Abluminus DES+ technology that merges the features of a sirolimus coated balloon with those of a bioresorbable polymer drug eluting stent appears to be safe and effective. This safety/efficacy profile was consistent in patients with or without DM.
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http://dx.doi.org/10.23736/S2724-5683.20.05413-4DOI Listing
October 2021

An Asia-Pacific study on healthcare workers' perceptions of, and willingness to receive, the COVID-19 vaccination.

Int J Infect Dis 2021 May 26;106:52-60. Epub 2021 Mar 26.

Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Division of Neurology, Department of Medicine, National University Health System, Singapore.

Objective: In the fight against COVID-19, vaccination is vital in achieving herd immunity. Many Asian countries are starting to vaccinate frontline workers; however, expedited vaccine development has led to hesitancy among the general population. We evaluated the willingness of healthcare workers to receive the COVID-19 vaccine.

Methods: From 12 to 21 December 2020, we recruited 1720 healthcare workers from 6 countries: China, India, Indonesia, Singapore, Vietnam and Bhutan. The self-administrated survey collected information on willingness to vaccinate, perception of COVID-19, vaccine concerns, COVID-19 risk profile, stigma, pro-socialness scale, and trust in health authorities.

Results: More than 95% of the healthcare workers surveyed were willing to vaccinate. These respondents were more likely to perceive the pandemic as severe, consider the vaccine safe, have less financial concerns, less stigmatization regarding the vaccine, higher pro-socialness mindset and trust in health authorities. A high perceived pandemic risk index, low vaccine harm index and high pro-socialness index were independent predictors in multivariable analysis.

Conclusions: The majority of healthcare workers in Asia are willing to receive COVID-19 vaccination. Perceived COVID-19 susceptibility, low potential risk of vaccine harm and pro-socialness are the main drivers. These findings may help formulate vaccination strategies in other countries.
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http://dx.doi.org/10.1016/j.ijid.2021.03.069DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7997703PMC
May 2021

Systematic Development of Structured Semi-interactive Stroke Prevention Package for Secondary Stroke Prevention.

Ann Indian Acad Neurol 2020 Sep-Oct;23(5):681-686. Epub 2020 Oct 7.

Department of Neurology, Christian Medical College, Ludhiana, Punjab, India.

Background: Lack of compliance to medication and uncontrolled risk factors are associated with increased risk of recurrent stroke and acute coronary syndrome in patients with recent stroke. Multimodal patient education may be a strategy to improve the compliance to medication and early adoption of nonpharmacological measures to reduce the vascular risk factor burden in patients with stroke. We thus aim to develop multilingual short messaging services (SMS), print, and audio-visual secondary stroke prevention patient education package. The efficacy of the package will be tested in a randomized control trial to prevent major cardiovascular and cerebrovascular events.

Methods: In the stage, intervention materials (SMS, video, and workbook) were developed. In the stage, the package was independently assessed and modified by the stakeholders involved in the stroke patient care and local language experts. The modified stroke prevention package was tested for implementation issues ( stage).

Results: Sixty-nine SMS, six videos, and workbook with 11 chapters with 15 activities were developed in English language with a mean ± SD SMOG index of 9.1 ± 0.4. A total of 355 stakeholders including patients (24.8%), caregivers (24.8%), doctors (10.4%), nurses (14.1%), local language experts (2.8%), physiotherapists (13.2%), and research coordinators (9.8%) participated in 10 acceptability stage meetings. The mean Patient Education Material Assessment Tool understandability score in all languages for SMS, video scripts, and workbook was 95.2 ± 2.6%, 95.2 ± 4.4%, and 95.3 ± 3.6%, respectively. The patients [ = 20, mean age of 70.3 ± 10.6 years and median interquartile range (IQR) baseline NIHSS 1 (0-3)] or the research coordinators ( = 2) noted no implementation issues at the end of 1 month.

Conclusion: An implementable complex multilingual patient education material could be developed in a stepwise manner. The efficacy of the package to prevent major adverse cardiovascular events is being tested in the SPRINT INDIA study.
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http://dx.doi.org/10.4103/aian.AIAN_639_19DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7887475PMC
October 2020

Clonazepam tops the list of potentially inappropriate psychotropic (PIP) medications in older adults with psychiatric illness: A cross-sectional study based on Beers criteria 2019 vs STOPP criteria 2015.

Asian J Psychiatr 2021 Apr 13;58:102570. Epub 2021 Feb 13.

Indian Council of Medical Research Scientist-l, Multidisciplinary Research Unit (Department of Health Research, Government of India), Guru Gobind Singh Medical College, Faridkot, Punjab, 151203, India. Electronic address:

Background: In older adults, polypharmacy and potentially inappropriate psychotropic (PIP) medication use are prominent prescription challenges. However, there is limited information available on the use of PIP medication in older adults having psychiatry illness.

Objective: To find out the most commonly prescribed PIP in tertiary care hospitals of developing countries with respect to Beers criteria 2019 and Screening Tool of Older Persons' Potentially Inappropriate Prescriptions (STOPP) and predictors of PIP.

Methods: A cross-sectional analysis of 456 patients of either sex with a median age of 65 years visiting the outpatient department of psychiatry was performed at the tertiary care hospital of North India with respect to Beers criteria 2019 and STOPP criteria 2015. Bivariate logistic regression was used to figure out the predictors of PIP medication.

Results: Results of the study reflects a staggering number of older adults, (more than 91 % and 73 %) out of total 456 patients were prescribed with at least one PIP medication as per Beers criteria and STOPP criteria, respectively. Long-acting benzodiazepine like clonazepam, chlordiazepoxide were identified as one of the most commonly prescribed PIP medications with respect to the both set of criteria. Further analysis revealed that polypharmacy (≥5 medications with odds Ratio (OR) 17.33, 95% Confidence Interval (CI) 1.42-210.66, P-0.025) as the sole important predictor for PIP medication.

Conclusion: According to the Beers criterion and the STOPP criteria, the use of PIP medicine is very prevalent among older adults with psychiatric illness. The Beers criteria dramatically diagnose more PIP medication than STOPP criteria.
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http://dx.doi.org/10.1016/j.ajp.2021.102570DOI Listing
April 2021

Macrolevel association of COVID-19 with non-communicable disease risk factors in India.

Diabetes Metab Syndr 2021 Jan-Feb;15(1):343-350. Epub 2021 Jan 20.

Department of Medicine and Critical Care, Eternal Hospital, Eternal Heart Care Centre & Research Institute, Jaipur, India; Academic Research Development Unit, Rajasthan University of Health Sciences, Jaipur, India. Electronic address:

Background & Aims: Greater COVID-19 related mortality has been reported among persons with various non-communicable diseases (NCDs). We performed an ecological study to determine the association of state-level cases and deaths with NCD risk factors and healthcare and social indices.

Methods: We obtained cumulative national and state-level data on COVID-19 cases and deaths from publicly available database www.covid19india.org from February to end November 2020. To identify association with major NCD risk factors, NCDs, healthcare related and social variables we obtained data from public sources. Association was determined using univariate and multivariate statistics.

Results: More than 9.5 million COVID-19 cases and 135,000 deaths have been reported in India towards end of November 2020. There is significant positive correlation (Pearson r) of state-level COVID-19 cases and deaths per million, respectively, with NCD risk factors- obesity (0.64, 0.52), hypertension (0.28, 0.16), diabetes (0.66, 0.46), NCD epidemiological transition index (0.58, 0.54) and ischemic heart disease mortality (0.22, 0.33). Correlation is also observed with indices of healthcare access and quality (0.71, 0.61), urbanization (0.75, 0.73) and human (0.61, 0.56) and sociodemographic (0.70, 0.69) development. Multivariate adjusted analyses shows strong correlation of COVID-19 burden and deaths with NCD risk factors (r = 0.51, 0.43), NCDs (r = 0.32, 0.16) and healthcare (r = 0.52, 0.38).

Conclusions: COVID-19 disease burden and mortality in India is ecologically associated with greater state-level burden of NCDs and risk factors, especially obesity and diabetes.
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http://dx.doi.org/10.1016/j.dsx.2021.01.005DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7817457PMC
March 2021

"PGI Score": A Simplified Three-point Prognostic Score for Acute Aluminum Phosphide Poisoning.

Indian J Crit Care Med 2020 Sep;24(9):790-793

Department of Internal Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India.

Introduction: Aluminum phosphide (AlP) ingestion for self-harm is associated with a high case-fatality rate (CFR) in low- and middle-income countries. A reliable and accurate prognostic scoring tool is required for appropriate triaging, to guide clinical decision-making, and to evaluate the efficacy of therapeutic interventions for the patients with AlP toxicity.

Materials And Methods: We performed a prospective cohort study in a tertiary care hospital in north India in patients aged 15 years and over with acute AlP poisoning, investigating the parameters associated with CFR, and developing a reliable and simple prediction score.

Results: The CFR was 51% in this cohort of 105 patients. Three parameters-pH <7.25, score on Glasgow coma scale (GCS) <13, and systolic blood pressure (SBP) <87 mm Hg were most robust predictors of CFR (odds ratio; 12.614, 18.621, and 17.600, respectively; area under the receiver operating characteristic curve-0.808, 0.796, and 0.776, respectively). Based on these parameters (with 1 point to each), a prognostic score was developed, ranging from 0 to 3 points. A total score of 3 had a 98.2% specificity and a positive predictive value of 96.4%, whereas a score ≤1 had a 100% sensitivity and 100% negative predictive value.

Conclusion: A scoring system based on low pH (P), low GCS score (G), and impaired or low SBP (I) ("PGI" score) may provide a simplified predictive model for mortality in AlP poisoning.

How To Cite This Article: Pannu AK, Bhalla A, Sharma A, Sharma N. "PGI Score": A Simplified Three-point Prognostic Score for Acute Aluminum Phosphide Poisoning. Indian J Crit Care Med 2020;24(9):790-793.
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http://dx.doi.org/10.5005/jp-journals-10071-23555DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7584820PMC
September 2020

Asian-Pacific perspective on the psychological well-being of healthcare workers during the evolution of the COVID-19 pandemic.

BJPsych Open 2020 Oct 8;6(6):e116. Epub 2020 Oct 8.

Division of Neurology, Department of Medicine, National University Health System, Singapore; and Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore.

Background: The coronavirus disease 2019 (COVID-19) pandemic has led to significant strain on front-line healthcare workers.

Aims: In this multicentre study, we compared the psychological outcomes during the COVID-19 pandemic in various countries in the Asia-Pacific region and identified factors associated with adverse psychological outcomes.

Method: From 29 April to 4 June 2020, the study recruited healthcare workers from major healthcare institutions in five countries in the Asia-Pacific region. A self-administrated survey that collected information on prior medical conditions, presence of symptoms, and scores on the Depression Anxiety Stress Scales and the Impact of Events Scale-Revised were used. The prevalence of depression, anxiety, stress and post-traumatic stress disorder (PTSD) relating to COVID-19 was compared, and multivariable logistic regression identified independent factors associated with adverse psychological outcomes within each country.

Results: A total of 1146 participants from India, Indonesia, Singapore, Malaysia and Vietnam were studied. Despite having the lowest volume of cases, Vietnam displayed the highest prevalence of PTSD. In contrast, Singapore reported the highest case volume, but had a lower prevalence of depression and anxiety. In the multivariable analysis, we found that non-medically trained personnel, the presence of physical symptoms and presence of prior medical conditions were independent predictors across the participating countries.

Conclusions: This study highlights that the varied prevalence of psychological adversity among healthcare workers is independent of the burden of COVID-19 cases within each country. Early psychological interventions may be beneficial for the vulnerable groups of healthcare workers with presence of physical symptoms, prior medical conditions and those who are not medically trained.
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http://dx.doi.org/10.1192/bjo.2020.98DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7542327PMC
October 2020

Continuing Burden of Rheumatic Heart Disease in India.

J Assoc Physicians India 2020 Oct;68(10):60-65

Department of Medicine and Cardiology, Eternal Heart Care Centre and Research Institute, Jaipur, Rajasthan.

Rheumatic heart disease (RHD) disables millions in Asia and Africa. Epidemiological data and clinical studies in India have reported a significant decline in its prevalence in last century. Global Burden of Disease (GBD) study estimated that RHD in India led to 395/100000 disability adjusted life years (DALYs) and 9.2/100000 deaths in 1990. This declined to 270/100000 and 7.9/100000, respectively, in 2017. School-based epidemiological studies in India have reported decline in clinically diagnosed RHD. On the other hand, GBD study has reported that in terms of absolute numbers, India contributes to one-third of global RHD burden. RHD in 1990 led to 3.44 million DALYs and 80,470 deaths which has increased to 3.73 million DALYs and 108,460 deaths in 2017. India Disease Burden Initiative has reported high RHD burden in many less developed states of the country, e.g., Bihar, Odisha, Assam, Chhattisgarh, Uttar Pradesh, etc. Echocardiographic epidemiology studies have reported high burden of subclinical RHD. Significant proportions of patients in hospital-based echocardiographic clinics have RHD and it contributes to 25-45% of cardiac surgeries in government hospitals. The continuing burden of RHD needs proper public health and clinical response.
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October 2020

Characteristics and Outcomes of Hospitalized Young Adults with Mild Covid -19.

J Assoc Physicians India 2020 Aug;68(8):62-65

Department of Research, RUHS College of Medical Sciences, Rajasthan.

Background: Stormy course has been reported among hospitalized adults with COVID-19 in high- and middle-income countries. To assess clinical outcomes in consecutively hospitalized patients with mild covid-19 in India we performed a study.

Methods: We developed a case registry of successive patients admitted with suspected covid-19 infection to our hospital (n=501). Covid-19 was diagnosed using reverse transcriptase polymerase chain reaction (RT-PCR). Demographic, clinical, investigations details and outcomes were recorded. Descriptive statistics are presented.

Results: Covid-19 was diagnosed in 234 (46.7%) and data compared with 267 (53.3%) negative controls. Mean age of covid-19 patients was 35.1±16.6y, 59.4% were <40y and 64% men. Symptoms were in less than 10% and comorbidities were in 4-8%. History of BCG vaccination was in 49% cases vs 10% controls. Cases compared to controls had significantly greater white cell (6.96+1.89 vs 6.12+1.69x109 cells/L) and lower lymphocyte count (1.98+0.79 vs 2.32+0.91x109 cells/L). No radiological and electrocardiographic abnormality was observed. All these were isolated or quarantined in the hospital and observed. Covid-19 patients received hydroxychloroquine and azithromycin according to prevalent guidelines. One patient needed oxygen support while hospital course was uncomplicated in the rest. All were discharged alive. Conversion to virus negative status was in 10.2±6.4 days and was significantly lower in age >40y (9.1±5.2) compared to 40-59y (11.3±6.1) and ≥60y (16.4±13.3) (p=0.001).

Conclusions: This hospital-based registry shows that mildly symptomatic or asymptomatic young covid-19 patients have excellent prognosis.
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August 2020

Consensus Statement - Suggested Recommendations for Acute Stroke Management during the COVID-19 Pandemic: Expert Group on Behalf of the Indian Stroke Association.

Ann Indian Acad Neurol 2020 Apr 22;23(Suppl 1):S15-S23. Epub 2020 Apr 22.

Department of Neurology, Krishna Institute of Medical Sciences, Hyderabad, Telangana, India.

The ongoing pandemic of COVID-19 is a global public health emergency. This has led to challenges for healthcare facilities to optimally manage other important medical emergencies. Stroke is an important public health emergency with significant mortality and morbidity. Timely treatment of acute stroke is critical to prevent disability. The current expert consensus statement on behalf of the Indian Stroke Association outlines the issues and suggestions related to the management of stroke during this ongoing COVID-19 pandemic.
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http://dx.doi.org/10.4103/aian.AIAN_302_20DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7213027PMC
April 2020

The SARS-CoV-2/COVID-19 pandemic and challenges in stroke care in India.

Ann N Y Acad Sci 2020 08 12;1473(1):3-10. Epub 2020 May 12.

Department of Pharmacology and Toxicology, National Institute of Pharmaceutical Education and Research (NIPER), Ahmedabad, Gandhinagar, Gujarat, India.

Stroke care in India has evolved rapidly in the last decade with a focus on stroke awareness, prevention, rapid triage, treatment, and rehabilitation. But acute stroke care and poststroke rehabilitation in the country have limitations owing to the economic constraints and poor access to health care. The SARS-CoV-2/COVID-19 pandemic has made stroke care even more challenging. We outline the unfavorable circumstances in stroke care induced by the pandemic; propose mitigating measures; crisis management; and provide a comparative evaluation of stroke care between India and the United States during the pandemic. There is a need for public health systems in both developed and developing countries to improve awareness, implement proper strategies of triage, acute treatment, well-defined rehabilitation plans, telemedicine services, and virtual check-ins.
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http://dx.doi.org/10.1111/nyas.14379DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7273096PMC
August 2020
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