Pandian J.D.,Royal Brisbane and Womens Hospital |
Pandian J.D.,Betty Cowan Research and Innovation Center |
Dalton K.,Royal Brisbane and Womens Hospital |
Scott J.,Queensland Institute of Medical Research |
And 2 more authors.
Journal of Clinical Neuroscience | Year: 2010
We aimed to derive normative data for cardiovascular autonomic function tests (AFT) in an older population using new measures. The AFT were performed in 48 healthy control subjects. The average heart rate (HR) response to deep breathing (DB) (HRDB), Valsalva ratio (VR), magnitude of the HR and blood pressure (BP) response of different phases of the Valsalva maneuver, BP recovery times (PRT 100 and PRT 50) and HR and BP changes on head-up tilting were calculated. The mean age (±standard deviation) of study participants was 58 ± 14.5 years (range 20-82 years), of whom 29 (60%) were men. The systolic blood pressure (SBP) early phase 2 amplitude showed an inverse relationship with age (p = 0.03). There was a trend for progressive attenuation of SBP late phase 2 amplitude with age (p = 0.09). The systolic BP recovery time was not affected by age, gender or body mass index. We concluded that age has a significant effect on most AFT variables. Age and gender did not influence the systolic BP recovery time; hence, systolic BP recovery time could be useful in the evaluation of adrenergic failure. © 2009 Elsevier Ltd.
Pandian J.D.,Betty Cowan Research and Innovation Center
Neurology India | Year: 2011
Carotid stenosis is seen in 10% of patients with ischemic stroke, and carotid endarterectomy (CEA) and carotid artery stenting (CAS) are the two invasive treatments options available. Pooled analysis of the three largest randomized trials of CEA involving more than 3000 symptomatic patients estimated 30-day stroke and death rate at 7.1% after CEA. Some subgroups among the symptomatic patients appeared to have more benefit from CEA. These include patients aged 75 years or more, patients with ulcerated plaques, and patients with recent transient ischemic attacks within 2 weeks of randomization. Selection of asymptomatic patients for carotid revascularization should be guided by an assessment of comorbid conditions, life expectancy, and other individual factors, and should include a thorough discussion of the risks and benefits of the procedure with an understanding of patient preferences. The recent trials comparing CEA with CAS has not established its superiority over CEA. The carotid revascularization endarterectomy versus stenting (CREST) study showed that CAS is still associated with a higher periprocedural risk of stroke or death than CEA. In patients over 70 years of age, CEA is clearly superior to CAS. The increased risk of nonfatal myocardial infarction in the CREST group subjected to CEA clearly suggests that patients being considered for CEA or CAS require a careful preliminary cardiac evaluation. CAS can be justified for patients whose medical comorbidities or cervical anatomy make them questionable candidates for CEA. The benefit of revascularization by either method versus modern aggressive medical therapy has not been established for patients with asymptomatic carotid stenosis.
Pandian J.D.,Betty Cowan Research and Innovation Center |
Kaur A.,Betty Cowan Research and Innovation Center |
Jyotsna R.,Betty Cowan Research and Innovation Center |
Sylaja P.N.,Ananthapuri Hospitals and Research Center |
And 8 more authors.
Journal of Stroke and Cerebrovascular Diseases | Year: 2012
The prognosis and final outcome in patients who sustain stroke are significantly affected by medical complications occurring during the acute phase of stroke. Only limited information is available from India and other developing countries regarding acute complications of stroke. This study examined the frequency of acute stroke and the factors associated with complications of stroke in India. In this prospective multicenter study, running from March 2008 to September 2009, 6 hospitals collected information on complications of first-ever stroke during admission. Complications were defined in accordance with standard criteria. Outcome at 30 days poststroke was assessed using the modified Rankin Scale. Stroke characteristics, length of hospital stay, and stroke severity (based on the National Institutes of Health Stroke Scale) were documented. Hematologic (ie, hemoglobin) and biochemical (ie, total proteins and albumin) parameters also were obtained. A total of 449 patients out of the recruited 476 completed follow-up. The mean age was 58.1 ± 13.7 years (range, 16-96 years), and the majority were men (n = 282; 62.8%). The mean National Institutes of Stroke Scale score was 10.2 ± 5.3. Overall, 206 patients (45.9%) experienced complications during admission. In the logistic regression analysis, limb weakness (odds ratio [OR], 0.12; 95% confidence interval [CI], 0.02-0.67; P =.01), anemia (OR, 0.35; 95% CI, 0.15-0.81; P =.01), length of hospital stay (OR, 0.89; 95% CI, 0.85-0.94; P <.0001), and stroke severity (OR, 0.27; 95% CI, 0.10-0.72; P =.01) were the variables associated with complications. Such complications as urinary tract infection (OR, 0.31; 95% CI, 0.13-0.78; P =.01), chest infection (OR, 1.81; 95% CI, 1.12-2.93; P =.02), bedsores (OR, 3.52; 95% CI, 1.02-12.08; P =.05), other pain (OR, 0.21; 95% CI, 0.09-0.49; P <.0001), and depression (OR, 2.22; 95% CI, 1.30-3.80; P <.01) were associated with poor outcome. Our study shows high rates of complication in acute stroke. Limb weakness, stroke severity, length of hospital stay, and anemia were the factors associated with complications. Other complications, such as urinary tract infection, chest infection, bedsores, other pain, and depression, can lead to poor outcome. © 2012 by National Stroke Association.
Girotra M.,Betty Cowan Research and Innovation Center |
Gera C.,Betty Cowan Research and Innovation Center |
Abraham R.,Betty Cowan Research and Innovation Center |
Gauba R.,Betty Cowan Research and Innovation Center |
And 4 more authors.
Annals of Indian Academy of Neurology | Year: 2011
Background: Neurocysticercosis (NCC) is a common cause of epilepsy in developing countries. In order to plan and implement prevention programs, it is essential to study the awareness of NCC. Objective: To study the awareness of NCC among patients with NCC and compare with age- and gender-matched controls without NCC. Setting and Design: Hospital based case-control study. Materials and Methods: Two hundred and fourteen subjects were studied (109 NCC patients, and 105 age- and gender-matched controls without NCC). The participants were selected from neurology and medical wards of a tertiary referral hospital in northwest India. They were interviewed by trained medical interns using a questionnaire. Results: 64.2% of the NCC patients and 19% of control group had heard about NCC (P < 0.001). Knowledge regarding organ affected by NCC in the NCC group was 61.4% and in the control group was 80% (P = 0.09). Only 12.9% of the NCC group and none in the control group identified tape worm as a causative agent for NCC (P = 0.092). Negative effects of NCC on marriage and social life were more often cited by the NCC group but in the control group it was towards education (P = 0.004). Conclusions: The awareness of NCC was poor in both the groups. Educational programs are needed to improve the awareness about NCC among the patients and the public.