Amarpreet Kaur

Endovascular treatment of acute ischemic stroke.

Early recanalization of the occluded artery leads to better clinical outcomes in patients with acute ischemic stroke (AIS) through protection of the time-sensitive penumbra. Intravenous administration of pharmacologic thrombolytic agents has been a standard treatment for AIS. To get better rates of recanalization, enhance the time window, and diminish the possibility of intracranial hemorrhage, endovascular thrombectomy was launched, with first authorization of the Merci clot retriever, a corkscrew-like apparatus, followed by approval of the Penumbra thromboaspiration system. Both devices lead to a high rate of recanalization. On the other hand, time to recanalization was on an average of 45 minutes, with most of the patients attaining only partial recanalization. More lately, retrievable stents have shown promise in decreasing the time to recanalization, and attaining a superior rate of complete clot resolution. The retrievable stent can be released within the clot to engage it within the struts of the stent, and afterwards it is taken back by pulling it under flow arrest. Neurointerventional techniques have a persistently ever-increasing and stimulating role in the management of AIS, as indicated by the advent of several important techniques. Stent retrievers have the capability to be ascertained as the most important approach to endovascular stroke treatment.

Clot composition and treatment approach to acute ischemic stroke: The road so far

Recent histological studies of thrombi retrieved from patients with an acute ischemic stroke using the endovascular thrombectomy devices and correlation with early vessel computed tomography (CT) and magnetic resonance imaging (MRI) characteristics have given relevant insights into the pathophysiology of thrombotic lesions and may facilitate the development of improved reperfusion treatment approaches. We present a review of recent studies on the histopathologic analysis of thrombi, studies of MRI, and CT imaging correlation with thrombus histology, and detailed structural analysis of thromboemboli retrieved by thrombectomy devices during an acute ischemic stroke.

A prospective study assessing clinicians attitude and knowledge on radiation exposure to patients during radiological investigations.

Background: Exposure to radiation during radiological investigations is of health concern, which referring physicians should rationalize. Hence, we assessed the clinicians awareness and concern of radiation exposure to patients, in relation to their referral practice. Materials and Methods: A prospective study was conducted involving specialists from Punjab (India), who were handed a standard set of questionnaire concerning knowledge of radiation hazards and doses from imaging procedures, consideration of radiation dose and age when referring, referrals not likely to affect treatment, and use of referral guidelines were included. Of the 150 medical doctors given the questionnaire, 106 returned it. Results: Majority of the clinicians underestimated radiation doses, while a few overestimated it. Almost half of the clinicians (55.5%) favored to select the rationale of asking about previous radiological examinations as clinical need only, which was surprising. Rates of referrals unlikely to affect treatment were more (66%) than reported rates in previous studies. Worryingly, only 30.1% of the clinicians had knowledge of referral guidelines and alarmingly only 10.5% had made use of it. Conclusions: Our study although in a small population size identifies inadequate knowledge on radiation and its guidelines among referral physicians, which warrants the immediate need for training programs to bridge this knowledge gap.

The Effect of Exclusive Breastfeeding on Hospital Stay and Morbidity due to Various Diseases in Infants under 6 Months of Age: A Prospective Observational Study

Background. Mothers milk is the best for the babies. Protective and preventive role of breast milk was evaluated in this study by assessing the relation of type of feeding and duration of hospital stay or morbidity. Methods. This prospective study was conducted in a tertiary care hospital and 232 infants in the age group of 14 weeks to 6 months formed the sample. There are two groups of infants, that is, one for breastfed and one for top fed infants. Statistical analysis was done and results were calculated up to 95% to 99% level of significance to find effect of feeding pattern on hospital stay due to various diseases and morbidity. Results. Prolonged hospital stay, that is, >7 days, was lesser in breastfed infants and results were statistically significant in case of gastroenteritis (p value < 0.001), bronchopneumonia (p value = 0.0012), bronchiolitis (p value = 0.005), otitis media (p value = 0.003), and skin diseases (p value = 0.047). Lesser morbidity was seen in breastfed infants with gastroenteritis (p value 0.0414), bronchopneumonia (p value 0.03705), bronchiolitis (p value 0.036706), meningitis (p value 0.043), and septicemia (p value 0.04). Conclusions. Breastfed infants have shorter hospital stay and lesser morbidity in regard to various diseases as compared to top fed infants.

Telephonic consultation and follow-up in diabetics: Impact on metabolic profile, quality of life, and patient compliance

Background: Diabetes mellitus (DM), being a long-term condition, requires consistent blood glucose monitoring and adjustment of doses of the antidiabetic drugs and insulin. Telehealth is an emerging field that can have a positive impact on the management of this disease. Aim: The aim was to study the impact of the frequency of consultation and follow-up on telephone of diagnosed follow-up patients of DM on glycemic and metabolic profiles, the patients′ compliance, and their quality of life (QoL), and to compare the effectiveness of different modes of follow-up. Materials and Methods: One hundred twenty patients were enrolled from the outpatient department (OPD) including both type 1 and type 2 DM patients who had already been diagnosed and were on treatment. They were randomly assigned to one of three groups, each consisting of 40 subjects, according to the mode of follow-up: A (rare, i.e., less frequent outpatient visits), B (moderate, i.e., more frequent outpatient visits), and C (frequent, i.e., more frequent outpatient visits with weekly telephonic consultation). Metabolic profiles and the QoL were monitored. The patients′ compliance with and adherence to the treatment, and dietary and exercise advice were assessed. Results: The patients′ compliance with and adherence to the treatment was higher in group C, followed by groups B and A. There was a net decrease in adverse events, with an increase in the frequency of follow-up. Changes in glycated hemoglobin (HbA1c) suggested a positive impact of weekly telephonic consultation. The lipid profile was also positively affected, with maximum improvement being in high-density lipoproteins (HDLs) and triglycerides. There was an improvement in the QoL domains pertaining to physical health and endurance in patients with higher frequency of follow-ups. There was no effect on emotional or mental health. There was an overall deterioration of the financial domain, being most marked in group B. The treatment satisfaction questionnaire showed better results in the telephone intervention group. Conclusion: Telephonic consultation can be a useful measure to improve the follow-up and management of patients with DM.

Frequency distribution of Hepatitis C virus in different geographical regions of Punjab: Retrospective study from a tertiary care centre in North India

Background and Aim: There is a scarcity of published information on epidemiology of Hepatitis C infection in India particularly in Punjab. We conducted a retrospective study to assess the frequency distribution, including demographic and geographical data of patients with Hepatitis C in different regions of Punjab. Materials and Methods: We retrospectively collected the clinical, demographic and geographical data of 516 patients with Hepatitis C admitted in our hospital from January 2010 to December 2010. Punjabi patients with positive anti-Hepatitis C virus (HCV)-enzyme linked immune sorbent assay test for the detection of anti-HCV antibodies were included. Results: There was predominantly rural distribution (67.3%) of patients with maximum cases from Ludhiana district (30.04%). Highest frequency of Hepatitis C infection was found in the middle aged (41-60 years) patients with male predominance. High proportions (44.8%) of the patients included in our study were incidentally detected with Hepatitis C infection on routine screening. Various associations of HCV infection with other diseases were also identified. Conclusions: Hepatitis C is an emerging disease in Punjab with a sizeable cluster of HCV infected asymptomatic persons who can act as a pool for its continuous transmission. The study helps us to predict the probable risk factors for Hepatitis C infection in Punjab. The need of the hour is to increase awareness about HCV among the public and practicing physicians.

Qualitative and Quantitative Hippocampal MRI Assessments in Intractable Epilepsy

Aims. To acquire normative data of hippocampal volumes and T2 relaxation times, to evaluate and compare qualitative and quantitative assessments in evaluating hippocampi in patients with different durations of intractable epilepsy, and to propose an imaging protocol based on performance of these techniques. Methods. MRI analysis was done in 50 nonepileptic controls and 30 patients with intractable epilepsy on 1.5T scanner. Visual assessment and hippocampal volumetry were done on oblique coronal IR/T2W and T1W MP-RAGE images, respectively. T2 relaxation times were measured using 16-echo Carr-Purcell-Meiboom-Gill sequence. Volumetric data was normalized for variation in head size between individuals. Patients were divided into temporal (n = 20) and extratemporal (n = 10) groups based on clinical and EEG localization. Results. In controls, right hippocampal volume was slightly more than the left with no effect of age or gender. In TLE patients, hippocampal volumetry provided maximum concordance with EEG. Visual assessment of unilateral pathology concurred well with measured quantitative values but poorly in cases with bilateral pathologies. There were no significant differences of mean values between extratemporal group and controls group. Quantitative techniques detected mild abnormalities, undetected on visual assessment. Conclusions. Quantitative techniques are more sensitive to diagnose bilateral and mild unilateral hippocampal abnormalities.

The relationship between feeding and nutritional status: a prospective and observational study conducted in northern region of India

According to the Prime Minister of Norway, GroBruntland, a physician and Director General of WHO, real development of a nation is possible only with healthy population. For the sustenance of freedom, democracy and economic growth as well as human dignity, health requires to be treated as a basic human right. With an objective of health as a basic right the infant health should be assigned a topmost priority. Emphasis on infant health through better nutrition as well as medical care is being laid by WHO and targets were fixed by United Nation through the Millennium Development Goals.

Effect of rimonabant on the components of metabolic syndrome: A randomized, controlled study done on Punjabi population

The objectives of this study were to study the total and differential effect of Rimonabant on weight parameters, lipid profile, glycemic profile, and blood pressure and to evaluate its safety profile in obese population of Punjab. Materials and Methods: This was a randomized open controlled study, carried out on 100 subjects that included Punjabi adults (18-70 years) who were obese or overweight (with associated risk factors) according to Asia pacific guidelines. Treatment group (n = 50) was given Rimonabant 20 mg once-daily, and control group (n = 50) was given placebo for 12 weeks. Alterations in weight and lipid parameters, Fasting blood sugar (FBS), and blood pressure were recorded. Psychiatric adverse events were monitored by HADS score. Analysis was done using SPSS software. Results: Statistically significant difference was observed in two groups in reduction in weight, waist circumference, body mass index. Overall reduction in number of patients in the obese category was 20% in group 1 and 6.25% in group 2. In lipid parameters, significant changes were observed in triglycerides (TG), HDL cholesterol, and total cholesterol: HDL ratio (P < 0.001). No significant change was observed for LDL cholesterol and total cholesterol. Effect on Fasting Blood Sugar (FBS) was also significant. Moderate decrease in systolic blood pressure and no significant change was observed in diastolic blood pressure. Using multivariate regression model, Rimonabant was found to have weight-loss independent effect on lipid parameters with triglycerides having the maximum percentage difference between regression coefficients. No significant correlation was observed between changes in lipid parameters and weight loss. Amongst the lipids, changes in triglycerides and HDL cholesterol correlated best. Decrease in FBS correlated with weight loss but not to lipid parameters. Adverse event profile was comparable in both groups. Depressive symptoms were noted in 3 subjects in treatment group with 1 requiring termination of treatment. Frequency of anxiety symptoms was same in both groups with none showing tendency towards suicide. Conclusions: This is the first study of Rimonabant on Punjabi population and reports the depressive adverse events to be occurring in low frequency and of mild intensity in this group. Thus, it provides a clue to the need for further studies of cannabinoid receptor antagonists on larger samples in such ethnically predisposed populations to reevaluate the safety profile and its genetic correlation. It also suggests need for further research on differential effect of antagonism of cannabinoid receptors in CNS and adipose tissue and its use to produce drug that targets metabolic derangements by selective action on adipose tissue receptors.