Effect of endovascular therapy in large anterior circulation ischaemic strokes: A systematic review and meta-analysis of randomised controlled trials.

INTRODUCTION: The benefit of endovascular treatment in large anterior circulation ischaemic strokes with low ASPECTS score (<6) is uncertain. Recent randomised studies have demonstrated the benefit of endovascular treatment (EVT) in large ischaemic strokes. The present meta-analysis aims to assess the combined effect of these studies on efficacy and safety of endovascular treatment in this group of patients. MATERIALS AND METHODS: We conducted a systematic review and meta-analysis according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. Databases MEDLINE, PubMed, EMBASE, SCOPUS, Google Scholar, Tripdatabase were searched for randomised controlled trials with at least 50 participants from inception until February 16, 2023. The primary efficacy outcome analysed was the relative risk of functional independence defined as mRS - 0-2 at 90 days. Secondary efficacy outcomes included early neurological improvement, death due to any cause at 90 days and proportion of patients requiring decompressive hemicraniectomy. The primary safety outcome was the risk of developing symptomatic intracerebral haemorrhage (sICH). RESULTS: A total of three studies (RESCUE Japan-LIMIT, SELECT 2 and ANGEL ASPECTS) involving 1011 patients; 510 in the EVT arm and 501 in the medical management (MM) arm met the defined criteria (ASPECTS-3-5). The combined RR for the primary outcome of mRS 0-2 was 2.53 [1.84-3.47] (p = <0.0001) favouring EVT over MM. The primary safety outcome of sICH was not significant in the EVT arm with a combined RR of 1.84 [0.94-3.60] (p = 0.5157). Mortality rates were similar in both arms (26.67% in EVT arm vs 27.94% in MM arm) with a combined RR of 0.95 [0.78; 1.16] (p = 1.000). CONCLUSION: In patients with Large vessel occlusion (LVO) and low ASPECTS (3-5), EVT was associated with higher likelihood of achieving functional independence and early neurologic improvement but did not provide any mortality benefit.

Validation and Diagnostic Accuracy of Hindi Restless Legs Syndrome (RLS-H) Screening Tool.

Background Restless legs syndrome (RLS), a prevalent and treatable entity, has high impact on quality of life, requiring a better screening tool for its early detection. Thus, present study aimed to derive a Hindi RLS (RLS-H) screening tool for its use in Indian population. Materials and Methods RLS-H screening tool, derived by translating first four criteria of 2012 revised International Restless Legs Syndrome Study Group (IRLSSG) diagnostic criteria in Hindi and was validated in 50 RLS and 50 non-RLS patients. This validated RLS-H tool was used to screen 1,066 patients attending neurology clinic for assessing its diagnostic accuracy. Internal consistency, discriminatory validity, and various diagnostic yields were calculated. IRLSSG was used as gold standard for final diagnosis of RLS. Results RLS-H screening tool had an internal consistency of 0.910. No correlation was found between RLS-H screening tool and Epworth sleepiness scale, Pittsburgh sleep quality index, or International Restless Legs Syndrome Study Group rating scale indicating satisfactory discriminant validity. Prevalence of RLS was 13.6%. The question (Q)1 had highest sensitivity (97.9%) and Q4 had highest specificity (92.66%). Thus, its combinations (Q1 + Q4) along with addition of Q2 or Q3 were compared for best combination of diagnostic accuracy. A minimum cutoff value of RLS-H screening tool was 2.5 for considering patients requiring detailed RLS evaluation. Conclusion RLS-H screening tool can be used as a screening tool for early detection of RLS among susceptible patients. Patients answering "yes" to more than two questions (cutoff = 2.5) or "yes" to Q1 and Q4 should be interviewed and assessed for RLS.

Nephrocalcinosis-A gateway to the Diagnosis.

Nephrocalcinosis (NC) is the augmented calcium content within the renal parenchyma. Its pathogenesis mainly involves hypercalciuria. The presence of medullary NC provides a window to the clinician for the diagnosis of many important diseases. In this case series, we highlight three diseases that could be diagnosed with a high index of suspicion and detailed evaluation after their presentation as medullary NC.