The Distribution of Lifestyle Risk Factors Among Patients with Stroke in the Indian Setting: Systematic Review and Meta-Analysis.

Background: The burden of stroke is increasing in India, but there is limited understanding of the distribution of reported risk factors in the Indian setting. It is vital to generate robust data on these modifiable risk factors to scale up appropriate strategies for the prevention of cerebrovascular diseases in this setting. Summary: The objective of this study is to estimate the overall proportion of life style risk factors of patients with stroke in the Indian setting. We searched PubMed and Google Scholar and relevant studies published till February 2022 were included. The risk of bias assessment was considered for the study selection criterion in the meta-analysis. The publication bias was evaluated by funnel plots and Egger's test. We identified 61 studies in the systematic review and after quality assessment, 36 studies were included for meta-analysis. Random effect model was used due to the significant inconsistency among the included studies (I2 > 97%). The mean age of the participants was 53.84±9.3 years and patients with stroke were predominantly males (64%). Hypertension (56.69%; 95% CI: - 48.45 - 64.58), obesity (36.61%; 95% CI: - 19.31 - 58.23), dyslipidemia (30.6%; 95% CI: - 22 - 40.81) and diabetes mellitus (23.8%; 95% CI: - 18.79 - 29.83) are the leading intermediate conditions associated with stroke. The Physical inactivity - 29.9% (95% CI: - 22.9 - 37.1), history of tobacco use (28.59 %; 95% CI: - 22.22 - 32.94) and alcohol use (28.15 %; 95% CI: - 20.49 - 37.33) were reported as the behavioral risk factors for stroke in this setting. Key Messages: The current meta-analysis provides robust estimates of the life style related risk-factor of stroke in India based on the observational studies conducted from 1994 to 2019. Estimating the pooled analysis of stroke risk factors is crucial to predict the imposed burden of the illness and ascertain the treatment and prevention strategies for controlling the modifiable risk factors in this setting.

Fourteen Days vs 28 Days of Albendazole Therapy for Neurocysticercosis in Children: An Open Label Randomized Controlled Trial.

BACKGROUND: There is a paucity of literature to support 14-days albendazole therapy for neurocysticercosis (NCC). OBJECTIVE: To compare the efficacy of 14-day and 28-day albendazole therapy in the management of children with newly diagnosed active NCC. STUDY DESIGN: Open-labelled randomized controlled trial. PARTICIPANTS: Children aged 1-14 years with newly diagnosed active neurocysticercosis. INTERVENTION: Albendazole (15 mg/kg/day) for either 14 days or 28 days. OUTCOME: The primary outcome measure was proportion of children with radiological resolution of active lesion at 6-month follow up. Secondary outcome measures were proportion of children with seizure recurrence, duration to seizure recurrence and calcification on follow up imaging. RESULTS: 65 children with newly diagnosed NCC were rando-mized to receive albendazole therapy for 14 days (n=32) or 28 days (n=33). The proportion of children with complete resolution was comparable between the two groups [6 (18.8%) vs. 9 (27.3%); OR (95%CI):0.61 (0.19 to 1.98); P=0.56]. Similarly, proportion of children with seizure recurrence [5(15.6%) vs 2(6.1%); OR (95%CI): 2.87(0.51-16.0); P=0.26] and proportion of children with calcification on follow-up imaging [26(81.2%) vs 23(69.7%); OR (95%CI): 1.88 (0.59-5.99); P=0.39] were also comparable. There were no major side-effects noted during the study. CONCLUSION: 14-day treatment with albendazole therapy is as effective as 28-day treatment in achieving radiological resolution at six-month follow up. However, high rate of calcification in both the groups indicates need for further evaluation with an adequately powered study and longer follow up.

Association of SUMOylation Pathway Genes With Stroke in a Genome-Wide Association Study in India.

OBJECTIVE: To undertake a genome-wide association study (GWAS) to identify genetic variants for stroke in an Indian population. METHODS: In a hospital-based case-control study, 8 teaching hospitals in India recruited 4,088 participants, including 1,609 stroke cases. Imputed genetic variants were tested for association with stroke subtypes using both single-marker and gene-based tests. Association with vascular risk factors was performed with logistic regression. Various databases were searched for replication, functional annotation, and association with related traits. Status of candidate genes previously reported in the Indian population was also checked. RESULTS: Associations of vascular risk factors with stroke were similar to previous reports and show modifiable risk factors such as hypertension, smoking, and alcohol consumption as having the highest effect. Single-marker-based association revealed 2 loci for cardioembolic stroke (1p21 and 16q24), 2 for small vessel disease stroke (3p26 and 16p13), and 4 for hemorrhagic stroke (3q24, 5q33, 6q13, and 19q13) at p < 5 × 10-8. The index single nucleotide polymorphism of 1p21 is an expression quantitative trait locus (p lowest = 1.74 × 10-58) for RWDD3 involved in SUMOylation and is associated with platelet distribution width (1.15 × 10-9) and 18-carbon fatty acid metabolism (p = 7.36 × 10-12). In gene-based analysis, we identified 3 genes (SLC17A2, FAM73A, and OR52L1) at p < 2.7 × 10-6. Eleven of 32 candidate gene loci studied in an Indian population replicated (p < 0.05), and 21 of 32 loci identified through previous GWAS replicated according to directionality of effect. CONCLUSIONS: This GWAS of stroke in an Indian population identified novel loci and replicated previously known loci. Genetic variants in the SUMOylation pathway, which has been implicated in brain ischemia, were identified for association with stroke.

Role of Immuno-Polymerase Chain Reaction (I-PCR) in Resolving Diagnostic Dilemma Between Tuberculoma and Neurocysticercosis: A Case Report.

BACKGROUND Tuberculoma and neurocysticercosis (NCC) often show similar clinical and neuroimaging features. Differential diagnosis of these 2 diseases is imperative, as tuberculoma is an active infection that requires immediate anti-tubercular therapy (ATT). CASE REPORT We present the case of a 17-year-old Indian girl with fever, severe headache, and right 6th cranial nerve palsy. Brain magnetic resonance imaging (MRI) showed multiple tiny ring-enhancing lesions in bilateral cerebral parenchyma with mild perilesional edema, which were initially thought to be NCC, but subsequently were diagnosed as brain tuberculomas. Based on clinical findings, mildly increased choline/creatine ratio (1.35) with slight prominent lipid lactate peak and absence of alanine, succinate peak by magnetic resonance spectroscopy (MRS), and the detection of Mycobacterium tuberculosis (Mtb)-specific early-secreted antigenic target-6 (ESAT-6, Rv3875) protein from the cerebrospinal fluid (CSF) by indirect ELISA, as well as indirect immuno-PCR (I-PCR) assay, diagnosis of brain tuberculomas associated with tuberculous meningitis (TBM) was confirmed, which was followed by ATT. The patient responded well and the symptoms resolved. CONCLUSIONS In this case, multiple ring-enhancing lesions of the brain by MRI were diagnosed as tuberculomas associated with TBM by MRS and indirect ELISA/I-PCR method, thus resolving the diagnostic dilemma.

Proteus Syndrome.

Proteus syndrome is an extremely rare disorder with a documentation of only 100 cases world over till date. This sporadic disorder involves the skeletal system, central nervous system, eyes, skin, soft tissues and vascular system. We report a case of Proteus syndrome in a 22 year male presenting with abnormally enlarged and hypertrophied feet resulting in marked physical constraints.

Hurler Scheie Disease.

We present a very rare case of mucopolysaccharidosis type I (MPS I) which presented to us with respiratory distress. Our patient had short stature, coarse facial features, claw hands and clouding of both corneae. This article highlights the salient features present in a case of mucopolysaccharidosis type I.