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BACKGROUND: Increased glycated hemoglobin (HbA1c) levels have shown an association with an increased risk of stroke in patients admitted to a tertiary care center in Jharkhand. OBJECTIVES: To find out and estimate the risk of acute ischemic stroke in patients with increased HbA1c levels compared with controls. METHODS: This observational case-control study was conducted on patients admitted to the department of general medicine at a tertiary care center in Ranchi from June 2021 to November 2022. The patients included in this study were those aged 18 years or older and who were clinically and radiologically diagnosed with acute ischemic stroke. Only patients with a first episode of stroke were included, and patients with hemorrhagic stroke or transient ischemic attack were excluded from this study. An equal number of control participants were also included. Ion exchange high-performance liquid chromatography was used to perform the HbA1c tests. The same method was used to measure HbA1c levels in the controls. All findings were recorded in a Microsoft Excel sheet (Microsoft Corporation, Redmond, WA), and the data were analyzed using SPSS version 22.0 software (IBM Corp., Armonk, NY). After performing a descriptive statistical analysis, the findings were classified over a range of values and described accordingly. For each variable, an independent t-test was performed to compare the cases with the controls. A multivariable logistic regression analysis was used to choose the appropriate potential factors to determine the association in the multivariable analysis. RESULTS: A total of 185 cases and 185 controls were included. The mean age of the cases with ischemic stroke was 63.77 ± 10.312, and that of the controls was 53.18 ± 11.35 (p < 0.01). The mean HbA1c level in the patients of acute ischemic stroke was 6.97 ± 1.84, and that of the controls was 5.99 ± 1.69 (p < 0.01). The mean random blood sugar (RBS) value in the ischemic stroke cases was 170.21 ± 84.16, and that of the controls was 150.03 ± 82.25 (p = 0.02). To compare the factors that were determined to be statistically significant between ischemic stroke cases and controls, a multivariable logistic regression analysis was performed. The HbA1c p-value was 0.01, the odds ratio (OR) was 1.280, and the 95% CI was 1.11-1.48. The other variables apart from HbA1c that were statistically significant between the ischemic stroke cases and the controls were age (p < 0.01, OR: 1.280, 95% CI: 1.06-1.11), hypertension (p = 0.618, OR: 1.130, 95% CI: 0.70-1.83), and high-density lipoprotein (p = 0.055, OR: 0.975, 95% CI: 0.95-1.00). When other cofounders were considered, it was concluded that with a 1% increase in HbA1c, the risk of stroke increases by 28% (OR: 1.28, 95% CI: 1.11-1.48). To compare the variables that were determined to be statistically significant between the control and ischemic stroke case groups, a multivariable logistic regression was used. The area under the receiver operating characteristic curve for HbA1c was 0.773 and RBS was 0.600. CONCLUSION: This study shows that higher HbA1c levels in patients increase the risk of ischemic stroke. This study brings to light the need to screen the population periodically for diabetes by routinely testing for Hba1c in those who are at high risk of diabetes. Stroke risk can be reduced with early management and intervention. This study also concludes that HbA1c is a better predictor for assessing the risk of ischemic stroke than RBS levels.
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Introduction Stroke is a devastating and disabling cerebrovascular disease with a significant amount of residual deficit. The prevalence of stroke is in a rising trend in India. Larger studies are needed for the evaluation of risk factors. Material and methods This cross-sectional study aimed to assess the clinical profile of patients with stroke. The demographic details of the patients were taken, comorbidities were noted, and laboratory tests were done. Observation The most common age group who presented with stroke was 61-80 years, followed by 41-60 years, comprising 47% and 46%, respectively. Ischemic stroke was more common (60%) than hemorrhagic stroke (40%). Male patients were more than female patients. Alcohol, smoking, hypertension, diabetes, anemia, and proteinuria were present in the study group. Conclusion Regular evaluation of blood pressure, blood sugar, lipid profile, and proteinuria should be routinely done in patients with diabetes and hypertension who are more than 40 years old.
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Background: Snakebite is a common occupational hazard in tropical countries such as India. India has the highest number of snakebites and accounts for nearly 50% of global snakebite deaths. Jharkhand is a state with abundant flora and fauna, with a large rural population, prone to snakebite deaths. We aimed to study various clinical and laboratory parameters in snakebite patients and their association with mortality. Material and Methods: This study was an analytical cross-sectional study conducted from October 2019 to April 2021. Snake-bitten individuals admitted in the in-patient department (General Medicine) of a tertiary care centre of Jharkhand state were included in this study. Information regarding gender, species of the snake, site of bite, symptoms (neurological and haematological), signs, reaction to ASVS, procedures performed (haemodialysis), general examinations, systemic examinations, and investigations were collected and analysed to predict mortality. Results: Out of 60 snakebite patients, 39 (65%) were males and 21 (35%) were females. Snakebite in 41.67% patients was because of unknown species, snakebite in 26.67% patients was because of Russell's viper, snakebite in 21.67% was because of krait, and snakebite in 10% was because of cobra. 41.67% of individuals sustained bites over the right leg, 23.33% over the left leg, 18.33% over the right arm, and 15% over the left arm. Mortality was seen in 8 (13.33%) patients. Haemorrhagic manifestations including haematuria and haemoptysis were seen in 10 (16.66%) and 3 (5%) patients, respectively. Neurological symptoms were present in 27 (45%) patients. In laboratory examination, the total leucocyte count, international normalised ratio, d-dimer, urea, creatinine, and amylase were significantly high in the non-survivor group (all P values < 0.05). In this study, mortality was significantly associated with increased requirement of haemodialysis because of renal failure and an increase in duration of hospital stay (P value < 0.05). The duration of hospital stay independently predicts mortality with an odds ratio of 0.514 (95% confidence interval 0.328 to 0.805; P = 0.004). Conclusion: Early evaluation of clinical and laboratory parameters is needed to identify various complications (haematological and neurological) as they may prolong the hospital stay, leading to an increase in mortality.