Predictors of Posterior Reversible Encephalopathy Syndrome (PRES) in Women With Pre-eclampsia/Eclampsia: A Retrospective Analysis.

CONTEXT:  Posterior reversible encephalopathy syndrome (PRES) is a clinical-radiological entity characterized by acute neurological symptoms with reversible subcortical vasogenic brain edema. One of the most common risk factors is pre-eclampsia/eclampsia. AIMS:  This study aimed to compare the clinical and radiological characteristics of PRES with those without PRES in patients with pre-eclampsia/eclampsia and attempts to find independent predictors of PRES. METHODS AND MATERIALS:  This was a single-center, retrospective study. Fifty-three female patients admitted to the Department of Obstetrics & Gynaecology, AIIMS Rishikesh between 2018 and 2021 with severe pre-eclampsia/eclampsia were included. Brain imaging was done to confirm the diagnosis of PRES. Baseline characteristics between patients whose imaging was suggestive and not suggestive of PRES were compared. RESULTS:  Fifty-three patients with pre-eclampsia/eclampsia were included in the analysis. The median age and period of gestation of the study population were 28 (range 19-37) years and 36.6 (range 24.2-41.5) weeks respectively. Twelve patients (22.6%) had eclampsia, and 41 (87.4%) had pre-eclampsia of which 28 (52.8%) had severe pre-eclampsia. Twelve patients were diagnosed with PRES. Patients with PRES were significantly younger with a median age of 23 [range 20-30 vs 29 (range 19-37; p = 0.005) years], and more likely to be primiparous (91.7% vs 36.6%; p < 0.001) compared to those without PRES. PRES was significantly more common in patients with eclampsia. Of 12 patients with eclampsia, nine (75%) had evidence of PRES. The maternal and fetal outcome, however, was similar in both groups. Patients with PRES were more likely to have poor sensorium compared to those without PRES (83.3% vs 5.3%; p < 0.01). Eclampsia was found in the independent predictor of PRES (odds ratio, OR 20.9; 95% confidence interval, CI 3.0-147.0, p = 0.02). CONCLUSIONS:  In this study, patients with PRES were younger and significantly more likely to be primiparous and have eclampsia compared to those without PRES. Headache followed by seizures and altered sensorium were the most common clinical manifestations and subcortical white matter hyperintensities involving fronto-parieto-occipital lobes were the most common radiological finding. Eclampsia emerged as an independent risk factor for PRES.

Effect of Vitamin B6, B9, and B12 Supplementation on Homocysteine Level and Cardiovascular Outcomes in Stroke Patients: A Meta-Analysis of Randomized Controlled Trials.

Globally, stroke is the fifth-most leading cause of mortality and also the third leading cause of disability. This study aimed to assess the effect of vitamin B6, B9, and B12 supplementation on homocysteine level, risk of stroke, cardiovascular disorders, and vascular death among stroke participants. An extensive literature search was done through PubMed, Medline, Embase, and Clinical key database from 1 January 2000 to 1 January 2020. Effect of vitamin B (B6, B9, and B12) supplementation on homocysteine was assessed with a mean difference in both vitamin and placebo groups. Risk ratio (RR) was calculated for determining the risk of stroke, major cardiovascular disorder, and vascular death by using a fixed-effect model. A total of eight trials with 8513 participants were included for the final analysis. Vitamin B supplementation intervention was found to have a significant benefit in reducing homocysteine in stroke patients (mean difference -3.84; p<0.00001). The intervention of vitamin B supplementation showed a significant risk reduction of 11% for combined risk of stroke, myocardial infarction, and vascular death among stroke patients, 13% for stroke and 17% for vascular death, whereas no beneficial effect was seen for cardiovascular disorders. This meta-analysis demonstrated up-to-date evidence on the beneficial effect of vitamin B supplementations in reducing homocysteine and preventing the combined risk of stroke, myocardial infarction, and vascular death among stroke patients.

Successful thrombolysis in essential thrombocythemia-related acute ischaemic stroke.

Essential thrombocythemia (ET)-related acute ischaemic stroke (AIS) may account for approximately 0.25%-0.5% of all ischaemic strokes. If left undiagnosed and untreated, patients with ET carry an increased risk of recurrent thrombosis involving major organs including the brain. We report an interesting case of a 67-year-old man, who was successfully thrombolysed for AIS resulting from ET. He presented with sudden onset of left-sided hemiparesis with a left-ventricular clot. His subsequent investigations including positive JAK2 V617F mutation confirmed the diagnosis of ET. He made a significant recovery with thrombolysis, anticoagulation, antiplatelet and hydroxyurea. A fear of post-thrombolytic haemorrhagic complications appears the major reason for the lack of reports of thrombolysis in ET-related AIS. Although the diagnosis of ET was confirmed on subsequent investigations, successful thrombolysis in our case provides preliminary evidence that ET-related AIS cases can undergo successful thrombolysis using tenecteplase. To date, ours is only the second case of ET-related AIS being thrombolysed.

The see-saw of Keap1-Nrf2 pathway in cancer.

Keap1-Nrf2 pathway is continuously involved in the cytoprotection from oxidative stress generated due to various factors either extrinsic or intrinsic in origin. This role of Nrf2 in the response to oxidative stress is well established. Following oxidative insult, Nrf2 mediates the regulation of the inducible expression of cytoprotective genes. The level and functional capacity of Nrf2 is regulated at the post-transcriptional level, mainly through its association with an actin-associated protein, Keap1. Various studies reported that any discrepancy from their routine may lead to promotion of tumor as well. So there is need to explore their role in cytoprotection and tumor promotion if any. This review is an attempt to critically analyze the available data that may lighten up the present knowledge and unveil the new regime for cancer prevention and treatment.

Prolonged elevated postprandial sugar augments severity in kidney disease: a north Indian hospital-based study.

AIM: Diabetes plays a major role in progression of renal failure. The risk-factor profile changes during the progression of chronic kidney disease (CKD) from mild/moderate to end-stage renal disease. The relationship between glycemic indices, blood pressure, body mass index (BMI) and age at diagnosis in Indians has been less investigated. We assessed association of these risk factors with CKD stages in Indian population. METHODS: This study was carried out on patients (n = 162) who were diagnosed with CKD and normal control group (n = 155). For BMI, National Institutes for Health criteria were used to categorize the patients. RESULT: The mean age of CKD patients were significantly increased with the advancement of stage. BMI, systolic blood pressure (SBP), postprandial sugar level (PP), urea and creatinine were also significantly higher with elevated stages, whereas no differences were observed in diastolic blood pressure (DBP) and fasting blood sugar (FBS). The logistic regression study gave a significant result (p = 0.000) when we compared the group of CKD patients with established/prolonged postprandial blood sugar. It was independently associated with mild CKD [odds ratio (OR) = 5.213, 95% confidence interval (CI) = 2.06-13.21, p = 0.000], moderate CKD (OR = 7.724, 95% CI = 4.05-14.74, p = 0.000) and severe CKD (OR = 7.610, 95% CI = 4.03-14.36, p = 0.000). CONCLUSION: SBP and PP were the best predictors of prevalent nephropathy in this population, while DBP and FBS were found to be less effective. This may have implication for kidney disease risk stratification and protection.