Tenecteplase versus standard of care for minor ischaemic stroke with proven occlusion (TEMPO-2): a randomised, open label, phase 3 superiority trial.

BACKGROUND: Individuals with minor ischaemic stroke and intracranial occlusion are at increased risk of poor outcomes. Intravenous thrombolysis with tenecteplase might improve outcomes in this population. We aimed to test the superiority of intravenous tenecteplase over non-thrombolytic standard of care in patients with minor ischaemic stroke and intracranial occlusion or focal perfusion abnormality. METHODS: In this multicentre, prospective, parallel group, open label with blinded outcome assessment, randomised controlled trial, adult patients (aged ≥18 years) were included at 48 hospitals in Australia, Austria, Brazil, Canada, Finland, Ireland, New Zealand, Singapore, Spain, and the UK. Eligible patients with minor acute ischaemic stroke (National Institutes of Health Stroke Scale score 0-5) and intracranial occlusion or focal perfusion abnormality were enrolled within 12 h from stroke onset. Participants were randomly assigned (1:1), using a minimal sufficient balance algorithm to intravenous tenecteplase (0·25 mg/kg) or non-thrombolytic standard of care (control). Primary outcome was a return to baseline functioning on pre-morbid modified Rankin Scale score in the intention-to-treat (ITT) population (all patients randomly assigned to a treatment group and who did not withdraw consent to participate) assessed at 90 days. Safety outcomes were reported in the ITT population and included symptomatic intracranial haemorrhage and death. This trial is registered with ClinicalTrials.gov, NCT02398656, and is closed to accrual. FINDINGS: The trial was stopped early for futility. Between April 27, 2015, and Jan 19, 2024, 886 patients were enrolled; 369 (42%) were female and 517 (58%) were male. 454 (51%) were assigned to control and 432 (49%) to intravenous tenecteplase. The primary outcome occurred in 338 (75%) of 452 patients in the control group and 309 (72%) of 432 in the tenecteplase group (risk ratio [RR] 0·96, 95% CI 0·88-1·04, p=0·29). More patients died in the tenecteplase group (20 deaths [5%]) than in the control group (five deaths [1%]; adjusted hazard ratio 3·8; 95% CI 1·4-10·2, p=0·0085). There were eight (2%) symptomatic intracranial haemorrhages in the tenecteplase group versus two (<1%) in the control group (RR 4·2; 95% CI 0·9-19·7, p=0·059). INTERPRETATION: There was no benefit and possible harm from treatment with intravenous tenecteplase. Patients with minor stroke and intracranial occlusion should not be routinely treated with intravenous thrombolysis. FUNDING: Heart and Stroke Foundation of Canada, Canadian Institutes of Health Research, and the British Heart Foundation.

Exploring different stroke populations' information needs: a cross-sectional study in England.

BACKGROUND: While tailored information might have the potential to motivate stroke survivors to make essential lifestyle changes and improve long-term outcomes, how this varies among different stroke populations is not yet fully understood. METHOD: From November 2022 to May 2023, stroke survivors in the UK, who were clinically stable, participated in a community-based, descriptive cross-sectional study. Participants rated several information themes on a Likert scale from one to five, indicating the relevance of each information group to them. Data were analysed using Wilcoxon and chi-squared tests on SPSS. Descriptive statistics were employed for examining the preferred information delivery method, timing, personnel, and frequency. RESULTS: Seventy survivors, with an average age of 67 ± 19 (61% males), were recruited. Survivors emphasised the importance of symptoms, risk factors, and recovery information during hospital stay, while medication and lifestyle change information were more significant in the community. Subgroup analysis revealed distinct patterns: First-time stroke survivors highlighted the importance of social and financial support (acute phase median Likert score 3, chronic phase median Likert score 4; p < 0.01), while those with prior strokes emphasised information on driving and working after stroke (acute phase median Likert score 4, chronic phase median Likert score 3; p < 0.05). Survivors recruited after six months of stroke prioritised knowledge of carer support in the community (acute phase median Likert score 3.5, chronic phase median Likert score 4; p < 0.01). CONCLUSION: Survivors' information needs differ depending on factors such as the recovery phase, type of stroke, time since diagnosis, and the presence of a previous stroke. Considering these factors is essential when developing or providing information to stroke survivors.

The Liverpool Heart And bRain Project (L-HARP): Protocol for an Observational Cohort Study of Cardiovascular Risk and Outcomes Following Stroke.

Further research is needed to refine risk prediction models for adverse cardiovascular outcomes following stroke in contemporary clinical practice, such as incident atrial fibrillation (AF), recurrent stroke, and cognitive impairment and dementia. The aims of this study are to prospectively investigate cardiovascular outcomes and risk factors for incident cardiovascular disease in a post-stroke cohort, and to externally validate, refine and expand current risk prediction models for cardiovascular and cardiovascular-related outcomes. The study sample size was based on the development of post-stroke risk prediction models for AF and was calculated as 1222 participants. The study design is a multicentre, prospective, observational cohort study. Participants will be adult patients admitted for ischaemic stroke confirmed by stroke physician or transient ischaemic attack (TIA) confirmed by MRI. Routinely collected data will be used in addition to the completion of simple validated questionnaires by the participants. Follow-up will be undertaken 12-months from the date of admission to hospital, in addition to linkage to routinely collected follow-up hospitalisation and mortality data. The primary outcomes are cardiovascular outcomes (including incident AF, stroke, TIA and myocardial infarction) at 12-month follow-up, all-cause mortality and mortality from cardiovascular causes, and incident cognitive impairment and dementia. Secondary outcomes include changes in function, depression, anxiety, fatigue and quality of life. The study has received approval from the Health Research Authority Research Ethics Committee (21/WA/0209), and is registered on https://www.clinicaltrials.gov/ (Identifier NCT05132465). Recruitment for the study began in October 2021 with completion of recruitment at all participating centres anticipated by October 2022.

Immersive Virtual Reality for the Cognitive Rehabilitation of Stroke Survivors.

We present the results of a double-blind phase 2b randomized control trial that used a custom built virtual reality environment for the cognitive rehabilitation of stroke survivors. A stroke causes damage to the brain and problem solving, memory and task sequencing are commonly affected. The brain can recover to some extent, however, and stroke patients have to relearn how to carry out activities of daily living. We have created an application called VIRTUE to enable such activities to be practiced using immersive virtual reality. Gamification techniques enhance the motivation of patients such as by making the level of difficulty of a task increase over time. The design and implementation of VIRTUE is described together with the results of the trial conducted within the Stroke Unit of a large hospital. We report on the safety and acceptability of VIRTUE. We have also observed particular benefits of VR treatment for stroke survivors that experienced more severe cognitive impairment, and an encouraging reduction in time spent in the hospital for all patients that received the VR treatment.

Cerebral and muscle near-infrared spectroscopy during lower-limb muscle activity - volitional and neuromuscular electrical stimulation.

Chronic venous insufficiency (CVI) can lead to blood clotting in the deep veins of the legs, a disease known as deep vein thrombosis. An estimated 40 percent of people in the United States have venous insufficiency that may be ameliorated with neuromuscular electrical stimulation (NMES). Near-infrared spectroscopy (NIRS) is a non-invasive optical imaging method for monitoring hemodynamics. NIRS, being an optical technique has no stimulation artefact, can be combined with NMES for theranostics application. In this study, we combined muscle NIRS (mNIRS) with electromyogram (EMG) of the calf muscles to detect blood volume changes (based on total hemoglobin concentration) in the muscle during volitional tiptoe movements at different frequencies. Also, blood volume changes were measured during NMES (using the geko™ device) at different device settings. In the mNIRS+NMES study, we also measured the cerebral hemodynamics using functional NIRS (fNIRS). The mNIRS was conducted using a frequency domain (FD) method (called FDNIRS) that used a multi-distance method to isolate muscle hemodynamics. FDNIRS-EMG study in ten healthy humans found a statistically significant (p<0.05) effect of the tiptoe frequencies on the EMG magnitude (and power) that increased with tiptoe frequency. Also, the muscle blood volume (standing/rest) decreased (p<0.01) with increasing tiptoe frequency and increasing NMES intensity that was statistically significantly (p<0.05) different between males and females. Moreover, increasing NMES intensity led to a statistically significant (p<0.01) increase in the cerebral blood volume - measured with fNIRS. Therefore, combined mNIRS and fNIRS with NMES can provide a theranostics application for brain+muscle in CVI.

Etiologic Workup in Cases of Cryptogenic Stroke: A Systematic Review of International Clinical Practice Guidelines.

Background and Purpose- Identifying the etiology of acute ischemic stroke is essential for effective secondary prevention. However, in at least one third of ischemic strokes, existing investigative protocols fail to determine the underlying cause. Establishing etiology is complicated by variation in clinical practice, often reflecting preferences of treating clinicians and variable availability of investigative techniques. In this review, we systematically assess the extent to which there exists consensus, disagreement, and gaps in clinical practice recommendations on etiologic workup in acute ischemic stroke. Methods- We identified clinical practice guidelines/consensus statements through searches of 4 electronic databases and hand-searching of websites/reference lists. Two reviewers independently assessed reports for eligibility. We extracted data on report characteristics and recommendations relating to etiologic workup in acute ischemic stroke and in cases of cryptogenic stroke. Quality was assessed using the AGREE II tool (Appraisal of Guidelines for Research & Evaluation). Recommendations were synthesized according to a published algorithm for diagnostic evaluation in cryptogenic stroke. Results- We retrieved 16 clinical practice guidelines and 7 consensus statements addressing acute stroke management (n=12), atrial fibrillation (n=5), imaging (n=5), and secondary prevention (n=1). Five reports were of overall high quality. For all patients, guidelines recommended routine brain imaging, noninvasive vascular imaging, a 12-lead ECG, and routine blood tests/laboratory investigations. Additionally, ECG monitoring (>24 hours) was recommended for patients with suspected embolic stroke and echocardiography for patients with suspected cardiac source. Three reports recommended investigations for rarer causes of stroke. None of the reports provided guidance on the extent of investigation needed before classifying a stroke as cryptogenic. Conclusions- While consensus exists surrounding standard etiologic workup, there is little agreement on more advanced investigations for rarer causes of acute ischemic stroke. This gap in guidance, and in the underpinning evidence, demonstrates missed opportunities to better understand and protect against ongoing stroke risk. Registration- URL: https://www.crd.york.ac.uk/PROSPERO/; Unique identifier: CRD42019127822.

Etiologic workup in cases of cryptogenic stroke: protocol for a systematic review and comparison of international clinical practice guidelines.

BACKGROUND: Stroke is a leading cause of death and disability worldwide. Identifying the aetiology of ischaemic stroke is essential in order to initiate appropriate and timely secondary prevention measures to reduce the risk of recurrence. For the majority of ischaemic strokes, the aetiology can be readily identified, but in at least 30% of cases, the exact aetiology cannot be determined using existing investigative protocols. Such strokes are classed as 'cryptogenic' or as a stroke of unknown origin. However, there exists substantial variation in clinical practice when investigating cases of seemingly cryptogenic stroke, often reflecting local service availability and the preferences of treating clinicians. This variation in practice is compounded by the lack of international consensus as to the optimum level and timing of investigations required following a stroke. To address this gap, we aim to systematically review and compare recommendations in evidence-based clinical practice guidelines (CPGs) that relate to the assessment and investigation of the aetiology of ischaemic stroke, and any subsequent diagnosis of cryptogenic stroke. METHOD: We will search for CPGs using electronic databases (MEDLINE, Health Management Information Consortium (HMIC), EMBASE, and CINAHL), relevant websites and search engines (e.g. guideline specific websites, governmental, charitable, and professional practice organisations) and hand-searching of bibliographies and reference lists. Two reviewers will independently screen titles, abstracts and CPGs using a pre-defined relevance criteria form. From each included CPG, we will extract definitions and terms for cryptogenic stroke; recommendations related to assessment and investigation of the aetiology of stroke, including the grade of recommendations and underpinning evidence. The quality of the included CPGs will be assessed using the AGREE II (Appraisal of Guidelines for Research and Evaluation) tool. Recommendations across the CPGs will be summarised descriptively highlighting areas of convergence and divergence between CPGs. DISCUSSION: To our knowledge, this will be the first review to systematically compare recommendations of international CPGs on investigating the aetiology of ischaemic stroke. The findings will allow for a better understanding of international perspectives on the optimum level of investigations required following a stroke and thus contribute to achieving greater international consensus on best practice in this important and complex area. SYSTEMATIC REVIEW REGISTRATION: PROSPERO CRD42019127822.

PULSE-I - Is rePetitive Upper Limb SEnsory stimulation early after stroke feasible and acceptable? A stratified single-blinded randomised controlled feasibility study.

BACKGROUND: Reduction in sensorimotor function of the upper limb is a common and persistent impairment after stroke, and less than half of stroke survivors recover even basic function of the upper limb after a year. Previous work in stroke has shown that repetitive sensory stimulation (RSS) of the upper limb may benefit motor function. As yet, there have been no investigations of RSS in the early-acute period despite this being the time window during which the neuroplastic processes underpinning sensorimotor recovery are likely to occur. METHODS: A single-blinded, stratified, randomised controlled feasibility study was undertaken at two NHS acute trusts to determine the recruitment rate, intervention adherence, and safety and acceptability of an RSS intervention in the early period after stroke. Participants were recruited within 2 weeks of index stroke. Stratified on arm function, they were randomised to receive either 45 min of daily RSS and usual care or usual care alone (UC) for 2 weeks. Changes from baseline on the primary outcome of the Action Research Arm Test (ARAT) to measurements taken by a blinded assessor were examined after completion of the intervention (2 weeks) and at 3 months from randomisation. RESULTS: Forty patients were recruited and randomised (RSS n = 23; UC n = 17) with a recruitment rate of 9.5% (40/417) of patients admitted with a stroke of which 52 (12.5%) were potentially eligible, with 10 declining to participate for various reasons. Participants found the RSS intervention acceptable and adherence was good. The intervention was safe and there were no serious adverse events. CONCLUSIONS: This study indicates that recruitment to a trial of RSS in the acute period after stroke is feasible. The intervention was well tolerated and appeared to provide additional benefit to usual care. In addition to a definitive trial of efficacy, further work is warranted to examine the effects of varying doses of RSS upon arm function and the mechanism by which RSS induces sensorimotor recovery in the acute period after stroke. TRIAL REGISTRATION: ISRCTN, registry no: ISRCTN17422343 ; IRAS Project ID: 215137. Registered on October 2016.

Motivational interviewing for low mood and adjustment early after stroke: a feasibility randomised trial.

BACKGROUND: Management of psychological adjustment and low mood after stroke can result in positive health outcomes. We have adapted a talk-based therapy, motivational interviewing (MI), and shown it to be potentially effective for managing low mood and supporting psychological adjustment post-stroke in a single-centre trial. In the current study, we aimed to explore the feasibility of delivering MI using clinical stroke team members, and using an attention control (AC), to inform the protocol for a future definitive trial. METHODS: This parallel two-arm feasibility trial took place in north-west England. Recruitment occurred between December 2012 and November 2013. Participants were stroke patients aged 18 years or over, who were medically stable, had no severe communication problems, and were residents of the hospital catchment. Randomisation was to MI or AC, and was conducted by a researcher not involved in recruitment using opaque sealed envelopes. The main outcome measures were descriptions of study feasibility (recruitment/retention rates, MI delivery by clinical staff, use of AC) and acceptability (through qualitative interviews and completion of study measures), and fidelity to MI and AC (through review of session audio-recordings). Information was also collected on participants' mood, quality of life, adjustment, and resource-use. RESULTS: Over 12 months, 461 patients were screened, 124 were screened eligible, and 49 were randomised: 23 to MI, 26 to AC. At 3 months, 13 MI and 18 AC participants completed the follow-up assessment (63% retention). This was less than expected based on our original trial. An AC was successfully implemented. Alternative approaches would be required to ensure the feasibility of clinical staff delivering MI. The study measures, MI, and AC interventions were considered acceptable, and there was good fidelity to the interventions. There were no adverse events related to study participation. CONCLUSIONS: It was possible to recruit and retain participants, train clinical staff to deliver MI, and implement an appropriate AC. Changes would be necessary to conduct a future multi-centre trial, including: assuming a recruitment rate lower than that in the current study; implementing more strategies to increase participant retention; and considering alternative clinical staff groups to undertake the delivery of MI and AC. TRIAL REGISTRATION: ISRCTN study ID: ISRCTN55624892. TRIAL FUNDING: Northern Stroke Research Fund.

Reactive hypoglycaemia: a rarely considered 'stroke mimic' in non-diabetic individuals.

Hypoglycaemia is a well-documented 'stroke mimic'. The literature documents numerous case reports of patients presenting with focal neurological deficits subsequently attributed to hypoglycaemia. The significant majority of these cases are found in patients with pre-existing diabetes. We present case histories of two patients with no history of diabetes presenting to secondary care with reactive hypoglycaemia causing transient symptoms that were responsible for referral as a possible transient ischaemic attack. Although uncommon, metabolic disturbances such as hypoglycaemia should be considered in all patients presenting as a suspected stroke, even if they are not known to have diabetes.

Management of experimental hypochlorhydria with iron deficiency by the composite extract of Fumaria vaillantii L. and Benincasa hispida T. in rat.

The aim of the present study was to search the effective ratio of whole plant of Fumaria vaillantii Loisel (Fumaria vaillantii L.) and fruit of Benincasa hispida Thunb. (Benincasa hispida T.) in composite form, namely "FVBH" for the management of hypochlorhydria along with iron deficiency in male albino rats. Hypochlorhydria refers to suppression of hydrochloric acid secretion by the stomach. Hypochlorhydria was induced by ranitidine in this study. We used four composite extracts of the mentioned plant and fruit with different ratios (1:1, 1:2, 2:1, and 3:2) for searching the most effective composite extract for the correction of hypochlorhydria. Gastric acidity is an important factor for iron absorption. Thus, hypochlorhydria causes iron deficiency in rat and it was prevented significantly by the extract treatment at the ratio of 1:1 of the said plant and fruit. The correction of iron deficiency by the composite extract was compared with iron supplementation to hypochlorhydric rat. It was found that preadministration followed by coadministration of FVBH-1 (1:1) able to prevent the ranitidine-induced hypochlorhydria and iron deficiency. The composite extract, FVBH-1 (1:1) significantly (P<0.05) increased the pepsin concentration, chloride level in gastric juice, iron levels in serum and liver along with blood hemoglobin level than other ratios used here. Hence, it can be concluded that FVBH-1 (1:1) is an effective herbal formulation for the management of hypochlorhydria and related iron deficiency.

Ameliorating effect of mother tincture of Syzygium jambolanum on carbohydrate and lipid metabolic disorders in streptozotocin-induced diabetic rat: Homeopathic remedy.

BACKGROUND: Syzygium jambolanum (S jambolanum) is widely used in homeopathy for treating patients with diabetes mellitus. In the present study, an attempt has been made to investigate the remedial effect of homeopathic drug S jambolanum on carbohydrate and lipid metabolic disorders on streptozotocin induced diabetic rat. MATERIALS AND METHODS: Diabetes induction in Wistar strain rat was performed as per standard method using streptozotocin at the dose of 4 mg/100 gm body weight. Activities of carbohydrate metabolic enzymes in hepatic tissue, and glycogen content in hepatic and muscular tissues were assessed biochemically following the standard protocols. Serum lipid profile level and activities of GOT and GPT in serum were measured as per standard method using specific kits. RESULTS: The homeopathic drug, mother tincture of S jambolanum significantly decreased fasting blood glucose levels and improved carbohydrate metabolic key enzyme activities in hepatic tissue i.e., hexokinase, glucose-6-phosphate dehydrogenase and glucose-6-phosphatase in diabetic rats. Alongside, serum lipid profile biomarkers i.e., triglyceride (TG), total cholesterol (TC), low density lipoprotein cholesterol (LDLc), very low density lipoprotein cholesterol (VLDLc) and high density lipoprotein cholesterol (HDLc) levels were significantly ameliorated in homeopathic drug supplemented diabetic animals in compared with the untreated diabetic animal. Side by side, the S jambolanum has the capacity to attenuate diabetes induced hepatic injury in model animal, which has been assessed here by the recovery of GOT and GPT activities in serum of drug treated diabetic animal. CONCLUSION: The result of the present study indicated that the homeopathic drug S jambolanum (mother tincture) has a protective effect on diabetic induced carbohydrate and lipid metabolic disorders in STZ-induced diabetic animal.

Antihyperglycemic and antihyperlipidemic effects of n-hexane fraction from the hydro-methanolic extract of sepals of Salmalia malabarica in streptozotocin-induced diabetic rats.

Bio-efficacy of n-hexane fraction of sepal of Salmalia malabarica was evaluated covering the biochemical sensors for the management of hyperglycemic and hyperlipidemic effects. Evaluation of n-hexane fraction of Salmalia malabarica (SMH) from hydro-methanolic (2:3) extract at the dose of 0.1 gm/kg body weight twice a day were investigated in normal and streptozotocin (STZ) induced diabetic rats. Normal and STZ-induced diabetic rats were divided into five groups. The effect of the fraction on fasting blood glucose (FBG), serum insulin, hemoglobin, glycated hemoglobin, total cholesterol (TC), triglyceride (TG), high density lipoprotein cholesterol (HDLc), low density lipoprotein cholesterol (LDLc), very low density lipoprotein cholesterol (VLDLc), phospholipids, free fatty acids, urea, uric acid, creatinine, albumin and transaminases were investigated in STZ-induced diabetic rat. A significant reduction of FBG level was observed after SMH treatment in STZ-induced diabetic rat. Treatment of diabetic rats with n-hexane fraction of this plant restored the levels of the above biochemical sensors significantly (p<0.001) in respect to the control. Histological studies of pancreas showed a qualitative diminution in the area of the islet's of Langerhans in diabetic group which was recovered by said fraction. Phytochemical screening of the fraction revealed the presence of flavonoids, terpenoids and steroids.

Antihyperglycemic and antioxidative effects of the hydro-methanolic extract of the seeds of Caesalpinia bonduc on streptozotocin-induced diabetes in male albino rats.

BACKGROUND: No satisfactory effective treatment is available yet to cure diabetes mellitus. Though, synthetic drugs are used but there are several drawbacks. The attributed antihyperglycemic effects of many traditional plants are due to their ability for the management of diabetes mellitus. MATERIALS AND METHODS: A hydromethanolic extract was administered orally at a dose of 250 mg/kg of body weight per day for 21 days. Its effects on the fasting blood glucose (FBG) level, activities of key carbohydrate metabolic enzymes like hexokinase, glucose-6-phosphatase, and glucose-6-phosphate dehydrogenase, and antioxidant enzymes like catalase and superoxide dismutase along with the effect on the lipid peroxidation level in hepatic tissues were measured. Glycogen levels were also assessed in hepatic and skeletal muscles and some toxicity parameters, such as serum glutamate oxaloacetate transaminase, glutamate pyruvate transaminase, and alkaline phosphates activities were measured. RESULTS: Treatment of the hydromethanolic extract of the seeds of Caesalpinia bonduc resulted in a significant (P < 0.05) recovery in the activities of carbohydrate metabolic enzymes along with correction in FBG and glycogen levels as compared with the untreated diabetic group. The extract also resulted in a significant (P < 0.05) recovery in the activities of toxicity assessment enzyme parameters. Activities of antioxidant enzymes like catalase and superoxide dismutase along with the lipid peroxidation levels were also recovered significantly (P < 0.05) after the treatment of the extract. The corrective effects produced by the extract were compared with the standard antidiabetic drug, glibenclamide. CONCLUSION: Our findings provide that the extract shows possible antihyperglycemic and antioxidative activities.

Inhibitory effect of hydro-methanolic extract of seed of Holarrhena antidysenterica on alpha-glucosidase activity and postprandial blood glucose level in normoglycemic rat.

ETHNOPHARMACOLOGICAL RELEVANCE: The present experiment was conducted to search out the effect of hydro-methanolic extract of seed of Holarrhena antidysenterica on intestinal α-glucosidase activity in dose dependent manner and on the management of postprandial hyperglycemia in starch loaded rats. MATERIALS AND METHODS: Activity of intestinal α-glucosidase was measured by in vitro method. Fasting blood glucose level was determined by single touch glucometer. Total phenol and flavonoids of seed extract of Holarrhena antidysenterica were estimated using gallic acid and quercetin standard curves, respectively. RESULTS: The degree of elevation in blood glucose level after starch administration was significantly (p<0.05) less by the extract in respect to the control. The said extract also inhibited α-glucosidase activity having an IC(50) of 0.52mg/ml. Phytochemical study revealed that the extract is rich in phenolic compounds (60.23mg of gallic acid equivalent/g of extract) and flavonoids (360.23mg of quercetin equivalent/g of the extract). CONCLUSION: The extract exerts its antihyperglycemic effect by retarding the carbohydrate absorption from intestine through the inhibition in α-glucosidase activity and therefore resists postprandial hyperglycemia.

Antidiabetic Potentiality of the Aqueous-Methanolic Extract of Seed of Swietenia mahagoni (L.) Jacq. in Streptozotocin-Induced Diabetic Male Albino Rat: A Correlative and Evidence-Based Approach with Antioxidative and Antihyperlipidemic Activities.

Antidiabetic, antioxidative, and antihyperlipidemic activities of aqueous-methanolic (2 : 3) extract of Swietenia mahagoni (L.) Jacq. (family Meliaceae) seed studied in streptozotocin-induced diabetic rats. Feeding with seed extract (25 mg 0.25 mL distilled water(-1)100 gm b.w.(-1)rat(-1) day(-1)) for 21 days to diabetic rat lowered the blood glucose level as well as the glycogen level in liver. Moreover, activities of antioxidant enzymes like catalase, peroxidase, and levels of the products of free radicals like conjugated diene and thiobarbituric acid reactive substances in liver, kidney, and skeletal muscles were corrected towards the control after this extract treatment in this model. Furthermore, the seed extract corrected the levels of serum urea, uric acid, creatinine, cholesterol, triglyceride, and lipoproteins towards the control level in this experimental diabetic model. The results indicated the potentiality of the extract of S. mahagoni seed for the correction of diabetes and its related complications like oxidative stress and hyperlipidemia. The extract may be a good candidate for developing a safety, tolerable, and promising neutraceutical treatment for the management of diabetes.

Antioxidant potential of hydro-methanolic extract of seed of Caesalpinia bonduc: An in vitro study.

It is well known that the over production of reactive oxygen species is harmful for living organisms and it damages major cellular constituents such as DNA, protein, and lipid. At present, searching of new plant sources having free radical scavenging activity is an important field of research in phytomedicine as natural products are safe and relatively low cost. In this respect, attention has been focused to evaluate the antioxidant potential of hydro-methanolic extract of seed of Caesalpinia bonduc (Caesalpenacae) using different in vitro models. To evaluate the antioxidant activity, extract was examined on 2, 2-diphenyl-1-picrylhydrazyl radical scavenging effect, scavenging of hydrogen peroxide, hydroxyl radical scavenging potential, and anti-lipid peroxidation activity by biochemical methods. Total phenol and flavonoids contents in the said extract were measured biochemically as per standard methods. Results were compared with butylated hydroxyl toluene and α-tocopherol. Results indicated that hydro-methanolic extract has strong scavenging activity on 2, 2-diphenyl-1-picrylhydrazyl radical with IC(50) value 157.4 µg/ml, hydroxyl radical with IC(50) value 61.9 µg/ml and hydrogen peroxide with IC(50) value 64.32 µg/ml. Hydro-methanolic extract also showed notable inhibition in lipid peroxidation having IC(50) value 58.87 µg/ml. Phytochemical study focused that the extract is rich in phenolic compounds (24.66 mg gallic acid equivalent/g dried extract) and flavonoids (136.65 mg quercetin equivalent/g dried extract). Findings of the experiment indicated that the hydro-methanolic extract of seed of Caesalpinia bonduc is a source of natural antioxidants.

Effect of Diashis, a polyherbal formulation, in streptozotocin-induced diabetic male albino rats.

This study focuses on the effect of 'Diashis', a polyherbal formulation composed of eight medicinal plants for the management of streptozotocin (STZ)-induced diabetes in rats. As oxidative stress is one of the consequences of diabetes, the activities of hepatic antioxidant enzymes and metabolic enzymes were evaluated. Treatment with 'Diashis' in STZ-induced diabetic rats resulted in a significant (P < 0.01) recovery in the activities of hepatic hexokinase, glucose-6-phosphate dehydrogenase, and glucose-6-phosphatase along with correction in the levels of fasting blood glucose, glycated hemoglobin, and liver and skeletal muscle glycogen. The oxidative stress status in the liver was corrected by 'Diashis' which was highlighted by the recovery in the activities of catalase, peroxidase, and glutathione-S-transferase along with the correction in the quantity of thiobarbituric acid-reactive substances and conjugated diene. 'Diashis' was not found to have any metabolic toxicity. The antidiabetic effects of 'Diashis' were compared with those of the antidiabetic drug, 'Glibenclamide'.

Methyl iodide poisoning presenting as a mimic of acute stroke: a case report.

INTRODUCTION: Stroke mimics are usually non-vascular disease processes. These raise the possibility of a stroke and are common in clinical practice. It is necessary to distinguish these mimics in order to provide early and appropriate management, as well as reduce possible harm on our patient. CASE PRESENTATION: We report the case of a 50-year-old Caucasian man who developed symptoms suggestive of posterior circulation stroke after he was exposed to methyl iodide at his workplace. Results of stroke investigations of our patient were negative, and a detailed occupational history clinched the diagnosis. Acute presentation with a stroke-like picture is rare in cases of methyl iodide poisoning. We have attempted to discuss the differential diagnosis of stroke mimics through a review of literature. CONCLUSION: Stroke mimics are difficult to diagnose in an emergency room situation and may be initially treated as stroke. This case report underlines the importance of history taking, especially occupational history, in the differential diagnosis of stroke. We also stress the need to recognize mimics at presentation in order to arrive at an early and appropriate management of patients.