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Fulltext The invisible evil twin of an adrenal adenoma

Aimi Fadilah M, Fatimah MS, Nor Aisyah Z, Nur’Aini EW, Nazimah AM, Effat O, et al.

Journal of Clinical and Health Sciences, 2019;4(1):58-63.
MyJurnal

Primary aldosteronism (PA) causes a persistently elevated blood pressure (BP) due to
excessive release of the hormone aldosterone from the adrenal glands. Classically, it is called
Conn’s syndrome and is described as the triad of hypertension and hypokalemia with the
presence of unilateral adrenal adenoma. It can be cured with surgical resection of the
aldosterone-secreting adenoma leading to resolution of hypertension, hypokalemia and
increased cardiovascular risk associated with hyperaldosteronism. We present a case of a man
with previous ischemic heart disease (IHD) who presented with resistant hypertension.
Investigations for secondary causes of hypertension revealed an elevated aldosterone level
and saline suppression test confirmed the diagnosis of PA. Radiological examination revealed
a left adrenal adenoma and a normal right adrenal gland. However, adrenal venous sampling
showed lateralization of aldosterone secretion towards the right. He subsequently underwent
a laparoscopic right adrenalectomy which improved his BP control promptly. This case
highlights the importance of recognizing the need to investigate for secondary causes of
hypertension. It also underscores the importance of dynamic tests, which may not be easily
accessible to most clinicians but should pursue, to allow a definitive diagnosis and effective
treatment.

Matched MeSH terms: Myocardial Ischemia
Fulltext Effects of vitamin E on stroke: a systematic review with meta-analysis and trial sequential analysis

Loh HC, Lim R, Lee KW, Ooi CY, Chuan DR, Looi I, et al.

Stroke Vasc Neurol, 2021 Mar;6(1):109-120.
PMID: 33109618 DOI: 10.1136/svn-2020-000519

There are several previous studies on the association of vitamin E with prevention of stroke but the findings remain controversial. We have conducted a systematic review, meta-analysis together with trial sequential analysis of randomised controlled trials to evaluate the effect of vitamin E supplementation versus placebo/no vitamin E on the risk reduction of total, fatal, non-fatal, haemorrhagic and ischaemic stroke. Relevant studies were identified by searching online databases through Medline, PubMed and Cochrane Central Register of Controlled Trials. A total of 18 studies with 148 016 participants were included in the analysis. There was no significant difference in the prevention of total stroke (RR (relative risk)=0.98, 95% CI 0.92-1.04, p=0.57), fatal stroke (RR=0.96, 95% CI 0.77-1.20, p=0.73) and non-fatal stroke (RR=0.96, 95% CI 0.88-1.05, p=0.35). Subgroup analyses were performed under each category (total stroke, fatal stroke and non-fatal stroke) and included the following subgroups (types of prevention, source and dosage of vitamin E and vitamin E alone vs control). The findings in all subgroup analyses were statistically insignificant. In stroke subtypes analysis, vitamin E showed significant risk reduction in ischaemic stroke (RR=0.92, 95% CI 0.85-0.99, p=0.04) but not in haemorrhagic stroke (RR=1.17, 95% CI 0.98-1.39, p=0.08). However, the trial sequential analysis demonstrated that more studies were needed to control random errors. Limitations of this study include the following: trials design may not have provided sufficient power to detect a change in stroke outcomes, participants may have had different lifestyles or health issues, there were a limited number of studies available for subgroup analysis, studies were mostly done in developed countries, and the total sample size for all included studies was insufficient to obtain a meaningful result from meta-analysis. In conclusion, there is still a lack of statistically significant evidence of the effects of vitamin E on the risk reduction of stroke. Nevertheless, vitamin E may offer some benefits in the prevention of ischaemic stroke and additional well-designed randomised controlled trials are needed to arrive at a definitive finding. PROSPERO registration number: CRD42020167827.

Matched MeSH terms: Brain Ischemia
Stroke and Novel Coronavirus Infection in Humans: A Systematic Review and Meta-Analysis

Lee KW, Yusof Khan AHK, Ching SM, Chia PK, Loh WC, Abdul Rashid AM, et al.

Front Neurol, 2020;11:579070.
PMID: 33123082 DOI: 10.3389/fneur.2020.579070

Background: As the world witnessed the devastation caused by the coronavirus disease 2019 (COVID-19) outbreak, a growing body of literature on COVID-19 is also becoming increasingly available. Stroke has increasingly been reported as a complication of COVID-19 infection. However, a systematic synthesis of the available data has not been conducted. Therefore, we performed a systematic review and meta-analysis of currently available epidemiological, clinical, and laboratory data related to both stroke and COVID-19 infection. Methods: We systematically searched Medline, Cinahl, and PubMed for studies related to stroke and COVID-19 from inception up to June 4, 2020. We selected cohort studies, case series, and case reports that reported the occurrence of stroke in COVID-19 patients. A fixed-effects model was used to estimate the pooled frequency of stroke in COVID-19 patients with a 95% confidence interval (CI). Results: Twenty-eight studies were included in the systematic review and seven studies for the meta-analysis. The pooled frequency of stroke in COVID-19 patients was 1.1% (95% CI: 0.8, 1.3). The heterogeneity was low (I2 = 0.0%). Even though the frequency of stroke among patients having COVID-19 infection was low, those with concomitant COVID-19 infection and stroke suffered from a more severe infection and eventually had a poorer prognosis with a higher mortality rate (46.7%) than COVID-19 alone. Many COVID-19 patients shared the common traditional risk factors for stroke. We noted that ischemic stroke involving the anterior circulation with large vessels occlusion is the most common type of stroke with more strokes seen in multi-territorial regions, suggesting systemic thromboembolism. An elevated level of D-dimers, C-reactive protein, ferritin, lactic acid dehydrogenase, troponin, ESR, fibrinogen, and a positive antiphospholipid antibody were also noted in this review. Conclusions: The occurrence of stroke in patients with COVID-19 infection is uncommon, but it may pose as an important prognostic marker and indicator of severity of infection, by causing large vessels occlusion and exhibiting a thrombo-inflammatory vascular picture. Physicians should be made aware and remain vigilant on the possible two-way relationship between stroke and COVID-19 infection. The rate of stroke among patients with COVID-19 infection may increase in the future as they share the common risk factors.

Matched MeSH terms: Brain Ischemia
Sudden cardiac death in a young adult man due to spontaneous coronary artery dissection

Subramaniam K, Siew SF, Mahmood MS

Malays J Pathol, 2019 Apr;41(1):51-54.
PMID: 31025638

Spontaneous coronary artery dissection is a rare event and commonly associated with pregnancy and female gender. This condition can reduce or completely obstruct the blood flow to the heart, causing a myocardial ischaemia, abnormalities in heart rhythm or sudden death. We present a case of a 28-year-old Indian male with no previous medical illness who complained sudden onset of chest pain prior to his death. Autopsy revealed a left anterior descending coronary artery dissection associated with plaque rupture. The anterior wall of left ventricle showed contraction band necrosis. There was also atheroma present in the right coronary artery which was insignificant. Histologically, dissection was associated with atherosclerosis. There was no evidence of vasculitis. The cause of death was given as coronary artery dissection due to coronary artery atherosclerosis.

Matched MeSH terms: Myocardial Ischemia
Fulltext Prevention of brain hypoperfusion-induced neurodegeneration in rat’s hippocampus by black cumin fixed oil treatment

Marwan Saad Azzubaidi, Al-Ani, Imad Matloub, Anil Kumar Saxena, Ghasak Ghazi Faisal

International Medical Journal Malaysia, 2018;17(1):103-112.
MyJurnal

Introduction: The oil extract of black cumin seeds Nigella sativa (NSO) demonstrated considerable
preservation of spatial cognitive functions in rats subjected to chronic brain hypoperfusion (CBH). The hippocampal CA1 region pyramidal cells are the earliest neurons suffering neurodegeneration following CBH. Objective: The current study was devoted to assess the protective effects of Nigella sativa (NSO) treatment on CA1 hippocampal pyramidal cells of rats subjected to chronic brain hypoperfusion (CBH) that was achieved through permanent two vessel occlusion (2VO) procedure. Methods: Twenty four rats were equally divided into three groups; sham control, untreated 2VO and NSO treated group (2VO with daily oral NSO treatment. After the 10th postoperative week coronal sections of the hippocampus were collected for histopathological and electron microscopical examinations. Results: The number of viable pyramidal cells within CA1 hippocampal region in sham control and NSO treated groups was significantly higher than that of untreated 2VO group, while the difference was not significant when comparing the viable pyramidal cells number of sham control with NSO treated groups. Furthermore, 2VO group showed marked intracellular ultrastructural distortions that were less pronounced in NSO treated group. Conclusion: NSO displayed a robust potential to protect hippocampal pyramidal cells from CBH induced neurodegeneration putting forward its prospective neuroprotective activity against age related cognitive decline of Alzheimer’s disease and vascular dementia.

Matched MeSH terms: Brain Ischemia
Fulltext The silver lining of COVID-19: estimation of short-term health impacts due to lockdown in the Yangtze River Delta region, China

Huang L, Liu Z, Li H, Wang Y, Li Y, Zhu Y, et al.

Geohealth, 2020 Jul 07.
PMID: 32838101 DOI: 10.1029/2020GH000272

The outbreak of COVID-19 in China has led to massive lockdowns in order to reduce the spread of the epidemic and control human-to-human transmission. Subsequent reductions in various anthropogenic activities have led to improved air quality during the lockdown. In this study, we apply a widely used exposure-response function to estimate the short-term health impacts associated with PM2.5 changes over the Yangtze River Delta (YRD) region due to COVID-19 lockdown. Concentrations of PM2.5 during lockdown period reduced by 22.9% to 54.0% compared to pre-lockdown level. Estimated PM2.5-related daily premature mortality during lockdown period is 895 (95% confidential interval: 637-1081), which is 43.3% lower than pre-lockdown period and 46.5% lower compared with averages of 2017-2019. According to our calculation, total number of avoided premature death associated PM2.5 reduction during the lockdown is estimated to be 42.4 thousand over the YRD region, with Shanghai, Wenzhou, Suzhou (Jiangsu province), Nanjing, and Nantong being the top five cities with largest health benefits. Avoided premature mortality is mostly contributed by reduced death associated with stroke (16.9 thousand, accounting for 40.0%), ischemic heart disease (14.0 thousand, 33.2%) and chronic obstructive pulmonary disease (7.6 thousand, 18.0%). Our calculations do not support or advocate any idea that pandemics produce a positive note to community health. We simply present health benefits from air pollution improvement due to large emission reductions from lowered human and industrial activities. Our results show that continuous efforts to improve air quality are essential to protect public health, especially over city-clusters with dense population.

Matched MeSH terms: Myocardial Ischemia
Fulltext Stroke Care Trends During COVID-19 Pandemic in Zanjan Province, Iran. From the CASCADE Initiative: Statistical Analysis Plan and Preliminary Results

Ghoreishi A, Arsang-Jang S, Sabaa-Ayoun Z, Yassi N, Sylaja PN, Akbari Y, et al.

J Stroke Cerebrovasc Dis, 2020 Dec;29(12):105321.
PMID: 33069086 DOI: 10.1016/j.jstrokecerebrovasdis.2020.105321

BACKGROUND: The emergence of the COVID-19 pandemic has significantly impacted global healthcare systems and this may affect stroke care and outcomes. This study examines the changes in stroke epidemiology and care during the COVID-19 pandemic in Zanjan Province, Iran.
METHODS: This study is part of the CASCADE international initiative. From February 18, 2019, to July 18, 2020, we followed ischemic and hemorrhagic stroke hospitalization rates and outcomes in Valiasr Hospital, Zanjan, Iran. We used a Bayesian hierarchical model and an interrupted time series analysis (ITS) to identify changes in stroke hospitalization rate, baseline stroke severity [measured by the National Institutes of Health Stroke Scale (NIHSS)], disability [measured by the modified Rankin Scale (mRS)], presentation time (last seen normal to hospital presentation), thrombolytic therapy rate, median door-to-needle time, length of hospital stay, and in-hospital mortality. We compared in-hospital mortality between study periods using Cox-regression model.
RESULTS: During the study period, 1,026 stroke patients were hospitalized. Stroke hospitalization rates per 100,000 population decreased from 68.09 before the pandemic to 44.50 during the pandemic, with a significant decline in both Bayesian [Beta: -1.034; Standard Error (SE): 0.22, 95% CrI: -1.48, -0.59] and ITS analysis (estimate: -1.03, SE = 0.24, p

Matched MeSH terms: Brain Ischemia/diagnosis; Brain Ischemia/mortality; Brain Ischemia/therapy*
Relapsing retroperitoenal abscess secondary to juvenile dermatomyositis: Complexity in management

Jothinathan M, Lau KS, Vanusha D

Med J Malaysia, 2020 03;75(2):178-180.
PMID: 32281605

Juvenile dermatomyositis (JDM) is a systemic autoimmune condition with myopathy. Gastrointestinal and pulmonary manifestations are rare presentation of JDM. Gastrointestinal perforation incidence in JDM is associated with vasculopathy and ischaemia. There are only few reported case of management of JDM with gastrointestinal complication. Management of such condition is challenging. We present a 21-year-old man with spontaneous descending colon perforation undergoing Hartmann's procedure. He subsequently presented with recurrent retroperitoneal abscess at five and 30 months following the initial presentation which was treated with percutaneous drainage. A high index of suspicion is necessary in JDM patients presenting with acute abdomen.

Matched MeSH terms: Ischemia
Platelet function in stroke/transient ischemic attack patients treated with tocotrienol

Slivka A, Rink C, Paoletto D, Sen CK

FASEB J, 2020 Sep;34(9):11838-11843.
PMID: 32686874 DOI: 10.1096/fj.201902216RR

The purpose of this study was to characterize the effects of tocotrienol form of vitamin E (TCT) on platelet function in patients with stroke or transient ischemic attack (TIA). A double blind, randomized, single center phase II clinical trial was conducted comparing placebo (PBO) and 400 and 800 mg TCT daily for a year in 150 patients with a sentinel ischemic stroke or TIA event in the prior 6 months. Platelet function was measured at baseline and then, at 3 month intervals for a year, using light transmission aggregometry. The incidence of aspirin resistance in aspirin-treated patients or platelet inhibition in patients on clopidogrel alone was compared between the three treatment groups. Results showed that in patients taking aspirin and clopidogrel, the incidence of aspirin resistance was significantly decreased from 40% in PBO-treated patients to 9% in the 400 mg TCT group and 25% in the TCT 800 mg group (P = .03). In conclusion, patients on aspirin and clopidogrel had a higher incidence of aspirin resistance than all patients treated with aspirin alone and TCT decreased the frequency of aspirin resistance in this group.

Matched MeSH terms: Brain Ischemia
Fulltext Superficial femoral artery thrombosis after midshaft femoral fracture fixation with an intramedullary nail: a case report

Ramachandran Rubenandran, Rampal Sanjiv, Sivalingarajah Prema, Tan Eng Kee, Devaraj Navin Kumar

Malaysian Journal of Medicine and Health Sciences, 2020;16(3):316-318.
MyJurnal

Intramedullary nailing is the preferred method of closed shaft fracture fixation of long bones. One of the most dread- ed complications to occur following internal fixation of a lower limb fracture is pseudo- or false aneurysm which can lead to the loss of the limb due to acute ischemia. This diagnosis is made by contrast angiogram of the limb. Pointers to the diagnosis include absent distal limb pulsation as well as other signs of acute ischemia post trauma or surgery. We present a case of development of pseudo-aneurysm in an elderly patient following open reduction and internal fixation of a femoral fracture. This case report outlines a prompt multidisciplinary approach of management in a rare case of pseudoaneurysm post fixation of long bone.

Matched MeSH terms: Ischemia
Screening for phaeochromocytoma in patients with acute cerebrovascular disease: Is it necessary?

Mohamed Zainuddin N, Sthaneshwar P, Ratnasingam J

Malays J Pathol, 2020 Aug;42(2):203-207.
PMID: 32860372

INTRODUCTION: Phaeochromocytoma may present with uncontrolled hypertension leading to haemorrhagic stroke (HS), ischaemic stroke (IS) and transient ischaemic attack (TIA). False elevation in the levels of CATS/ METS has been reported in acute cerebrovascular disease. Our aim was to analyse the frequency and pattern of elevations of CATS/METS in patients with acute cerebrovascular disease and to determine associated factors.
MATERIALS AND METHODS: This is a retrospective study of 112 samples of CATS/ METS received by the laboratory over a two-year period, from patients with acute cerebrovascular disease. CATS/METS were measured using LC/MS/MS method. Clinical details and CATS/METS level were obtained from the database. Mann-Whitney U test and Kruskal Wallis test were used for statistical analysis. These statistical analyses were performed using SPSS v.20.0 (IBM Corp., Armonk, NY, USA).
RESULTS: Of the 112 patients, 39% had HS, 54% had IS and 7% had TIA. A total of 29% of patients had elevated CATS/ METS. Elevated levels of CATS/METS were noted in 41% and 25% of HS and IS patients, respectively (p=0.53). Median norepinephrine, epinephrine and metanephrine levels in HS were significantly higher than IS (p< 0.05). Systolic blood pressure was higher in those who had elevated CATS/ METS (p=0.04). Only for two patients with elevated CATS/METS repeat testing was performed. Age, diastolic blood pressure and the time of sample collection in relation to the presentation, for CATS/METS were not significantly different between groups that had elevated levels of CATS/ METS versus those who did not.
CONCLUSION: We noted that CATS/METS were elevated in one-third of patients, especially in patients with high systolic blood pressure. Increase in CATS/METS should be appropriately followed up with repeat testing. Since false elevation in CATS/METS has been reported in cerebrovascular disease, screening for phaeochromocytoma is best deferred for a month.

Matched MeSH terms: Brain Ischemia
Fulltext Burden of premature mortality in Malaysia

Ummi Nadiah Yusoff, Diana Mahat, Azahadi Omar, Teh, Chien Huey, Norzawati Yoep, Riyanti Saari

Int J Public Health Res, 2013;3(1):249-258.
MyJurnal

Mortality estimates are important parameters for health monitoring and are routinely used as evidence for health policy and planning. This study aimed to estimate the mortality component of Burden of Disease in Malaysia in 2008. The 2008 mortality data from the Statistics Department were used to estimate cause-specific mortality (by age and sex) in Malaysia. Data were coded using the ICD10 (International Classification of Disease) coding. Calculation of mortality component of Burden of Disease (ie: Years of Life Lost (YLL) was done using the standard Global Burden of Disease Methodology. The total estimated deaths in Malaysia in 2008 were 124,857, of which 72,202 (57.8%) were males. The total years of life lost (YLL) for the Malaysian population in 2008 was 1.51 million in which 0.92 million (60.7%) was among males. Almost three quarter (68%) of the burden of premature deaths resulted from non-communicable diseases, followed by communicable diseases (20%) and injury (12%). Among the top three leading causes of YLL were ischaemic heart disease (17.1%), stroke (9.6%) and road traffic injuries (8.3%). In Malaysia, premature mortality mainly contributed by non-communicable diseases followed by communicable diseases and injury. A multi-agency collaboration is needed to prevent premature death and to improve quality of life.

Matched MeSH terms: Myocardial Ischemia
Fulltext Diffusion tensor imaging of Leukoaraiosis, normal appearing brain tissue, and normal brain tissue

Nur Hartini Mohd Taib, Wan Ahmad Kamil Wan Abdullah, Ibrahim Lutfi Shuaib

Malaysian Journal of Medicine and Health Sciences, 2015;11(1):1-10.
MyJurnal

Diffusion Tensor Imaging (DTI) is an advanced magnetic resonance imaging (MRI) technique. DTI provides quantitative information at microstuructural level via its parameter indices e.g. mean diffusivity (MD) and fractional anisotropy (FA). It also allows for visualization of neuron fibres through a specific technique called fibre tractography. Leukoaraiosis is an asymptomatic pathological condition of the brain white matter which appears hyperintense on T2-weighted MRI images. Association of leukoaraiosis with age and ischemic heart disease have been previously reported. The objective of this study is to compare MD and FA values measured in various areas of the brain white matter (WM), grey matter (GM), and cerebrospinal fluid (CSF) in humans using DTI. 30 subjects with leukoaraiosis and 12 subjects without leukoaraiosis underwent brain scan using GE 1.5 Tesla MRI system. Region of interests were located in the CSF and various WM and GM areas. Comparison of MD and FA values was made between leukoaraiosis tissue (LA) and normal appearing brain tissue (NABT) measured within the same leukoaraiosis subjects, and with normal brain tissue (CONTROL) of healthy control subjects. LA demonstrated a significantly higher MD and lower FA compared to NABT and CONTROL in frontal and occipital WM areas. No differences were observed in MD in any brain region between NABT and CONTROL. Whereas no differences were observed in FA between NABT and CONTROL except in the occipital WM. Fibre tractography showed 31.7% to 56.1% lesser fibre tracts in LA subjects compared to CONTROL subjects. Significant differences were found between pathological tissue compared to normal appearing brain tissue and normal brain tissue. Fibre tractography exposed reduced number of neural fibres in leukoaraiosis subjects as compared to normal subjects.

Matched MeSH terms: Myocardial Ischemia
Concomitant measurements of serum annexin A5 levels and hematological indices as markers in recent and old myocardial infarction with low ejection fraction: A preliminary study

Alhusseiny AH, Al-Nimer MS, Mohammad FI, Ali Jadoo SA

Int J Cardiol, 2016 Nov 15;223:514-518.
PMID: 27552568 DOI: 10.1016/j.ijcard.2016.08.244

Serum annexin A5 (anxA5) level is significantly increased in patients with acute coronary syndrome. Hematological indices are significantly increased in patients with ischemic heart disease. This study aimed to demonstrate the changes in the distribution of blood cells and the levels of anxA5 in patients presented with significant low ejection fraction ST-elevation acute myocardial infarction (STEMI) in comparison with corresponding patients with ischemic heart disease.

Matched MeSH terms: Myocardial Ischemia
Fulltext Quality of life amongst post coronary artery bypass Patients at the national heart institute, malaysia

Ho, SE, Noor Siah, A.A., Zaidah, Z., Teoh, KH, Gurbinder, J.S., Ismail, M.S., et al.

Medicine & Health, 2010;5(2):77-85.
MyJurnal

Coronary Artery Bypass Grafting (CABG) surgery has increased the survival rate for individuals suffering from myocardial infarction or coronary ischemia. The present study aimed to examine the perception of quality of life amongst post CABG patients at the National Heart Institute Malaysia. A total of 69 post CABG patients, were studied using the Medical Outcomes Short Form 36 (SF-36). The findings showed that post CABG respondents possessed good level of quality of life (SF-36) physically and mentally. There were significant differences between the role physical in the physical functioning domains of quality of life with gender (t=0.286, p

Matched MeSH terms: Myocardial Ischemia
Fulltext Cost analysis of hypertension management in an urban Primary Medical Centre Kuala Lumpur

Azimatun Noor, A., Amrizal, M.N., Weng Kang, T, Rafidah, A.R., Hong, Y Geok, Adibah, A, et al.

Malaysian Journal of Public Health Medicine, 2014;14(3):0-0.
MyJurnal

Hypertension is one of the commonest health problems in Malaysia and its cases are on a rise. In conjunction with the above statement, it is predictable that the cost of healthcare services will further increase in the future. Therefore, cost study is necessary to estimate the health related economic burden of hypertension in Malaysia. A cross sectional study was carried out to quantify the direct treatment cost of hypertension. Three hundred and ninety one hypertensive patients’ data from Bandar Tasik Selatan Primary Medical Centre in year 2010 were collected and analysed. The direct treatment costs were calculated. The result showed that out of 391 hypertensive patients, 12.5% was diagnosed hypertensive without any co-morbidity, 25.3% with 1 co-morbidity dyslipidemia only; 4.3% with diabetes mellitus type 2 only; 0.5% with chronic kidney disease only and none with ischaemic heart disease. Patients with 2 co-morbidities (dyslipidemia and diabetes mellitus type 2) were 42.2%; with 3 co-morbidities (diabetes mellitus type 2, dyslipidemia and chronic kidney disease) was 4.3%. The mean cost of direct treatment of hypertension per visit/ year was RM289.42 ±196.71 with the breakdown costs for each component were medicines 72.2%, salary 14.6%, laboratory tests 5.0%, administration 4.4% and radiology tests 3.8%. Dyslipidemia is by far the commonest co-morbidity among hypertensive patients. Direct costs of treating hypertension are mostly dependent on present of co-morbidity and numbers of drugs used. Thus, the annual budget could be calculated precisely in the future especially for drugs.

Matched MeSH terms: Myocardial Ischemia
Fulltext Predictors of stroke-associated pneumonia after the first episode of acute ischaemic stroke

Nor Adina, A.T., Ahmad, M.A., Uduman, A., Hamidon, B.B.

Malaysian Journal of Medicine and Health Sciences, 2012;8(1):37-43.
MyJurnal

Pneumonia is one of the most common complications of stroke with significant impact on patients’ outcome. The aim of this study is to look for the predictors of stroke-associated pneumonia (SAP) and its 30-day mortality and to analyse the survival of ischaemic stroke patients with pneumonia. Methodology: This is a prospective observational study, involving all acute first time ischaemic stroke patients admitted to a tertiary hospital that fulfilled the inclusion and exclusion criteria over a 6-month period. Demographic data were obtained on admission. Patients were reassessed for SAP, on day 5 and day 30. Assessment was done using the National Institutes of Health Stroke Scale (NIHSS) score, Barthel index and modified Rankin scale (MRS). All patients with pneumonia were assessed with the pneumonia severity index (PSI) for SAP. Results: One hundred and twenty patients were enrolled consecutively within the 6-month study period. 15.8% developed SAP. Independent predictors of SAP were clinical dysphagia (OR 76.32; 95%CI 4.46 to 1307.05), random blood glucose (RBS) on admission (OR 1.34; 95%CI 1.06 to 1.68) and NIHSS score on admission (OR 1.15; 95%CI 1.02 to 1.30). Independent predictors for 30-day mortality were NIHSS score on day 5 (OR 1.20; 95%CI 1.08 to 1.33) and occurrence of pneumonia (OR 14.90; 95% CI 3.34 to 66.42). There was a significant difference in mean survival between SAP and non-SAP patients. Conclusions: Clinical dysphagia, RBS on admission and NIHSS score on admission were independent predictors of SAP. NIHSS score on day 5 and pneumonia were independent predictors of 30-day mortality. SAP patients had shorter survival
time compared to non-SAP patients.

Matched MeSH terms: Brain Ischemia
The protective mechanisms of polydatin in cerebral ischemia

Tang KS, Tan JS

Eur J Pharmacol, 2019 Jan 05;842:133-138.
PMID: 30385347 DOI: 10.1016/j.ejphar.2018.10.039

The prevalence of stroke is high in both developing and developed nations. It causes a heavy social and financial burden to the sufferers and their caregivers. Thrombolytic therapy is the only pharmacological treatment available for stroke. However, thrombolytic agents do not provide substantial improvement on long term motor and cognitive disabilities. Thus, there is a need to explore for new compounds that can halt or reverse the deterioration of neurons in the stroke patients' brain. Polydatin, a precursor of resveratrol, is a natural stilbene commonly found in food. This review article describes how different parameters were altered with ischemic injury and polydatin treatment, why it is important and how it could be beneficial or useful in future studies. Our review of polydatin provides convincing evidence regarding the potential of polydatin to be developed into preventive or therapeutic products for ischemic stroke. Nevertheless, additional studies are necessary in order to properly elucidate the biological mechanisms of polydatin, especially its molecular mechanisms of protection and target proteins, in cerebral ischemia.

Matched MeSH terms: Brain Ischemia
Fulltext Hair Thread Tourniquet Syndrome in an Infant: Emergency Exploration Saves Limbs

Kesu Belani L, Leong JF, Narin Singh PSG, Abdullah S

Cureus, 2019 Dec 13;11(12):e6377.
PMID: 31938655 DOI: 10.7759/cureus.6377

Hair thread tourniquet syndrome (HTTS) is a rare condition where fibres constrict around appendages causing ischaemia and necrosis. It is a sporadically reported condition, where almost all reported cases showed involvement of fingers, toes or genitalia. A significant number of the cases are infants aged two weeks to six months where it is attributed to the mother's excessive hair fall due to hormonal changes after delivery. We present a two-month-old infant who was irritable for the past two days with her left ring finger exhibiting an ischaemic constriction with no apparent insulting agent. She successfully treated surgically after we suspected an incomplete removal of hair thread in the emergency department. We would like to highlight the importance of a high index of suspicion in cases as such as early intervention saves the appendage.

Matched MeSH terms: Ischemia
Fulltext TRPM2 Channel in Microglia as a New Player in Neuroinflammation Associated With a Spectrum of Central Nervous System Pathologies

Malko P, Syed Mortadza SA, McWilliam J, Jiang LH

Front Pharmacol, 2019;10:239.
PMID: 30914955 DOI: 10.3389/fphar.2019.00239

Microglial cells in the central nervous system (CNS) are crucial in maintaining a healthy environment for neurons to function properly. However, aberrant microglial cell activation can lead to excessive generation of neurotoxic proinflammatory mediators and neuroinflammation, which represents a contributing factor in a wide spectrum of CNS pathologies, including ischemic stroke, traumatic brain damage, Alzheimer's disease, Parkinson's disease, multiple sclerosis, psychiatric disorders, autism spectrum disorders, and chronic neuropathic pain. Oxidative stress is a salient and common feature of these conditions and has been strongly implicated in microglial cell activation and neuroinflammation. The transient receptor potential melastatin-related 2 (TRPM2) channel, an oxidative stress-sensitive calcium-permeable cationic channel, is highly expressed in microglial cells. In this review, we examine the recent studies that provide evidence to support an important role for the TRPM2 channel, particularly TRPM2-mediated Ca2+ signaling, in mediating microglial cell activation, generation of proinflammatory mediators and neuroinflammation, which are of relevance to CNS pathologies. These findings lead to a growing interest in the TRPM2 channel, a new player in neuroinflammation, as a novel therapeutic target for CNS diseases.

Matched MeSH terms: Brain Ischemia

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