39 results on '"Sanjith Aaron"'
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2. STENOSIS: Long-term single versus dual antiplatelet therapy in patients with ischaemic stroke due to intracranial atherosclerotic disease – a randomised trial
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Ashish Sharma, Thomas Iype, Deepti Vibha, Jeyaraj Durai Pandian, Rajesh Kumar Singh, Rajinder K Dhamija, Rohit Bhatia, Ayush Agarwal, Shweta Jain, Dheeraj Khurana, Sudhir Sharma, Shyam K Jaiswal, Biman Kanti Ray, Sunil K Narayan, Deepti Arora, Meenakshi Sharma, Ajay Garg, Pamidimukkala Vijaya, Vivek Nambiar, Rajsrinivas Parthasarathy, Pooja Gupta, Girish Baburao Kulkarni, Sanjith Aaron, Deepti Bal, PN Sylaja, Arvind Sharma, MV Padma Srivastava, Saman Fatima, Risha Sarkar, Imnameren Longkumer, Aneesh Dhasan, Srijithesh P Rajendran, Jayanta Roy, Paul J Alapatt, Awadh K Pandit, Venugopalan Y Vishnu, Rahul Huilgol, KS Arya Devi, Pheba Susan Raju, RS Dhaliwal, Sanjeev Kumar Bhoi, Binod Sarmah, SP Gorthi, Somasundaram Kumaravelu, Lakshya Jyoti Basumatary, Neetu Ramrakhiani, Rupjyoti Das, NV Sundarachary, Vijay Sardana, Chithra Mukesh, Sulena Sulena, Abhishek Pathak, T Harisuthan, Aparna R Pai, TCR Ramakrishnan, AO Saroja, Ravishankar Naik, Neeraj Bhutani, Soaham Desai, Gaurav Kumar Mittal, S Saravanan, and Leve S Joseph Devaranjan
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Neurosciences. Biological psychiatry. Neuropsychiatry ,RC321-571 - Abstract
Rationale Intracranial atherosclerotic disease (ICAD) is a pathological process that causes progressive stenosis and cerebral hypoperfusion, leading to stroke occurrence and recurrence around the world. The exact duration of dual antiplatelet therapy (DAPT) for ICAD is unclear in view of long-term risk of bleeding complications.Aim The current study aims to study the efficacy and safety of long-term DAPT (up to 12 months) in patients with ICAD.Sample size Using 80% power and an alpha error of 5 %, presuming a 10%–15% drop-out rate, a total of 2200 patients will be recruited for the study.Methodology This is a prospective, randomised, double-blind, placebo controlled trial.Study outcomes The primary outcomes include recurrent ischaemic stroke (IS) or transient ischaemic attack and any intracranial haemorrhage (ICH), major or minor systemic bleeding at the end of 12 months. Secondary outcomes include composite of any stroke, myocardial infarction or death at the end of 12 months. The safety outcomes include any ICH, major or minor bleeding as defined using GUSTO (Global Use of Streptokinase and tPA for occluded Coronary Arteries) classification at the end of 12 months and 1 month after completion of the drug treatment phase.Discussion The study will provide level I evidence on the duration of DAPT among patients with IS due to ICAD of more than or equal to 50%.
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- 2024
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3. Stroke in Asia
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Kay Sin Tan, Jeyaraj Durai Pandian, Liping Liu, Kazunori Toyoda, Thomas Wai Hon Leung, Shinichiro Uchiyama, Sathoshi Kuroda, Nijasri C. Suwanwela, Sanjith Aaron, Hui Meng Chang, and Narayanaswamy Venketasubramanian
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Diseases of the circulatory (Cardiovascular) system ,RC666-701 - Abstract
Background There is a significant burden of stroke in Asia. Asia has the largest population in the world in 2023, estimated at 4.7 billion. Approximately 9.5-10.6 million strokes will be anticipated annually in the backdrop of a diverse group of well-developed and less developed countries with large disparities in stroke care resources. In addition, Asian countries are in varying phases of epidemiological transition. Summary In this review, we examined recent epidemiological features of ischaemic stroke and intracerebral haemorrhage in Asia with recent developments in hyperacute stroke reperfusion therapy and technical improvements in intracerebral haemorrhage. The article also discussed the spectrum of cerebrovascular diseases in Asia which include intracranial atherosclerosis, intracerebral haemorrhage, infective aetiologies of stroke, moyamoya disease, vascular dissection, radiation vasculopathy and cerebral venous thrombosis. Key Messages The review of selected literature and recent updates, call for attention to the different requirements for resources within Asia and highlights the breadth of cerebrovascular diseases still requiring further research and more effective therapies,
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- 2024
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4. RE-OPEN: Randomised trial of biosimilar TNK versus TPA during endovascular therapy for acute ischaemic stroke due to large vessel occlusions
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Deepti Vibha, Rajesh Kumar Singh, Rohit Bhatia, Ayush Agarwal, Shweta Jain, Dheeraj Khurana, Deep Das, Biman Kanti Ray, Deepti Arora, Meenakshi Sharma, Ajay Garg, Pamidimukkala Vijaya, Vivek Nambiar, Girish Baburao Kulkarni, Sanjith Aaron, Angel T Miraclin, PN Sylaja, MV Padma Srivastava, Saman Fatima, Risha Sarkar, Imnameren Longkumer, Shailesh Gaikwad, Leve S Joseph Devaranjan, Jeyaraj Durai Pandian, Aneesh Dhasan, Srijithesh P Rajendran, Jayanta Roy, Paul J Alapatt, Awadh K Pandit, Venugopalan Y Vishnu, Rajeshwar Sahonta, Rahul Huilgol, KS Arya Devi, Chirag Ahuja, Pheba Susan Raju, ER Jayadevan, Sapna Erat Sreedharan, K Santhosh Kumar, K Sajith, KP Abdurehiman, LK Sreevidya, Subhadeep Banerjee, Srinivas Reddy, Pritam Raja, and RS Dhaliwal
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Neurosciences. Biological psychiatry. Neuropsychiatry ,RC321-571 - Abstract
Rationale Rapid and timely treatment with intravenous thrombolysis and endovascular treatment (EVT) in patients with acute ischaemic stroke (AIS) and large vessel occlusion (LVO) significantly improves patient outcomes. Bridging therapy is the current standard of care in these patients. However, an incompletely answered question is whether one thrombolytic agent is better than another during bridging therapy.Aim The current study aims to understand if one thrombolytic agent is superior to the other during bridging therapy in the treatment of AIS and LVO.Sample size estimates Using 80% power and an alpha error of 5 %, presuming a 10% drop out rate, a total of 372 patients will be recruited for the study.Methods and design This study is a prospective, randomised, multicentre, open-label trial with blinded outcome analysis design.Study outcomes The primary outcomes include proportion of patients who will be independent at 3 months (modified Rankin score (mRS) ≤2 as good outcome) and proportion of patients who achieve recanalisation modified thrombolysis in cerebral infarction grade 2b/3 at first angiography run at the end of EVT. Secondary outcomes include proportion of patients with early neurological improvement, rate of symptomatic intracerebral haemorrhage (ICH), rate of any ICH, rate of any systemic major or minor bleeding and duration of hospital stay. Safety outcomes include any intracranial bleeding or symptomatic ICH.Discussion This trial is envisioned to confirm the theoretical advantages and increase the strength and quality of evidence for use of tenecteplase (TNK) in practice. Also, it will help to generate data on the efficacy and safety of biosimilar TNK.Trial registration number CTRI/2022/01/039473.
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- 2024
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5. Changes in the profile of Coronavirus disease (COVID-19) and related neuroimaging findings during the first and second waves: a South Indian perspective
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Matthew Monachen, Anitha Jasper, Pavithra Mannam, Sanjith Aaron, Ajith Sivadasan, A. T. Prabhakar, Harshad Vanjare, and Bernice T. Selvi
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Coronavirus disease 2019 ,Stroke ,Acute invasive fungal sinusitis ,Mucormycosis ,Medical physics. Medical radiology. Nuclear medicine ,R895-920 - Abstract
Abstract Background The spectrum of COVID-19 infection-related neurological imaging findings in East Asian and Western populations has been well documented. In the Indian subcontinent, certain extracranial neurological imaging manifestations such as acute invasive fungal sinusitis were noted to occur with increasing frequency when compared to that reported in literature. This anomaly was more evident during the second wave of infection and since there is a paucity of literature documenting this change, we undertook this retrospective observational study. Results Patients with COVID-19 who underwent brain or spine imaging between 1st March 2020 and 31st May 2021 were assessed for inclusion. We considered cases with imaging done in 2020 as the 1st wave, and cases with imaging done in 2021 as the 2nd wave. In the first wave, the most common neuroimaging findings were ischemic stroke (82, 26.5%), acute invasive fungal sinusitis (34, 11%), dural venous sinus thrombosis (15, 4.9%), and brain hemorrhages (15, 4.9%). In the second wave, the most common were acute invasive fungal sinusitis (44, 21.9%), ischemic stroke (39, 19.4%), and noninvasive sinusitis (30, 14.9%). The second wave had significantly more cases of acute invasive fungal sinusitis (44, 21.9% vs. 34, 11%; p-value .001), noninvasive sinusitis, and orbital cellulitis when compared to the first wave. Conclusions While we had ischemic stroke, followed by acute invasive fungal sinusitis, dural venous sinus thrombosis, and brain hemorrhages as the most common neuroimaging findings in the first wave, the second wave was dominated by the extracranial complications of Mucormycosis, namely acute invasive fungal sinusitis.
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- 2023
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6. The facilitators and barriers to home-based robotic rehabilitation in India: a pilot feasibility study
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Aravind Nehrujee, A. T. Prabhakar, Sathish Balaraman, Rasika Bombatkar, Henry Prakash, Selvaraj Samuelkamaleshkumar, Sanjith Aaron, Suranjan Bhattacharji, S. Sujatha, and Sivakumar Balasubramanian
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rehabilitation robot ,home-based ,usability ,serious games ,hand ,stroke ,Medicine - Abstract
IntroductionRobot-assisted rehabilitation has emerged as a promising approach for enhancing motor function in stroke survivors. However, the feasibility and effectiveness of home-based robotic training in this population are underexplored, especially in low/middle-income countries.MethodsThis feasibility study aimed to address this gap by examining the feasibility and effectiveness of independent home-based training using PLUTO, a robotic device for hand training. A total of 7 chronic stroke survivors were recruited, with 5 completing the study.ResultsThe results revealed high engagement and adherence to the home-based training program, with participants averaging 1659.8 min of training over 24.8 days. The PLUTO system demonstrated excellent usability and elicited positive user perceptions. Significant improvements were observed in functional outcomes, as evidenced by a noteworthy increase in Fugl-Meyer Assessment scores (mean increase of 6.2 points, exceeding the minimal clinically important difference (MCID) of 5.35 points). Furthermore, participants showed improvements in the ABILHAND measure (mean improvement of 1.24 logits, surpassing the MCID of 0.2 logits) and the Barthel Index (mean increase of 8.8 points).ConclusionThese findings demonstrate the feasibility and effectiveness of home-based robotic rehabilitation for chronic stroke survivors. This has implications for expanding access to rehabilitation services in low- and middle-income countries, enhancing patient engagement and adherence, and improving functional outcomes. Larger controlled studies are warranted to evaluate the effectiveness of home-based robotic rehabilitation programs.
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- 2024
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7. The burden, risk factors and unique etiologies of stroke in South-East Asia Region (SEAR)
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Jeyaraj D. Pandian, Madakasira Vasantha Padma Srivastava, Sanjith Aaron, Udaya K. Ranawaka, Narayanaswamy Venketasubramanian, Ivy Anne Sebastian, Ranjit J. Injety, Dorcas B.C. Gandhi, Nistara S. Chawla, Pranay J. Vijayanand, Sukanya Rangamani, and Yogeshwar V. Kalkonde
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Stroke burden ,Stroke risk factors ,Unique etiologies ,Public aspects of medicine ,RA1-1270 - Abstract
Summary: The World Health Organization (WHO) South East Asia Region (SEAR) comprises 11 countries, which are one of the most culturally, topographically, and socially diverse areas worldwide, undergoing an epidemiological transition towards non-communicable diseases, including stroke and other cardiovascular diseases (CVDs). This region accounts for over 40% of the global stroke mortality. Few well-designed population-based epidemiological studies on stroke are available from SEAR countries, with considerable variations among them. Ischemic stroke, a common stroke subtype, has higher frequencies of intracerebral hemorrhage in many countries. Along with an aging population, the increased prevalence of risk factors such as hypertension, diabetes mellitus, tobacco and alcohol consumption, lack of physical activity, high ambient pollution, heat, and humidity contribute to the high burden of stroke in this region. SEAR's many unique and uncommon stroke etiologies include cerebral venous thrombosis, tuberculosis, dengue, scrub typhus, falciparum malaria, snake bite, scorpion sting, etc. Current data on stroke burden and risk factors is lacking, compelling an urgent need for high-quality hospital-level and population-level data in all SEAR countries. Strategies towards a consolidated approach for implementing improved stroke prevention measures, stroke surveillance, and established stroke systems of care are the path to bridging the gaps in stroke care.
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- 2023
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8. Direct oral anticoagulants for the treatment of cerebral venous thrombosis – a protocol of an international phase IV study
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Anita van de Munckhof, Mayte Sánchez van Kammen, Katarzyna Krzywicka, Sanjith Aaron, Diana Aguiar de Sousa, Florina Antochi, Antonio Arauz, Miguel A. Barboza, Adriana B. Conforto, Francesco Dentali, Daniel Galdames Contreras, Xunming Ji, Katarina Jood, Mirjam R. Heldner, María Hernández-Pérez, Wayneho Kam, Timothy J. Kleinig, Espen S. Kristoffersen, Ronen R. Leker, Robin Lemmens, Sven Poli, Nilüfer Yeşilot, Mohammad Wasay, Teddy Y. Wu, Marcel Arnold, Lia Lucas-Neto, Saskia Middeldorp, Jukka Putaala, Turgut Tatlisumak, José M. Ferro, and Jonathan M. Coutinho
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cerebral venous thrombosis ,anticoagulants ,DOAC ,vitamin K antagonist ,treatment ,Neurology. Diseases of the nervous system ,RC346-429 - Abstract
IntroductionCurrent guidelines recommend that patients with cerebral venous thrombosis (CVT) should be treated with vitamin K antagonists (VKAs) for 3–12 months. Direct oral anticoagulants (DOACs), however, are increasingly used in clinical practice. An exploratory randomized controlled trial including 120 patients with CVT suggested that the efficacy and safety profile of dabigatran (a DOAC) is similar to VKAs for the treatment of CVT, but large-scale prospective studies from a real-world setting are lacking.MethodsDOAC-CVT is an international, prospective, observational cohort study comparing DOACs to VKAs for the prevention of recurrent venous thrombotic events after acute CVT. Patients are eligible if they are 18 years or older, have a radiologically confirmed CVT, and have started oral anticoagulant treatment (DOAC or VKA) within 30 days of CVT diagnosis. Patients with an absolute contra-indication for DOACs, such as pregnancy or severe renal insufficiency, are excluded from the study. We aim to recruit at least 500 patients within a three-year recruitment period. The primary endpoint is a composite of recurrent venous thrombosis and major bleeding at 6 months of follow-up. We will calculate an adjusted odds ratio for the primary endpoint using propensity score inverse probability treatment weighting.DiscussionDOAC-CVT will provide real-world data on the comparative efficacy and safety of DOACs versus VKAs for the treatment of CVT.Clinical trial registrationClinicalTrials.gov, NCT04660747.
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- 2023
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9. A case–control study on risk factors for development of tuberculous meningitis in adults
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Meban Aibor Kharkongor, Jaya Prakash Muliyil, Balamugesh Thangakunam, Devasahayam Jesudas Christopher, Vignesh Kumar Chandiraseharan, Appaswamy Thirumal Prabhakar, Sanjith Aaron, Samuel George Hansdak, Abi Manesh, Manjeera Jaganautti, Anand Zachariah, and Thambu David Sudarsanam
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bacillus calmette–guérin vaccination ,food insecurity ,social stress ,tuberculous meningitis ,Medicine ,Nursing ,RT1-120 - Abstract
Introduction: Tuberculous meningitis remains the most severe and devastating form of tuberculosis with relatively severe morbidity and mortality. Risk factors for TB meningitis have not focused on the role of the BCG vaccine or social and food insecurity which are known to have a role in pulmonary TB. Methods: We prospectively conducted a Case-Control study among 65 patients with TB meningitis and 41 controls with other forms of meningitis. We evaluated the role of the BCG vaccine, the Household Food Insecurity Access Scale (HFIAS) and the Social Readjustment Rating Scale (SRRS) to look for food and social stress respectively. We also evaluated the known risk factors for TB meningitis including age, HIV co-infection, alcoholism, malignancies, use of immunosuppression, head injury among others. A bivariate followed by multivariate regression analysis was performed. Results: The presence of BCG scar was seen in 64.6 percent of patients with Tuberculous meningitis and 61.0 percent of control (P= 0.71). There was no difference in the size of the scars (P= 0.45) . Household food insecurity using the Household Food Insecurity Access Scale (HFIAS) ( a positive answer in any of the 9 items) was present in 16.9% of the patients in the TBM group and in 14.6% of the patients in the control group. (P= 0.75). Social stress assessed using the Social Readjustment Rating Score (< 150 suggest no social stress, 150 – 300 moderate social stress,> 300 high social stress) showed that a majority of the patients in both the groups reports no social stress. Only 9.8% of patients in the TBM group and 18.5% in the control group reports moderate presence of social stress whereas none of the patients had severe social stress. Logistic regression analysis suggested that only higher BMI was associated with lesser incidence of Tuberculous meningitis, odds ratio 0.83 (95% confidence interval of 0.73 – 0.930) and individuals performing clerical and unskilled and under-skilled jobs- odds ratio 0.13 (95% confidence interval of 0.02 – 0.93) had lower risk for TB Meningitis. Conclusions: In our sample of TB meningitis patients the BCG vaccine, food insecurity nor social stress appear to be risk factors. Bigger BMI and certain occupations appear to be possibly protective.
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- 2023
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10. Posterior circulation strokes – Clinico-Radiological features and predictors of outcome at 6 months
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Anju Susan Jacob, Sanjith Aaron, Sunithi Mani, Kundavaram Paul Prabhakar Abhilash, Ajay Kumar Mishra, Samuel George Hansdak, Ramya Iyyadurai, Alice Joan Mathuram, Sheena Evelyn Ebenezer, Mahendri V Narayana, Visalakshi Jeyaseelan, and Thambu David Sudarsanam
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cohort ,outcome ,posterior-circulation-stroke ,prediction ,Medicine ,Nursing ,RT1-120 - Abstract
Introduction: Posterior circulation stroke (PCS) is often diagnosed late and long-term outcomes have not been described in South India. We wished to study clinical features, long-term outcomes, and independent predictors of the same. Materials and Methods: We conducted a prospective cohort study in PCS patients from January 2014 to May 2017. Morbidity and mortality at discharge, at 3 months and 6 months was studied. Univariate and multivariate analysis of predictors of poor outcome as well as the survival analysis was computed. Results: We recruited 291 PCS during the study period; prevalence of PCS among all strokes was 12.9% in 2014. The mean age was 53.34 years (standard deviation 13.34). Young strokes constituted 28.8%. The common comorbidities were hypertension 72%, diabetes mellitus 52.6%, smoking 38.5%, and dyslipidemia 32.6%. The common presenting symptoms were giddiness 79%, unsteadiness 75.35%, ataxia 56%, motor deficits 48.8% and nausea and vomiting 43%. Most were Ischemic strokes (86.5%); 10.3% gave a history of preceding TIAs. Common arteries involved were posterior cerebral 45%, posterior inferior cerebellar 38%, and basilar artery 19.2%. Among ischemic strokes, large artery atherosclerosis was 50.8%. Dysphagia was seen in 32.6% and sepsis in 19.2%; post stroke pain in 23%, followed by cognition decline in 10.3%. Bad outcome (modifies Rankins score 4–6) was 16.8% at discharge, 16.4% at 1 month, 14.4% at 3 months, and 13.8% at 6 months. Independent predictors of bad outcomes at 6 months were baseline National Institute of Health Stroke Scale (NIHSS) score (Odds ratio [OR] 1615.59 confidence interval [CI] 27.64–94447.7), invasive ventilation (OR 7.77 CI 1.57–38.43), sepsis (OR 17.22 CI 1.45–204.08), and basilar artery involvement (OR 19.98 CI 1.67–238.81). Baseline NIHSS scores between 0 and 5 suggest a good outcome while scores more than 13 suggest a bad outcome at 6 months. At 6 months, half are unemployed. Conclusions: The prevalence, clinical features, and comorbidities were also similar to previous studies. There was good survival at 6 months. NIHSS score is useful in predicting poor outcomes.
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- 2023
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11. Do bone mineral density, trabecular bone score, and hip structural analysis differ in indian men with parkinson's disease? A case-control pilot study from a tertiary center in Southern India
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Basavaraj G Sooragonda, Kalyani Sridharan, Rohit Ninan Benjamin, A T Prabhakar, Ajith Sivadasan, Nitin Kapoor, Kripa Elizabeth Cherian, Felix K Jebasingh, Sanjith Aaron, Vivek Mathew, Hesarghatta S Asha, Nihal Thomas, and Thomas V Paul
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bone mineral density ,hip structural analysis ,parkinson's disease ,trabecular bone score ,Neurology. Diseases of the nervous system ,RC346-429 - Abstract
Objective: Parkinson's disease (PD) is a neurodegenerative condition that is characterized by bradykinesia, rigidity, and gait instability. Inherent to this condition is an increased predisposition to falls and fractures. Bone health in Parkinson's disease in India has not been studied thus far. This study aimed to assess the bone mineral density (BMD), trabecular bone score (TBS), and hip structural analysis (HSA) in Indian men with PD and compare them with matched controls. Methodology: A case-control study done at a tertiary care center from southern India. Bone biochemistry, BMD, TBS, and HSA were assessed. Results: Among 40 cases and 40 age, gender, and body mass index (BMI)-matched controls, there was no significant difference in BMD between both groups. The mean (SD) TBS at the lumbar spine [1.349 (0.090)] was significantly (P = 0.019) lower in men with PD as compared to matched controls [1.401 (0.089)]. Among the parameters of HSA, the buckling ratios were significantly higher at the femoral neck [11.8 (2.2) vs 9.4 (2.2); P = 0.001] and inter-trochanteric region [9.4 (2.1) vs 7.8 (1.4); P = 0.002] among cases as compared to matched controls. Vitamin D deficiency was significantly higher in this cohort of patients as was bone turnover marker indicating bone loss and a high bone turnover state. Conclusion: A comprehensive bone health assessment comprising BMD, TBS, and HSA may be required to capture all aspects of bone strength in Indian men with PD as BMD assessment as a stand-alone tool may not suffice to obtain all information pertaining to fracture risk in these individuals.
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- 2023
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12. Changing Dynamics of Self-Harm by Attempted Suicidal Hanging during the COVID-19 Pandemic
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Shalini Nair, Tryphena Selwyn, Mammen P. Varghese, Reka Karuppusami, and Sanjith Aaron
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covid-19 ,deliberate self-harm ,family quarrel ,hanging ,screen time ,suicide ,Medicine - Abstract
Background: The second wave of coronavirus disease (COVID-19) in 2021 was devastating for low- and middle-income countries (LMICs). This led to increased suicide rates among the young, economically productive age group. We analyzed the cohort of attempted suicidal hangings needing admission to the intensive care unit (ICU) and compared the data from the pre-COVID-19 era. Materials and Methods: We conducted a retrospective, observational, cohort study of suicidal hanging cases according to the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) guidelines. Six-month data of such cases admitted to the neurological ICU after the lockdown of the second wave of COVID-19 from July 2021 to January 2022 were collected. Demographic data along with the cause of attempted hanging, severity of sickness from hanging, and its outcome were gathered and compared with similar data acquired during 2003–2015 by the same authors in the same ICU. Results: There was a threefold increase in the incidence of suicidal hangings needing ICU care, from 9 to 27% in the pre- and post-COVID-19 era. A shift toward older aged males, in the third decade of life, was observed. The common cause of attempted suicide was a familial dispute (P = 0.03). Among the younger age group (18–25 years), increased screen time led to fights in the family. The cohort was also sicker with more severe lung involvement, longer ventilation, and hospital stay (P < 0.001). Conclusion: The increased incidence of hanging among young adults, amid the socioeconomic effects of COVID-19, needs urgent attention. Suicide prevention measures need novel strategies aimed at de-addiction from electronic gadgets and reducing screen time.
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- 2023
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13. Secondary prevention with a structured semi-interactive stroke prevention package in INDIA (SPRINT INDIA): a multicentre, randomised controlled trial
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Jeyaraj Durai Pandian, Mahesh Pundlik Kate, Padmavathyamma Narayanapillai Sylaja, Dheeraj Khurana, Vijaya Pamidimukkala, Biman Kanti Ray, Vivek Keshavan Nambiar, Sanjith Aaron, Gaurav Kumar Mittal, Sundarachary Nagarjunakonda, Aparna Ramakrishna Pai, Sankar Prasad Gorthi, Somasundaram Kumaravelu, Yerasu Muralidhar Reddy, Sunil Narayan, Nomal Chandra Borah, Rupjyoti Das, Girish Baburao Kulkarni, Vikram Huded, Thomas Mathew, M Vasantha Padma Srivastava, Rohit Bhatia, Pawan Tarkeshwarnath Ojha, Jayanta Roy, Sherly Mary Abraham, Anand Girish Vaishnav, Arvind Sharma, Shaikh Afshan Jabeen, Abhishek Pathak, Sanjeev Kumar Bhoi, Sudhir Sharma, Sulena Sulena, Aralikatte Onkarappa Saroja, Neetu Ramrakhiani, Madhusudhan Byadarahalli Kempegowda, Sapna Erat Sreedharan, Gautam Das, Tina George, Ivy Sebastian, Rajeshwar Sahonta, Shyam Krishnakumar Jaiswal, Lalitha Pidaparthi, Rajeshwari Aghoram, Jemin Jeyachandra Webster, Rakesh Hasmukhlal Shah, Menka Jha, Karkal Ravishankar Niak, Deepti Arora, Shweta Jain Verma, Rahul Huilgol, Aneesh Dhasan, Vishnu Renjith, Himani Khatter, Prabhakaran Sarma, Sadasivan Laila Visakh, Sukhmandeep Kaur, Tagallamudi Nagamalleswara Rao, Venkatesh Dumpala, Gargi Podder, Arindam Biswas, Karthika Rani, Nishanthini Dhamodharan, Shilpa Sekhar, Satish Kumar Chinka, Varsha Aroor Prabhu, Farhaz Zaha, Sarvotham Ramanathan, Deepika Pabbu, Nupur Choudhury, Ramya Ramanathan, Saji K James, Neha Kuthalia, Sakshi Sharma, Mayuri Ramchandra Gaikwad, Purbita Sen, Sumita Basumatary, Rachana Dhruvesh Bhatt, Dipal Patel, Mareena Cyriac, Sasmita Swain, Narinder Kumar, Amaresh Kurubara, Devang Sharma, Meenakshi Sharma, Rupinder Dhaliwal, Jagarlapudi Murali Krishna Murthy, Prem Pais, Denis Xavier, Parthasarathy Satishchandra, Subash Kaul, Vishnubhatla Sreenivas, Suresh Chandran, Rajneesh Kumar Calton, and Jacob George
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Public aspects of medicine ,RA1-1270 - Abstract
Summary: Background: There is a high burden of stroke, including recurrent stroke, in India. We aimed to assess the effect of a structured semi-interactive stroke prevention package in patients with subacute stroke to reduce recurrent strokes, myocardial infarction, and death. Methods: This was a multicentre, randomised, clinical trial conducted in 31 centres of the Indian Stroke Clinical Trial Network (INSTRuCT). Adult patients with first stroke and access to a mobile cellular device were randomly allocated (1:1) to intervention and control groups by the research coordinators at each centre using a central, in-house, web-based randomisation system. The participants and research coordinators at each centre were not masked to group assignment. The intervention group received regular short SMS messages and videos that promoted risk factor control and medication adherence and an educational workbook, in one of 12 languages, and the control group received standard care. The primary outcome was a composite of recurrent stroke, high-risk transient ischaemic attack, acute coronary syndrome, and death at 1 year. The outcome and safety analyses were done in the intention-to-treat population. The trial is registered with ClinicalTrials.gov, NCT03228979 and Clinical Trials Registry-India (CTRI/2017/09/009600) and was stopped for futility after interim analysis. Findings: Between April 28, 2018, and Nov 30, 2021, 5640 patients were assessed for eligibility. 4298 patients were randomised to the intervention group (n=2148) or control group (n=2150). 620 patients were not followed up at 6 months and a further 595 patients were not followed up at 1 year because the trial was stopped for futility after interim analysis. 45 patients were lost to follow-up before 1 year. Acknowledgment of receipt of the SMS messages and videos by the intervention group patients was low (17%). The primary outcome occurred in 119 (5·5%) of 2148 patients in the intervention group and 106 (4·9%) of 2150 patients in the control group (adjusted odds ratio 1·12; 95% CI 0·85–1·47; p=0·370). Among the secondary outcome measures, alcohol cessation and smoking cessation were higher in the intervention group than in the control group (alcohol cessation 231 [85%] of 272 in the intervention group vs 255 [78%] of 326 in the control group; p=0·036; smoking cessation 202 [83%] vs 206 [75%]; p=0·035). Medication compliance was better in the intervention group than in the control group (1406 [93·6%] of 1502 vs 1379 [89·8%] of 1536; p
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- 2023
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14. Opsoclonus myoclonus ataxia syndrome, ovarian teratoma and anti-NMDAR antibody: an ‘unresolved’ mystery
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Vivek Mathew, Sanjith Aaron, Ajith Sivadasan, Sharon Milton, Angel T Miraclin, Arun Mathai Mani, Aditya Nair, Munagapati Christina, Abigail Ruth Gojer, John A Jude Prakash, Rohit N Benjamin, and Appaswamy Thirumal Prabhakar
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Neurosciences. Biological psychiatry. Neuropsychiatry ,RC321-571 - Abstract
Background Opsoclonus–myoclonus–ataxia syndrome (OMAS) is characterised by the combination of opsoclonus and arrhythmic action myoclonus with axial ataxia and dysarthria. In adults, a majority are paraneoplastic secondary to solid organ tumours and could harbour antibodies against intracellular epitopes; however, certain proportions have detectable antibodies to various neuronal cell surface antigens. Anti-N-methyl-D-aspartate (NMDAR) antibodies and ovarian teratomas have been implicated in OMAS.Methods Report of two cases and review of literature.Results Two middle-aged women presented with subacute-onset, rapidly progressive OMAS and behavioural changes consistent with psychosis. The first patient had detectable antibodies to NMDAR in the cerebrospinal fluid (CSF) alone. Evaluation for ovarian teratoma was negative. The second patient had no detectable antibodies in serum or CSF; however, she had an underlying ovarian teratoma. Patient A was treated with pulse steroids, therapeutic plasma exchange (TPE) followed by bortezomib (BOR) and dexamethasone, while patient B was treated with steroids, TPE followed by surgical resection of ovarian teratoma. Both patients had favourable outcomes and were asymptomatic at the 6 monthly follow-up.Conclusions With coexistent neuropsychiatric manifestations, OMAS can be considered a distinct entity of autoimmune encephalitis, pathogenesis being immune activation against known/unknown neuronal cell surface antigens. The observation of absence of anti-NMDAR antibody in patients with teratoma-associated OMAS and vice versa is intriguing. Further research on the potential role of ovarian teratoma in evoking neuronal autoimmunity and its targets is required. The management challenge in both cases including the potential use of BOR has been highlighted.
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- 2023
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15. Management of Severe Cerebral Venous Sinus Thrombosis Using Mechanical Balloon Assisted Thrombectomy
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Anand Alwan, Angel T Miraclin, Deepti Bal, Vinu Moses, Pavithra Mannam, Munawwar Ahmed, Santhosh Babu K.B, Kumar Muthukumar, Anitha Jasper, Sunithi Elizabeth Mani, Shalini Nair, Appaswamy Thirumal Prabhakar, Ajith Sivadasan, Vivek Mathew, Mathew Alexander, Shyamkumar N Keshava, and Sanjith Aaron
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CVT ,mechanical thrombectomy ,modified Fogarty balloon‐assisted thrombectomy ,Neurology. Diseases of the nervous system ,RC346-429 ,Diseases of the circulatory (Cardiovascular) system ,RC666-701 - Abstract
Background Cerebral venous thrombosis is a devastating condition with, despite optimal medical management, a significant proportion deteriorating due to involvement of the deep venous system, worsening intracranial pressures, and hemorrhage. In this study, we report the characteristics, immediate and long‐term outcomes of mechanical thrombectomy (MT) using a Forgarty balloon catheter among patients with cerebral venous thrombosis. Methods A prospective study conducted at the Christian Medical College, Vellore over 5 years (February 2017–February 2022), wherein patients with cerebral venous thrombosis who had clinical deterioration despite best medical management and requiring MT were included. MT was performed through retrograde venous access through internal jugular veins using a Fogarty balloon. The primary outcome was composite end point of mortality and proportion of patients with favorable clinical response at last follow‐up, defined as a disability score in modified Rankin scale 0–2. Results Among 546 patients treated in our center during the study period, 57(10%), patients required MT. The median age of the study population was 33 years (interquartile range: 17–70 years) with equal gender predilection. Hemorrhagic venous infarction was seen in 28/57 (50%) patients. The mean duration between starting medical treatment and to MT was 43 hours (interquartile range: 5–260 hours) with the most common indication being clinical deterioration (70%). Five patients (9%) required decompressive hemicraniectomy. The mortality at discharge was 5% (n=3), and at last follow‐up visit was 7% (n=4). Younger patients without hemorrhagic venous infarction and non‐involvement of the frontoparietal lobes seem to benefit the most. Favorable functional outcome at discharge (modified Rankin scale 0–2) was seen in 65% which further improved to 77% at 1‐year follow‐up. Conclusion Balloon‐assisted MT is safe and effective in a subset of patients with severe cerebral venous thrombosis, with clinical deterioration despite optimal medical management.
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- 2023
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16. Patent foramen ovale closure in India; Feasibility, challenges and mid-term outcomes
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Viji S. Thomson, Sanjith Aaron, Nathaniel Samson D, Jesu Krupa, A.T. Prabhakar, John Jose, Paul George, Oommen K. George, George Joseph, and Bijesh Kumar Yadav
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Patent foramen ovale (PFO) ,Cryptogenic stroke ,Embolic stroke of undetermined source(ESUS) ,Surgery ,RD1-811 ,Diseases of the circulatory (Cardiovascular) system ,RC666-701 - Abstract
Patent foramen ovale closure (PFO) is an underutilized therapy, and our study explored the challenges and feasibility of PFO closure in the Indian setting.Eighty patients with Embolic Stroke of Undetermined Source (ESUS) were screened by transcranial Doppler (TCD) for PFO. Twenty-nine patients underwent successful closure.High-risk features of a long tunnel, inter-atrial septal aneurysm, and large defect were present in 31%, 28%, and 59%. Transcranial Doppler had a sensitivity and specificity of 78% and 53% (p = 0.02) to detect PFO. Anticoagulation was withdrawn in 85% of patients post closure. Two patients had residual shunts at follow-up of 19 (9,34) months.
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- 2021
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17. Visual impairment in cerebral venous thrombosis: The various shades of gray
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Sanjith Aaron and Anupriya Arthur
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Neurology. Diseases of the nervous system ,RC346-429 - Published
- 2023
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18. Clinical spectrum, therapeutic outcomes and prognostic predictors in paraneoplastic neurological syndromes – Experiences from a tertiary care center in India
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Asish Vijayaraghavan, Pullumpallil Thomas Alexander, Aditya Vijayakrishnan Nair, Ajith Sivadasan, Arun Mathai Mani, Donna Mathew, Atif Shaikh, Rohit Ninan Benjamin, A T Prabhakar, John Jude, Sunithi Mani, Sanjith Aaron, Vivek Mathew, and Mathew Alexander
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classical and nonclassical syndromes ,modified rankin score ,onconeural antibodies ,paraneoplastic neurological syndromes ,Neurology. Diseases of the nervous system ,RC346-429 - Abstract
Background: Paraneoplastic Neurological Syndromes (PNSs) are a heterogeneous group of immune-mediated disorders that often precede tumor diagnosis. There are few systematic studies on the spectrum and follow-up of PNSs. Objective: To analyze the clinical spectrum, associated tumors, antibody profile, outcomes, and prognostic predictors in a cohort of PNSs admitted in a tertiary care center. Methods: This retrospective study included 97 patients (2008-2019). PNSs were further classified as “classical,” “nonclassical,” “definite,” and “possible.” Clinical profile, diagnostic strategies, therapeutic options, and predictors of outcomes were identified. Results: The median age was 54 years (range 17–81). Thirty-nine (40.2%) had classical PNS, and 58 (59.8%) had nonclassical PNS, 74 (76.3%) had “Definite” PNS while 23 (23.7%) had “Possible” PNS. Cerebellar degeneration, peripheral neuropathy, and encephalopathy were the three most common neurological syndromes. Tumors were diagnosed in 66 (68%) patients; Lung cancer was the most common primary tumor. Antibodies were positive in 52 (53.6%). Anti-Yo antibody and anti-Ma2 antibody were the most common antibodies. The majority (57.7%) received immunotherapy in addition to definitive treatment for the tumor. A good outcome was seen in 53 (54.6%). Factors associated with good outcome were: early diagnosis, mRS
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- 2021
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19. Bone mineral density and body composition in males with motor neuron disease: A study from teaching hospital in southern part of India
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Basavaraj G Sooragonda, Sandeep Agarwal, Rohit Ninan Benjamin, A T Prabhakar, Ajith Sivadasan, Nitin Kapoor, Kripa E Cherian, Felix K Jebasingh, Sanjith Aaron, Nihal Thomas, Vivek Mathew, Hesarghatta S Asha, and Thomas V Paul
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body composition ,bone mineral density ,motor neuron disease ,sarcopenic obesity ,southern india ,Neurology. Diseases of the nervous system ,RC346-429 - Abstract
Background: Osteoporosis and sarcopenia are important aspects of motor neuron disease (MND). Individuals with amyotrophic lateral sclerosis (MND-ALS) have an increased risk of falls and fractures. Currently, the standard of care does not involve a routine assessment of bone mineral density (BMD) and body composition in these patients. We aimed to assess BMD, bone mineral parameters and body composition in men with MND and compared them with healthy controls. Methods: Consecutive males between 50 and 80 years of age diagnosed as MND-ALS by revised El Escorial criteria and able to walk unassisted attending Neurology outpatient clinic were recruited into the study. Age, gender and body mass index (BMI) matched healthy controls were recruited from the local community. BMD and body composition were assessed by dual-energy x-ray absorptiometry (DXA). Bone mineral parameters and bone turnover markers (BTMs) were also assessed in them. Results: A total of 30 subjects with MND-ALS and 33 controls were recruited. The mean age (years) was 59.2 in cases and 61.2 in controls. The mean BMD (g/cm2) between the two groups was similar; however, BTMs were significantly higher in the MND group (P < 0.05). Subjects with MND-ALS had significantly lower mean appendicular lean mass (ALM) (19.9 versus 22.4 kg; P = 0.007) and ALM corrected for BMI than the healthy control group (0.858 versus 0.934 kg/kg/m2; P = 0.034). Sarcopenic obesity (Percentage fat mass >27% + ALM/BMI
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- 2021
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20. Role of pain-related evoked potential in the diagnosis of meralgia paresthetica
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Atif Iqbal Ahmed Shaikh, Monika Das, Anupama Roy, Bini Baby, Dolcy Dhar, Jebalin Abigayil, Vitty Susan Varghese, Vivek Mathew, Sanjith Aaron, Ajith Sivadasan, Paul Premkumar, Tharan Suresh, and Appaswamy Thirumal Prabhakar
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diagnosis ,evoked potential ,lateral femoral cutaneous nerve of thigh ,meralgia paresthetica ,pain-related evoked potential ,Neurology. Diseases of the nervous system ,RC346-429 - Abstract
Introduction: Entrapment of the lateral femoral cutaneous nerve (LFCN) of thigh results in meralgia paresthetica (MP). Standard electrophysiological tests for MP are technically demanding and unreliable. We aimed to study the role of pain-related evoked potentials (PREP) in the diagnosis of MP. Methods: Patients with MP and normal volunteers were included. PREP was recorded by stimulating the skin over the lateral thigh 20 cm below the anterior-superior iliac spine and recording from the cortex at Cz. Results: A total of 28 subjects and 56 LFCNs were studied. 36 nerves had MP and 20 were normal. The mean PREP latency was 118 (8) ms among normal controls and 164 (10.8) ms in MP. The optimal cut-off point for the diagnosis of MP was 134 ms. Area under receiver operator characteristic curve was 0.97; sensitivity was 91.7% and specificity was 100%. Conclusion: PREP is reliable and easy to use electrophysiological test in establishing the diagnosis of MP.
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- 2021
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21. Acute Ischemic Stroke in Term Pregnancy Treated with Recombinant Tissue Plasminogen Activator
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Sanjith Aaron, Pavitra Ratna Mannam, Atif Shaikh, Arun Mathai Mani, Deepti Bal, and Jeyaraj Durai Pandian
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acute ischemic stroke ,pregnancy ,recombinant tissue plasminogen activator ,Neurology. Diseases of the nervous system ,RC346-429 - Abstract
Recombinant tissue plasminogen activator (rtPA) may be considered in acute ischemic strokes (AIS) occurring in pregnancy. This recommendation is based on case reports which had demonstrated the efficiency and safety of rtPA in early pregnancy. However, most of the pregnancy-related strokes occur in the peripartum period. There is a paucity of literature on the management of AIS in this clinically relevant period of pregnancy; with only 2 case reports describing the use of IV rt-PA in the last trimester. Here, we report a case of AIS in a full-term pregnancy treated successfully with intravenous rt-PA. The patient went on to have an uncomplicated vaginal delivery after 72 h post thrombolysis. To the best of our knowledge, this is only the third such case in the English literature.
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- 2020
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22. Acute Ischemic Stroke in Sickle Cell Disease Challenges for Thrombolysis
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Amal Al Hashmi and Sanjith Aaron
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blood ,hematology ,neurology ,sickle cell disease ,hemoglobinopathy ,acute ischemic stroke ,management ,thrombolysis ,tissue type plasminogen activator ,stroke mimics ,oman ,treatment ,vascular ,Medicine - Abstract
Sickle cell disease (SCD) is a hemoglobinopathy disorder that was recognized in 1949. Stroke is one of the most devastating complications of this disorder. The risk of stroke in SCD patients varies with the genotype; the highest rate has been reported with hemoglobin S. Tissue type plasminogen activator (t PA) is class I recommended therapy for acute ischemic stroke (AIS) since 1996. Although it is unclear if SCD patients were included in the t PA trail, SCD has never been identified as contraindication. The debate of offering t PA for adult SCD patient presenting with AIS continued for at least 2 decades. It is not up and until 2 years ago when the American Heart Association and American stroke association (AHA/ASA) announced that intravenous (IV) t PA can be offered to adult SCD patients presenting with AIS. Here, we report a case where successful IV thrombolytic therapy was offered to an adult SCD patient presenting with AIS with excellent outcome.
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- 2020
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23. Cerebral venous thrombosis, seasonal trends, and climatic influence: A region-specificstudy
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Sanjith Aaron, Jeyaseelan Lakshmanan, Thambu D Sudarsanam, Kenneth Benjamin, Jothilakshmi Durairaj, Vivek Mathew, Ajith Sivadasan, A T Prabhakar, Shyam Kumar N. Keshava, Pavitra R Mannam, Prabhu Kirubakaran, Jayaprakash Muliyil, and Mathew Alexander
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ambient temperatures ,cerebral venous thrombosis ,climate ,epidemiology ,incidence ,season ,Neurology. Diseases of the nervous system ,RC346-429 - Abstract
Background and Purpose: Studies looking at seasonal variation on cerebral venous thrombosis (CVT) are few with conflicting conclusions. In this region-specific study, we looked for climatic influence and seasonal trends on the incidence of CVT. Methods: Imaging proven adult CVT cases treated over a period of 18 years from a specific geographical location with similar seasons and climatic conditions were studied. Metrological parameters prepared using 30 years of data was used. Quantum geographical information system (QGIS software) and SPSS v 22 were used for patient plotting and analysis. Results: Total of 970 cases were studied. The incidence was significantly higher in summer 411 (42.3%) compared with autumn 317 (32.7%) and winter 242 (25.05); P = 0.038. This trend was consistent across all the 18 years in time series analysis. Mean age was 33.5 years (range 18–88 years). A significant majority 673 (69.4%) were below 40 years of age; P = 0.012. Females constituted 394 (40.6%) of cases. Postpartum CVT cases constituted 237 (30%). Interaction analysis showed younger age (
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- 2020
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24. Clinical spectrum and outcome of neurosarcoidosis: A retrospective cohort study from a teaching hospital in India
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Arun Mathai Mani, A T Prabhakar, Pavithra Mannam, Rohit Ninan Benjamin, Atif Iqbal Ahmed Shaikh, Donna Mathew, Pankaj Singh, Aditya Nair, P T Alexander, Asish Vijayaraghavan, Ajith Sivadasan, Sunithi Mani, Vivek Mathew, Sanjith Aaron, and Mathew Alexander
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cranial neuropathy ,multiple cranial nerve involvement ,neurosarcoidosis ,pachymeningitis ,sarcoidosis ,Neurology. Diseases of the nervous system ,RC346-429 - Abstract
Context: Neurosarcoidosis (NS) is a chronic disease with a diverse clinical spectrum, therapeutic response, and outcome. There is scarce literature from our country regarding the same. Aims: The aim of this study was to evaluate the clinical spectrum, therapeutic responses, and outcomes of NS in an Indian cohort. Settings and Design: In a cross-sectional study, we included all patients with NS treated at a quaternary care teaching hospital in India from January 2007 to October 2019. Subjects and Methods: Patients older than 18 years of age fulfilling the diagnostic criteria for NS from the Neurosarcoidosis Consortium Consensus Group were included in the study. The therapeutic response and the degree of disability at last follow-up were assessed. Results: We identified 48 patients, among them 3 were categorized as having definite NS, 30 probable NS, and 15 possible NS. Cranial neuropathy was the most common presentation (47.9%), followed by myelopathy (25%). Systemic involvement was identified in 95.83% and mediastinal lymph nodes were the most common site. Clinical improvement was seen in 65.8% and disease stabilized in 28.9%, while 5.26% deteriorated. Fifty percent recovered without any residual disability, while 26.3% had minor and 23.7% had major residual sequelae. Conclusions: NS is a diverse illness, with a heterogeneous spectrum of clinical presentation, treatment response, and outcome. Cranial neuropathy is the most common presenting feature and has a good prognosis while myelopathy has an unfavorable prognosis. Meningeal and brain parenchymal disease is difficult to diagnose accurately unless systemic involvement is present. The diagnosis of NS should be clinically suspected in the appropriate clinical setting, the presence of systemic involvement should be investigated, and histologic confirmation should be attempted.
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- 2020
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25. Tolosa–Hunt syndrome: Long-term outcome and role of steroid-sparing agents
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Anupriya Arthur, Ajith Sivadasan, Pavitra Mannam, A T Prabakhar, Sanjith Aaron, Vivek Mathew, M Karthik, Rohith Ninan Benjamin, Shaikh Atif Iqbalahmed, Gideon Lyngsyun Rynjah, and Mathew Alexander
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cavernous sinus syndrome ,painful ophthalmoplegia ,tolosa–hunt syndrome ,Neurology. Diseases of the nervous system ,RC346-429 - Abstract
Background: Tolosa-Hunt Syndrome (THS) is one of the causes of cavernous sinus syndrome causing painful ophthalmoplegia. Literature on long-term outcome of this rare condition is scarce. Aims and Objectives: The aim is to study the recurrence and role of steroid-sparing agents in THS. Methodology: All cases of THS treated at a tertiary-level teaching hospital during a 10-year period were studied. Clinical and radiological profile, response to treatment and recurrences were noted. Results: A total of 44 cases were studied. The mean age was 49.5 years, Males constituted 23/44 (52%). The first symptom was pain in 90%. Ptosis with ophthalmoplegia was the most common deficit 29/44 (66%). Lesions confined to cavernous sinus 27/44 (61%) was the most frequent magnetic resonance imaging finding. All patients received steroids as the initial treatment and 15/44 (34%) received steroid-sparing agents. Follow-up ranged from 6 to 120 months (Mean 39 months). Two patients had alternative diagnosis of leptomeningeal malignancy and hypertrophic pachymeningitis on follow-up. Recurrences occurred in 18/37 (48.6%). Time for recurrence varied from 8 months to 7 years. (Mean 18 months). No clinical or radiological predictors for recurrence were identified. Patients who received steroid-sparing agents had a significantly lower recurrence 3/15 (20%) versus 14/26 (53.8%)P < 0.034. Conclusions: Around 50% of patients with THS can have recurrence. Steroid-sparing agents appear to prevent recurrence. A prospective multicenter randomized controlled trial may help to evaluate the risk and benefits of steroid-sparing therapy and to identify any possible predictors for recurrence.
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- 2020
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26. Neural Correlates of Urinary Retention in Lateral Medullary Infarction
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Appaswamy Thirumal Prabhakar, Atif Shaikh Iqbal Ahmed, Aditya Vijayakrishnan Nair, Vivek Mathew, Sanjith Aaron, Ajith Sivadasan, and Mathew Alexander
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lateral medullary infarction ,urinary retention ,neural control ,Diseases of the genitourinary system. Urology ,RC870-923 - Abstract
Purpose The brainstem plays an important role in the control of micturition, and brainstem strokes are known to present with micturition dysfunction. Micturition dysfunction in cases of lateral medullary infarction (LMI) is uncommon, but often manifests as urinary retention. In this study, we investigated the neuro-anatomical correlates of urinary retention in patients with LMI. Methods This was a hospital-based retrospective study conducted in the neurology unit of a quaternary-level teaching hospital. Inpatient records from January 2008 to May 2018 were searched using a computerized database. Cases of isolated LMI were identified and those with micturition dysfunction were reviewed. MRI brain images of all patients were viewed, and individual lesions were mapped onto the Montreal Neurological Institute (MNI) space manually using MRIcron. Nonparametric mapping toolbox software was used for voxel-based lesion-symptom analysis. The Liebermeister test was used for statistical analysis, and the resultant statistical map was displayed on the MNI template using MRIcron. Results During the study period, 31 patients with isolated LMI were identified. Their mean age was 48 years and 28 (90%) were male. Six of these patients (19%) developed micturition dysfunction. All 6 patients had urinary retention and 1 patient each had urge incontinence and overflow incontinence. In patients with LMI, the lateral tegmentum of the medulla showed a significant association with urinary retention. Conclusions In patients with isolated LMI, we postulate that disruption of the descending pathway from the pontine micturition centre to the sacral spinal cord at the level of the lateral tegmentum results in urinary retention.
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- 2019
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27. Comorbidities and long-term outcomes in a cohort with myasthenic crisis: Experiences from a tertiary care center
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Ajith Sivadasan, Mathew Alexander, Sanjith Aaron, Vivek Mathew, Shalini Nair, Karthik Muthusamy, A T Prabhakar, Rohit N Benjamin, Atif Shaikh, and Gideon Rynjah
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comorbidities ,muscle-specific tyrosine kinase ,myasthenia gravis ,myasthenic crisis ,refractory myasthenia gravis ,thymoma ,Neurology. Diseases of the nervous system ,RC346-429 - Abstract
Introduction: There is scarce literature regarding the clinical course, comorbidities and long-term outcomes after myasthenic crisis (MC). The natural history of myasthenia gravis (MG) in this subset remains uncertain. Methods: The study included a cohort admitted with MC (2007–2017) in a tertiary care hospital. The comorbidities, outcomes after discharge, and prognostic factors were analyzed. Results: Sixty-two patients (89 episodes of MC) were included. Demographic data was comparable between the early- (
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- 2019
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28. Clinical Features of Four West Nile Virus Cases and Its Molecular Characterization from a South Indian Tertiary Care Hospital
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Shoba Mammen, Aiswarya Nair, Santhosh Kumar, Zayina Zonderveni, A. T. Prabhakar, Turaka Vijay Prakash, Sanjith Aaron, Mathew Alexander, Anand Zachariah, and Asha Mary Abraham
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Infectious and parasitic diseases ,RC109-216 - Abstract
West Nile virus (WNV) is currently a significant reemerging virus of the 21st century. It belongs to the family Flaviviridae and genus Flavivirus. Although it is primarily transmitted by the Culex spp of mosquitoes, other routes of transmission are also well defined. Of eight lineages described, Lineage 1a has been reported from many parts of South India and is known to cause neuroinvasive illness. Many tests and serological techniques have been described to diagnose WNV infection such as complement fixation, neutralization, heamagglutination inhibition, ELISA, and PCR for molecular confirmation. The latter far outweighs the limitations inherent in the other tests. WNV infection is being reported from Vellore for the first time after 1968. This paper aims to describe four cases of WNV infection causing central nervous system manifestations with its molecular characterization. West Nile virus infection was diagnosed with the available molecular techniques such as PCR and sequencing, which emphasizes the need for considering West Nile virus in the differential diagnosis of acute meningoencephalitis and the wider availability of molecular diagnostic tests.
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- 2020
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29. The Spectrum of Autonomic Dysfunction in Myasthenic Crisis
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Rohit Ninan Benjamin, Sanjith Aaron, Ajith Sivadasan, Suresh Devasahayam, Amalan Sebastin, and Mathew Alexander
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Autonomic dysfunction ,composite autonomic symptom scale 31 ,heart rate variability ,myasthenia ,Neurology. Diseases of the nervous system ,RC346-429 - Abstract
Background: Autoimmune autonomic dysfunction is described in Myasthenia Gravis. In myasthenic crisis, the spectrum of autonomic dysfunction is hitherto uncharacterized. Objective: The objective of this study is to describe the spectrum of autonomic dysfunction in myasthenic crises using the composite autonomic symptom scale 31 (COMPASS 31) autonomic symptom questionnaire and power spectral analysis of heart rate variability (HRV), which is a simple way of estimating general autonomic dysfunction. Methods: Adult patients with myasthenic crisis from January 1, 2014 to March 15, 2015, were prospectively included in this study. The COMPASS 31 questionnaire for symptoms of autonomic dysfunction and power spectral analysis of HRV were assessed. These were compared with the patient's demographic and clinical parameters and with previous literature. IRB approval was obtained. Results: Sixteen patients were included (M:F 3:1). 15/16 patents (93%) had autonomic dysfunction on COMPASS 31 questionnaire. The domains of involvement were gastrointestinal (80%), orthostatic (67.7%), pupillomotor (67.7%); sudomotor (33.3%), and vasomotor (13.3%). Parasympathetic dysfunction predominance was suggested by the symptom profile. HRV analysis showed a low frequency (LF) spectral shift suggesting slowed parasympathetic responsiveness (LF normalized unit (nu): high frequency [HF] nu mean 8.35, standard deviation ± 5.4, 95% confidence interval 2.2–12.5), which significantly exceeded the mean LF nu: HF nu ratios of the majority of previously reported noncrises myasthenic populations. Conclusions: Myasthenic crisis has autonomic dysfunction involving multiple organ systems. Increased latency of parasympathetic reflexes is suggested. A comprehensive management protocol addressing different autonomic domains is required for holistic patient care.
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- 2018
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30. Role of penumbra mechanical thrombectomy device in acute dural sinus thrombosis
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Suraj Mammen, Shyamkumar Nidugala Keshava, Vinu Moses, Sanjith Aaron, Munawwar Ahmed, George K Chiramel, Sunithi E Mani, and Mathew Alexander
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dural sinus thrombosis ,neurointervention ,recanalization ,thrombectomy ,Medical physics. Medical radiology. Nuclear medicine ,R895-920 - Abstract
Background: In dural venous sinus thrombosis (DVST), the mortality ranges 5–30%. Deep venous system involvement and septic dural sinus thrombosis have a higher mortality rate. In acute occlusion, collateral flow may not be established, which may result in significant edema and mass effect. Endovascular interventions may be considered as a treatment option in appropriate high-risk patients with DVST. Materials and Methods: Eight patients with magnetic resonance imaging (MRI)-confirmed dural sinus thrombosis, who did not respond to the conventional standard medical treatment, were subsequently treated with mechanical thrombectomy using the Penumbra System®. In all cases, medical treatment including anticoagulants were continued following the procedure for a minimum period of 1 year. Results: Recanalization of the dural sinus thrombosis was achieved in all 8 cases. There were no immediate or late endovascular-related complications. One death occurred due to an unrelated medical event. At 6 months, there was notable improvement in the modified Rankin Score (mRS), with 5/8 (62%) patients achieving mRS of 2 or less. The follow-up ranged between 3 months and 26 months (mean: 14.5 months), and there were no new neurological events during the follow-up period. Conclusion: Cerebral venous sinus thrombosis is a rare but life-threatening condition that demands timely diagnosis and therapy. In cases of rapidly declining neurological status despite standard therapy with systemic anticoagulation and anti-edema measures, mechanical thrombectomy could be a lifesaving and effective option. In this study, good outcomes were observed in the majority of patients at long-term follow up.
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- 2017
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31. Study of refractory status epilepticus from a tertiary care center
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Sahil Kohli, Suresh Babu Pasangulapati, Sangeetha Yoganathan, Gideon Lyngsyun Rynjah, A T Prabhakar, Sanjith Aaron, Mathew Alexander, and Vivek Mathew
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Nonrefractory status epilepticus ,refractory status epilepticus ,status epilepticus ,status epilepticus severity score ,super-refractory status epilepticus ,Neurology. Diseases of the nervous system ,RC346-429 - Abstract
Objectives: To determine the proportion of refractory status epilepticus (RSE) and super-RSE (SRSE) among patients with status epilepticus (SE) and to analyze RSE and non-RSE (NRSE) in terms of etiology and predictors for RSE. Materials and Methods: Patients were identified from discharge summaries database with keywords of SE and records of the portable electroencephalogram (EEG) machine from January 2011 to March 2016. Results: Two hundred and eighteen events were included in the study with 114 (52.3%) males, bimodal age preponderance age
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- 2017
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32. Ayurvedic Treatment of Acute Ischemic Stroke: A Prospective Observational Study
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J Aarthi Harini BAMS, Avineet Luthra BPT, MSc, Shrey Madeka MSc, Prasan Shankar BAMS, MD (Ayu.), Pitchaiah Mandava MD, PhD, MSEE, Ravishankar Pervaje BAMS, MS (Ayu.), Sanjith Aaron MBBS, MD, DM, and Archana Purushotham MD, PhD
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Medicine (General) ,R5-920 ,Public aspects of medicine ,RA1-1270 - Abstract
Background The western medical arsenal for treating stroke is rather limited, and the only treatments shown to improve outcomes are not accessible to most in the third world. Even in the developed world, many patients present too late to receive thrombolysis or thrombectomy. Stroke patients in India commonly use Ayurvedic therapies, but there are no published data regarding the efficacy or safety of these therapies, the latter being of particular concern in acute ischemic stroke (AIS). Objective To obtain preliminary data on the safety and efficacy of stand-alone whole-system Ayurvedic treatment in AIS. Methods We present here an observational study prospectively comparing outcomes in 2 cohorts of AIS patients treated with whole-system classical Ayurveda (n = 13) or conservative (nonthrombolytic, noninterventional) western biomedicine (n = 20). Results Pooled analysis of outcomes did not show statistically significant differences in mortality (15.38% vs 15%, P = 1.00), nonfatal adverse event rates (15.38% vs 30%, P = .4), or functional disability measures. A paired analysis performed using a matching algorithm to reduce baseline disparities between the cohorts also showed no statistically significant differences in outcomes. Conclusions The safety profiles of classical Ayurveda and conservative western biomedicine in AIS are similar. This is the first ever report of stand-alone Ayurvedic therapy in AIS. Our results support the conduct of a randomized controlled trial to study the efficacy of Ayurvedic treatment of AIS.
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- 2019
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33. A case of Erdheim Chester disease with central nervous system involvement
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Anil Kumar Patil, Karthik Muthusamy, Sanjith Aaron, Mathew Alexander, Nanda Kachare, Sunithi Mani, and Sudhakar Sniya
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Erdheim Chester disease ,histiocytosis ,sclerotic bone ,Neurology. Diseases of the nervous system ,RC346-429 - Abstract
Erdheim Chester disease (ECD) is a rare non-Langerhans cell histiocytosis, commonly involving the musculoskeletal system. Other tissue can also be involved, including the central nervous system with wide spectrum of clinical features, at times being nonspecific. This can cause diagnostic dilemmas with delay in diagnosis and initiation of therapy. Here we describe a 63-year-old man who had presented with ataxia and behavioral changes, bony pains, weight loss, and fatigue. His computed tomography (CT), 99Tc scintigraphy and histopathological features on bone biopsy were consistent with ECD. Thus, ECD should be considered as a differential diagnosis in patients presenting with bony pain and nonspecific features of multiorgan involvement.
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- 2015
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34. Mechanical thrombectomy for acute ischemic stroke in pregnancy using the penumbra system
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Sanjith Aaron, N K Shyamkumar, Sunithi Alexander, P Suresh Babu, A T Prabhakar, Vinu Moses, T V Murthy, and Mathew Alexander
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Mechanical thrombectomy in pregnancy ,penumbra system ,stroke in pregnancy ,Neurology. Diseases of the nervous system ,RC346-429 - Abstract
Even though intravenous thrombolysis with tissue plasminogen activator (IV tPA) is the standard of care in acute ischemic stroke, its use in pregnancy is not clearly defined. Mechanical thrombectomy devices can be an option; however, literature on the use of such mechanical devices in stroke in pregnancy is lacking. Here we describe two cases that developed acute embolic stroke during pregnancy who were successfully treated by mechanical clot retrieval using the Penumbra system 28 (Penumbra Inc., Alameda, California, USA). To the best of our knowledge, these are the only case reports on the use of the Penumbra device in pregnant patients with acute ischemic stroke.
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- 2016
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35. Derangements in bone mineral parameters and bone mineral density in south Indian subjects on antiepileptic medications
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George Koshy, Ron Thomas Varghese, Dukhabandhu Naik, Hesargatta Shyamsunder Asha, Nihal Thomas, Mandalam Subramaniam Seshadri, Mathew Alexander, Maya Thomas, Sanjith Aaron, and Thomas Vizhalil Paul
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Anticonvulsants ,bone mineral density ,epilepsy ,vitamin D ,Neurology. Diseases of the nervous system ,RC346-429 - Abstract
Background: Although there are reports describing the association of alternations of bone and mineral metabolism in epileptic patients with long-term anticonvulsant therapy, there are only limited Indian studies which have looked at this aspect. Objectives: This study was done to compare the prevalence of changes in bone mineral parameters and bone mineral density (BMD) in ambulant individuals on long-term anticonvulsant therapy with age- and body mass index (BMI)-matched healthy controls. Materials and Methods: There were 55 men (on medications for more than 6 months) and age- and BMI-matched 53 controls. Drug history, dietary calcium intake (DCI), and duration of sunlight exposure were recorded. Bone mineral parameters and BMD were measured. Results: The control group had a significantly higher daily DCI with mean ± SD of 396 ± 91 mg versus 326 ± 101 mg (P = 0.007) and more sunlight exposure of 234 ± 81 vs 167 ± 69 min (P = 0.05). BMD at the femoral neck was significantly lower in cases (0.783 ± 0.105 g/cm 2 ) when compared to controls (0.819 ± 0.114 g/cm 2 ). Majority of the patients (61%) had low femoral neck BMD (P = 0.04). There was no significant difference in the proportion of subjects with vitamin D deficiency (
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- 2014
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36. Ophthalmic masquerades of the atherosclerotic carotids
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Anupriya Arthur, Anika Alexander, Simerpreet Bal, Ajith Sivadasan, and Sanjith Aaron
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Mean deviation ,non-proliferative diabetic retinopathy ,short fluctuations ,short wave automated perimetry ,standard automated perimetry ,Antimicrobial effect ,conventional silicone oil ,endophthalmitis agents ,heavy silicone oil ,Keratoconus ,modified deep anterior lamellar keratoplasty ,steep corneal curvature ,Bevacizumab ,branch retinal vein occlusion ,intravitreal ,macular edema ,triamcinolone ,Blindness ,disability evaluation ,quality of life ,visual acuity ,Mitomycin C ,pterygium recurrence ,pterygium surgery ,subconjunctival bevacizumab injection ,Imaging in glaucoma ,optical coherence tomography ,pediatric ,retinal nerve fiber layer ,Autogenous tissue grafting ,lacrimal drainage system ,lacrimal fossa ,bypass surgery ,Cornea ,excimer laser ,growth factors ,myopia ,photorefractive keratectomy ,Triamcinolone acetonide ,human trabecular meshwork cells ,in vitro ,Hyperopic implantable collamer lens ,myopic implantable collamer lens ,optical quality ,wavefront aberrations ,Dacryocystorhinostomy ,nasolacrimal duct obstruction ,silicone tube ,Age ,anterior chamber depth ,body height ,primary angle closure glaucoma ,sex ,Children ,eye injury vitrectomy study ,eye injury ,trauma ,vitrectomy ,Corneal biomechanics ,corneal hysteresis ,corneal resistance factor ,intraocular pressure ,keratoplasty ,ocular response analyser ,Aspherical intraocular lens ,quality of vision ,spherical aberrations ,Benign ,excision ,lids and caruncle ,no recurrence ,ocular FH ,inflammation ,sterile endophthalmitis ,Carotid artery disease ,ocular ischemic syndrome ,retinal emboli ,Ophthalmology ,RE1-994 - Abstract
Patients with carotid atherosclerosis can present with ophthalmic symptoms. These symptoms and signs can be due to retinal emboli, hypoperfusion of the retina and choroid, opening up of collateral channels, or chronic hypoperfusion of the globe (ocular ischemic syndrome). These pathological mechanisms can produce many interesting signs and a careful history can bring out important past symptoms pointing toward the carotid as the source of the patient′s presenting symptom. Such patients are at high risk for an ischemic stroke, especially in the subsequent few days following their first acute symptom. It is important for clinicians to be familiar with these ophthalmic symptoms and signs caused by carotid atherosclerosis for making an early diagnosis and to take appropriate measures to prevent a stroke. This review elaborates the clinical features, importance, and implications of various ophthalmic symptoms and signs resulting from atherosclerotic carotid artery disease.
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- 2014
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37. Cerebral venous sinus thrombosis: changing trends in the incidence, age and gender (findings from the CMC Vellore CVT registry)
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Vivek Mathew, Mahasampath Gowri, Sanjith Aaron, Ajith Sivadasan, George Abraham Ninan, Rohit N Benjamin, Appaswamy Thirumal Prabhakar, Angel Miraclin T, John Davis Prasad, Deepti Bal, and Atif Iqbal Ahmed Shaikh
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Neurology. Diseases of the nervous system ,RC346-429 - Abstract
Background Multiple cerebral venous sinus thrombosis (CVT) registries from various geographical regions indicate that female gender, the use of contraceptive pills, pregnancy and puerperium are important risk factors. In this study, we report the changes in the epidemiology of patients with CVT managed over the past 26 years.Methods The CMC Vellore CVT registry is a prospectively maintained database at the Christian Medical College, Vellore since January 1995. Stata software was used to analyse the data and assess the changes in the incidence, age and gender distribution over the previous 26 years.Results Among 1701 patients treated during the study period, 908 (53%) were women and 793 (47%) were men. The mean incidence of CVT was 49 per 100 000 admissions before 2010, which increased to 96 per 100 000 after 2010. Male gender had a higher odds of developing CVT (OR – 2.07 (CI 1.68 to 2.55, p
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38. The prevalence and severity of autonomic dysfunction in chronic inflammatory demyelinating polyneuropathy
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Pasangulapati, Suresh, Murthy, T., Sivadasan, Ajith, Gideon, L., Prabhakar, A., Sanjith, Aaron, Mathew, Vivek, and Alexander, Mathew
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Prevalence studies (Epidemiology) -- Research ,Chronic inflammatory demyelinating polyradiculoneuropathy -- Research -- Diagnosis -- Care and treatment -- Risk factors ,Health - Abstract
Byline: Suresh. Pasangulapati, T. Murthy, Ajith. Sivadasan, L. Gideon, A. Prabhakar, Aaron. Sanjith, Vivek. Mathew, Mathew. Alexander Introduction: In chronic inflammatory demyelinating polyneuropathy (CIDP), emphasis has been on motor disabilities, [...]
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- 2017
39. Cerebral venous sinus thrombosis presentation in severe scrub typhus infection: A rare entity
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Jena, Subhransu, Mathew, Alexander, Sanjith, Aaron, Ajith, Sivadasan, Nair, Bijesh, and Prakash, John
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Cerebral embolism and thrombosis -- Case studies -- Diagnosis -- Causes of ,Scrub typhus -- Complications and side effects -- Case studies ,Health - Abstract
Byline: Subhransu. Jena, Alexander. Mathew, Aaron. Sanjith, Sivadasan. Ajith, Bijesh. Nair, John. Prakash Sir, Scrub typhus is a common re-emerging infection in the Indian subcontinent. [sup][1] The severity of infection [...]
- Published
- 2014
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