Arturo Solís Herrera*, María del Carmen Arias Esparza and Ruth Isabel Solís Arias
Published on: 7th February, 2025
Stroke and acute myocardial infarction are primary global causes of mortality. Statistical studies have shown that acute myocardial infarction is responsible for around 9 million deaths each year. Ischemic stroke and myocardial infarction have a significant role in global adult physical disabilities. While reperfusion is vital for tissue recovery, it may paradoxically, inadvertently increase damage through oxidative stress, inflammation, and cell death. Early reperfusion procedures are currently the sole therapy to reduce infarct size. There are many mysteries about heart biology. It is not known the source of energy for myocardial tissues. The heart-beating force (120 mm Hg) cannot explain how erythrocytes are impelled through almost 95,000 km of capillaries in less than 5 minutes. A better knowledge of how the heart is oxygenated should allow the development of new therapies.
Jayantee Kalita*, Dhiraj Kumar, Nagendra B Gutti, Sandeep K Gupta, Anadi Mishra and Vivek Singh
Published on: 4th April, 2025
Stress in acute stroke may increase mortality and complications, but there is a paucity of information on the efficacy of beta blockers over other anti-hypertensive. To report efficacy of metoprolol over amlodipine in reducing mortality, disability and infections in acute stroke. CT/MRI confirmed stroke patients within 3 days of onset were included whose age was 18 to 75 years. Patients with secondary intracerebral hemorrhage, organ failure, pregnancy, malignancy, and immunosuppressant or on beta-blocker/amlodipine were excluded. Stroke risk factors, Glasgow Coma Scale (GCS) score, National Institute of Health Stroke Scale (NIHSS) score and CT/MRI findings were noted. Patients with a blood pressure of > 160/90 mm of Hg were randomized using 1:1 randomization to metoprolol (25 mg on day 1, 50 mg if BP is not controlled) or amlodipine (2.5 mg on day 1, then 5 mg then 10 mg on, subsequent days if BP is not controlled). Other standard treatment was continued. The primary outcome was mortality at 1 month; secondary outcomes included were in-hospital gastrointestinal hemorrhage, pneumonia, sepsis and 3 months functional outcome based on modified Rankin Scale (mRS). Side effects were noted. 18 (14.4%) patients died; 6 (9.7%) in metoprolol and 12 (19%) in amlodipine (p = 0.20) group. At 3-months, 66 patients had good outcome; 45 (80.4%) in metoprolol and 21 (43.3%) in amlodipine group (p < 0.001). The other secondary outcomes were comparable between the two groups. Metoprolol was withdrawn in 6 patients due to bradycardia, and amlodipine in 5 due to hypotension and in 1 due to allergic reaction. Metoprolol is associated with improved functional outcomes in acute stroke compared to amlodipine.
Dural Venous Sinus Thrombosis (DVST) is a rare although serious clinical entity that causes approximately 0.5% of all stroke cases. Head trauma with skull base fracture, aneurysm, CNS infection, thrombophilia, and vasculitis may be identified as a possible cause of DVST. Vernet’s Syndrome is characterized by a constellation of unilateral cranial nerve palsies involving the 9th, 10th, and 11th cranial nerves due to compression or narrowing of the jugular foramen. We herein present a case of 33 years old Bangladeshi worker from Malaysia who had history of severe Traumatic Brain Injury (TBI) following road traffic accident with multiple skull bone fracture and extradural hematoma 3 months back, presented with acute dysphagia, dysphonia, fever and cough for 6 days. Neurologic examination revealed deviation of uvula to the left side and features of consolidation over right upper chest. Magnetic Resonance Venography (MRV) revealed thrombosis involving right transverse sinus, sigmoid sinus extending up to right internal jugular vein. The diagnosis of vernet syndrome with aspiration pneumonia was made. Later thrombophilia screen showed protein S deficiency. He was treated with broad spectrum antibiotics and started anticoagulation with dabigatran. After 6 months of anticoagulation he recovered fully with no residual neurological deficit.
Mythili G*, Prathap Suganthirababu and Lakshana Selvaraj
Published on: 30th November, -0001
Purpose: Stroke frequently causes severe deficits in upper limb function, which makes it difficult for patients to carry out daily tasks. An organized home-based intervention called the Graded Repetitive Arm Supplementary Program (GRASP) was developed to help stroke patients regain function in their hands and arms. This systematic review assesses the data demonstrating beneficial effects of the GRASP approach on hand function, gross and fine motor control of the upper limb in individuals post-stroke.Methods: A systematic search was performed in databases including PubMed, Scopus, CINAHL, and Cochrane Library up to April 2025. We searched the data using Keywords such as “GRASP,” “Graded Repetitive Arm Supplementary Program,” “stroke rehabilitation,” “upper limb recovery,” “fine motor skills,” and “gross motor control.” Inclusion criteria were randomized controlled trials (RCTs), quasi-experimental studies, and cohort studies involving adult stroke survivors undergoing GRASP. Studies were excluded if they were non-English and focused on other forms of intervention. Quality assessment was performed using the PEDro scale and Cochrane risk-of-bias tool.Results: Out of 243 studies initially screened, 8 met the inclusion criteria. Most studies reported significant improvements in upper limb function, including enhanced hand dexterity, grip strength, and coordination following participation in GRASP programs. High adherence rates and participant satisfaction were consistently noted. Some studies indicated that benefits were maintained at follow-up, suggesting long-term efficacy. Common outcome measures included the Fugl-Meyer Assessment (FMA), Box and Block Test (BBT), and Action Research Arm Test (ARAT).Discussion: The findings suggest that GRASP is an effective adjunct to conventional stroke rehabilitation, particularly for enhancing hand function and motor control. The structured yet flexible nature of GRASP allows for scalability and adaptability to various patient needs. Limitations of the reviewed studies include small sample sizes, heterogeneity in intervention duration, and variability in outcome measures. Further research with standardized protocols and larger samples is warranted.Conclusion: The GRASP approach appears to be a promising intervention for improving functional ability of the hand, and gross and fine motor control in the upper limbs post-stroke. Incorporating GRASP into home-based rehabilitation could enhance recovery and reduce long-term disability. Continued research is essential to establish best practices for implementation and to optimize patient outcomes.
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