European Journal of Molecular & Clinical Medicine

Aim: The aim of the present study was to assess levels of High Sensitivity C-reactive Protein in patients with Acute Ischemic and Hemorrhagic Stroke.
Methods: The present descriptive Prospective Observational Study was conducted on 100 CT/ MRI confirmed cases of Stroke admitted in Medicine Dr. DY Patil Medical College Hospital and Research Centre, Pimpri, Pune during the period from October 2020 to September 2022.
Results: The Mean Age group of study participants was 61.74±11.28 with 5% in 18-40 years, 6% in 41-50, 31% in 51-40, 41% in 61-70, 15% in 71-80 and 2%  were above 80. There were 32% were females and 68% males. In our study 33 patients had right side hemiparesis and 6 patients on right side had hemiplegia, 47 patients had left side hemiparesis, 12 patients had hemiplegia 2 had monoparesis. There were 10% cases had cranial nerve involvement in our study. In Hemorrhagic Pattern of Stroke there were 92% hypertensives and in Non-Hemorrhagic Ischemic type 77%. There are 84.6% of diabetics in hemorrhagic subjects and 67.5% in ischemic subjects. The data showed 22% patients had Hs-CRP levels <10 and 78% had CRP levels >10.
Conclusion: Our Study showed that HS-CRP are elevated and can be considered as independent risk factors of Stroke.

The calcium ion (Ca2+) is a ubiquitous intracellular messenger during and immediately after an ischemic period. Clinical studies suggest that severity of clinical symptoms, prognosis and infarct volume are also associated with levels of serum calcium.
Aim: The aim of this study is to determine Serum calcium as a marker of severity in acute ischaemic stroke patients.
Methodology: This prospective observational study was conducted on 80 patients of acute ischemic stroke admitted in the department of medicine at Jhalawar medical college, Jhalawar during the period of 1 year. Adjusted serum calcium level was obtained within 72 hours from onset.
Results: Out of 80 patients of acute ischemic stroke, 49 (61.25%) had low serum calcium while 31 (38.75 %) participants had normal level of serum calcium. Most common age group was 61 to 70 years (36.7%). NIHSS score was higher with low serum calcium level. Out of the 49 patients who had low levels of calcium, 49% (24) had severe stroke with NIHSS score 21-42. Among 49 patients with low serum calcium, 91.5% (45) had poor outcome. MRS score was higher with low serum calcium level. Chi square analysis revealed lower adjusted serum calcium levels accompanied by poor outcome statistically significant (p= <0.0103).
Conclusion: Based on these results, we can conclude that low adjusted calcium levels in patients with acute ischemic stroke is an independent risk factor and have poor outcome than patients with normal serum adjusted calcium level

Several pieces of data imply that metabolic syndrome (Met S) increases the risk of stroke. The modified Rankin scale (MRS), a clinician-reported evaluation of global impairment, is frequently used to assess the outcomes of patients with acute ischemic stroke. Patients with Met S and AIS were examined using modified Rankin Scale scores to determine their prognosis.
Methods:
The study involved fifty patients hospitalised at the D Y Patil Medical College Kolhapur between October 2020 and August 2022 with acute ischemic stroke symptoms. Initial symptomatic atherothrombotic ischemic stroke was detected using the diagnostic criteria of the Trial of Org 10172 in Acute Stroke Treatment (TOAST). They were utilising the NCEP ATP III criteria for metabolic syndrome evaluation. Mortality at three months was the primary outcome. (a Rankin modified score of 4-6) At three months, secondary outcomes included recovery, disability, and death.
Results:
Fifty individuals were hospitalised for the trial. In the present study, 62 per cent (31 out of 50) of ischemic stroke patients were found to have metabolic syndrome. Compared to patients without metabolic syndrome, 67.74% of those diagnosed had an MRS score of more than 3. In contrast, only 31.58% of those without metabolic syndrome had an MRS value larger than 3. Compared to persons who did not have metabolic syndrome, those who did were more likely to die (19%) and be handicapped (71%) than those who did not have metabolic syndrome (47% and 16%). The incidence of discharge was significantly higher among individuals without metabolic syndrome (37%) compared to those with metabolic syndrome (10%).
 Conclusion:
According to the results of our research, Met S was shown to be associated with a bad outcome in individuals diagnosed with acute ischemia. The development of efficient prophylactic interventions against metabolic syndrome and its separate components is required to bring the risk of future strokes down to a more manageable level

Non communicable diseases are responsible for 71% of all deaths globally, that is 41 million people each year. Each year 85% of the premature death occurs due to non communicable disease in low and middle income courtiers. Cerebrovascular accident or stroke is one of the most common causes of death. Ultrasonography of the carotid arteries is an easily available, costeffective, noninvasive method of evaluation. Treatment of stroke depends on reaching the most accurate diagnosis. Accurate and prompt diagnosis is crucial because timely and appropriate therapy can significantly reduce the risk of stroke and long term sequelae. Several modalities of investigation are available to determine carotid arterystatus

Introduction: Stroke has many different aspects, depending on the type, demography, and severity. Vitamin D insufficiency may bear an association with acute stroke. Vitamin D deficiency is frequent in people who have been paralysed due to a stroke. Vitamin D, a neurosteroid with receptors found throughout the brain, plays a role in neuroprotection via a variety of mechanisms. Objective Role of vitamin D in stroke and its outcome. Materials And Methodology: A total of 325 stroke patients were included, with 130 instances of hypovitaminosis being randomised into two groups, GROUP A and B, each of which had 65 cases. Vitamin D levels and the Scandinavian Stroke Scale (SSS) score were measured before and after treatment. Intervention: In addition to conventional stroke treatment and physiotherapy, GROUP A got a single IM injection of 6 Lac IU of Vitamin D, while GROUP B (control) received standard stroke treatment and physiotherapy. Design of The Study: randomized control trial in a Tertiary Care Teaching hospital

Background: Stroke is one of the leading causes of death and disability worldwide. The aim of the study was to find out the incidence of different types of strokes and the associated risk factors .
Methods: The study dealt with 100 patients of stroke who were admitted to Rangaraya Medical college ,Andhra Pradesh. Each patient was analyzed in detail about clinical presentation and the investigations were aimed to establish the pathologic type of stroke and estimation of risk factors.
Results: Stroke incidence was more in males (Male: Female= 2.57:1). Maximum incidence of stroke was in 6th decade (34%) followed by 5th decade (25%). Among modifiable risk factors, history of hypertension was the commonest (79%) followed by Diabetes (62% patients) ,smoking (15%)  and ,alcohol(15%)exclusively, found in males. Facial weakness was the most common presentation (88%) followed by hemiparesis(85%). Chest X-ray was abnormal in 17% patients, abnormal ECG was found in 36% patients .
Conclusions: Apart from control of hypertension and diabetes, abnormal lipid profile remains an important modifiable risk factor for stroke. Keywords: Stroke, Risk factor

Back ground: WHO defines stroke as “the rapid development of clinical signs and symptoms of a focal neurological disturbance which lasts for more than 24 hours or leading to death with vascular origin as the cause. Stroke is a clinical syndrome, which describes a sudden neurological deficit of presumed vascular origin.The risk factors for stroke are diabetes mellitus, smoking, alcohol and hypertension. Colour doppler ultrasound is one of the important tool for the evaluation of exracranial insufficiency of the carotid arteries. This study was performed to assess the carotid arteries with the help of color doppler in carotid artery disease. Aims and objectives: To elaborate the color Doppler evaluation of extracranial carotid arteries and risk factors in predicting cerebro vascular accident in patients with carotid atheromatous disease. Materials and Methods: Of the 102 patients who had come to our department during the study period with symptoms of cerebrovascular disease such as transient episodes of neurological dysfunction, sudden weakness or numbness, hemiparesis, focal neurological deficits, sudden loss of consciousness, altered sensorium, aphasia, slurring of speech, diminution or loss of vision were included into the study. CT scan of brain and color doppler evaluation for the extracranial carotid arteries was done for all the patients to assess the atheromatous disease of extracranial carotid arteries and comparison with brain changes in cerebrovascular disease patients.

Aims: The present study was designed to assess LAD and LADi as a predictive marker for Acute Ischemic Stroke and to analyse their association in patients with AF in Acute Ischemic Stroke patients.
Materials & methods: This study was conducted on 50 patients with acute ischemic stroke and 50 patients without stroke who attended outdoor department or who were admitted in Medicine Department of Guru Nanak Dev Hospital, attached to Government Medical College, Amritsar. The patients were divided into two groups (Group A and B) as follows: Group A includes 50 Patients with acute ischemic stroke, and Group B includes Age and sex matched 50 patients without stroke. Left atrial diameter (LAD) was measured using Two-dimensional echocardiography from the posterior aortic wall to the posterior left atrial wall according to a leading edge to leading edge convention in the parasternal long-axis view at the end-ventricular systole (i.e., just before the mitral valve opening). Indexed left atrial diameter (LADi) was calculated by dividing Left atrial diameter with body surface area (BSA). The data was collected systematically and analysed using Microsoft excel sheet and statistical package for social science version 21.0 (SPSS, Chicago, IL, USA).
Results:In group A, the mean left atrial diameter was 4.02 cm and in group B, the mean left atrial diameter was 3.44 cm. The mean LADi was 2.30 cm/m² and 1.98 cm/m² in Group A and Group B respectively. The mean LADi was higher in group A as compared to Group B and the difference was significant statistically (p<0.0001). In addition, among 23 ischemic stroke patients who were having AF, 21.7% had normal LAD and 78.3% had increased LAD. Among 27 control patients who did not have AF, 63% had normal LAD and 37% had increased LAD. The difference was statistically significant (p=0.03). In group A patients in whom AF was absent, 48.1% had normal LADi and 51.9% had increased LADi. In group B patients in whom AF was absent, 84.6% had normal LADi and 15.4% had increased LADi. The difference was again statistically significant (p=0.002)

Introduction: Identification of risk factors for stroke as well as awareness of relative importance of each, and of their interaction should facilitate stroke prevention. The understanding of stroke in a clinical setting is pivotal to create awareness among masses to prevent the burden of vascular diseases as well as to educate people regarding modifiable and non-modifiable risk factors. Hence, the present study was conducted to reveal signs, symptoms, and risk factors of stroke in patients with this condition.
Materials and Methods: The current cross-sectional observational study comprised of 100 patients who were diagnosed as stroke cases. The clinical profile of all enrolled patients was noted as per the proforma. Relevant clinical history was taken, and laboratory investigations was carried, and lipid profile was studied. CT scan of brain was conducted. For statistical analysis of the study, X² with k<0.5 and a p-value<0.01 was considered as significant value.
Results: In this study 4% cases of stroke were below 40 year, 16% cases in age 40-50 years, 27% in 51-60 years, 34% in 61-70 years, 15% in 71-80 years, 3% in 81-90 years, 1% in 91-100 years. Regarding clinical symptoms, 62% patients present with right hemiplegia, 38% patients presented with left hemiplegia, 48% patients present with cranial n palsy, 30% present with altered sensorium. 55% patients had a history of (h/o) smoking, 50% patients had h/o hypertension, 34% patients had h/o ischemic heart disease, 15% patients had transient ischemic attack, 13% patients were alcoholics, 57% had diabetes mellitus while 51% were presented with intermittent claudication.
Conclusion: The present study concludes that age, gender, smoking tobacco, alcohol intake, hypertension, diabetes as well as dyslipidemia are the most common risk factor for the stroke. Active lifestyle with moderate physical activity and diet control can help in prevention of substantial proportion of stroke incidence.

Background:Stroke causes mortality and disability. Thrombolytic therapy is standard
for ischemic strokes up to 4.5 h after symptoms. Although artery occlusion can be
diagnosed by DSA, MRA, and CTA, thrombus composition and development
timeframes may not be known. SWI is used to detect thrombus in acute ischemic stroke.
SWI can indicate a thrombus as a hypointense SVS.Wecompared the detection of
hemorrhage by using susceptibility weighted imaging (SWI) with T1, T2 and Fluid
attenuation inversion recovery (FLAIR) sequences in acute stroke.
Materials and Methods: From October 2020 to October 2021, 150 patients with
suspected acute stroke were examined prospectively at Kakatiya Medical College/MGM
Hospital Warangal using the above sequences. Acute infract haemorrhage detection was
evaluated and compared.
Results: In 58 individuals, 48 had arterial infarcts and 10 had venous infarcts.
Hemorrhage affected 38 (25.33%) of 94 male patients and 18 (12%) of 56 female
patients.When compared to T1, T2, and FLAIR, SWI was significantly more sensitive
and specific (p value 0.0031) for detecting haemorrhage in acute infract. There were 26
(17.33%) cases of Susceptibility sign, which indicates an intravascular thrombus.
Conclusion: SWI is the most effective sequence for detecting haemorrhage in acute
infracts. It can also determine the source of an infraction by detecting the susceptibility
sign. The SWI sequence must be included in the protocol for evaluating patients with
acute stroke.

Stroke is considered one of the leading causesof morbidity and mortality in many
countries. Many studies investigated the outcomes after the occurrence of stroke.
Some of those research studies indicated that obesity and the increasein the
bodymass index areestablished risk factors for mortality among stroke patients.
However, the results of these studies were inconsistent.The main aim of this review
article was to examine the association between bodymass index and mortality
among stroke patients. The majority of the studies had shown a possible effect of
overweight on mortality among stroke patients; the evidence regarding the
association's presence is limited.On the other hand, the majority of the studies had
shown a protective effect of obesity (mild obesity, bodymass index between 30-35)
onreducingthe risk of mortality among stroke patients. This means underweight
stroke patients have more risk of mortality. Thus, the argument regarding the effect
of high bodymass index on mortality has been explained by the obesity paradox.
However, most of those studies were observational, and results could be attributed
to the methodological flaw. There is a need to well-designed prospective studies that
to overcome the limitation of the previous studies.

Aim: One of the most common disorders in stroke is hemispatial neglect. Regarding treatment of hemispatial neglect, there are many physiotherapy interventions including top-down, bottom-up and non-invasive approaches. In this study, we aimed to systemically examine the effect of these approaches in hemispatial neglect patient.

An individual brought into the world paralyzed because of a birth deformity, or incapacitated abruptly because of a stroke or spinal string injury, will be halfway or absolutely unfit to move the influenced body parts. Simultaneously, the individual may encounter muscle firmness and diminished inclination in the influenced body parts. These people depend vigorously on family and parental figures as they can't perform numerous exercises of everyday living. We propose this undertaking utilizing an epic incitement setup and control standards so as to give dependable actuation of the muscles liable for hand developments, a movement control system to invigorate the muscle. So as to activate the muscle we have to secure the EEG signals and its procedure the equivalent. The handled EEG signal is presently used to control and activate muscle when required. This proposed framework concocts answer for an incapacitated people by methods for "mind-controlled" muscle incitement

BACKGROUND:One of the leading cause for disability and morbidity in India is Stroke.Among the stroke survivors, Urinary Incontinence (UI) is the most common condition that is more associated to disability and mortality. A study stated that among the continent stroke survivors 35% of them had an incidence of UI in a week.The ―Vagus nerve stimulation‖ is a generalized term describing any method of stimulation of Vagus nerve. OBJECTIVE:To Find out the Effectiveness of Transcutaneous Electrical Nerve Stimulation of Vagus nerve in post stroke urinary incontinence . METHODOLOGY:The study design is experimental,study type was Single Blinded Randomized type, Sampling method was Random sampling Method with 30 subjects and Study duration was 8 weeks,Studysetting was SRM Medical College Hospital and Research Centre, Kattankulathur A total of 30 subjects were taken randomly ,Group-A subjects were given transcutaneous Vagus Nerve Stimulation (tVNS) and Kegel’s exercise. Group-B control group was given Kegel’s exercise alone. OUTCOME MEASURES:Barthel Index Score (BIS) and Overactive Bladder Symptom Score (OBSS) RESULTS: There is a significantly more improvement in the control of urinary bladder in Group-A than Group-B CONCLUSION: tVNS shows an increase in the bladder control in post stroke urinary incontinence patients.

Relevance: The high prevalence, high risk of social maladjustment as a result of the consequences of acute cerebrovascular accident and, accordingly, one of the main causes of mortality gives cerebrovascular pathology a special status, as evidenced by numerous publications. the task was to identify in the studied patients the entire spectrum of clinical manifestations corresponding to the lesions of the brain structures supplied by the blood vessels of VBD and to determine the presence of a statistically significant dependence of clinical manifestations of COPD. As well as the identification of risk factors and their influence on the rehabilitation of patients with stroke in the vertebrobasilar system.
Patients with IS in VBD and COPD - 62 people (group I) - 29 men and 33 women aged 50 to 74 years (59.8 ± 5.8). Patients with IS in VBD - 64 people (group II). Of these, 31 were men and 33 were women aged 51 to 80 years (62.4 ± 5.4). All patients received traditional treatment in the most acute and acute periods of IS, patients with COPD received COPD treatment in parallel with traditional IS therapy. in group I, BMI averaged 29.3 ± 5.8 kg / m2, in men - 28.9 ± 6.3 kg / m2, in women - 29.9 ± 5.1 kg / m2 (the difference is not significant, p = 0.58), while 11 patients (17.7%) had a normal BMI, 1 patient (1.6%) had a body weight deficit, 26 patients (41.9%) had preobesity, 15 patients (24, 2%) had first degree obesity, 9 patients (14.5%) had second degree obesity. Accordingly, preobesity or obesity was recorded in 50 patients of group I (80.65%) (Figure 3.3)
And in group II, BMI averaged 28.7 ± 6.1 kg / m2, in men - 27.8 ± 5.7 kg / m2, in women - 30.1 ± 5.6 kg / m2 (the difference is not significant, p = 0.6), while 17 patients (26.6%) had a normal BMI, 3 patients (4.7%) were found to be underweight, 29 patients (45.3%) had preobesity, 8 patients (12 , 5%) had first degree obesity, 7 patients (10.9%) had second degree obesity. Accordingly, preobesity or obesity was recorded in 44 patients of group II (68.8%). In patients of group I, among the clinical manifestations of IS in PBS, ataxia prevailed, which occurred in 35 patients (56.5%), including hemiataxia, which occurred in 20 patients (31.3%). Paresis and paralysis of the limbs were detected in 31 patients (50%). Complaints about a subjective feeling of unsteadiness, instability in an upright position, and imbalance occurred in 25 patients (40.3%). Dysarthria also occurred in 25 cases (40.3%). Nystagmus was detected in 22 cases (35.5%), rotational dizziness (vertigo) - in 20 cases (32.3%), depression of consciousness - in 21 cases (33.9%). Symptoms such as hemianopsia and ophthalmoparesis occurred each in 14 cases (22.6%). Sensory disorders were detected in 12 patients (19.4%), autonomic disorders - in 8 patients (12.9%), diplopia - in 8 patients (12.9%), dysphagia - in 7 patients (11.3%) , aphasia and headache - 6 patients each (9.7% each), dysphonia - 7 patients (11.3%), confusion and visual agnosia - 4 patients each (6.5% each), respiratory failure - 3 patients (4.8%). There were also 2 cases (3.2% each) of amnesia, ignorance syndrome and a feeling of generalized weakness.

Acute ischemic damage to neurons during the development of a focus of cerebral infarction (CI) is based on a complex cascade of interaction between the endothelium of the vascular wall, hemostatic factors, neurons and microglia. Oxygen starvation of tissues stimulates the production of endothelial cells of endothelial dysfunction markers produced by blood vessel endotheliocytes, macrophages, neurons and neuroglia in response to hypoxic brain damage. The so-called “cell death genes” are activated, which are responsible for the development of apoptosis, or programmed death of ischemic penumbra cells, as a result of the expansion of which the infarction volume increases

The problem of cerebrovascular diseases and stroke is significant not only for clinical neurology, but also for society as a whole. Stroke is the second most common cause of death in many developed countries. In Russia, more than 450 thousand cases of this disease are registered per year, and in the Republic of Uzbekistan there are more than ten thousand cases, the mortality rate in the acute period of stroke in Russia reaches 35%, increasing by another 12-15% by the end of the first year after the stroke. Stroke ranks first among the causes of persistent disability, which necessitates timely drug therapy not only in the acute period of the disease, but also throughout the recovery phase.

Taking into account the above, the identification of the possibilities of using acupuncture methods, along with other methods of treating acute cerebrovascular accidents, becomes relevant both from a practical and economic point of view. Intensive therapy, early rehabilitation and prevention of complications, the search for new approaches to treatment will reduce the mortality and disability of patients with this type of pathology

The steering while sitting in the driver's seat is one of the most basic and important driving performances. The purpose of this study was to investigate the characteristics of sitting symmetry and steering accuracy of stroke drivers compared to healthy drivers, and to examine the correlation between them.Fifteen stroke drivers and fifteen healthy drivers participated in this study. Both group performed the large and small s-curve driving during five minute. Accuracy index (AI) was measured by comparing the performance line that drove along large s-curve and small s-curve (target line). Symmetry index (SI) was calculated by difference of right and left seat pressure.The steering AI of stroke drivers was significantly lower than that of healthy adult drivers (p <0.05), and the AI of small S-curves was significantly lower than that of large S-curves (p <0.05). The sitting SI of stroke drivers was significantly greater than that of healthy driver (p <0.05). Also, AI of stroke driver showed significant correlation with SI in both S-curve. However, healthy drivers had no significant correlation between SI and AI (p> 0.05). SI and AI are valid variables for evaluating the stroke driver's driving ability in off-road environment.

The purpose of this study was to investigate the effects of attentional focus on static postural control in chronic stroke patients. Twenty four subjects diagnosed with chronic stroke participated in the experiment. All subjects maintained quiet standing on a force plate for 30 s with three attentional focus conditions: baseline (BL), internal focus (IF), andexternal focus (EF). No instructions regarding attentional focus were given to the subjects for the BL condition. The subjects were instructed to stand with their attention focused on their feet for the IF condition. Under the EF condition, the subjects were first instructed to check red markers indicated on the force plate. Then the subjects were asked to look front but to concentrate on the markers. The results demonstrated that the EF condition reduced the amount and instability of postural sway more than the other attentional focus conditions. The effects of attentional focus on postural sway were only exhibited in the mediolateral direction. This study suggests that directing attention focused on the movement effect that occurs in the external environment around the body may help stroke patients enhance the postural control of quiet standing.This might result from reduced asymmetric weight distribution with external focus. The present results provide a possible use of external focus to stabilize static posture in physical therapy for patients with stroke.

A stroke is the third most common cause of death and the fourth most common cause of infection. Stroke is characterized by the WHO as a clinical condition involving the rapid development of clinical indications of a central aggravation of cerebral capacity lasting more than 24 hours or causing death without a clear reason other than a vascular source. In the present study, a large part of the cases of intense ischemic stroke were found among the males. In the present study, mean cholesterol values, triglyceride values are directly proportional to the severity of the ischemic stroke, among the study subjects. In the present study, 8% cases died, while 92% discharged at home. The current study proved the association of serum uric acid levels with the severity of the acute ischemic stroke.