10 research outputs found
Comparison of best medical management with carotid intervention procedures in the prevention of stroke recurrence in patients with symptomatic internal carotid artery stenosis
No full textBackground: As per the current recommendations, carotid interventional procedures (carotid endarterectomy/carotid artery stenting) are considered superior to medical management in reducing the stroke recurrence in patients with symptomatic extracranial internal carotid artery (ICA) stenosis. Objective: The objective of this study is to compare the best medical management with carotid interventional procedures in the prevention of stroke recurrence in the patients with symptomatic extracranial ICA stenosis. Materials and Methods: This was a parallel, prospective, two-arm, open-label, observational study. Participants were selected consecutively and prospectively among patients from Outpatient and Inpatient Departments of Neurology at Nizam's Institute of Medical Sciences, Hyderabad, Telangana, India. The study period was from January 2012 to December 2017. Results: Of 150 patients with symptomatic extracranial ICA stenosis of ≥50%, 100 preferred best medical management (m = 75, f = 25) and 50 (m = 37, f = 13) opted for carotid intervention. The mean age of the patient cohort was 59.8 ± 12.7. Follow-up was done at regular intervals from 3 months to 1 year. In the medical group, the recurrence occurred in 10 patients; 4 (40%) within 6 months, 5 (50%) within 6–12 months, and 1 (10%) after 1 year. In the intervention group, the recurrence occurred in 6 patients; 5 (83%) within the first 6 months and 1 (17%) within 6–12 months. Conclusions: Overall, there was no statistically significant difference in the rate of recurrence between the best medical management and the carotid interventional procedures
Genetic and functional evaluation of the role of DLL1 in susceptibility to visceral leishmaniasis in India
No full textChromosome 6q26–27 is linked to susceptibility to Visceral Leishmaniasis (VL) in Brazil and Sudan. DLL1 encoding the Delta-like 1 ligand for Notch 3 was implicated as the etiological gene. DLL1 belongs to the family of Notch ligands known to selectively drive antigen-specific CD4 T helper 1 cell responses, which are important in protective immune response in leishmaniasis. Here we provide further genetic and functional evidence that supports a role for DLL1 in a well-powered population-based study centred in the largest global focus of VL in India. Twenty-one Single Nucleotide Polymorphisms (SNPs) at PHF10/C6orf70/DLL1/FAM120B/PSMB1/TBP were genotyped in 941 cases and 992 controls. Logistic regression analysis under an additive model showed association between VL and variants at DLL1 and FAM120B, with top associations (rs9460106, OR = 1.17, 95%CI 1.01–1.35, P = 0.033; rs2103816, OR = 1.16, 95%CI 1.01–1.34, P = 0.039) robust to analysis using caste as a covariate to take account of population substructure. Haplotype analysis taking population substructure into account identified a common 2-SNP risk haplotype (frequency 0.43; P = 0.028) at FAM120B, while the most significant protective haplotype (frequency 0.18; P = 0.007) was a 5-SNP haplotype across the interval 5′ of both DLL1 (negative strand) and FAM120B (positive strand) and extending to intron 4 of DLL1. Quantitative RT/PCR was used to compare expression of 6q27 genes in paired pre- and post-treatment splenic aspirates from VL patients (N = 19). DLL1 was the only gene to show differential expression that was higher (P < 0.0001) in pre- compared to post-treatment samples, suggesting that regulation of gene expression was important in disease pathogenesis. This well-powered genetic and functional study in an Indian population provides evidence supporting DLL1 as the etiological gene contributing to susceptibility to VL at Chromosome 6q27, confirming the potential for polymorphism at DLL1 to act as a genetic risk factor across the epidemiological divides of geography and parasite species
Prevalence of visual impairment and severity of diabetic retinopathy in various ethnic groups in the UK
No full textDiabetic Retinopathy (DR) is a leading cause of visual impairment (VI) in the working population. Minor ethnic groups are at increased risk of diabetes. Diabetic Retinopathy In Various Ethnic groups in the United Kingdom (DRIVE UK) is a cross-sectional study to estimate the prevalence of DR, VI and associated risk factors for sight threatening diabetic retinopathy (STDR) in Afro-Caribbeans (AC) and South Asians (SA) compared to Caucasians. People with diabetes in two regions in the United Kingdom who were screened and/or treated for DR from September 2008 to September 2009 were included in this study. VI and severe visual impairment (SVI) were defined as Snellen visual acuity of ≤ 6/18 and ≤ 6/60 respectively. DR was graded according to National Screening Committee (NSC) for diabetes guidelines UK.
There were 57,144 people on the diabetic register, of which retinopathy data was available from 50,285 (88.1%) subjects (type 1 n=3,323, type 2 n=46,962). In type 1 and type 2 diabetes, any DR was detected in 53.1%, 39.5%, diabetic maculopathy in 13.1%, 8.4% and STDR in 9.91%, 4.0% of people respectively. STDR was significantly more prevalent in the SA (10.3%) and AC (11.5%) populations compared to Caucasians (5.5%). Overall VI was significantly higher in the ethnic minority population. A total of 7.5% (95% CI 7.3, 7.8) people with diabetes were not eligible for driving based on their visual acuity, 3.4% (95% CI 3.2, 3.5) were classified as VI and 0.4% (95% CI 0.33, 0.44) as SVI. Risk factors for STDR were found to include longer duration of diabetes and higher mean HbA1c.
This study provides information that could be used to help develop future service frameworks and guidelines for local health bodies responsible for delivery of end userservices. The study also supports the need to explore the role of inflammatory, genetic and epigenetic factors as markers for ethnic differences in DR and potential treatment avenues for diabetic retinopathy
Global, regional, and national burden of meningitis and its aetiologies, 1990–2019: a systematic analysis for the Global Burden of Disease Study 2019
No full textBackground Although meningitis is largely preventable, it still causes hundreds of thousands of deaths globally each year. WHO set ambitious goals to reduce meningitis cases by 2030, and assessing trends in the global meningitis burden can help track progress and identify gaps in achieving these goals. Using data from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019, we aimed to assess incident cases and deaths due to acute infectious meningitis by aetiology and age from 1990 to 2019, for 204 countries and territories.
Methods We modelled meningitis mortality using vital registration, verbal autopsy, sample-based vital registration, and mortality surveillance data. Meningitis morbidity was modelled with a Bayesian compartmental model, using data from the published literature identified by a systematic review, as well as surveillance data, inpatient hospital admissions, health insurance claims, and cause-specific meningitis mortality estimates. For aetiology estimation, data from multiple causes of death, vital registration, hospital discharge, microbial laboratory, and literature studies were analysed by use of a network analysis model to estimate the proportion of meningitis deaths and cases attributable to the following aetiologies: Neisseria meningitidis, Streptococcus pneumoniae, Haemophilus influenzae, group B Streptococcus, Escherichia coli, Klebsiella pneumoniae, Listeria monocytogenes, Staphylococcus aureus, viruses, and a residual other pathogen category.
Findings In 2019, there were an estimated 236 000 deaths (95% uncertainty interval [UI] 204 000-277 000) and 2.51 million (2.11-2.99) incident cases due to meningitis globally. The burden was greatest in children younger than 5 years, with 112 000 deaths (87 400-145 000) and 1.28 million incident cases (0.947-1.71) in 2019. Age-standardised mortality rates decreased from 7.5 (6.6-8.4) per 100 000 population in 1990 to 3.3 (2.8-3.9) per 100 000 population in 2019. The highest proportion of total all-age meningitis deaths in 2019 was attributable to S pneumoniae (18.1% [17.1-19.2]), followed by N meningitidis (13.6% [12.7-14.4]) and K pneumoniae (12.2% [10.2-14.3]). Between 1990 and 2019, H influenzae showed the largest reduction in the number of deaths among children younger than 5 years (76.5% [69.5-81.8]), followed by N meningitidis (72.3% [64.4-78.5]) and viruses (58.2% [47.1-67.3]).
Interpretation Substantial progress has been made in reducing meningitis mortality over the past three decades. However, more meningitis-related deaths might be prevented by quickly scaling up immunisation and expanding access to health services. Further reduction in the global meningitis burden should be possible through low-cost multivalent vaccines, increased access to accurate and rapid diagnostic assays, enhanced surveillance, and early treatmen
