Women of childbearing age with epilepsy are often concerned about hazards of antiepileptic drugs exposure on their baby, during pregnancy and lactation. Valproic acid (VPA) is a well-established human teratogen that is frequently prescribed in the treatment of epilepsy, migraines, and bipolar affective disorder. We investigate the protective effect of Nigella sativa (NS) oil extract on the spinal neurons and glia cells damage induced by prenatal VPA administration on the morphology of mice embryos spinal cord and placenta. Five groups of six pregnant mice each were used for the study. Group 1 was administered VPA 600mg/kg/day, group 2 and 3 had VPA 600mg/kg/day and 0.1ml and 0.2ml of NS oil respectively, group 4 received VPA 600mg/kg and folic acid 400µg daily. The fifth group had saline only and served as control. The treatment were given orally from GD 9 to GD 11. The dams were sacrificed on GD 15 and the embryos with the placenta were explanted from the uterus and fixed in 4% formaldehyde and processed for H&E and examine with Nikon image analyser. The histopathological changes in the spinal cord of VPA exposed embryos include distortion in the central canal and gray matter of the spinal cord, which were found to be prevented by administering NS with VPA. Necrosis that was recorded in the placenta of VPA only treated dams was also prevented by NS. In conclusion we proposed NS oil extract can be used in preventing histopathological effects of VPA on the spinal cord cell of mice embryos and placenta.
Introduction: Nonvalvular atrial fibrillation is a common cause of cardioembolic stroke which accounts around 50% of all cardioembolic emboli. Oral anticoagulants remain the main choice of stroke prevention in patients with atrial fibrillation. Our study is aimed to determine the safety (absence or presence of bleeding events) and efficacy (absence or presence of ischemic stroke occurrence) of dabigatran versus warfarin for stroke prevention in patients with nonvalvular atrial fibrillation. Methods: A retrospective audit study was conducted based on past data obtained from Electronic Hospital Information System (EHIS) records in Serdang Hospital. Our sample was 150 patients with nonvalvular atrial fibrillation who were at risk of getting stroke and being prescribed with oral anticoagulants either warfarin or dabigatran from the year 2013 until 2019. Results: Our study showed that there was lesser occurrence of ischemic stroke in patients from dabigatran group (1.3%) as compared to those in warfarin group (2.7%). There were also almost 2 times lesser bleeding events in dabigatran group (6.7%) as compared to those in warfarin group (14.7%). The median of CHA2DS2-VASc Score in warfarin sampled patients (median=3+/-1) was lower than dabig- atran sampled patients (median=4+/-1). Conclusion: Both warfarin and dabigatran are effective in preventing stroke for patients with nonvalvular atrial fibrillation. However, dabigatran is associated with lesser bleeding events with lower incidence of major bleeds compared to warfarin.
Stroke care service in Malaysia is suboptimal despite the fact that it is one of the commonest cause of death. This is due to several limitations, including lack of resources and funding for the stroke care establishment and the man- agement itself. Alternatively, other regions have come up with numerous ways to combat the difficulties in order to provide better stroke care services. We have identified the overwhelming benefits of creating stroke care units, thrombolysis services, and endovascular thrombectomy. For this reason, we designed a Regional Emergency Stroke Quick Response Network (RESQ) based on the needs of the current situation in Malaysia. With a standardised RESQ training, we hope to achieve close-knitted cooperation in between the emergency medical services, emergency de- partment team and the RESQ, which subsequently will create an ideal improvised stroke care units.
The period of hospital stay and the first month after discharge have been found to be the most problematic stages for family caregivers of stroke survivors. It is just at home that patients and caregivers actually understand the whole consequences of the stroke. The adult offspring often have more different needs and concerns than spousal caregivers. However, relatively little attention has been paid to the needs of this particular group of caregivers. Therefore, this qualitative content analysis study aimed to explore the supportive needs and coping behaviors of daughter and daughter in-law caregivers (DILs) of stroke survivors one month after the patient's discharge from the hospital in Shiraz, Southern of Iran.
BACKGROUND: Aspirin use is known to reduce the recurrence of stroke. However, the clinical response to aspirin has been mixed. The rate of stroke recurrence whilst on aspirin treatment is still unacceptably high. A plausible explanation for this may be resistance to the effects of aspirin. The causes of aspirin resistance are manifold and multi-factorial. We conducted a study to investigate the prevalence rate of biochemical aspirin resistance in a cohort of aspirin-naïve stroke patients. We also sought to determine the inherent factors that may predispose towards the development of aspirin resistance.
METHOD: This was a cross-sectional, observational study conducted on patients admitted to our centre with an acute stroke who were aspirin-naïve. The diagnosis of an acute stroke was confirmed by clinical history and brain imaging. Fifty consecutive patients were prospectively enrolled. Socio-demographic data were collected and baseline blood investigations were performed. Patients were tested for biochemical aspirin resistance using Multiplate platelet analyser (Dynabyte, Munich, Germany) after 5 doses of aspirin, corresponding to a total dose of 900 mg.
RESULTS: The median age of patients was 65.5 years and 54 % of patients were female. There were 11 smokers; of these 10 were male. Twenty-six (52 %) patients were Chinese, 21 (41 %) were Malay and 3 (6.0 %) were Indian. Aspirin resistance was present in 14 % of our patients. There was an inverse relationship between the presence of aspirin resistance and plasma HDL levels (r = -0.394; p = 0.005). There was no relationship observed between aspirin resistance and total cholesterol, triglycerides, LDL, HbA1c, ALT, ALP, urea and creatinine levels. There were no significant differences in demographic profiles or smoking status between the aspirin resistant and non-aspirin resistant groups. We did not find any link between ethnicity and aspirin resistance.
CONCLUSIONS: Our results indicate that a lower HDL level is associated with biochemical aspirin resistance. This may increase platelet aggregation and consequently increase the risk of a recurrent stroke. The clinical implications for aspirin resistance are far reaching. Any evidence that correctable factors may negatively influence the action of aspirin warrants further investigation. The prevalence rate of biochemical aspirin resistance in our study is comparable to the findings in other studies performed in an Asian population. Further research is required to determine how our findings translate into clinical aspirin resistance and stroke recurrence.
KEYWORDS: Asia; antiplatelet therapy; aspirin; aspirin resistance; developing countries; ischaemic stroke; risk factors