Type 2 diabetes mellitus is widely prevalent in South Asians, and has a significant effect on health, as well as the economies of South Asian countries, particularly when the disease is associated with complications. There are certain characteristics associated with the South Asian phenotype that make South Asians especially prone to diabetes, as well as its complications. Microvascular complications cause considerable morbidity and mortality. There are significant differences in the epidemiology of microvascular complications between South Asians and people of other races. There is evidence of higher prevalence of nephropathy and retinopathy in South Asians compared with Caucasians; however, recent studies indicate that this trend seems to be leveling off. Importantly, diabetic neuropathy occurs less frequently in South Asians compared with Caucasians. These observations have important implications in managing South Asian patients with diabetes and microvascular complications.

Epidemiology of microvascular complications of diabetes in South Asians and comparison with other ethnicities

Background Stroke is usually end result of predisposing conditions that originated years before the ictus. Identification of its modifiable risk factors can help in planning preventive strategies. Objective To study the risk factors of stroke in adult patients. Methods A hospital based prospective cross sectional study was carried out in 160 stroke patients admitted in Manipal Teaching Hospital, Pokhara from November 2007- October 2010. Diagnosis of stroke was confirmed by CT scan of brain. Patients were then investigated for presence of conventional risk factors. The data was statistically analysed using Epi-Info. Results The mean age of stroke patients was 65.98 years ± 10.69 with 126 (78.8%) of patients belonging to age group ? 60 years. It afflicted higher percentage of males 104 (65%) than females 56 (35%). Analysis of stroke subtypes showed preponderance of haemorrhagic stroke in 85 (53.1%) as against infarction in 75 (46.9%) of cases. Other conventional modifiable risk factors were seen as follows: hypertension 98 (61.2 %), cigarette smoking 95 (59.4%), alcohol use 43 (26.9%), left ventricular hypertrophy 44 (27.5%), atrial fibrillation 37(23%), elevated triglyceride 37(23%), diabetes mellitus 15 (9.3%) and elevated total cholesterol 12 (7.5%). Multiple risk factors (? 2) were seen in 122 (76.5 %) cases. Conclusions The maximum occurrence of stroke was seen in patients > 60 years. Overall male preponderance and higher occurrence of haemorrhagic stroke was seen in our study. Significant risk factors in order of descending order were hypertension, cigarette smoking, left ventricular hypertrophy, alcohol use, atrial fibrillation and elevated triglycerides. DOI:  http://dx.doi.org/10.3126/kumj.v9i4.6337 Kathmandu Univ Med J 2011;9(4):244-7

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A Study of Risk Factors of Stroke in Patients Admitted in Manipal Teaching Hospital, Pokhara.

Based on disability-adjusted life years, stroke is one of the major causes of death and is among the top five diseases in Nepal. Despite this fact, information on the prevalence, morbidity, and mortality of stroke in Nepal is limited to urban areas, with no official reports published on the epidemiology of stroke throughout the country. The mean age of stroke patients in Nepal is between 59 and 62 years, with males affected more frequently. Hypertension, cigarette smoking, alcohol consumption, and diabetes are the main predisposing factors for stroke, and ischemic stroke is more common (63%) than hemorrhagic stroke (37%). Because of a lack of facilities and specialists, most stroke patients, especially in the rural areas, seek traditional healers to treat their conditions. More governmental and non-governmental organizations should be involved in improving facilities and implementing prevention strategies.

Burden of stroke in Nepal

Summary Stroke is an important cause of morbidity and mortality worldwide. The case fatality rates from stroke are two- to three-fold higher in sub-Saharan Africa, including Nigeria, than in the developed world, mainly because of limited healthcare facilities and untreated risk factors. The aim was to deter mine the prevalence of traditional cardiovascular risk factors among Nigerians with stroke and compare the prevalence of risk factors between young and older adults with stroke. Methods: The study was cross-sectional in design, and was carried out on stroke patients who were 15 years of age or older, in the medical wards and neurology clinic of Aminu Kano Teaching Hospital, Nigeria. Data was collated consecutively over six months. Results: A total of 81 patients were studied. Sixteen of them (19.8%) were under 45 years old (group 1) while the remaining 65 patients (80.2%) were 45 years or older (group 2). All patients had at least one risk factor. one-third of group 1 patients (37.5%) and 81.5% of group 2 patients had three or more cardiovascular risk factors (p 5 0.0004). The most widespread risk factor in all patients, particularly in group 2 patients was systemic hypertension, while dyslipidaemia was most common among group 1 patients. Recurrent stroke was significantly more common among group 2 than group 1 patients (30.8 and 6.3% respectively) (p 5 0.045). Conclusion: Cardiovascular risk factors, particularly hyper tension and dyslipidaemia were prevalent in the studied patients with stroke. The older patients in group 2 had more multiple-risk factors than the younger ones in group 1. Secondary prevention strategies including detection and treatment of risk factors may curtail the burden of the disease. Cardiovasc J Afr 2007; 18: 290–294 www.cvjsa.co.za Globally, stroke is the second leading cause of death. 1

Prevalence of traditional cardiovascular risk factors among Nigerians with stroke.

Purpose
Although vitamin K antagonists (VKAs) are effective for long-term thromboprophylaxis in atrial fibrillation (AF), their limitations have led to widespread underutilisation, especially in the developing world. Novel oral anticoagulants (NOACs) have emerged as promising alternatives to VKAs, although there are some particular considerations and challenges to their introduction in developing countries. This review summarises the current state of antithrombotic management of AF in the developing world, explores the early evidence for the NOACs and describes some of the special considerations that must be taken into account when considering the role of the NOACs within developing countries’ health care systems.

Potential use of NOACs in developing countries: pros and cons

Stroke is a major public health burden worldwide. Prevention programme are essential to reduce the incidence of stroke and to prevent the all but inevitable stroke epidemic, which will hit our population (developing countries) hard as our population age and adopt lifestyle of the more developed countries. In this study we have tried to find the clinical characteristics of the stroke patients admitted in NMCTH and the commonest risk factors and its magnitude in our population. In these retrospective clinical case series study, we included the cases which were admitted in NMCTH over the past 2 years (from 1st April 2003 to 31st march 2005). All these patients were confirmed cases of stroke (CT scan was done in all these cases). Clinical profiles of all these patients were studied and analyzed using SPSS 11.0 version software. Seventy two patients were diagnosed as having cerebrovascular accident. The mean age of the patients having stroke in our study was 61 years. The commonest symptom was unable to move one side of the body (90.0%), other common symptoms were slurring of speech (33.0%), loss of consciousness (29.0%), headache (23.0%) and deviation of mouth (22.0%). 70 patients (97.0%) had 2 or more than 2 symptoms (i.e. multiple symptoms). Smoking (61.0%), hypertension (60.0%) and atrial fibrillation (8.0%) were the commonest modifiable risk factors, while increased age (mean 61 years) was the commonest nonmodifiable risk factor. Ischemic stroke (68.0%) was common than hemorrhagic (32.0%) stroke. In this study we found that smoking and hypertension was the commonest risk factor in our study group. Atrial fibrillation (8.0%) and diabetes mellitus (8.0%) were among the less common risk factors, whereas alcoholism and hypercholesterolemia were negligible in our study population. Multiple clinical features are common with unable to move the one side of the body being the commonest. The commonest form of stroke detected in our study group was ischemic type which is comparable to the study done in the past. Despite of these findings a bigger epidemiological study is needed to generalize this view over our community.

Stroke: a case series study in Nepal Medical College Teaching Hospital.

Background & Objectives:Sarcoidosis is a multi-system granulomatous disorder of unknown origin.The frequency and the clinical presentation of sarcoidosis vary among the geographical regions. This study is a retrospective analysis of the sarcoidosis patients diagnosed in Nepalese population. The aim of this study was to find the prevalence of sarcoidosis in Nepalese population which has high prevalence of tuberculosis and to understand the clinical profiles and ethnic differences.Materials & Methods:A retrospective chart analysis was done in all the patients from January first, 2005 to December 31st, 2010 who had abnormal chest radiograph and who were diagnosed with sarcoidosis. The study was done at Nepal Medical College Teaching Hospital and Everest Nursing Home.Results:A Forty two patients were diagnosed to have sarcoidosis over a five year period, of which 23/42 (55.0%) were females and 19/42 (45%) were males. The mean age was 36 years with minimum age being 18 years and maximum 72 years. As far as Ethnicity is concerned, 15/42 (36.0%)were Brahmins,08/42(19.0%) were Marwadi, and 07/42(17.0%) were Chhetri. The most common presenting symptom was cough 19/42 (45.0%).Out of the 42 patients, eight were being treated for pulmonary tuberculosis. Most common radiographic findings were bilateral hilar lymphadenopathy 15/42 (36.0%).Conclusion:Sarcoidosis is common in Nepal and should be considered in the differential diagnosis before treating the patient empirically for tuberculosis.

Vikas Pathak

Papers

Stroke: a case series study in Nepal Medical College Teaching Hospital.

Sarcoidosis in Nepal: Epidemiology, Clinical Presentation and Ethnic Differences