Abstract:WHO defines stroke as an event caused by the interruption of the blood supply to the brain, usually because a blood vessel bursts or is blocked by a clot. This cuts off the supply of oxygen and nutrients, causing damage to the brain tissue [1]. Globally, stroke is the third commonest cause of mortality [2] and the fourth leading cause of disease burden [3]. Ischemic stroke is the most common cerebrovascular disease, most often due to atherothrombotic diseases and uncommonly by disorders of hypercoagulation. Disorders of coagulation leading to thrombotic disorders are approximately 1% of all ischemic strokes and 4-8% of young strokes. Similarly combined deficiency of protein C and S can lead to hypercoagulable state and rarely present as cerebrovascular accident. We describe here a rare case of 27 year old male who presented with right middle cerebral artery territory infarct due to combined protein C and S deficiency.Key words: Stroke, Blood Coagulation, Protein C, Infarction, Middle Cerebral Artery, Brain.
IntroductionCerebrovascular diseases are one of the common causes of high morbidity and mortality all over the world and out of all cerebrovascular diseases most of them are ischemic strokes (85%). Stroke in young individual poses a major problem as these young family members are the major income earner of the family. Abraham et al [4] from Vellore, South India reported that 25% cases of the stroke were less than 40 years of age. Other Indian studies have highlighted a high incidence 24-35% of stroke in young population [5]. Atherothrombotic diseases are most common cause for ischemic stroke, however disorder of coagulation although uncommon but can lead to hypercoagulability resulting in ischemic stroke.
Case ReportA 27 year old male presented with complains of weakness in left side of body since last 10 days. General physical examination was unremarkable. Neurological examination revealed findings consistent with left-sided hemiparesis. No precipitating factors such as obesity, diabetes, hypertension, valvular heart disease, chronic drug intake, intravenous drug abuse and smoking were present. Family history was negative for vascular events
Background: Evidence for using colposcopy in the absence of a squamous intraepithelial lesion on conventional cytology has important position in cervical cancer screening. Aim of this study to evaluate sensitivity, specificity and diagnostic accuracy of colposcopy and cytology in unhealthy cervix to know role of colposcopy in concurrent use with cytology or replacing to cytology at tertiary centre experience. Methods: Prospective study was carried out over a period of one year, in patients attending Gynaecology OPD, King George's Medical University, Lucknow, Uttar Pradesh. After informed consent and ethical clearance from institutional ethics committee, total 664 diagnostic colposcopy were performed in women presenting with gynaecological complaint. These women were called for concurrent colposcopy and pap smear. 41 women were lost to follow up, only 623 women were subjected for concurrent colposcopy and cytology. 99 women who had high grade colposcopy with Swede score ≥5 underwent colposcopic guided biopsy and tissue were sent for histopathological examination and cytology of same patients were compared for analysis. Results: Mean age of women was 42.68±11.69 years and mean age of consummation of marriage 20.94±3.21years. Cervical erosion was most common finding (41.4%) followed by hypertrophy of cervix (33.3%) and cervix bleeds on touch (17.2%). 24.14% (n=7) women with ASCUS cytology had high grade HPE (CIN2 +) while 42.3% (n=11) women with LSIL had high grade HPE (CIN2 +). Taking ASCUS and above as cutoff , the sensitivity, specificity, of Pap smear was 97.8%, 14.6% and diagnostic accuracy was 55.3%. For overall analysis of Colposcopy Swede Score at ≥5, colposcopy was 100% sensitive and 41.2% specific and diagnostic accuracy was 69.7%. At swede score ≥7, colposcopy was 64.6% sensitive and 100% specific and diagnostic accuracy was 82.8%. Conclusion: Colposcopy has good sensitivity and specificity as compared to cytology and can be used in evaluation of abnormal or controversial cytology to obtain better outcome.
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