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In the
past few decades, modern advancements made in medical field have given rise to
treatment protocols ensuring maximum recovery and minimum mortality rate.
Stroke or cerebrovascular accident is a clinical condition manifested as
paralysis of either half or full human body, loss of voluntary movements,
spastic and hypertonic muscles along with slurred speech, dysphagia and
sometimes prolonged periods of unconsciousness as well. Previously it was
thought that stroke is not curable and there is only supportive medication
available for it capable of preventing further worsening as there was no
clinical medicine or agent available that could reverse the pathology. In last
ten years USA, Japan and Europe enhanced the clinical usage of Cytidine-5’-diphosphocholine
(CDP-choline) prompt and complete treatment of stroke patients. These choline
molecules are readily available in two basic forms i.e., free CDP choline or
Liposome encapsulated choline molecules having increased intake rate by damaged
brain tissue for preventing further break down of brain phospholipids and
reduces cerebral edema. As per results of our clinical survey patients who were
administered with free CDP choline molecules showed less recovery as compared
to those who were administered with liposome encapsulated choline molecules as
these molecules had more enhanced capacity to reduce cerebral ischemia and
brain swelling.
Keywords: Free
CDP-Choline, Phospholipid breakdown, Cerebral edema, Cerebral ischemia, Liposome
covered choline molecule
Abbreviations: CT: Computerized
Tomography; MRI: Magnetic resonance imaging; TIA: Transient Ischemic Attack;
SPSS: Statistical Package for the Social Sciences
INTRODUCTION
Choline and its derivatives have been known as significant medication which is monetarily accessible as curative treatment protocol in Western countries since last two decades. Choline molecules have demonstrated useful impacts in cerebral ischemia [1] along with enhanced recovery ratio in cases of spastic paralysis i.e. hemiplegic, diaplegic and paraplegic cases [2]. Clinical preliminaries in Spain and Italy demonstrated that choline uptake by damaged brain tissues resulted in improved recuperation; while researches conducted in regions of Germany and USA [3] have given questionable outcomes. Western world has been indulged in conducting clinical experiments on therapeutic effects of choline knowing it’s an impressively curative medicine for stroke, since stroke is the 4th principal reason of death in entire western world. It indorses disability and handicapped population in a nation adding socioeconomic burden [4]. Choline derivatives have emerged as a magical invention owing to their ability of reducing cerebral ischemia and edema by decreasing phospholipid breakdown ratio [5]. Hydrolysis of CDP-choline results in formation of cytidine and choline easily taken by brain tissues as they cross blood-brain barrier [6]. Previous researches concluded that administration of either exogenous choline molecules or liposome covered molecules within one hour of Transient Ischemic Attack (TIA) as more the time passes, cerebral ischemia expands and involves more of the brain tissue [7]. Previous studies suggest that the efficacy of liposome encapsulated choline molecules in reducing size of cerebral infarct if administered within 24 h of TIA or ischemic stroke attack is much more as compared to free choline molecules. In current study patients who received infusion of liposome covered choline molecules manifested better and prompt recovery. A clinical survey trial reported that patients receiving choline molecules as their foremost treatment of stroke had fast rate of recovery as administration of CDP-choline reduces process of phospholipid break down and promotes phospholipid synthesis [8]. In USA multiple researches have been conducted to evaluated beneficial properties of choline derivative (citicoline) in treatment of cerebral ischemia and how it reduces size of cerebral infarct and rate of phospholipid breakdown. Previous researches suggest that mortality rate in stroke patients treated with citicoline is greatly reduced [9]. The sole motivation behind this investigation is to create mindfulness with respect to helpful treatment of CDP choline in hypertensive patients and its effect in diminishing stroke episode in hypertensive guys and females. There isn’t any such investigation directed beforehand in Pakistan featuring the helpful utilization of choline subordinates [10-15].
MATERIALS &
METHODS
Study subjects
We conducted
a clinical survey from October 2017 to October 2018. Cases, 162 stroke
patients, i.e., both males and females were chosen from the patients admitted
to Mediks international Hospital, Islamabad, Pakistan. All cases were
first-ever stroke patients and were diagnosed on the basis of computerized
tomography (CT)-scan and Magnetic
resonance imaging (MRI) reports [16-23].
Patients who
were treated with either free CDP molecules or liposome encapsulated choline
molecules fulfilling inclusion criterion (aged between 45-75, diabetic,
hypertensive, post-menopausal and osteoporotic) were enrolled in the study via
simple convenient sampling after signing informed consent [24-26].
Statistical
analysis
A specially
designed questionnaire having two parts was used, 1st part
containing demographic details, history of associated co-morbidities and risk
factors was filled for all the patients. Second part of the questionnaire was
regarding variant treatment protocols patients have been through and what
prospective outcomes they had. Two specific treatment methods were taken into
consideration, i.e., administration of 500 mg/kg of CDP-choline in 5 ml of 0.9%
saline, intraperitoneally, 24 hourly and 1 hourly prior to middle cerebral
artery occlusion [27]. Second treatment protocol observed was Liposome typified
CDP-choline administration after 1 h transient center cerebral vein impediment
and 24-hourly reperfusion in unexpectedly hypertensive patients.
Immunohistochemistry reports of all the patients were observed for drawing
results regarding efficacy of both treatment protocols. Data was analyzed using
Statistical Package for the Social Sciences (SPSS) version 23. Descriptive Statistical data was analyzed by
SPSS version 23. In data analysis, mean ¬+ standard deviation was calculated
for quantitative variables and frequency/percentages were calculated for categorical
variables.
RESULTS
The aim of this study was to evaluate the therapeutic correlation of choline derivatives in treatment of stroke. Figure 1 and Table 1 shows age and gender characteristics of stroke patients enrolled in the study with an overall predominance of female gender, i.e., 105, 64.8% and males were 57, 35.1% out of total 162 patients, the age range was from 45-75 with mean age of 60.
Table 2 shows that l administration of CDP choline within 24 h after ischemic stroke results in reduction of phosphorylation. Table 3 shows that liposome encapsulated choline reduces size of infarction with more efficacy as compared to free choline molecules. A p-value of less than 0.01 shows that results are highly significant.
DISCUSSION
The sole
purpose of conducting this research was to develop awareness regarding
miraculous effects of choline to cure ischemic stroke and enhance process of
recovery. Variant researches on beneficial effects of choline and its
sub-ordinates have been conducted all over the world but unfortunately very
little or no work has been done on it in Pakistan. We conducted this clinical
survey to promote awareness regarding its benefits and to help people who have
given up on their lives thinking stroke is not curable. Our research results
cannot be generalized to entire population of Pakistan as people living in
peripheral areas cannot be benefited by this advanced treatment protocol and
tertiary medical centers are still following old standard treatment methods
depriving people of basic health facilities. It is our moral obligation to
spread awareness regarding advanced treatment methods making people sure that
stroke is curable. The stereotype treatment protocols must be abolished and
physicians should adapt modern treatment methods as being followed all over the
world for betterment of their people. We all need to get together on a single
platform to ensure advanced medical care facilities to people who are
underprivileged and underserved in terms of basic facilities and necessities.
CONCLUSION
Choline
molecules serve an important role in reduction of size of infarction and early
recovery in stroke patients provided that it is administered within 24 h after
attack of stroke.
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