Letters to the Editor

References 1. 2.






Asbury AK, Cornblath DR. Assessment of current diagnostic criteria for Guillain-Barré syndrome. Ann Neurol 1990;27(Suppl):S21-4. Toman MA, Chakravorty U, Gupta S. India and Global Climate Change: Perspectives on Economics and Policy from a Developing Country, Resources for the Future Press. Washington, DC: RFF Press;2003. The prognosis and main prognostic indicators of Guillain-Barré syndrome. A multi — centre prospective study of 297 patients. The Italian Guillain-Barré Study Group. Brain 1996;119:2053-61. Hadden RD, Karch H, Hartung HP, Zielasek J, Weissbrich B, Schubert J, et al.; Plasma Exchange/Sandoglobulin Guillain-Barré Syndrome Trial Group. Preceding infections, immune factors, and outcome in Guillain-Barrésyndrome. Neurology 2001;56:758-65. Jackson BR, Zegarra JA, López-Gatell H, Sejvar J, Arzate F, Waterman S, et al. Binational outbreak of Guillain-Barré syndrome associated with Campylobacter jejuni infection, Mexico and USA, 2011. Epidemiol Infect 2013;1-11. Greene SK, Rett MD, Vellozzi C, Li L, Kulldorff M, Marcy SM, et al. Guillain-Barré syndrome, influenza vaccination, and antecedent respiratory and gastrointestinal infections: A case-centered analysis in the vaccine safety datalink, 2009-2011.PLoS One 2013;8:e67185. Singh R, Singh PP, Rathore RS, Dhama K, Malik SV. Studies on effect of seasonal variations on the prevalence of Campylobacter jejuni in poultry faecal samples collected from Western Uttar Pradesh. India J Comp Microbiol Immunol Infect Dis 2008;29:45-8.



Parkar SFD, Sachdev D, deSouza N, Kamble A, Suresh G,Munot H, et al.Prevalence, seasonality and antibiotic susceptibility of thermophilic Campylobacters in ceca and carcasses of poultry birds in the “live-bird market”. AfrJ Microbiol Res 2013;7:2442-53. 9. Broor S, Krishnan A, Roy DS, Dhakad S, Kaushik S, Mir MA, et al. Dynamic patterns of circulating seasonal and pandemic A (H1N1)pdm09 influenza viruses from 2007-2010 in and around Delhi, India. PLoS One 2012;7:e29129. 10. Sriganesh K, Netto A, Kulkarni GB, Taly AB, Umamaheswara Rao GS. Seasonal variation in the clinical recovery of patients with Guillain Barré syndrome requiring mechanical ventilation. Neurol India2013;61:349-54. 11. Sharma G, Sood S, Sharma S. Seasonal, age and gender variation of Guillain Barre syndrome in a tertiary referral center in India. Neurosci Med 2013;4:23-8. Access this article online Quick Response Code:

Website: www.annalsofian.org

DOI: 10.4103/0972-2327.132662

Accounting for attitude in a KAP Study: A comment on knowledge, attitude and practice of stroke in India versus other developed and developing countries Sir, Went through an article entitled “Knowledge, attitude, and practice of stroke in India versus other developed and developing countries” published in Ann Indian Acad Neurol (2013; 16:488-93). [1] The authors need to be congratulated for their effort in touching an important aspect neuroepidemiology related to stroke in India. As we all aware awareness about a medical condition is the cornerstone for planning prevention. By referring to the study as a review, the authors have been honest in their interpretation of the methodology used to choose studies included in this study. However, given the vast body of evidence referred to in this article, one would have been happy to see a systematic review as a methodology for conducting this study. Systematic reviews and meta-analyses are a key element of evidence-based healthcare. This would have answered our concerns as to why did the authors select certain studies and not others? What did they do to pool results? This would also have reflected on the inadequate number of studies reflecting on all components of KAP (Knowledge, A itude and Practice) on stroke across populations. A review becomes systematic if it is based on a clearly formulated question, identifies relevant studies, appraises their quality and summarizes the evidence by use of explicit methodology. The authors rightly talk of a itude toward stroke being an almost unexplored area of research. Most of the KAP studies

lack in measuring a itude properly (the second part of a standard KAP survey questionnaire.[2] And if studies make an effort to understand a itude, the efforts are inadequate. This study highlights this fact again. A itude essentially includes three components: a. A cognitive or knowledge element, b. An affective or feeling element, and c. A tendency to action.[3] The authors tend to do well with the feeling element of the a itude, but have handle “tendency to action” inadequately. This is also reflected in the statement used by the authors; Indian participants were observed to hold an a itude that stroke could occur without any risk factors, simply being an event associated with senility and hence consultation with health personnel was reportedly low. Further it goes on to add that about more than half of the study participants reported that they did not know the appropriate treatment for stroke. Both these statements actually are an extension of awareness or knowledge component only.

Sunil Kumar Raina Department of Community Medicine, Dr. Rajendra Prasad Government Medical College, Tanda, Kangra, Himachal Pradesh, India Annals of Indian Academy of Neurology, April-June 2014, Vol 17, Issue 2


Letters to the Editor

For correspondence: Dr. Sunil Kumar Raina, Department of Community Medicine,


Dr. Rajendra Prasad Government Medical College, Tanda, Kangra-176 001, Himachal Pradesh, India. E-mail: [email protected]

Park K. Medicine and social sciences. Park’s Textbook of Preventive and Social Medicine. 21st ed. Jabalpur: M/s Banarsidas Bhanot; 2011. p. 626. Access this article online Quick Response Code:

References 1.


Das S, Das SK. Knowledge, attitude and practice of stroke in India versus other developed and developing countries. Ann Indian Acad Neurol 2013;16:488-93. Raina S. Assessment of knowledge, attitude, and practice in health care delivery. N Am J Med Sci 2013;5:249-50.

Website: www.annalsofian.org

DOI: 10.4103/0972-2327.132663

Author’s reply: Evolution of mobile plaque to complete division of carotid lumen Sir, The comments by Akgün et al.,[1] on our case report about mobile plaque were welcome and highly appreciated. We completely agree that there are substantial drawbacks of power Doppler ultrasound in the evaluation of the wall and plaque surface due to artifacts, and the advantages of the B-mode in the assessment of blood vessel intimal surface and intimal flap.[2] However, the power mode image that was published was the most illustrious one, and supplemented by a B-mode video clip. Sometimes a single ultrasound image got from one position of the ultrasound probe is not enough to present realistic picture that the examiner has. In that case, the projections of lateral and posterior probe positions should ensure the more thorough evaluation. Unfortunately, not all the images can be presented. We strongly agree that mobile flap possibly remained a er endarterectomy, gradually enlarged during the time and eventually caused an embolic stroke, as we noted in our case report.[2] Further on, we followed the mobile plaque enlargement which was in the form of a ridge, and grew until finally it divided the lumen of the common carotid artery. From the coronal magnetic resonance angiography images, longitudinal continuity of an intimal flap could not be seen. On contrary, there was only a short transversely positioned formation in the common carotid which divided the lumen, in length of about 5 mm [Figure 1]. This corresponded to the ridge-shaped plaque that had been previously monitored by ultrasound.

Petar Slankamenac1,2, Zeljko Zivanovic1,2, Branka Vitic1, Aleksandar Jesic1,2 1

Department of Neurology, Clinical Centre of Vojvodina, Novi Sad, 2Medical faculty, University of Novi Sad, Novi Sad, Serbia For correspondence: Dr. Zivanovic Zeljko, Department of Neurology, Clinical Centre of Vojvodina, 1 Hajduk Veljkova St,

Annals of Indian Academy of Neurology, April-June 2014, Vol 17, Issue 2

Figure 1: Magnetic resonance (MR) angiography showed the small transversely positioned plaque which divided the lumen of the common carotid artery

Novi Sad - 21000, Serbia. E-mail: [email protected]

References 1. 2.

Akgün H, Battal B, Akgün V, Yücel M, Oz O, Demirkaya S. Two conjoined plaques or a flap? Ann Indian Acad Neurol 2013;16:293. Petar S, Zeljko Z, Branka V, Aleksandar J. Evolution of mobile plaque to complete division of carotid lumen. Ann Indian Acad Neurol 2012;15:347-8. Access this article online Quick Response Code:

Website: www.annalsofian.org

DOI: 10.4103/0972-2327.132666

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