title: Smokeless Tobacco and Stroke - A Clinico-epidemiological Follow-up Study in A Tertiary Care Hospital.
abstract: BACKGROUND
  Among the modifiable risk factors for stroke, tobacco smoking is well recognized. In some studies the use of Smokeless Tobacco (ST) has also been contributed as a risk factor for ischemic stroke. Use of ST is very common in South-East Asia. The form of ST varies according to the geographical and cultural variation.
  
  
  OBJECTIVE
  To study the various clinical symptoms and radiological findings of stroke due to different types of ST.
  
  
  METHODS
  This was a prospective hospital based study carried out over a period of 2 years. All the cases within age group of 16 - 60 years and with a clinical and radiological diagnosis of acute stroke were included in the study. The Fagerström Test for Nicotine Dependence for ST of more than 6 was taken as the inclusion criteria. Patients having other addictions like smoked tobacco, alcohol, etc., and with important risk factors like hypertension, diabetes, dyslipidemia were excluded. The cases were extensively investigated and followed up for at least 6 months. Analysis was done using the Statistical Package for Social Sciences (SPSS- version 16.0). Descriptive statistics like percentage, mean were used wherever appropriate.
  
  
  RESULTS
  During a period of 2 years, a total of 54 patients were studied. Forty two (77.7%) were males and 12(22.3%) were females. The mean age at presentation was 42.72(± 8.6) years and among all 96.3% patients were diagnosed as ischemic stroke. Among ST, pan was most commonly used in 21(38.9%) patients with an average of 14.6(±3.27) years of addiction. Hemiplegia was the predominant symptom on presentation (46, 85.2%). According to Oxfordshire Stroke Classification, partial anterior circulation infarct was most common in 20(38.4%). The mean Modified Rankin scale after 5 days of hospital stay was 3.83(±1.03) and after 6 months of follow-up was 2.1(±0.8). Patients were counseled for deaddiction and after 6 months follow-up 48(88.8%) patients had quit ST.
  
  
  CONCLUSIONS
  ST is an important etiological factor for young ischemic stroke. This is the first study depicting clinical symptomatology of ST addicted ischemic stroke patients from India. Considering the increasing prevalence of ST use in south-east Asia, further long term studies are needed from this region.
authors.affiliation: Associate Professor, Department of Neurology, IMS & SUM Hospital , Sector-8, Kalinga Nagar, Bhubaneswar, Odisha, India .
authors.forename: Subhransu Sekhar
authors.initials: SS
authors.lastname: Jena
authors.affiliation: Associate Professor, Department of Medicine, IMS & SUM Hospital , Sector-8, Kalinga Nagar, Bhubaneswar, Odisha, India .
authors.forename: Shobhitendu
authors.initials: S
authors.lastname: Kabi
authors.affiliation: Professor, Department of Medicine, IMS & SUM Hospital , Sector-8, Kalinga Nagar, Bhubaneswar, Odisha, India .
authors.forename: Baikuntha Nath
authors.initials: BN
authors.lastname: Panda
authors.affiliation: Student, IMS & SUM Hospital , Sector-8, Kalinga Nagar, Bhubaneswar, Odisha, India .
authors.forename: B C
authors.initials: BC
authors.lastname: Kameswari
authors.affiliation: Student, IMS & SUM Hospital , Sector-8, Kalinga Nagar, Bhubaneswar, Odisha, India .
authors.lastname: Payal
authors.affiliation: Associate Professor, Department of Emergency and Critical Care, IMS & SUM Hospital , Sector-8, Kalinga Nagar, Bhubaneswar, Odisha, India .
authors.forename: Ishwar Chandra
authors.initials: IC
authors.lastname: Behera
authors.affiliation: Assistant Professor, Department of Biochemistry, IMS & SUM Hospital , Sector-8, Kalinga Nagar, Bhubaneswar, Odisha, India .
authors.forename: Subrat Kumar
authors.initials: SK
authors.lastname: Tripathy
authors.affiliation: Junior Resident, Department of Neurology, IMS & SUM Hospital , Sector-8, Kalinga Nagar, Bhubaneswar, Odisha, India .
authors.forename: Seemanchana
authors.initials: S
authors.lastname: Mahanta
keywords: Cerebro-vascular disease; Cigarette smoking; Nicotine