Noncommunicable diseases are a cause of great concern in developing countries, particularly cardiovascular disease (CVD). CVD is most commonly attributable to risk factors such as obesity, high-blood pressure (BP), lack of physical activity and smoking. This study aims to summarize previous research on the prevalence and risk factors of CVD in the United Arab Emirates (UAE). Search engines and databases such as PubMed, Scopus and Science Direct, as well as several local journals, were utilised to identify relevant literature. Inclusion was limited to studies published between 2007 and 2016 in the English language and conducted with UAE participants (citizens and/or expatriates). Twenty-one relevant studies were found, including cross-sectional studies (n = 11), population-based studies (n = 3), literature reviews (n = 2) and a case–control study (n = 1). Estimates of the prevalence of CVD are considerably high, although there is insufficient information available on prevalence in the UAE as a whole. Primary determinants of CVD include obesity, smoking and diabetes mellitus. The prevalence of risk factors associated with CVD has increased in the UAE and will continue to increase, as made clear by the reviewed studies and as predicted by projections and future estimates. Some risk factors can be controlled, treated and prevented. Further attention should be given to developing preventative and curative strategies in order to reduce BP, increase physical activity, improve dietary habits and reduce smoking.

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Smoking, as recreational activity, is being practiced by over 1 billion people globally. The main objective of the present study was to explore smoking prevalence, its effects and people attitude in the Kingdom of Saudi Arabia (KSA) by literature review. PubMed was used for systematic search. Search was made with key words ‘Smoking AND Saudi Arabia’ and a total of 790 articles were found. When limits were applied with English language and studies on human, 502 articles were left. All abstracts of these articles were reviewed with the application of inclusion criteria of studies in the KSA and Saudi Arabia population and 75 articles were left. Then, these articles were categorised according to content, attitudes, cross-sectional studies, factors or diseases, its effects and associations to risk factors, original articles, prospective and retrospective studies, studies about smoking, surveys, studies showed different prevalences of smoking among schoolchildren, medical colleges, university students, health professionals and other population. Tobacco smoking was a major and modifiable risk factor for cardiac diseases and other diseases in Saudi Arabian population. Majority of smokers were found motivated to quit smoking, needed guidance and treatment. Second-hand smoke (SHS) affects newborns and children's health. Waterpipe smoking and SHS were potential threats for population's health in SA. It was concluded that in the KSA, smoking is a forthcoming alarming threat for different tobacco-related diseases. Now, it can be controlled in minimal time with lesser efforts by strategic planning, designing tobacco control programmes according to sex, age groups and education levels.

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Immunoassays are rapid, simple, cost-effective, robust and sensitive laboratory techniques that are extensively used in many important areas of clinical medicine such as diagnosis, prevention, treatment and management of diseases. Universally, it is one of the most extensively used in vitro diagnostic testing methods, and its demand has been increasing exponentially over the past four decades. Routinely, these methods can quantify minute amounts of diverse analytes such as hormones, antibodies, proteins and drugs present in highly complex biological fluids, such as serum, urine, sweat, meconium and cerebrospinal fluid. Immunoassays are successful techniques that can detect up to picomolar concentrations using antigen–antibody reactions without the need of prior extraction. Although immunoassays are useful techniques that help physicians to take quick decisions, they too are subjected to interference from both exogenous and endogenous sources, resulting in false-positive and false-negative results. When the immunoassay results do not appear to fit the clinical picture, it becomes a great challenge to a clinical biochemist, alarms clinicians and confounds immunoassay manufacturers. Sometimes, these results can mislead or miss a diagnosis, resulting in unnecessary investigations and mental trauma to the patient and families. Hence, it is very important for one to be aware of the limitations of this immunoassay, to have knowledge about them and to take necessary actions or precautions to get the right result. There is no single procedure that can rule out all interferences. Furthermore, it is difficult for the laboratorians to identify antibody interference with immunoassay, and thus, physicians should be encouraged to communicate specifically with the laboratory about discordance between results and clinical findings. If there is any suspicion of discordance between the clinical and the laboratory data, an attempt should be made to reconcile the difference. Procedures should be put in place when interference is suspected. Constant communication is required between physician and laboratory about unexpected immunoassay results. Manufacturers can also be communicated to identify the presence of interfering antibody.

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Background: Diarrhoeal disease is one of the most common problems affecting children across the world. This study assessed the prevalence of diarrhoea and related risk factors among children aged <5 years. Methods and Material: A cross-sectional study was conducted over 8 months at Sam Specialized Paediatric Centre and Al-Mamoon Diagnostic Medical Centre, Yemen, involving 1570 children aged <5 years with diarrhoea. Detailed data regarding age, sex, diarrhoeal episodes, family size, education level of mother or female caregiver, breastfeeding and weight were collected. Results: Of 5400 patients seen for different causes, 1570 patients were children aged <5 years presenting with diarrhoea, giving a prevalence of 29.07%. A total of 850 children were boys and 720 were girls, with ages ranging from 6 to 60 months. There were 1325 children aged <12 months, 160 aged 1–2 years and 85 aged 3–5 years. There were 700 (44.59%) children from small families and 870 (55.41%) from large families. A total of 922 (58.73%) children were malnourished and 648 (41.27%) were not. There were 1125 (71.66%) children whose mothers or female caregivers had no or low-level formal education and 445 (28.34%) whose mothers or female caregivers had secondary or high-level education. A total of 651 (41.46%) children were breastfed, 735 (46.82%) were mixed fed and 184 (11.72%) were bottle-fed. Conclusion: The prevalence of diarrhoea in children was high; it was highest in those who were aged <12 months, from a large family, malnourished and not exclusively breastfed, and in those whose mother or female caregiver had no or low-level education. It is important to encourage family planning, a balanced diet, exclusive breastfeeding and maternal education, and to strengthen health intervention programmes, in order to reduce the incidence of diarrhoea.

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Low back pain is number one reason for disability in patients under the age of 45 year and the number two reason to see a doctor after flue in the USA. Early intervention for the treatment of patients with Degenerative Disc Disease (DDD) using regenerative medicine or ultra-minimal invasive approaches have gained traction over the past 20 years as alternatives to invasive, costly, and complicated surgical interventions. This review article discusses the pathophysiology of DDD and summarizes the literature encompassing the use of biologic-based therapies for DDD. Articles and patents published in the past 40 years were reviewed, cell-based, bimolecular or gene therapies, as well as companies investigating the utility of allogeneic and tissue-engineered intervertebral discs were included. Additionally, published and unpublished ongoing clinical trials were also included. These exciting non-invasive therapies have encouraging initial positive results across multiple strategies paving the road for a potentially thriving regenerative techniques and increase in the number of DDD clinical trials.

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We are confronted with a rapid growth in medical knowledge. It has become more and more difficult for health care professionals to keep pace with the state of knowledge. At the same time teaching concepts have changed with a similar speed, propelled by the evolution of the internet, social media, and digital technology. Online education plays an increasing role in all stages of education and can help to overcome some of the difficulties that health care professionals encounter. E-Learning can be more effective, interactive, and adaptive to the needs of the learner. But most importantly, it is available anytime and anywhere. This article focuses on the different stages of learning in a physician's career and on new teaching concepts that are applying innovative technologies to improve education.

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Rotator cuff injuries are common and frequently seen by orthopaedic surgeons. Accurate diagnosis of the injury is crucial for appropriate management. Imaging studies are the cornerstone of diagnosis and have great value compared with clinical assessment alone.

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Rehabilitation after peripheral nerve lesions involves several professional groups such as medical doctors, physiotherapists, occupational therapists and orthopaedic technicians. The therapy goal is not only to treat the immediate symptoms due to the nerve lesion but also to avoid secondary damage. Peripheral nerve lesions often lead to severe functional limitations that affect the quality of life and professional and social participation and require appropriately targeted intervention in this regard.

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Background/Aim: The prevalence of diabetes is on the rise globally causing excessive burden on the health systems. Pancreatic beta-cell mass destruction/neogenesis/proliferation (seen in type1diabetes) and/or malfunction (type 2 diabetes) have been implicated in the aetiology, pathology, progression as well as in responses towards therapies and disease managements. Oxidative stress and alterations in mitochondrial energy metabolism play important roles in diabetes-induced cellular complications. Several studies, including our own, have suggested that Rin-5F pancreatic beta cells are extremely susceptible to oxidative stress due to excessive production of endogenous and exogenous reactive oxygen/nitrogen species (ROS/RNS) and low antioxidant defences, particularly, associated with GSH metabolism. Our aim was to investigate the molecular mechanism of streptozotocin (STZ), a beta cell-specific antibiotic, cytotoxicity in pancreatic cells. Methods: Rin-5F cells were treated with STZ under varying conditions to study oxidative stress-related changes. Results: Our studies have suggested that treatment of Rin-5F cells with STZ, inhibits cell survival and induces cytotoxicity by altering cellular survival and apoptotic signalling and gene expressions. Increased oxidative stress with increased DNA fragmentation and oxidative protein carbonylation were seen in STZ-treated cells. We also observed that beta cells treated with high glucose (up to 25mM) exhibited enhanced cytotoxicity. Cells exposed to conditions mimicking diabetes (hyperglycaemia) were under elevated oxidative stress and showed increased apoptosis and altered redox homeostasis leading to increased cytotoxicity. N-acetyl cysteine (NAC) treatment attenuated these changes in STZ-treated cells. Conclusion: These results may have implications in understanding the mechanism of beta cell survival/death in response to potential therapeutics/managements as well as in the aetiology and pathophysiology of diabetes.

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Anorectal malformations (ARMs) occur in approximately 1 of every 5000 newborns and management still differs widely among practitioners. In this review, we adress some of the current accepted concepts in management. Missmanagement can have devastating consequences such as faecal incontinence, urinary incontinence and sexual disfunction. We briefly review common pecularities of the most common cases the and initial management oft he newborn. In this article I intend to present a brief overview without going into details but hopefully will motivate interest and further reading. Further the recommendation is made that case referal to a centre with a high volume load provides the highest benefits fort he patient in the form of better prognosis and long term management.

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Intracranial aneurysms are uncommon during pregnancy. Haemodynamic stress during pregnancy is a key factor in the multifactorial pathogenesis of cerebral aneurysm, contributing to the risk of aneurysm formation, progression and rupture. Successful management requires multidisciplinary care; anaesthetists require knowledge of obstetric anaesthesia, neuro-anaesthesia and critical care. The incidence of subarachnoid haemorrhage in pregnancy is 0.01%—0.05%, with a maternal mortality rate of 11% in treated cases and a foetal mortality rate of 5% in treated cases.^[1] Definitive treatment involves either open neurosurgical clipping or endovascular therapy, maintaining stable transmural pressure in the aneurysm to prevent rupture. Very few cases have been reported in the literature, and guidelines for the management of intracranial aneurysm during pregnancy and evidence-based recommendations for obstetric anaesthesia in patients with unruptured intracranial aneurysm during labour do not exist. A review of the literature reveals varying results, differing on a case-by-case basis, for the treatment of intracranial aneurysms during pregnancy and labour. Reducing risks associated with intracranial aneurysm must focus on both mother and child. This review encourages the establishment of formal guidelines for an algorithmic approach to manage the intracranial aneurysm during pregnancy and labour.

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Background: Polymethylmethacrylate (PMMA) has been the most popular material for the construction of denture bases since 1937. This is largely due to its favourable although not ideal characteristics. Aims of the study: To study the structural characterisation using Fourier transform infrared (FTIR) of adding aluminium oxide (Al₂O₃) and silver nanofillers on heat cure acrylic powder treated with microwave radiation and microwave-treated PMMA powder ground by micronizer. Materials and Methods: PMMA powder was treated with microwave radiation at a power level of 360 watt for ¾ h. The obtained PMMA powder was then grinded using a domestic blender group (V). The next step is particle size reduction of the microwave-treated PMMA powder using micronizer group (M). Two concentrations of Al₂O₃and Ag nanoparticles (NPs) were added separately into untreated PMMA powder group (P) and microwave-treated PMMA powder group (V and M) compared with the control group. The structural characterisations of all experimental groups are determined by FTIR. The samples were divided into 15 groups, one sample for each group. Results: The FTIR analysis has confirmed that the structural behaviour of both microwave and micronizer groups showed that there were no changes in the regions of the band locations for C=C and C=O when compared with the control one. The infrared spectra of all acrylic groups with (Al₂O₃and Ag) NPs additives showed all of the unique peaks attributed to the PMMA. These bands appeared in the same regions of the acrylic except the carbon double bond carbon (C=C) were absent in the infrared spectrometer chart. Conclusion: The FTIR test charts provide strong evidence that there are no chemical changes in all experimental groups. Except for the C=C band from the methacrylate group did not appear in samples containing NPs, which in turn indicates that the residual monomer of these groups is remarkably decreased.

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Background: Healthcare workers are under substantial level of negative health outcomes due to risk of exposure, workload and moral dilemmas when India is on upsurge of coronavirus disease 19 (COVID-19) cases. Since there is a scare of research on this issue from India, we decided to conduct online survey to evaluate psychological impact and quality of life. Methods: From 25 May to 10 June 2020, a web-based Frontline-COVID survey was conducted. Feeling-related questions, Impact of Event Scale-Revised, Connor-Davidson Resilience Scale (CD-RISC) and Professional Quality of life were administered among healthcare workers from different departments. Results: Among the respondents, 218 (52.1%) belong from low-risk unit and 200 (47.9%) from the 'high-risk unit' including higher proportion of nurses 191 (45.7%), female 282 (67.5%), aged 31–40 years (48.3%) and married 220 (52.6%). Overall female nurses, doctors and working in emergency unit had a greater proportion of psychological distress. Middle aged (31–40 years) had a higher level of resilience contrast to this; working in COVID-19 unit was associated with a lower scale of resilience. Resilience and QoL were an important predictor for psychological distress. Conclusion: Results implicate interventions for stress management and social support among medical staff working in the pandemic. Need for systematic and longitudinal assessment for holistic strategies by policy makers targeting resilience and training for public health emergency.

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Functional posterior shoulder instability (Polar Type III) can lead to posterior subluxation and/or dislocation during shoulder movement. Disturbed activation of external rotators and periscapular muscles generating a force imbalance in the shoulder can result in instability, weakness and pain as the leading symptoms patients present. Recommended conservative treatment is often ineffective, alternative surgical treatment may diminish function even further and aggravate pain. The implementation of the Shoulder-Pacemaker was evaluated in a prospective clinical trial. Patients suffering from functional posterior shoulder instability refractory to previous treatment options should regain glenohumeral shoulder stability after our conservative therapeutic training regime with the Shoulder-Pacemaker. 19 cases with therapy-resistant functional posterior shoulder instability had been included in the Shoulder-Pacemaker therapy-concept. Previously all patients were treated unsuccessfully with at least 3 months of regular physiotherapy. Failed surgical stabilization attempts were not an exclusion criterion. Prior to treatment, a fluoroscopy was performed for diagnosis assurance as well as the evaluation of current MR-Imaging for excluding structural defects. The Shoulder-Pacemaker therapy consisted of a 3- to 6- weeks conservative treatment regime with electric muscle stimulation and regular physiotherapy. For longitudinal evaluation of shoulder function, a specifically developed questionnaire including SSV, ROWE and WOSI score was assessed. After treatment, all patients were very satisfied and fully recommended the Shoulder-Pacemaker therapy. All cases improved in all scores assessed and patients had been able to return to physically demanding and even sporting activities. Patients with completed 3-month follow-up achieved a Rowe score of 92 ± 14, SSV of 95 ± 6%, and WOSI score of 372 ± 181 [Figure 1]. In 2 out of 19 cases the training was not completed because of lack of compliance. No complications were observed. The Shoulder-Pacemaker therapy is a very effective treatment option in patients with functional posterior shoulder instability. Even if previous conservative or surgical stabilization attempts failed, the Shoulder-Pacemaker therapy successfully re-established glenohumeral stability and seems to have a long-lasting effect. Because of the short time of follow up, these results remain preliminary.

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Antisynthetase (AS) syndrome is a rare idiopathic inflammatory myopathy characterised by myositis, Raynaud's disease, fever, interstitial lung disease (ILD), 'mechanic's hands' and arthropathy, and it is associated with the presence of antibodies against aminoacyl-tRNA synthetase especially anti-Jo-1. We report the case of a 31-year-old Egyptian male who presented with fever, mechanic's hands, subclinical myositis, arthritis and ILD. He had been treated previously at another hospital with broad-spectrum antibiotics but without response. He was extensively worked up for infections and found to have mycoplasma infection and strongly positive anti-Jo-1 and anti-Ro/SSA antibodies. AS syndrome was confirmed based on clinical features and laboratory results. The patient was treated with high-dose steroids and subsequently with mycophenolate mofetil and dramatically improved. This case highlights the importance of awareness of this rare condition and that careful examination of the hands can be crucial as mechanics's hands is a unique manifestation of AS syndrome, occurring in ≈20% of cases. Mycoplasma infection may have been a triggering factor in this case.

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Despite a huge amount of research investiment during the past three decades there is still no cure or disease-modifying therapy of any kind for Alzheimer's disease, and only very limited progress has been made since the millenium. This review provides a perspective on how Alzheimer's disease symptoms are currently treated with pharmacological and non-pharmacological approaches, and what the evidence for each is. In the absence of new drugs, it is remarkable how well medical foods and behavioural interventions fare in comparison, although much research is still required. A true causal therapy of Alzheimer's disease will have to await the unvailing of its ultimate cause.

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As initial studies reported that magnetic resonance imaging (MRI) was useful for the evaluation of the small intestine, this modality has become increasingly important in the diagnosis, assessment and exclusion of small bowel disease. The use of MRI for the assessment of inflammatory bowel disease is increasing, at the expense of the current primary imaging modality and computed tomography (CT) enterography. MRI has many advantages over CT, including a lack of radiation exposure, lower prevalence of adverse events, availability of dynamic information, higher resolution and better soft-tissue contrast. New MRI techniques, including diffusion-weighted imaging, spectroscopy, motility study, positron-emission tomography-MRI and molecular imaging, are currently under investigation to improve the diagnosis, follow-up and management of the disease.

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Hughes Syndrome is now recognised world-wide as a common, major illness, impacting on specialties including neurology, cardiology and surgery. It is the commonest, treatable cause of recurrent miscarriage, and has had a profound impact on the practice of obstetrics.

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Introduction: A vast number of adult persons suffering from vertigo associated with migraine are reported on a daily clinical practice. However, clinical identification of VM still remains hindered in Dubai due to dearth of agreement in diagnostic criteria. Aim: The aim of this study is to determine the prevalence of VM in the general population of Dubai. Methods: A total of 218 adult persons who visited outpatient otolaryngology and rhinology clinic in a given year 2017 with a complaint of vertigo were retrospectively studied and accounted in research. Further, labelling of each person was done based on the presented symptoms. Results and Discussion: To calculate the prevalence of VM, total number of each diagnosis was counted and was further subjected to a formula to calculate prevalence. Out of the 218 persons considered in the study, 30 were diagnosed with migraine (2 persons with migraine alone and 28 persons with VM). This accounts to a prevalence of 0.9% migraine alone and 12.8% VM in a clinical setting for 1 year. Conclusion: The high prevalence of VM in a clinical setup for 1 year hints toward the need for careful diagnosis of a person.

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Background: Antacids are common over-the-counter medications for relief in common dyspeptic symptoms. However, antacid use has decreased with the availability powerful acid suppressant medications such as histamine H2 blockers, proton-pump inhibitors and prostaglandin analogues. Of late, a resurgence in the usage of antacids has been noted because of the improved profiles of newer antacid formulations, for example, the addition of pain-relieving component, oxetacaine (a local anaesthetic), anti-flatulent (alginate base compounds), in some antacid preparations. Aims and Objectives: The study investigated the efficacy (in terms of acid-neutralising capacity [ANC]) and cost-effectiveness of commercially available antacid formulations (both liquid and solid formulations). Materials and Methods: ANC was carried out using simple titrimetric methods and cost-effectiveness of antacid preparations was based on cost (in Saudi riyal) per milliequivalents of the acid neutralised. Results: ANC/gram was highest for antacid A1 (Moxal Plus solid) and lowest for antacid A3 (Fawar effervescent powder). The ANC/gram varied greatly among different antacid products and it ranged from 3.48 to 13.18. In general, solid antacids showed a high ANC/gram compared to the liquid antacids. Furthermore, solid antacids were also found to be cost-effective compared to liquid dosage forms. In terms of efficacy, the newer antacid containing simethicone (A1) was found to be more cost-effective followed an antacid containing calcium carbonate (A2) and magnesium carbonate. Conclusion: In conclusion, mentioning ANC on antacid formulation labels may help to guide the choice of appropriate antacid, while cost-effectiveness study would govern the prescribing pattern of an antacid.

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Aim: The aim of this study was to investigate the outcome of pregnancy among women with threatened miscarriage, and the risk factors that can affect it and to determine the effect of bed rest and progestogen therapy on that outcome. Materials and Methods: This is a retrospective study that involved all pregnant women who attended the Early Pregnancy Assessment Unit in Latifa Hospital in Dubai with an intrauterine pregnancy and vaginal bleeding up to 14 weeks of gestation. The study was done in the period from March 2010 to March 2011. The main outcome measures included gestational age, baby weight at delivery and placental outcome. Results: A total of 129 pregnant women who met the inclusion criteria were analysed. The early foetal loss rate was 37.2%. Of the remaining, 62.8% who had continued their pregnancy, 23.4% of them had pre-term delivery and 9.9% had placental abruption. Regarding the baby outcome, 35.8% of women delivered low-birth-weight (LBW) babies (<2.5 kg). There was a statistically significant effect of increasing maternal age, increasing gravidity and increasing number of previous miscarriages on increasing the risk of miscarriage in current pregnancy (P < 0.05). No significant difference was found in using bed rest for the management of threatened miscarriage. On the other hand, using progestogen therapy significantly reduced the rate of miscarriage and the rate of LBW babies (P < 0.05). However, we found it had no significant effect on reducing pre-term delivery. Conclusions: Vaginal bleeding in early pregnancy (i.e. threatened miscarriage) is an important risk factor for adverse pregnancy outcomes, which should be taken into consideration when deciding on antenatal surveillance and counselling after a bleeding event. Overall, the results showed the positive effect of using progestogen therapy on pregnancy outcome. However, strong meta-analyses of prospective studies with good methodological quality are still needed to support its routine use in threatened miscarriage management.

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Background: Self-concept is vital for the nurses to understand about themselves and their patient in the health care setting. In order to meet the patient needs, it is important that the nurses should possess healthy self-concept that makes them more responsible and be more confident to handle the situations skillfully. Every nurse is an important member of the health care organization to provide quality patient care, their work environment and other related factors are essential to satisfy their job. Objective: The objective of the study was to determine the association of self-concept and job satisfaction of registered nurses working at cross-cultural setting. Study Design and Settings: A descriptive correlational study was conducted with 1061 registered nurses working in selected government hospitals using convenience-sampling method. The registered nurses self-concept and job satisfaction were surveyed using the standardized tool Nurses Self-Concept Questionnaire (NSCQ) and Mccloskey/Muller job satisfaction scale (MMSS). SPSS software version 20 was used to analyze the collected data to report descriptive and inferential statistics. Results: The current study identified that there is a relationship between registered nurses self-concept and job satisfaction and the correlation coefficients were statistically very highly significant (P < 0.001). The association of job satisfaction with sub component of self-concept reveals that Nurses General Self-Concept r = 0.273, P < 0.001, Care r = 0.141, P < 0.001, Staff relation r = 0.320, P < 0.001, Communication r = 0.174, P < 0.001, Knowledge r = 0.218, P < 0.001, and lower association with 'Leadership' (r = 0.063, P < 0.05). Conclusion: The results of this research demonstrated the importance of registered nurses self-concept and its effect on job satisfaction that is essential for nurses to provide effective care to the patients.

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An intracranial colloid cyst is a rare, slow-growing cyst typically found near the foramen of Monro. The mechanisms of its origin are still debated. It has a reported occurrence of 0.2%–2% of all intracranial tumours. A nasopharyngeal/Tornwaldt's cyst is also a rare developmental benign cyst commonly present in the midline of the posterior nasopharynx with a reported incidence of 1.4%–3.3% on autopsy specimens and 0.2%–5% on magnetic resonance imaging. To the best of our knowledge, while a few reports are available where these have been reported separately in different patients, the contemporaneous coexistence of these 2 cysts in the same patient has not been reported before.

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The progressive pathological metamorphosis of one normal organ system into another is unique to fibrodysplasia ossificans progressiva and unveils a pathophysiologic process that can be exploited for therapy of disabling extraskeletal ossification. Here, we review the recent remarkable insight from medical research and the potential of targeted therapy for this rare condition as well as for many common forms of heterotopic ossification.

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Antihypertensive drugs are very effective in secondary stroke prevention. More important than the choice of a class of antihypertensives is to achieve the systolic and diastolic blood pressure targets (<140/90 mmHg in nondiabetics and < 130/80 mmHg in diabetics). In many cases, this requires a combination therapy and lifestyle modification. Statin therapy reduces the rate of recurrent stroke and vascular events. The target range of low-density lipoprotein is 70–100 mg/dL. Patients with transient ischemic attack (TIA) or ischemic stroke should receive antiplatelet drugs. The choices are acetylsalicylic acid (ASA 50–150 mg) or clopidogrel (75 mg). Short-term use of dual antiplatelet therapy (ASA plus clopidogrel) may be considered in patients with acute minor stroke or TIA and high risk of recurrence. Patients with a cardiac source of embolism, in particular atrial fibrillation (AF), should be treated with oral anticoagulation. Options for patients with AF include dose-adjusted warfarin (international normalized ratio 2.0–3.0), apixaban, dabigatran, edoxaban, or rivaroxaban. Patients with contraindications to use oral anticoagulation should receive ASA 100–300 mg/day. Symptomatic patients with significant stenosis of the internal carotid artery (degree of stenosis between 70% and 95%) should undergo carotid endarterectomy. Carotid artery stenting is an alternative to endarterectomy in patients who are unsuitable or at high risk for endarterectomy. Patients should receive ASA before, during, and after endarterectomy or the combination of clopidogrel (75 mg) plus ASA (75–100 mg) and after carotid stenting for 1–3 months. Symptomatic patients with intracranial stenosis or occlusions should be treated with optimal medical management, which includes antiplatelet therapy and high-dose statins (if deemed appropriate). In patients with recurrent events, angioplasty can be considered.

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