scholarly journals A cross-sectional study of awareness regarding dog bite and its management in rural community of Maharashtra, India

2020 ◽  
Vol 7 (9) ◽  
pp. 1307
Author(s):  
Mohammed Alqwaifly
Keyword(s):  
Saudi Arabia ◽  
Ischemic Stroke ◽  
Acute Stroke ◽  
Acute Ischemic Stroke ◽  
Stroke Care ◽  
Cross Sectional Study ◽  
Sectional Study ◽  
Acute Stroke Care ◽  
Cross Sectional ◽  
Stroke Treatment

Background: Stroke is a major cause of morbidity and disability worldwide. However, its outcomes have improved in the last few years with advancement in acute stroke treatment, including the use of tissue plasminogen activator (t-PA) within 4.5 hours of onset, which led several international guidelines to adopt it as the standard of care. In this study, authors sought to assess the knowledge, practices, and attitudes of emergency and medicine staff in Qassim, Saudi Arabia toward acute ischemic stroke care.Methods: A quantitative observational cross-sectional study involving 148 physicians from emergency and medicine departments (only three neurologists) was conducted in three main hospitals of the Qassim region, Saudi Arabia. Information was obtained from a self-administered questionnaire. A logistic regression model was used to control for potential confounding factors.Results: Ninety-two percent of participants were aware of t-PA. Eighty-seven percent of participants thought that t-PA was an effective treatment for acute ischemic stroke. Only 20% of participants had given t-PA or participated in the use of t-PA in acute ischemic stroke. Moreover, 64% of participants believed that allowing blood pressure to remain high was the most appropriate action in the first 24 hours in acute ischemic stroke patients who presented outside the t-PA window.Conclusion: Most of the emergency and medicine staff are well informed about t-PA, but the majority of these physicians have never given t-PA or participated in the administration of t-PA to a stroke patient. The main finding here is the positive outlook among emergency and medicine physicians in Qassim toward training in acute stroke care and administering t-PA for stroke, which will positively impact patient outcomes.

scholarly journals Mutually Risk Roles of Oral Cleanliness and Stroke-associated Pneumonia in Patients with Acute Ischemic Stroke: A Cross-Sectional Study

2020 ◽  
Author(s):  
Xiaohua Yang ◽  
Huijuan Chen ◽  
Wanling Yang ◽  
Bin Deng ◽  
Jialing Zheng ◽  
...  
Keyword(s):  
Risk Factors ◽  
Logistic Regression ◽  
Ischemic Stroke ◽  
Dental Caries ◽  
Acute Ischemic Stroke ◽  
Oral Hygiene ◽  
Cross Sectional Study ◽  
Sectional Study ◽  
Stroke Patients ◽  
Cross Sectional

Abstract Background: Stroke-associated pneumonia (SAP) is a major complication after stroke, oral microorganisms are important contributors to SAP. Here, we aimed to investigate whether the oral hygiene was associated with SAP and related risk factors of them in patients with acute ischemic stroke. Methods: We performed a cross-sectional study that recruited 331 patients with acute ischemic stroke from two medical centers. A series of assessments were performed to evaluate the neurological status and habits of oral hygiene. According to whether the oral hygiene was abnormal and SAP occurred, univariate analyses were performed in cohort 1 (normal / abnormal oral hygiene groups) and cohort 2 (SAP / non-SAP groups). Multiple logistic regression analyses were conducted to confirm risk factors of oral cleanliness and SAP in stroke patients. Results: A total of 12 and 8 independent variables were included in the model 1 and 2 analysis. After adjusting for confounders, multivariable logistic regression analysis showed that oral cleanliness was not only closely related to SAP (OR=2.219, P=0.026), dental caries (OR=1.292, P=0.005) and age (OR=1.030, P=0.006) in model 1, but also an independent risk factor for predicting SAP (OR=1.678, P=0.001) in model 2. Barthel index was a protective factor for oral cleanliness (OR=0.986, P=0.019) and SAP (OR=0.977, P=0.002) in ischemic stroke patients. Conclusions: Mutually primary risk roles of abnormal oral cleanliness and SAP exist in patients with acute ischemic stroke. Dental caries and aging are important risk factors for oral health disorders. Improving the activities of daily living would have protective effects on both oral hygiene and SAP prevention in stroke patients.

scholarly journals Global Epidemiology of Stroke and Access to Acute Ischemic Stroke Interventions

Neurology ◽  
2021 ◽  
Vol 97 (20 Supplement 2) ◽  
pp. S6-S16
Author(s):  
Vasu Saini ◽  
Luis Guada ◽  
Dileep R. Yavagal
Keyword(s):  
Ischemic Stroke ◽  
Acute Stroke ◽  
Acute Ischemic Stroke ◽  
Randomized Clinical Trials ◽  
Time Window ◽  
Systems Of Care ◽  
Stroke Care ◽  
Acute Stroke Care ◽  
Vessel Occlusion ◽  
Global Epidemiology

Purpose of the ReviewTo provide an up-to-date review of the incidence of stroke and large vessel occlusion (LVO) around the globe, as well as the eligibility and access to IV thrombolysis (IVT) and mechanical thrombectomy (MT) worldwide.Recent FindingsRandomized clinical trials have established MT with or without IVT as the usual care for patients with LVO stroke for up to 24 hours from symptom onset. Eligibility for IVT has extended beyond 4.5 hours based on permissible imaging criteria. With these advances in the last 5 years, there has been a notable increase in the population of patients eligible for acute stroke interventions. However, access to acute stroke care and utilization of MT or IVT is lagging in these patients.SummaryStroke is the second leading cause of both disability and death worldwide, with the highest burden of the disease shared by low- and middle-income countries. In 2016, there were 13.7 million new incident strokes globally; ≈87% of these were ischemic strokes and by conservative estimation about 10%–20% of these account for LVO. Fewer than 5% of patients with acute ischemic stroke received IVT globally in the eligible therapeutic time window and fewer than 100,000 MTs were performed worldwide in 2016. This highlights the large gap among eligible patients and the low utilization rates of these advances across the globe. Multiple global initiatives are underway to investigate interventions to improve systems of care and bridge this gap.

scholarly journals Ongoing Improvement in Acute Ischemic Stroke Therapy Per Concurrent Guidelines and Easily Implementable Quality Improvement Protocol

2021 ◽  
Vol 8 (6) ◽  
pp. 01-09
Author(s):  
Wengui Yu
Keyword(s):  
Quality Improvement ◽  
Ischemic Stroke ◽  
Acute Stroke ◽  
Acute Ischemic Stroke ◽  
Stroke Care ◽  
Linear Regression Models ◽  
Stroke Therapy ◽  
Acute Stroke Care ◽  
Stroke Registry ◽  
Intravenous Tissue Plasminogen Activator

Background: Despite proven efficacy of intravenous tissue plasminogen activator (tPA) and endovascular thrombectomy (EVT) in acute ischemic stroke, there has been slow administration of these therapies in the real world practice. We examined the ongoing quality improvement in acute stroke care at our comprehensive stroke center. Methods: Consecutive patients with acute ischemic stroke from 2013 to 2018 were studied. Patients were managed using Code Stroke algorithm per concurrent AHA guidelines and a simple quality improvement protocol implemented in 2015. Demographics and clinical data were collected from Get-With-The-Guideline-Stroke registry and electronic medical records. Patients were divided into 3 groups per admission and implementation date of quality improvement initiatives. Quality measures, including rates of intravenous tPA and EVT, door-to-needle (DTN) time, and door-to-puncture (DTP) time, were analyzed with general mean linear regression models and Jonckheere-Terpstra test. Results: Of the 1,369 eligible patients presenting within 24 hours of symptom onset or wakeup stroke, the rate of intravenous tPA was 20%, 30% and 22%, respectively, in 2013-2014, 2015-2016, and 2017-2018. In contrast, EVT rate was 9%, 14% and 15%, respectively. Based on Jonckheere-Terpstra test, there was significant ongoing improvement in the median DTN time (57, 45, 39 minutes; p < 0.001) and DTP time (172, 130, 114 minutes; p =0.009) during the 3 time periods, with DTN time ≤ 60 and ≤45 minutes in 80% and 63% patients, respectively, in 2017-2018. Conclusions: Getting with the guidelines and simple quality improvement initiatives are associated with satisfactory rates of acute stroke therapy and ongoing improvement in door to treatment times.

Abstract T P37: Routine CT Angiography in Acute Stroke Does Not Delay Acute Stroke Care

Stroke ◽  
2015 ◽  
Vol 46 (suppl_1) ◽  
Author(s):  
Gisele S Silva ◽  
Renata C Miranda ◽  
Rodrigo M Massaud ◽  
Andreia M Vacari ◽  
Miguel Cendoroglo Neto
Keyword(s):  
Ischemic Stroke ◽  
Acute Stroke ◽  
Acute Ischemic Stroke ◽  
Intravenous Thrombolysis ◽  
Stroke Care ◽  
Tertiary Hospital ◽  
Acute Stroke Care ◽  
Time Intervals ◽  
Radiology Report ◽  
Group 2

Introduction: Vascular imaging is increasingly used for diagnosis of arterial occlusions in acute ischemic stroke. Hypothesis:We hypothesized that time intervals using a CTA based acute ischemic stroke protocol are not increased when compared to an earlier non-CTA based protocol. Methods: We evaluated a database of consecutive patients admitted to a Brazilian tertiary hospital with acute ischemic stroke from February 2009 to March 2014 and reviewed our stroke quality measures data to determine if the time required to obtain CTA prolonged door-to-neuroimaging, door to radiology report and door-to-needle times. Patients were categorized into: Group 1 (February 2009 to October 2013) (Non-contrast CT Scan based acute stroke protocol) and Group 2 (November 2013 to August 2014) (CTA based acute stroke protocol). Time intervals were compared between the two groups.Results: We evaluated 415 consecutive patients, 20 of whom (4.8%) had a CTA in the acute phase (Group 2). Patients in groups 1 and 2 had similar onset-to-door times (1.86 [0.75-3.58] versus 2.75 hours [1.0-8.49], p=0.09); door to neuroimaging times (27.6 [18.6-46.8] versus 37.8 minutes [23.4-46.2], p=0.28 ) and door to radiology report intervals (39 [27-60.6] versus 53.4 minutes[35.4-61.2], p=0.09). The frequency of treatment with recanalization therapies ( either intravenous thrombolysis or endovascular procedures) was similar between groups 1 (30%) and 2 (21%), p=0.33, as well as door to needle times (p=0.09). Conclusions: CTA based acute stroke care does not significantly delay time to neuroimaging or thrombolysis in routine clinical practice.

scholarly journals Acute Ischemic Stroke in COVID-19: Putative Mechanisms, Clinical Characteristics, and Management

2020 ◽  
Vol 2020 ◽  
pp. 1-7
Author(s):  
Ademola S. Ojo ◽  
Simon A. Balogun ◽  
Ahmed O. Idowu
Keyword(s):  
Ischemic Stroke ◽  
Acute Stroke ◽  
Acute Ischemic Stroke ◽  
Disease Transmission ◽  
Clinical Characteristics ◽  
Severe Disease ◽  
Stroke Care ◽  
Current Evidence ◽  
Future Research ◽  
Acute Stroke Care

The emergence and spread of the highly contagious novel coronavirus disease (COVID-19) have triggered the greatest public health challenge of the last century. Aside from being a primary respiratory disease, acute ischemic stroke has emerged as a complication of the disease. While current evidence shows COVID-19 could cause ischemic stroke especially in severe disease, there are similarities in the risk factors for severe COVID-19 as well as ischemic stroke, underscoring the complex relationship between these two conditions. The pandemic has created challenges for acute stroke care. Rapid assessment and time-sensitive interventions required for optimum outcomes in acute stroke care have been complicated by COVID-19 due to the need for disease transmission preventive measures. The purpose of this article is to explore the putative mechanisms of ischemic stroke in COVID-19 and the clinical characteristics of COVID-19 patients who develop ischemic stroke. In addition, we discuss the challenges of managing acute ischemic stroke in the setting of COVID-19 and review current management guidelines. We also highlighted potential areas for future research.

scholarly journals Association Between Spesific Enolase Serum Levels And Outcome Acute Ischemic Stroke onset 1-month

2019 ◽  
Vol 25 (2) ◽  
pp. 135
Author(s):  
Yuri Haiga ◽  
Darwin Amir ◽  
Yuliarni Syafrita
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Serum Levels ◽  
Cross Sectional Study ◽  
Stroke Onset ◽  
P Value ◽  
Sectional Study ◽  
Cross Sectional

Pendahuluan: Stroke adalah masalah kesehatan global, karena penyebab kematian kedua dan kecacatan utama pada hampir seluruh negara di dunia. Penyakit ini memiliki dampak yang besar terhadap penderita, lingkungan sosial dan beban ekonomi. Sehingga diperlukan penanda spesifik yang berperan dalam menegakkan diagnosis, penentuan faktor risiko, serta tingkat keparahan stroke iskemik. Salah satu penanda yang diteliti adalah kadar NSE serum, yang diperkirakan dapat menggambarkan beratnya kerusakan otak pada pasien stroke.Metode: Penelitian ini menggunakan metode Cross sectional study pada 77 pasien stroke iskemik , dilaksanakan mulai Juli 2016 sampai Agustus 2017, di ruang rawat inap di Bagian Penyakit Saraf RS. DR. M. Djamil Padang. Setiap pasien dilakukan pemeriksaan kadar NSE serum dan  penilaian skor mRS pada bulan-1 setelah onset stroke iskemik. Dan dilakukan uji Spearmen untuk menilai korelasi antara dua variabel. Nilai p <0.05 dianggap signifikan secara statistikHasil: Berdasarkan jenis kelamin didapatkan laki-laki 42 orang (54.54%).  Median  usia 58.21 (16-88). Median kadar NSE  5.94 ( 2.77-36.75) µg/L. Skor  mRS onset bulan-1 dengan  median 3 (1-6). Terdapat hubungan antara kadar serum NSE dengan fungsi luaran stroke iskemik onset bulan-1 (r = 0.286, p value= 0.012, R2= +8.2%)Diskusi: Terdapat hubungan antara kadar serum NSE dengan fungsi luaran stroke iskemik onset bulan-1.Kesimpulan: Terdapat hubungan antara kadar serum NSE dengan fungsi luaran stroke iskemik onset bulan-1.

scholarly journals Childhood Stroke: A Cross-sectional Study in a Tertiary Level Hospital of Bangladesh

2018 ◽  
Vol 6 (1-2) ◽  
pp. 20-24
Author(s):  
Farhana Rahman ◽  
Fauzia Nahid ◽  
Mahmuda Begum ◽  
Nadia Nusrat
Keyword(s):  
Ischemic Stroke ◽  
Acute Stroke ◽  
Age At Onset ◽  
Arterial Occlusion ◽  
Cross Sectional Study ◽  
Hypertensive Encephalopathy ◽  
Sectional Study ◽  
Childhood Stroke ◽  
Cross Sectional ◽  
Clinical Criteria

Background & objective:The present study was undertaken to find the prevalence and pattern of childhood stroke and to see its clinical presentation and sub-types. Materials & Methods:The present cross sectional study was conducted in the Department of Pediatrics, BSMMU, Dhaka over a period of 6 months. A total of 30 children suffering from childhood stroke, provisionally diagnosed on the basis of clinical criteria and confirmed by neuroimaging were the study population.The demographic variables were age, sex, age at onset and age at case taking. The signs and symptoms at presentation, causes, investigations, neuro-imaging findings and final diagnosis were recorded. Result: Over half (53.4%) of the patients were in the range of 13 – 36 months with mean age of the patients being 39.1 ± 8.2 months. The mean age at onset was 36.2 ± 8.3 months. About 47% of patients were male and 53% female. Paresis of limb was invariably present, unconsciousness at onset (50%), convulsion (33.3%), aphasia (26.7%), raised blood pressure (23.3%), vomiting (13.3%), visual defect (8.7%) and headache (6.7%). Arterial occlusion was the main cause of childhood stroke (36.7%) followed by hypertensive encephalopathy (10%), migraine, hematoligical disease, cardiomyopathies (each 6.7%). Investigations revealed that over one-third (36.7%) of the patients had leucocytosis and 13.3% abnormal echocardiography. All the children either exhibited ischemia or infarction or hemorrhage on Computed Tomography (CT) and 86.7% on Magnetic Resonance Imaging (MRI). Seventy percent and 36.7% of patients had MRA and MRV abnormality respectively. About 47% of the patients had acute ischemic stroke, 13.3% AIS with left-sided haemiparesis with facial palsey and another 13.3% AIS with right-sided haemiparesia. Acute haemorragic stroke (AHS), acute stroke with Hb beta-thalassaemia, acute stroke with right-sided haemiparesis with cardiomyopathy and recurrent haemorragic stroke were rare. Conclusion: The study concluded that childhood stroke occurs most frequently between one to three years of age and equally affects male and female. Paresis of limb and unconsciousness at the onset were the main presenting features and arterial hypertension and hypertensive encephalopathy were the common cause of childhood stroke. Nearly three-quarters of the children present with ischemic stroke and the rest with haemorrhagic stroke. Ibrahim Card Med J 2016; 6 (1&2): 20-24

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