scholarly journals The frequency and impact of admission hyperglycemia on short term outcome of acute stroke patients admitted to Tikur Anbessa teaching hospital, Addis Ababa, Ethiopia

2019 ◽  
Author(s):  
Yared Zenebe Zewde ◽  
Abenet Tafesse Mengesha ◽  
Yeweyenhareg Feleke Gebreyes ◽  
Halvor Naess
Keyword(s):  
Diabetes Mellitus ◽  
Blood Glucose ◽  
Acute Stroke ◽  
Functional Outcome ◽  
Neurological Outcome ◽  
Urban Setting ◽  
Stroke Severity ◽  
Stroke Outcome ◽  
Stroke Management ◽  
Stroke Patients

Abstract Background:- Although acute stroke accompanied by hyperglycemia is often associated with worse prognosis, the relationship between hyperglycemia and stroke outcome has not been studied in Ethiopian patients. As better understanding of this potentially adverse influence on stroke outcome would provide guidance for stroke management and acute care. This study aimed to determine frequency of admission hyperglycemia and its impact on thirty day functional outcome and case fatality among acute stroke patients in an urban setting in Ethiopia. Methods:- From July to December 2016, we collected information on 103 consecutive first ever acute stroke patients admitted within 72 hours of symptom onset to Tertiary hospital in Ethiopia. We obtained demographic, clinical and neuro-imaging data including capillary blood glucose at admission. National Institute of Health Stroke Scale and modified Rankin Scale were used to assess the baseline stroke severity and the degree of disability at thirty day. Results:- A total of 103 first ever acute stroke patients were enrolled with, mean age = 55.5+ 15.3 years, 64.1% male, 65% under the age of 65 years, and 31.1% were farmers by occupation . Fifty one (49.5%) patients had a documented hyperglycemia at admission with median National Institute of Health Stroke Scale score of 14 and 3(2.9%) of them were later diagnosed with diabetes mellitus. The mean modified Rankin score at 30-day was 3.6 + 1.45 while 34 (79.1%) of hyperglycemic stroke survivors scored between 3 and 5. Older age >65 years (p = 0.037), admission hyperglycemia (p = 0.04) and stroke severity (p <0.001) were significantly correlated with poor functional outcome. Conclusions:- High blood glucose on admission was significantly associated with sever disability in acute stroke patients, independent of the presence of diabetes mellitus. By establishing the negative impact of admission hyperglycemia on the neurological outcome, this study suggests that achieving normal blood glucose in the early stages of stroke could have a favorable impact on improved neurological outcome and quality of life for stroke patients. The study provides a rationale for acute stroke management that addresses the potentially adverse consequences of hyperglycemia at the time of presentation in an urban Ethiopian setting.

scholarly journals The frequency and impact of admission hyperglycemia on short term outcome of acute stroke patients admitted to Tikur Anbessa Teaching Hospital, Addis Ababa, Ethiopia: a cross-sectional study

2019 ◽  
Author(s):  
Yared Zenebe Zewde ◽  
Abenet Tafesse Mengesha ◽  
Yeweyenhareg Feleke Gebreyes ◽  
Halvor Naess
Keyword(s):  
Blood Glucose ◽  
Acute Stroke ◽  
Functional Recovery ◽  
Cross Sectional Study ◽  
Stroke Severity ◽  
Sectional Study ◽  
Stroke Management ◽  
Stroke Patients ◽  
Short Term ◽  
Cross Sectional

Abstract Background: Admission hyperglycemia (HG) has been associated with worse outcomes among acute stroke patients. A better understanding and awareness of the potentially adverse influence of hyperglycemia on the clinical outcome of acute stroke patients would help to provide guidance for acute stroke management and prevention of its adverse outcomes. We aimed to assess the frequency of admission hyperglycemia and its impact on short term (30-days) morbidity and mortality outcomes of stroke in adult Ethiopian patients in an urban setting.Methods: A prospective, cross-sectional study was conducted among acute stroke patients admitted to Tikur Anbessa Specialized Hospital (TASH), within 72 hours of symptom onset, from July to December 2016. Socio-demographic data, neuroimaging findings and capillary blood glucose values were obtained on admission. Hyperglycemia was defined as >140mg/dl. National Institute of Health Stroke Scale (NIHSS) and modified Rankin Scale (mRS) were used to assess the baseline stroke severity and the 30-days post-stroke outcome, respectively.Results: A total of 103 first-ever acute stroke patients were included (mean age = 55.5+15.3 years, 64.1% male and 65% under the age of 65 years) and 51 (49.5%) were hyperglycemic at time of admission. The median admission NIHSS score was worse in the hyperglycemic patients 14 (IQR 10-19) compared to normoglycemic patients 11 (IQR 8-15). Among stroke survivors, patients with hyperglycemia were 3.83 times (95% CI, 1.99-6.19) more likely to be functionally impaired (mRS = 3-5) at 30-days compared to normoglycemic patients (p = 0.041).Older age (≥ 65 years) (p = 0.017) and stroke severity (NIHSS >14) (p = 0.006) at admission were both significantly associated with poor functional recovery at 30-day. Among the patients who died at 30-day, two-third (66.7%) were hyperglycemic but they failed to show any significant association.Conclusions: Hyperglycemia is prevalent among Ethiopian stroke patients at the time of presentation and it is associated with significantly poor functional recovery at 30th-days of follow up. This finding provides a rationale for achieving normal blood glucose in the course of acute stroke management which could have a favorable impact on the neurological outcome and quality of life for patients.

scholarly journals The frequency and impact of admission hyperglycemia on short term outcome of acute stroke patients admitted to Tikur Anbessa Specialized hospital, Addis Ababa, Ethiopia: a cross-sectional study

BMC Neurology ◽  
2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Yared Zenebe Zewde ◽  
Abenet Tafesse Mengesha ◽  
Yeweynhareg Feleke Gebreyes ◽  
Halvor Naess
Keyword(s):  
Acute Stroke ◽  
Cross Sectional Study ◽  
Stroke Severity ◽  
Sectional Study ◽  
Stroke Management ◽  
Stroke Patients ◽  
Short Term ◽  
Cross Sectional ◽  
Specialized Hospital ◽  
Tikur Anbessa Specialized Hospital

Abstract Background Admission hyperglycemia (HG) has been associated with worse outcomes among acute stroke patients. A better understanding and awareness of the potentially adverse influence of hyperglycemia on the clinical outcome of acute stroke patients would help to provide guidance for acute stroke management and prevention of its adverse outcomes. We aimed to assess the frequency of admission hyperglycemia and its impact on short term (30-days) morbidity and mortality outcomes of stroke in adult Ethiopian patients in an urban setting. Methods A prospective, cross-sectional study was conducted among acute stroke patients admitted to Tikur Anbessa Specialized Hospital (TASH), within 72 h of symptom onset, from July to December 2016. Socio-demographic data, neuroimaging findings and capillary blood glucose values were obtained on admission. Hyperglycemia was defined as > 140 mg/dl. National Institute of Health Stroke Scale (NIHSS) and modified Rankin Scale (mRS) were used to assess the baseline stroke severity and the 30-days post-stroke outcome, respectively. Results A total of 103 first-ever acute stroke patients were included (mean age = 55.5 + 15.3 years, 64.1% male and 65% under the age of 65 years) and 51 (49.5%) were hyperglycemic at time of admission. The median admission NIHSS score was worse in the hyperglycemic patients 14 (IQR 10–19) compared to normoglycemic patients 11 (IQR 8–15). Among stroke survivors, patients with hyperglycemia were 3.83 times (95% CI, 1.99–6.19) more likely to be functionally impaired (mRS = 3–5) at 30-days compared to normoglycemic patients (P = 0.041).Older age (≥ 65 years) (P = 0.017) and stroke severity (NIHSS > 14) (P = 0.006) at admission were both significantly associated with poor functional recovery at 30-day. Among patients who died at 30-day, two-third (66.7%) were hyperglycemic but they failed to show any significant association. Conclusions Hyperglycemia is prevalent among Ethiopian stroke patients at the time of presentation and it is associated with significantly poor functional recovery at 30th-day of follow up. This finding provides a rationale for achieving normal blood glucose in the course of acute stroke management which could have a favorable impact on the neurological outcome and quality of life for patients.

scholarly journals Serum vitamin D levels in acute stroke patients

2019 ◽  
Vol 55 (1) ◽  
Author(s):  
Fayrouz O. Selim ◽  
Rasha M. Fahmi ◽  
Ayman E. Ali ◽  
Nermin Raafat ◽  
Ahmed F. Elsaid
Keyword(s):  
Vitamin D ◽  
Serum Level ◽  
Acute Stroke ◽  
Vitamin D Deficiency ◽  
Control Group ◽  
Cerebral Stroke ◽  
Stroke Severity ◽  
Stroke Outcome ◽  
Stroke Patients ◽  
Vitamin D Levels

Abstract Background Vitamin D deficiency has been proposed as a risk factors of cerebrovascular stroke. Objectives The aim of this study was firstly, to assess the serum level of vitamin D in cerebral stroke patients and secondly, to examine if its deficiency was associated with stroke severity and outcome. Methods We utilized a case-control study design and recruited 138 acute stroke patients and 138 age- and sex-matched controls from subjects attending outpatient clinic for other reasons. All participants were subjected to full general and neurological examination. Brain imaging CT and/or MRI was performed. Blood samples were collected for measurement of serum level of vitamin D (ng/ml) by ELISA, alkaline phosphatase, serum calcium, and phosphorous. The stroke severity was assessed by the National Institutes of Health Stroke Scale (NIHSS) and stroke outcome was assessed by modified Rankin Scale (mRS). Results Stroke patients had significant lower levels of vitamin D compared with the control group. Vitamin D deficiency remained significantly associated with the NIHSS stroke severity score and the mRS 3-month stroke outcome after controlling for other significant factors such as age, dyslipidemia, and infarction size using multivariable logistic regression analysis. Conclusion Our results demonstrated that stroke patients suffer from vitamin D deficiency, which was associated with both stroke severity and poor outcome. Vitamin D supplementation could exert a therapeutic role in the management of cerebral stroke.

scholarly journals A Study on the Relationship of Glycaemic Status with Nature of Lesions in Acute Stroke Patients

2021 ◽  
Vol 6 (1) ◽  
pp. 13-20
Author(s):  
Justin Haobam ◽  
Chingakham Arunkumar ◽  
Konjengbam Ghanachandra Singh
Keyword(s):  
Diabetes Mellitus ◽  
Blood Glucose ◽  
Clinical Outcome ◽  
Blood Glucose Level ◽  
Acute Stroke ◽  
Glucose Control ◽  
Control Group ◽  
Stroke Patients ◽  
Stress Hyperglycaemia ◽  
Stroke Lesion

Background: Stroke in patients of Diabetes Mellitus is a common complication all over the world. The present study was done with the aim to assess the blood glucose level in acute stroke patients of Manipur and find out any correlation with types, size and prognosis of different glycaemic group. Method: The study was a prospective cross-sectional study of all patients who were admitted as acute stroke in Medicine ward, Jawaharlal Nehru Institute of Medical Sciences (JNIMS), Imphal, Manipur. Clinical parameter including History and clinical examination findings were recorded. CT scan of brain, blood glucose level, HbA1c were taken in all the patients. Results: Of 109 patients of acute stroke patients included in the study, 34 were known cases of Diabetes, 10 were newly detected Diabetes cases summing up to a total of 64 cases of Diabetes, 44 of the cases had stress hyperglycaemia and 21 were euglycaemic. Maximum cases consisted of ischaemic strokes (84.4%) and maximum number of haemorrhagic strokes falls under the known diabetes group.None of the euglycaemic patients had any large sized lesions, maximum of them (89.5%) had small sized lesions. Most of the stress glycaemia patients had medium sized strokes while the known diabetes and newly detected diabetes groups had no case of small sized lesion with the maximum large sized lesions occurring in the known diabetes group (78.9%). Clinical outcome was worst in poor glucose control group with 70.3% fatality in this group while maximum clinical improvement was seen in Non-Diabetics (84.6%) consisting of euglycaemia and stress hyperglycaemia groups. Conclusion: There was a good correlation with admission day hyperglycaemia with the size of the stroke lesion in all cases of stroke. The diabetes especially poor glucose control group is associated with increased size of the stroke lesion, severity and poor clinical outcome. Keywords: Stroke, diabetes mellitus, stress hyperglycaemia, euglycaemia.

Post Stroke Hyperglycemia as a marker of Stroke Severity and Prognosis: A cohort study

QJM ◽  
2021 ◽  
Vol 114 (Supplement_1) ◽  
Author(s):  
Ayman Mahmoud Mahmoud Alsayes ◽  
Mohammed Mahmoud Maarouf ◽  
Ayman Ibrahim Tharwat Sayed ◽  
Azza Atef Abdelaleim Ahmed
Keyword(s):  
Diabetes Mellitus ◽  
Cohort Study ◽  
Acute Stroke ◽  
Stroke Severity ◽  
University Hospitals ◽  
Stroke Patients ◽  
Glycemic Status ◽  
The Third ◽  
Control Of Diabetes

Abstract Background Stroke is the third most leading cause of death worldwide after coronary heart disease and cancer especially ischemic infarcts. Hyperglycaemia is common in patients with acute stroke, occurring in up to 60% of patients overall and approximately 12–53% of acute stroke patients without a prior diagnosis of diabetes, Aim of the Work The aim of this work is study of the glycemic status after acute stroke and assess the role of glycemic status in influencing stroke outcome. Patients and Methods This was a prospective cohort study conducted in the Critical Care Department of Ain-Shams University Hospitals and Damanhour Medical National Institute for six months from January 2018 to June 2018. Conclusion From our study we can conclude that diabetes mellitus as a risk factor in cases of stroke leads to increase complications and worsens the outcome in cases of stroke whether hemorrhagic or ischemic. Recommendations From our study we recommended strict control of diabetes mellitus when present in cases of stroke to avoid bad outcome and to prevent complications in these cases.

Method of virtual reality for early comprehensive rehabilitation of patients with acute stroke

2020 ◽  
pp. 39-45
Author(s):  
N. Nozdryukhina ◽  
E. Kabayeva ◽  
E. Kirilyuk ◽  
K. Tushova ◽  
A. Karimov
Keyword(s):  
Virtual Reality ◽  
Literature Review ◽  
Acute Stroke ◽  
Functional Outcome ◽  
Recovery Process ◽  
Stroke Patients ◽  
Post Stroke ◽  
Stroke Disability ◽  
Comprehensive Rehabilitation ◽  
High Level

Despite significant advances in the treatment and rehabilitation of stroke, level of post-stroke disability remains at a fairly high level. Recent innovative developments in the rehabilitation of these patients provide good results in terms of functional outcome. One of such developments is method of virtual reality (VR), which affects not only the speed and volume of regaining movement, as well as coordination, but also normalizes the psycho-emotional background, increasing the motivation of patients to improve the recovery process. This article provides a literature review of the use of the VR method in the rehabilitation of post-stroke patients, neurophysiological aspects of recovery of lost functions using this method are considered.

scholarly journals Bottlenecks in the Acute Stroke Care System during the COVID-19 Pandemic in Catalonia

2021 ◽  
pp. 1-9
Author(s):  
Anna Ramos-Pachón ◽  
Álvaro García-Tornel ◽  
Mònica Millán ◽  
Marc Ribó ◽  
Sergi Amaro ◽  
...  
Keyword(s):  
Acute Stroke ◽  
Functional Outcome ◽  
Stroke Care ◽  
Care Quality ◽  
Point Of View ◽  
Stroke Severity ◽  
Acute Stroke Care ◽  
Vessel Occlusion ◽  
Prehospital Delays ◽  
The Impact

<b><i>Introduction:</i></b> The COVID-19 pandemic resulted in significant healthcare reorganizations, potentially striking standard medical care. We investigated the impact of the COVID-19 pandemic on acute stroke care quality and clinical outcomes to detect healthcare system’s bottlenecks from a territorial point of view. <b><i>Methods:</i></b> Crossed-data analysis between a prospective nation-based mandatory registry of acute stroke, Emergency Medical System (EMS) records, and daily incidence of COVID-19 in Catalonia (Spain). We included all stroke code activations during the pandemic (March 15–May 2, 2020) and an immediate prepandemic period (January 26–March 14, 2020). Primary outcomes were stroke code activations and reperfusion therapies in both periods. Secondary outcomes included clinical characteristics, workflow metrics, differences across types of stroke centers, correlation analysis between weekly EMS alerts, COVID-19 cases, and workflow metrics, and impact on mortality and clinical outcome at 90 days. <b><i>Results:</i></b> Stroke code activations decreased by 22% and reperfusion therapies dropped by 29% during the pandemic period, with no differences in age, stroke severity, or large vessel occlusion. Calls to EMS were handled 42 min later, and time from onset to hospital arrival increased by 53 min, with significant correlations between weekly COVID-19 cases and more EMS calls (rho = 0.81), less stroke code activations (rho = −0.37), and longer prehospital delays (rho = 0.25). Telestroke centers were afflicted with higher reductions in stroke code activations, reperfusion treatments, referrals to endovascular centers, and increased delays to thrombolytics. The independent odds of death increased (OR 1.6 [1.05–2.4], <i>p</i> 0.03) and good functional outcome decreased (mRS ≤2 at 90 days: OR 0.6 [0.4–0.9], <i>p</i> 0.015) during the pandemic period. <b><i>Conclusion:</i></b> During the COVID-19 pandemic, Catalonia’s stroke system’s weakest points were the delay to EMS alert and a decline of stroke code activations, reperfusion treatments, and interhospital transfers, mostly at local centers. Patients suffering an acute stroke during the pandemic period had higher odds of poor functional outcome and death. The complete stroke care system’s analysis is crucial to allocate resources appropriately.

scholarly journals Effects of state-wide implementation of the Los Angeles Motor Scale for triage of stroke patients in clinical practice

2021 ◽  
Vol 3 (1) ◽  
Author(s):  
Stefanie Behnke ◽  
Thomas Schlechtriemen ◽  
Andreas Binder ◽  
Monika Bachhuber ◽  
Mark Becker ◽  
...  
Keyword(s):  
Los Angeles ◽  
Acute Stroke ◽  
Unsolved Problem ◽  
Standard Operating Procedure ◽  
Stroke Management ◽  
Stroke Patients ◽  
Vessel Occlusion ◽  
Standard Operating ◽  
Los Angeles Motor Scale ◽  
Triage Decisions

Abstract Background The prehospital identification of stroke patients with large-vessel occlusion (LVO), that should be immediately transported to a thrombectomy capable centre is an unsolved problem. Our aim was to determine whether implementation of a state-wide standard operating procedure (SOP) using the Los Angeles Motor Scale (LAMS) is feasible and enables correct triage of stroke patients to hospitals offering (comprehensive stroke centres, CSCs) or not offering (primary stroke centres, PSCs) thrombectomy. Methods Prospective study involving all patients with suspected acute stroke treated in a 4-month period in a state-wide network of all stroke-treating hospitals (eight PSCs and two CSCs). Primary endpoint was accuracy of the triage SOP in correctly transferring patients to CSCs or PSCs. Additional endpoints included the number of secondary transfers, the accuracy of the LAMS for detection of LVO, apart from stroke management metrics. Results In 1123 patients, use of a triage SOP based on the LAMS allowed triage decisions according to LVO status with a sensitivity of 69.2% (95% confidence interval (95%-CI): 59.0–79.5%) and a specificity of 84.9% (95%-CI: 82.6–87.3%). This was more favourable than the conventional approach of transferring every patient to the nearest stroke-treating hospital, as determined by geocoding for each patient (sensitivity, 17.9% (95%-CI: 9.4–26.5%); specificity, 100% (95%-CI: 100–100%)). Secondary transfers were required for 14 of the 78 (17.9%) LVO patients. Regarding the score itself, LAMS detected LVO with a sensitivity of 67.5% (95%-CI: 57.1–78.0%) and a specificity of 83.5% (95%-CI: 81.0–86.0%). Conclusions State-wide implementation of a triage SOP requesting use of the LAMS tool is feasible and improves triage decision-making in acute stroke regarding the most appropriate target hospital.

scholarly journals Association between plasma levels of hyaluronic acid and functional outcome in acute stroke patients

2014 ◽  
Vol 11 (1) ◽  
pp. 101 ◽  
Author(s):  
Sung-Chun Tang ◽  
Shin-Joe Yeh ◽  
Li-Kai Tsai ◽  
Chaur-Jong Hu ◽  
Li-Ming Lien ◽  
...  
Keyword(s):  
Hyaluronic Acid ◽  
Acute Stroke ◽  
Functional Outcome ◽  
Plasma Levels ◽  
Stroke Patients

scholarly journals STROKE OUTCOMES IN NON-DIABETIC, DENOVO DIABETIC AND DIABETIC INDIAN PATIENTS MEASURED BY MODIFIED RANKIN SCALE: AN OBSERVATIONAL STUDY

2017 ◽  
Vol 9 (8) ◽  
pp. 94
Author(s):  
Syed Junaid Ahmed ◽  
Abdur Rahman Mohd Masood ◽  
Safiya Sumana ◽  
Khadeer Ahmed Ghori ◽  
Javed Akhtar Ansari ◽  
...  
Keyword(s):  
Blood Glucose ◽  
Observational Study ◽  
Hospital Admission ◽  
Acute Stroke ◽  
Mean Difference ◽  
Modified Rankin Scale ◽  
Stroke Patients ◽  
Glucose Levels ◽  
Blood Glucose Levels ◽  
The Mean

Objective: Hyperglycemia is a known risk factor which adversely impacts the outcomes in stroke patients compared to patients with normal blood glucose levels. Patients suffering from an acute stroke who are previously nonhyperglycemic may show elevated blood glucose levels. The present study was designed to measure the outcomes in denovo diabetic and diabetic stroke patients compared to nondiabetics.Methods: A prospective observational study over a period of 6 mo, in which 103 patients were divided into three cohorts based on their blood glucose levels (nondiabetic, denovo diabetic and diabetics). The modified Rankin scale (mRS) score was calculated at in-hospital admission and discharge in these three cohorts. The initial and final scores were correlated and mean differences with respect to outcomes between all the three cohorts was calculated.Results: The mean mRS at the time of hospital admission in diabetics and nondiabetics was 3.6±0.81 and 3.3±0.78 which decreased to 2.8±0.95 and 2.9±0.83 respectively at the time of discharge. The mean mRS score in denovo diabetic stroke patients during in-hospital admission was 4±0.81 which was calculated as 3.7±0.85 at the time of discharge. The mean difference in mRS score in diabetics vs non-diabetics was found to be 0.73±0.8 (p =<0.001). The mean difference in mRS score of denovo diabetics vs non-diabetics and denovo diabetics vs diabetics was 0.30±0.63 and 0.38±0.61 respectively (p = 0.1).Conclusion: Results of these observational study in Indian patients, highlights the need for controlling hyperglycemia in stroke patients to improve outcomes and to prevent mortality arising out of acute stroke attacks.

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