Influence of Socio-Economic Status on Patients’ Choice of Thrombolytic Agent and It's Outcome in Acute Ischemic Stroke

2021 ◽  
Author(s):  
Alex Rebello ◽  
Shiva Narayan Pattanayak ◽  
Subhangi Thakur Hameer ◽  
Megha Varshney ◽  
Manoj Kumar Goyal ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Thrombolytic Agent ◽  
Economic Status ◽  
Socio Economic Status

Role of socio-economic status in choosing thrombolytic agent and its outcome in acute ischemic stroke: Data from a tertiary care center in North India

2021 ◽  
Vol 429 ◽  
pp. 118688
Author(s):  
Alex Rebello ◽  
Manoj Goyal ◽  
Vivek Lal ◽  
Manish Modi ◽  
Sarath Aleti ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Thrombolytic Agent ◽  
Economic Status ◽  
Care Center ◽  
Tertiary Care ◽  
North India ◽  
Tertiary Care Center ◽  
Socio Economic Status

scholarly journals ROLE OF CONSUMPTION OF COMPOSITE FLOUR IN MANAGEMENT OF LIFESTYLE DISORDERS

2021 ◽  
Vol 21 (2) ◽  
Author(s):  
Mitaigiri Taffreeda Banua ◽  
Jaspreet Kaura ◽  
Vishesh Bhadariya ◽  
Jyoti Singh ◽  
Kartik Sharma
Keyword(s):  
Ischemic Stroke ◽  
Cardiovascular Diseases ◽  
Coeliac Disease ◽  
Economic Status ◽  
Composite Flour ◽  
Socio Economic Status ◽  
Long Run ◽  
Composite Flours

Composite flour is a combination of only either various grains or both various grains and vegetables it is a storehouse of various nutrients like vitamins, minerals, antioxidants, and dietary fiber. In the present day, there has been an increased demand for nutritional and health-based variants of food due to changes in lifestyle and socio-economic status. There is no surprise in saying that people are seeing the food being consumed on a day-to-day basis as a status symbol and are striving to get better quality of health through the food they consume and are ready to spend huge amounts of money on the products which are so-called healthy and are being commercially marketed in a smart manner capturing both peoples mind and attention knowing to bring down various lifestyle disorders like Diabetes, Cardiovascular diseases, Hypertension, Cancer, Atherosclerosis, Ischemic stroke, Obesity, Coeliac disease, Alzheimer’s and many other diseases and disorders when consumed frequently in long run. The foods which fall under such category especially are composite flours and ready-to-cook mixes occupying more than 70% of both the food and health industry today being recommended by most of the nutritional experts. This paper is a review-based article collected from various papers focusing on role of consumption of composite flours in management of lifestyle disorders such as diabetes, hypertension, cancer etc.

scholarly journals Successful recanalization using the Embolus Retriever with Interlinked Cage for acute stroke due to calcified cerebral emboli

2018 ◽  
Vol 24 (6) ◽  
pp. 674-677 ◽  
Author(s):  
Hyo S Kwak ◽  
Jung S Park
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Thrombolytic Agent ◽  
Mechanical Thrombectomy ◽  
Computed Tomographic Angiography ◽  
Sudden Onset ◽  
Aspiration Thrombectomy ◽  
Computed Tomographic ◽  
Tomographic Angiography ◽  
Left Middle

Mechanical thrombectomy is a safe and effective treatment in patients with acute ischemic stroke caused by large vessel occlusions. However, in rare cases, the procedure may be challenging due to the composition of the embolus. We describe a case of a mechanical thrombectomy with the Embolus Retriever with Interlinked Cage (ERIC) device in a patient with an acute ischemic stroke due to calcified cerebral emboli in the middle cerebral artery. The procedure was done after a failed recanalization attempt with manual aspiration thrombectomy. An 82-year-old woman presented to the emergency department with a sudden onset of right-sided weakness. A computed tomographic angiography showed left middle cerebral (M1 branch) calcified emboli. After the administration of an intravenous thrombolytic agent, the patient was transferred to the angiographic suite for a mechanical thrombectomy. After failure to recanalize the vessel with manual aspiration thrombectomy, successful recanalization was achieved via mechanical thrombectomy using the ERIC device. Mechanical thrombectomy with an ERIC device can be a useful option in cases of acute ischemic stroke caused by calcified cerebral emboli.

scholarly journals Real-world comparative safety and efficacy of tenecteplase versus alteplase in acute ischemic stroke patients with large vessel occlusion

2021 ◽  
Vol 14 ◽  
pp. 175628642098672
Author(s):  
Klearchos Psychogios ◽  
Lina Palaiodimou ◽  
Aristeidis H. Katsanos ◽  
Georgios Magoufis ◽  
Apostolos Safouris ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Real World ◽  
Thrombolytic Agent ◽  
Large Vessel ◽  
Large Vessel Occlusion ◽  
Vessel Occlusion ◽  
Safety And Efficacy ◽  
Neurological Improvement ◽  
Safety Outcomes

Background and aims: Tenecteplase has recently emerged as an alternative thrombolytic agent in acute ischemic stroke (AIS) patients with large vessel occlusion (LVO), possibly superior in achieving early reperfusion compared with alteplase. We aimed to compare the safety and efficacy of intravenous tenecteplase with intravenous alteplase for AIS patients with LVO in everyday clinical practice settings. Methods: We prospectively evaluated patients with AIS due to LVO, treated with intravenous thrombolysis (IVT) with or without mechanical thrombectomy in two tertiary stroke centers. Patients were treated with standard-dose alteplase (0.9 mg/kg) or 0.25 mg/kg tenecteplase. Safety outcomes included prevalence of symptomatic intracranial hemorrhage (sICH) and mortality. Efficacy outcomes included averted thrombectomy, major neurological improvement at 24 h (defined as decrease in baseline NIHSS score of 8 points or greater) and functional status on discharge and on 3 months assessed by modified Rankin Scale (mRS). Results: Nineteen AIS patients with LVO received tenecteplase and 39 received alteplase. We observed a non-significant higher rate of averted thrombectomies (32% versus 18%, p = 0.243) and a non-significant higher rate of sICH (16% versus 5%, p = 0.201) in the tenecteplase group. The rate of 24 h major neurological improvement was higher in the tenecteplase group (64% versus 33%, p = 0.046) but this was marginally attenuated in multivariable analyses (adjusted OR 10.22, 95% CI: 0.73–142.98; p = 0.084). Discharge mRS, 3-months mRS, and 3-month functional independence (mRS scores of 0–2) did not differ ( p > 0.2) between the two groups. The rates of 3-month mortality (11% versus 18%, p = 0.703) were similar in the two groups. No independent association between thrombolytic agent and safety or efficacy outcomes emerged in multivariable regression analyses. Conclusion: The present pilot observational study highlights that AIS patients with LVO treated with 0.25 mg/kg bolus administration of tenecteplase had increased likelihood to achieve early neurological improvement compared with AIS patients treated with alteplase, but this association was attenuated after adjustment for potential confounders. There were no significant differences in 3-month functional or safety outcomes between the two groups. This preliminary real-world observation requires independent confirmation in larger, multicenter studies.

scholarly journals Value-based healthcare in ischemic stroke care: case-mix adjustment models for clinical and patient-reported outcomes

2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Arvind Oemrawsingh ◽  
Nikki van Leeuwen ◽  
Esmee Venema ◽  
Martien Limburg ◽  
Frank-Erik de Leeuw ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Regression Models ◽  
Economic Status ◽  
Stroke Care ◽  
Patient Reported Outcome ◽  
Care Quality ◽  
Case Mix ◽  
Socio Economic Status ◽  
Patient Reported ◽  
Case Mix Adjustment

Abstract Background Patient-Reported Outcome Measures (PROMs) have been proposed for benchmarking health care quality across hospitals, which requires extensive case-mix adjustment. The current study’s aim was to develop and compare case-mix models for mortality, a functional outcome, and a patient-reported outcome measure (PROM) in ischemic stroke care. Methods Data from ischemic stroke patients, admitted to four stroke centers in the Netherlands between 2014 and 2016 with available outcome information (N = 1022), was analyzed. Case-mix adjustment models were developed for mortality, modified Rankin Scale (mRS) scores and EQ-5D index scores with respectively binary logistic, proportional odds and linear regression models with stepwise backward selection. Predictive ability of these models was determined with R-squared (R2) and area-under-the-receiver-operating-characteristic-curve (AUC) statistics. Results Age, NIHSS score on admission, and heart failure were the only common predictors across all three case-mix adjustment models. Specific predictors for the EQ-5D index score were sex (β = 0.041), socio-economic status (β = − 0.019) and nationality (β = − 0.074). R2-values for the regression models for mortality (5 predictors), mRS score (9 predictors) and EQ-5D utility score (12 predictors), were respectively R2 = 0.44, R2 = 0.42 and R2 = 0.37. Conclusions The set of case-mix adjustment variables for the EQ-5D at three months differed considerably from the set for clinical outcomes in stroke care. The case-mix adjustment variables that were specific to this PROM were sex, socio-economic status and nationality. These variables should be considered in future attempts to risk-adjust for PROMs during benchmarking of hospitals.

scholarly journals A Pilot Study of a New Thrombolytic Agent for Acute Ischemic Stroke in Taiwan Within A Five-Hour Window

Stroke ◽  
2006 ◽  
Vol 37 (3) ◽  
pp. 918-919 ◽  
Author(s):  
Han-Hwa Hu ◽  
Michael Mu-Huo Teng ◽  
Li-Chi Hsu ◽  
Wen-Jang Wong ◽  
Lee-Min Wang ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Pilot Study ◽  
Acute Ischemic Stroke ◽  
Thrombolytic Agent

scholarly journals Tenecteplase vs. alteplase for acute ischemic stroke: a systematic review

2022 ◽  
Vol 15 (1) ◽  
Author(s):  
Neha Potla ◽  
Latha Ganti
Keyword(s):  
Systematic Review ◽  
Clinical Trials ◽  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Thrombolytic Agent ◽  
Randomized Clinical Trials ◽  
Lower Cost ◽  
Controlled Trials ◽  
Search Term ◽  
Randomized Controlled

Abstract Introduction Thrombolysis for acute ischemic stroke (AIS) with alteplase is the currently approved therapy for patients who present within 4.5 h of symptom onset and meet criteria. Recently, there has been interest in the thrombolytic tenecteplase, a modified version of alteplase, due to its lower cost, ease of administration, and studies reporting better outcomes when compared to alteplase. This systematic review compares the efficacy of tenecteplase vs. alteplase with regard to three outcomes: (1) rate of symptomatic hemorrhage, (2) functional outcome at 90 days, and (3) reperfusion grade after thrombectomy to compare the efficacy of both thrombolytics in AIS Methods The search was conducted in August 2021 in PubMed, filtered for randomized controlled trials, and studies in English. The main search term was “tenecteplase for acute stroke.” Results A total of 6 randomized clinical trials including 1675 patients with AIS was included. No one’s study compared alteplase to tenecteplase with all three outcomes after acute ischemic stroke; however, by using a combination of the results, this systematic review summarizes whether tenecteplase outperforms alteplase. Conclusions The available evidence suggests that tenecteplase appears to be a better thrombolytic agent for acute ischemic stroke when compared to alteplase.

Oral Language Behavior of Older Cerebral Palsied Children

1964 ◽  
Vol 7 (4) ◽  
pp. 349-359 ◽  
Author(s):  
Russell J. Love
Keyword(s):  
Oral Language ◽  
Economic Status ◽  
Educational Background ◽  
Socio Economic Status ◽  
Language Behavior ◽  
Hearing Acuity

A battery of six tests assessing various aspects of receptive and expressive oral language was administered to 27 cerebral palsied children and controls matched on the variables of age, intelligence, sex, race, hearing acuity, socio-economic status, and similarity of educational background. Results indicated only minimal differences between groups. Signs of deviancy in language behavior often attributed to the cerebral palsied were not observed. Although previous investigators have suggested consistent language disturbances in the cerebral palsied, evidence for a disorder of comprehension and formulation of oral symobls was not found.

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