scholarly journals THE EFFECT OF CITICOLIN IN MOTORIC IMPROVEMENT OF ACUTE ISCHEMIC STROKE PATIENTS IN SITI KHODIJAH SEPANJANG HOSPITAL

2020 ◽  
Vol 4 (2) ◽  
pp. 76-82
Author(s):  
Dza’wan Maula Iwanatud Diana ◽  
Laily Irfana ◽  
Yelvi Levani ◽  
Uning Marlina
Keyword(s):  
Ischemic Stroke ◽  
Cell Membranes ◽  
Neuronal Cell ◽  
Case Control ◽  
Wilcoxon Test ◽  
Stroke Patients ◽  
Chi Square ◽  
Brain Reperfusion ◽  
Main Component ◽  
Motor Improvement

ABSTRACT Background: According to WHO, stroke is the leading cause of morbidity and the second cause of death with a mortality rate of around 5.54 million. Stroke, based on its etiology, consists of ischemic and hemorrhagic. Ischemic stroke is caused by a blockage in the blood-brain, whereas hemorrhagic stroke occurs due to the rupture of brain blood vessels. Based on the pathophysiology of ischemic stroke, its therapy consists of thrombolytic in thrombus for brain reperfusion and anticoagulants or antiplatelet in strokes due to embolization because it is grown in a collateral-containing lavatory and neuroprotectant assistance to trace cytotoxic nerves. Neuroprotectants that are often used are piracetam and citicoline. Citicoline improves neuronal cell membranes by increasing synthesis of the main component of cell membranes, phosphatidylcholine, then repaired neuronal cell membranes. Objective: To find out motor improvement in stroke patients at Siti Khodijah Sepanjang Hospital by giving 500mg of citicoline per day orally for 5 days. Methods: A case-control observational analytic study using medical record data. Consists of a group with standard therapy, antiplatelets, and another group with 500mg/day antiplatelet and citicoline therapy for 5 days. Patients were examined for MRC motor on the first day and the fifth day. Results: The statistical test used the Chi-Square test  and wilcoxon test with a significance value of 0.00 and 0,01 (<0.05). Conclusion: obtained significant motor improvement in stroke patients 500mg/day for 5 days at Siti Khodijah Sepanjang Hospital. Keywords: Citicoline, Motoric Repair, Ischemic Stroke   ABSTRAK Latar belakang: Menurut WHO stroke menjadi penyebab utama morbiditas dan sebab kematian nomor dua dengan angka kematian sekitar 5,54 juta. Stroke berdasarkan etiologinya diklasifikasikan menjadi stroke iskemik dan stroke hemoragik. Stroke iskemik merupakan stroke yang diakibatkan oleh adanya sumbatan pada pembuluh darah di otak sedangkan stroke hemoragik akibat adanya pecahnya pebuluh darah otak. Berdasarkan patofisiologinya terapi stroke iskemik terdiri dari trombolitik pada iskemik akibat trombus untuk reperfusi otak dan antikoagulan atau antiplatelet pada stroke akibat emboli sebagai pencegahan terbentuknya trombus pada pembuluh darah kolateral serta pemberian neuroprotektan untuk menghambat penyebaran kerusakan neuroglia pada penumbra akibat proses sitotoksik. Neuroprotektan yang sering digunakan adalah pirasetam dan citicolin. citicolin berfungsi memperbaiki membran sel neuron dengan meningkatkan sintesis komponen utama membran sel yaitu phosphatidylcholine sehingga terjadi peningkatan perbaikan membran sel neuron. Tujuan: Untuk mengetahui perbaikan motorik pada pasien stroke iskemik akut di RS Siti Khodijah Sepanjang. Metode: Jenis penelitian analitik observasional case-control bersifat retrospektif menggunakan data rekam medis. Terdiri dari kelompok dengan terapi standar yaitu antiplatelet dan kelompok lain dengan terapi antiplatelet dan citicolin 500mg/hari selama 5 hari. Pasien dilakukan pemeriksan motorik MRC di hari pertama dan hari kelima. Hasil: Uji statistik menggunakan uji Chi-Square dan uji wilcoxon dengan nilai signifikansi masing-masing 0,00 dan 0,01 (<0,05). Kesimpulan: didapatkan perbaikan motorik yang signifikan pada pasien stroke iskemik akut dengan pemberian citicoline 500mg/hari selama 5 hari di Rumah Sakit Siti Khodijah Sepanjang. Kata Kunci: Citicolin, Perbaikan Motorik, Stroke Iskemik

Abstract TP24: Trends in Iv r-tpa and Thrombectomy Treatment Rates Before and After the LVO RCT’s in a Regional Tele-stroke Network

Stroke ◽  
2017 ◽  
Vol 48 (suppl_1) ◽  
Author(s):  
Naregnia Pierre Louis ◽  
Suman Nalluri ◽  
Benny Kim ◽  
Aashish Anand ◽  
Tanzila Shams ◽  
...  
Keyword(s):  
Systematic Review ◽  
Ischemic Stroke ◽  
Mechanical Thrombectomy ◽  
Statistical Test ◽  
Stroke Therapy ◽  
Stroke Patients ◽  
Chi Square ◽  
The Third ◽  
Before And After ◽  
Acute Stroke Therapy

The presentation of endovascular stroke trials at international stroke conference was a land mark event in acute stroke therapy. This study aims to analyze the rates of utilization of IV r-tPA, with or without mechanical thrombectomy before and after the 2015 International Stroke Conference (ISC) in a large regional tele-stroke network. Methods: A systematic review of prospective telestroke and procedure database was performed for 18 months prior and 18 months post conference. There were three groups included in the analysis. The first group consisted ischemic stroke patients presented within 12 hours of onset including inpatient events, transfers from primary centers and rural clinics. The second group consisted of patients who received IV r-tPA, and the third group consisted of patients who received IV r-tPA and/or underwent mechanical thrombectomy for a demonstrated LVO. Results: A total of 2628 consecutive ischemic stroke events presented within 12 hours of onset were evaluated. In the pre-ISC conference group, there were 1135 ischemic stroke patients. IV r-tPA was given 535 times(47.1%) and mechanical thrombectomy was utilized in addition to IV r-tPA or alone 42 times(3.7%). In the post-ISC conference group, there were 1493 ischemic stroke patients. IV r-tPA was given 642 times(43%) and mechanical thrombectomy was utilized in addition to IV r-tPA or alone 132 times(8.84%). The Chi Square statistical test was performed comparing these groups. When comparing the rate of IV r-tPA usage, there was a significant decrease from the pre-ISC conference group to the post-ISC conference group (P= 0.04). When comparing the rate of mechanical thrombectomy performed, there was a significant increase of greater than double the percentage of thrombectomy procedures performed in the post conference group compared to the preconference group (p< 0.001). Conclusion: There was a significant decrease in IV r-tPA usage but a greater than double the increase in the thrombectomy rate . This may be secondary to increased awareness of benefit of thrombectomy at referral centers. Slightly lower rates of IV r-tPA usage may be secondary to an increase in transfers of patients outside of the 0-4.5 hr window but were deemed candidates for thrombectomy.

Abstract NS2: Effect of Volume-Viscosity Swallow Test (V-VST) in Acute Ischemic Stroke Patients With Dysphagia: A Hospital-Based Case-Control Study

Stroke ◽  
2020 ◽  
Vol 51 (Suppl_1) ◽  
Author(s):  
Ting Ye ◽  
Yi Dong ◽  
Shengyan Huang
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Case Control Study ◽  
Tube Feeding ◽  
Case Control ◽  
Stroke Patients ◽  
Post Intervention ◽  
Post Stroke ◽  
Volume Viscosity ◽  
Control Study

Background: The dysphagia screening in acute ischemic stroke plays an important role in patients with risk of dysphagia. The aim of this hospital-based case-control study is to explore if V-VST, as a new nurse-driven dysphagia screening tool for AIS patients, might help to reduce the rate of post-stroke pneumonia and early withdraw of feeding tube. Methods: 1598 acute ischemic stroke patients were enrolled in this study. The standard protocol in AIS patients were assessed by WST (before intervention and plus with V-VST after intervention). The V-VST assessment were be trained in two senior nurses and all AIS patients were assessed by V-VST during July 1and Dec 30 th , 2017. Among 299 AIS patients with suspected, all clinical data were analyzed. The comparison of their rate of pneumonia in hospital and withdraw rate of tubefeeding before discharge were performed between patients post-intervention (January 1, 2018-June 30, 2019)and those admitted before the intervention (January 1, 2016-June 30, 2017). Results: The baseline characteristics of the pre- and post- intervention AIS groups were similar in age, gender, NIHSS. The implementation of V-VST have a statistically significant reducing the risk of pneumonia with an adjusted HR (0.60, 95% CI 0.43-0.84, P=0.003). Additionally, follow-up V-VST were likely to be associated the withdraw rate of tube-feeding at discharge (29/168 vs 38/131 P=0.016).There is also a trend of length of tube-feeding decreasing (8.32±12.27 vs 6.84±8.61 P=0.241). Conclusion: In our study, the V-VST is a feasible bedside tool. The implemental might be associated with the reduction of post-stroke pneumonia. Therefore, it meets the requirements of a clinical screening test for dysphagia in acute stroke patients at bedside. Large prospective interventional study is needed to confirm our findings. V-VST: Volume-viscosity Swallow Test WST: Water Swallow Test AIS: Acute Ischemic Stroke HR: hazard ratio

Abstract 4: Variation and Temporal Trends in the Characteristics of US Hospitals Treating Acute Ischemic Stroke Patients with IV-tPA: Findings from GWTG-Stroke

Stroke ◽  
2013 ◽  
Vol 44 (suppl_1) ◽  
Author(s):  
Lee H Schwamm ◽  
Syed F Ali ◽  
Mathew J Reeves ◽  
Eric E Smith ◽  
Jeffrey L Saver ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Systems Of Care ◽  
Team Building ◽  
Temporal Trends ◽  
High Volume ◽  
Wilcoxon Test ◽  
Chi Square ◽  
Over Time ◽  
Iv Tpa

Introduction: Utilization of IV tPA is challenging for many hospitals. Using data from the national Get With The Guidelines-Stroke program, we analyzed changes over time in the characteristics of the hospitals that treated patients with tPA. Methods: We analyzed patient-level data from 2003-2011 at 1600 GWTG hospitals that joined the program at any time during the study period and admitted any acute ischemic stroke (AIS) patients arriving ≤ 2 hr of onset and eligible for tPA. Descriptive trends by time were analyzed by chi-square or Wilcoxon test for continuous data. Results: IV tPA was given within 3 hr at 1394 sites to 50,798/ 75,115 (67.6%) eligible AIS patients arriving ≤ 2 hr; 206 (14.8%) sites had a least one eligible patients but no tPA use. IV tPA treatment rates varied substantially across hospitals (median 61.2%, range 0-100%), with > 200 hospitals providing tPA < 10% of the time (Figure). Over time, more patients and a larger proportion of patients were treated at smaller (median bed size 407 vs. 372, p< 0.001), non-academic, Southern hospitals, and those with lower annualized average ischemic stroke volumes (252.4 vs. 235.2, p< 0.001) (Table). While more than half of all tPA patients were treated at Primary Stroke Centers, this proportion did not change over time. The proportion of patients treated at high volume tPA treatment sites (average > 20/year) increased over time (31.9 vs. 34.5, p< 0.007). Conclusion: Over the past decade, while primary stroke centers still account for more than half of all treatments, tPA has been increasingly delivered in smaller, non-academic hospitals. These data support the continued emphasis on stroke team building and systems of care at US hospitals.

scholarly journals Are Outcomes of Ischemic Strokes Improved When a Neurologist is Attending?

Stroke ◽  
2001 ◽  
Vol 32 (suppl_1) ◽  
pp. 383-383
Author(s):  
Leslie A Gillum ◽  
S. Claiborne Johnston
Keyword(s):  
Ischemic Stroke ◽  
Hospital Mortality ◽  
Administrative Database ◽  
Emergency Rooms ◽  
Stroke Patients ◽  
Chi Square ◽  
Risk Of Death ◽  
Improved Outcomes ◽  
Admission Status ◽  
Treatment Volume

P239 BACKGROUND: Whether admission of stroke patients to neurologists is associated with improved outcomes is uncertain. Though prior studies suggested ischemic stroke patients under the care of neurologists had lower rates of in-hospital mortality than those treated by internists, these studies were uncontrolled for the possibility that patients with better prognosis were admitted to neurologists. METHODS: The University HealthSystem Consortium administrative database contains patient information from 84 large academic health centers and associates. Discharge abstracts for ischemic strokes admitted through emergency rooms 1997–1999 were obtained. Database variables were validated by comparison with a detailed chart review of 927 patients at 36 institutions. Attending physician specialty was evaluated as a predictor of in-hospital mortality using chi-square statistics and multivariable logistic regression. To determine whether hospital rates of stroke admission to neurologists were predictive of in-hospital mortality, generalized estimating equations (GEE) were used. This multivariable method accounts for clustering of observations at institutions, which broadens confidence intervals (CI). All multivariable analyses were adjusted for age, gender, race, admission status, and treatment volume. RESULTS: Of 28,571 ischemic strokes admitted through the emergency department, 58% were admitted to neurologists. Univariate analyses demonstrated a lower risk of in-hospital mortality in cases admitted to neurologist (4.7%) compared to non-neurologists (9.4%; p<0.001). Adjustment for case-mix did not alter the association (odds ratio, 0.48; 95% CI, 0.43–0.53; p<0.001). However, risk of death was not lower at hospitals admitting a larger portion of ischemic stroke cases to neurologists (p=0.54) as would be expected if admission to neurologists led to improved outcomes. CONCLUSIONS: In academic medical centers, ischemic stroke patients admitted to neurologists are less likely to die in the hospital compared to those admitted to other services. However, this may be due to selection of patients with better prognosis for admission to neurologists.

scholarly journals PERBEDAAN LUARAN PASIEN STROKE ISKEMIK AKUT DENGAN LEUKOSIT NORMAL DAN LEUKOSITOSIS

2018 ◽  
Vol 36 (1) ◽  
Author(s):  
Clarissa Tertia ◽  
Belinda Orline Olivia Singgih ◽  
I Ketut Sumada ◽  
Ni Ketut Candra Wiratmi ◽  
Putu Eka Widyadharma
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Leukocyte Count ◽  
Clinical Manifestations ◽  
Acute Onset ◽  
National Institutes Of Health ◽  
Stroke Patients ◽  
Chi Square ◽  
Acute Ischemic Stroke Patient ◽  
Normal Leukocyte

    DIFFERENCE IN OUTCOME OF ACUTE ISCHEMIC STROKE PATIENT WITH NORMAL LEUKOCYTE AND LEUKOCYTOSISABSTRACTIntroduction: Inflammation is an independent risk factor for ischemic stroke, which needs to be inhibited to reduce worsening occlusion of arteries due to atherosclerotic plaques. Increased leukocyte count is considered an acute damage marker of brain tissue that experiences ischemia and is used to determine the severity and prognosis of acute ischemic stroke.Aims: To analyse association between the number of leukocytes in acute onset ischemic stroke patients during admission and discharge.Methods: A prospective analytical observational study with a cohort design on acute ischemic stroke patients in Wangaya Regional Hospital, Denpasar-Bali between January and September 2018. Clinical manifestations were assessed using National Institutes of Health Stroke Scale (NIHSS). Data was collected through medical records and analysed using Chi-square test and Mann-Whitney.Results: Seventy-six subjects devided into 2 groups;  normal  leucocytes and  leucocytosis group,  38 patients respectively. The normal leucocytes group was dominated with male subject (78.9%) and mean leucocytes count was 7,612/mm3. While leucocytosis group was dominated with female subjects (63.2%) and mean leucocytes count was 12,294/ mm3. Mean NIHSS at admission in normal leucocytes group and leucocytosis group was 5 (moderate) and 8 (moderate) respectively. Mean NIHSS at discharge in normal leucocytes group and leucocytosis group was 3 (low) and 11 (moderate) respectively.Discussion: Patients with acute onset ischemic stroke with normal leukocyte count during admission, tend to have better clinical outcome two times fold compared to the patients with leucocytosis.Keywords: Leukocytes, leucocytosis, acute ischemic stroke, NIHSSABSTRAKPendahuluan: Inflamasi merupakan faktor risiko independen terjadinya stroke iskemik, yang perlu dihambat untuk mengurangi perburukan oklusi pada pembuluh darah akibat plak aterosklerotik. Peningkatan kadar leukosit dianggap menunjukkan kerusakan akut jaringan otak yang mengalami iskemia dan digunakan untuk mengetahui tingkat keparahan dan prognosis stroke iskemik akut.Tujuan Mengetahui hubungan antara kadar leukosit terhadap manifestasi klinis pasien stroke iskemik onset akut pada saat masuk dan keluar perawatan.Metode: Penelitian observasional analitik prospektif dengan rancangan kohort terhadap pasien stroke iskemik onset akut yang dirawat di RSUD Wangaya, Denpasar, pada bulan Januari hingga September 2018. Manifestasi klinis subjek dinilai berdasarkan derajat beratnya stroke menggunakan National Institutes of Health Stroke Scale (NIHSS). Data dikumpulkan melalui rekam medis dan di analisis dengan uji Chi-square dan Mann-Whitney.Hasil: Didapatkan 76 subjek yang dibagi menjadi 2 kelompok, yaitu masing-masing 38 subjek pada kelompok dengan leukosit normal dan kelompok dengan leukositosis. Kelompok subjek leukosit normal, didominasi oleh subjek laki- laki (78,9%) dan rerata kadar leukosit 7.612/mm3, sedangkan pada kelompok leukositosis mayoritas perempuan (63,2%) dan rerata kadar leukosit 12.294/mm3. Rerata skor NIHSS saat masuk pada kelompok leukosit normal adalah 5 (moderat) dan  pada kelompok dengan leukositosis adalah 8 (moderat). Adapun rerata skor NIHSS pada kelompok leukosit normal saat pasien keluar adalah 3 (ringan) dan 11 (moderat) pada kelompok leukositosis.Diskusi: Subjek stroke iskemik akut dengan kadar leukosit awal yang normal cenderung memiliki perbaikan manifestasi klinis pada saat keluar RS dua kali lebih baik daripada subjek dengan leukositosis.Kata kunci: Leukosit, leukositosis, stroke iskemik akut, skor NIHSS

scholarly journals HUBUNGAN PENINGKATAN KADAR LDL KOLESTEROL PADA PASIEN STROKE ISKEMIK DI RUMAH SAKIT UMUM HAJI MEDAN

2019 ◽  
Vol 1 (2) ◽  
pp. 104-109
Author(s):  
Zaim Anshari
Keyword(s):  
Ischemic Stroke ◽  
General Hospital ◽  
Medical Records ◽  
Ldl Cholesterol ◽  
Stroke Patients ◽  
Chi Square ◽  
Inconsistent Result ◽  
Chi Square Test ◽  
High Level ◽  
Test Result

Introduction: The causes of ischemic stroke by the high level of ldl cholesterol is still uncertain or can not be confirmed yet. The researches regarding the correlation of the high level of ldl cholestrol on the ischemic stroke patients only in small numbers with inconsistent result. Purpose: to know the correlation of high level of idl cholestrol on ischemic stroke patients. Method: this research is an analytic research by using restrospective study method on ischemic stroke patients whom hospitalized in Haji Medan General Hospital period January to Maret 2019. The datas were taken from patient medical records. Those datas will be analyzed by using chi square test. Result: there were 40 subjects whom are in ages of 61-70 years old. There was no correlation of high level of ldl cholestrol on ischemic stroke patients (p=0.943) which means (p>0.05) H○ is unaccepted. Discussion: there is no correlation of high level of ldl cholestrol on ischenic stroke patients

scholarly journals STROKE PATIENTS

2015 ◽  
Vol 22 (07) ◽  
pp. 887-895
Author(s):  
Santosh Kumar ◽  
Muhammad Aslam ◽  
Maria Maria ◽  
Saleem Saleem
Keyword(s):  
Ischemic Stroke ◽  
Hemorrhagic Stroke ◽  
University Hospital ◽  
P Value ◽  
Stroke Patients ◽  
Chi Square ◽  
Aged Patients ◽  
Chi Square Test ◽  
Bed Sores ◽  
Medical Wards

Stroke is one of the leading factors of morbidity and mortality worldwide. Toreduce the incidences of stroke, it is essential to identify and modify the risk factors for stroke.Risk factors can be modifiable and non modifiable. The aim of study was to ascertain theoutcome of stroke patient admitted in all Medical Wards in Liaquat University Hospital HyderabadObjective: To see the mortality, morbidity, disability and co-infection in stroke patients. StudyDesign: Prospective study. Period: One year. Setting: Medical Wards of Liaquat UniversityHospital Hyderabad / Jamshoro. Material and Methods: 200 Patients were enrolled in ourstudy to see the excepted outcome like mortality, Disability, Bed Sores, UTI & Pneumonia andDehydration in Stroke patients. All the patients were Young Adults, greater than 12 years inage and old aged patients, with Ischemic & Hemorrhagic stroke. On categorical variable suchas sex, mortality, morbidity chi-square test was applied at 95% confidence interval and the P-value ≤0.05 was considered as statically significant while the mean ±SD will be calculated forquantitative variables. Results: Mean age of the patient in our study was 57.03 years with thestandard deviation of ±7.35 years. Gender distribution shows most of the patients in our studywere male, i.e. 75% while, only 25% of the patients were female. Ischemic Stroke was foundin 126(63%) patients while, hemorrhagic stroke was found in 74(37%) patients. Regardingoutcome, mortality was found in 5% patients, disability 2%, UTI 2%, pneumonia 15%, Coinfection4%, Bed Sores 21.5% and dehydration was present in 50.5% patients. Conclusion:The study concludes that maximum patients had Ischemic Stroke. Among these patientsdehydration was the most common entity followed by bed Sores, pneumonia, mortality, Coinfection,disability and UTI.

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