Acute stroke management and late referrals-Clinician and community unawareness, A one month case series from Tumbi regional referral hospital Pwani, Tanzania

Stroke is among the common emergency department presentations in Tanzania at large. In the developing world, still there are challenges in diagnosis, management and monitoring of these cases hence high morbidity and mortality. A one month case series is presented here, from Pwani region Tanzania, to demonstrate the encountered challenges. Keywords: Acute stroke management clinician; Community unawareness.

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Canadian Stroke Best Practice Recommendations for Acute Stroke Management: Prehospital, Emergency Department, and Acute Inpatient Stroke Care, 6th Edition, Update 2018

International Journal of Stroke ◽

10.1177/1747493018786616 ◽

2018 ◽

Vol 13 (9) ◽

pp. 949-984 ◽

Cited By ~ 73

Author(s):

JM Boulanger ◽

MP Lindsay ◽

G Gubitz ◽

EE Smith ◽

G Stotts ◽

...

Keyword(s):

Emergency Department ◽

Ischemic Stroke ◽

Acute Stroke ◽

Transient Ischemic Attack ◽

Best Practice ◽

Stroke Care ◽

Stroke Management ◽

Practice Recommendations ◽

Prehospital Emergency ◽

Ischemic Attack

The 2018 update of the Canadian Stroke Best Practice Recommendations for Acute Stroke Management, 6th edition, is a comprehensive summary of current evidence-based recommendations, appropriate for use by healthcare providers and system planners caring for persons with very recent symptoms of acute stroke or transient ischemic attack. The recommendations are intended for use by a interdisciplinary team of clinicians across a wide range of settings and highlight key elements involved in prehospital and Emergency Department care, acute treatments for ischemic stroke, and acute inpatient care. The most notable changes included in this 6th edition are the renaming of the module and its integration of the formerly separate modules on prehospital and emergency care and acute inpatient stroke care. The new module, Acute Stroke Management: Prehospital, Emergency Department, and Acute Inpatient Stroke Care is now a single, comprehensive module addressing the most important aspects of acute stroke care delivery. Other notable changes include the removal of two sections related to the emergency management of intracerebral hemorrhage and subarachnoid hemorrhage. These topics are covered in a new, dedicated module, to be released later this year. The most significant recommendation updates are for neuroimaging; the extension of the time window for endovascular thrombectomy treatment out to 24 h; considerations for treating a highly selected group of people with stroke of unknown time of onset; and recommendations for dual antiplatelet therapy for a limited duration after acute minor ischemic stroke and transient ischemic attack. This module also emphasizes the need for increased public and healthcare provider’s recognition of the signs of stroke and immediate actions to take; the important expanding role of paramedics and all emergency medical services personnel; arriving at a stroke-enabled Emergency Department without delay; and launching local healthcare institution code stroke protocols. Revisions have also been made to the recommendations for the triage and assessment of risk of recurrent stroke after transient ischemic attack/minor stroke and suggested urgency levels for investigations and initiation of management strategies. The goal of this updated guideline is to optimize stroke care across Canada, by reducing practice variations and reducing the gap between current knowledge and clinical practice.

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A case series on post-covid deadly fungal infection: mucormycosis

International Journal of Otorhinolaryngology and Head and Neck Surgery ◽

10.18203/issn.2454-5929.ijohns20213287 ◽

2021 ◽

Vol 7 (9) ◽

pp. 1503

Author(s):

Kalpana G. ◽

Amol A. Patil ◽

Manohar Shaan ◽

Mitusha Verma ◽

Gayatri Harshe

Keyword(s):

Fungal Infection ◽

Opportunistic Infection ◽

Surgical Intervention ◽

Case Series ◽

Medical Intervention ◽

Morbidity And Mortality ◽

Diabetic Patients ◽

High Morbidity ◽

Per Se

<p class="abstract">The prevailing pandemic situation by SARS-CoV-2 infection is not only worrisome by the disease per se but also for the accompanying opportunistic infection are in the rise especially in diabetic patients. We presented a case series of post-covid rhino orbital cerebral mucormycosis infection in diabetic patients resulting in high morbidity. The need to present this was to emphasis on the timely surgical and medical intervention needed to reduce morbidity and mortality by the infection. The study highlighted the importance of surgical intervention in the deadly infection.</p>

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Ruptured Splenic Artery Aneurysm in the Postpartum Patient: A Case Series

Clinical Practice and Cases in Emergency Medicine ◽

10.5811/cpcem.2020.4.46946 ◽

2020 ◽

Vol 4 (3) ◽

pp. 304-307

Author(s):

Angel Rochester ◽

Tracy Lance ◽

Dane Smith ◽

Camiron Pfennig ◽

Adam Tyson ◽

...

Keyword(s):

Emergency Department ◽

Differential Diagnosis ◽

Splenic Artery ◽

Case Series ◽

Artery Aneurysm ◽

Multiple Organ ◽

Splenic Artery Aneurysm ◽

High Morbidity ◽

Organ Systems ◽

Mortality Case

Introduction: The evaluation of an unstable peripartum patient in the emergency department includes a differential diagnosis spanning multiple organ systems. Splenic artery aneurysm (SAA) is one of those rare diagnoses with potentially high morbidity and mortality. Case Series: This case series explores two unusual cases of postpartum SAAs. Despite differences in presentation, both patients had a ruptured SAA. Conclusion: Often, SAAs are misdiagnosed. Early diagnosis is key, especially for the fetus. If the patient presents in shock, the expedited diagnosis and treatment can be lifesaving for both the mother and the fetus.

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An enigmatic triad of acute pancreatitis, diabetic ketoacidosis and hypertriglyceridaemia: who is the culprit?

BMJ Case Reports ◽

10.1136/bcr-2016-217272 ◽

2019 ◽

Vol 12 (7) ◽

pp. e217272 ◽

Cited By ~ 2

Author(s):

Umasankar Mathuram Thiyagarajan ◽

Amirthavarshini Ponnuswamy ◽

Alex Chung

Keyword(s):

Acute Pancreatitis ◽

Diabetic Ketoacidosis ◽

Acute Abdomen ◽

Causal Factor ◽

Morbidity And Mortality ◽

High Morbidity ◽

The Real ◽

Common Causes ◽

Recent Diagnosis ◽

The Common

Acute pancreatitis(AP) is one of the common causes of acute abdomen and known to be associated with high morbidity and mortality in severe cases. Though most common causes of AP are cholelithiasis and alcoholism, it has also been reported in association with diabetic ketoacidosis (DKA). Triad of AP, hypertriglyceridaemia (HTG) and DKA is rare co-association and here the causal factor of AP is still not fully established. We report a case of AP in a DKA patient with recent diagnosis of hyperlipidaemia and diabetes. Usually AP has been associated with severe HTG; interestingly, our patient showed only moderate raise in triglycerides but still suffered AP during DKA. Hence, it raises question about the real culprit in this enigmatic triad.

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Stress hyperglycemia and electrolytes disturbance in patients with acute cerebrovascular stroke

The Egyptian Journal of Neurology Psychiatry and Neurosurgery ◽

10.1186/s41983-019-0137-0 ◽

2019 ◽

Vol 55 (1) ◽

Author(s):

Bastawy M. El-Fawal ◽

Reda Badry ◽

Wael A. Abbas ◽

Ahmed K. Ibrahim

Keyword(s):

Acute Stroke ◽

Heart Diseases ◽

Glycosylated Hemoglobin ◽

Morbidity And Mortality ◽

Medical Emergency ◽

Mortality Data ◽

Stroke Severity ◽

High Morbidity ◽

Stress Hyperglycemia ◽

Electrolyte Disturbance

Abstract Background Stroke is a medical emergency and considered the 2nd leading cause of mortality worldwide. High morbidity and mortality of stroke are due to some complications like cerebral edema, infection, and associated heart disease. Stroke may cause stress hyperglycemia and electrolyte disturbance that may be independent predictors for increased morbidity and mortality. Data on electrolyte disorder in neurological conditions especially acute stroke are somewhat scanty and not frequently interpreted. Objectives The current study aimed to evaluate the effect of stress induced by acute stroke on the blood glucose and serum electrolytes and its relationship to the type, severity, and prognosis of stroke. Subjects and methods A total of 100 patients admitted with acute stroke were included in the study. After informed consent, fasting blood sugar, glycosylated hemoglobin, serum sodium, and potassium levels were measured simultaneously. Stroke severity and outcome were assessed using the Glasgow Coma Scale. Results Stress hyperglycemia was noted in 21 patients, out of which 62% presented with hemorrhagic stroke. Undiagnosed diabetes was found in 47% of cases. Also, 13 % of our patients had both stress hyperglycemia and electrolyte disturbance simultaneously. Mortality among hemorrhagic versus ischemic patients was 46% and 22%, respectively. The independent predictors of mortality were stress hyperglycemia, electrolytes disturbance, ischemic heart diseases, and type and admission severity of stroke. Conclusion Stress hyperglycemia and electrolyte disturbance after acute stroke were found in 21% and 47% of patients respectively and may adversely affect outcome of stroke especially those with cerebral hemorrhage.

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Predictors of Medication-Related Emergency Department Admissions Among Patients with Cardiovascular Diseases at Mbarara Regional Referral Hospital, South-Western Uganda

Open Access Emergency Medicine ◽

10.2147/oaem.s309508 ◽

2021 ◽

Vol Volume 13 ◽

pp. 279-290

Author(s):

Joshua Kiptoo ◽

Tadele Mekuriya Yadesa ◽

Conrad Muzoora ◽

Juliet Sanyu Namugambe ◽

Robert Tamukong

Keyword(s):

Emergency Department ◽

Cardiovascular Diseases ◽

Referral Hospital ◽

Regional Referral Hospital ◽

Western Uganda

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Survey On Methanol Poisoning Epidemic in Rafsanjan City in Year 2013

Internal Medicine And Medical Investigation Journal ◽

10.24200/imminv.v2i3.47 ◽

2017 ◽

Vol 2 (3) ◽

pp. 84

Author(s):

Vahid Mirzaee ◽

Zahra Riahi ◽

Zahra Sharifzadeh ◽

Moein Kardoust Parizi ◽

Amir Adinehpour

Keyword(s):

Metabolic Acidosis ◽

Gastrointestinal Symptoms ◽

Case Series ◽

Morbidity And Mortality ◽

Diagnosis And Treatment ◽

High Morbidity ◽

Methanol Poisoning ◽

Arterial Blood ◽

Number Of Patients ◽

Case Series Study

Background: Examination and early detection of the methanol toxicity epidemic are very important, so identification and initiation of appropriate therapy can significantly reduce morbidity and mortality. Therefore, this study was aimed to investigation methanol poisoning epidemic in Rafsanjan city.Methods: This case series study was conducted in 252 patients with methanol poisoning in 2013 in the Ali-ibn-Abi-Talib hospital of Rafsanjan. Data were through interviews and records that were collected at hospital admission. Due to the large number of patients and the possible lack of ability of rapid measurement of serum levels of methanol and need of rapid intervention, treatment to reduce any further complications, early diagnosis and treatment were carried out by clinical history and interpretation of arterial blood gas test results. Data record on provided checklists and then analyzed using SPSS version 19.Results: The mean pH was 0.13±7.27. The most frequent clinical features were visual disturbances (39.7%), dyspnea (1.2%), and gastrointestinal symptoms (7.1%). There was a trend towards decreasing PCO2 with decreasing pH amongst the patients surviving. The opposite trend was demonstrated in the dying; the difference was highly significant by linear regression analyses (P< 0.001).Conclusions: Methanol poisoning still has a high morbidity and mortality, mainly because of late diagnosis and treatment. Respiratory arrest, coma and severe metabolic acidosis upon admission were strong predictors of poor outcome. Early admission and ability of respiratory compensation of metabolic acidosis were associated with survival.

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Thrombolysis in Acute Stroke Due to Thrombosed Aneurysm

The Neurohospitalist ◽

10.1177/1941874418825187 ◽

2019 ◽

Vol 9 (4) ◽

pp. 226-229

Author(s):

Rongzhi (Ronda) Lun ◽

Elana Adela Cora ◽

Dana Iancu ◽

Justin Graveline ◽

Priya Figurado ◽

...

Keyword(s):

Ischemic Stroke ◽

Acute Stroke ◽

Mechanical Thrombectomy ◽

Case Series ◽

Intravenous Thrombolysis ◽

Stroke Management ◽

Thrombosed Aneurysm ◽

Future Case

We describe a case of a patient who presented with an acute stroke and thrombosed aneurysm of the same vessel. We review the literature on acute stroke management in the setting of an ischemic stroke caused by a thrombosed aneurysm, including intravenous thrombolysis and mechanical thrombectomy. We found that it is unclear whether thrombolysis is safe in these cases. Future case series may be helpful in answering the question.

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PS02.148: ENDOSCOPIC MANAGEMENT OF GASTRO-BRONCHIAL FISTULA FOLLOWING 2-STAGE OESOPHAGECTOMY USING OVER-THE-SCOPE-CLIP (OTSC): CASE SERIES

Diseases of the Esophagus ◽

10.1093/dote/doy089.ps02.148 ◽

2018 ◽

Vol 31 (Supplement_1) ◽

pp. 162-163

Author(s):

Chih Ying Tan ◽

Htet Arkar Kyaw ◽

Bruno Lorenzi ◽

Alex Charalampopoulos ◽

Naga Venkatesh Jayanthi ◽

...

Keyword(s):

Conflicts Of Interest ◽

Treatment Algorithm ◽

Case Series ◽

Complete Healing ◽

Morbidity And Mortality ◽

Heavy Smoker ◽

Endoscopic Management ◽

High Morbidity ◽

Bronchial Fistula ◽

Over The Scope Clip

Abstract Background Post-oesophagectomy gastro-bronchial fistula (GBF) has significant morbidity and mortality. Management of GBF remains non-standardized due its rarity and limited available evidence. Re-operation and surgical repair has been the main approach. More recently, multimodal endoscopic treatment is gaining popularity as primary treatment option due to its relatively non-invasiveness, increasing evidence of success rate and reduced morbidity. We present a case series of GBF managed endoscopically using over-the-scope-clip (OTSC). Methods A dedicated, prospective and contemporaneous regional Upper GI cancer database was searched to identify GBF from January 2015 to December 2017. Clinical notes and investigation images of identified cases were analysed. Results Three patients developed post-oesophagectomy GBF during study period. Mean age of patients was 53. Mean time of GBF diagnosis was 233 days (range: 20–608). Two patients had endoscopic stent placement prior to OTSC application. Primary technical success was achieved in all patients. No adverse events were reported. Two patients had complete healing of GBF and mean healing time was 15 days (range: 6–24). One patient who had significant co-morbidities (peripheral arterial disease, diabetes, hepatitis C, rheumatoid arthritis and heavy smoker) developed persistent leak of GBF and died from cardiac event. Conclusion GBF and its surgical treatment are associated with a high morbidity and mortality. We present this case series where two out of three patients with GBF were successfully treated with this modality. Endoscopic therapy incorporating OTSC placement is a feasible option in management of post-oesophagectomy GBF. Further studies are required to understand and establish its role in treatment algorithm of post-oesophagectomy GBF. Disclosure All authors have declared no conflicts of interest.

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