A study on short term outcome of stroke in a rural tertiary care center of Sub Himalayan Terai

Background: Stroke is the second most common cause of mortality in the world, causing immense morbidity and economic burden. The proper knowledge of the factors which influence the good clinical outcome in stroke is utmost strength of the clinicians in India, where post stroke rehabilitative measures are limited.Aims and Objective: To find out the association of outcome of stroke with different risk factors.Materials and Methods: A descriptive observational design study was formulated for a period of six months on hundred stroke patients in internal medicine unit of at North Bengal Medical College & Hospital, India. Patients were selected after proper screening by inclusion and exclusion criteria. The “In-hospital-outcome” of CVA patient was determined by Glasgow outcome scale. The neurological condition was determined by National Institute of Health Stroke Scale (NIHSS). The Modified Rankin Scale and Barthel Index were utilized to asses disability status of patient in different period of hospital admission. The data were analyzed by EPI INFO software.Results: Clinical outcome showed statistically significant (P<0.05) correlation with age, sex, level of consciousness, blood pressure, diabetes, past history, mass effect, size and depth of infarction and intra-ventricular extension of intra cerebral bleeding. Other parameters like type of stroke (ischemic or hemorrhagic), delay in admission, dyslipidemia, presence of heart disease, smoking, alcoholism, family history, depth and volume of intra cerebral bleeding, although showed poorer clinical outcome, their correlation was not statistically significant.Conclusion: In-hospital outcome of stroke as determined by Glasgow outcome scale correlates with diverse clinical parameters including various risk factors.Asian Journal of Medical Sciences Vol.9(4) 2018 1-9

Sex-related differences in risk factors, type of treatment received and outcomes in patients with atrial fibrillation and acute stroke: Results from the RAF-study (Early Recurrence and Cerebral Bleeding in Patients with Acute Ischemic Stroke and Atrial Fibrillation)

Introduction Atrial fibrillation is an independent risk factor of thromboembolism. Women with atrial fibrillation are at a higher overall risk for stroke compared to men with atrial fibrillation. The aim of this study was to evaluate for sex differences in patients with acute stroke and atrial fibrillation, regarding risk factors, treatments received and outcomes. Methods Data were analyzed from the “Recurrence and Cerebral Bleeding in Patients with Acute Ischemic Stroke and Atrial Fibrillation” (RAF-study), a prospective, multicenter, international study including only patients with acute stroke and atrial fibrillation. Patients were followed up for 90 days. Disability was measured by the modified Rankin Scale (0–2 favorable outcome, 3–6 unfavorable outcome). Results Of the 1029 patients enrolled, 561 were women (54.5%) ( p < 0.001) and younger ( p < 0.001) compared to men. In patients with known atrial fibrillation, women were less likely to receive oral anticoagulants before index stroke ( p = 0.026) and were less likely to receive anticoagulants after stroke (71.3% versus 78.4%, p = 0.01). There was no observed sex difference regarding the time of starting anticoagulant therapy between the two groups (6.4 ± 11.7 days for men versus 6.5 ± 12.4 days for women, p = 0.902). Men presented with more severe strokes at onset (mean NIHSS 9.2 ± 6.9 versus 8.1 ± 7.5, p < 0.001). Within 90 days, 46 (8.2%) recurrent ischemic events (stroke/TIA/systemic embolism) and 19 (3.4%) symptomatic cerebral bleedings were found in women compared to 30 (6.4%) and 18 (3.8%) in men ( p = 0.28 and p = 0.74). At 90 days, 57.7% of women were disabled or deceased, compared to 41.1% of the men ( p < 0.001). Multivariate analysis did not confirm this significance. Conclusions Women with atrial fibrillation were less likely to receive oral anticoagulants prior to and after stroke compared to men with atrial fibrillation, and when stroke occurred, regardless of the fact that in our study women were younger and with less severe stroke, outcomes did not differ between the sexes.