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Goel D, Shangari S, Mittal M, Bhat A. Endogenous defense mechanism-based neuroprotection in large-vessel acute ischemic stroke: A hope for future. Brain Circ 2024; 10:51-59. [PMID: 38655439 PMCID: PMC11034449 DOI: 10.4103/bc.bc_56_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Revised: 09/29/2023] [Accepted: 10/03/2023] [Indexed: 04/26/2024] Open
Abstract
BACKGROUND Stroke is a leading cause of morbidity and mortality worldwide and a leading cause of disability. None of the neuroprotective agents have been approved internationally except edaravone in Japanese guidelines in acute ischemic stroke. We here discuss that there are two types of endogenous defense mechanisms (EDMs) after acute stroke for neuromodulation and neuroregeneration, and if both can be activated simultaneously, then we can have better recovery in stroke. AIMS AND OBJECTIVES We aimed to study the effect of combination of neuroprotection therapies acting on the two wings of EDM in acute large-vessel middle cerebral artery (LMCA) ischemic stroke. METHODS Sixty patients of LMCA stroke were enrolled and randomized within 72 h into two groups of 30 patients each. The control group received standard medical care without any neuroprotective agents while the intervention group received standard medical care combined with oral citicoline with vinpocetine for 3 months with initial 1 week intravenous and edaravone and cerebrolysin injection, started within 72 h of onset of stroke. Patients were assessed on the basis of the National Institutes of Health Stroke Scale, Fugl-Meyer Assessment Score, Glasgow Coma Scale, and Mini-Mental Status Examination at admission, discharge, and after 90 days. RESULTS The intervention group showed significant and early improvements in motor as well as cognitive recovery. CONCLUSION Combination therapy for neuroprotection which is acting on two pathways of EDM can be useful in functional recovery after acute ischemic stroke.
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Affiliation(s)
- Deepak Goel
- Department of Neurology, Swami Rama Himalayan University, Dehradun, Uttarakhand, India
| | - Sushant Shangari
- Department of Neurology, Swami Rama Himalayan University, Dehradun, Uttarakhand, India
| | - Manish Mittal
- Department of Neurology, Swami Rama Himalayan University, Dehradun, Uttarakhand, India
| | - Ashwani Bhat
- Department of Neurology, Swami Rama Himalayan University, Dehradun, Uttarakhand, India
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Panda BK, Suryawanshi VR, Attarde G, Borkar N, Iyer S, Shah J. Correlation of Quality Metrics of Acute Stroke Care with Clinical Outcomes in an Indian Tertiary-care University Hospital: A Prospective Evidence-based Study. Indian J Crit Care Med 2023; 27:806-815. [PMID: 37936803 PMCID: PMC10626231 DOI: 10.5005/jp-journals-10071-24566] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Accepted: 09/25/2023] [Indexed: 11/09/2023] Open
Abstract
Aim To characterize the impact of adherence to quality metrics of stroke care on the clinical outcomes of ischemic stroke (IS) and intracerebral hemorrhage (ICH) admissions. Methods Consecutive patients with acute stroke were prospectively followed up for their demographic and clinical characteristics, acute stroke management, and associated clinical outcomes at discharge. Stroke quality metrics [adopted from the American Heart Association (AHA)/American Stroke Association's Get with The Guidelines (GWTG)] with a specific interest in an association between acute reperfusion therapies and functional recovery in stroke patients are analyzed and presented. A composite measure of care was considered "0 (non-adherence) to 1 (adherence)." An all-or-none measure of care was calculated to check whether eligible patients received all the quality-of-care interventions. Multivariate Cox regression models were used to study an association between optimal adherence and clinical outcomes. Results During the study period, of the total 256 stroke admissions, 200 (78.1%) patients had IS, and the remaining 56 (21.9%) patients had ICH. The median [interquartile range (IQR)] age of total stroke admissions was 57 (36-78) years. Male preponderance was observed (IS: 80% and ICH: 67.9%). The conformity of performance metrics in IS patients was from 69.1% [95% confidence interval (CI), 68.5-69.6] for the use of deep vein thrombosis prophylaxis (DVTp) to 97.8% (95% CI, 96.2-98.6) for the use of statins. In ICH patients, it ranged from 61.7% (95% CI, 60.4-62.5) for the use of DVTp to 89.9% (95% CI, 88.6-89.7) for stroke rehabilitation. The unadjusted odds ratio (OR) of mortality (in-hospital plus the 28th-day postdischarge) was higher in ICH patients vs IS patients (4.42, p = 0.005). Optimal adherence with intravenous recombinant tissue plasminogen activator (IV-rtPA) therapy [hazards ratio (HR) = 0.23], in-hospital acute measures [IS (HR = 0.41) and ICH (HR = 0.63)], and discharge measures [IS (HR = 0.35) and ICH (HR = 0.45)] were associated with reduced hazards of the 28th-day mortality in both cohorts. Compared to ICH, IS patients had significantly improved neurofunctional recovery [modified Rankin score (mRS) ≤ 2, p < 0.01]. Conclusion Adherence to quality metrics and performance measures was associated with low mortality and favorable clinical outcomes. Also, DVTp as an in-hospital (acute) measure of stroke care needs attention in both cerebrovascular events. How to cite this article Panda BK, Suryawanshi VR, Attarde G, Borkar N, Iyer S, Shah J. Correlation of Quality Metrics of Acute Stroke Care with Clinical Outcomes in an Indian Tertiary-care University Hospital: A Prospective Evidence-based Study. Indian J Crit Care Med 2023;27(11):806-815.
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Affiliation(s)
- Bijoy Kumar Panda
- Department of Pharmacy Practice, Krishna Institute of Pharmacy, Krishna Vishwa Vidyapeeth (Deemed to be University), Karad, Maharashtra, India
| | - Vaibhav R Suryawanshi
- Department of Pharmacy Practice, Poona College of Pharmacy, Bharati Vidyapeeth (Deemed to be University), Pune, Maharashtra, India
| | - Gargi Attarde
- Department of Pharmacy Practice, Poona College of Pharmacy, Bharati Vidyapeeth (Deemed to be University), Pune, Maharashtra, India
| | - Nilima Borkar
- Department of Pharmacy Practice, Poona College of Pharmacy, Bharati Vidyapeeth (Deemed to be University), Pune, Maharashtra, India
| | - Shivakumar Iyer
- Department of Critical Care Medicine, Bharati Vidyapeeth (Deemed to be University), Medical College, Pune, Maharashtra, India
| | - Jignesh Shah
- Department of Critical Care Medicine, Bharati Vidyapeeth (Deemed to be University), Medical College, Pune, Maharashtra, India
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Shah A, Diwan A. Stumbling Blocks to Stroke Thrombolysis: An Indian Perspective. Indian J Crit Care Med 2023; 27:616-619. [PMID: 37719355 PMCID: PMC10504641 DOI: 10.5005/jp-journals-10071-24517] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Accepted: 07/26/2023] [Indexed: 09/19/2023] Open
Abstract
Background and purpose Stroke is a leading cause of morbidity and mortality worldwide. Developing countries, however, still lag behind in providing timely thrombolytic therapy (TLT) to many eligible patients owing to various reasons. This study aims to identify such factors. Materials and methods This was a descriptive observational study undertaken over a period of 18 months at a tertiary care teaching hospital and included 252 acute ischemic stroke patients of which 200 were not thrombolyzed. The reasons for nonthrombolysis were recorded and analyzed. Results The study included 252 acute ischemic stroke patients of which only 20% were thrombolyzed. Of the 200 nonthrombolyzed patients, 55% arrived out of the window period while patient-related factors were the second biggest factor preventing thrombolysis. Hospital factors at 14% and financial constraints at 4.5% contributed significantly. Delayed consent emerged as an important factor making 6% of the delays. Conclusion Stroke thrombolysis still faces various pre- and intrahospital barriers in India. There is an urgent need to improve infrastructure and organizational streamlining to enable eligible patients to receive prompt treatment. How to cite this article Shah A, Diwan A. Stumbling Blocks to Stroke Thrombolysis: An Indian Perspective. Indian J Crit Care Med 2023;27(9):616-619.
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Affiliation(s)
- Aviral Shah
- Department of Medicine, Atal Bihari Vajpayee Institute of Medical Sciences and Dr Ram Manohar Lohia Hospital, New Delhi, India
| | - Arundhati Diwan
- Department of Medicine, Bharati Vidyapeeth (Deemed to be University) Medical College, Pune, Maharashtra, India
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Platelet-targeted thrombolysis for treatment of acute ischemic stroke. Blood Adv 2022; 7:561-574. [PMID: 35482909 PMCID: PMC9984306 DOI: 10.1182/bloodadvances.2021006691] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Revised: 03/28/2022] [Accepted: 04/09/2022] [Indexed: 11/20/2022] Open
Abstract
Thrombolysis with tissue-type plasminogen activator (tPA) remains the main treatment for acute ischemic stroke. Nevertheless, tPA intervention is limited by a short therapeutic window, low recanalization rates, and a risk of intracranial hemorrhage (ICH), highlighting the clinical demand for improved thrombolytic drugs. We examined a novel thrombolytic agent termed "SCE5-scuPA," comprising a single-chain urokinase plasminogen activator (scuPA) fused with a single-chain antibody (SCE5) that targets the activated glycoprotein IIb/IIIa platelet receptor, for its effects in experimental stroke. SCE5-scuPA was first tested in a whole blood clot degradation assay to show the benefit of platelet-targeted thrombolysis. The tail bleeding time, blood clearance, and biodistribution were then determined to inform the use of SCE5-scuPA in mouse models of photothrombotic stroke and middle cerebral artery occlusion against tenecteplase. The impacts of SCE5-scuPA on motor function, ICH, blood-brain barrier (BBB) integrity, and immunosuppression were evaluated. Infarct size was measured by computed tomography imaging and magnetic resonance imaging. SCE5-scuPA enhanced clot degradation ex vivo compared with its nonplatelet-targeting control. The maximal SCE5-scuPA dose that maintained hemostasis and a rapid blood clearance was determined. SCE5-scuPA administration both before and 2 hours after photothrombotic stroke reduced the infarct volume. SCE5-scuPA also improved neurologic deficit, decreased intracerebral blood deposits, preserved the BBB, and alleviated immunosuppression poststroke. In middle cerebral artery occlusion, SCE5-scuPA did not worsen stroke outcomes or cause ICH, and it protected the BBB. Our findings support the ongoing development of platelet-targeted thrombolysis with SCE5-scuPA as a novel emergency treatment for acute ischemic stroke with a promising safety profile.
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Barrera-Vázquez OS, Gomez-Verjan JC, Ramírez-Aldana R, Torre PGD, Rivero-Segura NA. Structural and Pharmacological Network Analysis of miRNAs Involved in Acute Ischemic Stroke: A Systematic Review. Int J Mol Sci 2022; 23:ijms23094663. [PMID: 35563054 PMCID: PMC9105699 DOI: 10.3390/ijms23094663] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Revised: 04/09/2022] [Accepted: 04/10/2022] [Indexed: 02/05/2023] Open
Abstract
Acute ischemic stroke (AIS) is among the main causes of mortality worldwide. A rapid and opportune diagnosis is crucial to improve a patient’s outcomes; despite the current advanced image technologies for diagnosis, their implementation is challenging. MicroRNAs have been recognized as useful as biomarkers since they are specific and stable for characterization of AIS. However, there is still a lack of consensus over the primary miRNAs implicated in AIS. Here, we performed a systematic review of the literature covering from 2015–2021 regarding miRNAs expression during AIS and built structural networks to analyze and identify the most common miRNAs expressed during AIS and shared pathways, genes, and compounds that seem to influence their expression. We identified two sets of miRNAs: on one side, a set that was independent of geographical location and tissue (miR-124, miR-107, miR-221, miR-223, miR-140, miR-151a, miR-181a, miR-320b, and miR-484); and on the other side, a set that was connected (hubs) in biological networks (miR-27b-3p, miR-26b-5p, miR-124-3p, miR-570-3p, miR-19a-3p, miR-101-3p and miR-25-3p), which altered FOXO3, FOXO4, and EP300 genes. Interestingly, such genes are involved in cell death, FOXO-mediated transcription, and brain-derived neurotrophic factor signaling pathways. Finally, our pharmacological network analysis depicted a set of toxicants and drugs related to AIS for the first time.
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Affiliation(s)
| | - Juan Carlos Gomez-Verjan
- Dirección de Investigación, Instituto Nacional de Geriatría, Mexico City 10200, Mexico; (J.C.G.-V.); (R.R.-A.)
| | - Ricardo Ramírez-Aldana
- Dirección de Investigación, Instituto Nacional de Geriatría, Mexico City 10200, Mexico; (J.C.G.-V.); (R.R.-A.)
| | - Paola García-dela Torre
- Unidad de Investigación Médica en Enfermedades Neurológicas, Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, Mexico City 06720, Mexico;
| | - Nadia Alejandra Rivero-Segura
- Dirección de Investigación, Instituto Nacional de Geriatría, Mexico City 10200, Mexico; (J.C.G.-V.); (R.R.-A.)
- Correspondence: ; Tel.: +52-55-5573-9087
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de Souza AC, Sebastian IA, Wan Asyraf WZ, Nasreldein A, Bazadona D, Amaya P, Elkady A, Gebrewold MA, Vorasayan P, Yeghiazaryan N, Michel P, Khatri P, Pandian JD, Martins SCO, Hacke W, Lioutas VA. Regional and national differences in stroke thrombolysis use and disparities in pricing, treatment availability and coverage. Int J Stroke 2022; 17:990-996. [PMID: 35137645 DOI: 10.1177/17474930221082446] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Major disparities have been reported in recombinant tissue Plasminogen Activator (rtPA) availability among countries of different socioeconomic status. AIMS To characterize variability of rtPA price, its availability, and its association with and impact on each country's health expenditure (HE) resources. METHODS We conducted a global survey to obtain information on rtPA price (50mg vial, 2020 US Dollars) and availability. Country-specific data, including Low, Lower Middle (LMIC), Upper Middle (UMIC) and High-Income Country (HIC) classifications, and Gross Domestic Product (GDP) and HE, both nominally and adjusted for purchasing power parity (PPP), were obtained from World Bank Open Data. To assess the impact of rtPA cost, we computed the rtPA price as percentage of per capita GDP and HE and examined its association with the country income classification. RESULTS rtPA is approved and available in 109 countries. We received surveys from 59 countries: 27 (46%) HIC, 20 (34%) UMIC and 12 (20%) LMIC. Although HIC have significantly higher per capita GDP and HE compared to UMIC and LMIC (p<0.0001), the median price of rtPA is non-significantly higher in LMICs [USD 755, IQR (575-1300)] compared to UMICs [USD 544, IQR (400-815)] and HIC [USD 600, IQR (526-1000)]. In LMIC, rtPA cost accounts for 217.4% (IQR (27.1-340.6%) of PPP-adjusted per capita HE, compared to 17.6% (IQR [11.2-28.7%], p<0.0001) for HICs. CONCLUSIONS We documented significant rtPA availability and variability in its price among countries. Relative costs are higher in lower income countries, exceeding the available HE. Concerted efforts to improve rtPA affordability in low-income settings are necessary.
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Affiliation(s)
| | | | - Wan Zaidi Wan Asyraf
- Medical Department, Universiti Kebangsaan Malaysia Medical Center, Kuala Lumpur, Malaysia 60607
| | - Ahmed Nasreldein
- Department of Neurology and Psychiatry, Assuit University, Assuit, Egypt 68797
| | - Danira Bazadona
- Department of Neurology, University Hospital Centre Zagreb, Croatia 567843
| | - Pablo Amaya
- Department of Neurology, Stroke Program, Fundación Valle del Lili, Cali, Colombia 67597
| | - Ahmed Elkady
- Department of Neurology, Saudi German Hospital, Jeddah, Saudi Arabia 48051
| | | | - Pongpat Vorasayan
- Department of Medicine, King Chulalongkorn Memorial Hospital, Bangkok, Thailand 26683
| | - Nune Yeghiazaryan
- Department of Neurology, Stroke Unit, Erebouni Medical Center, Yerevan, Armenia 366969
| | - Patrik Michel
- Stroke Center, Neurology Service, Department of Clinical Neurosciences, Neurology Service, Lausanne University Hospital, Lausanne, Switzerland
| | - Pooja Khatri
- Department of Neurology, Vascular Neurology Division, University of Cincinnati 2514
| | | | | | - Werner Hacke
- Senior professor, University of Heidelberg, Heidelberg, Germany
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Uivarosan D, Bungau S, Tit DM, Moisa C, Fratila O, Rus M, Bratu OG, Diaconu CC, Pantis C. Financial Burden of Stroke Reflected in a Pilot Center for the Implementation of Thrombolysis. MEDICINA (KAUNAS, LITHUANIA) 2020; 56:E54. [PMID: 32013001 PMCID: PMC7074434 DOI: 10.3390/medicina56020054] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/02/2019] [Revised: 01/06/2020] [Accepted: 01/27/2020] [Indexed: 01/01/2023]
Abstract
Stroke represents a serious illness and is extremely relevant from the public health point of view, implying important social and economic burdens. Introducing new procedures or therapies that reduce the costs both in the acute phase of the disease and in the long term becomes a priority for health systems worldwide. The present study quantifies and compares the direct costs for ischemic stroke in patients with thrombolysis treatment versus conservative treatment over a 24-month period from the initial diagnosis, in one of the 7 national pilot centres for the implementation of thrombolytic treatment. The significant reduction (p < 0.001) of the hospitalization period, especially of the days in the intensive care unit (ICU) for stroke, resulted in a significant reduction (p < 0.001) of the total average costs in the patients with thrombolysis, both at the first hospitalization and for the subsequent hospitalizations, during the period followed in the study. It was also found that the percentage of patients who were re-hospitalized within the first 24-months after stroke was significantly lower (p < 0.001) among thrombolyzed patients. The present study demonstrates that the quick intervention in cases of stroke is an efficient policy regarding costs, of Romanian Public Health System, Romania being the country with the highest rates of new strokes and deaths due to stroke in Europe.
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Affiliation(s)
- Diana Uivarosan
- Department of Preclinical Disciplines, Faculty of Medicine and Pharmacy, University of Oradea, 410073 Oradea, Romania;
| | - Simona Bungau
- Department of Pharmacy, Faculty of Medicine and Pharmacy, University of Oradea, 410028 Oradea, Romania; (D.M.T.); (C.M.)
| | - Delia Mirela Tit
- Department of Pharmacy, Faculty of Medicine and Pharmacy, University of Oradea, 410028 Oradea, Romania; (D.M.T.); (C.M.)
| | - Corina Moisa
- Department of Pharmacy, Faculty of Medicine and Pharmacy, University of Oradea, 410028 Oradea, Romania; (D.M.T.); (C.M.)
| | - Ovidiu Fratila
- Department of Medical Disciplines, Faculty of Medicine and Pharmacy, University of Oradea, 410073 Oradea, Romania; (O.F.); (M.R.)
| | - Marius Rus
- Department of Medical Disciplines, Faculty of Medicine and Pharmacy, University of Oradea, 410073 Oradea, Romania; (O.F.); (M.R.)
| | - Ovidiu Gabriel Bratu
- Clinical Department 3, University of Medicine and Pharmacy “Carol Davila”, 050474 Bucharest, Romania;
| | - Camelia C. Diaconu
- Department 5, University of Medicine and Pharmacy ”Carol Davila”, 050474 Bucharest, Romania;
- Internal Medicine Clinic, Clinical Emergency Hospital of Bucharest, 014461 Bucharest, Romania
| | - Carmen Pantis
- Department of Surgical Disciplines, Faculty of Medicine and Pharmacy, University of Oradea, 410073 Oradea, Romania;
- Emergency Clinical County Hospital, 410169 Oradea, Romania
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8
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Sabau M, Bungau S, Buhas CL, Carp G, Daina LG, Judea-Pusta CT, Buhas BA, Jurca CM, Daina CM, Tit DM. Legal medicine implications in fibrinolytic therapy of acute ischemic stroke. BMC Med Ethics 2019; 20:70. [PMID: 31610781 PMCID: PMC6792206 DOI: 10.1186/s12910-019-0412-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2019] [Accepted: 09/26/2019] [Indexed: 01/01/2023] Open
Abstract
Background Before the advent of fibrinolytic therapy as a gold standard method of care for cases of acute ischemic stroke in Romania, issues regarding legal medicine aspects involved in this area of medical expertise were already presented and, in the majority of cases, the doctors seem to be unprepared for these situations. Main text The present research illustrates some of the cases in which these aspects were involved, that adressed a clinical center having 6 years of professional experience in the application of fibrinolytic treatment for stroke. The following cases report either situations in which the afore mentioned therapy was not rightfully administrated or legal aspects regarding the obtainment of informed consent. Conclusion Obtaining informed consent is a mandatory procedure, which takes time, to the detriment of application of fibrinolytic treatment.
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Affiliation(s)
- Monica Sabau
- County Clinical Emergency Hospital, Oradea, Romania.,Faculty of Medicine and Pharmacy, Department of Psycho-Neurosciences and Rehabilitation, University of Oradea, Oradea, Romania
| | - Simona Bungau
- Faculty of Medicine and Pharmacy, Department of Pharmacy, University of Oradea, Oradea, Bihor, Romania
| | - Camelia Liana Buhas
- Faculty of Medicine and Pharmacy, Department of Morphological Disciplines, University of Oradea, 50 Clujului St., 410060, Oradea, Bihor, Romania. .,Bihor County Forensic Service, 50 Clujului St, 410060, Oradea, Bihor, Romania.
| | - Gheorghe Carp
- County Clinical Emergency Hospital, Oradea, Romania.,Faculty of Medicine and Pharmacy, Department of Surgical Disciplines, University of Oradea, Oradea, Romania
| | - Lucia-Georgeta Daina
- County Clinical Emergency Hospital, Oradea, Romania.,Faculty of Medicine and Pharmacy, Department of Psycho-Neurosciences and Rehabilitation, University of Oradea, Oradea, Romania
| | - Claudia Teodora Judea-Pusta
- Faculty of Medicine and Pharmacy, Department of Morphological Disciplines, University of Oradea, 50 Clujului St., 410060, Oradea, Bihor, Romania.,Bihor County Forensic Service, 50 Clujului St, 410060, Oradea, Bihor, Romania
| | | | - Claudia Maria Jurca
- Faculty of Medicine and Pharmacy, Department of Preclinical Disciplines, University of Oradea, Oradea, Romania.,Department of Genetics, Municipal Clinical Hospital, Dr. Gavril Curteanu, Oradea, Romania
| | - Cristian Marius Daina
- County Clinical Emergency Hospital, Oradea, Romania.,Faculty of Medicine and Pharmacy, Department of Psycho-Neurosciences and Rehabilitation, University of Oradea, Oradea, Romania
| | - Delia Mirela Tit
- Faculty of Medicine and Pharmacy, Department of Pharmacy, University of Oradea, Oradea, Bihor, Romania
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Nagendra CV, Kumar TSS, Bohra V, Wilben V, Karan V, Huded V. Factors Affecting the Effective Management of Acute Stroke: A Prospective Observational Study. Indian J Crit Care Med 2018; 22:138-143. [PMID: 29657369 PMCID: PMC5879854 DOI: 10.4103/ijccm.ijccm_232_17] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Background Stroke, characterized by sudden loss of cerebral function, is among one of the leading cause of death and disability world over. The newer treatment modalities have changed the landscape of stroke treatment but are very much time bound. Aim To characterize pre-hospital and in-hospital factors affecting acute stroke management thus defining lacunae in stroke management. Subjects and Methods A prospective observational study, conducted at the emergency department of a tertiary care center in southern India from August 2015 to July 2016. All stroke patients presenting within first 24 hours of onset were included. A pre -defined Knowledge-Attitude-Practice (KAP) questionnaire was used. Results Total of 133 patients were eligible out of which 28 were excluded for various reasons. Majority were >60 years age and male (61%). About 60% arrived within window. Distance from the hospital was one of the major factors for arrival within the window period. When compared by KAP questionnaire, bystanders of those arriving within window period had better awareness of stroke symptoms. Conclusions Improving awareness of stroke symptoms and increasing availability of EMS is likely increase chances of stroke patients receiving appropriate acute management.
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Affiliation(s)
- C V Nagendra
- Department of Emergency Medicine, Narayana Institute of Cardiac Sciences, Bengaluru, Karnataka, India
| | - T S Srinath Kumar
- Department of Emergency Medicine, Narayana Institute of Cardiac Sciences, Bengaluru, Karnataka, India
| | - Vikram Bohra
- Department of Neurology, Narayana Institute of Cardiac Sciences, Bengaluru, Karnataka, India
| | - Viju Wilben
- Department of Emergency Medicine, Narayana Institute of Cardiac Sciences, Bengaluru, Karnataka, India
| | - Vivek Karan
- Department of Neurology, Narayana Institute of Cardiac Sciences, Bengaluru, Karnataka, India
| | - Vikram Huded
- Department of Neurology, Narayana Institute of Cardiac Sciences, Bengaluru, Karnataka, India
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Gurav SK, Zirpe KG, Wadia RS, Naniwadekar A, Pote PU, Tungenwar A, Deshmukh AM, Mohopatra S, Nimavat B, Surywanshi P. Impact of "Stroke Code"-Rapid Response Team: An Attempt to Improve Intravenous Thrombolysis Rate and to Shorten Door-to-Needle Time in Acute Ischemic Stroke. Indian J Crit Care Med 2018; 22:243-248. [PMID: 29743763 PMCID: PMC5930528 DOI: 10.4103/ijccm.ijccm_504_17] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Objective: “Stroke code” (SC) implementation in hospitals can improve the rate of thrombolysis and the timeline in care of stroke patient. Materials and Methods: A prospective data of patients treated for acute ischemic stroke (AIS) after implementation of “SC” (post-SC era) were analyzed (2015–2016) and compared with the retrospective data of patients treated in the “pre-SC era.” Parameters such as symptom-to-door, door-to-physician, door-to-imaging, door-to-needle (DTN), and symptom-to-needle time were calculated. The severity of stroke was calculated using the National Institutes of Health Stroke Score (NIHSS) before and after treatment. Results: Patients presented with stroke symptoms in pre- and post-SC era (695 vs. 610) and, out of these, patients who came in window period constituted 148 (21%) and 210 (34%), respectively. Patients thrombolyzed in pre- and post-SC era were 44 (29.7%) and 65 (44.52%), respectively. Average DTN time was 104.95 min in pre-SC era and reduced to 67.28 min (P < 0.001) post-SC implementation. Percentage of patients thrombolyzed within DTN time ≤60 min in pre-SC era and SC era was 15.90% and 55.38%, respectively. Conclusion: Implementation of SC helped us to increase thrombolysis rate in AIS and decrease DTN time.
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Affiliation(s)
- Sushma K Gurav
- Neuro Trauma Unit, Ruby Hall Clinic, Pune, Maharashtra, India
| | - Kapil G Zirpe
- Neuro Trauma Unit, Ruby Hall Clinic, Pune, Maharashtra, India
| | - R S Wadia
- Department of Neurology, Ruby Hall Clinic, Pune, Maharashtra, India.,Deapartment of Medicine, BJMC, Pune, Maharashtra, India
| | | | - Prajakta U Pote
- Neuro Trauma Unit, Ruby Hall Clinic, Pune, Maharashtra, India
| | - Amit Tungenwar
- Resident General Medicine, Ruby Hall Clinic, Pune, Maharashtra, India
| | | | - Srikanta Mohopatra
- Department of Accident and Emergency, Ruby Hall Clinic, Pune, Maharashtra, India
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Pandian JD, William AG, Kate MP, Norrving B, Mensah GA, Davis S, Roth GA, Thrift AG, Kengne AP, Kissela BM, Yu C, Kim D, Rojas-Rueda D, Tirschwell DL, Abd-Allah F, Gankpé F, deVeber G, Hankey GJ, Jonas JB, Sheth KN, Dokova K, Mehndiratta MM, Geleijnse JM, Giroud M, Bejot Y, Sacco R, Sahathevan R, Hamadeh RR, Gillum R, Westerman R, Akinyemi RO, Barker-Collo S, Truelsen T, Caso V, Rajagopalan V, Venketasubramanian N, Vlassovi VV, Feigin VL. Strategies to Improve Stroke Care Services in Low- and Middle-Income Countries: A Systematic Review. Neuroepidemiology 2017; 49:45-61. [DOI: 10.1159/000479518] [Citation(s) in RCA: 52] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2017] [Accepted: 07/11/2017] [Indexed: 01/10/2023] Open
Abstract
Background: The burden of stroke in low- and middle-income countries (LMICs) is large and increasing, challenging the already stretched health-care services. Aims and Objectives: To determine the quality of existing stroke-care services in LMICs and to highlight indigenous, inexpensive, evidence-based implementable strategies being used in stroke-care. Methods: A detailed literature search was undertaken using PubMed and Google scholar from January 1966 to October 2015 using a range of search terms. Of 921 publications, 373 papers were shortlisted and 31 articles on existing stroke-services were included. Results: We identified efficient models of ambulance transport and pre-notification. Stroke Units (SU) are available in some countries, but are relatively sparse and mostly provided by the private sector. Very few patients were thrombolysed; this could be increased with telemedicine and governmental subsidies. Adherence to secondary preventive drugs is affected by limited availability and affordability, emphasizing the importance of primary prevention. Training of paramedics, care-givers and nurses in post-stroke care is feasible. Conclusion: In this systematic review, we found several reports on evidence-based implementable stroke services in LMICs. Some strategies are economic, feasible and reproducible but remain untested. Data on their outcomes and sustainability is limited. Further research on implementation of locally and regionally adapted stroke-services and cost-effective secondary prevention programs should be a priority.
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Daffue K, Joubert G, Otto S. Computed tomography stroke findings and population demographics at Pelonomi Hospital, Bloemfontein. SA J Radiol 2016. [DOI: 10.4102/sajr.v20i1.993] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
Background: Stroke remains the highest cause of death in patients more than 50 years old in South Africa, and the fourth highest cause of death overall. There is a paucity of information regarding this disease in the Free State Province.Objectives: To assess the stroke profile of patients referred for computed tomography (CT) imaging to our institution along with evaluating factors that could improve stroke management.Method: The demographic information, stroke risk factors, stroke types and time to imaging were evaluated for all patients who presented for CT stroke imaging from July 2014 until July 2015. Information was gathered prospectively from the hospital and radiology information systems.Results: The study included 174 patients (53.5% female, 46.5% male). Their mean age was 59 years (standard deviation (SD) 14.6). The most prevalent risk factors were hypertension (83.7%), smoking (20.5%) and diabetes (15.0%). The population group consisted of 67.8% ischaemic (n = 118) and 32.2% (n = 56) haemorrhagic strokes. The majority of patients with a known time of symptom onset (n = 102) presented after 8 hours (82.4%). The median order to report time (ORT) was 61 min (range 18 min–1361 min). The median arrival to report time (ART) was 32 min (range 4 min–893 min).Conclusion: Our stroke population did not differ significantly from others in South Africa and Africa overall. Pre- and in-hospital delays significantly influenced patient numbers qualifying for thrombolysis.
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