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1. Acute Stroke Care
H o w f a r h a v e w e r e a c h e d ?
N e p a l
Lekhjung Thapa, MD, DM (Neurology)
Associate Professor of Neurology
Hospital Director
UDM-National Institute of Neurological and Allied Sciences
Founder President, Nepal Stroke Association (NSA)
Commissioner Nepal, Lancet Commission on Stroke for LMICs

2. Objectives
1. Stroke burden in Nepal
2. Stroke Treatment
3. Publications
4. Public Awareness
5. Nepal Stroke
Association (NSA)
Background
• A major cause of
morbidity and mortality
• LMICs:
• Deaths: 86% of
global stroke death
• DALY’s: 7 X Higher
• Feigin et. al; 2009

3. Objectives
“Each year”
• 50,000 people have stroke
• 15,000 people die from stroke
The Jaya Stroke Foundation
1. Stroke burden in Nepal
2. Stroke Treatment
3. Publications
4. Public Awareness
5. Nepal Stroke
Association (NSA)
Estimation

4. Objectives
Bhandari GP. State of non-communicable diseases in Nepal. BMC Public Health. 2014;14:23.
1. Stroke burden in Nepal
2. Stroke Treatment
3. Publications
4. Public Awareness
5. Nepal Stroke
Association (NSA)
CVD in General

5. Objectives
• No official reports on community-based study of
Stroke
• Hospital-based study:
• Annual incidence: 64 per 1000 admission
Thapa A et al. 2018
1. Stroke burden in Nepal
2. Stroke Treatment
3. Publications
4. Public Awareness
5. Nepal Stroke
Association (NSA)
Hospital-based Incidence

6. Objectives
1. Stroke burden in Nepal
2. Stroke Treatment
3. Publications
4. Public Awareness
5. Nepal Stroke
Association (NSA)
Stroke Prevalence (Community Survey)
2018 Aug-Sept. Thapa LJ, Shrestha S, Paudel R. et al. NSA Community Survey

7. Objectives
Mean age: 59-62 years
M>F
Risk factors: HTN, Cigarette smoking, Alcohol,
Diabetes
Type: Ischemic (63%) Vs Hemorrhagic (37%)
Unique: Traditional healers in rural area
Shaik MM, Loo KW, Gan SH. Burden of stroke in Nepal. IJS 2012
1. Stroke burden in Nepal
2. Stroke Treatment
3. Publications
4. Public Awareness
5. Nepal Stroke
Association (NSA)
Stroke Demographics

8. Objectives
1. Stroke burden in Nepal
2. Stroke Treatment
3. Publications
4. Public Awareness
5. Nepal Stroke
Association (NSA)
Stroke Risk Factors
0 10 20 30 40 50 60
Atrial Fibrillation (n=1004)
Diabetes (n=2819)
Dyslipidemia (n=682)
Alcohol (n=1728)
Smoking (n=2362)
Hypertension (n=2573)
15.6
16.1
29.5
31.4
47.9
50.0
Percentage
Common stroke risk factors of Nepal 2017

9. Objectives
• 1923: Radiology started in Nepal. X-ray machine in
Military Hospital (Tri-Chandra Electromedical
Institute)
• 1984: First CT scan at Bir Hospital
• 1989: First MRI (0.2T) at Shree Birendra Military
Hospital
Source: Dr. DN Gongal & Dr. RK Ghimire
Brant WE, Budathoki TB, Pradhan R. Radiology in Nepal. AJR Am J Roentgenol. 1996;166(2):259-262.
Subedi KS, Sharma P. Development of Radiology in Nepal: Gearing Up for Mountainous Challenges. JACR 2013;10(4): 291-295
1. Stroke burden in Nepal
2. Stroke Treatment
3. Publications
4. Public Awareness
5. Nepal Stroke
Association (NSA)
Stroke Diagnosis

10. Objectives
• 30-day mortality: 0.5%
• 3-year mortality: 8.3%
• Thapa A. NJN 2018
• ICU setting outside valley:
• 7 days mortality:
• 29.54% (70% ischemic 30% Hemorrhagic)
• Thapa L. JNMA 2013
1. Stroke burden in Nepal
2. Stroke Treatment
3. Publications
4. Public Awareness
5. Nepal Stroke
Association (NSA)
Stroke Outcome

11. Objectives
1. Stroke burden in Nepal
2. Stroke Treatment
3. Publications
4. Public Awareness
5. Nepal Stroke
Association (NSA)
Reality: A Decade Ago

12. Objectives
1. Stroke burden in Nepal
2. Stroke Treatment
3. Publications
4. Public Awareness
5. Nepal Stroke
Association (NSA)
Reality: 2019
“Hurdles in implementing proper stroke care”
5% (15 out of 300)
ELIGIBLE FOR THROMBOLYSIS

13. Objectives
1. Stroke burden in Nepal
2. Stroke Treatment
3. Publications
4. Public Awareness
5. Nepal Stroke
Association (NSA)
Thrombolysis
J Neurosci Rural Pract. 2016 Jan-Mar; 7(1): 55–60.

14. Objectives
1. Stroke burden in Nepal
2. Stroke Treatment
3. Publications
4. Public Awareness
5. Nepal Stroke
Association (NSA)
Acute Stroke Care

15. Objectives
1. Stroke burden in Nepal
2. Stroke Treatment
3. Publications
4. Public Awareness
5. Nepal Stroke
Association (NSA)
First Dedicated Stroke Unit
12 December 2018; 2075 Mangsir 26

16. Objectives
1. Stroke burden in Nepal
2. Stroke Treatment
3. Publications
4. Public Awareness
5. Nepal Stroke
Association (NSA)
First Dedicated Stroke Clinic
2018 December

17. Objectives
Thapa LJ, Shrestha AM, Bhattarai S, Raut M, Mahaseth A, K.C..N. Current Status of
Stroke Thrombolysis in Nepal (2017)
1. Stroke burden in Nepal
2. Stroke Treatment
3. Publications
4. Public Awareness
5. Nepal Stroke
Association (NSA)
Treatment-Delay

18. Objectives
1. Stroke burden in Nepal
2. Stroke Treatment
3. Publications
4. Public Awareness
5. Nepal Stroke
Association (NSA)
Treatment-Delay: The Reasons

19. Objectives
1. Stroke burden in Nepal
2. Stroke Treatment
3. Publications
4. Public Awareness
5. Nepal Stroke
Association (NSA)
Acute Stroke Team
2019
TOP: Suman Bhattarai, Binita, Mayush, Anzil MS Maharjan
BOTTOM: Subash Phuyal, Lekhjung Thapa, Shikher Shrestha

20. Objectives
1. Stroke burden in Nepal
2. Stroke Treatment
3. Publications
4. Public Awareness
5. Nepal Stroke
Association (NSA)
First Mechanical Thrombectomy
PC: Dr Subash Phuyal
Total number: 43, as of July 04, 2020 [Grande & UDM-NINAS]

21. Objectives
www.thelancet.com/lancetgh Vol 8 May 2020
1. Stroke burden in Nepal
2. Stroke Treatment
3. Publications
4. Public Awareness
5. Nepal Stroke
Association (NSA)
Mechanical Thrombectomy

22. Objectives
1. Stroke burden in Nepal
2. Stroke Treatment
3. Publications
4. Public Awareness
5. Nepal Stroke
Association (NSA)
Mechanical Thrombectomy
March 11, 2020: First Biplane Cath-Lab in Country, UDM-NINAS

23. 0
1
2
3
4
5
6
7
8
2001 2006 2008 2011 2012 2013 2014 2015 2016
Numberofpublication
Year of publication
Trend of Stroke studies of Nepal (n=24)
23
Shrestha S. (2016) Stroke in Nepal: an update 2016.
1. Stroke burden in Nepal
2. Stroke Treatment
3. Publications
4. Public Awareness
5. Nepal Stroke
Association (NSA)
Objectives

24. Journals coverage of stroke studies
(n=24)
24
79.2
20.8
0 20 40 60 80 100
National journals
International journals
Percentage
Very few acceptance in international journals
Shrestha S. (2016) Stroke in Nepal: an update 2016.
1. Stroke burden in Nepal
2. Stroke Treatment
3. Publications
4. Public Awareness
5. Nepal Stroke
Association (NSA)
Objectives

25. Stroke Researches in Nepal
1. Stroke burden in Nepal
2. Stroke Treatment
3. Publications
4. Public Awareness
5. Nepal Stroke
Association (NSA)
Objectives

26. Stroke Researches in Nepal
1. Stroke burden in Nepal
2. Stroke Treatment
3. Publications
4. Public Awareness
5. Nepal Stroke
Association (NSA)
Objectives

27. Stroke Researches in Nepal
1. Stroke burden in Nepal
2. Stroke Treatment
3. Publications
4. Public Awareness
5. Nepal Stroke
Association (NSA)
Objectives

28. 0 1 2 3 4 5 6
PMJN
JNHRC
JMHC
JNDT
JCMS
IJCRR
JIOM
JNRP
NJN
NMCJ
JNMA
KUMJ
Number
Nameofjournal
Journals coverage of stroke studies till 2016
(n=24)
1. Stroke burden in Nepal
2. Stroke Treatment
3. Publications
4. Public Awareness
5. Nepal Stroke
Association (NSA)
Objectives

29. 1. Stroke burden in Nepal
2. Stroke Treatment
3. Publications
4. Public Awareness
5. Nepal Stroke
Association (NSA)
Objectives Stroke Specific Journal

30. 1. Stroke burden in Nepal
2. Stroke Treatment
3. Publications
4. Public Awareness
5. Nepal Stroke
Association (NSA)
Objectives

31. 1. Stroke burden in Nepal
2. Stroke Treatment
3. Publications
4. Public Awareness
5. Nepal Stroke
Association (NSA)
Objectives First World Stroke Day Celebration, Nepal
BP Koirala Institute of Health
Sciences, Dharan, 2008
Dr Lekhjung Thapa
Dr Sailendra Shrestha

32. 1. Stroke burden in Nepal
2. Stroke Treatment
3. Publications
4. Public Awareness
5. Nepal Stroke
Association (NSA)
Objectives Nepal Stroke Association (NSA)
Established March 2017; Founder President: Dr Lekhjung Thapa, Current President: Dr Raju Paudel

33. 1. Stroke burden in Nepal
2. Stroke Treatment
3. Publications
4. Public Awareness
5. Nepal Stroke
Association (NSA)
Objectives Nepal Stroke Association (NSA)
“The Team that Dreamt”

34. 1. Stroke burden in Nepal
2. Stroke Treatment
3. Publications
4. Public Awareness
5. Nepal Stroke
Association (NSA)
Objectives Nepal Stroke Association (NSA)
The NSA members grew very rapidly..

35. 1. Stroke burden in Nepal
2. Stroke Treatment
3. Publications
4. Public Awareness
5. Nepal Stroke
Association (NSA)
Objectives Nepal Stroke Association (NSA)
Dr Lekhjung Thapa (Founder President),
Dr Raju Paudel (Current President)
Anup Pahari
Vice-Governor Nepal,
Lions International
Dr P Jalan, Vice-President
Nepal Stroke Association

36. NSA: Public Awareness
1. Stroke burden in Nepal
2. Stroke Treatment
3. Publications
4. Public Awareness
5. Nepal Stroke
Association (NSA)
Objectives

37. NSA: Public Awareness
1. Stroke burden in Nepal
2. Stroke Treatment
3. Publications
4. Public Awareness
5. Nepal Stroke
Association (NSA)
Objectives

38. NSA: Public Awareness
1. Stroke burden in Nepal
2. Stroke Treatment
3. Publications
4. Public Awareness
5. Nepal Stroke
Association (NSA)
Objectives

39. NSA Promotes Stroke Education
1. Stroke burden in Nepal
2. Stroke Treatment
3. Publications
4. Public Awareness
5. Nepal Stroke
Association (NSA)
Objectives

40. NSA: Physiotherapy & Stroke
1. Stroke burden in Nepal
2. Stroke Treatment
3. Publications
4. Public Awareness
5. Nepal Stroke
Association (NSA)
Objectives
R Kandu, K Senthil, DN Gongal, LJ Thapa, R Paudel, Avinash Chandra, 2018 KTM

41. NSA: Public Speaking-Training
1. Stroke burden in Nepal
2. Stroke Treatment
3. Publications
4. Public Awareness
5. Nepal Stroke
Association (NSA)
Objectives

42. NSA Promotes Stroke Education
1. Stroke burden in Nepal
2. Stroke Treatment
3. Publications
4. Public Awareness
5. Nepal Stroke
Association (NSA)
Objectives
Back: D napit, V Rauniyar, P Jalan: Front: M Sharma, LJ Thapa, DN Gongal

43. NSA Promotes Stroke Education
1. Stroke burden in Nepal
2. Stroke Treatment
3. Publications
4. Public Awareness
5. Nepal Stroke
Association (NSA)
Objectives

44. International Association
1. Stroke burden in Nepal
2. Stroke Treatment
3. Publications
4. Public Awareness
5. Nepal Stroke
Association (NSA)
Objectives

45. 1. Stroke burden in Nepal
2. Stroke Treatment
3. Publications
4. Public Awareness
5. Nepal Stroke
Association (NSA)
Objectives

46. International Association
1. Stroke burden in Nepal
2. Stroke Treatment
3. Publications
4. Public Awareness
5. Nepal Stroke
Association (NSA)
Objectives

47. Stroke App in Nepali
1. Stroke burden in Nepal
2. Stroke Treatment
3. Publications
4. Public Awareness
5. Nepal Stroke
Association (NSA)
Objectives

48. Thank you