This study analyzed outcomes of emergency department-based thrombolysis for stroke performed at Scarborough Acute Trust in the UK between 2004-2009. 110 patients received thrombolysis for acute ischemic stroke. 79 patients treated through the emergency department had an average treatment time of 2.7 hours and 6-month mortality of 15%. 19 patients treated from hospital wards had a treatment time of 3.4 hours and 12% mortality. Outcomes were similar to other European cohorts. The study concluded that thrombolysis for acute ischemic stroke is achievable and safe in district general hospital settings.
Effect of Continuous Infusion of Hypertonic Saline vs Standard Care on 6-Mont...Khaled Ali Ghanayem
Effect of Continuous Infusion of Hypertonic Saline vs Standard Care on 6-Month Neurological Outcomes in Patients With Traumatic Brain Injury The COBI Randomized Clinical Trial - Journal club.
JAMA. 2021;325(20):2056-2066. doi:10.1001/jama.2021.5561
Pharmacological management of cerebral vasospasm in subarachnoid hemorrhagePrisma Health Upstate
Medical management of vasospasm in subarachnoid hemorrhage patients. Despite targeting multiple pathophysiological mechanisms of DCI and vasospasm, most of the trials did not yield results that could translate to clinical practice. Fasudil and emerging therapies like cisternal irrigation and lumbar drainage combined with intrathecal vasodilators and phosphodiesterase medications showed promising results but need to be tested in a randomized clinical trial for effectiveness.
Effect of Continuous Infusion of Hypertonic Saline vs Standard Care on 6-Mont...Khaled Ali Ghanayem
Effect of Continuous Infusion of Hypertonic Saline vs Standard Care on 6-Month Neurological Outcomes in Patients With Traumatic Brain Injury The COBI Randomized Clinical Trial - Journal club.
JAMA. 2021;325(20):2056-2066. doi:10.1001/jama.2021.5561
Pharmacological management of cerebral vasospasm in subarachnoid hemorrhagePrisma Health Upstate
Medical management of vasospasm in subarachnoid hemorrhage patients. Despite targeting multiple pathophysiological mechanisms of DCI and vasospasm, most of the trials did not yield results that could translate to clinical practice. Fasudil and emerging therapies like cisternal irrigation and lumbar drainage combined with intrathecal vasodilators and phosphodiesterase medications showed promising results but need to be tested in a randomized clinical trial for effectiveness.
An overview of Decompression hemicraniectomy in patients with large hemispheric infarctions. The presentation touches upon definition, pathophysiology, medical management, rationale for surgery, mortality, functional outcomes of DHC, and complications in a nutshell.
Trial of decompressive craniectomy for traumatic intracranial hypertension1Dr fakhir Raza
The New England Journal of Medicine, Trial of Decompressive Craniectomy for Traumatic Intracranial Hypertension, Extended Glasgow Outcome Scale (GOS-E), vegetative state, lower severe disability, traumatic brain injury, RESCUEicp,
Associations B/W early blood pressure (BP) variability and clinical outcomes with ICH after antihypertensive therapy clarified by a post hoc analysis of Intensive Blood Pressure Reduction in Acute Cerebral Hemorrhage Trial 2 (INTERACT2)
Confirmed in Stroke Acute Management with Urgent Risk-factor Assessment and Improvement (SAMURAI)-intracerebral hemorrhage study cohort
Tenecteplase is a newer generation tissue plasminogen activator which can be given as a bolus dose than continuous infusion. Genentech, the same company that manufactures Alteplase makes Tenecteplase. Phase 2 RCTs have been done on Tenecteplase comparing its feasibility and safety against Alteplase and so far the studies have been encouraging. In a pooled meta analysis from the Australian TNKase trial and ATTEST trials, tenecteplase seems to be better in recanalizing LVO compared to Alteplase which also showed to improve functional outcome in the first 24hrs and 3 months mRS. But it is difficult to extrapolate the evidence into clinical practice yet as this is a very small number of patients and phase 3 RCTs will answer further questions. This tPA sibling to Alteplase is cheaper and widely available due to its use in Acute coronary syndrome management and its ease of administration demonstrate better profile. But as Genentech is the same company that manufactures both, there is skepticism that it will do any company led phase 3 RCTs to build the evidence for TNKase in Acute ischemic stroke as it is cheaper than Alteplase and they even increased the price of alteplase to >100% since its introduction into the market.
Terapi Endovaskuler, Standar Baru Manajemen Stroke Iskemik Akut? Ersifa Fatimah
Konon, plenary pertama International Stroke Conference (ISC) 2015 yang digelar di Nashville, Tennessee bulan Februari lalu merupakan sesi ISC terseru selama beberapa tahun terakhir. Sebagaimana diberitakan dalam Medscape (Hughes, 2015), para presenter terpaksa memberi jeda beberapa saat untuk menyambut applause dari audiens. Suatu kejadian langka dalam partemuan saintifik. Adalah MR CLEAN, ESCAPE, EXTEND-IA, dan SWIFT PRIME yang menjadi topik hangat lantaran keempat studi ini dirilis dengan hasil yang positif dramatis hingga diprediksi bakal menjadikan terapi endovascular sebagai standar baru dalam manajemen stroke iskemik akut. Sehebat apakah 4 studi yang “menyejarah” dalam tatalaksana stroke iskemik akut ini? Bagaimana bila studi-studi ini diadopsi dan diaplikasikan dalam praktik sehari-hari di sentra kita?
Note: Esai ini ditulis saat SWIFT PRIME fulltext belum published (akhir Maret-awal April 2015). Update & beberapa revisi dibuat menjelang presentasi tanggal 18 Mei 2015.
Pesit trial New England Journal of MedicineDr fakhir Raza
first episode of syncope, should we do workup for Pulmonary embolism well simplified criteria D dimer level CT angiogram ventilation perfusion scanning
An overview of Decompression hemicraniectomy in patients with large hemispheric infarctions. The presentation touches upon definition, pathophysiology, medical management, rationale for surgery, mortality, functional outcomes of DHC, and complications in a nutshell.
Trial of decompressive craniectomy for traumatic intracranial hypertension1Dr fakhir Raza
The New England Journal of Medicine, Trial of Decompressive Craniectomy for Traumatic Intracranial Hypertension, Extended Glasgow Outcome Scale (GOS-E), vegetative state, lower severe disability, traumatic brain injury, RESCUEicp,
Associations B/W early blood pressure (BP) variability and clinical outcomes with ICH after antihypertensive therapy clarified by a post hoc analysis of Intensive Blood Pressure Reduction in Acute Cerebral Hemorrhage Trial 2 (INTERACT2)
Confirmed in Stroke Acute Management with Urgent Risk-factor Assessment and Improvement (SAMURAI)-intracerebral hemorrhage study cohort
Tenecteplase is a newer generation tissue plasminogen activator which can be given as a bolus dose than continuous infusion. Genentech, the same company that manufactures Alteplase makes Tenecteplase. Phase 2 RCTs have been done on Tenecteplase comparing its feasibility and safety against Alteplase and so far the studies have been encouraging. In a pooled meta analysis from the Australian TNKase trial and ATTEST trials, tenecteplase seems to be better in recanalizing LVO compared to Alteplase which also showed to improve functional outcome in the first 24hrs and 3 months mRS. But it is difficult to extrapolate the evidence into clinical practice yet as this is a very small number of patients and phase 3 RCTs will answer further questions. This tPA sibling to Alteplase is cheaper and widely available due to its use in Acute coronary syndrome management and its ease of administration demonstrate better profile. But as Genentech is the same company that manufactures both, there is skepticism that it will do any company led phase 3 RCTs to build the evidence for TNKase in Acute ischemic stroke as it is cheaper than Alteplase and they even increased the price of alteplase to >100% since its introduction into the market.
Terapi Endovaskuler, Standar Baru Manajemen Stroke Iskemik Akut? Ersifa Fatimah
Konon, plenary pertama International Stroke Conference (ISC) 2015 yang digelar di Nashville, Tennessee bulan Februari lalu merupakan sesi ISC terseru selama beberapa tahun terakhir. Sebagaimana diberitakan dalam Medscape (Hughes, 2015), para presenter terpaksa memberi jeda beberapa saat untuk menyambut applause dari audiens. Suatu kejadian langka dalam partemuan saintifik. Adalah MR CLEAN, ESCAPE, EXTEND-IA, dan SWIFT PRIME yang menjadi topik hangat lantaran keempat studi ini dirilis dengan hasil yang positif dramatis hingga diprediksi bakal menjadikan terapi endovascular sebagai standar baru dalam manajemen stroke iskemik akut. Sehebat apakah 4 studi yang “menyejarah” dalam tatalaksana stroke iskemik akut ini? Bagaimana bila studi-studi ini diadopsi dan diaplikasikan dalam praktik sehari-hari di sentra kita?
Note: Esai ini ditulis saat SWIFT PRIME fulltext belum published (akhir Maret-awal April 2015). Update & beberapa revisi dibuat menjelang presentasi tanggal 18 Mei 2015.
Pesit trial New England Journal of MedicineDr fakhir Raza
first episode of syncope, should we do workup for Pulmonary embolism well simplified criteria D dimer level CT angiogram ventilation perfusion scanning
Acute management of patients with stroke is to stabilize the patient and to complete initial evaluation and assessment, including imaging and laboratory studies, within 60 minutes of patient arrival.
Critical decisions focus on the need for intubation, blood pressure control, and determination of risk/benefit for thrombolytic intervention.
Thrombolysis and thrombectomy for acute ischaemic strokeHan Naung Tun
Reperfusion by intravenous thrombolysis or endovascular
mechanical thrombectomy improves functional outcomes
after stroke, but benefit for both treatment modalities is highly
time-dependent. Maximum benefit requires minimisation
of onset-to-treatment times. The safety and efficacy of IV
rtPA is established across a broad range of clinical scenarios.
Endovascular treatment now offers greatly improved outcome
among patients with poor response to IV rtPA but efficacy
has been established only in the context of highly organised
neurovascular interventional services.
Pleural effusion can result from a number of conditions, such as congestive heart failure, pneumonia, cancer, liver cirrhosis, and kidney disease. [1] The characteristics of the fluid depend on the underlying pathophysiologic mechanism. The fluid can be transudate, nonpurulent exudate, pus, blood, or chyle. Imaging studies are valuable in detecting and managing pleural effusions but not in accurately characterizing the biochemical nature of the fluid.
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...kevinkariuki227
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
Report Back from SGO 2024: What’s the Latest in Cervical Cancer?bkling
Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
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1. JOURNAL PRESENTATION FROM :
BRITISH MEDICAL JOURNAL.
By A P Volans, Emergency Department,
Scarborough Acute Trust. U.K.
Published in June 2011.
2. AN ANALYSIS OF OUTCOMES OF
EMERGENCY PHYSICIAN/DEPARTMENT
– BASED THROMBOLYSIS FOR STROKE
3.
4. INTRODUCTION
• For many years, stroke was a condition that was
primarily diagnosed by emergency physicians, but
only few effective interventions were available in
the emergency department to reduce the burden of
the disease.
• Intravenous thrombolysis has been recommended
for the treatment of ischaemic stroke with in 3 to 4
½ hours of onset of symptoms.
5. • There is a difficulty in delivery of effective
thrombolysis across the system.
• There is a need for timely intervention in
stroke and to develop services for stroke
patients across the country.
6. AIM OF THE STUDY
• To describe the services and the outcomes of
thrombolysis in stroke in District hospital
setting.
• To study the outcome and complications in the
treated cohort.
7. METHOD AND METHODOLOGY
• Study done at Scarborough Acute Trust- a 320
bedded DGH.
• The emergency department has 42,000
patients and 25,000 minor cases are seen at
periphery minor injury units.
8. • It is equipped with CCU and CT scanning is
available 24hrs a day.
• Scarborough had introduced stroke
thrombolysis in 2004.
• Initially it was done under the auspices of the
Safe Implementation of Thrombolysis in Stroke
– Monitoring Study (SITS-MOST).
9. • Patients presenting to emergency department at
Scarborough were entered into SITS-MOST
registry, and the national and the international
comparisons were made.
• This database collects demographic, physiological,
clinical and radiological data at presentation and
records initial stroke severity using NIH Stroke
Scale(NIHSS) score and determines outcome at 7
days using a Global Score and at three months
using Rankin Scale.
10. • For presentation of the local results of stroke
outcome, patients were categorized at
discharge into:
• 1. Good responders- improvement in multiple
areas of neurological loss.
• 2. Partial responders- improvement one area.
• 3. Poor responders- no improvement.
11. • Complications related to treatment (significant
intra-cerebral bleeding) – obtained from
patient notes.
• Mortality was determined at 6 months after
presentation.
13. RESULTS
• Between 2004-09 Jan, Scarborough treated 110
cases of stroke with thrombolysis and data of 98
patients was available.
• Age of the patients ranged between 39-91 yrs.
• 79 patients were treated through ED-pathway, with
average time of treatment of 2.7hrs and cohort
6months mortality of 15%.
• 19 cases from wards, admitted for other diagnoses
including TIA, were treated with treatment of
3.4hrs and a cohort mortality of 12%.
14. • Early deaths occurred in 7patients, all in non
responsive group.
• 5 patients died on day 1, CT of 4 showed massive
cerebral oedema. 5th died before a repeat CT, and
could be due post-thrombolysis intra-cerebral
haemorrhge .
• 5th oedema death was 5 days after stoke onset.
• Late deaths were associated with failure to
rehabilitate and had complications of stroke
recorded.
15.
16. DISCUSSION
• Thrombolysis in stroke could be provided
outside hyper acute stroke centers.
• The outcomes of thrombolysis are similar to
European based cohort.
• The use of objective coding systems like NIHSS
and availability of neurologists and stroke care
has made the decision of thrombolysis in
difficult cases much easier.
• Support of radiology is essential.
17.
18.
19. CONCLUSION
• Thrombolysis for acute ischaemic stroke is
achievable and safe within DGH settings.
• A DGH based thrombolysis service could
potentially offer thrombolysis to 10% of
patients presenting with an acute stroke.
• Thrombolysis should be available at the place
where patients with acute ischaemic stroke
present.
• Outcomes can be compared with different
settings.
20. Related studies
• Emergency department – focused thrombolysis
for acute ischaemic stroke: done at Department
of Emergency Royal United Hospital, Combe
Park, Bath, UK.
• Conclusion of this study:
• It is possible to provide ED- focused service for
thrombolysis of acute ischaemic stoke with
initial management and thrombolysis decisions
made with in the ED.
21. Continued…
• An ED stroke thrombolysis protocol can be
relatively easily instituted with in large district
hospital provided there is support.
• It is possible that the results of ECASS3
supporting the extension of thrombolytic
therapy up to 4.5hrs after the onset of stroke
may change impact and may increase public
awareness.
22. Continued..
• An ED stroke thrombolysis protocol seem to be the
most efficient and effective means of delivering this
treatment.
• The impact of public information campaign has
been minimal. However there is likely to be an
increase in the numbers of patients presenting in
the acute potential thrombolysis window in the
near future.
• There also a need to develop a sustainable service
24X7.
23. Positive Results Number Percentage
No. of patients presenting with acute stroke
between June 2008-June 2009
298 100%
Eligible for thrombolysis 24 8%
Thrombolysed 16 5%
Treated by emergency physician and stroke
physician
8 50%
Treated by emergency physicians autonomously 8 50%
24.
25. Indian studies
• Jeyaraj Durai Pandian
• Department of Neurology, Stroke Unit, Betty
Cowan Research and Innovation Centre,
Christian Medical College, Ludhiana - 141 008,
Punjab, India
• Re-canalization in acute ischemic stroke: The
strategies
26. • Re-canalization is an important predictor of stroke
outcome in all the modalities of thrombolysis.
• Thrombolysis in acute ischemic stroke evolved from
clinical trials with intravenous (IV) tissue plasminogen
activator (tPA) to combination treatments with Intra-
arterial (IA)/mechanical reperfusion techniques.
• The combined approach reduces time to initiation of
treatment and may increase re-canalization and chances
of a good clinical outcome.
27. • . In IV thrombolysis overall re-canalization rate
is 46.2% during the first 6-24 hrs.
• Intra-arterial thrombolysis has higher early re-
canalization rate, 63.2%.
• The highest re-canalization rate is seen with
mechanical thrombolysis, 83.6%.
28.
29. Other related study
• From Neurology Update Mumbai 2012
• Off label thrombolytic therapy : when and why.
By Peter Schillenger
• Most common limitations of Iv-rtPa are :
• Time window from onset of symptoms and
presentation, patient age, stroke severity on
lower and the end, history of diabetes and prior
stroke, and blood pressure management.
30.
31. The Modified Rankin Scale (mRS)
• The scale runs from 0-6, running from perfect health without symptoms to
death.
• 0 - No symptoms.
• 1 - No significant disability. Able to carry out all usual activities, despite
some symptoms.
• 2 - Slight disability. Able to look after own affairs without assistance, but
unable to carry out all previous activities.
• 3 - Moderate disability. Requires some help, but able to walk unassisted.
• 4 - Moderately severe disability. Unable to attend to own bodily needs
without assistance, and unable to walk unassisted.
• 5 - Severe disability. Requires constant nursing care and attention,
bedridden, incontinent.
• 6 - Dead.