Krishnadas N C

Abstract

Introduction: Stroke is a leading cause of morbidity and mortality worldwide and there is a significant gap in the availability of standard of care in different regions especially in the rural areas. Aims: To assess the clinical profile and outcome of patients treated with iv rtPA at a rural tertiary care center. Materials and Methods: A prospective observational study of consecutive window period stroke patients treated with iv rtPA. Clinical, epidemiological, imaging parameters, outcome measures including baseline NIHSS, NIHSS at 1 hour, 24 hours, discharge and mRS [modified Rankin Score] at 1 and 3 months were entered in structured proforma. Results: A total od 28 patients were thrombolysed with iv rtPA during the study period. Diabetes, Hypertension and smoking were the most common comorbidities. The mean arrival time in hospital was 151 minutes. The door to needle time was 68 minute. 22 had anterior circulation stroke and 6 with posterior circulation stroke. Mean NIHSS at arrival was 10.4. Mean NIHSS score at 24 hours was 10.1 and NIHSS at 7 days was 9.8. Major improvement as measured as a drop in NIHSS of 8 points was seen in 7 patients [25%]. The mean MRS at 1 month was 2.89 and at 3 months was 1.74. At 3 months follow up 10 out of 28 patients [35.7%] had major improvement characterized by mRS improvement of 3 from time of discharge or final mRS of 0 or 1. Conclusion: Thrombolysis with rtPA is safe and effective in rural setting.   Keywords: Stroke, rtPA, Thrombolysis, NIHSS, Rural.

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Abstract

Introduction: Tenecteplase is an approved engineered recombinant tissue plasminogen activator for treatment of acute ischemic stroke with molecular and practical advantages. It could be quintessential in this era of endovascular care provided that more studies come out, especially from resource poor settings. Aims: To observe the clinico-epidemiological profile and to assess the outcome of acute ischemic stroke patients treated with tenecteplase. Materials and Methods: A prospective observational study of stroke patients treated with tenecteplase. On admission clinical characteristics, temporal, epidemiological, imaging parameters, outcome measures including baseline NIHSS, NIHSS at 1 hour, 24 hours, at discharge, and modified Rankin Scores (mRS) at 0, 1 and 3 months were recorded in a structured proforma. Results: Out of the 19 patients thrombolysed with tenecteplase 68.4% were males. Mean age of the study population was 61.3 years. Hypertension (57.9%), diabetes mellitus (36.8%) and smoking(26.3%) were the most common risk factors.Time parameters like mean onset to door time, door to image and door to needle time were 126 minutes, 29minutes and 66 minutes respectively, which were confirming with the international standards. Mean NIHSS was 11.1 and serial improvement was noted in the post treatment mean NIHSS scores at 1 hours, 24 hours and 7days with values of 8.6,8.0 and 7.7 respectively ( F=5.619,p=0.018). The mean mRS score was 3.5 and the follow up mRS at 1 month (2.4) and 3 months (1.7) (F=19.32, p Conclusion: Thrombolysis with tenecteplase is faster, safer and effective but the treatment response decreases with increasing age.   Keywords: Thrombolysis, Tenecteplase, Stroke, Rural

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Introduction: Delirium causes serious in-hospital morbidity. Aims: Prevalence, risk factors and outcome of delirium were studied in a medical ICU. Materials and Methods: This prospective study in the medical ICU identified delirium by CAM (Confusion Assessment Method). Comorbidities were assessed by Charlson Comorbidity Index. Socio-demographics, clinical parameters and outcome required a structured questionnaire. Data was analyzed using chi- square test, Pearson correlation and independent sample t test. Results: Of 467 patients assessed, 101satisfied CAM diagnosis of delirium (prevalence-21.6%). Females predominated (51.5%); average age was 59.6 years. Acute exacerbation of chronic obstructive pulmonary disease (COPD) was the most common illness, diabetes mellitus (58.4%) followed by hypertension (17.8%) the most common co-morbidities. Leukocytosis, raised serum creatinine and abnormal EEG were observed. 77.2% had nasogastric feeding, 22.8% needed ventilator support.76.2% of patients were on some medication. Delirium was hyperactive in 78.2%, idiopathic in 38.6%. Hypoactive delirium, the least common, was associated with acute pulmonary oedema and sepsis (51.3%). (p=0.009). Delirium resolved completely in 80.2%. Mortality rate was 13.9%. 78.6% patients died within 72 hours (p=0.008); death was increased in those with respiratory findings (p=0.01) and ventilator (p<0.001). Conclusion: A high prevalence of delirium was found in the Medical ICU. This was mostly hyperactive and idiopathic. Hypoactive delirium, the least common, was found associated with acute pulmonary oedema, sepsis. Acute exacerbation of COPD was the most common cause. Those with respiratory findings and on ventilator had higher mortality. Keywords: Delirium, Intensive care, Hypoactive delirium, Ventilator, Mortality.

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