There are approximately 15 million people worldwide suffering from cerebrovascular stroke each year. Of these, 5 million are permanently disabled. One of the disabling consequences of cerebrovascular stroke is functional impairment of the affected upper extremity since its recovery is often delayed than that of the lower extremity. Most rehabilitation strategies of acute hemiplegic patients focus on compensation rather than restoration of upper extremity function since patients use the unaffected upper extremity for activities of daily living. Promising approach to improve sensori-motor recovery after acute stroke is constraint induced movement therapy (CIMT), often labeled “forced use” treatment. CIMT is a behavioral approach in neuro-rehabilitation based on the principle of “learned non-use”. The major components of CIMT include intense repetitive training and behavioral shaping of the impaired limb with immobilization of the unimpaired arm. In our study, we functionally and neurophysiologically assessed the efficacy of CIMT on functional recovery of upper extremity in acute stroke patients.
Fibrinolytic therapy is a time critical intervention proven to reduce mortality and morbidity in patients with acute ST elevation myocardial infarction (STEMI). Limited data exists in South Africa regarding time to fibrinolytic therapy for STEMI patients and reasons for delayed therapy. We established the frequency of fibrinolytic therapy administration to patients presenting with STEMI to a single, urban center in Pretoria, South Africa. Furthermore, we identified reasons for delays in receiving fibrinolytic agents. We suggest potential solutions to address the myriad of challenges facing our country in this regard.
Stroke is located in first places of nontraumatic causes of death worldwide. Although significant improvements in the treatment of patients with acute stroke in recent years, stil was not observed significant fall in morbidity and mortality rate. Critical care of patients with acute stroke is a process that should be continued against time. Not just for ischemic strokes, for hemorrhagic strokes, with rapid diagnoses and with appropriate treatment practice in the pre-hospital and emergency services critical care can provide significant decrease in morbidity and mortality rates. This book provides information supported by recent guidelines related to pre-hospital and hospital diagnosis, treatment and critical care of acute ischemic and hemorrhegic stroke patients. The book light are holders to physicians working in emergency department, neurology and critical care areas.
Stroke is one of the leading cause of disability worldwide. The resultant is motor weakness which adversely affects the functional activities. The arm recovery after stroke is typically poor with 20% – 80% of patients showing incomplete recovery depending on the initial impairment. The upper limb dysfunction is characterized by paresis, loss of manual dexterity and movement abnormalities that may impact considerably on the performance of the ADL with the recovery being poor and ranging from 20%-80% depending on the initial impairment. Neurorehabilitation approaches and various therapeutic techniques have evolved over the years from muscle reeducation in the 1940s to the neurophysiological/neurodevelopmental approaches in the 1950s and 1960s including NDT, Movement Therapy in Hemiplegia, PNF and sensory stimulation techniques, functional/task specific training, strength training, constraint induced movement therapy and so on. in this study Motor Relearning program and Progressive Resistance Exercise is being compared to find out the their effectiveness in upper limb function in hemiplegics.
Stroke is a general term used to describe a focal neurologic event that is acute in onset and may have a vascular cause, etiology, or relevance. A stroke is a condition in which the brain cells suddenly die because of a lack of oxygen.Ischemic Stroke accounts for 80% of stroke. Renal impairment has been linked to higher stroke risk.Renal dysfunction in first-ever ischemic stroke Patients, however, has not been investigated thoroughly. This study investigated renal function status in cohort of patients with ischemic stroke in single ethnicity and from the same area.
Physicians are often facing the task of predicting the immediate and long-term outcome in stroke patients. Early predictor of mortality and poor outcome are crucial for planning the level of care and optimizing resource utilization. The performance of Glasgow Coma Scale (GCS) in prediction of mortality of acute stroke patients was investigated. During the study period every patient admitted to Medicine and Neuro-medicine wards for cerebral infarction (CI) or intracerebral hemorrhage (ICH), were included consecutively in this study. Data for GCS was recorded, follow up and mortality at 7 days and 28 days was determined. Total GCS were labeled into three groups (I, II, III). Prognosis of patients in 7-day and 28-day of 3 groups was tested by chi square (x2) test. On the basis of CT scan finding, one-week case fatality of ICH and CI was 44.8% and 36.4% respectively. Four-week case fatality of ICH and CI was 56.7% and 42.4% respectively. This study shows, GCS is a valuable tool for prediction of short-term mortality in acute stroke patients. The less the GCS score at the onset of acute stroke the more is mortality.
Stroke is a leading cause of disability and death Early and rapid diagnosis of stroke is essential for identifying the optimum treatment strategy. Recurrence can be prevented if the underlying mechanism is understood. The earlier appropriate rehabilitation programmes can be started, the better the chance of a strong recovery. Stroke provides the foundations for practice that will enhance your patient’s chances of recovery. The expert authors provide the evidence-based roadmap you need to provide the best bedside care including: Bedside evaluation of the stroke patient Neurovascular imaging Treatment of acute ischemic stroke and hemorrhagic stroke Diagnosis of stroke mechanism and secondary prevention Post stroke recovery Telemedicine for the acute stroke patient Clinical in approach, practical in execution, Stroke will help you diagnose and manage your patients more effectively.
The length of stay for patients with stroke in some South African government hospitals has been shown to be inadequate and there is little information on the physical impairments and functional abilities of this population once they return to the community. An assessment was done of the strength, range of movement and the presence of pain experienced by patients with stroke in the Daveyton community and the relationship between these impairments and the functional abilities of these patients was established.
In the work based on complex examinations of patients with acute disseminated encephalomyelitis features of the major variants of clinical course of this disease, the characteristics of cognitive functions, the parameters of neurospecific immunity and magnetic resonance tomography pattern in these patients are presented. The quality of life of patients with acute disseminated encephalomyelitis and the prognostic significance of clinical and paraclinical indices for different types of acute disseminated encephalomyelitis course and its transformation into multiple sclerosis are assessed and summarized.
Upper limb dysfunction in stroke patients has an impact on the performance of activity of daily living (ADLS). The ultimate goal for many stroke patients is to achieve maximum level of functional independence. Stroke rehabilitation is often described as a process of active (motor) learning that starts, preferably, within the first few days after the stroke. Some trials found that the favourable outcome in the ADL and independence is still significant at ten years post-stroke onset not only in the first six months depending on the type of rehabilitation.For this reason my work that Submitted for Fulfillment of the Requirements of Doctoral Degree in Physical Therapy for Neuromuscular Disorders and Its Surgery was established with the help of my supervisors Prof. Dr.; Moshera Hassan Darwish,Mohamed S. El Tamawy,Ann Ali Abd El Kader, Mye Ali Basheer to study the appropriate type of rehabilitation for the upper limb dysfunction in the chronic stroke patients that has an impact on brain plasticity in patients with stroke for more than one year.
The use of reperfusion strategies and their efficacy are inversely correlated with the time between the onset of symptoms suggestive of acute coronary disease and patients’ arrival at the hospital for treatment. Patients seeking medical care within the first hour of the onset of symptoms are more than 6 times more likely to receive thrombolytic therapy than the patients who delayed seeking medical care for more than 6 hours. Early thrombolytic therapy, especially within the first “golden hour”, can reduce both infarct size and subsequent disability and mortality. Despite the known importance of early intervention, delay in seeking medical care is common and constitutes a major unresolved public health problem. Therefore, the primary focus of the present study was to examine the extent of the delay and to delineate associated factors in seeking medical care for patients hospitalized with acute coronary syndromes and also to examine avoidable delay in initiation of the intervention at the health care facility. Further our study was also aimed to find out whether delay either in reporting or in intervention and its associated factors has any role in the health outcome.
In Pakistan, comprehensive data from population based studies on the incidence of childhood leukaemia is generally lacking. In developing countries, treatment of acute lymphoblastic leukaemia (ALL) usually relies on different immunophenotypic, cytogenetic and molecular subsets that have differing outcomes with different therapies. In Pakistan, treatment offered to patients is usually based on clinical features of disease at presentation. This books attempts to identify and characterize different risk factors and clinical and genetic prognostic markers in Pakistani ALL patients. Moreover, classification of patients into different risk groups and effects of conventional therapies on treatment outcome were also studied. The importance of research to identify the optimal therapy for children with ALL including well-designed clinical trials, identification of higher risk features with appropriate treatment changes and tailoring of therapy according to response and risk groups are emphasized.
Effective stroke therapy can be improved through real-time monitoring of the neurological and cardiovascular responses to treatment. This requires crucial knowledge on behalf of both the sonographer and stroke physician to make the best decisions for the patient so as to minimize the damage caused by the original stroke and the risk of further stroke. Cerebrovascular Ultrasound in Stroke Prevention and Treatment, Second Edition, takes a practical approach to the examination of patients, the interpretation of ultrasound studies and the application of cerebrovascular ultrasound in the development of management and treatment studies, assisting neurologists, radiologists, and ultrasonographers in stroke therapy.
This was a Retrospective Case-Control study conducted at the Antiretroviral department, Rajiv Gandhi Institute of Medical Sciences(RIMS),Kadapa,India.The study was conducted to assess the incidence, prevalence, severity pattern, predictability, preventability of adverse drug reactions (ADRs) to HAART, and to identify the risk factors for ADRs in HIV-positive patients receiving HAART. Patients between 2010 and May 2011 newly registered HIV patients on HAART therapy of either sex were included. Demographic details, occupations details, education, CD4 cell count, weight and hemoglobin (Hb),Laboratory data, drugs used and suspected ADRs observed were collected.This is the First Retrospective Case-Control study that was designed to evaluate the incidence of ARV therapy-induced ADRs in Indian HIV-positive patients.
Acute Myocardial Infarction is one of the leading causes of mortality worldwide . Arrhythmic events account for the major out of hospital mortality and also contributes significantly to the in hospital mortality. Various markers of adverse outcome in acute Myocardial infarction are in vogue and measurements of arrhythmogenic potential are believed to predict the risk in such patients. In this study we evaluated whether Heart Rate variablity and QT dispersion had prognostic significance in patients admitted with acute myocardial infarction.