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.
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.
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 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.
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.
Acute lung injury (ALI) is a common complication of different conditions like sepsis, shock and trauma, which may emerge into full-blown acute respiratory distress syndrome (ARDS). During the last 15 years, participation of the endothelin-1 (ET-1) system in the pathogenesis of ALI/ARDS has been intensively studied. In sepsis-induced acute lung injury (ALI), endothelin-1 (ET-1) is suspected of increasing lung capillary pressure and probably permeability. In present study, we studied pulmonary hemodynamic, volumetric and permeability effects of the non-selective ET-1 receptor antagonist, tezosentan, in animals with endotoxin or sepsis-induced ALI. We also studied the activation of protein kinase C alpha and expression of mRNA for prepro-ET-1 and its receptors in animals lung tissue cells. Additionally, we investigated the relationship between the plasma concentration of ET-1 and extravascular lung water index (EVLWI) in septicemic patients.
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.
Acute myocardial infarction (AIM) resulting change in the size and shape of left ventricle (LV). Aim- to determine whether parameters of echocardiography are important in AIM in predicting LV remodeling and in prediction of adverse cardiovascular events after AMI. Methods- The study included 70 patients with AMI. Patients were examined the clinical, laboratory and ECHO (dwo-dimensional, pulsed and tissue doppler) and angiographic and reviewed after 30 days. The outcomes were: death, reinfarction, or heart failure ((HF). Results- ECHO findings showed reduced systolic and diastolic LV function in the first 24 hours of AMI, while the E/Ea manifest high values > 9, After 30 days volumes increase in enddiastole and endsystole 18,6% patients had an ejection fraction (EF) 8 After 30 days 2D ECHO demonstrated that the HF significantly higher in patients with an increased dimensions and volume LV , an enlarged left atrium, mitral regurgitation and low EF, higher E wave and lower septal S Conclusion- ECHO parameters have prognostic significance in predicting recovery of LV after early reperfusion therapy and in predicting adverse events.
There are many issues that increase the complexity of health care today. Among these issues are (a) the cost of health care, (b) the quality of health care, (c) medical errors and patient injury, and (d) the shortage of nursing staff to care for the patients. There are drivers in place to overhaul the health care system. The drivers demand improvement in quality of care, reduction in medical errors and patient injury, improved patient health care outcomes, and a decrease in medical care expenditures. The key to addressing these issues lies within the transformation of the current hierarchical structure of the acute care unit into a High Performing Organization (HPO). This paper examines an evidence-based practice proposal utilizing Blanchard’s HPO model as a means to delineate the factors that impede high level functioning on an acute care unit, remove the barriers that obstruct high performance, and empower the staff in order to become a high performing unit (Blanchard, 2007). Leaders of high performing organizations partner with their employees in order to create an organization that is grounded in becoming high performing.
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.
The book focuses on the blood pressure management in acute ischemic stroke and in elderly hypertensive patients- still unresolved issues. The pathophysiology and management of the transient elevated blood pressure in acute ischemic stroke are presented. Blood pressure lowering may have a detrimental effect. The ultrasound carotid disease evaluation and cerebral hemodynamics monitoring, using bedside bilateral transcranial ultrasonography, during emergency blood pressure management are recommended. Such an approach could individualize the antihypertensive treatment and improve functional outcome. Epidemiological, clinical and neuroimaging data on the relationships between hypertension and cognitive functions in elderly hypertensive persons are given. The impact of antihypertensive treatment is reviewed. Blood pressure lowering could increase the risk of cerebral hypoperfusion and cognitive impairment. Neuropsychological assessments, ultrasound carotid disease evaluation and cerebral hemodynamics monitoring during blood pressure management in elderly hypertensive patients with the aim to prevent cognitive decline are recommended. The book is written for physicians.
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.
Acetaminophen is widely used as an analgesic and antipyretic drug. Prolong daily use or overdose of this drug may cause acute liver and kidney damage. This book was designed to assist in the diagnosis of patients with liver and kidney damage of indeterminate etiology for which acetaminophen is suspected. Thus, this book intends to add to the list of drugs that can possibly be used in treatment of acetaminophen overdose.
The metabolic syndrome a concurrence of disturbed glucose and insulin metabolism, overweight and abdominal fat distribution, dyslipidemia and hypertension, is associated with subsequent development of type 2 diabetes mellitus and cardiovascular disease (CVD). Despite its high prevalence in Asians, no national estimate is currently available on the metabolic syndrome in patients with acute myocardial infarction in Pakistan.A matched case control study using questionnaire and analysis of components of metabolic syndrome was carried out at tertiary care hospitals of Peshawar Pakhtunkhwa.The result showed that patients were 6.19 times more likely to have three or more diagnostic criteria of metabolic syndrome than the controls i.e. 55% vs 17%. This study contributed to the fact that metabolic syndrome is more common in patients with acute myocardial infarction. Screening of adults with central obesity for other parameters of the metabolic syndrome may help to reduce the prevalence of metabolic syndrome as well of myocardial infarction at an early age, which is the complication of metabolic syndrome.