Survival In Acute Stroke Research Articles

Incidence and Risk Factors of Poststroke Depression among Acute Stroke Survival Patients Attending Neurology Outpatient Department of a Selected Hospital in Kolkata

Background: Poststroke depression is consider as the most common emotional disorder of stroke survivors; it can affect one among three of stroke survivors at any time up to 5 years after stroke. Researcher chooses the topic to give focus on the emotional health of the stroke survivors after the stroke. This study was conducted to identify the incidence (short-term incidence) and risk factors of poststroke depression among acute stroke survival patients. Subjects and Methods: This descriptive survey design was conducted at neurology outpatient department of a selected hospital in Kolkata. Total 104 acute (within 3 months following stroke) stroke survival patients were selected by purposive sampling technique for this study purpose. Incidence of poststroke depression was identified by Montgomery–Asberg depression rating scale and for risk factors of poststroke depression; National Institutes of Health Stroke Scale, Barthel Index, and Mini-mental status examination were used. Tool was pretested before the final study. Results: The findings of the study showed that the incidence (short-term incidence) of poststroke depression was 52% (95% confidence interval: 42.2%–61.8%). The Chi-square value reveals that there is a significant association between poststroke depression and deterioration of disease condition from the onset of the disease, days of suffering from the disease, number of admission for the disease, severity of stroke, impairment of level of independence, and impairment of cognitive function. Conclusion: Identifying the risk factors of poststroke depression, the nurses can screen the stroke survival patients for early detection of depression following stroke.

Challenges faced by acute stroke survival patients, attending neurology OPD of a selected hospital in Kolkata

Background:Stroke is a leading cause of mortality & disability worldwide. Despite the remarkable progression in the treatment of stroke, the life quality, psychological & social events caused by stroke received limited attentions. Objective:This study was conducted to identify challenges faced by acute stroke survival patients at neurology OPD of a selected hospital in Kolkata.Methods:A descriptive survey design was applied and total 104 acute (within 3 months following stroke) stroke survival patients were selected by non-probability purposive sampling technique. Socio-demographic characteristics were collected using a structured questionnaire and semi-structured interview schedule was used to identify the challenges faced by acute stroke survival patients.Challenges were assessed in five domains that is physical, psychological, interpersonal, social & financial domain.Results: It was identified from the study findings that 17% of acute stroke survival patients faced mild challenges, 66% patients faced moderate challenges and 16% faced severe challenges following stroke.The study findings also reflects that 100% of acute stroke survival patients face challenges in physical domain and in in physical domain score ranges from 13-40 with a mean of 28.2 and mean percentage of 70.5 which ranked as 1stand the interpersonal domain which range from 4-18 with a mean of 8.4 and mean percentage of 42 ranked as 5th challenge.There is no association between challenges with socio-demographic characteristics. Conclusion:Ultimately identifying the challenges of those patients will provide some information which will help the nurses to counsel the patient so that they can overcome the challenges. Keywords: - Challenges, acute stroke survival patients, neurology OPD.

Abstract TP287: Validation of a Mice Model of Synangiosis to Quantify Neovascularization After Ischemic Stroke

Introduction: Some publications have shown encephalomyosinangiosis (EMAS) as a potential model for surgical indirect revascularizations (SIR). Despite these reports, the validity of this model for neovascularization has not been addressed, in particular the observed variability in vessel proliferation response to ischemia and spontaneous neovascularization. Therefore, we present a systematic quantitative approach to evaluate the validity and variability of EMAS as a SIR model. Methods: We induced precise cerebral ischemia by ligation of the distal MCA via a 3mm temporal craniotomy on C57/BL6J mice. Subjects were randomly allocated to EMAS (placement of temporalis muscle in direct apposition to the brain) or controls (placement of an inert barrier-Teflon). After surgery, animals received BrdU in drinking water to mark newly formed cells. Brain tissue was harvested 14 days after surgery and stained with CD31, NeuN, anti-BrdU-Ab, and DAPI. New-vessels were defined as BrdU/CD31 co-staining, neuronal survival was quantified with NeuN density percentage. Groups were compared using regression mixed models and variability was evaluated using the heterogeneity of variance (HOV) test. Results: New-vessels were seen in the control and EMAS groups. The mean number of new vessels was 8 (SD 4.4) in controls vs. 15.8 (SD 5.1) in EMAS. The effect of treatment (EMAS vs. control) was a significant predictor of new-vessel formation (p<0.01, OR = 1.5 (95% CI: 1.1 - 1.9). The HOV between groups was non-significant. However, CD31 staining alone was not different (controls = 0.58 vs EMAS = 0.59). In terms of neuronal survival, the median NeuN density percentage distribution was 0.9% (IQR=1.2) for controls and 1.6% (IQR= 0.8) for EMAS (p = 0.2). The HOV was also non-significant. Conclusion: EMAS is a suitable model for evaluation of neovascularization after ischemic stroke. However, isolated quantifications of endothelial markers, such as CD31, are insufficient. The use of BrdU, which incorporates in newly synthesized DNA, in combination with endothelial markers is essential to quantify neovascularization. Neovascularization requires time and, as shown in this model, have little impact in neuronal survival in acute stroke.

Abstract TP372: Implementation of a New Intermittent Pneumatic Compression Protocol in a Stroke Unit

Introduction: Intermittent pneumatic compression (IPC) has demonstrated to prevent deep venous thrombosis (DVT) and improve survival in acute stroke. Objective: We aimed to implement a new IPC protocol in our non-invasive stroke unit by applying IPC in the hyperacute stroke phase. Methods: All acute stroke patients with high DVT risk and contraindication for pharmacological DVT prophylaxis received IPC treatment. In ischemic stroke patients treated with reperfusion therapies, IPC protocol was planned for 24hours; intracraneal hemorrhage (ICH) patients were treated with IPC during 72hours. Clinical and hemodynamic variables were recorded. Nurses and patients were interviewed for satisfaction with the new protocol. Results: From March to August 2015, we enrolled 132 patients: 75 male (56.4%), mean age 71+/-15 y.o., ischemic strokes 103 (79.2%). Time from admission to IPC application 102+/-375min. Duration of treatment in ischemic patients was 37+/-21hours while in ICH was 44+/-26hours. No patient presented DVT in our series. We observed 6 deaths (4.5%) and 66 patients (56.4%) presented other complications, none of them related to IPC. Only at implementation phase nurses referred a relevant work burden with the new protocol compared to classical low-weighed-heparin DVT prophylaxis. After training it only takes a mean of 6±1.5 minutes to apply the treatment. Only 3 patients (2.3%) presented discomfort, 2 of them with early IPC drop off. Conclusion: IPC treatment is feasible, safe, and comfortable for stroke patients in the hyperacute phase. It increases work burden for nurses only at the implementation phase.

Estimated glomerular filtration rate and risk of survival in acute stroke

Estimated glomerular filtration rate and risk of survival in acute stroke

Elevated hematocrit is associated with reduced reperfusion and tissue survival in acute stroke

Elevated hematocrit (Hct) contributes to blood viscosity and has an adverse effect in acute stroke. The authors investigated the influence of Hct on tissue fate using serial MRI in acute stroke patients. The effects of Hct on reperfusion, penumbral salvage, and infarct expansion in 64 patients presenting within 24 hours of stroke onset were measured. MRI was performed at baseline (< 24 hours), days 3 to 5, and 90 days from stroke onset. Median Hct was 42% with a bimodal distribution. There was a strong inverse relationship between Hct and reperfusion (Spearman rho = -0.74, p < 0.0001). The odds of major reperfusion (> 50% resolution of the baseline perfusion-weighted imaging deficit) were significantly lower with increasing Hct (odds ratio [OR] = 0.53; 95% CI = 0.97 to 1.00), independent of age, perfusion, and diffusion lesion volumes and recombinant tissue plasminogen activator (rtPA) administration. There was a trend toward reduced penumbral salvage at days 3 to 5 with increasing Hct (p = 0.06, 95% CI = -4.76 to 0.14). An increasing Hct was a significant predictor of infarct growth (OR = 1.26, 95% CI = 1.00 to 1.59), independent of baseline perfusion and diffusion volumes and glucose. The effect of Hct on reperfusion and infarct expansion was similar irrespective of rtPA administration (p = 0.31) and independent of smoking status. Higher hematocrit (Hct) values have a significant independent association with reduced reperfusion and greater infarct size after ischemic stroke. An elevated Hct may also be a potential physiologic determinant of reduced penumbral salvage.