Status In Acute Stroke Patients Research Articles

Electrolytes Status in Acute Stroke Patient in Rajshahi Medical College Hospital

Background: Stroke is a major cause of mortality and morbidity worldwide, significantly impacting patients and healthcare systems. Electrolyte imbalances are common in acute stroke patients and can influence clinical outcomes. This study investigates the electrolyte status in acute stroke patients admitted to Rajshahi Medical College Hospital Objective: To evaluate the electrolyte status (sodium and potassium levels) in acute stroke patients and its association with stroke types (Ischaemic and haemorrhagic) and clinical outcomes. Method: A cross-sectional study was conducted over two years (July 2017 to June 2019) in the Medicine and Neuromedicine Department of Rajshahi Medical College Hospital. A total of 104 acute stroke patients were included. Serum sodium and potassium levels were measured upon admission. Sociodemographic data, stroke types, and electrolyte levels were analyzed. Results: Among the 104 stroke patients, 71 (68.27%) had ischaemic stroke, and 33 (31.73%) had haemorrhagic stroke. The age distribution was highest in the 50-60 years group (34.62%). Males comprised 58.65% of the patients. Sodium levels were normal in 61.54% of patients, high in 2.88%, and low in 35.58%. Potassium levels were normal in 68.27% of patients, high in 10.58%, and low in 21.15%. No significant difference was found in sodium (p>0.05) and potassium (p>0.05) levels between ischaemic and haemorrhagic stroke patients. Conclusions: Electrolyte imbalances are prevalent in acute stroke patients, but no significant differences were observed between ischaemic and haemorrhagic stroke types. Regular monitoring and correction of electrolytes are crucial in managing stroke patients to improve outcomes.

Plama Osmolality Status in Acute Stroke Patients and in Healthy Individuals in Rajshahi Medical College Hospital

Background: Stroke is the most prevalent neurological emergency and accounts for approximately 50% of all neurological disorders in medical college hospitals. It is the leading cause of adult neurological morbidity and the third leading cause of death globally. Changes in plasma osmolality are associated with increased complications, mortality, morbidity, and disability in stroke patients. Objective: This study aims to investigate the changes in plasma osmolality in different types of acute stroke patients and its impact on stroke outcomes. Method: The study included two groups: Group I comprised 104 acute stroke patients (mean age 58.87±13.70) as cases, and Group II consisted of 104 age- and sex-matched healthy individuals (mean age 57.55±12.60) as controls. Each stroke patient underwent cranial computed tomography within the first 24 hours. Blood tests for blood sugar, serum electrolytes, lipid profile, and blood urea were performed. The CT findings and pathological test results were analyzed using SPSS software. Result: Among the 104 stroke patients, 71 (68.27%) had ischemic stroke, and 33 (31.73%) had hemorrhagic stroke. Dyselectrolytaemia was observed in 73 (70.20%) of the stroke patients, while 31 (29.80%) had normal electrolyte levels. Hyperosmolality was present in 58 (55.77%) of the patients, and hypoosmolality was found in 3 (2.88%). Conclusions: Abnormal plasma osmolality is a significant independent risk factor for complications in acute stroke patients, both ischemic and hemorrhagic. Plasma osmolality estimation should be considered a crucial clinical investigation for evaluating acute stroke patients in the early stages.

Abstract WP457: Safety and Effect of Medium-Chain Triglycerides Oil to Prevent Deterioration of Nutritional Status in Acute Stroke Patients With Severe Renal Dysfunction

Introduction: When nutritional status in acute stroke patients with renal dysfunction is deteriorated, it is difficult to prevent further deterioration and improve nutritional status, because protein-enriched diet probably causes deterioration of renal function. Hypothesis: Medium-chain triglycerides (MCT) oil composed of caprylic acid (C8) and capric acid (C10) may safely prevent further deterioration and improve nutritional status in acute stroke patients with severe renal dysfunction, because medium-chain fatty acids do not deteriorate renal function. Methods: We included acute stroke patients who 1) were admitted between August 2016 and December 2018, 2) presented creatinine (Cre) of more than 1.5 mg/dl on admission, 3) underwent blood examination on admission, the 3rd day and 7th day, 4) presented prealbumin of less than 20 mg/dl on the 3rd day and 4) who took daily 15g of MCT from the 3rd to the 6th day. We evaluated patients’ features, albumin (Alb), PreAlb, high-sensitivity C-reactive protein (hs-CRP) and Cre on admission, 3rd day and the 7th day. Results: Thirteen patients met our inclusive criteria and were analyzed. The median age, body mass index, Cre, creatinine clearance (Ccr), blood glucose (BG), hs-CRP, Alb and PreAlb were 86 years, 23.2 kg/m2, 1.93 mg/dl, 19.2 mL/min, 117 mg/dl, 0.433 mg/dl, 3.6 g/dl and 17.3 mg/dl. Their Ccr was less than 15 mL/min in 4 (30.8%) of 13 patients, 15 or more and less than 30 mL/min in 7 (53.8%) of 13 patients and 30 or more and less than 40 mL/min in 2 patients (15.4%). Eleven patients received enteral feeding and two patients ate food orally. Their median calorie intake was 1,000 kcal/day except MCT supplementation. On the 3rd day, their median Alb and PreAlb levels decreased to 2.7 mg/dl (p<0.001) and 10.8 mg/dl (p<0.01), respectively, their median hs-CRP increased to 4.01 mg/dl (p<0.01) and Cre was 2.0 mg/dl (ns). On the 7th day following MCT supplementation, their median Alb was 2.7 mg/dl (ns) and median PreAlb increased to 12.2 g/dl (ns), their median hs-CRP decreased to 2.379 mg/dl (ns) and Cre decreased to 1.79 mg/dl (p<0.05). Conclusion: Four-days MCT supplementation of 15g per day probably prevented further deterioration of nutritional status, attenuated inflammation early and had no adverse effect on renal function.

Effect of a collaborative transdisciplinary team approach on oral health status in acute stroke patients.

Oral function deteriorates easily during the acute phase of cerebral stroke. Therefore, oral health care involving a transdisciplinary approach consisting of dental and medical professionals might be important, but has not been studied in detail. This study assessed the oral health status of patients with cerebral stroke in the acute phase, with the aim of elucidating the efficacy of collaborative, transdisciplinary oral health care involving dentists, dental hygienists, nurses and speech therapists. The participants were 115 consecutive acute cerebral stroke patients, who received oral health care while hospitalised at the university hospital. Their oral health status was assessed using the oral health assessment tool (OHAT) on admission and discharge. Patients with acute cerebral stroke had high OHAT scores on admission, meaning poor oral health status. The collaborative oral health care resulted in significant decrease of OHAT scores at discharge, indicative of the improvement of oral health status. Multivariate analysis identified OHAT score for tongue, dentures and oral cleanliness on admission as the significant variables associated with poor oral health status at discharge. Thus, the oral health of cerebral stroke patients in the acute phase can be improved by implementing transdisciplinary collaboration of medical and dental professionals. Particularly, patients with problems pertaining to the tongue, dentures and oral cleanliness as revealed through OHAT on admission may require more intensive intervention.

Altered Serum Electrolyte Status in Acute Stroke Patients in Western Odisha, A Predictor of Syndrome of Inappropriate ADH (SIADH) or Cerebral Salt Wasting Syndrome (CSWS)

Altered Serum Electrolyte Status in Acute Stroke Patients in Western Odisha, A Predictor of Syndrome of Inappropriate ADH (SIADH) or Cerebral Salt Wasting Syndrome (CSWS)

Imaging Recommendations for Acute Stroke and Transient Ischemic Attack Patients: A Joint Statement by the American Society of Neuroradiology, the American College of Radiology, and the Society of NeuroInterventional Surgery

Stroke is a leading cause of death and disability worldwide. Imaging plays a critical role in evaluating patients suspected of acute stroke and transient ischemic attack, especially before initiating treatment. Over the past few decades, major advances have occurred in stroke imaging and treatment, including Food and Drug Administration approval of recanalization therapies for the treatment of acute ischemic stroke. A wide variety of imaging techniques has become available to assess vascular lesions and brain tissue status in acute stroke patients. However, the practical challenge for physicians is to understand the multiple facets of these imaging techniques, including which imaging techniques to implement and how to optimally use them, given available resources at their local institution. Important considerations include constraints of time, cost, access to imaging modalities, preferences of treating physicians, availability of expertise, and availability of endovascular therapy. The choice of which imaging techniques to employ is impacted by both the time urgency for evaluation of patients and the complexity of the literature on acute stroke imaging. Ideally, imaging algorithms should incorporate techniques that provide optimal benefit for improved patient outcomes without delaying treatment.

급성기 뇌졸중 환자의 기능상태 측정을 위한 ICF 핵심지표

Purpose: This study was conducted to extract international classification of functioning, disability, and health (ICF) core sets for measuring functional status in acute stroke patients, and to evaluate clinical applicability of the core sets. Methods: A set of 22 ICF items on functional status in acute stroke patients were extracted from the Korean general ICF core sets and ICF core sets for stroke patients. The extracted ICF functional items were assessed at the time of admission and discharge among 100 stroke patients who were admitted in a university hospital. Results: Comparing to functional status at admission of acute stroke patients, the overall functional status at discharge was improved. However, functions on defecation, skin protection, and relationship with immediate family at the time of discharge were not significantly changed. Conclusion: The set of ICF functional items identified in this study may be reliable and valid to assess acute stoke patients' body functions, activities and participation and environmental factors in the holistic and comprehensive nursing context. Nursing interventions on bowel elimination and skin protection for acute stroke patients need to be developed.

Ceruloplasmin/Transferrin System Is Related to Clinical Status in Acute Stroke

In acute stroke, Iron (Fe) may amplify reperfusion injury by catalyzing the conversion of superoxide and hydrogen peroxide into highly reactive radicals. Transferrin (Tf) is the main protein regulating Fe homeostasis, whereas Ceruplasmin (CP) is a circulating ferroxidase enzyme able to oxidize ferrous ions to less toxic ferric forms. This study aims at investigating whether CP, Copper (Cu), Tf, and Fe play a role in the pathophysiology of acute stroke. We enrolled 35 acute stroke patients and 44 controls. All patients underwent: neurological examination assessed by National Institutes of Health Stroke Scale (NIHSS), ultrasound evaluation of carotid atherosclerosis, brain MRI to quantify ischemic lesion volume and measurement of serum levels of CP, Cu, Tf, Fe, hydro-peroxides, and Total plasmatic antioxidant capacity. In patients, NIHSS scores were associated with Tf (r=-0.48, P=0.004), hydro-peroxides (r=0.34, P=0.046), CP (r=0.43, P=0.012), and lesion volume (r=0.50, P=0.004). Lesion volume was inversely associated with Tf (r=-0.44, P=0.012). CP and hydro-peroxides were also largely related (r=0.81, P<0.001). The model multiple R was 0.57, resulting in a 32.5% of explained NIHSS variance with Tf accounting for 23.4% and CP for 9.1%. CP and Tf levels are representative of clinical status in acute stroke patients. Our findings suggest a protective role of Tf in acute stroke and a possible ambivalent role of CP.

Age Differences in Fluid Balance and Serum Na+ and K+ Levels After Nasogastric Tube Feeding in Stroke Patients: Elderly vs Nonelderly

Enteral nutrition support has been commonly used to improve nutrition status in acute stroke patients. The purpose of this study was to examine whether significant alterations in fluid and serum Na+ and K+ levels due to nasogastric tube feeding depended on patient age. This study was conducted by retrospective review of the medical records of tube-fed patients with acute brain infarction who had been hospitalized in a university hospital. Rates of overhydration were high before tube feeding in both elderly and nonelderly stroke patients. This overhydration rate became more prevalent after iso-osmolal tube feeding in the elderly but decreased somewhat in the nonelderly subjects, and this difference in fluid balance after tube feeding between the elderly and nonelderly was statistically significant. Contrary to fluid balance, serum Na+ and K+ concentrations were no different in the elderly and nonelderly patients after tube feeding. Although the results showed that overhydration state was prominent after tube feeding in the elderly, it appeared that there was a very mild clinical impact because the osmolality and serum sodium were not changed in this group. However, more attention to the maintenance of fluid balance in the elderly tube-fed stroke patients is needed because elderly patients have great difficulty in maintaining a normal fluid balance.

The effect of high protein enteral nutrition on protein status in acute stroke patients

The objective of this study was to determine the effect of high protein enteral nutrition on protein status in acute stroke patients. The subjects were divided into two groups using block randomisation, i.e. the intervention group that received high protein enteral nutrition (HPEN), and the control group that received enteral hospital diet. Thirty six out of 60 acute stroke patients had completed 7 days of follow-up. The results showed that HPEN have increased prealbumin level, decreased urinary creatinine excretion, and decreased the decline of albumin serum compared to the control group. (Med J Indones 2005; 14: 37-43) Keywords: albumin, prealbumin, urinary urea nitrogen, urinary creatinine, nitrogen balance

Antioxidant Status in Acute Stroke Patients and Patients at Stroke Risk

Background and Purpose: Antioxidant enzymes like copper/zinc superoxide dismutase (SOD), catalase and gluthatione peroxidase (GSHPx) are part of intracellular protection mechanisms to overcome oxidative stress and are known to be activated in vascular diseases and acute stroke. We investigated the differences of antioxidant capacity in acute stroke and stroke risk patients to elucidate whether the differences are a result of chronic low availability in arteriosclerosis and stroke risk or due to changes during acute infarction. Methods: Antioxidant enzymes were examined in 11 patients within the first hours and days after acute ischemic stroke and compared to risk- and age-matched patients with a history of stroke in the past 12 months (n = 17). Antioxidant profile was determined by measurement of glutathione (GSH), malondialdehyde (MDA), SOD, GSHPx and minerals known to be involved in antioxidant enzyme activation like selenium, iron, copper and zinc. Results: In comparison to stroke risk patients, patients with acute ischemic stroke had significant changes of the GSH system during the first hours and days after the event: GSH was significantly elevated in the first hours (p < 0.01) and GSHPx was elevated 1 day after the acute stroke (p < 0.05). Selenium, a cofactor of GSHPx, was decreased (p < 0.01). GSHPx levels were negatively correlated with National Institutes of Health Stroke Scale (NIHSS) scores on admission (r = –0.84, p < 0.001) and NIHSS scores after 7 days (r = –0.63, p < 0.05). MDA levels showed a trend for elevation in the first 6 h after the acute stroke (p = 0.07). No significant differences of SOD, iron, copper nor zinc levels could be identified. Conclusions: Differences of antioxidant capacity were found for the GSH system with elevation of GSH and GSHPx after acute stroke, but not for other markers. The findings support the hypothesis that changes of antioxidant capacity are part of acute adaptive mechanisms during acute stroke.