Factors associated with onset to hospital delay among stroke patients in the emergency department

Ischemic stroke is the most common neuro-emergency in the world. The only treatment approved for an acute stroke is thrombolysis, which has a narrow window. Thrombolysis to treat acute ischemic stroke is under-utilised. There are many factors associated with delays in treatment. In Indonesia, thrombolysis is not commonly used for acute stroke treatment. The study aimed to know what time is needed from the onset of the stroke condition to the Emergency Department in a stroke patient and the factors associated with the hospital delays. All stroke patients admitted to Dr. Soetomo General Hospital and Universitas Airlangga Hospital between October 2016-March 2017, who agree to participate in the research and were aged >18 y.o. are included. We reviewed all of the subjects for the demographic characteristics, distance to hospital, stroke risk factors and clinical data. All of the subjects will be asked for the time of stroke onset and the time when the patient arrived at the emergency department. We will also measure the stroke using a specialised scale. Results There were 107 subjects included in this research. The data was inadequate in 4 subjects. The mean age was 55.97±11.9 years, and there were more women (54.2%) than men. The distance from the patient's home to the hospital was mostly <15 km (65.1%). 63.6% of the subjects were referred from other hospital or clinic. Most of the patients had hypertension (71.4%) and diabetes (31.7%). Onset from the ictus of the stroke to the Emergency Department was 712.3±1324.6 minutes. A factor associated with the delay was the medical services accessed before the patient was referred to the hospital (0.215; p=0.026) and their pre-admission score (0.242; p=0.012). Conclusion Time from onset to the Emergency Department was longer than the treatment time window for thrombolysis. The factors associated with the onset of hospital delays was primary medical services and the pre-mRS score

Green Tea with Its Active Compound EGCG for Acute Ischemic Stroke Treatment

The current standard of treatment for acute ischemic stroke is thrombolysis. However, only less than 2% of the world undergo thrombolysis. Recent studies have shown that Citicholin, one of the popular neuroprotectants, is less effective as stroke therapy, so it is necessary to develop a new approach to protective therapy for ischemic stroke patients. Green tea (Camellia sinensis) is the most consumed beverage in the world and is a source of polyphenols known as catechins, including epigallocatechin-3-gallate (EGCG), which is 63% of total catechins. Many studies explain that green tea consumption will decrease stroke risk, but not many studies explain its benefit in treating acute stroke. This chapter will discuss the benefit of green tea in acute stroke. C. sinensis with the active ingredient EGCG inhibits neuronal cell death through apoptosis and necroptosis in acute ischemic stroke as in the Rattus norvegicus model of Middle Cerebral Artery Occlusion (MCAO), it also can decrease necroptosis and increase M2 type microglia. The study on the benefit of green tea should be conducted in the clinical setting to know the benefit of green tea in acute ischemic stroke. Its potential benefit can be an adjunct treatment for acute ischemic stroke besides standard treatment

Low CD4 Level Increased the Risk of Cognitive Impairment in the HIV Patient

Background: HIV infection leads to neurological damage that results in cognitive and behavioural impairment called HIV-associated neurocognitive disorder (HAND). There are several factors associated with HAND which include the CD4 count. Patients who present with the CD4 level lower than 200 cells/ mm3 are considered very vulnerable of experiencing neurological complications such as HAND. Objective: To investigate the association between CD4 level and cognitive impairment evaluated using MoCA-INA among HIV patients. Materials and Method: This cross-sectional study involves 72 consecutive patients with HIV (Human Immunodeficiency Virus) infection from the Infecion Ward of Soetomo General Hospital Indonesia. All participating patients was measured its cognitive impairment through MoCA-INA score. Blood samples were collected for CD4 evaluation. Statistics were evaluated with SPSS 25.0. Results: The research participant consisted of 43 (59.7%) male and 29 (40.3%) female with mean age of 38.22 ± 9.159, CD4 level of 447.4 ± 247.48 and MoCA-INA score of 26.36 ± 2.770. Chi-Square analysis showed a significant difference (p-value of 0.023) in the cognitive function in the HIV patient with low CD4 (CD4<200cell/mm3) compared tonormal CD4 (CD4≥200 cell/mm3) with Odd Ratio of 4.900 (95% CI,1.278–18.793). Conclusions: Low CD4 level increase the risk of cognitive impairment assessed using MoCA-INA scoring system. These suggested that HIV patient with low CD4 should have initial screening of cognitive impairment

D-Dimer Levels as a Predictor of Clinical Outcome and Mortality in Acute Ischemic Stroke Patients: A Systematic Review and Meta-Analysis

Highlight: • An increase in the D-dimer level indicates activation of the coagulation system through thrombus formation and fibrinolysis. • The meta-analysis found a significant relationship between elevated d-dimer levels and worsening clinical outcomes and increased mortality. • The D-dimer level can be used as a predictor for predicting clinical outcomes and mortality in acute ischemic stroke patients at each duration of follow-up.   ABSTRACT Introduction: In ischemic stroke, high D-dimer levels are frequently found, indicating coagulation with ongoing thrombus formation and fibrinolysis. Objective: The purpose of this study was to analyze the role of D-dimer in predicting clinical outcomes and mortality in acute ischemic stroke patients. Methods: A systematic literature search was conducted using the PRISMA method through the PubMed, Science Direct, and Google Scholar databases. The quality of the article was assessed using the Newcastle-Ottawa Scale (NOS) and statistically analyzed using Review Manager software version 5.4.1. Results: Eight articles had good quality according to NOS and matched the criteria for the literature search. Elevated D-dimer levels and worsened clinical outcomes have a significant result when discharged from the hospital: OR 2.37 (95% CI 1.68–3.35); I2 = 45% p < 0.00001; 1-month: OR 1.75 (95% CI 1.38–2.23), I2 = 47% p < 0.00001; 3-months: OR 2.43 (95% CI 2.00–2.95), I2 0% p < 0.00001; 6-months: OR 2.64 (95% CI 1.92–3.63), I2 = 0% p < 0.00001; and 12-months: OR 1.92 (95% CI 1.31–2.82), I2 = 62% p < 0.0008. Elevated D-dimer level and increased mortality have a significant result with OR 2.25 (95% CI 1.78–2.85), I2 = 45% p < 0.00001. Conclusion: D-dimer can be used as a predictor of clinical outcome and mortality in acute ischemic stroke

Nurse Performance and Influence Factors in Discharge Planning Based on Knowledge Management SECI Model in Stroke Patients

Abstract Background: Implementation of discharge planning was found to be unsystematic and structured in stroke patients, resulting in gaps in knowledge transfer and knowledge between nurses, patients, and families regarding discharge planning directives. Discharge planning based on the Knowledge management SECI model is expected to overcome information and knowledge gaps in stroke patients. This study aims to analyze the influence of nurse factors, family factors, patient factors, and organizational factors on the SECI Model knowledge management-based discharge planning in Jombang Regency, Indonesia. Design and method: This research was conducted with a cross-sectional analytic study design. A sample of 133 stroke unit nurses at Jombang District Hospital, Ploso Hospital, and Jombang Hospital, was then analyzed and interpreted to test the model with SEM-PLS. Results: Nurse factors influence discharge planning (t-statistic 2.484 > 1.96 and p-value 0.014 1.96 and p-value 0.011 1.96 and p-value 0.000 1.96 and p-value 0.013 1.96 and p-value 0.000 <0.05). Conclusion: The research findings prove that nurse factors, patient factors, family factors, and organizational factors influence discharge planning based on the SECI knowledge management mode

The Relevance of Right and Left Hemisphere Classification to Predict Cognitive Outcome After Stroke

Introduction: Stroke is the fifth leading cause of disability-adjusted life years (DALYs) in the world. Cognitive impairment is one of the disabilities found in the acute phase of stroke and persists in long-term outcomes which can be assessed using the Mini-Mental State Examination (MMSE). However, a clinical classification to predict the cognitive outcome remained unclear. This study is aimed to identify differences of MMSE results in stroke patients between right and left hemisphere lesions to ensure the mentioned location classifications may contribute to cognitive outcome prediction. Method: With the cross-sectional analytic observational design, 32 acute phase patients hospitalized in the Neurology Department Soetomo General Hospital from October–December 2019 were assessed using the Indonesian version of MMSE with purposive sampling and analyzed using the chi-square test. Result: There was no significant difference between MMSE scores in right or left hemisphere lesion. This might happen because (1) MMSE was insensitive and not a domain-specific test; (2) a more specific infarct location was needed to predict cognitive outcome post-stroke, including microarchitecture of the brain especially those involved in the cortico-striato-thalamocortical loop. Conclusion: The right or left hemisphere lesion classification did not contribute significantly to predict cognitive impairment

Knowledge, Attitude and Practice of Primary Care Physicians in Dealing with Acute Stroke in Indonesia

Abstract Objective: There are still many things that interfere with the practice of effective acute stroke management, with one of them being the failure of health workers providing appropriate management. Hence, this study was conducted to evaluate the level of knowledge, attitude and practices of primary care physicians (PCPs) in acute stroke management in Indonesia. Material and Methods: This cross-sectional face-to-face survey was conducted among all PCPs, from 63 primary health care centres; from October, 2019 to January, 2020 in Surabaya, Indonesia. A self-designed questionnaire, consisting of 25 questions, based on several guidelines, was used as the instrument of this survey. Results: In total, 134 PCPs participated. The majority of their level of knowledge obtained was in the moderate category (51.5%), while the majority of their attitude and practices towards stroke were in the good category (67.9% and 75.2%). Nearly 75.0% of PCPs also knew about thrombolytic therapy, but only <50.0% knew the ‘golden period’ of thrombolytic therapy. A significant correlation was found between PCPs knowledge-attitude (p-value<0.001), knowledge-practices (p-value=0.002) and attitude-practices (p-value<0.001). There was also a significant difference in the level of stroke knowledge between PCPs, with different clinical practice experience (p-value=0.015). Better stroke knowledge tended to be obtained by PCPs with younger clinical practice experience. Conclusion: The level of knowledge, attitude and practices of PCPs in acute stroke management in Indonesia is good, but should still be improved; especially knowledge about the use of thrombolytic therapy and its ‘golden period.

In Silico Analysis of Pongamia pinnata to Inhibit Neuronal Apoptosis after Ischemic Stroke via NMDAR and Caspase-3

Highlight: • The potential of Pongamia pinnata as an inhibitor of apoptosis in ischemic stroke has never been evaluated before. • Pongamia pinnata has potential to inhibit neuronal apoptosis via NMDAR and Caspase-3 in ischemic stroke. • Karanjachromene has the best binding interaction to inhibit NMDAR.   ABSTRACT Introduction: One of the cardiovascular diseases with the highest mortality rate is stroke. Stroke is the second-leading cause of death worldwide. Each year, 12.2 million new cases of stroke occur, of which 7.6 million are ischemic strokes. In ischemic stroke, there are several pathways that cause neuronal apoptosis. The activity of NMDAR and caspase-3 is one of the pathways. Pongamia pinnata phytochemicals have a neuroprotective function against neurological disorders. However, its use as an inhibitor of apoptosis in ischemic stroke has never been evaluated before. Objective: This research was designed to evaluate the phytochemicals of Pongamia pinnata as inhibitors of neuronal apoptosis in ischemic stroke using an in silico study. Methods: This study used four main phytochemicals of Pongamia pinnata, namely Karanjin, Karanjachromene, Pongapin, and Pongachromene. The protein targets for neuronal apoptosis were NMDAR and caspase-3. The molecular docking processes were ligand preparation, protein preparation, grid box determination, molecular docking, and visualized molecular docking. Results: In silico results showed that at NMDAR target proteins, Karanjin, Karanjachromene, Pongapin, and Pongachromene have binding energies of -5.12, -5.83, -5.03, and -5.13 kcal/mol. At protein targets, Caspase-3, Karanjin, Karanjachromene, Pongapin, and Pongachromene have binding energies of -4.87, -4.98, -4.88, and -5.08 kcal/mol. Conclusion: The phytochemicals of Pongamia pinnata have the potential to inhibit neuronal apoptosis via NMDAR and caspase-3 in ischemic stroke. The binding of Karanjachromene to NMDAR demonstrated the compound's best interaction

PROFILE OF EPILEPSY PATIENTS IN PEDIATRIC WARD AT DR. SOETOMO GENERAL ACADEMIC HOSPITAL, SURABAYA, INDONESIA IN THE PERIOD OF JANUARY-DECEMBER 2017

Background: Various risk factors of epilepsy in children had been reported although differences were found amongst regions. Objective: To identify the profile of epilepsy patients and previous febrile seizure history in children aged 0-17 years at Pediatric Ward, Dr. Soetomo General Academic Hospital, Surabaya, Indonesia, in 2017. Materials and Methods: This was a cross-sectional retrospective study, using secondary data from medical records of epilepsy patients with febrile seizure history in children aged 0-17 years old at Pediatric Ward, Dr. Soetomo General Academic Hospital, Surabaya, Indonesia, in the period of January-December 2017. Data analysis was done using t-test and Chi- Square test (Microsoft Excel 2007 and SPSS 22). The level of significance was p<0.05. Results: Seventy-four male and 38 female patients were included. Febrile seizure history was observed in 42 patients and there was no significant difference between febrile seizure history and prevalence of epilepsy. The general type of seizure was found in 79 patients; mostly from Surabaya, Indonesia and the parents’ occupation was private employee. The most observed type of seizure was general type. Conclusion: In this study, epilepsy was predominantly found in males than females; and a significant number of the patients were without febrile seizure history. General type of seizure was the most common type amongst others. These patients were mostly from Surabaya, Indonesia, whose parents' occupation was private employees

Ekspresi Kaspase 8 dan Perubahan Jumlah Sel Neuroglia pada Regulasi Mekanisme Apoposis Sel Otak Akibat Keracunan Merkuri

Introduction : Mercury is a potent neurotoxin since it induces apoptosis and inflammatory respond in brain. Caspases e.g. caspase 8is one of central effectors of apoptosis and serve as signaling mediators that orchestrate apoptotic execution pathways by cleaving a subset of cellular proteins. Whereas brain inflammatory response is triggered by the activation of neuroglial e.g. microglial cells and astrocytes and this glial reactivity has been used as an early marker of neurotoxicity.To study the effects of neurotoxicity mercury we use caspase 8 and microglial as a parameter of methyl mercury neurotoxicity. Aims : To observe the process of apoptosis and inflammatory processes in the brain caused by methylmercury poisoning rats Rattus novergicus. Methods : Rattus novergicus aged 4 months was used as experiental model and devided into 3 group of treatment with orally administered: aquabidest; methylmercury 0,2 mg and 0,4 mg/BW/day. Brains of the mice were removed after 30 days of exposure and tissue samples were obtained for examination. Caspase8 was identified by imunohystochemistry staining using Avidin-biotin complex method. Microglial cell was counted from hystophatology examination of the HE stained brain tissue. Results : Mean of caspase 8 in group of aquabidest; methylmercury 0.2 and 0.4 mg/BW/day were 68?8.95;197.3?36.83;275.6?34.19 respectively whereas mean of microglial cell count:65.6?19.61;137.1?15.32;167.9?12.8 respectively. Conclusions : Mercury exposure increases both of caspase 8 expression and neuroglia cell count in Rattus novergicus brain tissue. The result suggests that methylmercury induces apoptosis and inflammatory respond in brain