Evaluating the Effect of Novel Ways of Teaching Symptoms and Treatment of Acute Stroke on Thrombolytic Therapy

Background and Objective: Given that a small percentage of people with ischemic stroke are treated with recombinant tissue plasminogen activator (rtPA) in Iran, it is necessary to use appropriate educational methods that, in addition to raising the awareness of patients about stroke, lead them to refer health centres early. The purpose of this study was to evaluate the effect of new methods of training warning signs of acute stroke on thrombolytic therapy.Method: This was a community-based empirical intervention study in Ahvaz, Iran, in 2018. Initially, educational content was provided, including warning signs of a stroke, its risk factors, and the need for prompt referral to a well-equipped treatment centre for thrombolytic therapy. This content was used to prepare brochures, pamphlets, posters, and training sessions for health care personnel. Before starting, immediately, and three months after the training course, a questionnaire was used to assess staff knowledge of stroke symptoms and the need for rapid patient referral for FAST-based thrombolytic therapy. Also, the timely referral of patients with suspected stroke to hospital, as well as their thrombolytic therapy during the six months after the intervention and the similar six months in the previous year were compared.Results: The level of knowledge was significantly increased at the end of training (P<0.0001). Although this average was reduced three months after completion of training, the difference was not significant (P = 0.42). Based on the results, the number of stroke patients referred to hospital in golden time (less than 4.5 hours) from the beginning of training to 6 months after the end of the course (n = 54) was increased compared to the same period last year (n=38). The number of thrombolytic patients from the beginning of the training course to 6 months after the course (n=38) increased compared to the same period of the previous year (n=21).Conclusion: Based on the results, the implementation of educational programs was reported to be effective in raising public awareness of stroke symptoms and the need for prompt hospital referral for appropriate and timely treatment

Comparison of Efficacy and Complication of Alteplase Injection in Acute Ischemic Stroke

Background and Aim: Alteplase is a thrombolytic drug that is produced by recombinant DNA technology. Tissue plasminogen activator enzyme which converts plasminogen to the active form of plasmin is also produced by the same technology; it causes fibrinolysis and clot dissolution. This study aimed to compare the efficacy and complications of Alteplase injection in patients with acute ischemic stroke (AIS( during the first 3 hours and  3-4.5 hours after the onset of symptoms. Methods: In this study, patients with AIS who were referred to Golestan Hospital of Ahvaz city during 2018-2019 were selected. Information was collected by a checklist. Results: The results showed that the mean Modified Rankin Scale (mRS) for 3 months and 6 months (p-value: 0.91 for 3 months and p-value: 0.80 for 6 months) and National Institutes of Health Stroke Scale (NIHSS) (p-value: 0.21) were not significantly different between both groups; statistically, no significant relationship was observed between them. The incidence of complications after treatment was almost similar, in both groups. Conclusion: Finally, it was concluded that complications and efficacy of rt-PA (Alteplase) injection were not statistically different, between the two groups under study. *Corresponding Author: Gholamreza Shamsaei; Email: [email protected]; [email protected] Please cite this article as: Amirazodi E, Shamsaei G, Rafie S, Kashipazha D, Hesam S. Comparison of Efficacy and Complication of Alteplase Injection in Acute Ischemic Stroke. Arch Med Lab Sci. 2021;7:1-6 (e4). https://doi.org/10.22037/amls.v7.3350

The Effect of Midazolam on Prevention of Post-Dural-Puncture Headache

Objective: Post-dural-puncture headache (PDPH) is the most common side effect associated with a lumbar puncture (LP). The present study aims to evaluate the effect of midazolam on the prevention of PDPH.Methods: This single-blind randomized clinical trial study was performed on 120 patients aged 18-60 years who were candidates for diagnostic LP in 2017-2018. In the intervention group (n=30), 3 mg of midazolam was injected intravenously for two minutes 5-10 minutes before LP, and the control group received normal saline as placebo. Patients in both groups were evaluated and compared with each other in terms of incidence, onset, severity, and duration of PDPH.Results: The incidence of PDPH was lower in the midazolam group, but the difference was not significant (P>0.05). Mean severity, onset time, and duration of PDPH were not significantly different between the two groups (P<0.05). All patients in the intervention group and 75% of patients in the control group with PDPH had a history of headache. There was no significant difference between gender, mean age, BMI, pressure and CSF volume in patients with PDPH (P>0.05). The mean age of patients with PDPH was significantly lower in both groups, and the percentage of women with PDPH was considerably higher than that of men (P<0.05).Conclusion: Although there was no significant difference between the parameters studied in the two groups, patients with less age, history of headache, lower CSF pressure, and female gender were more likely to develop PDPH

Practical snow depth sampling around six snow telemetry (SNOTEL) stations in Colorado and Wyoming, United States

2012 Summer.Includes bibliographical references.Across the Western United States, the Natural Resources Conservation Service (NRCS) operates about 700 automated snowpack telemetry (SNOTEL) measurement stations. These stations measure snow depth (SD), snow water equivalent (SWE), air temperature and precipitation. To assess how representative the stations are of the surrounding 1 km2 area, a set of approximately 200 snow depth measurement were taken using ten 1000-m transects sampled at 50-m intervals. This sampling was undertaken at the Dry Lake, Joe Wright, Lizard Head, Niwot, (in Colorado) South Brush Creek, and Togwotee Pass (in Wyoming) SNOTEL stations during the winters of 2008, 2009, and 2010. Various sampling patterns were employed at each sampling point, such as three depth measurements in a row parallel or perpendicular to a transect, and five in a row or five in a plus pattern. We used these patterns and various sub-sets of the 1 km2 surrounding area to assess suitable and practical sampling strategies, to determine the minimum number of transects need for measuring the average SD of each station, to evaluate if each station represent the SD average of its 1 km2 area surrounding, and to investigate inter- and intra-annual variations of SD for each station. Statistical analysis used the least-significant-based analysis of variance with a 95 percent confidence level. Statistical analyses showed snow depth averages of incorporated sampling methods were not significantly difference at the 95 percent confidence level. Therefore, any sampling method could be used for SD measurement based on sampling constraints. We recommend measuring three to five snow depths at each sampling spot and the distance between sampling spots should be less than 200m. The minimum number of transects needed for each station was not the same and it depended upon the physiographic and vegetation heterogeneity of the area surrounding a station. Snow depth varied within a 1 km2 area surrounding of SNOTEL station and we did not find two sampling methods that had the same average SD. However, this did not mean that the average SD using a variety of sampling methods was significantly different at the 95 percent confidence level. A heterogeneous snowpack is caused variations in precipitation, wind patterns, solar radiation, etc. Physiographic and vegetation characteristics can be used as surrogates for these meteorological factors that vary at the small and large scale. The effect of these factors on snowpack heterogeneity is more likely greater when the distance of sampling spots is more than 1 km. The correlation between snowpack heterogeneity and the surrogate characteristics varied in spatially and temporally, and from location to location. The Dry Lake, Joe Wright, Lizard Head, and Niwot SNOTEL stations represented the SD average of their 1 km2 area surrounding while Lizard Head station represented the SD average of its 0.36 km2 area surrounding, all at the 95 percent confidence level. However, the Togwotee Pass and South Brush Creek stations did not represented the SD average of their surrounding area. Whether a SNOTEL station does or does not represent the SD average of its surrounding area is related to the complexity of the terrain. For example, the area surrounding the Joe Wright station has complex terrain but represented the station SD while the South Brush Creek terrain was more homogeneous and did not represent station SD. The performance of the SD sensor at the SNOTEL station can be affected by the interaction of meteorology, physiography, vegetation, and possibly human influences, that can produce an highly varying snow pack under and/or around a SD sensor and led to a lack of sensor representivity or sensor error. Due to potential SD sensor and sampling errors a reasonable amount of error for snow samples, such as 5-10% should be considered

Neurological manifestations in hospitalized COVID-19 patients: a cross-sectional study

Abstract Background Accumulating evidence on the neurological sequelae of COVID-19 is a serious concern, with patients possibly being at risk of permanent debilitation if not managed appropriately. We aimed to determine the prevalence and pattern of neurological manifestations and diagnostic and therapeutic findings among hospitalized COVID-19 patients consulted with the neurology service for neurological disorders. We conducted a retrospective, observational study at the Golestan Hospital of Ahvaz, Iran, between March 20, 2020, and March 19, 2021. Patients' demographic, clinical, paraclinical, and therapeutic characteristics were extracted from medical records and then subjected to statistical analysis. Results Overall, 6.7% (157/2340) of COVID-19 patients at Golestan Hospital had a neurological disorder. Most of the patients (90/157) were men, and the mean age of patients was 62.91 ± 91 years. A total of 56.68% of patients (89/157) were SARS-CoV-2 RT-PCR positive. The mean chest CT severity score was 8.26 ± 4.4, ranging from 1 to 19. The most common neurologic disorders were cerebrovascular disease (72.6%), encephalopathy (8.9%), and Guillain–Barre syndrome (6.4%). The CSF SARS-CoV-2 PCR test was positive in one patient with Guillain–Barre syndrome. The in-hospital mortality rate was 43.9%. Definite COVID-19, ICU admission, history of stroke and dementia, and comorbidities were associated with an increased mortality risk in these patients. Conclusions Patients with COVID-19 can present with serious neurological disorders such as cerebrovascular disease and impaired consciousness, even without typical COVID-19 symptoms. Close monitoring for neurological symptoms may help improve prognosis in hospitalized COVID-19 patients