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

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

Epidemiology and outcomes of hospital-acquired bloodstream infections in intensive care unit patients: the EUROBACT-2 international cohort study

Purpose: In the critically ill, hospital-acquired bloodstream infections (HA-BSI) are associated with significant mortality. Granular data are required for optimizing management, and developing guidelines and clinical trials. Methods: We carried out a prospective international cohort study of adult patients (≥ 18 years of age) with HA-BSI treated in intensive care units (ICUs) between June 2019 and February 2021. Results: 2600 patients from 333 ICUs in 52 countries were included. 78% HA-BSI were ICU-acquired. Median Sequential Organ Failure Assessment (SOFA) score was 8 [IQR 5; 11] at HA-BSI diagnosis. Most frequent sources of infection included pneumonia (26.7%) and intravascular catheters (26.4%). Most frequent pathogens were Gram-negative bacteria (59.0%), predominantly Klebsiella spp. (27.9%), Acinetobacter spp. (20.3%), Escherichia coli (15.8%), and Pseudomonas spp. (14.3%). Carbapenem resistance was present in 37.8%, 84.6%, 7.4%, and 33.2%, respectively. Difficult-to-treat resistance (DTR) was present in 23.5% and pan-drug resistance in 1.5%. Antimicrobial therapy was deemed adequate within 24 h for 51.5%. Antimicrobial resistance was associated with longer delays to adequate antimicrobial therapy. Source control was needed in 52.5% but not achieved in 18.2%. Mortality was 37.1%, and only 16.1% had been discharged alive from hospital by day-28. Conclusions: HA-BSI was frequently caused by Gram-negative, carbapenem-resistant and DTR pathogens. Antimicrobial resistance led to delays in adequate antimicrobial therapy. Mortality was high, and at day-28 only a minority of the patients were discharged alive from the hospital. Prevention of antimicrobial resistance and focusing on adequate antimicrobial therapy and source control are important to optimize patient management and outcomes.</p

Epidemiology and outcomes of hospital-acquired bloodstream infections in intensive care unit patients: the EUROBACT-2 international cohort study

Purpose In the critically ill, hospital-acquired bloodstream infections (HA-BSI) are associated with significant mortality. Granular data are required for optimizing management, and developing guidelines and clinical trials. Methods We carried out a prospective international cohort study of adult patients (≥ 18 years of age) with HA-BSI treated in intensive care units (ICUs) between June 2019 and February 2021. Results 2600 patients from 333 ICUs in 52 countries were included. 78% HA-BSI were ICU-acquired. Median Sequential Organ Failure Assessment (SOFA) score was 8 [IQR 5; 11] at HA-BSI diagnosis. Most frequent sources of infection included pneumonia (26.7%) and intravascular catheters (26.4%). Most frequent pathogens were Gram-negative bacteria (59.0%), predominantly Klebsiella spp. (27.9%), Acinetobacter spp. (20.3%), Escherichia coli (15.8%), and Pseudomonas spp. (14.3%). Carbapenem resistance was present in 37.8%, 84.6%, 7.4%, and 33.2%, respectively. Difficult-to-treat resistance (DTR) was present in 23.5% and pan-drug resistance in 1.5%. Antimicrobial therapy was deemed adequate within 24 h for 51.5%. Antimicrobial resistance was associated with longer delays to adequate antimicrobial therapy. Source control was needed in 52.5% but not achieved in 18.2%. Mortality was 37.1%, and only 16.1% had been discharged alive from hospital by day-28. Conclusions HA-BSI was frequently caused by Gram-negative, carbapenem-resistant and DTR pathogens. Antimicrobial resistance led to delays in adequate antimicrobial therapy. Mortality was high, and at day-28 only a minority of the patients were discharged alive from the hospital. Prevention of antimicrobial resistance and focusing on adequate antimicrobial therapy and source control are important to optimize patient management and outcomes