The role of officially supported export credits in sub-Saharan Africa's external financing

This paper addresses the question of how important officially supported export credits (OSECs) were, both in quantity and quality, in Sub-Saharan Africa's (SSA) external financing during the last two decades, and examines the prospects for the 1990s. The paper begins by briefly explaining the financial structure of foreign trade, the role of export credits in this context, and the basic functions of export credit agencies (ECAs). It goes on to present the trends in OSECs during the 1970s and the 1980s as a source of external finance for developing countries in general, and for SSA in particular. The authors deal with some of the distortions caused by export credit subsidies, including the problems of"moral hazard"and"adverse selection". The paper looks at the current need and prospects for external finance in the 1990s and addresses how to enhance the efficiency of OSECs, emphasizing the cooperation between ECAs and multilateral development agencies, an issue which is particularly important for poorer developing countries such as those found in SSA.Economic Theory&Research,Banks&Banking Reform,Environmental Economics&Policies,Financial Intermediation,International Terrorism&Counterterrorism

Bir devlet hastanesi bakiş açisiyla akut iskemik inmede intravenöz trombolitik tedavi

OBJECTIVE: Acute ischemic stroke (AIS) is a clinical emergency. Intravenous recombinant tissue plasminogen activator (IV rt-PA), Alteplase, is only approved treatment of AIS when given within 4.5 hours of symptom onset. The aim of this study is to review the experience of our clinic in thrombolithic treatment. METHODS: Demographic and clinical variables of 25 patients who were admitted to the neurology clinic of Aydin State Hospital with AIS and took IV rt-PA treatment were examined retrospectively for 2.5 years starting from January, 2014. The neurological and disability assessment of the patients were done by The National Institutes of Health Stroke Scale (NIHSS) and modified Rankin Scale (mRS) respectively. Onset-to-door (ODT), door-to-needle (DNT), and onset-to-needle (ONT) times were calculated and analyzed in comparison with the literature data. RESULTS: 25 patients with AIS received IV rt-PA. Mean age of our patients was 70.8±14 years and twelve of them (% 48) were female. The mean ODT, DNT, ONT times were 61±43, 70±40, 130±54 minutes, respectively. 20 patients were treated in the first 3 hours (%80). NIHSS mean scores were 12±4 and 8±7 before the treatment and 24 hours after the treatment.14 patients (%64) showed significant improvement in clinical activity 24 hours after the treatment. Symptomatic intracranial hemorrhage was occured in four patients (%16) as a result of IV rt-PA therapy and two of them (%8) were died. On the third month after the treatment, the number of functionally independent (mRS 0–2) patients were 15 (%60) and the number of dependent (mRS 3–5) patients were 2 (%8) according to mRS. 8 patients died three months after the treatment (%32). CONCLUSION: Despite the small sample size, our study shows that the IV rt-PA is efficient and safe treatment in AIS. If the appropriate conditions and organization provided, state hospitals have the potential to be suitable centers for the thrombolytic therapy

Comparison of stroke cases with other neurological diseases on the basis of haemogram parameters

Aims This study aimed to examine the haemogram parameters, including the neutrophil/lymphocyte ratio (NLR), which is fast, easy and practical to determine, in stroke patients who present with more physiological stress and inflammation and compare them with patients presenting other neurological diseases. Methods The demographic, laboratory and imaging features of all patients who were admitted to the neurology clinic within a three-year period and met the study criteria were retrospectively analysed. A haemogram from peripheral venous blood samples was taken at the time of admission, and its parameters was calculated. Results A total of 3152 patients, 1604 of whom were women (50.9%), with a mean age of 66.1 +/- 14 (18-100) years who were hospitalised in the neurology clinic from 1 January 2015 to 1 January 2018, comprised the study's sample. Mean age, mean leukocyte-neutrophil count and NLR were significantly higher in stroke patients than in those without stroke (P < .001, P P < .001, respectively), but mean red blood cell, platelet and lymphocyte counts, and haemoglobin and haematocrit values were found to be significantly lower (P < .001, P < .001, P < .001, P P < .001, respectively). When the haemogram parameters were compared according to stroke type, red blood cell, haemoglobin, haematocrit and NLR values in patients with haemorrhagic stroke (P = .019, P = .002, P = .002 and P = .001, respectively) and platelet and lymphocyte values in ischaemic stroke patients were found to be significantly higher (P = .002 and P < .001, respectively). Conclusion In this study, significant data obtained by comparing the haemogram parameters of those with stroke and other neurological diseases are presented. All neurological diseases, especially acute stroke and its types, should be examined in future prospective, randomised and controlled studies with all haemogram parameters, especially the NLR. However, it should be noted that haematological parameters are more useful for group studies rather than determining the diagnosis of an individual patient

CASE REPORT: Isolated unilateral pitosis; involvement of partial fasiculer due to midbrain infarction

Ptosis could be caused by oculomotor nerve palsy in the midbrain infarction. Isolated midbrain infarction is rare. We report a patient with isolated unilateral ptosis caused by partial fascicular oculomotor paresis due to midbrain infarction. A 59-year-old woman was unable to open her right eye on waking up the morning and was admitted to our hospital. Ptosis was found in the right eye. The other examination findings were normal. In radiological imaging showed an acute infarction in the right paramedian midbrain and the lesion was compatible with localization of the right oculomotor fascicle. She was diagnosed with partial fascicular oculomotor paresis due to paramedian midbrain infarction. By administration of anti-platelet agents, ptosis was resolved within 1.5 months. The anatomy of the third cranial nerve fascicle and its courses through the midbrain is a topic of debate. Previous reports of oculomotor fascicular infarction have elucidated the human oculomotor fascicular arrangement and from these material topographical models have been proposed. Compared to proposed models for arrangement of oculomotor fascicle, this case demonstrates that the fibers to levator palpebrae may be located in the most caudal portion of the oculomotor fascicles. The case is interesting in that the isolated ptosis due to the oculomotor fascicular palsy only involved the levator palpebrae fibers and is intended to contribute to the literature by being discussed with the oculomotor fascicles models

An evaluation of the relation between atrial fibrillation and smoking in patients undergoing stroke

Aim and objective Atrial fibrillation (AF) occupies an important place among the etiological agents in ischemic cerebrovascular disease. Smoking is thought to be a predisposing factor for AF. The probable relation between smoking and AF can be explained in terms of oxidant mechanisms and inflammation. This study investigated the probable link between smoking and AF against a background of stroke. Methods Three centers were included in the study. Cases diagnosed with stroke and transient ischemic attack (TIA) arriving at these centers were evaluated in terms of demographic, clinical, and radiological characteristics. The Modified Rankin Score (MRS) and National Institutes of Health Stroke Scale (NIHSS) scores were used to assess severity of stroke. Results Three hundred forty-one patients with a mean age of 73.73±11.40 were enrolled; 282 were evaluated as ischemic stroke, 50 as hemorrhagic stroke, and 9 as TIA. Mean MRS was 2.92±1.63, and mean NIHSS was 10.12±8.01. Of the study group, 65.7% had never smoked, 23.2% were active smokers, and 11% had quit. The relation between etiological factors and smoking was investigated based on the TOAST classification in the ischemic subgroup. Stroke associated with large or small vessel disease and the AF-related stroke group were compared in terms of smoking status, and smoking status was significantly higher in the AF group (p=0,04). A significant difference was observed in mean EF values at echocardiography performed on patients in the ischemic subgroup between the smoking and non-smoking groups (57.71±14.37, and 60.83±8.92, respectively, p=0,002). Conclusions Our study determined no relation between smoking and stroke subtypes, severity, or other risk factors, while smoking emerged as a risk factor in AF-related stroke. This once again shows that smoking, in other words nicotine, lays the foundation for AF through inflammation, catecholamine-mediated effects, and oxidative stress, constitutes a risk factor for stroke, together with advanced age

Decompressive surgery in stroke

OBJECTIVE: Our aim was to present the acute stroke cases carried out decompression surgery and to discuss our results with literature. METHODS: Decompression surgery was carried out in 8 patients including 4 women and 4 men who followed and clinically progressed despite the medical treatment within 1-11 days in Dokuz Eylül University Hospital Neurology Clinic between August 2010 and February 2012. Extensive hemicraniectomy+duraplasty were performed in 6 patients and suboccipital craniectomy was performed in 2 patients. RESULTS: One patient with middle cerebral artery infarction died because of widespread posterior system infarction and additionally one patient died due to infection following operation. In remaining patients followed for 35 to 95 days postoperatively, mRS was change 2 points in 2 patients, 4 points in 2 patients, 3 points in 1 patient and 5 points in 1 patient. CONCLUSION: Although sample size was limited, our results were showed that surgical treatment reduces mortality and helps to provide the functional recovery in some patients

Decompressive surgery in stroke

OBJECTIVE: Our aim was to present the acute stroke cases carried out decompression surgery and to discuss our results with literature. METHODS: Decompression surgery was carried out in 8 patients including 4 women and 4 men who followed and clinically progressed despite the medical treatment within 1-11 days in Dokuz Eylül University Hospital Neurology Clinic between August 2010 and February 2012. Extensive hemicraniectomy+duraplasty were performed in 6 patients and suboccipital craniectomy was performed in 2 patients. RESULTS: One patient with middle cerebral artery infarction died because of widespread posterior system infarction and additionally one patient died due to infection following operation. In remaining patients followed for 35 to 95 days postoperatively, mRS was change 2 points in 2 patients, 4 points in 2 patients, 3 points in 1 patient and 5 points in 1 patient. CONCLUSION: Although sample size was limited, our results were showed that surgical treatment reduces mortality and helps to provide the functional recovery in some patients