Predictors of ischemic versus hemorrhagic strokes in hypertensive patients.

OBJECTIVE: To identify the factors that predispose to ischemic versus hemorrhagic stroke in hypertensive patients. DESIGN: Cohort study. PLACE AND DURATION OF STUDY: The study was conducted at the Aga Khan University Hospital (AKUH), Karachi, from August 1999 to May 2001. MATERIALS AND METHODS: All the hypertensive patients, who were registered in AKUH acute stroke outcome data base, over a period of 22 months, were identified and from this cohort the patients with first ever stroke were selected. The data regarding demographics, stroke type (ischemic vs. hemorrhagic), pre-existing medical problems, laboratory and radiological investigations was recorded and analyzed. RESULTS: Five hundred and nineteen patients with either ischemic stroke or parenchymal hemorrhage were registered over a period of 22 months. Three hundred and forty-eight patients (67%) had hypertension and of these, 250 had first ever stroke at the time of admission. Presence of diabetes mellitus (OR: 3.76; CI:1.67-8.46) and ischemic heart disease (OR: 6.97; CI:1.57-30.98) were found to be independent predictors of ischemic strokes. CONCLUSION: Presence of diabetes mellitus and ischemic heart disease predict ischemic stroke in a patient with hypertension

Survey of artemisinin production by diverse <it>Artemisia </it>species in northern Pakistan

<p>Abstract</p> <p>Background</p> <p>Artemisinin is the current drug of choice for treatment of malaria and a number of other diseases. It is obtained from the annual herb, <it>Artemisia annua </it>and some microbial sources by genetic engineering. There is a great concern that the artemisinin production at current rate will not meet the increasing demand by the pharmaceutical industry, so looking for additional sources is imperative.</p> <p>Methods</p> <p>In current study, artemisinin concentration was analysed and compared in the flowers, leaves, roots and stems of <it>Artemisia annua </it>and 14 other <it>Artemisia </it>species including two varieties each for <it>Artemisia roxburghiana </it>and <it>Artemisia dracunculus </it>using high performance liquid chromatography (HPLC).</p> <p>Results</p> <p>The highest artemisinin concentration was detected in the leaves (0.44 ± 0.03%) and flowers (0.42 ± 0.03%) of <it>A. annua</it>, followed by the flowers (0.34 ± .02%) of <it>A. bushriences </it>and leaves (0.27 ± 0%) of <it>A. dracunculus var dracunculus</it>. The average concentration of artemisinin varied in the order of flowers > leaves > stems > roots.</p> <p>Conclusion</p> <p>This study identifies twelve novel plant sources of artemisinin, which may be helpful for pharmaceutical production of artemisinin. This is the first report of quantitative comparison of artemisinin among a large number of <it>Artemisia </it>species.</p

Frequency and management of maternal infection in health facilities in 52 countries (GLOSS): a 1-week inception cohort study

Background Maternal infections are an important cause of maternal mortality and severe maternal morbidity. We report the main findings of the WHO Global Maternal Sepsis Study, which aimed to assess the frequency of maternal infections in health facilities, according to maternal characteristics and outcomes, and coverage of core practices for early identification and management. Methods We did a facility-based, prospective, 1-week inception cohort study in 713 health facilities providing obstetric, midwifery, or abortion care, or where women could be admitted because of complications of pregnancy, childbirth, post-partum, or post-abortion, in 52 low-income and middle-income countries (LMICs) and high-income countries (HICs). We obtained data from hospital records for all pregnant or recently pregnant women hospitalised with suspected or confirmed infection. We calculated ratios of infection and infection-related severe maternal outcomes (ie, death or near-miss) per 1000 livebirths and the proportion of intrahospital fatalities across country income groups, as well as the distribution of demographic, obstetric, clinical characteristics and outcomes, and coverage of a set of core practices for identification and management across infection severity groups. Findings Between Nov 28, 2017, and Dec 4, 2017, of 2965 women assessed for eligibility, 2850 pregnant or recently pregnant women with suspected or confirmed infection were included. 70·4 (95% CI 67·7–73·1) hospitalised women per 1000 livebirths had a maternal infection, and 10·9 (9·8–12·0) women per 1000 livebirths presented with infection-related (underlying or contributing cause) severe maternal outcomes. Highest ratios were observed in LMICs and the lowest in HICs. The proportion of intrahospital fatalities was 6·8% among women with severe maternal outcomes, with the highest proportion in low-income countries. Infection-related maternal deaths represented more than half of the intrahospital deaths. Around two-thirds (63·9%, n=1821) of the women had a complete set of vital signs recorded, or received antimicrobials the day of suspicion or diagnosis of the infection (70·2%, n=1875), without marked differences across severity groups. Interpretation The frequency of maternal infections requiring management in health facilities is high. Our results suggest that contribution of direct (obstetric) and indirect (non-obstetric) infections to overall maternal deaths is greater than previously thought. Improvement of early identification is urgently needed, as well as prompt management of women with infections in health facilities by implementing effective evidence-based practices