Recurrence stroke of ischemic stroke patients in Thailand: a nationwide study

Stroke is a global health problem and a leading cause of mortality and disability. Patients who survived an initial stroke are at risk for a recurrence stroke of the same type or another. However, few studies have documented at a national level. This research aimed to investigate the magnitude of recurrence stroke among ischemic stroke patients. This descriptive study used the data from neurology database collected between 2006 to 2020 in hospitals under the National Health Security System (NHSO) of Thailand. Among 511,322 ischemic stroke patients, recurrence of all types of strokes occurred in 85,968 patients or 16.81% (95% CI: 16.71-16.92). The prevalence was highest among patients with hypertension and diabetes mellitus at 18.89% (95% CI: 18.54-19.26), atrial fibrillation at 18.79% (95% CI: 18.42-19.15), and ischemic heart disease at 18.59% (95% CI: 18.05- 19.15). Furthermore, patients who received recombinant tissue plasminogen activator (rt-PA) treatment (12.15% %, 95%CI: 11.75-12.55) and rehabilitation (14.39%, 95% CI: 14.25-14.54) had a lower prevalence. Co- morbidities were an important factor had a high recurrence and treatment factors that patients receive had a low recurrence. Therefore, policymakers and health institutions could use these findings to implement treatment and monitoring policies for recurrence stroke

Use of Handheld Versus Standard Ultrasound Devices in Ultrasound Rotation at the Emergency Department

BACKGROUND: Recently, handheld ultrasound equipment has come to replace standard machines in the training of emergency medicine residents. However, there have been few studies examining how this change has affected medical education. AIM: We aimed to compare standard and handheld ultrasound machines as educational tools in the emergency medicine residency program. METHODS: A cross-sectional survey of 17 emergency medicine residents at Srinagarind Hospital emergency department were trained to use point-of-care ultrasound and provided with handheld ultrasound devices during their 2-week ultrasound rotations, which took place between July 2019 and May 2020. Participants were given a 25-question survey comparing their learning experiences with standard versus handheld ultrasound machines. Data were analyzed using an independent sample t-test, and p < 0.05 was considered statistically significant. RESULTS: The response rate was 100%. At the baseline survey, most participants rated their learning experience as greater than 4 out of 5 with both ultrasound devices. They rated the learning experience with the handheld device as being more enjoyable and accessible but not to a statistically significant extent. There were also no significant differences in participants’ ratings of image quality or the ease of obtaining images. However, they rated the handheld device as being more useful and convenient (p < 0.001 and 0.034, respectively). CONCLUSIONS: The handheld ultrasound machine is useful in the training of emergency medicine residents. Further studies should be conducted to evaluate residents’ competency in using these devices

Does the Use of Lights and Sirens on Ambulances Affect Pre-hospital Time?

BACKGROUND: The use of lights and sirens (L&S) alerts other drivers of the presence of an ambulance and that they are required yield, increasing the speed and safety of emergency medical services (EMS) operations. However, there have been no studies examining the effect of L&S on pre-hospital time conducted in Thai EMS agencies. AIM: The aim of the study was to compare the operation times of ambulances with and without the use of L&S. METHODS: This was a cross-sectional study consisting of patients over 18 years of age assessed and treated through the Srinagarind Hospital EMS between April 2019 and March 2020. Data were collected from the Srinagarind Hospital EMS operation database and hospital information database system. RESULTS: A total of 1764 patients were enrolled, 1426 (80.8%) of whom were transported in an ambulance that used L&S. The mean age of patients in the L&S group was 45.2 ± 6.2 years and 742 (52.0%) were male. The average response times in the L&S and non-L&S groups were 10.2 min and 18.2 min, respectively (p < 0.001). Average L&S transport time was 11.1 min and non-L&S transport time was 17.1 min (p = 0.008). CONCLUSIONS: The use L&S reduced the response and transport times of EMS operations but not affect on-scene time

Response Times of Motorcycle Ambulances during the COVID-19 Pandemic

BACKGROUND: Motorcycles (motorlance) are often deployed as ambulances to the scene of an emergency to reduce response time. The COVID-19 pandemic has affected emergency medical services (EMS) in Thailand in many respects, and this study was conducted to examine its effect on motorlance operation time. AIM: The aim of the study was to examine motorlance operation time during the COVID-19 pandemic in comparison to normal periods. METHODS: This cross-sectional study examined all EMS motorlance operations dispatched from Srinagarind Hospital (Thailand). Data were collected from the Srinagarind Hospital EMS operation database and hospital information database system. Data from June 1, 2018, to December 31, 2019 (normal period) were compared with those from January 13 to April 21, 2020 (COVID-19). RESULTS: Eight hundred seventy-one EMS operations were examined over two periods. Mean patient age during the COVID-19 pandemic was 41.5 ± 6.2 years, and 54.6% (n = 59) were male. Average response time was 6.20 ± 1.35 min during the normal period and 3.48 ± 1.01 min during the pandemic (p = 0.021). Transport time was also significantly shorter during the latter period (2.35 vs. 5.20 min). CONCLUSIONS: Motorlance response and transport time during the COVID-19 pandemic were significantly shorter than usual

Cognitive-Enhancing Effect of Quercetin in a Rat Model of Parkinson's Disease Induced by 6-Hydroxydopamine

Oxidative stress has been reported to induce cognitive impairment in Parkinson's disease. This paper aimed to determine the effect of quercetin, a substance possessing antioxidant activity, on the cognitive function in a rat model of Parkinson's disease. Male Wistar rats, weighing 200–250 g, were orally given quercetin at doses of 100, 200, 300 mg/kg BW once daily for a period of 14 days before and 14 days after the unilateral lesion of right substantia nigra induced by 6-hydroxydopamine (6-OHDA). Their spatial memory was assessed at 7 and 14 days of treatment and neuron density was determined, malondialdehyde (MDA) level, the activity of superoxide dismutase (SOD), catalase (CAT), and glutathione peroxidase (GPx) were evaluated at the end of the experiment. In addition, the activity of acetylcholinesterase (AChE) was also measured. It was found that all doses of quercetin enhanced spatial memory. Therefore, it is suggested that the cognitive-enhancing effect of quercetin occurs partly because of decreased oxidative damage resulting in increased neuron density

Epidemiology of status epilepticus in adults: A population-based study on incidence, causes, and outcomes

In 2015, the International League Against Epilepsy (ILAE) proposed a new definition of status epilepticus (SE): 5 minutes of ongoing seizure activity to diagnose convulsive SE (CSE, ie, bilateral tonic-clonic SE) and 10 minutes for focal SE and absence SE, rather than the earlier criterion of 30 minutes. Based on semiology, several types of SE with prominent motor phenomena at any time (including CSE) were distinguished from those without (ie, nonconvulsive SE, NCSE). We present the first population-based incidence study applying the new 2015 ILAE definition and classification of SE and report the impact of the evolution of semiology and level of consciousness (LOC) on outcome

Prediction of seizure control in non-ketotic hyperglycemic induced seizures

<p>Abstract</p> <p>Background</p> <p>To study the factors predictive for seizure control in non-ketotic hyperglycemic induced seizures (NKHS).</p> <p>Methods</p> <p>We studied 21 patients who were clinically diagnosed as NKHS at Khon Kaen University hospital, Thailand. Multiple linear regression analysis was used to identify the factors predictive for seizure control.</p> <p>Results</p> <p>Most patients had no previous history of diabetes and presented with repetitive partial seizures. The mean number of seizure attacks was 45 times prior to admission. The average duration to terminate seizure was 36 hours and significantly predicted by frequency of seizures (estimate 0.9, p value 0.013).</p> <p>Conclusion</p> <p>Frequency of seizures is the only predictive factor for the success of seizure control in NKHS.</p

Sex differences in stroke mortality in Thailand : a National cohort study.

Acknowledgements AA : primary author, drafting manuscript. TAP : statistical analysis and supervision. ST : data acquisition of Thai data, data interpretation. KS : data acquisition of Thai data, data interpretation. NK : data acquisition of Thai data, data interpretation. MAM : supervision, critical revision. PKM : supervision, senior author critical revision. PKM is the guarantor.Peer reviewedPostprin