Primary stroke prevention worldwide : translating evidence into action

Funding Information: The stroke services survey reported in this publication was partly supported by World Stroke Organization and Auckland University of Technology. VLF was partly supported by the grants received from the Health Research Council of New Zealand. MOO was supported by the US National Institutes of Health (SIREN U54 HG007479) under the H3Africa initiative and SIBS Genomics (R01NS107900, R01NS107900-02S1, R01NS115944-01, 3U24HG009780-03S5, and 1R01NS114045-01), Sub-Saharan Africa Conference on Stroke Conference (1R13NS115395-01A1), and Training Africans to Lead and Execute Neurological Trials & Studies (D43TW012030). AGT was supported by the Australian National Health and Medical Research Council. SLG was supported by a National Heart Foundation of Australia Future Leader Fellowship and an Australian National Health and Medical Research Council synergy grant. We thank Anita Arsovska (University Clinic of Neurology, Skopje, North Macedonia), Manoj Bohara (HAMS Hospital, Kathmandu, Nepal), Denis ?erimagi? (Poliklinika Glavi?, Dubrovnik, Croatia), Manuel Correia (Hospital de Santo Ant?nio, Porto, Portugal), Daissy Liliana Mora Cuervo (Hospital Moinhos de Vento, Porto Alegre, Brazil), Anna Cz?onkowska (Institute of Psychiatry and Neurology, Warsaw, Poland), Gloria Ekeng (Stroke Care International, Dartford, UK), Jo?o Sargento-Freitas (Centro Hospitalar e Universit?rio de Coimbra, Coimbra, Portugal), Yuriy Flomin (MC Universal Clinic Oberig, Kyiv, Ukraine), Mehari Gebreyohanns (UT Southwestern Medical Centre, Dallas, TX, USA), Ivete Pillo Gon?alves (Hospital S?o Jos? do Avai, Itaperuna, Brazil), Claiborne Johnston (Dell Medical School, University of Texas, Austin, TX, USA), Kristaps Jurj?ns (P Stradins Clinical University Hospital, Riga, Latvia), Rizwan Kalani (University of Washington, Seattle, WA, USA), Grzegorz Kozera (Medical University of Gda?sk, Gda?sk, Poland), Kursad Kutluk (Dokuz Eylul University, ?zmir, Turkey), Branko Malojcic (University Hospital Centre Zagreb, Zagreb, Croatia), Micha? Maluchnik (Ministry of Health, Warsaw, Poland), Evija Migl?ne (P Stradins Clinical University Hospital, Riga, Latvia), Cassandra Ocampo (University of Botswana, Princess Marina Hospital, Botswana), Louise Shaw (Royal United Hospitals Bath NHS Foundation Trust, Bath, UK), Lekhjung Thapa (Upendra Devkota Memorial-National Institute of Neurological and Allied Sciences, Kathmandu, Nepal), Bogdan Wojtyniak (National Institute of Public Health, Warsaw, Poland), Jie Yang (First Affiliated Hospital of Chengdu Medical College, Chengdu, China), and Tomasz Zdrojewski (Medical University of Gda?sk, Gda?sk, Poland) for their comments on early draft of the manuscript. The views expressed in this article are solely the responsibility of the authors and they do not necessarily reflect the views, decisions, or policies of the institution with which they are affiliated. We thank WSO for funding. The funder had no role in the design, data collection, analysis and interpretation of the study results, writing of the report, or the decision to submit the study results for publication. Funding Information: The stroke services survey reported in this publication was partly supported by World Stroke Organization and Auckland University of Technology. VLF was partly supported by the grants received from the Health Research Council of New Zealand. MOO was supported by the US National Institutes of Health (SIREN U54 HG007479) under the H3Africa initiative and SIBS Genomics (R01NS107900, R01NS107900-02S1, R01NS115944-01, 3U24HG009780-03S5, and 1R01NS114045-01), Sub-Saharan Africa Conference on Stroke Conference (1R13NS115395-01A1), and Training Africans to Lead and Execute Neurological Trials & Studies (D43TW012030). AGT was supported by the Australian National Health and Medical Research Council. SLG was supported by a National Heart Foundation of Australia Future Leader Fellowship and an Australian National Health and Medical Research Council synergy grant. We thank Anita Arsovska (University Clinic of Neurology, Skopje, North Macedonia), Manoj Bohara (HAMS Hospital, Kathmandu, Nepal), Denis Čerimagić (Poliklinika Glavić, Dubrovnik, Croatia), Manuel Correia (Hospital de Santo António, Porto, Portugal), Daissy Liliana Mora Cuervo (Hospital Moinhos de Vento, Porto Alegre, Brazil), Anna Członkowska (Institute of Psychiatry and Neurology, Warsaw, Poland), Gloria Ekeng (Stroke Care International, Dartford, UK), João Sargento-Freitas (Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal), Yuriy Flomin (MC Universal Clinic Oberig, Kyiv, Ukraine), Mehari Gebreyohanns (UT Southwestern Medical Centre, Dallas, TX, USA), Ivete Pillo Gonçalves (Hospital São José do Avai, Itaperuna, Brazil), Claiborne Johnston (Dell Medical School, University of Texas, Austin, TX, USA), Kristaps Jurjāns (P Stradins Clinical University Hospital, Riga, Latvia), Rizwan Kalani (University of Washington, Seattle, WA, USA), Grzegorz Kozera (Medical University of Gdańsk, Gdańsk, Poland), Kursad Kutluk (Dokuz Eylul University, İzmir, Turkey), Branko Malojcic (University Hospital Centre Zagreb, Zagreb, Croatia), Michał Maluchnik (Ministry of Health, Warsaw, Poland), Evija Miglāne (P Stradins Clinical University Hospital, Riga, Latvia), Cassandra Ocampo (University of Botswana, Princess Marina Hospital, Botswana), Louise Shaw (Royal United Hospitals Bath NHS Foundation Trust, Bath, UK), Lekhjung Thapa (Upendra Devkota Memorial-National Institute of Neurological and Allied Sciences, Kathmandu, Nepal), Bogdan Wojtyniak (National Institute of Public Health, Warsaw, Poland), Jie Yang (First Affiliated Hospital of Chengdu Medical College, Chengdu, China), and Tomasz Zdrojewski (Medical University of Gdańsk, Gdańsk, Poland) for their comments on early draft of the manuscript. The views expressed in this article are solely the responsibility of the authors and they do not necessarily reflect the views, decisions, or policies of the institution with which they are affiliated. We thank WSO for funding. The funder had no role in the design, data collection, analysis and interpretation of the study results, writing of the report, or the decision to submit the study results for publication. Funding Information: VLF declares that the PreventS web app and Stroke Riskometer app are owned and copyrighted by Auckland University of Technology; has received grants from the Brain Research New Zealand Centre of Research Excellence (16/STH/36), Australian National Health and Medical Research Council (NHMRC; APP1182071), and World Stroke Organization (WSO); is an executive committee member of WSO, honorary medical director of Stroke Central New Zealand, and CEO of New Zealand Stroke Education charitable Trust. AGT declares funding from NHMRC (GNT1042600, GNT1122455, GNT1171966, GNT1143155, and GNT1182017), Stroke Foundation Australia (SG1807), and Heart Foundation Australia (VG102282); and board membership of the Stroke Foundation (Australia). SLG is funded by the National Health Foundation of Australia (Future Leader Fellowship 102061) and NHMRC (GNT1182071, GNT1143155, and GNT1128373). RM is supported by the Implementation Research Network in Stroke Care Quality of the European Cooperation in Science and Technology (project CA18118) and by the IRIS-TEPUS project from the inter-excellence inter-cost programme of the Ministry of Education, Youth and Sports of the Czech Republic (project LTC20051). BN declares receiving fees for data management committee work for SOCRATES and THALES trials for AstraZeneca and fees for data management committee work for NAVIGATE-ESUS trial from Bayer. All other authors declare no competing interests. Publisher Copyright: © 2022 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 licenseStroke is the second leading cause of death and the third leading cause of disability worldwide and its burden is increasing rapidly in low-income and middle-income countries, many of which are unable to face the challenges it imposes. In this Health Policy paper on primary stroke prevention, we provide an overview of the current situation regarding primary prevention services, estimate the cost of stroke and stroke prevention, and identify deficiencies in existing guidelines and gaps in primary prevention. We also offer a set of pragmatic solutions for implementation of primary stroke prevention, with an emphasis on the role of governments and population-wide strategies, including task-shifting and sharing and health system re-engineering. Implementation of primary stroke prevention involves patients, health professionals, funders, policy makers, implementation partners, and the entire population along the life course.publishersversionPeer reviewe

Transsternal transpericardial approach for the repair of bronchopleural fistula with empyema

PubMedID: 10735669Background. Numerous surgical approaches have been reported for the repair of bronchopleural fistula. Recently the transsternal transpericardial approach has shown great promise with its positive results in cases of bronchopleural fistula complicated with empyema. The aim of this retrospective study was to assess the results of bronchopleural fistula treatment using the transsternal transpericardial approach. Methods. Bronchopleural fistula developed in 16 of the 172 patients who had pneumonectomy between 1982 and 1996. In one case closure with fibrin sealant by bronchoscopy was tried. In the remaining cases fistula was closed by the transsternal transpericardial approach. Results. The interval between pneumonectomy and fistula occurrence was 10 days or less in 5 patients and 10 days to 1 month in 11 patients. In all patients the empyema space was treated by continued drainage through the thoracostomy tube. Fibrin sealant was tried unsuccessfully for closure of moderate-sized bronchopleural fistula in one case. In three cases of right bronchopleural fistula, carinal resection and anastomosis of the trachea to the left main stem bronchus were performed. In the remaining cases bronchopleural fistula was closed using a hand suture technique. One patient died within 30 days after operation (6.25%) because of renal insufficiency. There was no recurrence of bronchopleural fistula. Conclusions. Transsternal transpericardial approach seems to be a safe and effective method with an easier technique in cases of bronchopleural fistula complicated with empyema. It has the added advantage of less recurrent fistula formation and enables resection in cases without sufficient bronchial stump. (C) 2000 by The Society of Thoracic Surgeons

A unusual case of right lung and right atrio-inferiocaval injury caused by stabbing

PubMedID: 19670127Penetrating thoracic injuries can damage more than one intrathoracic structure and frequently require urgent surgical intervention due to life-threatening consequences. These injuries demand extreme awareness and emergency measures. This paper reports on an unusual case with right lung and right atrio-inferiocaval junction injury caused by a knife penetrating through the right paravertebral region of the thorax. The patient was treated by immediate surgical repair under partial cardiopulmonary bypass and discharged successfully. This case emphasizes the fact that right chest paravertebral penetrating injuries may require cardiopulmonary bypass, although this zone has less risk for cardiac injury. © Georg Thieme Verlag KG Stuttgart - New York

Bilateral popliteal entrapment syndrome associated with plantar flexion of a phenomenon

Popliteal artery entrapment syndrome (PAES) presents with intermittent claudication; however, in the later stages, acute ischemia can occur as a result of complete arterial occlusion or embolism. We present a patient that symptomatic with plantar flexion. PAES was diagnosed with magnetic resonance imaging (MRI) and angiography. In operation medial head of gastrocnemius was resected and popliteal artery resection end to end anastomosis technic was performed. After surgery patient discharged with no symptom and problem. Ischemic symptoms in the lower leg in young patients with extremity movement, PAES must be considered. Correct diagnosis for PAES are important for preventing deterioration in the patient's clinical condition. © 2014, EManuscript Services. All rights reserved

Isolated giant intrathoracic meningocele associated with vertebral corpus deformity

Published reports of intrathoracic meningocele with vertebral corpus defects in the absence of neurofibromatosis are very rare. We report a 9-year-old male with intrathoracic meningocele. We believe that vertebral corpus defects may play a certain role in the etiology of intrathoracic meningocele. © 2004 Elsevier B.V. All rights reserved

The effect of low molecular weight heparin (Fraxiparine = Nadroparine calcium) on full heparinization. An experimental study

Purpose: Standard (unfractionated) heparin is still the only agent to perform extracorporeal circulation in open heart surgery. There are some important side effects of heparin like post-operative bleeding and adverse reactions while protamine reversal. Dose of heparin necessary for extracorporeal circulation was searched whether it could be decreased by using low molecular weight heparin (Fraxiparine*)(*Nadroparine calcium from Choay/Sanafi, Paris, France). Methods: An experimental animal study group was created with 12 pigs which had blood coagulation test values in normal limits. Fraxiparine 0.3 cc in prefilled syringes was administered subcutaneously into pigs twice a day for five days. Then the pigs were heparinized intravenously and the dose of standard heparin needed to get sufficient anticoagulant effect to perform extracorporeal circulation was calculated. Results: Although coagulation and activated coagulation times were slightly increased, these were not statistically significant. Pigs were full heparinized at the 5th day of the trial when compared to control values, these were not statistically significant (p > 0.05). Standard heparin dose to get sufficient anticoagulant effect was 4 mg/kg and this was not less than the dose found for the control group. Conclusion: According to these results, we reported preoperatively low molecular weight heparin use did not change the amount of heparin enough for extracorporeal circulation. We suggested that using low molecular weight heparin could be helpful to achieve the desired antithrombotic effect in the very early post-operative periods of coronary bypass and prosthetic heart valve operations

Cerebral circulation via right vertebral artery in Takayasu's arteritis

A 42-year-old woman had left fronto-orbital aching and amaurosis for 6 months. Fluorescein angiography of the left eye showed vasculitis. Aortography revealed total occlusion of both subclavian arteries, both carotid arteries, and the left vertebral artery, with serious narrowing of the abdominal aorta. The right vertebral artery was spared. Blood flow in the middle and anterior cerebral arteries was normal in spin-echo and phase-contrast magnetic resonance studies. Immunohistochemical findings indicated Takayasu's arteritis

Giant thoracic aneurysm associated with coarctation of the aorta

A 39-year-old male with low back pain, fatigue, and nausea of 2 years duration was referred with a suspected mass in the left lung. Computed tomography and magnetic resonance imaging showed a giant aneurysm associated with a coarctation of the descending thoracic aorta. A Dacron tube graft was interposed. Histopathologic examination revealed atherosclerosis of the aneurysmal wall

A background infusion of morphine enhances patient-controlled analgesia after cardiac surgery

PubMedID: 15310642Purpose: We compared the efficacy of patient-controlled analgesia (PCA), with or without a background infusion of morphine, on postoperative pain relief in patients extubated in the operating room after-coronary artery bypass grafting (CABG) surgery. Methods: With Faculty Ethics approval, 60 consenting adults undergoing elective coronary artery surgery were randomly assigned to receive either morphine PCA alone (group PCA-A, n = 30) or morphine PCA plus a background infusion (group PCA-B, n = 30) for 24 hr postoperatively. Pain scores with verbal rating scale (VRS; from 0 to 10) at rest, sedation scores, morphine consumption and delivery/demand ratios were assessed at zero, one, two, four, six, 12 and 24 hr after surgery. Hemodynamic variables and arterial blood gases were also recorded in the same periods. Results: Sedation scores in the two groups were similar. At all study periods after the first postoperative hour, VRS remained below 5 in both groups. Pain scores were significantly lower in the background infusion group, which also had greater cumulative morphine consumption (61.7 ± 10.9 mg vs 38.5 ± 16.2 mg). There were no episodes of hypoxemia or hypertension. Conclusion: Morphine PCA effectively controlled postoperative pain after cardiac surgery. The addition of a background infusion of morphine enhanced analgesia and increased morphine consumption

Electromechanical effects of protamine and verapamil in rat papillary muscle

The electromechanical effects of protamine sulfate and the calcium channel blocker verapamil on rat cardiac and skeletal muscles were studied using isolated left ventricular papillary muscle and phrenic nerve- hemidiaphragm preparations. Protamine produced significant decreases in isometric force in the cardiac tissue and contracture developed at concentrations of 40 and 80 mg · L-1. Isometric force also decreased significantly with verapamil at concentrations of 0.757 and 7.57 mg · L-1. Both drugs caused significant decreases in the contractile force of hemidiaphragm muscle when the tissue was stimulated indirectly. Protamine and verapamil caused the resting membrane potential and the amplitude of the action potential to decrease in cardiac tissue and overshoot failed to develop with 80 mg · L-1 of protamine or 7.57 mg · L-1 of verapamil. These bioelectrical changes developed in a dose-dependent manner. It was concluded that protamine had a similar effect to that of calcium channel blockers and it may act through a reduction of cellular calcium. This effect on cardiac tissue may be mediated through the sarcolemmal ion pumps or channels, leading to changes in calcium homeostasis