Roll Back Stroke: The Way Forward for Physicians and Patients

The 6-lettered word "Stroke" is an ancient disease, likened Biblicallyto "666" in Revelation 13 verse 18. Globally, it is the commonestcause of acquired long-term disability. While its incidence has beendeclining in high-, low/middle-income countries (LMICs) have witnessed an increase. This increase is driven byepidemiologic-transition/modernizatio n-complex, healthcaredisparities, and increasing prevalence of vascular risk-factors. Despitethe disproportionate burden of stroke in LMICs, these countrieshave the lowest rate of access to acute reperfusion-interventions leadingto greater stroke-related morbidity /mortality. Effective primordial,primary, secondary, and quaternary prevention-strategies coordinated at all levels of care are needed to reduce stroke incidenceand poor outcomes. The World Stroke Organization (WSO) hasproposed achieving global primary prevention through 1) Population-wide approach to limiting stroke risk-factors exposure, 2) App-basedmotivational population-wide approach to mitigating stroke risk-fa cto rs, 3 ) u se of lo w-co st co mbi n at io n /po ly- p il l to tre at hypertension/dyslipidemia and 4) addressing behavioural risk-factorsthrough interventions by community health-workers.The need to set-up stroke-units, post-hospitalisation rehabilitation-centres, stroke-registers/registries, stroke-clubs, and encouragecommunity health-education, must be emphasised for optimal care inLMIC.13 Community Health Empowerment (CHE) withthe AcronymBE FAST / STRoke as warning signs of stroke must be emphasised(B: Balance-loss; E: Eye vision-loss; F: Facial Asymmetry; A: Armweakness; S: Speech difficulties; T: Time is brain; Or first 3-lettersof STRoke ­ Can Patient Smile? Talk? Or Raise-arm?). Strokehemorheology/blood-flow and treatment involve 3Ps' of pathogenicprinciples/strategies (Passenger, Passage, Power). Its complicationsinclude the 10D's: Death, Disability, Depression, Dementia, Delirium,Dysphagia, Dehydration, Deep-Venous Thrombosis, Decubitus-ulcers, Dysphasia, Seizures.

Review of current concept in the management of pressure ulcers

Pressure ulcers are quite distressing, and they cut across all age groups. Aside from increasingmortality, it results in protracted hospital stay and an upsurge in the consumption of healthcare resourcesPressure ulcers are considered to be essentially preventable, but in order to prevent them it is important to identify the people most at risk and deliver timely preventative care. In case of severe acute respiratory distress syndrome (ARDS), as in coronavirus dis­ease 2019 (COVID-19) affected patients, prone position and invasive ventilation improve the clinical status of this group of patients. This form of therapy is associated with an increased risk of facial pressure ulcers. When pressure ulcer occurs, appropriate documentation of each ulcer and staging of the ulcer are essential for good wound assessment.Treatment involves, assessing the nutritional needs of the patient, management of infections, removal of necrotic tissue, maintenance of a moist environment for wound healing, and possibly surgery