Psychiatric morbidities after stroke in Asia: A systematic review

Background@#Stroke is currently the second leading cause of death worldwide and is one of the leading causes of long-term disability . Mood disorders are prevalent after a stroke and may hinder physical, functional, and cognitive recovery; hence, it is undeniably necessary to recognize them early. Stroke mortality is generally higher in Asia as most of the countries therein are in economic transition . Socioeconomic status is a major contributor to stroke burden as greater odds of disability are found in patients with lower educational status and income. @*Objectives@#The primary objective of this study is to identify the psychiatric morbidities commonly seen after a stroke in Asia. @*Search Methods@#The following databases were utilized for extensive literature search: PubMed (January 2002 to June 2022), Cochrane Library (January 2002 to June 2022), and EBSCO (January 2002 to June 2022). The search made use of keyword combinations, Boolean operators "AND" and "OR," truncations, and field tags last October 2022. @*Selection Criteria@#Articles on the prevalence and cross-sectional studies were included if they involved stroke survivors who developed post-stroke psychiatric morbidities in Asia. Additional inclusion criteria consisted of studies that have to be written in the English language and having free full texts available. @*Data Collection and Analysis@#This systematic review made use of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) standards and guidelines. The JBI Critical Appraisal Checklist for Studies Reporting Prevalence Data was used in the assessment for the quality of articles to be included in this systematic review. @*Results and Conclusion@#Affective disorders and generalized anxiety disorder were the common psychiatric morbidities identified post-stroke. The Hospital Anxiety and Depression Scale (HADS) may be used to diagnose post-stroke depression and anxiety. Males in their middle to late adulthood with higher National Institutes of Health Stroke Scale (NIHSS) scores and poor stroke outcomes (higher scores in the Modified Rankin Scale) were associated with a higher likelihood of developing the aforementioned psychiatric morbidities.

Betwixt and between: Exploring the liminal space of the 'first generation' Filipino physician through the lens of the rites of passage

@#<p style="text-align: justify;"><strong>Introduction:</strong> The 'first generation' physician gathers a lot of strength to venture into a world unknown to him. Unlike a physician born to a family of physicians who has a family to guide him, the 'first generation' physician only has himself to survive this endeavor. Through the life worlds of a select group of 'first generation' physician-in-training, this study seeks to answer the following central question: How do 'first generation' Filipino physicians collectively characterize their liminal spaces in transition from medical school to clinical practice?</p><p style="text-align: justify;"><strong>Methodology:</strong> Anchored on the Theory of the Rites of Passage, this phenomenological inquiry, intends to surface the lebenswelt or essence of the experience of being the only physician in the family. Respondents comprised a purposive sample of physicians-in-training (residents and fellows), who are the only physicians in the family. Data were gathered using semi-structured interviews. Triangulation and member checking procedures were done to ensure the data reliability. Data were then subjected to cool (categorization) and warm analysis (thematization) using the Colaizzi's method.</p><p style="text-align: justify;"><strong>Findings and Discussion:</strong> With all the transcribed experiences summarized and those with the same meaning analyzed, the following categories and themes were generated: The Intending Facet / Purpose: From Uncertainty towards Redefinition; The Thinking Facet / Process: From Perplexity towards Self-efficacy; The Relating Facet / People: From Isolation towards Integration; and The Transforming Facet / Power: From Vulnerability towards Empowerment. It was shown that a 'first generation' physician in this liminal space undergoes challenges and struggles during his training in medicine. This served as his Rite of Passage to transition him to someone dreaming only to become a physician, to become redefined with conviction, supported and integrated into the health system, empowered and transformed to the physician he is meant to be.</p><p style="text-align: justify;"><strong>Recommendations:</strong> Physicians undergo a lot of challenges and mental stress and it means a lot for trainers to enter into the trainees' life-world, especially that of a 'first generation' physician, so that they can build socio-emotional learning and mentoring programs and counselling services that address different facets of liminal space that the trainees go through.</p>

Multifocal motor neuropathy with Anti-GM1 antibody: A Filipino case report

@#As far as we are aware of, we report the fi rst documented case of a 51-year-old Filipino female with multifocal motor neuropathy who presented with asymmetric weakness, unusually in the lower extremity, and confi rmed with anti-GM1 antibody. The treatment of intravenous immunoglobulin with a total dose of 2 g/kg was initiated and repeated every two months with noticeable improvement based on electromyography and nerve conduction studies. Apart from the unreported Filipino case of multifocal motor neuropathy substantiated by features in clinical, electrophysiologic, antibody testing and response to immunotherapy, the unique occurrence in a female and involving the lower extremity in this rare disorder deserve this present documentation. Multifocal motor neuropathy is seen more in males with a ratio of 2.7:1. It is described as a pure motor disease without sensory defi cits and predominantly affects the upper extremities. The diagnosis for the disorder is supported by determination of ganglioside GM1 antibodies.

Aspirin resistance among patients with recurrent non-cardioembolic stroke detected by rapid platelet function analyzer

Background and Objective: The prevalence of aspirin resistance amongst patients with cardiovascular disease and in the healthy population has been reported to range from 5% to 45%. Lately, rapid platelet function analyzer (RPFA) a point-of-care determination of platelet aggregability has been introduced for rapid determination of aspirin resistant patients. The purpose of this paper is to report the prevalence of aspirin resistance among patients with recurrent non cardioembolic ischemic stroke as detected by RPFA (Ultegra®). Methods: Seventy-seven patients with mean age of 61.2 + 10.4 (range 33-87 years) who developed recurrent non-cardioembolic ischemic stroke were consecutively included in the study. Fifty-seven (74%) were males. Aspirin resistance was determined using the RPFA (Ultegra®) machine. Patients with an aspirin reaction unit (ARU) value above 550 were identified as aspirin resistant. Results: Following this method, the prevalence of aspirin resistance was determined to be 10.4% (95% CI: 1% to17%). Comparison of baseline characteristics between aspirin resistant and aspirin responsive patients did not show any significant difference. Conclusion: The prevalence of aspirin resistance in this study was 10.4% amongst patients with recurrent non-cardioembolic ischemic stroke. The study has shown the feasibility of utilizing RPFA (Ultegra®) machine in detecting aspirin resistance.