The Reasons Acute Stroke Patients Not Receiving Thrombolysis In An Indonesian Referral Hospital

Objective: The aim of this study was to identify reasons acute stroke patients did not receive thrombolysis despite meeting Code Stroke activation criteria in Cipto Mangunkusumo General Hospital during November 2015 until February 2019. Methods: This study retrospectively collected data of adult (aged>18 y old) acute stroke patients admitted to Cipto Mangunkusumo General Hospital from November 2015 to February 2019 who met criteria for Code Stroke activation but did not undergo thrombolysis. Patient’ data were collected from Code Stroke Registry of Cipto Mangunkusumo General Hospital. Results: There were 518 acute stroke patients who had Code Stroke activated in Cipto Mangunkusumo General Hospital from November 2015 to February 2019. 76.3% of acute stroke patients did not receive thrombolytic therapy (n=395). Hemorrhage on computed tomography (CT) scan was the most common reason patients did not receive thrombolysis. The following most common reasons were low or improved National Institutes of Health Stroke Scale (NIHSS) score, family refusal, and exceedance of time window. Conclusion: Hemorrhage on CT scan was the most common reason patients did not receive thrombolysis following by low or improved NIHSS score, family refusal, and exceedance of time window.

Blood Viscosity As A Determining Factor Of Ischemic Stroke Outcomes Evaluated With Nihss And Mrs On Day 7 And 30 Post-Thrombolysis

Objective: This study aimed to analyze blood viscosity as a determining factor of ischemic stroke outcomes evaluated with National Institutes of Health Stroke Scale (NIHSS) and modified Rankin Scale (mRS) on day 7 and 30 post-thrombolysis. Methods: This study was a 4-months cohort study taking place in Cipto Mangunkusumo General Hospital from January to April 2017. Subjects were collected at the Emergency Department or Neurology Outpatient Department. Eligible patients gave informed consent. Patients underwent numerous examinations, including blood viscosity test using digital microcapillary (DM) instrument. Outcomes of patients were identified on day 7 and day 30 post-thrombolysis using NIHSS and mRS, respectively. Results: Most acute ischemic stroke patients (88.6%) had blood hyperviscosity. 9.1% patients had poorer neurologic deficit on day 7 evaluated with NIHSS and 18.2% patients had poor outcome on day 30 evaluated with mRS. All patients with normal blood viscosity did not have a poorer neurologic deficit on day-7-evaluation. Conclusion: Blood viscosity determines the outcomes of acute ischemic stroke patients on day 7 and day 30 post-thrombolysis.

Efficacy Of Low-Dose Thrombolysis With Intravenous Alteplase Within 6 H Of Acute Ischemic Stroke Onset: Evidence From Single Referral Center In Indonesia

Objective: This study evaluated the efficacy of thrombolysis with 0.6 mg/kg intravenous alteplase for acute ischemic stroke patients within 6 h of stroke onset. Methods: This cross-sectional study collected data of patients with ischemic stroke received intravenous thrombolytic therapy with 0.6 mg/kg alteplase within 6 h of onset in Cipto Mangunkusumo General Hospital (Rumah Sakit Cipto Mangunkusumo [RSCM]) between November 2014 and August 2017. Efficacy of the thrombolytic therapy was evaluated using the National Institutes of Health Stroke Scale (NIHSS) and modified Rankin Scale (mRS). NIHSS evaluated on 24 h and 7 d post thrombolytic therapy portrayed clinical outcomes of patients while mRS evaluated on day 30 post-thrombolysis portrayed the functional outcome of patients. Results: The median NIHSS score decreased on 24 h and 7 d post-thrombolysis. 33.3% patients experienced a reduction of NIHSS score ≥4 on 24 h post thrombolytic therapy. On day 7 following thrombolysis, 57.4% patients had a good clinical outcome. On day 30 follow-up, 55.6% patients had a good functional outcome. Conclusion: Thrombolysis using 0.6 mg/kg intravenous alteplase within 6 h of onset is effective for acute ischemic stroke patients.

Mixed Medullary and Papillary Carcinoma Thyroid in a Young Female- A Rare Case Report

The medullary thyroid carcinomas (MTC) comprise 5-10% of all thyroid carcinomas. It is known to show many cyto-architectural variations. The WHO classification of thyroid tumors includes an entity called mixed medullary-papillary carcinoma, a rare malignancy known to represent <1% of all thyroid malignancies. Fewer than 40 such cases have been reported so far and include tumors showing morphological features of both medullary carcinoma and papillary carcinoma with immunoreactivity for calcitonin and CK19 &thyroglobulin respectively. We report a case of a 27-year-old female with complaints of gradually increasing neck swelling for 2 years, with difficulty in swallowing in the last 2 months. The swelling was more localized towards left. Ultrasound neck revealed a nodule in the left lobe of thyroid with benign features most likely nodular colloid goiter. Thyroid profile of the patient was normal. FNA revealed sheets and follicles lined by both hyperplastic and involutional follicular cells. Few micro follicles showed pleomorphic cells having hyperchromatic nuclei and mild anisonucleosis. A diagnosis of colloid goiter was given on cytology; however, on grounds of suspicion of a neoplastic process, histopathology was advised. The patient underwent total thyroidectomy. Hematoxylin & Eosin stained sections showed features of mixed medullary-papillary carcinoma of the thyroid which was further confirmed on Immunohistochemistry and raised serum calcitonin levels. It is important to know about this entity due to its prognostic implications, association with other endocrine disorders and to prevent any diagnostic dilemmas.

The role of The University of the West Indies Mona libraries in HIV/AIDS information access and dissemination / El papel de las bibliotecas de la Universidad de West Indies de Mona en VIH/SIDA acceso a la información y difusión

The recommendations for controlling HIV/AIDS, whether prescriptive or descriptive, underscore the value of information: its translation into knowledge, and knowledge into behaviour. Thus, accessing, evaluating, disseminating and applying authoritative, credible and scholarly information on HIV/AIDS are critical elements in the control of this pandemic in the Web 2.0 era. The University of the West Indies (UWI) Mona libraries have embraced this information role. This article provides insights into three of the information initiatives implemented by the UWI Mona libraries in this important capacity. In this regard, it also provides ideas for other West Indian information units and enhances communication on access to information products and services, albeit incrementally, in an important area of health services for the West Indies.

Las recomendaciones para el control del VIH/SIDA, ya sean preceptivas o descriptivas, subrayan el valor de la información, en cuanto esta se traduce en conocimientos, en tanto que los conocimientos se traducen a su vez en conducta. Por lo tanto, el acceder, evaluar, difundir y aplicar información proveniente de fuentes autorizadas, fidedignas y académicas sobre el VIH/SIDA, son elementos críticos en el control de esta pandemia en la era Web 2.0. Las bibliotecas de la Universidad de West Indies (UWI) en el campus de Mona han hecho suyas este rol de la información. Este artículo ofrece un panorama de tres de las iniciativas de información implementadas por las bibliotecas de UWI Mona en esta importante capacidad. En este sentido, también proporciona ideas para otros centros de información en las Antillas, y mejora la comunicación para el acceso a productos y servicios de información - si bien de forma gradual - en un área importante de servicios de salud para las Antillas.

Prevalence of refractive error in mentally retarded students of Kathmandu Valley.

Mental retardation also known as 'mentally handicap' means a delay or insufficient development of mental capacities. The prevalence of mental retardation in Nepal is 4.1%. Vision being the best sense for their education and daily activities, a cross-sectional and descriptive study was conducted to find out the refractive error among the students in the schools for mentally retarded people. A total of 134 clinically diagnosed cases of mentally retarded students from three different schools of Kathmandu Valley were examined. Distance visual acuity was taken with the help of Cat Ford Vision Drum, SG chart and Kay Picture Test method but first preference was given to SG chart. Cyclo-retinoscopy and fundus examination under mydriasis were done in all the cases. Examination revealed that more than half of the examined had one or more ocular disorders with refractive error being the most common type of ocular morbidity followed by ocular motility disorders. Refractive errors were found in 34.4% in which the most common type of refractive error was simple hypermetropia. In conclusion refractive error was seen commonly among mentally retarded people of Kathmandu Valley.

Primary hydatidosis of gluteus maximus.

Hydatid disease is a parasitic infestation of humans and herbivorous animals, caused by echinococcus granulosus.Dogs and some wild carnivores, like foxes, are definitive hosts, harboring worms in their intestines. Eggs are passed in feces and eaten by intermediate hosts and larvae encyst in the liver, lungs and other organs. Primary muscular hydatidosis without involving the thoracic or abdominal organs is extremely rare. A case of intramuscular gluteal hydatid cyst is being reported with the intent of highlighting this atypical localization of the disease. Since the soft tissue tumors may be confused with hydatid cysts, preoperative evaluation of these patients is critical for proper handling during surgery to avoid life-threatening complications. We report a case of a 24-year-old male patient with a cystic gluteal swelling turning out to be hydatid cyst on sonography and computerized scanning. Surgical excision with postoperative antihelmenthics formed the main modality of treatment.