Grave prognosis on spontaneous intracerebral haemorrhage: GP on STAGE score.

BACKGROUND AND OBJECTIVE: Spontaneous intracerebral haemorrhage (ICH) is more common in Asia than in western countries, and has a high mortality rate. A simple prognostic score for predicting grave prognosis of ICH is lacking. Our objective was to develop a simple and reliable score for most physicians. MATERIAL AND METHOD: ICH patients from seven Asian countries were enrolled between May 2000 and April 2002 for a prospective study. Clinical features such as headache and vomiting, vascular risk factors, Glasgow coma scale (GCS), body temperature (BT), blood pressure on arrival, location and size of haematoma, intraventricular haemorrhage (IVH), hydrocephalus, need for surgical treatment, medical treatment, length of hospital stay and other complications were analyzed to determine the outcome using a modified Rankin scale (MRS). Grave prognosis (defined as MRS of 5-6) was judged on the discharge date. RESULTS: 995 patients, mean age 59.5 +/- 14.3 years were analyzed, after exclusion of incomplete data in 87 patients. 402 patients (40.4%) were in the grave prognosis group (MRS 5-6). Univariable analysis and then multivariable analysis showed only four statistically significant predictors for grave outcome of ICH. They were fever (BT > or = 37.8 degrees c), low GCS, large haematoma and IVH. The grave prognosis on spontaneous intracerebral haemorrhage (GP on STAGE) score was derived from these four factors using a multiple logistic model. CONCLUSION: A simple and pragmatic prognostic score for ICH outcome has been developed with high sensitivity (82%) and specificity (82%). Furthermore, it can be administered by most general practitioners. Validation in other populations is now required.

Secondary prevention of stroke with antiplatelets - An economics analysis

The burden of stroke therapy has been ameliorated to a great extent with the use of anti-platelet agent for secondary prevention. The cost of health care in general is rising. Economic factors play a significant role in the cost of hospitalization for stroke patients in general and in the choice of anti-platelet agents in particular. The goal of this study is (1) to compare the total costs associated with prescription of anti-platelet drugs, (2) to determine the number-needed-to-treat (NNT) with each of the different anti-platelet drugs in the market: aspirin, dipyridamole, ticlopidine, cilostazol and clipidogrel; and (3) determine the direct cost incurred with the use of each anti-platelet drug. To do this, a cost-minimization analysis of total costs was done. Data were collected from all randomized control trials published evaluating drug treatment vs. placebo. Event rates, absolute risk reduction and NNT were calculated. Cost computation was done from direct medication and additional expenses were included for treatment or monitoring of adverse effects. Transportation and professional fees were excluded. The results of the study showed the following: NNT for ASA: 33; DP: 50; DP-ASA: 17; Ticlopidine: 33; Cilostazol: 17 and Clopidogrel: 100. Direct cost for two years treatment for ASA: Php13,678.90; DP: Php18,615.00, DP-ASA: Php3l,615.00, Ticlopidine: Php77,060.00, Cilostazol: Php64,240.00 and Clopidogrel: Php64,240,00. Total costs to prevent 1 stroke in two years treatment for ASA: Php451,403.70, DP: Php930,750.00, DP-ASA: Php537,455.00, Ticlopidine: Php2,542,980.00, Cilostazol: Phpl,092,080.00 and Clopidogrel: Php6,424,000.00. We conclude that aspirin should be the mainstay of therapy in preventing secondary stroke. (Author)

A correlation between ovulatory phase and cytohormonal maturation index of women with affected disorders: a preliminary study

Difference in endocrine features between men and women supports a biological hypothesis in affective disorders among women. Studies done showed high probability that mood changes in associated with hormonal alterations, particularly that of estrogen and progesterone. There are cyclic morphological changes occurring in the female reproductive system in response to these hormones. The cytohormonal maturation index (CHMI) is used to evaluate the female hormonal milieu. A differential of the three types of cells is expressed as percentages of the parabasal (P), the intermediate (I), and the superficial (S) cells, in that order. Predominance of the intermediate cells reflect high levels of progesterone, and the superficial cells that of estrogen. This study aims to compare the correlation of CHMI with ovulatory phase between women of reproductive age with affective disorder and normal control; and to compare the CHMI of the two groups. Eight women of reproductive age (mean age = 29.62 +/- 7.95), diagnosed to have affective disorders and having an episode of mania/hypomania or depression, underwent Paps smear. Written consents were obtained. LMP and PMP were obtained to determine the current ovulatory phase. The control group is composed of seven women of same age group (mean age = 29.29 +/- 6.65) having no manifestations of any psychiatric illnesses. Paps smear was performed by a Gynecology Resident. A Pathology Resident blinded to the study reviewed the slides for CHMI. Fishers exact I test and Mann-Whitney U test were utilized. A p value of 0.05 was considered as statistically significant. There is a significant difference in the proportion of agreement between the ovulatory phase and the CHMI between the two groups (p=0.045). However, there is no difference in the percentages of progesterone and estrogen between the two groups (p=0.247 and 0.452, respectively).

Is there a stigma of psychiatrists among medical colleagues in Tarlac?

Psychiatrists are numerous in urban areas, but are lacking in the provinces. Could there be a discrimination of psychiatrists by physicians in the rural areas? Is there a stigma attached to being a psychiatrist in the province? In an attempt to answer the above questions, a questionnaire survey of physicians in the province of Tarlac was conducted. Internal validity of the questionnaire was tested using Cronbach Alpha. Two pretests were conducted; the actual test consisted of 25 items with 92 points. Stigma was defined in terms of a cutoff value above 50% from the total number of points. In 75% of the respondents, there was a stigma attached to being a psychiatrist in Tarlac. The following were cited as disadvantages if being a psychiatrist in the said province: few patients, inadequate facilities and poor income. Some thought that psychiatrists might identify with their patients and acquire the same symptoms. The presence of stigma caries a negative implication as to the delivery of mental health care. There is a need to re-orient and re-educate physicians in Tarlac and reintegrate psychiatry into general medical practice.