Clinical and Safety Outcomes of Endovascular Therapy 6 to 24 Hours After Large Vessel Occlusion Ischemic Stroke With Tandem Lesions / 대한뇌졸중학회지

Background@#and Purpose Effect of endovascular therapy (EVT) in acute large vessel occlusion (LVO) patients with tandem lesions (TLs) within 6–24 hours after last known well (LKW) remains unclear. We evaluated the clinical and safety outcomes among TL-LVO patients treated within 6–24 hours. @*Methods@#This multicenter cohort was divided into two groups, based on LKW to puncture time: early window (<6 hours), and late window (6–24 hours). Primary clinical and safety outcomes were 90-day functional independence measured by the modified Rankin Scale (mRS: 0–2) and symptomatic intracranial hemorrhage (sICH). Secondary outcomes were successful reperfusion (modified Thrombolysis in Cerebral Infarction score ≥2b), first-pass effect, early neurological improvement, ordinal mRS, and in-hospital and 90-day mortality. @*Results@#Of 579 patients (median age 68, 32.1% females), 268 (46.3%) were treated in the late window and 311 (53.7%) in the early window. Late window group had lower median National Institutes of Health Stroke Scale score at admission, Alberta Stroke Program Early Computed Tomography Score, rates of intravenous thrombolysis, and higher rates for perfusion imaging. After adjusting for confounders, the odds of 90-day mRS 0–2 (47.7% vs. 45.0%, adjusted odds ratio [aOR] 0.71, 95% confidence interval [CI] 0.49–1.02), favorable shift in mRS (aOR 0.88, 95% CI 0.44–1.76), and sICH (3.7% vs. 5.2%, aOR 0.56, 95% CI 0.20–1.56) were similar in both groups. There was no difference in secondary outcomes. Increased time from LKW to puncture did not predicted the probability of 90-day mRS 0–2 (aOR 0.99, 95% CI 0.96–1.01, for each hour delay) among patients presenting <24 hours. @*Conclusion@#EVT for acute TL-LVO treated within 6–24 hours after LKW was associated with similar rates of clinical and safety outcomes, compared to patients treated within 6 hours.

Zika virus strategic response framework for the gulf states-2016: an urgent need for collaboration

The Zika virus [ZIKV] became the latest threat to global health security when WHO declared on 1[st] February 2016, that recently reported clusters of microcephaly and other neurological disorders in Brazil constitute a Public Health Emergency of International Concern [PHEIC]. These clusters were reported concurrently with an outbreak of ZIKV, which has been ongoing in Brazil and other countries in the America region since 2015. A growing body of clinical and epidemiological data possibly leans towards a causal role for ZEKV as the occurrence of the clusters of microcephaly and other neurological disorders principally the Guillain-Barre' syndrome are associated in time and place with the ongoing ZIKV transmission in the America region. So far, Zika viral transmission has been documented in a total of 69 countries and territories with autochthonous transmission from 2007 to 10 August 2016. The geographical range of ZIKV has been increasing steadily. Considering the presence of competent vectors that transmit ZIKV in some parts of the Gulf countries, and the close relationship with Brazil, a local transmission of the virus is plausible once the virus is introduced through travel. This review suggests the integration of epidemiological and entomological surveillance for monitoring and control of the vectors of ZIKV. The risks associated with ZIKV infection and the possible threat to the Gulf Sates was described. A strategic Zika response framework [SRF] for the Gulf States has been developed to meet their urgent need for a collaborative and coordinated response for prevention and spread of ZIKV infection. A coordinated response of all partners in the Golf States across sectors and services at national, as well as, regional levels is required

Zika virus: no cases in the Eastern Mediterranean Region but concerns remain

Following the WHO declaration on 1 February 2016 of a Public Health Emergency of International Concern [PHEIC] with regard to clusters of microcephaly and neurological disorders potentially associated with Zika virus, the WHO Regional Office for the Eastern Mediterranean conducted three rounds of emergency meetings to address enhancing preparedness actions in the Region. The meetings provided up-to-date information on the current situation and agreed on a set of actions for the countries to undertake to enhance their preparedness and response capacities to Zika virus infection and its complications. The most urgent action is to enhance both epidemiological and entomological surveillance between now and the coming rainy seasons in countries with known presence of Aedes mosquitoes. Zika virus like other vector-borne diseases poses a particular challenge to the countries because of their complex nature which requires multidisciplinary competencies and strong rapid interaction among committed sectors. WHO is working closely with partners and countries to ensure the optimum support is provided to the countries to reduce the risk of this newly emerged health threat

Contribution of laboratories in the WHO Eastern Mediterranean Region to the selection of candidate seasonal influenza vaccine, 2010-2015

The World Health Organization [WHO] formulates recommendations for viruses to be included in vaccines for the influenza seasons in the northern and southern hemispheres on the basis of analyses by its collaborating centres [CCs]. This report describes the contribution of influenza laboratories and national influenza centres in countries in the WHO Region for the Eastern Mediterranean to the selection process of seasonal and pre-pandemic influenza virus subtypes. Data submitted by 22 countries to FluNet and FluID between September 2010 and June 2015 were analysed. National Influenza Centres [NICs] in 12 countries [55%] reported data, 5 [23%] to both FluNet and FluID and 7 [32%] only to FluNet. The WHO CC in London characterized 78% of the samples, and the CC in Atlanta, characterized 21%. The contribution of influenza laboratories and NICs from this Region to global influenza surveillance is appreciable. However, enhancing the contribution through initiatives such as the Pandemic Influenza Preparedness Framework is still needed

Burden of acute respiratory disease of epidemic and pandemic potential in the WHO Eastern Mediterranean Region: a literature review

There are gaps in the knowledge about the burden of severe respiratory disease in the Eastern Mediterranean Region [EMR]. This literature review was therefore conducted to describe the burden of epidemic- and pandemic-prone acute respiratory infections [ARI] in the Region which may help in the development of evidence-based disease prevention and control policies. Relevant published and unpublished reports were identified from searches of various databases; 83 documents fulfilled the search criteria. The infections identified included: ARI, avian influenza A[H5N1], influenza A[H1N1]pdm09 and Middle East respiratory syndrome coronavirus [MERS-CoV] infection. Pneumonia and ARIs were leading causes of disease and death in the Region. Influenza A[H1N1] was an important cause of morbidity during the 2009 pandemic. This review provides a descriptive summary of the burden of acute respiratory diseases in the Region, but there still remains a lack of necessary data

Middle East respiratory syndrome coronavirus: current knowledge and future considerations

A literature review of publically available information was undertaken to summarize current understanding and gaps in knowledge about Middle East respiratory syndrome coronavirus [MERS-CoV], including its origin, transmission, effective control measures and management. Major databases were searched and relevant published papers and reports during 2012-2015 were reviewed. Of the 2520 publications initially retrieved, 164 were deemed relevant. The collected results suggest that much remains to be discovered about MERS-CoV. Improved surveillance, epidemiological research and development of new therapies and vaccines are important, and the momentum of recent gains in terms of better understanding of disease patterns should be maintained to enable the global community to answer the remaining questions about this disease

H1N1 influenza pandemic of 2009 in the Eastern Mediterranean Region: lessons learnt and future strategy

A novel strain of influenza A virus H1N1 surfaced in Mexico in April 2009 and quickly spread across the globe, turning an epidemic into a pandemic. Within two months, the World Health Organization [WHO] declared an international health emergency and raised the threat bar from level V to level VI, i.e. containment to mitigation. During this time, the WHO Regional Office for the Eastern Mediterranean worked closely with its Member States, other stakeholders and WHO headquarters to manage the situation. This report examines the steps taken as part of this response. Programme documents were reviewed and key personnel interviewed for this study. A hallmark of the response was the establishment of the Strategic Health Operations Centre to bring together experts from different technical backgrounds at regional level. Several lessons were learnt that can provide the basis for standard operating procedures, protocols and guidelines for emergency events in future

Characteristics of severe acute respiratory infection associated hospitalization in Yemen, 2014/15

This study aims to describe etiological agents, demographic details of patients, seasonality and underlying conditions among patients hospitalized due to viral severe acute respiratory infection [SARI] in Yemen. We carried out a retrospective descriptive analysis of data from January 2014 to December 2015. Nasopharyngeal swabs were taken from each patient for laboratory testing. A total of 1346 diagnostic specimens were tested, of which 733 [54%] were positive for influenza viruses. Influenza A[H3] and A[H1N1] pdm09 predominated. Respiratory syncytial virus [RSV] was reported predominantly among children [41%]. Males [61%] were more affected than females. The median age was 1 year [range 0.5-94.0]. The median length of hospitalization was 6 days. Chronic cardiovascular disease was the most commonly reported underlying condition, but 67% had no documented underlying disease. Respiratory viruses, particularly RSV, adenovirus and influenza, were commonly associated with hospitalization for SARI

Knowledge and perceptions of prescribers regarding adherence to standard treatment guidelines for malaria: a comparative cross-sectional study from Pakistan

Despite the availability of standard treatment guidelines for malaria in Pakistan adherence to protocols by prescribers is poor. This descriptive, cross-sectional study aimed to explore the perceptions and knowledge of prescribers in Islamabad and Rawalpindi cities towards adherence to standard treatment guidelines for malaria. A questionnaire was distributed to a random sample of 360 prescribers; 64.7% were satisfied with the available antimalarial drugs and 41.3% agreed that antimalarial drugs should only be prescribed after diagnostic testing. Only half the prescribers had the guidelines available in their health facility. Almost all the prescribers [97.7%] agreed that there was a need for more educational programmes about the guidelines. Most prescribers were unaware of the correct standard treatment regimen for Plasmodium falciparum and P. vivax malaria. There were no differences in knowledge between males and females, but prescribers having more experience, practising as general practitioners and working in private health-care facilities possessed significantly better knowledge than their counterparts

Infection prevention and control measures for acute respiratory infections in healthcare settings: an update

Viruses account for the majority of the acute respiratory tract infections [ARIs] globally with a mortality exceeding 4 million deaths per year. The most commonly encountered viruses, in order of frequency, include influenza, respiratory syncytial virus, parainfluenza and adenovirus. Current evidence suggests that the major mode of transmission of ARIs is through large droplets, but transmission through contact [including hand contamination with subsequent selfinoculation] and infectious respiratory aerosols of various sizes and at short range [coined as [opportunistic] airborne transmission] may also occur for some pathogens. Opportunistic airborne transmission may occur when conducting highrisk aerosol generating procedures and airborne precautions will be required in this setting. General infection control measures effective for all respiratory viral infections are reviewed and followed by discussion on some of the common viruses, including severe acute respiratory syndrome [SARS] coronavirus and the recently discovered novel coronavirus

comparative analysis of the Baska Mask vs. proseal laryngeal mask for general anesthesia with IPPV

To compare the sealing pressure of the Baska Mask [BM] with Proseal laryngeal mask [PLM] in patients undergoing general anesthesia for a variety of elective non-head and neck surgical procedures.. Prospective, randomized, ethical issues committee approved interventional study. Setting: Operating rooms of Khoula Hospital, Muscat [Oman]. 52 consecutive adult patients of either sex requiring general anesthesia were included in the study. Patients with BMI >30, having known tendency to nausea/vomiting or pharyngeal pathology were excluded from the study. Following uniform induction with propofol 2-2.5 mg/kg, fentanyl 1.0-1.5 ug/kg, and relaxation with cisatracurium 0.1 mg/kg, either BM [n=30] or PLM [n= 22] was placed. Primary outcome measure was airway seal pressure while secondary outcome measures included device insertion time, number of attempts, leak fraction, duration of use, and laryngopharyngeal morbidity [sore throat, dysphagia, and dysphonia] at 1 hour and 4 hours postoperatively. Data collection was done by a staff member not involved with the study. The mean insertion time was significantly shorter in the BM group as compared to the PLM group [16.43 +/- 4.54 vs. 21.45 +/- 6.13] [P=0.001]. Mean sealing pressure was significantly higher in the BM group [29.98 +/- 8.51 vs. 24.50 + 6.19] [p= 0.013]. The leak fraction showed no difference between the devices and it ranged from 5.5-20% and 5-20% in the BM and PLM group respectively. All other studied parameters showed insignificant differences between the two devices. BM takes significantly shorter placement time and provides a better seal as compared to PLM

Teaching of major communicable diseases in Sudanese medical schools: a critical look

This descriptive, cross-sectional study of Sudanese medical schools aimed to describe and analyse the proportion of their curricula currently allocated for teaching of communicable diseases and to assess the teaching methods and student assessment tools. Qualitative and quantitative data were collected from heads of departments and students in 20 of the 27 medical faculties and from ministry of health staff at federal and state levels. Curriculum designs ranged from traditional to innovative, community-oriented programmes. Problems regarding student evaluations were identified. Major limitations included shortages of staff, reference materials and teaching aids. Poor knowledge of students about different aspects of diseases endemic in Sudan was found. Recommendations include curriculum development, staff recruitment and training, and improvement of teaching and training of students

Comparison of fibroblastic proliferation and collagen deposition in response to CO[2] laser surgery and scalpel

CO2 laser is the advocated treatment for the removal of various soft tissue lesions in oral cavity in recent years. A number of clinical advantages are reported by CO2 laser as compared to scalpel. The objectives include oral tissue fibroblastic response after CO2 laser surgery and to compare advantages and disadvantages of CO2 laser and scalpel after an oral surgical procedure with special reference to fibrosis and collagen deposition. A comparative study, conducted at animal laboratory of Post Graduate Medical Institute, Lahore for about three months. This study was conducted on 150 Sprague - Dawley Albino rats, which were divided into 3 equal groups of 50. Partial glossectomy was done with 3 watts CO2 laser for group [A], with 6 watts CO2 laser for group [B] and with scalpel for group [C]. The fibroblastic activity and collagen deposition was observed and compared histologically, 24 hours, 3[rd] day, 7[th] day, 14th day and 28[th] day after surgery. Histologically fibrosis and collagen deposition were highly significant in A and C groups as compared to group B. Six watts CO2 laser wound was much better as compared to scalpel in terms of lesser fibroblastic activity and collagen thickness hence having a good wound healing response

Health disparities between Muslim and non-Muslim countries

We examined differences in health indicators and associated factors across countries according to the proportion of the population who are Muslim. Of 190 UN countries, 48 were classified as Muslim-majority countries [MMC] and 142 as non-MMC. Data on 41 potential determinants of health were obtained from 10 different data sources, and 4 primary outcome measures [male and female life expectancy, maternal mortality ratio and infant mortality rate] were analysed. Annual per capita expenditure on health in MMC was one-fifth that of non-MMC. Maternal mortality and infant mortality rates were twice as high in MMC as non-MMC. Adult literacy rate was significantly higher for non-MMC. Four significant predictors explained 52%-72% of the differences in health outcomes between the 2 groups: gross national income, literacy rate, access to clean water and level of corruption

Effect of hypertension on body mass index and total cholesterol levels as risk factors in ischemic heart diseases

Dyslipidaemia and hypertension are important predisposing factors leading to cardiovascular diseases. Obesity also increases the risk of hypertension, coronary artery disease and dyslipidaemia. Purpose of this study was to find out a relationship between body mass index and total cholesterol levels in 100 hypertensive patients. Study was performed in Chemical Pathology Department of Army Medical College, Rawalpindi in collaboration with Department of Medicine, Combined Military Hospital, Rawalpindi. It is a cross-sectional study and simple non-probability random sampling was used. Hundred hypertensive patients were included in the study. Data was recorded using a detailed proforma and analysis was done on SPSS version 17. Of the 100 hypertensive patients included in the study, there were 39 males while 61 were females. The mean age was 60.1 +/- 11.5 years. The mean blood pressure was 171 +/- 13.1/105.2 +/- 6.6 mm of Hg. Mean body mass index was 28.6 +/- 3.97. Mean of total cholesterol was 5.7 +/- 0.7 mmol/L in all the patients. Hypertension, dyslipidaemia and increased BMI increase go hand in hand with the risk of cardiovascular disease. Treatment strategies should be adopted to treat hypertension and dyslipidemia aggressively and lifestyle modifications are necessary for reducing BMI

Is laparoscopic inguinal hernia repair more effective than open repair?

To systematically review randomized controlled trials, [RCT] evidence comparing Lichtenstein to total extraperitoneal [TEP] hernia repair in terms of clinical and cost effectiveness. Case series. The study was conducted at University of Abderdeen, U.K. a comprehensive online literature search was undertaken using data bases such as MEDLINE, PubMed, EMBASE and Springerlink. Studies were then shortlisted according to the selection criteria [RCT with other 100 subject and English language publications from 1995 onwards] and appraised using the SIGN Methodology Checklist. A meta-analysis of the data was also performed using RevMan software. Analysis of reported data shows that TEP has less postoperative pain and return to work than Lichtenstein method. Operation time is shown to be longer in the TEP but this difference is shortened with increasing surgeon experience. The meta-analysis of the data on complications shows that there are no significant differences between the two types of procedures. TEP causes more short-term recurrences which are attributed to the learning curve effect. Long-term recurrence rates on the other hand show no significant differences. At present TEP is slightly more expensive than Lichtenstein repair. Both TEP and Lichtension repair are clinically effective procedures. The choice between them should be made on a case-by-case basis; which depends on the patients' preference and characteristics such as age, work and health status

Feasibility of early surgical intervention in postoperative entero-cutaneous fistulae

To study the out come and benefits of an early surgical intervention in postoperative entero-cutaneous fistulae. It's a retrospective descriptive study conducted at department of surgery LUMHS from Jan 2001 to November 2008. Two hundred and thirteen [213] post-operative fistulae are included as study subjects while those due to inflammatory bowel diseases, road traffic accidents or following blunt, stab or gunshot abdominal trauma are excluded. An aggressive treatment to build up nutritional status, correction of anaemia and control of sepsis was followed by surgical intervention as soon as the patient's condition permitted. Variables such as type of fistula, out put per 24 hours, duration since development, complications due to fistula, nutritional status, operative procedure, operative time, post-operative complications, total post-operative stay, follow up schedule, outcome. The results were statistically analysed on SPSS-12. A total 213 patients comprising 184 males [85.6%] and 29 [13.5%] females with a mean age of 36.08 years and a range of 64 [78-14] years presenting with post-operative enter-cutaneous fistula are included in the study. Maximum number of patients [171, 79.5%] developed fistula between 4[th]-6[th] postoperative day and a vast majority of fistula occurred in the ileum [207, 97.18%] either as a result of anastomotic failure [103], leak from primary closure [99] or from un-noticed missed perforations [5]. Of the total number, 24 patients eventually died making a mortality of 11.2%. Early surgical intervention proved life saving [p<0.001]. A strong relation was found pre-operative albumin levels and surgical closure of the fistula [p<0.001] and associated mortality [p<0.001]. High out put fistula is unlikely to close spontaneously on conservative measures. Early surgical intervention can be life saving

Pattern of acute intestinal obstruction: is there a change in the underlying etiology?

To study the changing pattern of acute intestinal obstruction at a teaching institute. Patients and It is a prospective descriptive study conducted at a teaching hospital during the period from June 2004 to June 2009. All patients with clinical or radiological evidence of acute intestinal obstruction were included in this study regardless of the gender of the patient. Patients below the age of 10 years were excluded from the study. The treatment strategy was planned ranging from conservative treatment to emergency laparotomy after resuscitation and rehydration of the patient. Details of individual patients were recorded on a pro forma sheet and data analyzed statistically on SPSS version 14. A total of 229 patients with acute intestinal obstruction were admitted and treated. The mean age of the study population was 43.08 +/- 13.07 years. Postoperative adhesions accounted for 41% [n= 95] of the total cases, followed by abdominal tuberculosis [25%, n= 58], obstructed/ strangulated hernias of different types [18%, n= 42]. There was an obvious change in the pattern of etiology of acute intestinal obstruction as the common causes were postoperative adhesions and abdominal tuberculosis instead of obstructed inguinal hernias. An increase in the adhesive obstruction and a concomitant decrease in the incidence of obstructed hernias indicate a changing trend towards early operation before it gets complicated. Abdominal tuberculosis is emerging as another common cause of acute bowel obstruction

Antimalarial prescribing and dispensing practices in health centres of Khartoum state, 2003-04

This indicator-based study assessed the antimalarial drug prescribing and dispensing practices of health care providers in health centres of Khartoum state, and compared these with national guidelines for malaria treatment. A total of 720 patients and their prescriptions in 24 health centres were included. Prescribers adhered to national treatment guidelines for only 278 [38.6%] of patients. Although all were treated for malaria, only 77.6% patients had fever or history of fever and only 64.6% had fever and positive blood films. More than 90% of prescriptions prescribed antimalarial drugs by generic names but dosage forms were correctly written in only 23.5%. There was a high rate of prescribing antimalarial injections. Only half the patients had adequate knowledge of their treatment

Small bowel perforations due to deliberate ingestion of injurious foreign bodies-a personal experience

Ingestion of foreign bodies is not an uncommon problem in our society. The patients usually ingest different types of foreign bodies either accidentally or deliberately. Rare in children but adults are not uncommonly affected and are either psychiatric patients or ingest foreign bodies accidentally. Life threatening complications may occur at times due to ingestion of sharp and pointed objects. An interesting case of ingestion of multiple injurious foreign bodies presenting with multiple small intestinal perforations is presented with review of literature