ABSTRACT
OBJECTIVE: The aim: is to evaluate peculiarities of clinical and neurological characteristics, quality of life, brain morphometry changes and metabolic deviations of patients, who suffered from aneurysmal subarachnoid hemorrhage. PATIENTS AND METHODS: Materials and methods: In the period of 2016-2019 we examined 114 patients, who signed the informed consent, taking into account their age, clinical and anatomical form of hemorrhage, disease duration, Hunt-Hess severity grade, complications of acute period. Such parameters were evaluated, as clinical and neurological characteristics, the degree of the Barthel index and the modified Rankin scale, cognitive functioning (MoCA), psycho-emotional sphere and quality of life (HADS, SF-36), morphometric parameters based on brain computed tomography measurements, explored the indicators of apoptosis, mitochondrial dysfunction, intracellular oxidative stress. RESULTS: Results: Сephalgia (90,35 %), pyramidal syndrome (53,50 %), sensibility deficit (36,84 %) were leading among the all neurological syndromes. Slight dependence and disability grade was found during assessment of the Barthel index and the modified Rankin scale. In 85,96 % of patiens we revealed cognitive impairment of different severity grades. The anxiety was manifested in 65,79 %, depression - in 64,91 % of patients. Due to the morphometry data, the process of cerebral atrophy was detected (central - in 26,31 % of patients, cortical - in 16,67% and mixed - in 28,07 %). AnV+ and PI+ - cells level exceeded normal values in 2,88 and 1,96 times while the level of JC-1+ and ROS+-cells - in 2,17 and 2,82 times (p<0,01). CONCLUSION: Conclusions: Having studied clinical and neurological, neuropsychological, morphometric and metabolic factors, we found their pathogenetic role in the course of late recovery and residual periods of aneurysmal subarachnoid hemorrhage, that would help us to improve the diagnostic tactics and reveal the predictors of unfavorable outcome.
Subject(s)
Subarachnoid Hemorrhage , Brain , Disease Progression , Humans , Quality of Life , Treatment OutcomeABSTRACT
INTRODUCTION: Despite the availability of prevention and therapies of stroke, their implementation in clinical practice, even of low-cost ones, remains poor. In 2015, the European Stroke Organisation (ESO) initiated the ESO Enhancing and Accelerating Stroke Treatment (EAST) program, which aims to improve stroke care quality, primarily in Eastern Europe. Here, we describe its methods and milestones. PATIENTS AND METHODS: The ESO EAST program is using an implementation strategy based on a 'detecting-understanding-reducing disparities' conceptual framework: stroke care quality is first measured (after developing a platform for data collection), gaps are identified in the current service delivery, and ultimately feedback is provided to participating hospitals, followed by the application of interventions to reduce disparities. The ESO EAST program is carried out by establishing a stroke quality registry, stroke management infrastructure, and creating education and training opportunities for healthcare professionals. RESULTS: Program management and leadership infrastructure has been established in 19 countries (Country Representatives in 22 countries, National Steering Committee in 19 countries). A software platform for data collection and analysis: Registry of Stroke Care Quality was developed, and launched in 2016, and has been used to collect data from over 90,000 patients from >750 hospitals and 56 countries between September 2016 and May 2019. Training in thrombolysis, nursing and research skills has been initiated. DISCUSSION: ESO EAST is the first pan-Eastern European (and beyond) multifaceted quality improvement intervention putting evidence-informed policies into practice. Continuous monitoring of stroke care quality allows hospital-to-hospital and country-to-country benchmarking and identification of the gaps and needs in health care.
