Mobile App Based Strategy Improves Door-to-Needle Time in the Treatment of Acute Ischemic Stroke.

BACKGROUND: Time to revascularization is critical in improving outcomes in stroke thrombolysis. We studied the effectiveness of a mobile app based strategy to improve door-to-needle time (DNT) in treatment of acute ischemic stroke. METHODS: Consecutive patients presenting with acute ischemic stroke to the emergency department at a tertiary care hospital in Southern India between April 2017 - September 2018 were included. The app enabled rapid entry of patient parameters, the NIH stroke scale (NIHSS), thrombolysis checklist and dose calculation along with team synchronization, notifying all on-call members and team leaders of the patient movement, and sharing of radiological images. DNT captured from the app was compared to previous values from our center using one-way Analysis of Variance (ANOVA) after adjusting for differences in baseline variables. RESULTS: A total of 76 patients were thrombolysed during the study period, while using the mobile app. The mean DNT was 41 min, with 89% being thrombolysed within 60 min and 57% being thrombolysed within 45 min. Compared to 100 consecutive patients thrombolysed in the months prior to April 2017 where the mean DNT was 57 min, with 67% thrombolysed within 60 min and 47% being thrombolysed within 45 min, there was a mean DNT decrease of 16 min with 1.3x increase in DNT < 60 min. This difference was statistically significant after adjusting for age, sex and NIHSS Score (p=0.005, One-Way ANOVA). CONCLUSION: We have been able to demonstrate a significant improvement in DNT using mobile app as a tool to improve team performance.

Leukoencephalopathy with intracranial calcifications and cysts in an adult: Case report and review of literature.

Leukoencephalopathy, intracranial calcifications, and cysts (LCC) is a very rare cerebral disorder, first described in 3 children in 1996. It has subsequently been reported in adults and children from Europe and America, but has not so far been reported from Asia. We report an adult patient with pathologically proven LCC from a tertiary care hospital in South India. He presented with features of ataxia and raised intracranial pressure. Magnetic resonance imaging of the brain showed multiple bilateral cerebral cystic lesions along with diffuse white matter lesions in the cerebral and cerebellar white matter, and computed tomography of brain showed multiple calcifications in the white matter and basal ganglia. A large right cerebellar cyst causing mass effect was surgically excised. Histopathologic features were consistent with earlier reports of LCC and showed Rosenthal fibers, angiomatous changes, and calcifications. Our report suggests that although it is rare, LCC has a global distribution.

Gait and cognition in older adults: Insights from the Bronx and Kerala.

BACKGROUND: Recent reports indicate that gait dysfunction can occur early in the course of cognitive decline suggesting that motor and cognitive functions in older adults may share common underlying brain substrates, pathological processes, and risk factors. OBJECTIVE: This study was designed to report the association between gait and cognition in older adults in USA and the southern Indian state of Kerala. MATERIALS AND METHODS: Literature review of gait and cognition studies conducted in Bronx County, USA as well as preliminary results from the Kerala-Einstein study (Kozhikode city, Kerala). RESULTS: Review of published studies based in the Bronx shows that both clinical and quantitative gait dysfunction are common in older adults with cognitive impairment. Furthermore, clinical and quantitative gait dysfunction in cognitively normal older adults was a strong predictor of future cognitive decline and dementia. Our preliminary study in Kozhikode city shows that timed gait is slower in older adults diagnosed with dementia and mild cognitive impairment syndrome compared to healthy older controls. CONCLUSIONS: A strong association between gait and cognition is seen in seniors in USA as well as Kerala. A better understanding of the relationship between gait and cognition may help improve current diagnostic and therapeutic approaches globally.

Intravenous thrombolysis for acute ischemic stroke: the Malabar experience 2003 to 2008.

We report the 5-year experience with thrombolysis in acute ischemic stroke from a tertiary care hospital in the Malabar region of South India. All stroke patients thrombolyzed with intravenous recombinant tissue plasminogen activator (rt-PA) from May 2003 to May 2008 were studied in an open, non-randomized, prospective study. Of 2,308 ischemic stroke patients admitted, 57 patients (2.5%) were thrombolyzed with rt-PA (age range, 35-78 years: 40 males, 17 females). The time from presentation at the hospital to initiation of thrombolysis ranged from 15 to 120 minutes (median 50 minutes). The dose of rt-PA used was from 0.6 mg/kg to 0.9 mg/kg. At 3 months 29 patients (51%) were functionally independent, with a modified Rankin scale score of 2 or less. Seven patients (12%) died within 3 months; one had an intracerebral hemorrhage (1.7%). The benefit of treatment was seen in all stroke subtypes. We have been able to show that intravenous thrombolysis in acute ischemic stroke is safe, effective and feasible in our part of the world.

Cirrhosis presenting as Parkinsonism.

Cirrhosis presenting as Parkinsonism is a distinct subset of acquired chronic hepatocerebral degeneration. The entity is not rare, and unless suspected, cirrhosis can easily be overlooked. We report our experience with three such patients. They presented to us, over a period of two years, with symmetrical Parkinsonism and were later diagnosed to have cirrhosis with portal hypertension. All patients had minimal or absent tremors. Reversal of serum albumin to globulin ratio and evidence of cirrhosis on abdominal ultrasound were consistent. All three patients had the characteristic MRI abnormality of symmetrical T1 hyperintensity in basal ganglia and anterior midbrain. They improved to variable extents after treatment for cirrhosis, along with dopa agonists. We stress the importance of recognizing this syndrome and briefly review the relevant literature.

Toxicological studies of two compounds isolated from Loranthus globosus Roxb.

The sub-acute toxicities of two compounds 3,4-dimethoxycinnamyl alcohol (1) and 3,4,5-trimethoxycinnamyl alcohol (2) isolated from the plant Loranthus globosus Roxb were studied on long Evan's rats. The studies included the gross general observation such as changes in body weight, haematological profiles [total count of Red Blood Cells (RBC) and White Blood Cells (WBC), differential count of WBC, platelet count and Haemoglobin (Hb)%], biochemical parameters of blood [Serum Glutamate Oxaloacetate Transaminase (SGOT), Serum Glutamate Pyruvate Transaminase (SGPT), Serum Alkaline Phosphatase (SALP), urea and creatinine) and histopathology of the liver, kidney, heart and lung of both control and experimental groups of rats. The changes in haematological and biochemical parameters were statistically not significant after the administration of compounds 1 and 2 in a dose of 300 microg/rat/day for consecutive 14 days. No abnormality was found in the histopathology of the liver, kidney, heart and lung in the experimental groups of rats following same dose when compared with control group. This preliminary study suggests that the isolated compounds may be used safely for clinical trial.