Incidence & prevalence of stroke in India: A systematic review.

Mounting Stroke Crisis in India: A Systematic Review

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Full-text available

Mar 2024

Stroke, a neurological disorder, has emerged as a formidable health challenge in India, with its incidence on the rise. Increased risk factors, which also correlate with economic prosperity, are linked to this rise, including hypertension, diabetes, obesity, sedentary lifestyle, and alcohol intake. Particularly worrisome is the impact on young adults, a pivotal segment of India's workforce. Stroke encompasses various clinical subtypes and cerebrovascular disorders (CVDs), contributing to its multifaceted nature. Globally, stroke's escalating burden is concerning, affecting developing nations. To combat this trend effectively and advance prevention and treatment strategies, comprehensive and robust data on stroke prevalence and impact are urgently required. In India, these encompass individuals with elevated BMIs, and those afflicted by hypertension, diabetes, or a familial history of stroke. Disparities in stroke incidence and prevalence manifest across India, with differences in urban and rural settings, gender-based variations, and regional disparities. Early detection, dietary changes, effective risk factor management, and equitable access to stroke care are required to address this issue. Government initiatives, like the National Programme for Prevention and Control of Cancer, Diabetes, Cardiovascular Diseases, and Stroke (NPCDCS) 2019, provide guidelines, but effective implementation and awareness campaigns are vital. Overcoming barriers to stroke care, especially in rural areas, calls for improved infrastructure, awareness campaigns, and support systems. Data standardization and comprehensive population studies are pivotal for informed public health policies.

Implementation of stroke care & road safety in India: Lessons from Australia

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Full-text available

Jul 2024
INDIAN J MED RES

India is home to one-fifth of the world’s population and is currently the fastest-growing economy. As the health industry is growing, India needs to develop robust implementation of evidence-based health care addressing the major public health issues. Two of such issues India is grappling with are the establishment of stroke care and the reduction of road accidents. Australia has achieved notable success in implementing stroke care and reducing road accidents. In stroke, Australian initiatives include dedicated stroke units, the development of clinical guidelines, the implementation of acute interventions, the establishment of a national stroke foundation, and the stroke registry. As a result, the combined, primary, and secondary prevention measures, acute treatment, and rehabilitation have reduced the total disease burden of stroke from 2003 to 2023 by 53 per cent, from 7.4 to 3.5 Disability Adjusted Life Years (DALYS) per 1,000 population, which is a 56 per cent decline in fatal burden and 23 per cent decline in non-fatal burden. For road safety, Australia implemented evidence-based practices such as education, legislation including mandatory use of seat belts, and other road safety initiatives. Data show that seat belt use reached 98 per cent in Australia in 2023. Furthermore, about 20 per cent of drivers as well as passengers who were killed in crashes in 2024 did not wear seat belts. The reduction of speed limits in built-up areas, the adoption of monitoring technology, and the clever use of infrastructure are proving to be effective in reducing fatalities and serious injuries. Australia’s implementation research can provide valuable insights into the efforts of mitigating the impact of stroke and enhancing road safety in India.

Therapeutic management of ischemic stroke

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Full-text available

Nov 2023
N Schmied Arch Pharmacol

Stroke is the third leading cause of years lost due to disability and the second-largest cause of mortality worldwide. Most occurrences of stroke are brought on by the sudden occlusion of an artery (ischemic stroke), but sometimes they are brought on by bleeding into brain tissue after a blood vessel has ruptured (hemorrhagic stroke). Alteplase is the only therapy the American Food and Drug Administration has approved for ischemic stroke under the thrombolysis category. Current views as well as relevant clinical research on the diagnosis, assessment, and management of stroke are reviewed to suggest appropriate treatment strategies. We searched PubMed and Google Scholar for the available therapeutic regimes in the past, present, and future. With the advent of endovascular therapy in 2015 and intravenous thrombolysis in 1995, the therapeutic options for ischemic stroke have expanded significantly. A novel approach such as vagus nerve stimulation could be life-changing for many stroke patients. Therapeutic hypothermia, the process of cooling the body or brain to preserve organ integrity, is one of the most potent neuroprotectants in both clinical and preclinical contexts. The rapid intervention has been linked to more favorable clinical results. This study focuses on the pathogenesis of stroke, as well as its recent advancements, future prospects, and potential therapeutic targets in stroke therapy. Graphical Abstract

A COMPARATIVE REVIEW OF TREATMENT MODALITIES: BOTULINUM TOXIN A VS. DRY NEEDLING IN POST-STROKE SPASTICITY Corresponding Author-Rahul Raj *

Article

Full-text available

Nov 2023

Post-stroke spasticity is a common motor impairment that can significantly impact the quality of life and functional independence of stroke survivors. This review article delves into the therapeutic interventions of botulinum toxin A (BoNT-A) and dry needling in the management of post-stroke spasticity. The aim of this comprehensive review is to analyze and compare the efficacy, mechanisms of action, clinical outcomes, and potential synergies between these two treatment modalities. The review presents a synthesis of current literature and clinical studies that have investigated the utilization of BoNT-A and dry needling in post-stroke spasticity rehabilitation. Mechanisms of action underlying both interventions are explored, elucidating the ways in which they target neural pathways and neuromuscular components to alleviate spasticity-related symptoms. Furthermore, the review evaluates the outcomes of clinical trials, case studies, and observational research to provide a balanced assessment of the benefits and limitations of BoNT-A and dry needling. Special attention is given to their effectiveness in reducing muscle tone, improving functional mobility, and enhancing patients' overall well-being. In addition to analyzing individual intervention strategies, potential synergies between BoNT-A and dry needling are discussed, aiming to uncover the benefits of combining these approaches for enhanced therapeutic outcomes. The review also addresses safety considerations, patient preferences, and the importance of personalized treatment plans in optimizing post-stroke spasticity management.

Correlation of Quality Metrics of Acute Stroke Care with Clinical Outcomes in an Indian Tertiary-care University Hospital: A Prospective Evidence-based Study

Article

Full-text available

Nov 2023
Indian J Crit Care Med

Aim To characterize the impact of adherence to quality metrics of stroke care on the clinical outcomes of ischemic stroke (IS) and intracerebral hemorrhage (ICH) admissions. Methods Consecutive patients with acute stroke were prospectively followed up for their demographic and clinical characteristics, acute stroke management, and associated clinical outcomes at discharge. Stroke quality metrics [adopted from the American Heart Association (AHA)/American Stroke Association's Get with The Guidelines (GWTG)] with a specific interest in an association between acute reperfusion therapies and functional recovery in stroke patients are analyzed and presented. A composite measure of care was considered “0 (non-adherence) to 1 (adherence).” An all-or-none measure of care was calculated to check whether eligible patients received all the quality-of-care interventions. Multivariate Cox regression models were used to study an association between optimal adherence and clinical outcomes. Results During the study period, of the total 256 stroke admissions, 200 (78.1%) patients had IS, and the remaining 56 (21.9%) patients had ICH. The median [interquartile range (IQR)] age of total stroke admissions was 57 (36–78) years. Male preponderance was observed (IS: 80% and ICH: 67.9%). The conformity of performance metrics in IS patients was from 69.1% [95% confidence interval (CI), 68.5–69.6] for the use of deep vein thrombosis prophylaxis (DVTp) to 97.8% (95% CI, 96.2–98.6) for the use of statins. In ICH patients, it ranged from 61.7% (95% CI, 60.4–62.5) for the use of DVTp to 89.9% (95% CI, 88.6–89.7) for stroke rehabilitation. The unadjusted odds ratio (OR) of mortality (in-hospital plus the 28th-day postdischarge) was higher in ICH patients vs IS patients (4.42, p = 0.005). Optimal adherence with intravenous recombinant tissue plasminogen activator (IV-rtPA) therapy [hazards ratio (HR) = 0.23], in-hospital acute measures [IS (HR = 0.41) and ICH (HR = 0.63)], and discharge measures [IS (HR = 0.35) and ICH (HR = 0.45)] were associated with reduced hazards of the 28th-day mortality in both cohorts. Compared to ICH, IS patients had significantly improved neurofunctional recovery [modified Rankin score (mRS) ≤ 2, p < 0.01]. Conclusion Adherence to quality metrics and performance measures was associated with low mortality and favorable clinical outcomes. Also, DVTp as an in-hospital (acute) measure of stroke care needs attention in both cerebrovascular events. How to cite this article Panda BK, Suryawanshi VR, Attarde G, Borkar N, Iyer S, Shah J. Correlation of Quality Metrics of Acute Stroke Care with Clinical Outcomes in an Indian Tertiary-care University Hospital: A Prospective Evidence-based Study. Indian J Crit Care Med 2023;27(11):806–815.

Multidimensional Approach of Genotype and Phenotype in Stroke Etiology: The MAGPIE Study

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Full-text available

Dec 2024

Background and Aims Stroke is a leading cause of mortality and morbidity in Bangladesh. It is estimated that genetic determinants account for around 40%–60% of its etiology, similar to environmental factors. This study aimed to provide a better understanding of the genetic, environmental, and clinical risk factors in stroke patients from Bangladesh. Methods The MAGPIE (Multidimensional Approach of Genotype and Phenotype In Stroke Etiology) study is a population‐based case‐control study that will allow a hypothesis‐free genome‐wide association study (GWAS) to identify genetic risk factors associated with adult stroke (age ≥ 18 years) in Bangladesh. This study will collect detailed phenotypic data as well as blood samples from stroke patients and control subjects. High‐molecular‐weight genomic DNA will be isolated and archived using Qiagen DNA isolation kits. Results We will utilize SPSS v28.0, vR‐4.3.2 and gPLINK v2.0 software to analyse the study variables, as appropriate. Further, appropriate statistical tests will be applied to test the significance level between study groups. As applicable, data will be presented in tables and graphs, such as Manhattan plots and Quantile‐Quantile (QQ) plots. A p < 0.05 will be considered as statistical significance. Conclusion This will be the first large‐scale carefully phenotyped biobank of Bangladeshi stroke patients which will enable a GWAS enabling an understanding of the association between gene‐phenotype risk factors which has the potential to revise and refine national stroke guidelines.

Ischemic Stroke: Pathophysiology and Evolving Treatment Approaches

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Full-text available

Oct 2024

Dhriti Chatterjee

Stroke remains a leading cause of mortality and disability, with ischemic stroke being the most common type. It occurs due to reduced cerebral blood flow, leading to a cascade of events initiated by oxygen and nutrient deprivation, triggering excitotoxicity, oxidative stress, and inflammation and finally culminating in neuronal injury and death. Key molecular players in ischemic stroke include glutamate receptors, acid-sensing ion channels, and purinergic receptors, exacerbating cellular damage through calcium influx, oxidative stress, and mitochondrial dysfunction. Understanding these mechanisms has shaped therapeutic strategies, such as neuroprotective agents and stem cell therapies. Current treatments such as tissue plasminogen activator (tPA) emphasize timely intervention, yet challenges persist in patient-specific variability and accessibility. This review provides an overview of ischemic stroke pathophysiology, emphasizing cellular responses to ischemia and current and future therapeutic approaches including stem cell therapies aimed at mitigating stroke-induced disabilities and improving long-term outcomes.

Experience of tenecteplase in acute ischemic stroke from Kutch, Gujarat; Strong interpersonal communication between doctors leads to favorable outcomes

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Full-text available

Oct 2024

Acute ischemic stroke is a major factor cause of severe morbidity and mortality in general population. Newer modality of treatment like IV thrombolysis has been established to prevent long term complications in this condition within 4.5 hours of symptoms onset. The data regarding IV thrombolysis is limited in rural areas. Various factors like lack of awareness among general population, patients reaching hospital beyond window period, cost of treatment pose difficulty in administration of this treatment. This article presents demographic profile of patients undergoing IV thrombolysis for acute ischemic stroke at a hospital from Kutch, Gujarat. This article also highlights the importance of strong interpersonal communication between physician for better outcomes in patients. The aim of this observational study is to observe demographic profile of patients with acute ischemic stroke receiving intravenous thrombolysis and to estimate the factors which might help in favorable patient outcome. The data was calculated during January 2023 to December 2023. 22 patients were thrombolysed for acute ischemic stroke within 4.5 hours from onset of symptoms. Males were predominant (86.3%), average age of patients was 57.4 years (range 31 – 80 years old). Majority of the strokes were anterior circulation stroke (77.2%). The comorbidities like Diabetes mellitus (36.3%), hypertension (54.5%), dyslipidemia (59%), old coronary artery disease (18%), old cerebro vascular disease (4.5%) were seen. The time from symptom onset to presentation to hospital is approximately 146 minutes. The time from presentation to hospital and IV thrombolysis administration is approximately 49 minutes. 17(77.2%) patients presented to hospital within 3 hours of symptom onset, 13 (59%) underwent IV thrombolysis within 30 minutes of presentation to hospital. Majority of this patients were referred by primary physician to the hospital. Mild stroke (NIHSS < 5) was seen in 1 (4.5%) patient, moderate (NIHSS 5-15) in 11(50%) patients, moderate -severe stroke (NIHSS 15-25)– in 10(45.5%) patients. Large vessel occlusion was seen in 12 (54.5 %), small vessel disease in 4 (18 %), Embolic etiology in 4(18%) and unknown in 2 (9%) of cases. The mean NIHSS at presentation was approximately 16, at 24 hours after IV thrombolysis was approximately 11.3 and after 72 hours of IV thrombolysis is 8.6. Early neurological deficit was seen in 6(27.2%) of cases. 4(18%) of all stroke who underwent thrombolysis required decompression craniotomy. The improving on mRS (grade 0-1) score was found in 16(72.8%) patients at 7 days of thrombolysis. Intravenous thrombolysis with recombinant tissue plasminogen activator is helpful in acute ischemic stroke within 4.5 hours of onset. Early diagnosis and swift evaluation and management helps in prevention of longterm disability.

Analyzing stroke burden and risk factors in India using data from the Global Burden of Disease Study

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Full-text available

Sep 2024

Stroke remains a critical global health issue, significantly impacting India with substantial contributions to mortality and disability. This study comprehensively analyses stroke incidence, mortality, and disability-adjusted life years (DALYs) across India from 1990 to 2021, using the latest Global Burden of Disease (GBD) 2021 data. We evaluate how Universal Health Coverage (UHC), health expenditure, human development index (HDI), and gross national income (GNI) influence stroke outcomes. Our findings reveal significant regional disparities, with higher stroke rates in urban areas and states like Goa and Kerala. Higher health expenditure and HDI are linked to lower stroke rates, while higher GNI per capita correlates with increased stroke incidence, likely due to lifestyle changes. Risk factors include air pollution, tobacco use, dietary risks, and high blood pressure. Air pollution notably impacts stroke mortality in Bihar and Jharkhand, while tobacco use is a major risk factor in Mizoram and Manipur. Dietary risks and hypertension are prevalent in Maharashtra and Jammu & Kashmir. The study highlights the need for targeted public health strategies addressing regional disparities and socioeconomic factors. Policymakers should focus on lifestyle modification programs, public awareness campaigns, and enhanced access to quality stroke care to reduce stroke-related morbidity and mortality effectively.

Design and evaluation of exoskeleton device for rehabilitation of index finger using nature-inspired algorithms

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Full-text available

Aug 2024
APPL INTELL

This work proposes a novel robotic exoskeleton for rehabilitation of the index finger. Though all motions of index finger are essential, the major range of motion is covered by flexion/extension motion. Hence, a Stephenson III six-bar mechanism has been synthesized for the robotic exoskeleton device for a pre-defined trajectory to address post stroke rehabilitation of patients. The flexion/extension trajectory was obtained experimentally using image processing. Based on the trajectory, a mathematical model was formulated which was used as the objective function for the optimization problem. To eliminate any defects that may be encountered during the synthesis, “loop-by-loop defect rectification” procedure was implemented along with well-established optimization algorithms such as TLBO, BWP, GWO and PSO for synthesis of the desired mechanism. It has been found that TLBO outperformed all the others as it could reduce the objective function value to 0.69849. whereas, BWP reduced it to 8.9952, GWO reduced it to 13.1388, and PSO could only reduce it to 6 × 10⁵. Therefore, the design obtained using TLBO was considered for developing the prototype of the device. The device was validated experimentally using image processing, and it is found to cover the prescribed range of motion. Thus, the proposed exoskeleton is deemed to be a viable solution for post stroke index-finger rehabilitation.

Safety and Efficacy of Injection Tenecteplase in 4.5 to 24 Hours Imaging Eligible Window Patients with Acute Ischemic Stroke (EAST-AIS) - Study Protocol

Article

Full-text available

Aug 2024
Ann Indian Acad Neurol

Background and Aims Tenecteplase is used as the standard of care treatment for thrombolysis in acute ischemic stroke (AIS) patients within 4.5 h of symptom onset. Documented reports were less certain to claim the benefits of it in an extended window period. EAST-AIS (CTRI/2022/03/040718) trial is designed to determine the success rate of thrombolysis in an extended window period for good clinical outcomes. Study Design It is a randomized, placebo-controlled trial of tenecteplase administered within 4.5–24 h of stroke onset (with or without large vessel occlusion) based on evidence of salvageable tissue through baseline computed tomography perfusion (CTP) or magnetic resonance imaging (MRI) scan. Criteria of patient inclusion are as follows: patients of both genders (male and female), age >18 years, pre-stroke modified Ranking Scale (mRS) <2, baseline NIHSS >5, CTP showing penumbra–ischemic core ratio >1.8, absolute difference in volume >10 ml, and ischemic core volume <70 ml. The sample size for the study is 100 patients: 50 in the tenecteplase arm (0.25 mg/kg body weight; maximum- 25 mg) and 50 in the placebo arm (controls). Study Outcomes The study’s primary objective is safety endpoints along with the efficacy of tenecteplase assessed using the mRS score at 90 days of stroke onset. Conclusion The result obtained from EAST-AIS will determine the safety and efficacy of tenecteplase injection administered 4.5–24 h following the symptom onset for AIS patients within the territory of Internal Carotid Artery (ICA), Middle Cerebral Artery (MCA), or Anterior Cerebral Artery (ACA) occlusion.

Stroke Characteristics among Patients admitted to Al-Sadiq Teaching Hospital, Babylon Province, Iraq

Article

Jan 2021

Background: Stroke is a common medical problem that causes permanent disabilities and mortality. Aim: To investigate the characteristics of stroke and the associated risk factors. Methods: In a hospital-based cross-sectional study, information was collected from patients' records and by direct interview of patients or their companions with the help of a semi-structured questionnaire. Results: The mean age of patients was (64), the male to female ratio was 1.37:1. The majority of patients had low educational levels, and two-thirds of them were urban dwellers. Comorbidities indicated that 71.9% patients had hypertension, 38.6% had diabetes, 37.7% had stroke history, and 16.7% had ischemic heart disease. Regarding social habits, 41.2% were current smokers or ex-smokers, 64.9% were overweight or obese. Regarding stroke awareness, 74.6% do not know the meaning of stroke. The majority 88.6% of cases were diagnosed in hospitals. Conclusion: Ischemic stroke is the most familiar type of stroke where males are mainly affected. Hypertension, diabetes, and stroke were the most common diseases in the medical and family history, respectively.

Unveiling Opportunities for Intervention: A Prospective Cohort Study Investigating the Clinical Significance of Diffusion-Weighted Imaging (DWI)-Fluid-Attenuated Inversion Recovery (FLAIR) Mismatch Beyond the Window Period in Acute Ischemic Stroke

Article

Full-text available

Jul 2024

Introduction: Acute ischemic stroke causes irreversible damage to the brain parenchyma surrounded by salvageable tissue known as the ischemic penumbra. Magnetic resonance imaging (MRI), particularly the mismatch between abnormal diffusion-weighted imaging (DWI) signals and normal fluid-attenuated inversion recovery (FLAIR) signals, plays a critical role in detecting ischemic penumbra. It also allows for the identification of patients who may benefit from reperfusion therapy. Hence, this prospective cohort study aimed to explore the correlation between DWI-FLAIR mismatch and clinical outcomes in acute ischemic stroke patients, specifically those with delayed or uncertain symptom onset, offering potential insights into reperfusion therapy. Methodology: A total of 38 thrombotic stroke patients aged above 18 were included in this prospective cohort study. Baseline data, including demographics, lifestyle factors, and medical history, were recorded. DWI-FLAIR mismatch was evaluated through brain MRI within 4.5 hours to 12 hours of symptom onset. Results: Of the cohort, 63.2% were males, predominantly in the 61-70 age group. Smoking and alcohol consumption were reported by 15.79% each. DWI-FLAIR mismatch was present in 20 out of 38 subjects. No statistically significant differences were noted in the mean National Institutes of Health Stroke Scale (NIHSS) and Modified Rankin Scale (MRS) scores between subjects with and without DWI-FLAIR mismatch. Thrombolysis in wake-up stroke subjects demonstrated a substantial reduction in mean MRS at discharge (1.29±0.95) and at six to eight weeks (1.71±1.11), suggesting potential benefits on functional outcomes. Conclusion: The prevalence of DWI-FLAIR mismatch was seen in the majority of patients beyond their window period and also showed beneficiary outcomes with a mean reduction in NHISS and MRS scores following thrombolysis.

Effectiveness of Soft Robotic Hand Aided Therapy on Improving Hand Function in Hemiparetic Stroke Subjects

Article

Full-text available

Mar 2024

Background and Objective: Hand disability is a common complication of a stroke which can impede participation in rehabilitation and has been associated with poor outcomes. Soft Robotic Hand Therapy is one of the adjunct treatments of choice with conventional hand rehabilitation in Physiotherapy. The objective of this study was to compare the effectiveness of soft robotic hand aided therapy versus conventional hand Rehabilitation alone for improving hand function in hemiparetic stroke subjects.

Age, gender, and regional variations in stroke epidemiology in India: A systematic review and meta-analysis

Article

Full-text available

Jun 2024

Introduction There is a wide variation in stroke epidemiology in India due to the differences in culture and the variability in the distribution of risk factors across the states. The present meta-analysis provides a pooled estimate of age, gender, and region-based stroke epidemiology in India based on epidemiological transition level (ETL) groups described in the Global Burden of Disease (GBD) Study (2016). Methods We searched in PubMed and Google Scholar, and relevant studies published till February 2022 were included. Observational studies conducted in the Indian setting were included and global or Indian studies that exclusively estimated the prevalence, incidence, or mortality data among patients with stroke were excluded. The Joanna Briggs Institute (JBI) Critical Appraisal Checklist was used for the risk-of-bias assessment and publication bias was evaluated by funnel plots and Egger’s test. The R software was used to perform this meta-analysis; I ² statistics were calculated to measure heterogeneity among studies. Results We included 58 studies in the systematic review, and after quality assessment, 47 studies were finally included for meta-analysis. The sample sizes of the included studies ranged from 40 to 4989 and the mean age of the participants ranged from 31.7 (Standard Deviation, SD-7.4) to 70.5 (SD-10.7). The burden of stroke was estimated based on the ETL groups described in the GBD Study 2016. We found a male preponderance (64.5%; 95% confidence interval [CI]: 62.5%-68.3%) in the gender distribution of strokes and 75.2% (95% CI: 68.7%-81.7%) of the stroke occurred above the age of 50 years. Ischemic stroke is the predominant subtype of stroke in India, with a higher proportion in the middle ETL region (74.0%; 95% CI: 65.1%-81.3%) as compared to those with low ETL (67.2%; 95% CI: 49.9%-80.8%) and high ETL regions (67.5%; 95% CI: 57.0%-76.4%). Conclusion There was a significant heterogeneity among the included studies. Majority of strokes occurred in the age group of more than 50 years with a male preponderance. Ischemic stroke was the most common type of stroke with its proportion varying from 67% to 74% depending on ETL. PROSPERO Registration: CRD42022316774.

Triglyceride and Glucose Index as a Marker on Severity of Ischemic Stroke

Article

Apr 2023

Mourice Aashin Archana Bhat

Identifying High-Risk Populations for Stroke in South Gujarat: A Cross Sectional Analysis of Risk Factors and Implications

Article

Aug 2023

Shifa Khan Saleha Pathan

Indian stroke rehabilitation care planner: a delphi study

Article

Full-text available

May 2024

A delphi study on a Stroke rehabilitation care planner

Analyzing Existing Algorithms and Identifying Gaps in Brain Stroke Detection

Article

Full-text available

Apr 2024

One of the global issues that matters most right now is healthcare. The primary cause of death globally is brain stroke. A valuable contribution to medicine is the early prediction and identification of brain stroke events. Numerous factors, including BMI (body mass index), age, sex, family history, gender, smoking status, hypertension, and so on, are linked to brain stroke deaths. While forecasting heart illness has received a great deal of interest in the medical community, predicting a brain stroke has received less attention. This study's primary goal is to evaluate various previously published research publications and select the most effective machine learning methods for brain stroke prediction for our next projects. It was shown that mortality rate and functional outcomes are the expected outcomes for the majority of the study work done after analyzing the various machine learning techniques used for stroke predictions and after accounting for the previously published studies. The techniques that were used most commonly were LR, DTC, RFC, SVM, and KNN.

A Study to Estimate the Red Cell Width Distribution and the Mean Platelet Volume in Predicting the 30-Day Mortality in Acute Ischemic Stroke Patients

Article

Full-text available

Apr 2024

Background Acute ischemic stroke, a clinical disorder caused by nontraumatic cerebrovascular disease, has an acute onset, frequently causes neurological deficit, and may persist for >24 hours or can be fatal in <24 hours. This study aimed to assess the red cell width distribution (RDW) and the mean platelet volume (MPV) in predicting 30-day mortality in acute ischemic stroke patients. In general, patients with acute ischemic stroke have a rather high mortality rate in the first 30 days due to various complications, but post the 30-day mark, the prognosis is comparatively better. Material and methods The present study was conducted on patients with a confirmed diagnosis of acute ischemic stroke based on history, physical examination, CT scan, and/or diffusion-weighted MRI scan performed during the first 24 hours. It was a prospective and cross-sectional study done at Saveetha Medical College over a period of two years. The data was collected by using the intra-hospital network and was analyzed using the IBM SPSS Statistics for Windows, Version 20 (Released 2011; IBM Corp., Armonk, New York, United States). Results In the present study, among 100 patients, the mean age was 57.4 ± 13.36 years. About 55% of our subjects were males in our study. The RDW on the 1stday was 14.17 ± 0.708, and it reduced drastically on the 30thday to1st 13.55 ± 1.11, and it was statically significant (p = 0.000). The MPV on day 1 was 11.11 ± 0.969 and, on day 30, was 10.82 ± 0.90; the MPV was reduced considerably on day 30, which was statistically significant (p = 0.000). RDW on the 1st day was significantly correlated with the MPV and the volume of stroke. The correlation was significant at the 0.01 level (two-tailed). On the 30th day of acute ischemic stroke patients, the red blood cell (RBC) width was significantly correlated with the MPV. The correlation was significant at the 0.01 level (two-tailed). At the end of 30 days, 10% mortality was observed in the present study. Day 30 saw a significant decrease in the MPV and RDW, particularly in the moderate to severe and severe categories. The National Institutes of Health Stroke Scale (NIHSS) score and the volume of stroke were significantly associated with the 30-day outcome. Conclusion The RDW and the MPV are well correlated in predicting the 30-day mortality in acute ischemic stroke patients. This could potentially be used as a significant marker for predicting mortality in stroke patients in the future, but to increase the generalization, further studies need to be carried out at other demographically distinct medical centers.

Comparison of Gyroscope Based Functional Electrical Stimulation Versus Ankle Foot Orthosis with Electrical Stimulation on Improving Muscle Performance and Gait in Post Stroke Subjects

Article

Full-text available

Mar 2024

Background and Objective: Foot drop is a common complication of a stroke which can impede participation in rehabilitation and has been associated with poor outcomes. Gyroscope based functional electrical stimulation is one of the adjunct treatments of choice. The objective of this study was to compare the effect of Gyroscope based FES versus Ankle foot orthosis with Electrical stimulation for improving muscle performance and gait in post stroke subjects.  Methods: Quasi experimental study design. 112 subjects with mean age of 58 years having a clinical diagnosis of stroke were allocated into two groups by using convenience sampling method. In Group A (n=56) were treated with Gyroscope based Functional Electrical Stimulation along with Standard rehabilitation program, whereas in Group B (n=56) subjects were treated by Ankle foot orthosis with Electrical Stimulation along with standard rehabilitation program. Participants were given intervention for five times a week for 6 weeks. The universal goniometer, pheezee and Tug were used to assess the intervention effectiveness.  Results: Independent ‘‘t’’ test was used to compare the mean significance difference between continuous variables. Paired ‘‘t’’ test was used to assess the statistical significance difference between pre and post test scores. Statistical analysis of this data revealed that both groups showed significant improvement in parameters when compared within groups, where as in between groups comparison Gyroscope based functional electrical stimulation along with standard rehabilitation program showed better improvement compared to Ankle foot orthosis with Electrical stimulation along with standard rehabilitation program.  Conclusion: In six weeks of intervention, both groups were shown statistically significant improvement in post-test values. However Gyroscope based functional electrical stimulation along with standard rehabilitation program was more effective when compared to Ankle foot orthosis with Electrical stimulation along with standard rehabilitation program. Hence treatment intervention may be incorporated in management of post stroke.

Effectiveness of moderate to vigorous physical activity among stroke risk predicted population. A pilot study

Article

Mar 2024

Background. The increasing prevalence of stroke, particularly among younger populations in countries like India, necessitates effective preventive strategies. Modifiable risk factors such as hypertension, diabetes, and smoking contribute significantly to stroke incidence. This study focuses on the implementation of a 12-week moderate to vigorous physical activity (MVPA) program to address these risk factors and reduce stroke incidence. Methodology. The study involved a structured MVPA intervention among individuals at risk of stroke, emphasizing consistent adherence to the protocol. Key outcomes, including systolic blood pressure, fasting blood glucose, and total cholesterol levels, were monitored. Cardiovascular fitness improvements were assessed using the Cooper's Run Test. The study also examined the feasibility and acceptability of the MVPA intervention through participant adherence rates. Results. The MVPA group exhibited significant reductions in systolic blood pressure, fasting blood glucose, and total cholesterol levels compared to the control group. These findings underscore the efficacy of MVPA in managing major stroke risk factors. Additionally, participants demonstrated enhanced cardiovascular endurance, highlighting the program’s positive impact on overall cardiovascular health. High adherence rates in the MVPA group indicated the feasibility of implementing structured exercise protocols for individuals at risk of stroke. Conclusion. This pilot study demonstrates the effectiveness of a 12-week MVPA program in reducing key stroke risk factors and improving cardiovascular fitness among individuals at risk of stroke. The findings emphasize the importance of structured exercise interventions in stroke prevention efforts. While promising, further research with larger sample sizes and longer durations is necessary to establish the sustained benefits and feasibility of such interventions. Implementing tailored MVPA programs holds significant potential for mitigating stroke risk, offering valuable insights for global stroke prevention strategies.

A Community-based Survey on Stroke Awareness in Underprivileged Urban Areas of Bangalore, India

Article

Mar 2024

Stroke is a major public health problem all over the globe, especially in low and middle-income countries like India. In the urban areas of India, the disease has grown to epidemic proportions. The underprivileged residents in urban slum areas have poor health literacy, usually resulting in poor health-seeking behaviours. Hence, efforts towards stroke prevention and risk factor control are critical in urban slum areas. The objective of the study was to assess the awareness about stroke among adults residing in the urban slum area of Bangalore, India. A cross-sectional survey was conducted using a mixed-methods approach, where data were collected from 490 adults using self-reported questionnaires. Over half of the participants (52%) did not know that the brain is the primary organ affected by stroke. Hypertension (44.9%) and diabetes mellitus (23.6%) were the most cited risk factors by participants. In binary logistic regression analysis, higher education was a predictor of stroke awareness (OR 0.65, p=0.02). Several misconceptions about stroke risk factors were identified among the participants. Poor awareness about stroke and its risk factors among the underprivileged urban population is demonstrated in this study. The study highlights the need to develop and implement strategies and programmes to improve awareness about stroke for the whole community.

Awareness of hemiplegic shoulder in hospital nurses: a cross-sectional study

Article

Full-text available

Jan 2024

Background: The hemiplegic shoulder, characterized by pain, weakness, and limited range of motion, is a common complication affecting individuals who have experienced hemiplegia due to stroke or other neurological conditions. It significantly impacts the quality of life of patients and hampers their rehabilitation progress. In the context of healthcare, nurses play a pivotal role in the holistic care of patients with hemiplegia. Their knowledge, assessment skills, and interventions contribute to the prevention and management of hemiplegic shoulder, thereby aiding in the overall recovery of patients, awareness of this condition is crucial because early identification and timely interventions can prevent its progression and associated complications. Furthermore, comprehensive knowledge of hemiplegic shoulder management can contribute to patient comfort, better rehabilitation outcomes, and improved patient satisfaction. Methods: A self-made questionnaire was validated and circulated via Google Forms to hospital nurses of all age groups. 60 participants who fit the inclusion criteria and gave consent to participate in the study were selected. Their responses were recorded, data analysis was done and results were obtained. Results: 60 responses were recorded via Google Forms. The average age of the population was 32 years. Out of the entire population, only 30.77% of the entire population were aware of the hemiplegic shoulder condition. Conclusions: According to this study there is a lack of awareness about the hemiplegic shoulder in the population of nurses in India, they need to be made more aware of the safe practices of handling stroke patients.

Targeted Physiotherapy for an Interesting Case of Spontaneously Resolving Extracapsular Infarct: A Case Report

Article

Full-text available

Jan 2024

Stroke is a prevalent and disabling illness that is becoming more common in developing countries. After a stroke, physical inactivity frequently results in long-term deconditioning and disappointing consequences. This case study focuses on an infrequent 0.3% of ischemic stroke cases that occur in the external capsular (ECC) or extreme capsular (EXC) region. In sub-insular infarcts, ECC-EXC lesions are distinct and frequently linked to the anterior opercular syndrome. We are presenting the case of an 86-year-old female patient who had a fall and loss of consciousness. Diagnostic tests revealed that the patient had an extracapsular ischemic event; due to unstable vital signs and frequent drop in saturation of peripheral oxygen (SpO2) levels, the patient was intubated and admitted to the intensive care unit (ICU). When stable, the patient experienced generalized weakness, for which she was referred for physical therapy. Balance and gait impairments were secondary to weakness. A planned two-week structured physiotherapy intervention was created with an emphasis on gait training, muscle strengthening, and balance. Adaptive gait training, progressive exercises, and balancing activities addressed the patient's limitations. This case study demonstrates how an elderly individual with an external capsule ischemic event can benefit from targeted physical therapy for increasing muscle strength, balance, and gait performance. Positive results emphasize how crucial early and targeted physiotherapy is for supporting stroke survivors' neurological recovery.

A Cross Sectional Study to Identify Perceived Barriers and Facilitators to Physical Activity and Exercise Participation of People with Post Stroke Depression

Article

Full-text available

Oct 2022

Background: Physical activity and exercises after stroke may prevent the disability and stroke recurrence; yet,psychological impairments like depression may inhibit post stroke exercise and subsequently limit recovery.Though it remains less clear how best is to encourage exercise uptake by individuals with depression after stroke.Objective: The objective of this study was to identify the perceived barriers and facilitators to physical activity andexercise participation among post stroke depressed individuals.Methods: Descriptive cross-sectional design was adopted using purposive sampling of stroke survivors. Fiftystroke survivors were screened and identified for depression using HAM-D.25 depressed and 25 non- depressedstroke survivors have been grouped into active and inactive groups based on exercise and physical activityguidelines. IPAQ scale has grouped them into physically active and physically inactive based on 3 METs. Using theEBBS scale, the percentage of positive responses for different domains for benefit and barrier scale was calculated.The significant difference in the percentage of response in barrier and benefit domains was analyzed using Chisquaretest.Results: There was significant difference in percentage of response in each benefit domain of EBBS betweendepressed and non- depressed active groups. Similarly there was significant difference in percentage of responsein each barrier domain of EBBS between depressed and non depressed inactive groups. Ten major perceivedbarriers were reported in depressed non-active group in which exercising cause fatigue (100%) was the highlyreported response.Conclusion: The study concluded that interventions could be designed for promoting the facilitators moreand addressing the barriers to exercise and time management which is likely to reduce the healthcare costs ofmanagement of stroke.

Predictors of Functional Recovery of Upper Limb Following acute Ischemic Stroke

Article

Full-text available

Dec 2022

Background: Although age-standardised rates of stroke mortality have decreased worldwide, overall stroke burden has significantly increased over the last two and half decades especially in developing countries.Objectives: To predict the functional recovery of upper limb potential after acute ischemic stroke.Methods: 51 people were recruited and studied. SAFE, NIHS Score, Median nerve SSEP, Conventional MRI brain imaging are done for all 51 patients. 40 patients were cooperative for further DTI neuroimaging & FA value analysis done within 1wk of stroke onset. Standard care & rehabilitation given. Followed up for upper limb recovery with ARAT scores at 1st, 2nd & 3rd months. Clinical, electrophysiological and neuroimaging recovery variables of upper limb were analyzed between two groups.Results: FA asymmetry index of posterior limb of internal capsule (PLIC) suggest more structural asymmetry of PLIC and poor recovery. There is a significant negative correlation between fractional anisotropy asymmetry index and ARAT III score. Correlation coefficient (r) is -0.319.Conclusion: With initial simple clinical assessment scales most of the recovery can be predicted and thereby patient expectations can be managed and use effective targeted rehabilitation strategies, time & resources to bring the best outcome

A Study on the Assessment of Severity of Stroke Patients at an Indian Tertiary Care Hospital

Article

Full-text available

Apr 2021

Aim: To assess the severity of stroke by using the NIH stroke scale among the ischemic and hemorrhagic stroke patients. Materials and Methods: Patients who were newly diagnosed with stroke were included in the study. All the demographics of the patient were collected by using a data collection form and the severity of the stroke was assessed by using the NIHSS questionnaire. According to this questionnaire, the severity of the stroke was classified into minor (0-4), moderate (5-15), moderate to severe (16-20) and severe (21-42). Results: Among the 150 patients involved in the study 107 (71.3%) were found to be males and 43 (28.7%) were found to be females. In this study, the patients with ischemic stroke were observed to be 97 (64.7%) where as the patients with hemorrhagic stroke were 53 (35.3%). Hypertension (40%) was the most common co-morbidity observed in this study The severity of the stroke in majority of the patients were observed to be severe (40.7%) followed by moderate severity (35.3%). Conclusion: In this study, ischemic stroke was more prevalent when compared to hemorrhagic stroke. Hypertension is the most common co morbidity observed. According to the NIH stroke scale assessment, the severity of the most of the study participants was observed to be severe followed by moderate in this study. Clinical pharmacists should create awareness among the general public regarding the negative consequences of the stroke and also should suggest the life style modifications which may increase the quality of life of the stroke patients.

RELIABILITY AND CONSTRUCT VALIDITY OF LATERAL STEP – UP TEST IN CHRONIC STROKE SUBJECTS: A CROSS SECTIONAL OBSERVATIONAL STUDY

Article

Full-text available

Dec 2023

Heena Pranavsinh Rathod

A Review on Combined Effect of Functional Electrical Stimulation and Robotic Hand Glove for Hand Rehabilitation in Post-Stroke Patients

Article

Full-text available

Oct 2023

Background: In stroke patients, upper extremity hemiplegia and loss of hand functions are primary impairments. Combined use of Functional Electrical Stimulation and Robotic Hand Glove was done to overcome the limitations in separate applications. Aims/Objective: To assess the combined effect of Robotic Hand Glove and Functional Electrical Stimulation to improve the hand functions and its impact on quality of life in post-stroke patients. Methodology: Different articles published between 2011 and 2022 were searched from online sources such as PUBMED, Google Scholar and Cochrane. In this review experimental study, clinical trial, preliminary investigation, pilot study, randomized control trial are included. A secondary search of the reference list of all identified articles was also conducted. Then each study was reviewed independently. Result: A total of 30 articles were searched. Out of 30 studies, 10 of them were screened out of which 4 studies were excluded due to flaws in methodology. The remaining 6 supportive studies reported that combining effect of Functional Electrical Stimulation and Robotic Hand Glove were more beneficial than conventional therapy alone to improve hand functions. Conclusion: Thus, it can be concluded that Functional Electrical Stimulation and Robotic Hand Glove were found to be more effective than conventional therapy to improve the specific task such as full reach, grasp, release, lifting tasks, drinking water, etc. in post-stroke patients. Key words: Functional Electrical Stimulation, Hand Rehabilitation, Robotic Hand Glove, Stroke.

Prevalence, contributing factors, and economic implications of strokes among older adults: a study of North-East India

Article

Full-text available

Oct 2023

Stroke is a significant cause of mortality and disability in India, with its economic impact on the rise. This study aims to investigate the prevalence and factors associated with stroke among the elderly population in seven north-eastern states of India and its economic consequences. Data from the initial phase of the Longitudinal Ageing Study in India (2017–2018) were utilized, and bivariate and multivariate analyses were done. Stroke prevalence (1.53%) was notable among both genders, with approximately 1% in females and 2.3% in males. Individuals with low physical activity, higher socio-economic status, and unemployment faced a higher risk of stroke. Females exhibited a 60% lower likelihood [AOR 0.40; (CI 0.250–0.627)] of stroke compared to males and hypertension was a significant risk factor. Stroke patients incur up to INR 50,000 of financial burden, with a considerable proportion facing disability in comprehension and speech. The economic burden of stroke-related hospitalization was significantly high, emphasizing the need for government-funded health insurance to cover stroke-related medications and reducing out-of-pocket expenses for patients seeking treatment in healthcare facilities. The study highlights the urgency for better schemes to address the growing threat of strokes in the north-eastern parts of India for comprehensively tackling this public health challenge.

Self-reported musculoskeletal disorders and associated factors among HIV/AIDS patients following ART at University of Gondar Comprehensive Specialized Hospital, Gondar, Ethiopia, 2021: Aa cross-sectional study design

Article

Full-text available

Aug 2023
BMC INFECT DIS

Background Musculoskeletal disorders is an inflammatory, degenerative diseases and disorders that cause pain and functional impairments. Musculoskeletal disorders are common and the major global health concern among people with human immunodeficiency virus/acquired immunodeficiency syndrome which causes physical disability. Despite, it is a recognized health problem among human immunodeficiency virus-positive patients, there is a lack of data on musculoskeletal disorders among patients following anti-retroviral therapy in sub-Saharan Africa, particularly Ethiopia. Therefore, the main aim of the study was to assess the prevalence and associated factors of musculoskeletal disorders among adult human immunodeficiency virus-positive patients following anti-retroviral therapy. Method An institutional-based cross-sectional study was conducted from September 1st to October 1st, 2021 at University of Gondar Comprehensive Specialized Hospital, Gondar, Ethiopia. The data was collected through an interview-administered questionnaire and patient medical record review of 324 participants. Binary logistic regression was used to identify associated risk factors of musculoskeletal disorders. The strength of the association was detected by the adjusted odds ratio and P-value. Result The annual prevalence of musculoskeletal disorders among participants was 158 (48.5%) with [95% CI: 43%, 54%], opportunistic infection [AOR, 10.43; 95% CI = 2.76–42.25], type of ART medication used, CD4-count [AOR, 0.13; 95% CI 0.03–0.85], and change in anti-retroviral therapy regimen change [AOR, 8.14; 95%CI 2.06–32.09] were significantly associated with musculoskeletal disorders. Conclusion The prevalence of musculoskeletal disorders was moderate. Recent CD4 count, opportunistic infection, antiretroviral therapy regime at initiation, and anti-retroviral therapy regime change were significantly associated with musculoskeletal disorder. A multidisciplinary approach is required for preventing and treating musculoskeletal disorders among human immunodeficiency virus-positive patients following anti-retroviral therapy.

Secondary prevention by structured semi-interactive stroke prevention package in INDIA (SPRINT INDIA): Findings from the process evaluation of a randomized controlled trial

Article

Full-text available

Aug 2023

Introduction Secondary Prevention by Structured Semi-Interactive Stroke Prevention Package in INDIA Trial delivered secondary stroke awareness intervention to sub-acute stroke patients in form of workbook, videos and SMS across 31 centres in 12 languages. Trial was stopped for futility due to fewer vascular outcomes than anticipated. Trial results indicated that trial intervention, did not lead to reduction in vascular events. We carried out process evaluation, to evaluate trial implementation and participant’s perspectives, to comprehend the trial’s futile outcomes. Materials and Methods Using mixed methods approach, qualitative interviews and quantitative data from case report forms, workbooks and questionnaires were analysed to measure intervention fidelity and contamination. Using purposive sampling, 115 interviews of patient-caregiver dyads and health professionals at 11 centres and 2 focus group discussions were held. Results and discussion Iterative thematic analysis of qualitative data was done with RE-AIM and realist models. There was good fidelity to intervention and adherence to protocol; however, there was dilution of inclusion criteria by randomly enrolling uneducated and caregiver-dependent patients. Centre coordinators provided counselling to both arms, not specified by protocol, causing bias. Coordinators found it difficult to keep patients motivated to view intervention which was corroborated by fidelity questionnaire showing decreased viewing of intervention for a year. Cardiovascular protection improved in routine care by virtue of participating in trial. No contamination of intervention was reported. Conclusion The intervention was acceptable by patients and caregivers, which could be made a community-based programme. Reasons identified for decreased viewing were repetitive content and non-availability of personal cellular device.

Association of Serum Calcium With Infarct Size and Severity in Acute Ischemic Stroke: A Rural Hospital-Based Cross-Sectional Study

Article

Full-text available

Aug 2023

Background One of the major mediators of ischemic neuronal cell death is calcium. It has been found that elevated serum calcium is associated with a better prognosis in patients with ischemic stroke. This study highlights the association of serum calcium, albumin-corrected calcium, and ionic calcium with the size of acute ischemic stroke as well as severity outcome in terms of the National Institutes of Health Stroke Scale (NIHSS) score and Barthel Index. Methods This cross-sectional study was conducted on 85 cases of acute ischemic stroke (based on a computerized tomography scan of the brain) from September 2019 to October 2021. All included patients had undergone complete clinical history, systemic examination, as well as estimation of serum total calcium, albumin corrected calcium, and ionic calcium. NIHSS score and Barthel Index were used to access the severity of each subject. Results A significant positive correlation was seen between infarct size with NIHSS with a correlation coefficient of 0.35. A significant negative correlation was seen between infarct size with serum calcium, albumincorrected calcium, and Barthel Index with a correlation coefficient of -0.483, -0.354, and -0.365 respectively. No correlation was seen between infarct size and ionic calcium with a correlation coefficient of 0.082. Conclusion It can be concluded that higher normal levels of serum calcium and albumin-corrected calcium are associated with a smaller-sized infarct and had less severity index among patients with acute ischemic stroke.

Examining the Feasibility and Preliminary Effects of Eyes-Open and Eyes-Closed Backward Treadmill Training on Balance, Mobility, and Fear of Falling in Sub-Acute Stroke Survivors: A Pilot Randomized Clinical Trial

Preprint

Full-text available

Sep 2024

Introduction: Gait impairment among stroke survivors is a prevalent and significant issue that necessitates appropriate rehabilitation interventions to address multiple factors such as muscle strength, balance, and coordination. One recommended approach for improving gait function is physical therapy, which helps to improve strength, balance, and coordination by reducing muscle weakness, spasticity, and tone. Other interventions that have demonstrated efficacy in enhancing gait function and mobility among stroke survivors include task-specific, high-velocity gait training. The effects of backward treadmill training were comparable to or superior to those of forward treadmill training in improving balance, gait speed, and stride length. Backward treadmill training can be considered as a potential rehabilitation intervention for stroke survivors with gait impairments. Methods: This study will be a two-arm, double-blinded, 4-week pilot, randomised clinical trial involving 4-week interventions & 2 weeks follow-up. Forty subacute stroke survivors will be recruited from a tertiary care hospital in India. The study participants will be randomly assigned to either the eyes-open backward treadmill training group EOBT(n=20) or the eyes-closed backward treadmill ECBT training group (n=20). The participants in both groups will receive 4-week interventions and standard care. Standard care consists of self-management exercises printed in a booklet. The primary outcomes will include a series of feasibility assessments of the study protocols about the study’s methodological procedures, including subject recruitment and follow-up processes, completion of study protocols, and feasibility acceptability and safety of the intervention such as balance, gait, and fear of fall, which will be evaluated using the Berg Balance Scale, Timed Up and Go Test, and Fall Efficacy Scale. Ethics and Dissemination: Ethical approval was obtained from the Institutional Ethical Committee of Sharda University (Ref No-SU/SMS&R/76-A/2022/73). The research results will be presented at conferences and disseminated through scientific journals subject to peer review. Trial Registration Number: -CTRI/2023/08/056653.

Barriers to Effective Prehospital and Hyperacute Stroke Care in India: A Physician Perspective

Article

Aug 2024

Introduction The incidence of stroke is increasing in India. Prehospital stroke care is crucial for reducing stroke morbidity and mortality, but its implementation in India faces several challenges. Limited original research exists on prehospital stroke care in India, making it essential to identify the problems in implementing effective prehospital stroke care. Methods A web-based survey was conducted among registered medical practitioners in India who treat acute stroke. The survey questionnaire was developed in English and included 26 questions divided into five parts: questions about the physician’s practice setup/hospital in India, perception of community awareness, existing prehospital care/systems, in-hospital stroke care availability, and specific issues faced. Results Eighty-three doctors in India participated in the survey (43% response rate). Most of the respondents worked in private hospitals (68%) and urban areas (76%). While 89% of hospitals had ambulance services, over 33% reported that patients had to pay for ambulance transport. Among respondents, 12% reported a community stroke care network, with infrequent prehospital procedures such as random blood glucose measurement (22%), stroke identification (15.7%), “last seen normal” documentation (14.5%), and low prehospital notification to hospitals (5%). Delays in referral from peripheral centers were reported by 73% of respondents. Most hospitals had standard operating procedures (SOPs) (84%), computed tomography (CT) (94%), magnetic resonance imaging (MRI) (85%), and offered intravenous thrombolysis (IVT) (77%). However, 24 h availability of CT was reported only by 6%, MRI by 19% and IVT by 12%. Nearly half (45%) reported treatment with thrombolysis was not covered by insurance. Mechanical thrombectomy was available in 34% of hospitals and 63% of hospitals conducted in-hospital audits for stroke patients. Conclusions The capabilities of stroke-catering hospitals in urban settings are encouraging, with many having SOPs, imaging capabilities, and thrombolysis and mechanical thrombectomy services. However, there is much room for improvement, in making the essential stroke care services financially accessible to all and available around the clock.

Navigating the Nexus: Acute Kidney Injury in Acute Stroke - A Prospective Cohort Study

Article

Full-text available

Aug 2024

Background Acute kidney injury (AKI) is prevalent in patients with acute stroke. Although AKI is linked to poor clinical outcomes, data about its incidence and effect on stroke outcomes is limited. Methods This was a prospective observational study carried out at a single tertiary care center that analyzed the data of 204 consecutive subjects with acute ischemic stroke and intracerebral hemorrhage. Considering serum creatinine at admission as the baseline, AKI was defined as a rise in serum creatinine value of 0.3 mg/dl over 48 h or a percentage increase of at least 50% from baseline over 7 days during hospitalization. The primary outcome was to measure the prevalence of AKI in patients with acute stroke. Secondary outcome measures were all-cause mortality, duration of hospital stay, need for dialysis, and comparison of outcomes in ischemic and hemorrhagic stroke. For both the stroke subtypes, we employed a multivariate logistic regression model, with AKI and hospital mortality being the outcomes. Covariates included gender, age, ventilatory requirement, duration of hospital stay, and National Institutes of Health Stroke Scale score at admission. Results There were 144 cases of ischemic stroke with 12 deaths (8.3%) and 60 cases of intracranial hemorrhage (ICH) with 22 deaths (36.7%). The mean age was 55 years, 72.6% were males, and AKI complicated 34% of ischemic stroke and 66.7% of ICH hospitalizations. AKI was linked to increased hospital mortality from ischemic stroke (odds ratio [OR] 27.21, 95% CI 3.39–218.13) and hemorrhagic stroke (OR 5.12, 95% CI 1.29–20.28) in multivariate analysis stratified by stroke type. Conclusions AKI complicates stroke frequently and increases hospital mortality. Additional studies are required to assess if the association is causal and if remedies to prevent AKI would decrease mortality.

A case study on cerebrovascular accident

Article

Full-text available

Jul 2024

Sujata Kumari

CVA is a significant global health problem and a major cause of mortality and morbidity in developed countries. Cerebral stroke (CVA) is a medical emergency that can cause permanent neurological damage or even death. According to the WHO statistics, stroke was the second most frequent cause of death worldwide in 2012 and the main cause of disability. The present study reported 59 years male ,married, hailing from Kokrajhar came to BH admitted in Intensive Care Unit on 13/08/2023 with the complain of Syncope, Not able to move right side of the body since 4 days,Face drooping at right side since 4 days,Loss of sensation in right side of the body since 4 days,Not able to eat food properly since 4 days,Difficulty speech since 4 days ,Patient was unconscious and was transferred to the ICU in stretcher and after various lab investigation, diagnostic procedures, patient was diagnosed as CVA and was treated with Tissue Plasminogen Activator and is under observation

Comparison of Electrical Dry Needling Versus Transcutaneous Electrical Nerve Stimulation on Improving Shoulder Pain and Function in Subjects with Hemiplegic Shoulder Pain

Article

Full-text available

Jul 2024

A review of recent advances in Neuroimaging and deep learning for stroke diagnosis

Conference Paper

Full-text available

Mar 2024

Elham Afarandeh

نهمین کنفرانس بین المللی دانش و فناوری مهندسی مکانیک,برق و کامپیوتر ایران، 28 اسفند 1402 در شهر تهران توسط موسسه برگزار كننده همايش هاي توسعه محور دانش و فناوري سام ايرانيان برگزار گردید

Prehospital Factors Associated with Delayed Hospital Arrival of Stroke Patients: A Regional Single-Center Study from India

Article

Full-text available

Apr 2024
Ann Indian Acad Neurol

Background Only a small percentage of patients with acute stroke are currently eligible for thrombolysis, partly due to severe delays in hospital arrival. We had previously conducted the first regional study to assess the factors delaying acute stroke care in India. The present study aims to understand and describe in depth the variables associated with prehospital delay among patients admitted with an acute ischemic stroke. Methods Data were prospectively collected by conducting an in-depth interview of 470 acute ischemic stroke patients and their bystanders, aged above 18 years, presenting to the Department of Emergency Medicine, Jubilee Mission Medical College and Research Institute, Thrissur. Patients who arrived within 4.5 h of symptom onset were considered as “early arrival” and those who arrived after 4.5 h were considered as “delayed arrival.” Univariate and multivariate analyses were undertaken to determine associations between variables of interest and delays to hospital presentation. Results Of the 470 patients who met the inclusion criteria, 73 patients reached within 4.5 h (15.5%), whereas 397 patients arrived after 4.5 h. The mean age of acute stroke patients who reached within 4.5 h was 63 ± 13.7 years, whereas the mean age of those who reached after 4.5 h was 63 ± 12.1 years. Binary logistic regression performed to quantify the associations of prehospital factors showed an increased risk of prehospital delay among individuals with lack of awareness (odds ratio [OR] = 5.16 [3.040–8.757], P < 0.001), followed by those for whom a vehicle was not available at the site of event (OR = 3.745 [1.864–7.522], P < 0.001). Within the predefined socioeconomic strata, compared to lower class, upper middle class had less risk (OR = 0.135 [0.018–1.035], P = 0.054), whereas the distance from first medical contact to emergency department contributed moderate risk (OR = 1.071 [1.028–1.116], P < 0.001) for prehospital delay. Conclusions Health promotion techniques that increase public knowledge about the early signs of stroke, transferring patients directly to hospitals with thrombolysis capabilities, and making ambulance services more widely available are appropriate measures to reduce prehospital delay.

Identification of Physical Problems of Patients with Acute Stroke

Article

Full-text available

Jan 2022

Background: Stroke patients experience a variety of physical problems which affect their activitiesof daily life. As there is need for identifying the physical problems of patients with acute stroke in theinitial stage, the present study was undertaken to identify the physical problems of patients with acutestroke. Objectives: the objectives of the study were to identify the physical problems of patients withacute stroke. Methods: This descriptive study was conducted at neurology department of a tertiarycare hospital in Kerala. 60 patients with acute stroke was selected by consecutive sampling technique.Physical problems of stroke patients were identified by standardised tools; National Institute of HealthStroke Scale (NIHSS) and Barthel index. Appropriate descriptive and inferential statistical methods wereused to analyze the data. Results: The major physical problems identified were immobility (81.7%),lower extremity weakness (75%), upper extremity weakness (71.6%), loss of bladder control (66.7%),loss of bowel control (65%), feeding problem (63.3%) and communication problems like dysarthria(55%) and aphasia (53.3%). Conclusion: The study stresses the importance of identification of variousexisting and emerging physical problems encountered by acute stroke patients and the preparation of anursing care protocol, which can be utilized in future, for managing the major physical problems.

Platelet ADP receptor (P2RY1) polymorphism and the risk of inadequate platelet response to aspirin: Study in patients with ischemic stroke

Preprint

Full-text available

Jan 2024

An estimated 5–60% of patients experience inadequate antiplatelet effects after taking aspirin. We investigated the gene variants that might determine the outcome of the aspirin response in stroke patients. A total of 293 ischemic stroke patients who were taking 150 mg of aspirin for more than 7 days, were enrolled and only 230 patients with serum salicylate levels > 30 µg/mL were included. Variants in COX1 (rs1236913 C > T), COX2 (rs20417 G > C), GpIIb/IIIa (rs5981 T > C), P2RY1 (rs701265 A > G & rs1371097 C > T), PEAR1 (rs2768759 C > A), ITGB3 (rs2317676 A > G) and UGT1A6 (rs1105879 A > G & rs2070959 A > C) were genotyped. Platelet aggregation tests were carried out by light transmittance aggregometry using adenosine-di-phosphate and arachidonic acid as agonists. The ‘T’ allele of P2RY1 (rs1371097 C > T) polymorphism was significantly associated with inadequate platelet response as measured by platelet aggregometry (OR, 95%, 1.71, 1.122–2.61; p = 0.0131). Presence of a single copy of the ‘T’ allele in P2RY1 (rs1371097 C > T) increased the risk of inadequate response by 3.46 times (adjusted OR (95%), 3.46 (0.043); p = 0.043).

Percieved Biopsychosocial Problems of Stroke Survivors Undergoing Home Care -A Qualitative Study

Preprint

Full-text available

Dec 2023

Background Stroke causes permanent neurological damage and disability. Depending on the severity and type, stroke can leave a person with residual impairment of physical, psychological and social functions. A recurrent stroke can be avoided through integrated and well-coordinated home care which is possible only if stroke survivors perceived needs and problems are identified. This study is designed to describe the biopsychosocial problems of stroke survivors Methods The study used an interpretive qualitative approach by conducting in-depth interviews with 10 stroke survivors who had experienced post stroke deficits within one to three years of stroke. Participants were recruited from an outpatient clinic to gain insights into their biopsychosocial issues. Data were analyzed using Diekelmann's hermeneutical approach to uncover themes. Results Stroke is a sudden, stressful occurrence that affects the victim as well as their family. Disease affects physical, psychological, and socioeconomic domain. Themes emerged were categorised into these three areas. Subthemes in physical domain included difficulty with movement, nutrition, elimination, rest and sleep and activities of daily living. Subthemes in psychological domain included emotional, behavioural and cognitive reaction. Social and economic factors formed the subtheme of sociecomonic problem theme. Conclusion Recognising the problems patients experience while undergoing home care is essential in planning rehabilitative services for stroke victims. It can guide policies and mobilise resources to provide organised home care and prevent hospital readmissions.

A study to assess the effectiveness of planned teaching programme on knowledge regarding stroke among nursing assistants in selected hospital, Mumbai

Article

Jul 2023

Effect of russian current in motor performance among chronic stroke survivors

Preprint

Nov 2023

Background and Aim Stroke is a leading cause of permanent disability in developing nations. Motor impairment in stroke contributes to limitations in activities of daily life, participation in community, and overall quality of life. Recovery following stroke is challenged by poor lower-limb muscle performance interfering with balance, gait, and functional tasks. Objective The objective of this study was to investigate the effect of Russian current over the quadriceps muscle in 10-m walk performance and Brunnstrom stages of lower-extremity recovery in chronic stroke survivors. Materials and Methods The Institutional Review Board approval was obtained for this pilot study, and a total of 36 chronic stroke survivors were recruited from the outpatient department of Alva’s College of Physiotherapy and Research Center, Moodubidire, Karnataka. Consent was obtained from the voluntary participants, and they were randomly assigned to one of the two groups; intervention and the control groups. Participants in the intervention group received Russian current over the quadriceps muscle in addition to the conventional rehabilitation, whereas the control group participants received only conventional rehabilitation. The study duration was 6 weeks. The outcomes measured were 10-m walk test and Brunnstrom stages of lower-extremity recovery. Results Statistical analysis was performed with SPSS statistical software. The Kolmogorov–Smirnov test was performed for normality. The paired t -test, within-group analysis, demonstrated a significant increase in the 10-m walk test ( P < 002) and Brunnstrom stage of lower extremity ( P < 0.043) for the intervention group. The independent t -test demonstrated a highly significant ( P = 0.001) value for the intervention group than the control group. Conclusion Statistical results conclude that Russian current is effective in improving 10-m walk performance and Brunnstrom stages of motor recovery of lower limb in chronic stroke survivors.

"THE KNOWLEDGE REGARDING CARE OF PATIENTS WITH STROKE AMONG RELATIVES FROM SELECTED HOSPITALS OF PUNE CITY IN VIEW TO DEVELOP INFORMATION BOOKLET''

Article

Full-text available

Oct 2023

Introduction: Paralysis or Stroke is a cerebro-vascular accident that that happens when the brain's blood supply is interrupted or due to a blockage in blood vessels and bleeding within the brain is called as stroke. Aim of the study: "The knowledge regarding care of patients with stroke among relatives from selected hospitals & to develop information booklet. Material and method: The study approach was a quantitative with non-experimental descriptive survey design. The sample selection technique was used non-probability purposive sampling technique. The sample size was 100 relatives of stroke patient aged between 18-60 years. Samples were selected from different hospitals of Pune city. The tool used for data collection was a self-structured questionnaire that contained demographic variables in section I, section II was related assessment of the knowledge regarding care of patients with stroke among relatives. The written informed consent was taken from the participants prior to the data collection, in order to establish reliability of the tool, the inter-rater method was used. Result: Majority i.e. 43% of samples were from 48-60 years of age, 52% of samples were female, 35% of samples were having primary education, 48% of samples were working in private sector and majority 60% of samples were from rural area. Majority 52% of samples had average knowledge regarding care of patient with stroke, 46% of samples had good knowledge regarding care of patient with stroke and 2% of samples had poor knowledge regarding care of patient with stroke. Significant association was not found between knowledge score with selected demographic variables. Conclusion: The study concluded that there is average knowledge regarding care of patient with stroke among their relatives.

WHO Systematic Assessment of Rehabilitation Situation (STARS): A systematic review on the status of stroke rehabilitation in India

Article

Full-text available

Aug 2023

Purpose of review To provide a 'Systematic Assessment of the Rehabilitation Situation' (STARS) on stroke rehabilitation in India in accordance with the World Health Organization (WHO) STARS guidelines. Understanding the current status will help in planning of future policy and development activities. Recent Findings The available stroke rehabilitation data from India is deficient. While the incidence of stroke is 33 to 295.9 per year per 100,000 people (in a country of 1.2 billion), there are about 1000 physiatrists and only 150 designated rehabilita- tion facilities. Among them almost 40% patients are moderate to severely disabled and around 50% patients are spastic. The pooled prevalence of dysphagia was 47.71%. Lack of standardised data, referral system, information gaps, and resources hinder stroke rehabilitation in India. Predominantly uni-disciplinary stroke units are clustered in metropolitan cities and tertiary centres. They are nearly absent at secondary and primary healthcare facilities. Integrating rehabilitation into health care system will improve stroke rehabilitation in India. Summary Stroke rehabilitation infrastructure in India is a work in progress, but structured planning is needed to make WHO rehabilitation for all a reality by 2030.

Knowledge and awareness of early stroke signs: an analytical review

Article

Jan 2023

Present study sought to provide a research-based evidence regarding knowledge and awareness of early stroke signs via a structured analytical review of the previous studies. This study was an analytical review that screened the previous studies published between 2018 and 2023 using a combination of the following keywords” Stroke, Knowledge, early signs, awareness, and signs and symptoms”. This review included studies published in English within the last five years and discussing similar outcome. A total of five studies were included in this structured analytical review. The included studies provided variation in the findings related to the knowledge and awareness about early signs of stroke. However, all of the studies stressed the significance of designing interventional educational programs that provide tailored education about early signs of stroke based on individuals’ socioeconomic and demographic characteristics. The study concluded that knowledge and awareness about early signs of stroke is an issue that requires more attention from the researchers at the global level as varied outcomes were reported and no evidences are retrieved about the level of knowledge and awareness about early signs of stroke.

Knowledge and awareness of early stroke signs: an analytical review

Article

Jan 2023

Present study sought to provide a research-based evidence regarding knowledge and awareness of early stroke signs via a structured analytical review of the previous studies. This study was an analytical review that screened the previous studies published between 2018 and 2023 using a combination of the following keywords” Stroke, Knowledge, early signs, awareness, and signs and symptoms”. This review included studies published in English within the last five years and discussing similar outcome. A total of five studies were included in this structured analytical review. The included studies provided variation in the findings related to the knowledge and awareness about early signs of stroke. However, all of the studies stressed the significance of designing interventional educational programs that provide tailored education about early signs of stroke based on individuals’ socioeconomic and demographic characteristics. The study concluded that knowledge and awareness about early signs of stroke is an issue that requires more attention from the researchers at the global level as varied outcomes were reported and no evidences are retrieved about the level of knowledge and awareness about early signs of stroke.

Incidence & prevalence of stroke in India: A systematic review.

Abstract

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