Neurologic emergencies in resource-limited settings: A review of stroke care considerations

Pharmacotherapy Pattern and Treatment Outcomes of Stroke Patients Admitted to Jimma University Medical Center, Ethiopia

Background

Despite the fact that stroke has been reported as one of the top three leading causes of death and morbidity in Ethiopia, there are limited data regarding the management of stroke and clinical outcomes. Hence, the present study aimed to evaluate the pharmacotherapy of stroke and factors associated with poor treatment outcomes.

Methods

A retrospective cross-sectional study was conducted at Jimma University Medical Center (JUMC) among adult stroke patients managed from 2014 to 2017. Clinical characteristics, treatment, and outcomes data were analyzed by using SPSS version 21. Multivariable logistic regression was performed to identify the predictors of poor treatment outcomes. Two-sided P < 0.05 was accepted as statistically significant.

Results

A total of 153 illegible patient cases were included in this study. The majority, 111 (72.5%), were male and the mean age of the patients was 57±13.7 years. Among 153 stroke patients, 112 (73.2%) patients presented with ischemic stroke. Aspirin and statins (78.6%) were the most commonly used treatment among ischemic stroke patients, whereas enalapril was used in about (43%) of stroke patients to treat high blood pressure. About 61 (40%) stroke patients had poor treatment outcomes; of this, 36 (23.5%) died in hospital. Older age (AOR = 1.034; 95% CI: 1.003–1.069), history of heart failure (AOR = 4.26; 95% CI: 1.58–11.48), loss of consciousness diabetes (AOR = 3.05 95% CI: 1.25–7.44), and aspiration pneumonia (AOR = 5.94; 95% CI: 2.46–14.32) were significantly associated with poor treatment outcomes.

Conclusion

Overall, treatment of stroke patients was sub-optimal and almost half of the patients had poor treatment outcomes. Availing of thrombolytic therapy, devising appropriate preventive measures of risk factors (hypertension), and decreasing preventable complication such as aspiration pneumonia could improve patient outcomes.

The Emergency Department Crash Cart: A systematic review and suggested contents

BACKGROUND

As the field of Emergency Medicine grows worldwide, the importance of an Emergency Department Crash Cart (EDCC) has long been recognized. Yet, there is paucity of relevant peer-reviewed literature specifically discussing EDCCs or proposing detailed features for an EDCC suitable for both adult and pediatric patients.

METHODS

The authors performed a systematic review of EDCC-specific literature indexed in Pubmed and Embase on December 20, 2016. In addition, the authors reviewed the 2015 American Heart Association (AHA) guidelines for cardiopulmonary resuscitation and emergency cardiovascular care, the 2015 European Resuscitation Council (ERC) guidelines for resuscitation, and the 2013 American College of Surgeons (ACS) Advanced Trauma Life Support (ATLS) 9th edition.

RESULTS

There were a total of 277 results, with 192 unique results and 85 duplicates. After careful review by two independent reviewers, all but four references were excluded. None of the four included articles described comprehensive contents of equipment and medications for both the adult and pediatric populations. This article describes in detail the final four articles specific to EDCC, and proposes a set of suggested contents for the EDCC.

CONCLUSION

Our systematic review shows the striking paucity of such a high impact indispensable item in the ED. We hope that our EDCC content suggestions help enhance the level of response of EDs in the resuscitation of adult and pediatric populations, and encourage the implementation of and adherence to the latest evidence-based resuscitation guidelines.

Enduring protection provided by NMITLI118RT+ and its preparation NMITLI118RT+CFM against ischemia/reperfusion injury in rats

Withania somnifera Dunal (Ashwagandha), is an Indian medicinal plant with significant pharmacological properties.