Background:It is a well-known fact that very few patients of stroke arrive at the hospital within the window period of thrombolysis. Even among those who do, not all receive thrombolytic therapy.Objective:The objectives of this study were to determine the proportion of early arrival ischemic strokes (within 6 h of stroke onset) in our hospital and to evaluate the causes of nonadministration of intravenous and/or intraarterial thrombolysis in them.Materials and Methods:Data of all early arrival acute stroke patients between January 2010 and January 2015 were included. Factors determining nonadministration of intravenous and/or intraarterial thrombolysis in early arrival strokes were analyzed.Results:Out of 2,593 stroke patients, only 145 (5.6%) patients presented within 6 h of stroke onset and among them 118 (81.4%) patients had ischemic stroke and 27 (18.6%) patients had hemorrhagic stroke. A total of 89/118 (75.4%) patients were thrombolyzed. The reasons for nonadministration of thrombolysis in the remaining 29 patients were analyzed, which included unavoidable factors in 8/29 patients [massive infarct (N = 4), hemorrhagic infarct (N = 1), gastrointestinal bleed (N = 1), oral anticoagulant usage with prolonged international normalized ratio (INR) (N = 1), and recent cataract surgery (N = 1)]. Avoidable factors were found for 21/29 patients, include nonaffordability (N = 7), fear of bleed (N = 4), rapidly improving symptoms (N = 4), mild stroke (N = 2), delayed neurologist referral within the hospital (N = 2), and logistic difficulty in organizing endovascular treatment (N = 2).Conclusion:One-fourth of early ischemic stroke patients in our study were not thrombolyzed even though they arrived within the window period. The majority of the reasons for nonadministration of thrombolysis were potentially preventable, such as nonaffordability, intrahospital delay, and nonavailability of newer endovascular interventions.
Background: Peptic ulcer was defined as a disruption of the mucosal integrity of the abdominal esophagus, stomach, duodenum leading to local defect or excavation due to active inflammation. Hospitalizations for peptic ulcer disease (PUD) have decreased since the advent of specific medical therapy & low tachyphylaxis associated with those drugs. This study aims to evaluate the surgical complications of peptic ulcer disease and tested the hypothesis that despite the decrease in hospitalization for PUD, the incidence of elective surgery for PUD during the recent three decades tends to decrease and in contrast, the frequency of emergency surgical interventions for complications of the PUD has remained consistent.Methods: A total of 60 patients operated for complications of PUD, admitted to PES Institute of Medical Sciences, Kuppam, from January 2018 to September 2019. All data that may be potential predictors concerning complications of PUD were prospectively analyzed.Results: In the present study, the most common complication was perforated peptic ulcer (78.3%) followed by Gastric outlet obstruction (15%) and rest bleeding peptic ulcer.Conclusions: Despite the efficacy of modern medical therapy, decreasing the overall PUD hospitalizations, the volume of procedures to treat complications of PUD has not declined.
Summary:Intravenous thronibolytic therapy has become stantlard treatment for acute myocardial infarction (AMI). We describe three patients with long-standing seropositive rheumatoid arthritis (RA) on chronic corticosteroid therapy who experienced very early ( I 4 h) mortality after the use of inlravenous thrombolytic therapy for the treatment of AMI. All three patients likely experienced electromechanical dissociation (EMD). Their charts were evnluated in depth, and thc literature was reviewed in regard to possible etiopathologic mechanisms. Within 1-6 h of apparently successful thrombolytic therapy for AMI, these three patients experienced sudden and profound bradycardia and hypotension and could not be resuscitated. The potential occunence of EM I1 in all three patients raises the possibility of accelerated myocardial rupture, as EMD is one ofthe clinical hallmarks of this condition. As suggested by the three clustered cases. this heretofore undescribed association between sudden unexpected cardiac death and thrombolytic therapy for AM1 in patients with seropositive, corticosteroid-dependent RA suggests that further study and observation are needed. This deleterious association, if verified. has important implications for the treatment of AM1 i n patients who have RA and arc corticosteroid dependent.
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