Changing Epidemiology of Stroke in Nepalese Population

Abstract

Corrigendum:The article published in Nepal Journal of Neurosciences 2018;15:10-18 by Amit Thapa et al was mistakenlypublished with wrong affi liation of some of the co-authors. The correct affi liation of the co-authors should read asBikram Shakya, MBBS, MS, MChLecturerDepartment of Neurological SurgeryKathmandu Medical College Teaching Hospital (KMCTH)Sinamangal, Kathmandu, NepalDipesh Kumar Yadav, MBBSMedical OfficerDepartment of Neurological SurgeryKathmandu Medical College Teaching Hospital (KMCTH)Sinamangal, Kathmandu, NepalKarjome Lama, MBBSMedical OfficerDepartment of Neurological SurgeryKathmandu Medical College Teaching Hospital (KMCTH)Sinamangal, Kathmandu, Nepal
 Abstract: We are witnessing changing patterns in stroke in our practice. Documenting changes in epidemiological profile are important for public health policy. We hereby present analysis of patients with stroke to stress upon the dynamics and update the improvement in their care. We retrospectively studied all patients with first time stroke presenting in Kathmandu Medical College Teaching Hospital during June 2012 till November 2015. Diagnosis was made on clinico-radiological basis with prospective follow up for at least 1 year from the event. Risk factors as well outcome in terms of Glasgow outcome score were studied. Statistical analysis was performed on SPSS. A total of 1017 patients of 16260 patients admitted to the hospital during the study period had first time stroke, a hospital based annual incidence of stroke of 64 per thousand admissions was hence calculated. Mean age was 55 years with 60.5% males. 503 patients (49.5%) had infarction with 20 patients having hemorrhagic conversion while 3 had TIA. 50.2% had hemorrhagic stroke. 56.7% females had ischemic stroke whereas 54.9% of males had hemorrhagic stroke (p=0.002). Common risk factors like HTN (54.7%), Smoking (41.5%), Alcohol (39.2%), dyslipidemia (34.1%) and DM (4.8%) were seen with stroke however, active smoker were more at risk of hemorrhagic stroke (p=0.000) while diabetic patients for ischemic stroke (p=0.000). Due to availability of neurosurgical services, 14.6% patient could undergo procedures like decompressive craniectomy, hematoma evacuation, CSF diversion procedures and carotid endarterectomy for stroke. 66.9% patients required surgical intervention within 48 hours of admission. We had 30 days mortality of 0.5% mortality in this series (majority in hemorrhagic stroke), however over 3 years duration of study mortality rose to 8.3% (majority in ischemic stroke). Almost 88.5% patients achieved mRS< Nepal Journal of Neuroscience, Volume 15, Number 1, 2018 11 2 over a period of 3 years. Persistent vegetative state was seen in 7.6% cases after 1 year. We observe a very high incidence of hemorrhagic stroke in general with higher than reported proportion of females being involved with ischemic stroke in our series. Most of the vegetative state conditions occurred in ischemic stroke patients however early mortality was common in hemorrhagic stroke. This change in pattern of stroke as well as need of surgical intervention mandates early involvement of neurosurgical services. Poor long term prognosis in ischemic stroke may be reversed by timely thrombolytic services and prevented by mitigating risk factors.
 Nepal Journal of Neuroscience 15:10-18, 2018

Carotid Plaques Among Different Ethinic Patients with Ischemic Stroke

“…4 There was slightly more prevalence of female patients (56.7%) in one recent study by A. thapa. 14 The mean age of the female patients was 68.5 years and that of male patients was 63.7 years which was more than the mean age of 59 years in study done by M.Shaik. 15 Younger patients less than 45 years accounted for 12 percent in this study which was less than the study done in Kathmandu Medical College.…”

Exploring the Caring Incorporating Yoga Program in Promoting Physical Recovery of Stroke Patients in Acute Phase

“…Despite advancement in medical technology and modern medicine in prevention and management of cardiovascular disease, stroke is still the leading cause of death and disability globally with high incidence and worse prognosis, particularly in developing countries [1]. including Nepal [2]. It poses signi cant effects on a person in terms of physical, functional, psychological, emotional and spiritual health as well as increased economic burden to the society [3].…”

Exploring the Caring Incorporating Yoga Program in Promoting Physical Recovery of Stroke Patients in Acute Phase

“…Despite advancement in medical technology and modern medicine in prevention and management of cardiovascular disease, stroke is still the leading cause of death and disability globally, with high incidence and worse prognosis, particularly in developing countries [1], including Nepal [2]. It poses signi cant effects on a person in terms of physical, functional, psychological, emotional and spiritual health as well as increased economic burden to the society [3].…”