Feasibility and efficacy of thrombolysis in acute ischemic stroke: A study from National Institute of Neurological and Allied Sciences, Kathmandu, Nepal

Thapa, Lekhjung; Shrestha, Shikher; Shrestha, Pratyush; Bhattarai, Suman; Gongal, Dinesh Nath; Devkota, Upendra Prasad

doi:10.4103/0976-3147.172161

Cited by 7 publications

(10 citation statements)

References 19 publications

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“…This can help better outcome of the case with recently introduced thrombolytic therapy in Nepal. [25] Thapa, et al: KAP of stroke amongst school students…”

Section: Discussionmentioning

confidence: 99%

Knowledge, attitude, and practice of stroke among high school students in Nepal

Thapa¹,

Sharma²,

Poudel³

et al. 2016

Journal of Neurosciences in Rural Practice

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Background:Baseline stroke knowledge in a targeted population is indispensable to promote the effective stroke education. We report the baseline knowledge, attitude, and practice (KAP) of high school students with respect to stroke from Nepal.Materials and Methods:A self-structured questionnaire survey regarding KAP about stroke was conducted in high school students of 33 schools of Bharatpur, Nepal. Descriptive statistics including Chi-square test was used, and the significant variables were subjected to binary logistic regression.Results:Among 1360 participants, 71.1% had heard or read about stroke; 30.2% knew someone with stroke. 39.3% identified brain as the organ affected. Sudden onset limb/s weakness/numbness (72%) and hypertension (74%) were common warning symptom and risk factor identified. 88.9% would take stroke patients to a hospital. Almost half participants (55.5%) felt ayurvedic treatment be effective. 44.8% felt stroke as a hindrance to a happy life and 86.3% believed that family care was helpful for early recovery. Students who identified at least one risk factor were 3.924 times (P < 0.001, confidence interval [CI] = 1.867–8.247) or those who identified at least one warning symptom were 2.833 times (P ≤ 0.023, CI = 1.156–6.944) more likely to take stroke patients to a hospital.Conclusion:KAP of high school Nepalese students regarding stroke was satisfactory, and the students having knowledge about the risk factors and warning symptoms were more likely to take stroke patients to a hospital. However, a few misconceptions persisted.

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“…This can help better outcome of the case with recently introduced thrombolytic therapy in Nepal. [25] Thapa, et al: KAP of stroke amongst school students…”

Section: Discussionmentioning

confidence: 99%

Knowledge, attitude, and practice of stroke among high school students in Nepal

Thapa¹,

Sharma²,

Poudel³

et al. 2016

Journal of Neurosciences in Rural Practice

Self Cite

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“…Until now, intravenous thrombolysis (IVT) with tissue plasminogen activator (t-PA) within 4.5 h and endovascular thrombectomy within 6 h are the only approved treatments for acute ischemic stroke [4, 5]. The use of IVT for the management of ischemic stroke was introduced in Nepal in 2012 [6]. Endovascular thrombectomy is one of the recent advances in the treatment of ischemic stroke but has its own limitations.…”

Section: Introductionmentioning

confidence: 99%

Status of prehospital delay and intravenous thrombolysis in the management of acute ischemic stroke in Nepal

et al. 2019

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Background Intravenous thrombolysis has been recently introduced in Nepal for the management of acute ischemic stroke. Pre-hospital delay is one of the main reasons that hinder thrombolytic therapy. The objective of this study was to evaluate the status of prehospital delay and thrombolysis in Nepal. Methods Data were prospectively collected from patients of both genders, age > 18 years who arrived at the emergency department (ED) with symptoms and neuroimaging findings consistent with an ischemic stroke. Patient data were obtained from ED form and standard questionnaires were used to assess factors resulting in prehospital delay. Modified Rankin scale and National Institute of Health stroke scale were used to assess the degree of disability and severity of stroke respectively. Results A total of 228 patients were enrolled in the study between August 2017 and August 2018. Only 46 (20.17%) patients arrived within the time frame for thrombolysis. Onset at daytime (OR: 4.07; 95% CI: 1.65–10.1; p = 0.001), stroke symptoms facial deviation (OR: 5.03; 95% CI: 2.47 to 10.26; p = 0.000) and speech disturbances (OR: 2.34; 95% CI: 1.06 to 5.1; p = 0.021), identification of stroke (OR: 22.36; 95% CI: 9.42–53.04; p = 0.000), rushing to ED after onset of symptoms (OR: 2.93; 95% CI: 1.5–5.7; p = 0.001), awareness of treatment of stroke (OR: 10.21; 95% CI: 4.8–21.6; p = 0.000), direct presentation (OR: 4.2; 95% CI: 2.09–8.66; p = 0.000), the distance less than 20 km (OR: 7.9; 95% CI: 3.8–16.5; p = 0.000), and education above high school (OR:4.85; 95% CI: 2.2–10.5; p = 0.000) were associated with early arrival. Heavy traffic, income below 1000 USD per annum and diabetes mellitus were associated with delayed arrival to ED. Out of 46 early arrival patients, only 30 patients (13.15%) received tissue plasminogen activator during the study period, while others were deprived because of their inability to afford the treatment cost. Conclusion Community-based intervention to spread awareness, establishing comprehensive stroke centers, training specialists, improving emergency services, establishment of telestroke facilities and encouraging the use of low-cost tenecteplase as an alternative to alteplase can help improve care for stroke patients in Nepal.

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“…Thrombolysis, as a definitive management, has revolutionized the outcome in patients of stroke which, when done in time, greatly reduces disability associated with stroke 6,7 . Thrombolysis in Nepal has recently been started in the capital city (Kathmandu) at four tertiary care centers (as of time of writing) and so far only a handful of cases have undergone thrombolysis 8,9 . This could largely be explained by lack of knowledge regarding identification of stroke and thrombolysis among the population.…”

Section: Introductionmentioning

confidence: 99%

“…6,7 Thrombolysis in Nepal has recently been started in the capital city (Kathmandu) at four tertiary care centers (as of time of writing) and so far only a handful of cases have undergone thrombolysis. 8,9 This could largely be explained by lack of knowledge regarding identification of stroke and thrombolysis among the population. Students preparing for undergraduate medical entrance examination are the prime focus of our study, as this could be an important group who could effectively inform their families and others about stroke and effective timing for thrombolysis.…”

mentioning

confidence: 99%

Knowledge, attitude, and practice of stroke and thrombolysis among students preparing for undergraduate medical entrance examination in Kathmandu, Nepal

Pradhan¹,

Jha

Bhandari

et al. 2021

Health Science Reports

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Background Stroke is a major disabling disease, especially for low and middle‐income countries like Nepal. The aim of our study is to assess knowledge, attitude, and practice (KAP) among the students preparing for undergraduate medical entrance examination regarding risk factors, warning signs and symptoms, and management of stroke. Methods A cross‐sectional, single staged study using self‐structured questionnaire intended to assess KAP about stroke and thrombolysis was conducted. Results A total of 378 students participated in our study (53% male; mean age = 18.12 ± 0.97). Majority of the participants (88.4%) had heard about stroke. The more common risk factors identified by them were hypertension (86.2%), oily food (48%), alcohol (37.8%), and smoking (32.8%). Limb weakness, slurring of speech and facial weakness as symptoms and signs of stroke were indicated by 43.4%, 30.2%, and 18.8% of the participants, respectively. Only 23.8% of the participants had heard about thrombolysis and 10% of all could rightly mention the window period of thrombolysis. Male participants had better knowledge about smoking [86 (43.0) vs 38 (21.3); P < .001] and oily food [108 (54.0) vs 73 (41.0); P = .012] being risk factors and facial weakness [50 (37.6) vs 21 (11.8); P = .001] being symptom of stroke compared with females. Similarly, male participants had heard more about thrombolysis than females [68 (34.0) vs 22 (12.4); P < .001]. Conclusion Knowledge regarding risk factors and signs and symptoms of stroke was adequate among the students preparing for undergraduate medical entrance examination. However, knowledge about thrombolysis was poor. Male participants had better knowledge about risk factors, warning signs and symptoms of stroke, and thrombolysis compared with female.

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Feasibility and efficacy of thrombolysis in acute ischemic stroke: A study from National Institute of Neurological and Allied Sciences, Kathmandu, Nepal

Cited by 7 publications

References 19 publications

Knowledge, attitude, and practice of stroke among high school students in Nepal

Knowledge, attitude, and practice of stroke among high school students in Nepal

Status of prehospital delay and intravenous thrombolysis in the management of acute ischemic stroke in Nepal

Knowledge, attitude, and practice of stroke and thrombolysis among students preparing for undergraduate medical entrance examination in Kathmandu, Nepal

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