acute stroke

In this review After Observing biomedical literature (starting from some heart disease) results that some pathological phenomena are deeply involved in some metabolic endocrine condition: Kinetics and gradients in metabolism, catabolism, time related, toxic like effect, electrical cell membrane status, smooth vascular muscle cell hyper-reactivity, platelet iperactivations, central autonomic control after acute stroke, great electrolytes unbalances et other factors as pro-hypertrophic signaling and oxidative stress. Observing actual current therapy in some metabolic endocrine therapy often is used association of drugs (in example in type II diabetes). In Many other pathologies efficacy drug therapy exist, and often only 1 pharmacological molecule resolve the pathological condition. But in many disease even associating 2-3-4 drugs the % of cure not increase (efficacy, effectiveness). It mean that this drugs strategies are not the really best? Or it mean a low active level? Why for this pathological condition this association drugs in currently use not do the right works as really needed? There is the need for new really efficacy drugs strategy that show a profile of efficacy as requested in order to resolve the pathological condition? Or to be added to the actual therapy? The actual pharmacological strategies in some metabolic endocrine disorder is really the best? Or other strategies can be introduced?

Background: Respiratory muscle strength can be reduced in patients diagnosed with stroke, which reasonably justifies the use of respiratory muscle training in this population. This study determines the comparative efficacy of inspiratory, expiratory, and combined respiratory muscle training on the pulmonary functions and chest expansion in acute stroke survivors. Method: Forty-five acute stroke survivors (15 in each group) completed all protocols of the study. Participants were randomly assigned to any one of three groups. In addition to the conventional exercise therapy, participants received any one of the three respiratory muscle training protocols (inspiratory muscle training, expiratory muscle training or combined respiratory muscle training). Chest expansion was assessed using tape measure and pulmonary function parameters were assessed using a spirometer. Results: Paired t-test analysis showed significant improvements in the chest expansion and the pulmonary function parameters following training in each group. One-way ANOVA showed significant improvements in the pulmonary function parameters across the three groups but not in the chest expansion with p - value = 0.405. Least significant difference (LSD), post-hoc analysis shows that the significant difference for FEV1, FVC and FEV1/FVC lies between inspiratory muscle training group and expiratory muscle training group. Conclusion: When the three training methods were compared, it was found that expiratory muscle training was the most beneficial in improving the pulmonary functions and chest expansion in acute stroke survivors.

Background and Objective: Thrombolytic and mechanical thrombectomy therapies are proven treatment methods in patients with acute stroke. Aim is to share our experience in acute stroke therapy with colleagues. Material and methods: In this study we evaluated the patients who underwent MT or MT + IV-tPA between 2018-2019 retrospectively. Demographic features, comorbid diseases of patients, symptom onset-to-gate and symptom gate-to-puncture durations, mRS (Modified Rankin Score) and NIHSS (National Institutes of Health Stroke Scale) score, treatment method and degree of recanalization were listed. Results: MT was applied to 29 patients, MT + bolus IV-tPA was applied to 12 patients and MT + full dose IV-tPA was applied to 7 patients. The mean age was 66 ± 15 years, arrival mRS was 2 ± 2, arrival NIHSS score was 14 ± 5, onset-to-gate duration was 185 minutes and gate-to-puncture duration was 118 minutes. Conclusion: The rate of recanalization, functional independence and mortality were similar to the HERMES study. It was observed a higher rate of intracranial hemorrhage in patients who received bolus or full dose IV-Tpa compared to patients who underwent MT. These results have led us to question the necessity of giving bolus or full dose IV-tPA before MT. Onset-to-gate and gate-to-puncture durations were found longer than the recommended durations. Rapid and effective management of AIS patients will provide good clinical results.

Background: The concurrent occurrence of acute ischemic stroke and acute myocardial infarction is an extremely rare emergency condition that can be lethal. The causes, prognosis and optimal treatment in these cases are still unclear.Methods: We conducted the literature review and 2 additional cases at Al-Shifa Hospital, we analyzed clinical presentations, risk factors, type of myocardial infarction, site of stroke, modified ranking scale and treatment options. We compare the mortality rate among patients with combination intervention treatment (both percutaneous coronary intervention for coronary arteries and mechanical thrombectomy for cerebral vessels) and medical treatment at the hospital and 90 days after stroke. Results: In addition to our cases, we identified 94 cases of concurrent cardio-cerebral infarction from case reports and series with a mean age of 62.5 ± 12.6 years. Female 36 patients (38.3%), male 58 patients (61.7%). Only 21 (22.3%) were treated with combination intervention treatment.The mortality rate at hospital discharge was (33.3%) and the mortality rate at 90 days was (49.2%). In patients with the combination intervention treatment group: the hospital mortality rate was 13.3% and the 90-day mortality rate was: 23.5% compared with the mortality rate in medical treatment (23.5% at the hospital and 59.5% at 90 days (p value 0.038 and 0.012 respectively) Conclusion: Concurrent cardio-cerebral infarction prognosis is very poor, about a third of patients died before discharge and half of the patients died 90 days after stroke. Despite only one-quarter of patients being treated by combination intervention treatment, this treatment modality significantly reduces the mortality rate compared to medical treatment.

Stress in acute stroke may increase mortality and complications, but there is a paucity of information on the efficacy of beta blockers  over other anti-hypertensive. To report efficacy of metoprolol over amlodipine in reducing mortality, disability and infections in acute stroke. CT/MRI confirmed stroke patients within 3 days of onset were included whose age was 18 to 75 years. Patients with secondary intracerebral hemorrhage, organ failure, pregnancy, malignancy, and immunosuppressant or on beta-blocker/amlodipine were excluded. Stroke risk factors, Glasgow Coma Scale (GCS) score, National Institute of Health Stroke Scale (NIHSS) score and CT/MRI findings were noted. Patients with a blood pressure of > 160/90 mm of Hg were randomized using 1:1 randomization to metoprolol (25 mg on day 1, 50 mg if BP is not controlled) or amlodipine (2.5 mg on day 1, then 5 mg then 10 mg on, subsequent days if BP is not controlled). Other standard treatment was continued. The primary outcome was mortality at 1 month; secondary outcomes included  were in-hospital gastrointestinal hemorrhage, pneumonia, sepsis and 3 months functional outcome based on modified Rankin Scale (mRS). Side effects were noted. 18 (14.4%) patients died; 6 (9.7%) in metoprolol and 12 (19%) in amlodipine (p = 0.20) group. At 3-months, 66 patients had good outcome; 45 (80.4%) in metoprolol and 21 (43.3%) in amlodipine group (p < 0.001). The other secondary outcomes were comparable between the two groups. Metoprolol was withdrawn in 6 patients due to bradycardia, and amlodipine in 5 due to hypotension and in 1 due to allergic reaction. Metoprolol is associated with improved functional outcomes in acute stroke  compared to amlodipine.