Comparison Process of in-Patient Versus Out of Hospital Stroke Onset of Metricsina Community Primary Stroke Center | Chapter 10 | Medical Research and Its Applications Vol. 5

Objective: The present study examines in-hospital stroke onset metrics and outcomes, quality of care, and mortality compared with out-of-hospital stroke in a single community-based primary stroke center.

Background: In-hospital stroke vs OHS comparisons of demographic characteristics, hospital characteristics, immediate treatment with thrombolysis therapy, and mortality have been found to favor OHS cohorts in multiple studies.

Patients and Methods: We performed a retrospective analysis of all patients for whom an IHS stroke alert occurred during admission to our hospital between January 1, 2013, and December 31, 2019. Time-sensitive stroke process metric data were collected for each incident stroke alert. The primary focus of interest was the time-sensitive stroke quality metrics. The secondary focus pertained to thrombolysis treatment or complications, and mortality. Descriptive and univariable statistical analyses were applied. Kruskal-Wallis and c2 tests were used to compare median values and categorical data between prespecified groups. The statistical significance was set at p<.05.

Results: The out-of-hospital group reported a more favorable response to time-sensitive stroke process

metrics than the in-hospital group, as measured by median stroke team response time (15.0 vs 26.0 minutes; P≤.0001) and median head computed tomography scan completion time (12.0 vs 41.0 minutes; p<.0001). There was no difference in the stroke alert time between the 2 groups (14.0 vs 8.0 minutes; p .99). Longer hospital length of stay (4 vs 3 days; p.0001) and increased hospital mortality (19.3% vs 7.4%; p.001) were observed for the in-hospital group. The association between time-sensitive stroke process metrics and outcomes, such as hospital mortality and hospital length of stay, in the IHS cohort may be co-founded by higher baseline comorbidities, a higher risk of hospital complications, lower eligibility, and a higher number of contraindications for intravenous thrombolysis therapy and thrombectomy in the IHS cohort.

Conclusions: It is revealed that the out-of-hospital groups' time-sensitive stroke process metrics and stroke outcome measures outperformed the in-hospital groups'. Enhancing time-sensitive stroke process indicators could lead to better outcomes for the stroke cohort receiving care in hospitals.

 

Author(s)details:-

 

Felix E Chukwudelunzu
Department of Neurology, Mayo Clinic Health System, Eau Claire, Wisconsin, USA.

 

Bart Demaerschalk
Department of Neurology, Mayo Clinic College of Medicine and Sciences, Phoenix, Arizona, USA.

Leonardo, Fugoso
Department of Neurology, Mayo Clinic Health System, Eau Claire, Wisconsin, USA.

 

Emeka, Amadi
Department of Medicine, Section Hospital Medicine, Mayo Clinic Health System, Eau Claire, Wisconsin, USA.

 

Donn, Dexter
Department of Neurology, Mayo Clinic Health System, Eau Claire, Wisconsin, USA.

 

Angela, Gullicksrud
Department of Neurology, Mayo Clinic Health System, Eau Claire, Wisconsin, USA.

 

Clinton, Hagen
Program of Hypoplastic Left Heart Syndrome, Mayo Clinic Rochester, Rochester, Minnesota. USA.

 

Please See the book here :- https://doi.org/10.9734/bpi/mria/v5/12660F

A Retrospective Study on Mesenteric Venous Thrombosis in a Referral Hospital in East Africa | Chapter 8 | New Frontiers in Medicine and Medical Research Vol. 15

Introduction: The superior mesenteric vein is the most prevalent location of thrombosis development in acute mesenteric venous thrombosis, which is a rare disorder. The Virchow trinity of endothelial damage, stasis, and hypercoagulability is usually disrupted in patients who are prone to this illness. The acute variant is characterised by intestinal ischaemia, making it difficult to diagnose before intestine gangrene occurs. A delayed diagnosis due to poor investigative ability results in patients suffering from acute renal failure and a high mortality rate, according to the limited experience with this ailment in the East African region. As a result, the goal of this research was to describe the presentation and treatment of four patients with mesenteric venous thrombosis in an East African referral hospital, followed by a review of the aetiology, clinical characteristics, and management of this illness.

Methods: Over the course of 18 months, a descriptive retrospective review of four patients was performed. From the patients' clinical files, demographic and clinical data were collected, and manual analysis was performed using a spreadsheet.

Four cases were identified over the course of 18 months. Acute symptoms persisted for 5 to 21 days in all patients, indicating a delay in diagnosis. Short bowel syndrome and severe renal failure killed two patients within 30 days of surgery. Two patients survived short bowel syndrome complications and one patient survived severe renal injury that necessitated dialysis.

This brief case series is characterised by a delay in the diagnosis of acute MVT. As a result, all of the cases had gangrenous bowel, which contributed to the high fatality rate. Anticoagulation prevents the spread of a clot in the veins, which is linked to a lower risk of death and recurrence. To avoid bowel with dubious viability, thrombolysis and thrombectomy might be considered in some cases. The mortality rate from MVT has reduced over the last four decades, and it now stands at 10-20%, however there isn't enough data in East Africa to make this determination.

Author (S) Details

Richard Wismayer

Department of Surgery, Masaka Regional Referral Hospital, Masaka, Uganda and Department of Surgery, Habib Medical School, IUIU University, Kampala, Uganda.

View Book :- https://stm.bookpi.org/NFMMR-V15/article/view/3868