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Article
Stroke Related Pneumonia Incidence and Possible Risk Factors

Authors: Ahmad M. Jaffer --- Kassim M. Sultan --- Akram Al-Mahdawi
Journal: Iraqi Academic Scientific Journal المجلة العراقية للاختصاصات الطبية ISSN: 16088360 Year: 2012 Volume: 11 Issue: 3 Pages: 376-381
Publisher: The Iraqi Borad for Medical Specialization المجلس العراقي للاختصاصات الطبية

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Abstract

ABSTRACT:BACKGROUND:The stroke patient is at risk of developing hospital acquired infection, with the lungs being especially vulnerable. Stroke associated pneumonia (SAP) occurring after two days of admission and is the most nosocomial infection seen in the medical wards , pneumonia is the major cause of morbidity and mortality after stroke .The establishment of an accurate diagnosis of stroke associated pneumonia remains problematic and yet there is still no accepted "gold standard" for diagnosis.OBJECTIVE:To determine the incidence and risk factors of stroke associated pneumonia.METHODS:This is prospective cohort study for 82 stroke patients admitted to medical wards .The study conduct from the 1st July 2009 to the 10th January 2010. Initially stroke diagnosed clinically and by CT scan. Theses cases are assessed after 48 hours after admission, full history, physical examination and investigations were done using clinical criteria (body temperature, WBC count and chest radiography ) for diagnosis of pneumonia.RESULTS:11(13.4%) patients developed stroke associated pneumonia from 82 stroke patients admitted to medical wards. Most patients who were developed pneumonia were older than patients who did not developed pneumonia . The incidence is higher in patient with infarction and older age groups than patients with hemorrhagic stroke and younger age groups, and there is no association between the disease and gender .The incidence of late onset is more common than early onset pneumonia. Presence of dysphagia was present in (81.8%) nasogastric tube in (72.7% ),unconsciousness(54.5%),tobacco ,vomiting (36.6%) and fit (27.2%) were found as an important risk factors .The mortality more in hemorrhagic(75%) than thrombotic stroke (14.3%).CONCLUSION:stroke associated pneumonia is an important cause of mortality. It is associated with older age, dysphagia , NG intubation ,coma ,vomiting and fit .Simple assessment of these variables could be used to identify patients at high risk of developing pneumonia after stroke.

Keywords

Pneumonia --- stroke --- risk factors


Article
Pregnancy with Stroke

Author: Abathar Qahtan
Journal: Iraqi Academic Scientific Journal المجلة العراقية للاختصاصات الطبية ISSN: 16088360 Year: 2012 Volume: 11 Issue: 4 Pages: 490-495
Publisher: The Iraqi Borad for Medical Specialization المجلس العراقي للاختصاصات الطبية

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Abstract

ABSTRACT:BACKGROUND:Although stroke in pregnancy is uncommon, the risk of stroke is increased during pregnancy and puerperium, and considered a major contributor to the serious morbidity and mortality of pregnancyOBJECTIVE:This study had been designed to find the frequency of stroke in relation to different periods of pregnancy and puerperium, to assess the effect of variable risk factors and their association with stroke and to verify which type of stroke is more frequent among pregnant ladiesMETHODS :This is a cross sectional study that enrolled 30 pregnant patients who had stroke either during pregnancy or puerperium and being admitted to the Neurology words of Al-Yarmouk, Baghdad and Al-kadhemia teaching hospitals during the period from the 1st of January, 2001, to the 31st of December, 2002. All of the patients, who had been included in this study, had been subjected to detailed history, physical and neurological examinations and investigations.RESULTS:19 patients (63.3%) of the sample included in this study acquired stroke during pregnancy while 11 patients (36.3%) had developed stroke during puerperium. 2/3rd of the sample had ischemic stroke. Impaired consciousness was the commonest presenting symptom with a frequency of 50% of the sample, cerebellar signs were the least observed signs, in the other hand; all of the patient included in this study had motor dysfunction during the disease course. 53.3% of the sample was hypertensive 6.7 % was diabetic, while 36.7% of them had no significant past medical history. Oral contraceptive pills had been used by 50% of the sample, 2/3rd of those using oral contraceptive pills had ischemic stroke. 63.3% of the sample had cesarean delivery, 50% of the sample had history of abortion, 60% of whom had positive history of recurrent abortion.CONCLUSION:This study revealed that most of stroke happened during the 3rd trimester and early weeks of puerperium. Being hypertensive, whether pregnant related or not, is the most important risk factor, in addition, other recognized risk factors included diabetes mellitus and use of oral contraceptive pills.

Keywords

stroke --- pregnancy --- puerperium.


Article
STROKE IN IRAQI CHILDREN: EXPERIENCE OF CHILDREN WELFARE TEACHING HOSPITAL

Authors: Nebal W Saadi نيبال وائل سعدي --- Batool A Gh Yassin بتول علي غالب ياسين
Journal: IRAQI JOURNAL OF MEDICAL SCIENCES المجلة العراقية للعلوم الطبية ISSN: P16816579,E22244719 Year: 2012 Volume: 10 Issue: 3 Pages: 265-272
Publisher: Al-Nahrain University جامعة النهرين

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Abstract

Background:Stroke in childhood is serious disorder about which little is published.Objective:To determine demographic and presenting features of children with stroke.Methods:A cross sectional study was conducted on cases of pediatric stroke admitted to Children Welfare Teaching Hospital during May 2008-August 2011. Cases classified radiologically into ischemic and hemorrhagic types. Basic data and clinical presentation were gathered.Results:Sixty nine children (49 boys, 20 girls), aged 1 month-14 years were enrolled. Annual hospital admission rate was 54.2 /100000; boys:girls ratio was 2.5:1, girls were younger than boys. Ischemic stroke was found in 58% of cases. Patients with hemorrhagic stroke were younger than those with ischemic type. Those aged <1year account for 55.1% (82.8% of patients with hemorrhagic stroke) while half of those with ischemic type aged 1-5 years. The commonest presentation in both types was seizure, mostly among infants. About 2/3 of patients were from Baghdad.Conclusion:Stroke in children is more common among boys. Ischemic type is commoner than hemorrhagic. Those with hemorrhagic stroke tend to be younger than ischemic. The majority of children with hemorrhagic type present at age younger than one year. Seizure was the most common presentation in both types.Key words:Stroke; Iraqi children; Ischemic; Hemorrhagic

Keywords

Stroke --- Iraqi children --- Ischemic --- Hemorrhagic


Article
The incidence of stress hyperglycemia in acute ischemic stroke patients (in Al-Yarmouk teaching hospital)

Authors: Abdul- Hameed Al-Kassir --- Zaid Tarik زيد طارق
Journal: Mustansiriya Medical Journal مجلة المستنصرية الطبية ISSN: 20701128 22274081 Year: 2012 Volume: 11 Issue: 1 Pages: 46-51
Publisher: Al-Mustansyriah University الجامعة المستنصرية

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Abstract

Aims: Stress hyperglycemia represents a transient increase in blood glucose in reaction to acute illness. Cases with stress hyperglycemia have higher mortality rates and worse functional outcomes than the ones with known diabetes or normoglycemia. This study evaluated the incidence of stress hyperglycemia in acute ischemic stroke patients and its relationship with stroke risk factors. Patients and Methods: WHO criteria is used to confirm hyperglycemia and HbA1c test to detect stress hyperglycemia in a sample of 220 patients with acute ischemic stroke who were admitted to Al-Yarmouk teaching hospital in Baghdad from 1 April to 31 December 2010. Results: thirty nine patients with acute ischemic stroke had stress hyperglycemia. There is significant effect of gender, hypertension, atrial fibrillation and dyslipidemia on patients with stress hyperglycemia while this is not found with obesity and smoking.Conclusions: stress hyperglycemia is a common phenomenon in patients who develop acute ischemic stroke.


Article
OBSERVING THE OUTCOME OF USING NEUROAID [MLC 601] ON A SAMPLE OF IRAQI STROKE PATIENTS

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Abstract

Background:Stroke is one of the major causes of morbidity and mortality throughout the world, and carries greater economic costs. [MLC 601] originates from Traditional Chinese Medicine approved in 7 countries as drug that can aids post-stroke recovery.Objective:To assess [MLC 601] efficacy in improving outcomes of Iraqi patients’ stroke.Methods:Two hundreds ischemic stroke patients and 17 intracerebral hemorrhage patients were participated in this study; they took [MLC601] at the onset of their disease for 3 months and were assessed monthly for the motor power using modified Rankin scale mRs scale, speech, and visual field assessments.Results:mRs grade [4-5] were changed from (zero out of 159) at onset to (89 out of 55) at first month and to 98 out of 134 ischemic stroke patients after 3 months; also mRs grade [4-5] were changed from (1 out of 17) at onset to (12 out of 17) at first month and to 12 out of 17 intracerebral hemorrhage patients after 3 months. In 44% of the enrolled patients with aphasia were improved. Visual field assessments showed improvement in 43% of the patients with homonymous heminopia after 3 months [MLC 601] treatment.Conclusion:[MLC 601] is associated with improvement in all post stroke disabilities and placebo controlled trial is crucial to assess the benefit of it.Key worlds:Stroke, intracerebral hemorrhage, MLC 601, NeuroAid


Article
SIGNIFICANCE OF PLATELET INDICES IN PATIENTS WITH ACUTE ISCHEMIC STROKE

Authors: Waseem F Al-Tameemi وسيم فاضل محمد التميمي --- Ameer MM Ameen امير محمد امين
Journal: IRAQI JOURNAL OF MEDICAL SCIENCES المجلة العراقية للعلوم الطبية ISSN: P16816579,E22244719 Year: 2012 Volume: 10 Issue: 4 Pages: 383-389
Publisher: Al-Nahrain University جامعة النهرين

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Abstract

Background :Platelets play an important role in the development of intravascular thrombosis. Platelet size has been considered to reflect platelet activity. Platelet indices had been studied as an independent predictor of acute ischemic stroke (IS).Objectives:Assessing the relation of acute IS with different platelet indices.Methods:Fifty patients were enrolled: 25 of them had first acute IS (mean age 64 years, 12 (48%) were males) [group 1], while the rest 25 patients were those with more than one IS (mean age 68 years, 16 (64%) were males) [group 2] in comparison with the control group (20) subjects (mean age 57 years, 10 (50%) males). Work up included history and clinical examination in addition to brain CT scan and platelet indices which are: mean platelet count (MPC), mean platelet volume (MPV), platelet large cell ratio (P-LCR), and platelet distribution width (PDW) within first 24 hours of patient presentation.Results:The mean platelet count (MPC) was found to show significant difference between group 2 versus group 1 and control (P=0.012, P=0.023 respectively), while no statistically significant differences were reported with the other indices (MPV, PDW or P-LCR). Linear negative correlation was demonstrated between MPC and MPV, PDW and P-LCR in group 1, such correlation wasn't found in group 2.Conclusion:Mean platelet count (MPC) differs significantly in cases of multiple stokes in comparison with those having first stroke or the control group; therefore, the significance of this finding needs further studies.Keywords:Platelet indices, platelet count, mean platelet volume, platelet distribution width, platelet-large cell ratio, ischemic stroke.

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