ABSTRACT
Background:
Stroke is the major cause of morbidity and mortality worldwide. The number of stroke patients receiving recombinant tissue plasminogen activator (rt-PA), also known as Alteplase, ...in the developing world is extremely low. We aim to study the feasibility and efficacy of thrombolysis for the 1
st
time in our country.
Materials and Methods:
In this retrospective study (July 2012-August 2015), acute ischemic stroke patients who were thrombolyzed within 3 h of stroke onset were included. Their demographic profiles, clinical profiles, risk factors, type of thrombolytic used, and outcomes were systematically recorded and analyzed.
Results:
A total of 9 patients were thrombolyzed. The mean time from the onset of stroke symptoms to first dose of rt-PA (onset to treatment) was 1.2 h. Six patients had good neurological outcome as measured by modified Rankin Scale (mRS). The median mRS at discharge was 3. Thrombolysis-related post treatment complication was noted in 44.4%, of which nonfatal intracranial bleed occurred only in 2 patients (22.2%). None of the patients receiving intravenous tenecteplase had thrombolysis-related complications, and none of the patients had fatal intracranial bleed.
Conclusion:
This study clearly demonstrates the beginning of a feasible and effective thrombolysis in the treatment of acute ischemic stroke in Nepal.
Chorea-acanthocytosis: a case report Thapa, Lekhjung; Bhattarai, Suman; Shrestha, Milan P ...
International medical case reports journal,
01/2016, Volume:
9, Issue:
Issue 1
Journal Article
Peer reviewed
Open access
Neuroacanthocytosis is a group of rare disorders. We report a 36-year-old right-handed female who presented with gradually progressive abnormal facial movements, generalized weakness, and lower-lip ...biting starting 4 years ago. On examination, she had lower-lip ulcer, orofacial dyskinesias, and peripheral neuropathy. Her peripheral blood smears showed acanthocytosis and magnetic resonance imaging revealed atrophied head of caudate nuclei and putaminal hyperintensities on T2-weighted and fluid attenuated inversion recovery images. Work-up for autoimmune and metabolic causes was negative. She was diagnosed with chorea-acanthocytosis, an entity under neuroacanthocytosis syndrome and the patient was offered symptomatic treatment.
Phewa watershed, the second largest natural lake system in Nepal, is considered vital for the well being and economy at local, provincial and national level. Phewa watershed offers multiple benefits ...to the downstream dwellers involved in tourism, hotel, boating, fishing, irrigation, hydropower, etc. The constant degradation of watershed has become a serious challenge to sustain the watershed. Payment for Ecosystem Services (PES) can be an effective environmental management tool for sustaining ecological and economic benefits, especially in an urban watershed like Phewa. This study has assessed the opportunities for the potentialityof PES in Phewa watershed. It first identified and ranked the tradable ecosystem services along with service providers and beneficiaries using Likert scale. Then, 137 households were surveyed to evaluate their perceptions of payment for ecosystem services and sustainable management of Phewa Lake. The results identified tourism as the major ecosystem service in the watershed followed by biodiversity and sediment retention to control flooding and erosion. Protected and community forests users groups within the watershed area, landowners, and farmers were identified as upstream users or service providers whereas the business owners like boat agencies, hotels and restaurants, drinking water users, and Nepal electricity authority were identifiedas the service beneficiaries of the identified ecosystem service. The challenges associated with implementing PES scheme were the lack of financial resource, lack of institutional organization and marketing for ecosystem services, population growth, lack of coordination between stakeholders, and lack of public participation. Thus, this study showed that education-based activities should be organized to enhance participation of beneficiaries and upstream dwellers. Also, PES policy mechanism with clear guidelines should be formulated for assuring the participation of the community people forthe implementation of PES.
Cerebral venous sinus thrombosis in itself is rarely encountered clinical entity and its association with immune thrombocytopenic purpura (ITP) makes it more unusual presentation. No any as such ...standard guidelines exist that guides the prompt evidence based management in such concurrent cases but neuroendovascular modality can play a pivotal role.
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