Background and Purpose-Some patients with mild or improving ischemic stroke symptoms do not receive intravenous tissue plasminogen activator (tPA) because they look "too good to treat" (TGT); however, some have poor outcomes. Methods-We retrospectively analyzed data from a prospective single-center study between 2002 and 2004. TGT patients were those arriving within 3 hours of symptom onset and not treated with intravenous tPA solely because of mild or improving symptoms. Results-Of 128 patients presenting within 3 hours, 41 (34%) were not given tPA because of mild or improving stroke.Of the TGT patients, 11 of 41 (27%) died or were not discharged home because of neurological worsening (nϭ6) or persistent "mild" neurological deficit (nϭ5). No single variable at presentation was associated with death or lack of home discharge. There were 10 of 41 TGT patients (24%) who had Ն4-point improvement in National Institutes of Health Stroke Scale score before tPA decision; these patients were more likely to have subsequent neurological worsening (relative risk, 4.1, 95% CI, 1.1 to 15.4; Pϭ0.05). Conclusion-A substantial minority of patients deemed too good for intravenous tPA were unable to be discharged home.A re-evaluation of the stroke severity criteria for tPA eligibility may be indicated.

Advance notification of patient arrival by EMS shortened time to CT and was associated with a modest increase in the use of thrombolysis at our hospital. This occurred even with protocols in place to shorten the time to CT for all acute stroke patients. Further research is needed to understand how to increase rates of advance notification by EMS in potential tPA candidates.

Background: Symptomatic intracerebral hemorrhage (sICH) is the most devastating complication of thrombolytic therapy for acute stroke. It is not clear whether patients with sICH continue to bleed after diagnosis, nor has the most appropriate treatment been determined.Methods: We performed a retrospective analysis of our prospectively collected Get With the Guidelines-Stroke database between April 1, 2003, and December 31, 2007. Radiologic images and all procoagulant agents used were reviewed. Multivariable logistic regression was performed to identify factors associated with in-hospital mortality.Results: Of 2362 patients with acute ischemic stroke during the study period, sICH occurred in 19 of the 311 patients (6.1%) who received intravenous tissue plasminogen activator and 2 of the 72 (2.8%) who received intra-arterial thrombolysis. In-hospital mortality was significantly higher in patients with sICH than in those without (15 of 20 [75.0]% vs 56 of 332 [16.9%], PϽ .001). Eleven of 20 patients (55.0%) received therapy for co-

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In January 2005, the Massachusetts Department of Public Health announced the designation of approved hospitals as Primary Stroke Services (PSS), based on verifiable demonstration of care pathways for acute ischemic stroke. We investigated the effect of hospital characteristics on participation in the PSS program.In 2003, the Massachusetts Department of Public Health surveyed 72 Massachusetts hospitals on their readiness for PSS designation. Survey results and PSS participation rates were compared among hospitals categorized by bed size (<150 vs. > or =150 beds), rural location, and major teaching hospital status. In answer to 2003 survey questions, smaller hospitals (n = 35) were less likely than larger hospitals to have acute stroke teams (P = 0.01), 24-hour rapid computed tomography scanning and interpretation (P = 0.0006), 24-hour neurosurgery coverage (P = 0.001), and a stroke registry (P = 0.007). Smaller hospitals were less likely to be interested in PSS application in 2003 (P = 0.008), and less likely to be designated PSS when ambulance rerouting to PSS hospitals began in July 2005 (P < 0.0001). Despite this, by December 2005 the majority of Massachusetts hospitals (66/71, 92%) had achieved PSS designation. Smaller hospitals were more likely to use telemedicine to access acute stroke teams (P = 0.003).Many smaller hospitals are able to acquire the resources needed for provision of acute stroke care, despite initial limitations. Innovative strategies, such as telemedicine consultation and transfer agreements, may successfully allow smaller hospitals to satisfy Brain Attack Coalition criteria for primary stroke centers.

SummaryJapanese encephalitis virus (JEV) is an important encephalitis virus in Asia, but there are few data on Malaysia. A hospital-based surveillance system for Japanese encephalitis (JE) has been in operation in Sarawak, Malaysia, for the last 10 years. JEV is endemic in Sarawak, with cases occurring throughout the year and a seasonal peak in the last quarter (one-way anova, P < 0.0001). Ninety-two per cent of 133 cases were children aged 12 years or younger; the introduction of JE vaccination in July 2001 reduced the number of JE cases (84 in the four seasons prior to vs. 49 in the six seasons after, McNemar's test, P = 0.0001). After implementation of the programme, the mean age of infected children increased from 6.3 to 8.0 years (Student's t-test, P = 0.0037), suggesting the need for a catch-up programme. (Fang et al. 1980) and Penang in 1988(Cardosa et al. 1995. A series of studies from the 1960s documented JEV isolation from mosquitoes in Sarawak and showed that pigs play an important role as amplifying hosts (Bendell 1970;Simpson et al. , 1974Simpson et al. , 1976Bowen et al. 1975). Seroconversion to JEV in pigs suggested that transmission occurs throughout the year with infection rates higher in the period from November to January coinciding with the major seasonal population increase of Culex tritaeniorynchus (Simpson et al. 1976).In 1997, a pilot hospital-based surveillance study for JE was set up in Sibu Hospital in Sarawak, followed in 1998 by passive surveillance for all other hospitals in the state. Patients were suspected to have Japanese encephalitis if they had fever (or a history of fever), and at least one of the following: reduced level of consciousness (lethargy, drowsiness or coma); severe headache; neck stiffness; tense anterior fontanelle; focal neurological signs and prolonged seizures.Paired sera and paired CSF for each patient were considered to be the ideal specimen set. However, in reality the complete specimen set was not obtained from many cases. Specimens were tested for JEV specific IgM by MAC ELISA (Venture Technologies Sdn Bhd, Malaysia), which distinguishes IgM elicited by JEV from that elicited by dengue viruses (Solomon et al. 1998;Cardosa et al. 2002). The sensitivity, specificity, positive predictive value and negative predictive value of the test used were 83%, 99%, 0.98 and 0.92, respectively for CSF and 91%, 95%, 0.92 and 0.94, respectively for serum. All cases of encephalitis with specific IgM to JEV in serum and ⁄ or CSF were considered to have been infected recently with JEV. It should be noted that patients with single IgM-negative sera or CSF cannot be considered conclusively negative because an IgM seroconversion can occur in a second specimen. With only single specimens, we lose this information. Here we report data obtained over a 10-year period from 1997 to 2006. Four seasons into the study period, in July 2001 the Sarawak Health Department implemented a JE vaccination programme. JE vaccine (Biken, Japan) was included in the Expanded Programme of Immunizati...

Many patients hospitalized with ischemic stroke/TIA, including those with known dyslipidemia and those taking lipid lowering agents, have measured low-density lipoprotein (LDL) that is higher than recommended by national guidelines. Patients at the greatest risk of cardiovascular events are the least likely to be at guideline-recommended LDL levels.

هدف البحث الى توظيف استراتيجية الصف المعكوس في تخفيف العبء المعرفي عند طلاب الصف الثالث المتوسط المسائي في حل المسائل الفيزيائية ، وتكونت عينته من (72) طالباً من طلاب الصف الثالث المتوسط للدراسة المسائية تم اختيارهم قصدياً من ثانوية تلكيف المسائية للبنين للعام الدراسي (2019 – 2020) ثم وزعوا بالأسلوب العشوائي البسيط الى مجموعتين متكافئتين بالعدد وفي بعض المتغيرات الاولى تجريبية تدرب افرادها على حل المسألة الفيزيائية باستراتيجية الصف المعكوس في حين تدرب افراد المجموعة الضابطة على المسائل نفسها بالطريقة الاعتيادية ، ولتحقيق هدف البحث اعد الباحثان اختباراً معرفياً لقياس قدرة افراد عينة البحث على حل المسائل الفيزيائية وتكون من ( 5 ) فقرات مقاليه محددة الاجابة واتسم بالصدق والثبات والخصائص السايكومترية . بعد ذلك طبق الباحث الثاني ( كونه مدرس في هذه الثانوية ) تجربة البحث بنفسه مع المجموعتين التجريبية والضابطة في بداية الفصل الدراســــــي الاول اعتبـــــاراً من ( 20 /10 /2019 ) واستمرت الـــى ( 26 / 12 / 2019 ) ، وفي نهاية التجربة طبق الباحثان الاختبار ثم حللا البيانات احصائياً باستخدام الاختبار الزائي للنسب لعينتين مستقلتين ودلت النتيجة الى :        "وجود فرق ذو دلالة احصائية عند مستوى (0.05) بين نسبتي تخفيف العبء المعرفي لحل المسائل الفيزيائية لدى افراد المجموعتين التجريبية والضابطة ولصالح التجريبية".         وفي ضوء هذه النتيجة خرج الباحثان بعدد من الاستنتاجات منها امكانية توظيف الصف المعكوس في تخفيف عبء حل المسائل الفيزيائية عن طلاب الدراسة المسائية ، وكما اوصيا مدرسي الفيزياء بتوظيف هذه الاستراتيجية في تدريس مادة الفيزياء فضلا عن اقتراح عناويين لبحوث مستقبلية.