At present, the only specific medical treatment for acute ischaemic stroke is intravenous administration of recombinant tissue plasminogen activator within 4.5 hours of stroke onset. In the last year, two scores for risk stratification of intracranial haemorrhage have been derived from multicentric European trial groups, the Safe Implementation of Treatment in Stroke – Symptomatic IntraCerebral Haemorrhage risk score (SITS-SICH) and the SEDAN score. The aim of this study was to pilot their use in a cohort of patients treated at a South African tertiary hospital.Prospectively collected data were used from a cohort of 41 patients who underwent thrombolysis at Groote Schuur Hospital from 2000 to 2012. Computerised tomography brain imaging was available for review in 23 of these cases. The SITS-SICH and SEDAN scores were then applied and risk prediction was compared with outcomes.Two patients suffered symptomatic intracranial haemorrhage (SICH), representing 4.9% (95% CI: 0–11.5%) of the cohort. This was comparable to the SICH rate in both the SITS-SICH (5.1%) and SEDAN (6.5%) cohorts. Patient scores in the Groote Schuur Hospital cohort appeared similar to those of the validation cohorts of both SITS-SICH and SEDAN.With increasing use of thrombolysis in a resource-constrained setting, these scores represent a potentially useful tool in patient selection of those most likely to benefit from intravenous thrombolysis, reducing risk for SICH and with the added benefit of curtailing cost.
-From bench to bedside: Seeing the future of ischaemic post-conditioning as a novel cardioprotective therapy for reperfusion injury, (9) causing swelling and rupture of the mitochondria, release of calcium and uncoupling of energy production leading to further damage and ultimately cell death. (9)(10)(11) There is a clear need for effective and novel therapeutic strategies to protect the heart against reperfusion injury. In this regard, the recent experimental discovery of ischaemic post-conditioning (12) represents a promising therapy for cardioprotection in patients with acute myocardial infarction (AMI). The discovery of posT-condiTioning Therapy in animal modelsIn 1986, Murray et al introduced the concept of ischaemic preconditioning, whereby brief episodes of a sub-lethal ischaemic insult offer significant protection from a subsequent lethal ischaemic insult. (13) This powerful protective mechanism reduces infarct size,
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