L’étude est centrée sur l’évaluation de la contribution de l’élevage de petits ruminants dans la réduction de la pauvreté et de la vulnérabilité des systèmes agricoles de trois zones agroécologiques en Egypte : la zone pastorale du littoral Nord- Ouest (région de Matrouh), les zones irriguées de la vallée du Nil (région de Sohag) et les oasis du désert Ouest (région de la Nouvelle Vallée). Une étude empirique sur 90 exploitations dans les trois zones agroécologiques portant sur différents indicateurs économiques et sociaux liés à la pauvreté a donné des indications sur le rôle des ovins et des caprins dans différents types d’exploitation, selon les dotations en ressources (en particulier terre, bétail, capital) et les ressources humaines. Les résultats ont montré que les petits ruminants constituaient la principale source de revenus des ménages pour échapper à la pauvreté, notamment pour les sans terre et les très petits propriétaires terriens. En outre, l’élevage était un capital qui générait d’autres richesses qui n’ont pas été prises en compte dans l’approche de la pauvreté monétaire.
Anticoagulant use, such as heparin, is usually contraindicated in acute stroke patients. We present a study of patients, who were treated with intravenous heparin after a stroke that were also found to have an intraluminal thrombus. Prior studies imply that recanalization is achieved with heparin; however heparin should only prevent thrombus propagation. Therefore it is unclear whether and how IV heparin can achieve recanalization of intraluminal thrombi in acute stroke patients. A retrospective review of all acute stroke patients from a single stroke center who received a therapeutic IV heparin infusion from 5/2006 to 9/2011 were included in the study. We compared patients who had complete/partial recanalization and/or improved flow versus those that did not, with both these groups on a standard intravenous heparin infusion protocol. Demographic data was compared between the groups. Average partial thromboplastin time (PTT) during heparin infusion, time between computed tomography angiographies (CTAs), time from stroke onset to receiving IV heparin, and vessel occluded were also compared between groups. Forty-one patients (19 female, 22 male) were included in the study with a total of 55 vessels (either carotid, middle cerebral artery, anterior cerebral artery, posterior cerebral artery/posterior circulation) having intraluminal thrombi; 31 patients had 41 vessels with either partial or complete recanalization of effected vessels, while 10 patients had 14 vessels that did not have at least one vessel recanalize while on heparin. Using t-test we noted that the average PTT between the vessels that had partial/complete recanalization group (61.74) and nonrecanalization group (66.30) was not statistical significantly different (P=0.37).The average time in days on heparin between vascular imaging studies (CTA/conventional angiogram) in the group of vessels with partial/complete recanalization (7.12 days) and the ones with no change (6.11 days) was not significantly different between the two groups (P=0.59). Patient’s vessels receiving heparin for <24 hours versus those >24 hours did not significantly differ either (P=0.17). This study compares patient characteristics associated with recanalization of intraluminal thrombi in acute stroke patients on heparin. Recanalization of intraluminal thrombi are not associated with average PTT or duration on heparin.
Early administration of tissue plasminogen activator (tPA) improves morbidity and mortality in acute ischemic stroke (AIS). However, the strict NINDS exclusion criteria, especially the emphasis on last known well times (LKWT) which are often unreliable in the acute setting, restrits tPA use to only 2-5% of all AIS patients. The MR-Witness and WAKE-UP trials propose using MRI diffusion-to-flair mismatch in these cases to better judge the age of an infarct, but the impact of this on post-discharge outcomes has not yet been reported. We conducted a retrospective analysis of all AIS patients in one comprehensive stroke center to further investigate this question. Of our total 1016 patients, 165 (16.2%) received tPA and 58 (5.7%) underwent mechanical thrombectomy. 380 patients (37.4%) were refused tPA due to an NINDS exclusion other than LKWT, 246 (24.2%) due to minimal or resolving neurological deficits, and 6 (0.6%) due to family preference. The remaining 161 patients (15.8%) were refused tPA only because of an unreliable LKWT. Statistical analyses comparing these 161 patients to the 165 who received tPA revealed no differences in age (p=0.306), gender (p=0.214), race, or even NIHSS score on presentation (p=0.306). However, while the total hospital stay was similar in both groups (p=0.954), patients who received tPA had significantly better post-discharge outcomes, with more patients going to acute rehab or home (p=0.033). In summary, comprehensive stroke centers generally out-perform national tPA administration averages (16.2% in our stroke center compared to 2-5% nationally). However, our study showed that a large percentage of AIS patients are still refused tPA only because of an unreliable LKWT. Obtaining emergent MRIs to assess diffusion-to-flair mismatch in these cases may increase the number of people with AIS eligible for tPA and substantially improve their post-discharge outcomes.
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