; for the Cleveland Pre-Hospital Acute Stroke Treatment (PHAST) Group IMPORTANCE Mobile stroke treatment units (MSTUs) with on-site treatment teams that include a vascular neurologist can provide thrombolysis in the prehospital setting faster than treatment in the hospital. These units can be made more resource efficient if the need for an on-site neurologist can be eliminated by relying solely on telemedicine for physician presence. OBJECTIVE To test whether telemedicine is reliable and remote physician presence is adequate for acute stroke treatment using an MSTU.
Abstract. We conducted a prospective cohort study of 496 adults starting antiretroviral treatment (ART) to determine the impact of neuropsychiatric symptoms and socioeconomic status on adherence and mortality. Almost 60% had good adherence based upon pharmacy records. Poor adherence was associated with being divorced, poorer, food insecure, and less educated. Longer travel time to clinic, concealing one's human immunodeficiency virus (HIV) status, and experiencing side effects predicted poor adherence. Over a third of the patients had cognitive impairment and poorer cognitive function was also associated with poor adherence. During follow-up (mean 275 days), 20% died-usually within 90 days of starting ART. Neuropsychiatric symptoms, advanced HIV, peripheral neuropathy symptoms, food insecurity, and poverty were associated with death. Neuropsychiatric symptoms, advanced HIV, and poverty remained significant independent predictors of death in a multivariate model adjusting for other significant factors. Social, economic, cognitive, and psychiatric problems impact adherence and survival for people receiving ART in rural Zambia.
We conducted a retrospective chart review of antiretroviral therapy (ART) clinic patients treated during the first 12 months after clinics opened in rural Zambia and assessed adherence based on clinic attendance, patient report, and staff assessment. We identified 255 eligible patients (mean age, 39.7 years; 44.3% male; 56.5% married; and 45.5% with only primary school education). Twenty percent had partners known to be HIV positive. Twenty percent were widowed. Thirty-seven percent had disclosed their HIV status to their spouse. Disclosure was less likely among women (27.5% versus 49.6%, P = 0.0005); 36.5% had "clinic buddies" to provide adherence support. Adherence rates were good for 59.2%. Disclosure of HIV status to ones' spouse (P = 0.047), knowing spouses' HIV status (P = 0.02), and having a clinic buddy (P = 0.01) were associated with good adherence. Social support is a key patient-level resource impacting ART adherence in rural Zambia. Limited spousal disclosure affects women more than men. Clinic buddies are associated with better adherence.
Compared with the traditional ambulance model, telemedicine-enabled ambulance-based thrombolysis resulted in significantly decreased time to imaging and treatment.
Our initial experience shows that MSTU may help in early triage and shorten the time to IAT for AIS.
Intensive lowering of SBP <140 mm Hg in acute ICH, particularly allowing SBP <120 mm Hg, is associated with increased remote cerebral ischemic lesions and acute neurologic deterioration.
Background: Long-term outcomes following febrile seizures in African children are not well described, but malaria-associated seizures are a risk factor for epilepsy. Design/Methods: 107 consecutive children admitted with febrile seizures (FS group) were age-matched to concurrently admitted children with febrile illness and no seizure, or febrile illness only (FIO). Quarterly follow-up assessments determined interim seizures and developmental outcomes. Results: 214 children were enrolled and followed for mean 20.4 months (median 24, mode 27). The most common diagnosis was clinical malaria. During follow-up, children in the FS group were more likely to have recurrent febrile seizures (29.9 vs. 11.3%; RR1.27; CI 1.10-1.46), an unprovoked seizure (27.1 vs. 1.9%; RR 1.35; CI 1.20-1.52) and epilepsy (11.2 vs. 0.9; RR 1.16; CI 1.04-1.20). Risk factors for unprovoked seizures during follow-up included younger age at enrollment (25.5 v. 34.6 months, p=0.04) and developmental delay preceding the index illness (33.3 vs. 13.1%, p=0.009). Within the FS group, children with focal seizures at enrollment were more likely to experience unprovoked seizures (52.9 vs. 20%, p=0.007) and epilepsy (41.7 vs. 7.8%, p=0.03). Conclusions: Children admitted with febrile seizures in rural Zambia have a high risk of subsequent epilepsy. Further research is needed to determine if specific infectious etiologies (e.g. malaria) are associated with epilepsy development in such children. Where access to healthcare services are limited, febrile seizure admission may also be a marker for a preexisting propensity toward later epilepsy. Regardless, follow-up is warranted to facilitate early initiation of treatment if recurrent, unprovoked seizures occur.
A 37-year-old woman without significant medical history was seen at an outside facility with 7 days of headache and fluctuating right hemiparesis. She had a normal head computed tomography (CT). She was diagnosed with migraine, received analgesics, and was discharged. Her headache and hemiparesis had improved but did not completely resolve. Three days later, she presented to a second facility with the same symptoms of headache and right-sided weakness and more recent onset of nausea and vomiting. She was again treated for migraine but developed worsening hemiparesis and difficulty with secretions requiring intubation. Magnetic resonance imaging (MRI) and magnetic resonance angiography (MRA) revealed basilar artery occlusion (BAO) and left vertebral artery dissection. She underwent successful endovascular recanalization of the basilar artery but severe neurological deficits remained. Case TwoA 41-year-old was brought to the emergency department where she was poorly responsive but had a nonfocal neurological examination. Urine toxicology showed cocaine and marijuana. Head CT was limited by motion but was otherwise unremarkable. She was initially treated for presumed seizures, but her level of consciousness worsened and she was intubated. She was empirically treated for meningitis/encephalitis. Thirty-six hours after admission when the cerebrospinal fluid was found to be normal and she failed to improve, magnetic resonance imaging and magnetic resonance angiography was performed, which demonstrated BAO with a large pontine infarct. Work-up showed lupus anticoagulant. Case ThreeA 45-year-old woman with lupus presented with 24 hours of nausea/vomiting, intermittent dizziness, dysarthria, and rightsided hemiparesis. Head CT was unremarkable. On admission, neurological examination showed right facial droop, dysarthria, right-sided hemiparesis, hyperreflexia, and a right extensor plantar reflex. Non-vascular etiologies were pursued initially. One day after presentation, worsening of right-sided weakness and headache prompted vascular imaging showing proximal BAO. Endovascular recanalization was attempted but was unsuccessful. Case FourA 57-year-old man with a history of stent-assisted coiling of a basilar artery aneurysm presented with brief loss of consciousness, transient dysarthria, decreased sensation in his left face, and left upper extremity drift. Head CT showed stent artifact. Intravenous tPA was not given because of his low National Institute of Health stroke scale of 2. He then developed seizure-like activity, deteriorated further neurologically, and required intubation. He was treated for seizures/nonconvulsive status epilepticus and transferred to a tertiary facility. On arrival, he was unresponsive, had absent brain stem reflexes, and extremity movement limited to triple flexion. Repeat head CT demonstrated extensive brain stem hypodensity. Diagnostic angiography demonstrated BAO, but no intervention was attempted because of extensive infarction. It was later learned that he had not taken antiplatelet agent...
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
hi@scite.ai
10624 S. Eastern Ave., Ste. A-614
Henderson, NV 89052, USA
Copyright © 2024 scite LLC. All rights reserved.
Made with 💙 for researchers
Part of the Research Solutions Family.