Poor awareness of stroke--a hospital-based study from South India: an urgent need for awareness programs.

BACKGROUND: Stroke treatment has reached a new benchmark with thrombolytic therapy. However, India has witnessed a tremendous increase in morbidity and mortality of stroke over the past few decades. The prime deciding factor is initiation of treatment within the time window, which requires early recognition of stroke symptoms. We wished to analyze the lacunae in the stroke knowledge in our population. This hospital-based study assessed awareness of the public regarding stroke. METHODS: Two trained medical students interviewed accompanying relatives using a structured questionnaire. Data were analyzed using Statistical Package for the Social Sciences, version 20. Univariate and multivariate analyses were done. Descriptive results are presented as mean ± SD. P less than .05 was considered as statistically significant. RESULTS: In total, 350 individuals formed the study group; mean age was 40.23 ± 13.4 years constituting 145 males (47.5%) and 205 females (58.5%). Only 50 (14%) respondents could identify that the patient had developed stroke; however, 35% respondents identified brain as the organ involved for the presenting complaints and 34% could identify the warning symptoms of stroke, limb weakness being the most common (30%). Sources of information were friends and media (8%). Median time of reaching the hospital was 10 hours with patients transported by ambulance reaching early (P < .03); 80% of patients were fed in drowsy state during transport. More than 50% of the respondents were not able to identify the risk factors nor were aware that stroke is a preventable or a life-threatening disease. Multivariate logistic regression analysis confirmed that higher level of education was the only variable, which correlated with the organ identification (P < .001), stroke recognition (P < .002), and identification of the warning symptoms (P < .001). CONCLUSIONS: This hospital-based study reveals that there is a poor knowledge of recognition of stroke, its warning signs, risk factors, and prehospital care. There is an urgent need to design stroke awareness programs in the country with emphasis on ambulance service to minimize the time to thrombolysis.

Female Caregivers and Stroke Severity Determines Caregiver Stress in Stroke Patients.

BACKGROUND: Stroke is among the major causes of short- and long-term disability. This study aimed to understand the caregivers (CGs) stress in stroke survivors. MATERIALS AND METHODS: A 22-item questionnaire was administered to 201 CGs of stroke survivors. The variables tested were physical and mental health, social support, financial, and personal problems. CGs were divided into Group A (Barthel index [BI] <75) and B (BI >75) according to patient's BI, according to gender (male and female CG) and relation; spouses (wife, husband), daughters, sons, daughter-in-law, grandchildren, and rest (father, mother, brother, sister, and in-laws). Data were analyzed using SPSS software version-21. Data were analyzed to determine which variables of the patient effects the CG stress. RESULTS: Majority of the CGs (74.62%) were females. 65% of CGs graded their burden as moderate to severe. 81% of CGs had left their work for caregiving. More than half of the CGs felt sleep disturbance and physical strain. Psychological instability and financial burdens were reported in 3/4th of CGs. Group A CGs faced more sleep, financial, health, and social life disturbance. Patient's bladder and bowel problems, shoulder pain, patients noncooperative attitude for medication administration, and physiotherapy were more upsetting for Group A CGs. Female CGs were subjected to more sleep disturbance, physical and psychological stress, faced more difficulty regarding the patient's bladder, bowel, personal hygiene needs, and physiotherapy. Female CGs felt less motivated in caregiving than male CGs. Wives and daughters-in-law experienced more burden. Time spent and burden perceived was more by female CGs (χ2 = 15.199, P = 0.002) than males (χ2 = 11.931, P = 0.018); wives and daughters than other relations (χ2 = 32.184, P = 0.000), (χ2 = 35.162, P = 0.019). CONCLUSION: Our study showed that caregiving burden was predominantly shouldered by females CGs. CGs faced physical, psychological, and socioeconomic burden. The burden was more evident in female CGs and in patients with severe stroke.

Role of brain natriuretic peptide as a novel prognostic biomarker in acute ischemic stroke.

AIM: We investigated to study the prognostic importance of brain natriuretic peptide (BNP) in ischemic stroke. MATERIALS AND METHODS: We prospectively enrolled 100 patients with acute ischemic stroke and measured plasma BNP levels and compared with age- and sex-matched healthy controls. Risk factors, biochemical parameters, lipid profile, carotid and vertebral Doppler, imaging, and cardiac evaluation were done. Stroke severity was assessed by the National Institutes of Health Stroke Scale (NIHSS) score on admission and functional disability by Barthel Index (BI) at 3 months. Ischemic stroke subtype was classified according to the Oxfordshire Community Stroke Project (OCSP). Data were entered in MS Excel, and appropriate statistical analysis was done using the SPSS software version 21.0. A P = 0.05 was considered as significant. RESULTS: Mean age of patients was 55.17 ± 11.37 years with a male:female ratio 3:1. OCSP showed total anterior circulation infarct (TACI) 35, partial anterior circulation infarct 9, lacunar infarct 12, and posterior circulation infarct 44. NIHSS on admission was average 10 ± 7 and BI was 57 ± 30. BNP in patients (435 ng/ml) was very high as compared to controls (<60 ng/ml) (P < 0.001). There was a positive correlation between age and BNP (R2 = 0.34; P < 0.00); NIHSS and BNP (R2 = 0.255; P < 0.01), negative correlation between BI and BNP (R2 = -0.064; P < 0.01). Mean BNP levels across the OCSP showed higher values in TACI (F = 4.609 P = 0.005). Regression analysis showed that BNP can predict BI which was statistically significant. CONCLUSION: Plasma BNP levels was significantly elevated in patients with ischemic stroke. Our study concludes that high BNP levels are seen in large anterior circulation stroke and is a predictor for the poor functional outcome at 3 months. Determination of BNP levels as a biomarker could be helpful in predicting the outcome in stroke patients.