RESUMO
While ischaemic stroke remains a leading cause of death and disability, there have been recent advancements in treatment modalities including thrombolysis and decompressive hemicraniectomy. A retrospective review of patients treated in our NHS teaching hospital, in Plymouth (UK), over a 2 year period identified 17 thrombolysed patients, of whom two had undergone subsequent decompressive hemicraniectomy. These were non-dominant hemisphere strokes in young patients, aged 51 and 57. Initial NIHSS scores were 16 and 17, and they received thrombolysis at 2 hrs 42 min and 5 hrs 10 min post onset of symptoms respectively. CT imaging demonstrated cerebral swelling with significant midline shift in both cases, and decompressive hemicraniectomy was undertaken at 29 hrs 8 min and 27 hrs 30 min post-thrombolysis. We found no significant intra-operative complications attributable to prior use of thrombolytics. Both patients have had acceptable psychological and physical outcomes, with Barthel Index scores of 40 and 25, and MMSE scores of 29/30 and 27/30. We conclude that the use of thrombolytic therapy does not contra-indicate subsequent decompressive hemicraniectomy in well selected patients with non-dominant hemisphere strokes. More research in this field is required to elucidate factors which would facilitate recognition of stroke patients who will benefit most from aggressive medical and neurosurgical intervention.
RESUMO
The potential of using juice of bilimbi (Averrhoa bilimbi L.) and tamarind (Tamarindus indica L.) to reduce Listeria monocytogenes Scott A and Salmonella Typhimurium ATCC 14028 populations on raw shrimps after washing and during storage (4 degrees C) was investigated. The uninoculated raw shrimps and those inoculated with approximately 9 log cfu/ml of L. monocytogenes Scott A and S. Typhimurium ATCC 14028 were washed (dipped or rubbed) in distilled water (SDW) (control), bilimbi or tamarind juice at 1:4 (w/v) concentrations for 10 and 5 min. Naturally occurring aerobic bacteria (APC), L. monocytogenes Scott A and S. Typhimurium ATCC 14028 counts, pH values and sensory analysis of washed shrimps were determined immediately after washing (day 0), and on days 3 and 7 of storage. Compared to SDW, bilimbi and tamarind juice significantly (p<0.05) reduced APC (0.40-0.70 log cfu/g), L. monocytogenes Scott A (0.84-1.58 log cfu/g) and S. Typhimurium ATCC 14028 (1.03-2.00 log cfu/g) populations immediately after washing (0 day). There was a significant difference (p<0.05) in bacterial reduction between the dipping (0.40-0.41 log for APC; 0.84 for L. monocytogenes Scott A and 1.03-1.09 log for S. Typhimurium ATCC 14028) and rubbing (0.68-0.70 log for APC; 1.34-1.58 for L. monocytogenes Scott A and 1.67-2.00 log for S. Typhimurium ATCC 14028) methods. Regardless of washing treatments or methods, populations of S. Typhimurium ATCC 14028 decreased slightly (5.10-6.29 log cfu/g on day 7 of storage) while populations of L. monocytogenes Scott A (8.74-9.20 log cfu/g) and APC (8.68-8.92 log cfu/g) increased significantly during refrigerated storage. The pH of experimental shrimps were significantly (p<0.05) decreased by 0.15-0.22 pH units after washing with bilimbi and tamarind juice. The control, bilimbi or tamarind-washed shrimps did not differ in sensory panellist acceptability (p>0.05) throughout the storage except for odour (p<0.05) attributes at 0 day when acidic or lemony smell was noticed in bilimbi- and tamarind-washed shrimps and not in control shrimps.