Hyperacute thrombolysis with IV rtPA of acute ischemic stroke: efficacy and safety profile of 54 patients at a tertiary referral center in a developing country.

BACKGROUND: Given the constraints of resources, thrombolysis for acute ischemic stroke (AIS) is under evaluation in developing countries. Prothrombin time (PT), platelet count and activated partial thromboplastin time (aPTT) may not be feasible within the time window. AIM: To evaluate the safety and efficacy of thrombolysis in selected patients without the coagulation profile. DESIGN: Open, nonrandomized, observational study. MATERIALS AND METHODS: Fifty-four stroke patients were classified using TOAST criteria (large artery atherosclerotic = 13; cardioembolic = 12; small vessel occlusion = 22; other determined etiology =three; undetermined etiology = four). The mean time to reach emergency was 2.4h (1.15-3.4), the mean door to CT, 24 min (10-47) and the door to recombinant tissue plasminogen activator (r-tPA) injection, 26.8 min (25-67). The NIHSS scores ranged from 11 to 22 (mean = 15.5 +/- 2.7). Patients with history of liver or renal disease or those on anticoagulants were excluded. The PT, aPTT and platelet count were not done. Recombinant tissue plasminogen activator was administered at a dosage of 0.9 mg/Kg. RESULTS: Thirty-five patients (65%) significantly improved on NIHSS at 48 h (> or =4 points) (mean change = 10; range= 4-17). At one month, 43 (79%) improved on Barthel Index (mean change = 45%). One each developed small frontal lobe hemorrhage and recurrent stroke; one died of aspiration; and eight showed no improvement. CONCLUSIONS: Hyperacute thrombolysis was found useful and safe in selected patients with AIS even without the coagulation studies.

Landau Kleffner syndrome: electroclinical and etiopathogenic heterogeneity.

Landau - Kleffner syndrome is a rare, functional, age-related epilepsy with aphasia and epileptiform discharges on EEG. The heterogenity of clinical presentations, course, long-term outcome and response to treatment suggests multiple underlying etiologies. Normal children abruptly develop deterioration of language functions along with spike and wave discharges on EEG. Clinical seizures may or may not be present. The aphasia responds poorly to most drugs. Valproic acid and benzodiazepines are most effective. Steroids and intravenous immunoglobulins have shown a variable response. Long-term outcome of aphasia is variable, many patients persist with residual impairment. Important questions regarding etiopathogenesis are unanswered.

Infant feeding and weaning practices in some semi-arid rural areas of Rajasthan.

The paper contains information on infant feeding and weaning practices in the rural communities of a semi-arid district of Rajasthan. The findings have been drawn from a recent survey of 328 rural mothers. The rural women of this area are found to believe in old deep seated beliefs and customs, which in turn deprive their infants from advantages of colostrum (77% discarded colostrum) and nutritionally rich supplements, which otherwise should be supplemented to them at any cost in order to keep them healthy. The practices of prolonged breast feeding and delayed supplementation to infants are rampant in this area. Mean age at weaning (27.1 months) again not only affects the health status of mothers and their children but also leads to the undernutrition among both. The findings of the study necessitate to evolve an exhaustive educative programme dealing with various aspects of infant feeding and weaning practices, keeping in view their traditions, so that the useful practices can be encouraged and harmful ones be prohibited.

Knowledge and attitudes of pregnant women regarding AIDS in a semi arid area of Rajasthan.

A total of 792 pregnant women from three hospitals of Jaipur were surveyed to assess and compare their knowledge and attitudes regarding various aspects of AIDS. Observations revealed that level of knowledge was significantly higher in pregnant women from upper income group than low income group (P < 0.05). The misconceptions regarding various aspects of AIDS viz. symptoms and signs, transmission and prevention and opinion towards the AIDS patients, indicate that there is strong need of AIDS education compaign in pregnant women too.

Nutritional status of school age children of salt-workers in Rajasthan.

Nutritional status of 1044 school age children (6-18 yr) of salt workers in various salt manufacturing sites of Rajasthan, was assessed using anthropometry. Heights and weights of girls were observed to be better than in boys in the menarcheal age groups. Children of the present study showed reduced growth in comparison to National Centre for Health Statistics (NCHS), World Health Organisation (WHO), well-to-do Indian children and Rajasthan reference values of the same age groups. The prevalence of stunted with severe wasting was 4.5 per cent in the children of salt workers. Higher prevalence of severe wasting was observed in girls than the boys (P < 0.01).

Morbidity profile of desert population engaged in salt production in Rajasthan.

A total 2120 salt workers were examined in 8 camps organised at different salt sites in Rajasthan. These camps were organised to find out the morbidity conditions among salt workers and to provide preventive and curative treatment for the ailments. The majority of salt workers who attended the camps were males (79.0%) in comparison to females (21.0%). The majority of workers belonged to Scheduled Castes followed by Backward Class and Scheduled Tribes at all sites. The major morbidity disorders observed during these camps were dermatological, respiratory, musculoskeletal, gastro-intestinal and ophthalmological in both the sexes. The prevalence of hypertension was 4.3% among both sexes. The morbidity pattern in male workers was agreeing among Sujangarh and Kuchaman and after that Pokran and Didwana were agreeing with highest rank correlation, whereas in female workers it was agreeing among Nawa and Sujangarh and after that Phalodi and Pokran were agreeing with highest correlation.