IMPETUS Stroke: Assessment of hospital infrastructure and workflow for implementation of uniform stroke care pathway in India.

BACKGROUND: India accounts for 13.3% of global disability-adjusted life years (DALYs) lost due to stroke with a relatively younger age of onset compared to the Western population. In India's public healthcare system, many stroke patients seek care at tertiary-level government-funded medical colleges where an optimal level of stroke care is expected. However, there are no studies from India that have assessed the quality of stroke care, including infrastructure, imaging facilities, or the availability of stroke care units in medical colleges. AIM: This study aimed to understand the existing protocols and management of acute stroke care across 22 medical colleges in India, as part of the baseline assessment of the ongoing IMPETUS stroke study. METHODS: A semi-structured quantitative pre-tested questionnaire, developed based on review of literature and expert discussion, was mailed to 22 participating sites of the IMPETUS stroke study. The questionnaire assessed comprehensively all components of stroke care, including human resources, emergency system, in-hospital care, and secondary prevention. A descriptive analysis of their status was undertaken. RESULTS: In the emergency services, limited stroke helpline numbers, 3/22 (14%); prenotification system, 5/22 (23%); and stroke-trained physicians were available, 6/22 (27%). One-third of hospitals did not have on-call neurologists. Although non-contrast computed tomography (NCCT) was always available, 39% of hospitals were not doing computed tomography (CT) angiography and 13/22 (59%) were not doing magnetic resonance imaging (MRI) after routine working hours. Intravenous thrombolysis was being done in 20/22 (91%) hospitals, but 36% of hospitals did not provide it free of cost. Endovascular therapy was available only in 6/22 (27%) hospitals. The study highlighted the scarcity of multidisciplinary stroke teams, 8/22 (36%), and stroke units, 7/22 (32%). Lifesaving surgeries like hematoma evacuation, 11/22 (50%), and decompressive craniectomy, 9/22 (41%), were performed in limited numbers. The availability of occupational therapists, speech therapists, and cognitive rehabilitation was minimal. CONCLUSION: This study highlighted the current status of acute stroke management in publicly funded tertiary care hospitals. Lack of prenotification, limited number of stroke-trained physicians and neurosurgeons, relatively lesser provision of free thrombolytic agents, limited stroke units, and lack of rehabilitation services are areas needing urgent attention by policymakers and creation of sustainable education models for uniform stroke care by medical professionals across the country.

Coexistence of allergic bronchopulmonary aspergillosis and allergic aspergillus sinusitis in a patient without clinical asthma.

All patients with prolonged cough with a history of atopy, even if not clinically asthmatic, should be evaluated for allergic bronchopulmonary aspergillosis (ABPA); also, we suspect that we may miss the early diagnosis of ABPA if bronchial asthma is considered as a major criteria for the diagnosis of ABPA.

Artifacts and noise removal in electrocardiograms using independent component analysis.

Independent component analysis (ICA) is a novel technique capable of separating independent components from electrocardiogram (ECG) complex signals. The purpose of this analysis is to evaluate the effectiveness of ICA in removing artifacts and noise from ECG recordings. ICA is applied to remove artifacts and noise in ECG segments of either an individual ECG CSE data base file or all files. The reconstructed ECGs are compared with the original ECG signal. For the four special cases discussed, the R-Peak magnitudes of the CSE data base ECG waveforms before and after applying ICA are also found. In the results, it is shown that in most of the cases, the percentage error in reconstruction is very small. The results show that there is a significant improvement in signal quality, i.e. SNR. All the ECG recording cases dealt showed an improved ECG appearance after the use of ICA. This establishes the efficacy of ICA in elimination of noise and artifacts in electrocardiograms.

A new statistical PCA-ICA algorithm for location of R-peaks in ECG.

The success of ICA to separate the independent components from the mixture depends on the properties of the electrocardiogram (ECG) recordings. This paper discusses some of the conditions of independent component analysis (ICA) that could affect the reliability of the separation and evaluation of issues related to the properties of the signals and number of sources. Principal component analysis (PCA) scatter plots are plotted to indicate the diagnostic features in the presence and absence of base-line wander in interpreting the ECG signals. In this analysis, a newly developed statistical algorithm by authors, based on the use of combined PCA-ICA for two correlated channels of 12-channel ECG data is proposed. ICA technique has been successfully implemented in identifying and removal of noise and artifacts from ECG signals. Cleaned ECG signals are obtained using statistical measures like kurtosis and variance of variance after ICA processing. This analysis also paper deals with the detection of QRS complexes in electrocardiograms using combined PCA-ICA algorithm. The efficacy of the combined PCA-ICA algorithm lies in the fact that the location of the R-peaks is bounded from above and below by the location of the cross-over points, hence none of the peaks are ignored or missed.