Mechanical thrombectomy in acute basilar artery stroke: a systematic review and Meta-analysis of randomized controlled trials.

BACKGROUND: The evidence for mechanical thrombectomy in acute basilar artery occlusion has until now remained inconclusive with basilar artery strokes associated with high rates of death and disability. This systematic review and meta-analysis will summarize the available evidence for the effectiveness of mechanical thrombectomy in acute basilar artery occlusion compared to best medical therapy. METHODS: We conducted a systematic review and meta-analysis of randomized controlled trials using Embase, Medline and the Cochrane Central Register of Controlled Trials (CENTRAL). We calculated risk ratios (RRs) and 95% confidence intervals (CIs) to summarize the effect estimates for each outcome. RESULTS: We performed a random effects (Mantel-Haenszel) meta-analysis of the four included randomized controlled trials comprising a total of 988 participants. We found a statistically significant improvement in the rates of those with a good functional outcome (mRS 0-3, RR 1.54, 1.16-2.06, p = 0.003) and functional independence (mRS 0-2, RR 1.69, 1.05-2.71, p = 0.03) in those who were treated with thrombectomy when compared to best medical therapy alone. Thrombectomy was associated with a higher level of sICH (RR 7.12, 2.16-23.54, p = 0.001) but this was not reflected in a higher mortality rate, conversely the mortality rate was significantly lower in the intervention group (RR 0.76, 0.65-0.89, p = 0.0004). CONCLUSIONS: Our meta-analysis of the recently presented randomized controlled studies is the first to confirm the disability and mortality benefit of mechanical thrombectomy in basilar artery stroke.

Correlation Of Caregivers' Strain With Patients' Disability In Stroke.

BACKGROUND: Stroke results in serious long-term disability in fifty percent of the survivors, making them dependent on others for activities of daily living. Our study aims to study the effect of this dependence on care-givers. Cross sectional study. METHODS: It was a cross sectional study conducted at Combined Military Hospital Peshawar from September to November 2020. Self-administered questionnaires were used to interview 96 patients with stroke and their caregivers selected through convenience sampling technique. Barthel Index was used to measure disability among patients, whereas Modified Caregivers Strain Index (M-CSI) was used for the caregivers. An association between the two scores was analyzed through Pearson's coefficient of correlation (r) and linear regression. RESULTS: Mean ages of the patients and their caregivers were 66.13±11.32 and 36.32±13.71 years respectively. Median score of Barthel index was 1.00 (interquartile range 0.00- 9.75). Mean M-CSI score was 17.31±5.04. There was significant negative correlation between Barthel Index and M-CSI (R=0.542, p<0.001). No significant association was found between duration of stroke and history of recurrent stroke with Barthel Index (p=0.399 and p=0.527 respectively). CONCLUSIONS: Greater the dependence of patients for activities of daily living on their caregivers, higher is the level of strain among the latter. There is dire requirement of social support and rehabilitation centers to address the physical and mental needs of both the patients and their care providers.

Electrical shock survival after prolonged cardiopulmonary resuscitation.

Electrical shock is typically an untoward exposure of human body to any source of electricity that causes a sufficient current to pass through the skin, muscles or hair causing undesirable effects ranging from simple burns to death. Ventricular fibrillation is believed to be the most common cause of death following electrical shock. The case under discussion is of a young man who survived following electrical shock after prolonged cardiopulmonary resuscitation (CPR), multiple defibrillations and artificial ventilation due to poor respiratory effort. Early start of chest compressions played a vital role in successful CPR.

Comparison of forced expiratory volume in one second (FEV1) among asymptomatic smokers and non-smokers.

OBJECTIVE: To compare the forced expiratory volume in first second (FEV1) among asymptomatic smokers and non-smokers for evaluating the effect of cigarette smoking on healthy subjects. METHODS: This was a Comparative cross-sectional study done at military hospital Rawalpindi from June 2006 till June 2007. Two hundred male subjects, 100 smokers and 100 non-smokers were included using non-probability convenience sampling. SCHILLER SPIROMETER (SP-1A) was used to measure forced expiratory volume in one second in all individuals. Best FEV1 was obtained after three efforts. RESULTS: FEV1 was measured in a population of male smokers less than 45 years of age, and compared with a matched group of non smokers, mean age being 35.08 +/- 4.73 years (n=200) and mean height of 170.73 +/- 5.76 cm (n=200). The prevalence rates of previously undetected airflow obstruction were studied according to the British Thoracic Society (BTS) criteria. This study showed that 16 out of 100 smokers had mild airway obstruction while only 01 non smoker out of 100 had FEV1 levels below 80%. The prevalence rate of airway obstruction was associated with age and the number of pack years of smoking. CONCLUSION: The prevalence of undetected airflow obstruction is high among asymptomatic smokers. Targeted screening therefore, especially in smokers needs to be considered. Since lung function declines with time, therefore best time to prevent morbidity and mortality from smoking-related illness should be early in life.