Strategies to Improve Stroke Care Services in Low- and Middle-Income Countries: A Systematic Review.

BACKGROUND: The burden of stroke in low- and middle-income countries (LMICs) is large and increasing, challenging the already stretched health-care services. AIMS AND OBJECTIVES: To determine the quality of existing stroke-care services in LMICs and to highlight indigenous, inexpensive, evidence-based implementable strategies being used in stroke-care. METHODS: A detailed literature search was undertaken using PubMed and Google scholar from January 1966 to October 2015 using a range of search terms. Of 921 publications, 373 papers were shortlisted and 31 articles on existing stroke-services were included. RESULTS: We identified efficient models of ambulance transport and pre-notification. Stroke Units (SU) are available in some countries, but are relatively sparse and mostly provided by the private sector. Very few patients were thrombolysed; this could be increased with telemedicine and governmental subsidies. Adherence to secondary preventive drugs is affected by limited availability and affordability, emphasizing the importance of primary prevention. Training of paramedics, care-givers and nurses in post-stroke care is feasible. CONCLUSION: In this systematic review, we found several reports on evidence-based implementable stroke services in LMICs. Some strategies are economic, feasible and reproducible but remain untested. Data on their outcomes and sustainability is limited. Further research on implementation of locally and regionally adapted stroke-services and cost-effective secondary prevention programs should be a priority.

Identification of spectrum of persistent post-COVID-19 symptoms and their duration in Central India: A pilot study.

Objectives: To uncover numerous post-COVID symptoms in individuals after SARS-CoV-2 infection and to raise concerns about the consequences for health care planning. Methodology: Patients declared negative with RTPCR and discharged from the hospital were followed up for three months. Results: The majority of patients who suffered from weakness since discharge are 63 (25.40%), body aches 40 (16.12%), loss of taste 26 (10.48%), and loss of smell 18 (7.25%). The total of reinfected patients in the 4th week was 9 (3.62%), in the 6th week 10 (4.03%), in the 8th week 7 (2.82%), and in the 12th week 11 (4.43%). A total of 54.7% of individuals still have the persistence of symptoms at the end of the 12th week. Conclusions: A significant number of participants developed long-term health issues as a result of post-COVID-19 syndrome. Our findings highlight the importance of initial preventive measures and patient-centered benefit programs in reducing post-COVID-19 complications.