Acute Stroke Management - A Race Against Time

Did you know that every 3.3 minutes someone dies of stroke, or that stroke is the third leading cause of death and adult disability worldwide!

In India, 1 person suffers from stroke every minute.

The word Stroke (Paralysis or lakva) is derived from the word ‘Strike’ – an analogue to the sudden, severe attack with which it affects the patient and changes their mortality and morbidity completely, if not treated in time.

It is caused by the interruption of the blood supply to the brain, usually because a blood vessel bursts (hemorrhagic) or is blocked by a clot (Ischaemic). This cuts off the supply of oxygen and nutrients to the brain, causing damage to the brain tissue. Ischaemic strokes account for approximately 85% of all strokes whereas 15 % are hemorrhagic strokes.

Treatment of Acute Ischaemic stroke and its outcome is time dependent. Every second a person has stroke symptoms, brain cells die. As seconds tick away, permanent cognitive (mental process involved in knowing, learning, and understanding things) and physical abilities are lost, and the risk of death looms. A stroke can have a profound effect on patients, their spouses and other family members.

Rapid injection of recombinant tissue-type plasminogen activator (r-tPA – a thrombolytic / clot dissolving injection) in blood is the early treatment. It should be administered within 3 – 4.5 hours of onset of above mentioned symptoms. International guidelines recommend a ‘door-to-needle time’ of 60 minutes or less (the time from entry of patient in emergency to administration of drug).

Lack of knowledge about stroke among the general public delays the initiation of immediate management of stroke. Delay in arrival of patient to the hospital, delayed consent by relatives for thrombolysis and unavailability of emergency ambulance services (especially in rural India) are the major reasons of treatment delay. The proportion of stroke patients reaching hospital within 3 hours in India is only 15%. Less than 20% of the general physicians are aware that r-tPA should be administered within the first 3 to 4.5 hours of stroke onset.

New drugs, advanced surgical techniques and interventional neuro-radiology procedures are among the effective new medical options available for stroke patients. These therapies have the potential to reverse the effects of stroke, significantly reduce permanent disability from stroke and lead to an optimal recovery, if administered within the first few hours after the onset of stroke symptoms.

On recognizing symptoms of stroke, patients should be rushed to any nearby hospital equipped to provide care for stroke management - 24/7, with a stroke team, 24 hour MRI / CT imaging facility, a laboratory and a Cathlab. A Stroke Team is a highly specialized, multidisciplinary team working round-the-clock to combat stroke emergencies. It includes the Emergency Physicians, Neurologists, Neurosurgeons, Neuro-Intervention radiologists, Intensivists, Rehabilitation specialists and the nursing team.

Unfortunately, in India, most patients present to the Emergency Departments beyond the 3 - 4.5 hour guideline from symptom onset, thereby missing the important brain and life-saving treatment.

Stroke is a life-changing event that affects not only the person who may be disabled, but their family and caregivers. This year, stroke will affect 4 out of 5 families in India - don't let yours be one of them.

City gynecologists unhappy as COVID plays spoilsport during Navratri.

Mumbai: The BMC's refusal to permit garba dandiya within city limits for the second consecutive year has evoked disappointment among obstetricians and gynaecologists. Expressing displeasure over the BMC's decision, city doctors shot off a letter to PM Modi demanding compensation from the central government against the losses due to the acute patient deficiency seen during 2 years of COVID affected Navratri festival.

It is a well known fact that apart from being the celebration of dance & life, and being Falguni Pathak’s bread and butter, the 9 day festival is also a breeding ground for young couples looking for a casual physical relationship. A study conducted at the Quackdoses Multispeciality Hospital had found that the sale of contraceptive devices and pills in Mumbai jump by a whopping 75 % during the 9 day celebration.

In an exclusive interview with the Quackdoses, Dr. Unglikar, a leading gynecologist in Mumbai said, “Like winter is the season for Chest Physicians and dentists with the increased number of patients coming with LRTI, exacerbation of Bronchial Asthma and COPD or tooth ache respectively, Navratri is a season for the obstetricians and gynecologists. Looking at the statistics of casual and unprotected sex people have after a garba-dandiya session, the 9 day festival is a boon for the obstetrician and gynecologists. Such couples come to us for abortions and even delivery after 9 months in select cases. Last 2 years have been so dry that even OPD consultation of couples with Questions like ‘kuch tension ki baat toh nai haina?’ has gone down.”

Unconfirmed sources have claimed that the National Association of Wicketkeepers (Obstetricians) and gynecologists are planning to organize a ‘yagya’ to please the Gods above and pray for a COVID-less Navratri next year.

Doctor spot diagnosed with encephalitis after returning pen to nurse.

Mumbai: In a never before incident in the history of modern medicine, a doctor was spot diagnosed with encephalitis after presenting with the ultimate sign of brain damage when he returned a pen to the nurse. The news has sent shock waves across the medical fraternity.

It is a well-known fact that most doctors never carry their own pen and end up borrowing one from their nurses to put patient notes. On most occasions, doctors pocket the pen, knowingly or unknowingly, and often forget or misplace pens in wards, patient rooms, operating theater, patient's abdomen or anus but never return them to anyone.

In an exclusive interview with the Quackdoses, Sister Pen-de, the nurse who was felicitated with the clinical acumen award for making this spot diagnosis of encephalitis said, “Doctors get this habit of borrowing pens from nurses right from their internship days. I was in utter disbelief and shock when the doctor came back and handed over my pen back to me. In all my years, I have shouted at and been shouted by many doctors but I have never seen them return a pen. That contributed to making the diagnosis as I knew he was in altered sensorium.”

Unconfirmed sources have claimed that Sister Pende is hopeful to spot diagnose her second case of encephalitis, and is now waiting for another doctor to return the stethoscope borrowed from the nursing counter.