BACKGROUND AND OBJECTIVE

The incidence of ischemic stroke typically increases with age; however, recent studies have shown a concerning trend of stroke cases among adults under the age of 45. This neurologic condition is called “Stroke in the Young” (SITY). SITY poses public health concerns due to its long-term consequences on individuals and their families. Despite significant impact, published literature on SITY among Filipinos is scarce. Given the potential differences in genetic background and lifestyle, the clinical characteristics and outcomes of SITY Filipinos may vary considerably from other populations. Therefore, the aim of this study is to describe the clinical features and outcomes of ischemic SITY Filipinos.

METHODS

The study was a two-center, five-year retro- spective cohort design involving 19- to 45-year-old  patients admitted between January 1, 2017, and December 31, 2022, diagnosed clinically and radiologically with ischemic stroke for the first time. Medical records were reviewed, including demographic data, stroke symptoms, cardiovascular or non-cardiovascular risk factors, and laboratory results. Ischemic stroke subtypes were categorized into cardioembolic, small artery occlusion, stroke of other determined causes, and stroke of undetermined cause through the Trial of ORG 10172 in Acute Stroke Treatment (TOAST) classification. Functional outcomes on hospital discharge were assessed by the Modified Rankin Scale (mRS). All data were analyzed using descriptive statistics in the Statistical Package for the Social Sciences (SPSS software, version 29).

RESULTS

A total of 205 cases of ischemic SITY were chart reviewed. The mean age was 37.30, with a female predominance of 68.3%. The most reported cardiovascular risk factors were obesity (56.6%), hypertension (51.2%), heavy alcohol consumption (36.5%), and diabetes mellitus type 2 (19.5%). Concurrently, the non-cardiovascular risk factors identified were pregnancy, particularly in the postpartum period (4.8%), use of estrogen-containing pills (4.8%), and migraine without aura (4.4%). Based on TOAST classification, small vessel occlusion (42.1%) and large artery atherosclerosis (30.2%) were the most frequent ischemic stroke subtypes of SITY Filipino females. Mostly showed no symptoms of disability (35.1%) on hospital discharge.

CONCLUSION

This study highlights the difference in the clinical profile of young Filipino adults with ischemic stroke. Contrary to previous studies, ischemic stroke was more predominant among young females. Aside from hypertension, obesity has emerged as the leading cardio- vascular risk factor for ischemic SITY. Moreover, noncardiovascular risk factors, specific to females (pregnancy, use of estrogen-containing pills, and migraine), were also identified in the study. With regards to stroke subtypes, small vessel occlusion and large artery atherosclerosis were frequently seen in young female patients. These f indings suggest a need for gender-specific approaches in the evaluation, management, and prevention of ischemic SITY.

Human ; Young Adult: 19-24 Yrs Old ; Ischemic Stroke

This is a case of a 63-year-old female with post-COVID-19 unilateral upper lip pain and numbness. Neurologic examination did not reveal any deficits other than deficits on pinprick in the maxillary division (V2) of the left trigeminal nerve. Brain neuroimaging showed signs of acute inflammation of the left maxillary sinus. Neuropraxia of the infraorbital nerve, a branch of the trigeminal nerve, was the diagnosis considered. Reports on trigeminal neurosensory changes following acute sinusitis are few, and isolated trigeminal neuropathy is rare except in cases of dental disorders. Up to this writing, there have been no reports on post-COVID-19 unilateral upper lip numbness and pain. This study will also serve as a concise review on the correlative neuroanatomy of the trigeminal nerve.
COVID-19 ; Trigeminal Nerve

BACKGROUND: Patients' understanding of prescriptions is one of the key elements to a successful treatment. In the Philippines, patients do not have the benefit of having pharmacists explaining the prescription when they purchase their medicines. Inability to understand and follow prescriptions may, therefore, contribute to medication non-compliance, which leads to unwanted disease progression, complications, and even premature death.

OBJECTIVE: To assess the understanding of Filipino patients of prescriptions given by their doctors and to identify the factors that significantly affect their understanding.

METHODS: In total, 392 individuals, using purposive sampling, were interviewed from pharmacies around a government hospital outpatient department (OPD), a private hospital OPD, private clinics, and local health centers in Manila, Philippines. The patients' knowledge about the proper intake of the prescribed drugs was assessed and the factors that were deemed to affect their understanding were then identified. Crude odds ratios (ORs) and 95% confidence intervals (CIs) were calculated according to the various study factors included in the study to measure the association between each study variable and incomplete understanding of prescriptions. A multivariate logistics regression model was constructed applying a stepwise procedure to enter variables in the model.

RESULTS: Among the 392 participants, 219(55.9%) patients had an incomplete understanding of prescriptions, 176 (44.9%) were not able to identify the correct dose of the prescribed drug, followed by 103(26.3%) who were not able to identify the name of the drug. Multivariate logistics regression analysis identified only three independent variables to be statistically significant predisposing factors to incomplete understanding of prescriptions: non-legible prescriptions (OR=4.598, 95% CI 2.671-7.913), prescriptions with an incomplete set of written instructions (OR=2.108, 95% CI 1.234-3.601), and patient having had no previous use of the prescribed drug or a similar drug (OR=2.126, 95% CI 1.361-3.320).

CONCLUSIONS: The results of this study suggest that physicians play an important role in promoting complete understanding of prescriptions. Non-legible prescriptions and prescriptions with an incomplete set of written instructions were found to significantly affect patients' understanding of prescriptions. Physicians should also be more careful in instructing patients who will take the prescribed medications for the first time. These information may be used to enhance better understanding of prescriptions among patients and thereby prevent non-compliance and treatment failure.

Human ; Male ; Female ; Aged ; Middle Aged ; Adult ; Pharmacies ; Pharmacists ; Mortality, Premature ; Medication Adherence ; Drug Prescriptions ; Prescription Drugs ; Hospitals, Private ; Disease Progression ; Causality