OBJECTIVE

This study aimed to determine whether adjunctive therapy with magnesium sulfate is more effective than diazepam alone in reducing mortality and morbidity rates among adult patients with tetanus admitted to Mariano Marcos Memorial Hospital and Medical Center (MMMH & MC) from January 1, 2012, to January 1, 2022.

METHODS

Retrospective cohort study using chart review and descriptive statistics. included patients admitted at East Avenue Medical Center for DFU. The primary endpoint was major amputation of the lower extremities. Data were analyzed using Receiver Operating Characteristic (ROC) analysis and logistic regression.

RESULTS

A total of 51 patients were included in the study, with 17 patients in the adjunct magnesium sulfate group and 34 patients in the diazepam group. Based on the results of this study, at a 95% confidence interval, ICU stay was significantly longer in the magnesium sulfate group compared to the diazepam group, along with an increased average hospital stay. There was no significant difference in patient mortality in terms of treatment, age, severity, ICU stay, or duration of mechanical ventilation.

CONCLUSION

The use of magnesium sulfate as an adjunct treatment for tetanus is not superior to standard stand-alone diazepam, regardless of severity. Magnesium sulfate use is associated with a longer overall hospital stay. Lastly, hospital-acquired pneumonia and aspiration pneumonia significantly increase the risk of mortality among patients with tetanus, regardless of age, treatment, or severity.

Human ; Tetanus ; Magnesium Sulfate ; Diazepam

Objectives: To determine the outcomes for patients with acute stroke improve with early intervention in a series of the first 50 patients with acute ischemic stroke who were thrombolysed at our center. Methods: National Institutes of Health Stroke Scale (NIHSS) scores were recorded by NIHSS-certified nurses-on-duty in their appropriate monitoring sheets in the chart, which was double-checked by the neurology consultant co-author on duty. Source chart entries were cross-checked with logs from the CT scan, pharmacy, and other department records before being collated by the primary author. Means and averages were used to describe the patients’ data. Results: We included the first 50 patients with acute ischemic stroke, eligible for and who consented for thrombolysis. The patients had an average age of 61 years (range: 29 to 87); 32 (64%) were ≥ 60 years; 16 (32%) were male. Male gender (24/50), age ≥ 60 years old (32/50), hypertension (30/50), heart disease (6/30), smoking (7/30), and ethanol intake (9/30) were the most common risk factors. Thirty-five (70%) suffered a moderate stroke. The mean NIHSS of the 50 patients was 12.6 (range: 2 to 28). All but one received intravenous recombinant tissue plasminogen activator (IV rTPA) within 4.5 hours of onset, at a dose of 0.6 to 0.9 mg/kg. Symptomatic hemorrhagic transformation occurred in one (2%); asymptomatic hemorrhagic transformation was seen in three (6%). Fifteen of the 50 (30%) were NIHSS = 0 on discharge; another 18 (36%) showed clinical improvement compared to their status upon admission. Three patients (6%) were mRS = 0; and 30 (60%) were at least ambulatory (mRS ≤ 3) on discharge. Four patients (8%) died, one (2%) from fatal hemorrhagic transformation. Ten patients (20%) developed nosocomial pneumonia; two (4%) had catheter-related urinary tract infections More than half (52%) did not develop any in-hospital complications. The patients were admitted for a mean of 6.6 days (range < 24 hours to 20 days). The average gross bill was ₱56,041.34 (range: ₱8,729.83 to ₱182,054.08); P32,194 was the average amount our Center shouldered per patient (range: zero to ₱154,272.88); almost all were Charity Service patients who used the ₱19,600 Philippine Health Insurance Corporation case rate and the 20% senior citizen discount to help defray the costs of their hospitalization. Conclusion Stroke thrombolysis can be done in a rural tertiary hospital safely and effectively if with strong government, administration, health care workers, and community support.

Stroke is the most common neurologic admission in our Center. Healthcare needs to be sustainable, while maintaining the standard of care. Will codifying acute stroke care into a pre- written clinical pathway reduce mortality, lengths of hospital stay, and costs? We pilot-tested an Acute Stroke Clinical Pathway based on the Stroke Society of the Philippines, Department of Health, and other international guidelines. Mortality rate, lengths of hospital stay, excess hospital costs and complication rates were compared. Those enrolled into the Ischemic Stroke pathway stayed one day less compared to those who were not. The hospital share for mild hemorrhagic stroke, mortality rate for moderate hemorrhagic stroke, and length of stay and hospital share in severe hemorrhagic stroke patients enrolled into a Hemorrhagic Stroke pathway were statistically significantly less. The savings in some patient groups (e.g., in Mild Hemorrhagic strokes) were offset by losses in others (e.g., in Moderate to Severe Ischemic Strokes). Patients enrolled into a stroke pathway were recorded to have more nosocomial infections. The findings show that using a pre-written clinical pathway reduces stroke patient mortality, length of stay, and hospital cost, but only in specific patient groups. The increase in reported nosocomial infections in stroke-pathway-enrolled patients is hypothesized to be due to better reporting.

Therapeutic plasma exchange (TPE) has been reported as a possible treatment for osmotic demyelination syndrome – central pontine myelinolysis (ODS-CPM), a degeneration of myelin within the central nervous system related to rapid hyponatremia correction, which though uncommon, has significant morbidity, and has no established specific treatment. We present our experience with a 41-year-old male with chronic kidney disease, maintained on steroids, who presented with lethargy and behavioral changes. Initial metabolic panel showed severe hyponatremia (Na 109 mEq/L). Despite cautious sodium correction, the patient’s sensorium decreased further and was intubated. Involuntary movements of the left face and arm were later seen. T2/FLAIR hyperintensities in the brainstem and thalami affirmed the diagnosis of ODS. A total of nine cycles (one cycle every two to three days) of TPE were completed. The patient was discharged with improved sensorium, from E2VxM4 to E4VxM6, and with no indication for hemodialysis due to improved creatinine. One year later, the patient has no remaining neurologic deficits. Our experience supports other case reports that TPE is a viable therapy for ODS-CPM.
Myelinolysis, Central Pontine ; Renal Insufficiency, Chronic

BACKGROUND: Hyperglycemia occurs in 60% of acute stroke patients, 12-52% of which maybe previously undiagnosed with diabetes. A retrospective study by Gacutan showed 21% admission hyperglycemia at the Philippine General Hospital. Screening for glucose disorders among hyperglycemic stroke patients provides a venue for secondary prevention. There are no current guidelines on screening for post-stroke hyperglycemia by the Stroke Society of the Philippines.

OBJECTIVE: To determine the prevalence and outcomes of unrecognized diabetes and prediabetes among acute stroke patients. Secondarily, we aim to determine the clinical and biochemical predictors of unrecognized/newly diagnosed diabetes mellitus among the acute stroke patients.

METHODOLOGY: Cross-sectional prospective study. Acute stroke patients admitted from January to December, 2008 with admission hyperglycemia were included. Random blood sugar, glycosylated hemoglobin & the National Institute of Health Stroke Scale (NIHSS) were done on admission. All were followed up six weeks post-discharge for an FBS and 75-grams OGTT except those discharged with anti-diabetes medications who were considered newly-diagnosed diabetes.

OUTCOMES: Glucose disorders were classified at six weeks post-discharge. Mortality was measured at six weeks and 12 weeks. Functional outcomes using the Modified Rankin Score & the Barthel's Index were measured at the OPD 6-weeks postdischarge.

RESULTS: There were 504 stroke patients of which 178(35%) had admission hyperglycemia. Majority were newly diagnosed diabetes 32.7%, stress hyperglycemia 29.56%, impaired glucose tolerance, (IGT) 13.8%, impaired fasting blood sugar, (IFG) 8.8%, combined IGT and IFG 3.7%, previous diabetes 11.32%. Age, body mass index, alcohol abuse, smoking, hypertension, nosocomial infections, acute coronary syndrome were associated with diabetes. No association was noted with diabetes and atrial fibrillation. By Kruskal-Wallis test, admission RBS and HbA1c were higher among diabetics compared to prediabetics and stress hyperglycemics. Triglycerides was higher and HDL was lower among diabetic versus the stress hyperglycemia. No trends were noted for total cholesterol and LDL cholesterol across groups. On multiple logistic regression, age (OR: 1.06, p0.07), smoking (OR: 9.81, p0.05) and Hba1c (OR:11.39, p
Human ; Human ; Male ; Female ; Adult ; Young Adult ; Middle Aged ; Aged ; Diabetes Mellitus ; Prediabetic State ; Hyperglycemia ; Prevalence ; Stroke

OBJECTIVE: To describe the long-term outcomes of admission hyperglycemia among adult stroke patients admitted at a tertiary hospital.

METHODOLOGY: All patients admitted into the Charity Neurology Service were scored using modified Rankin score, NIHSS and Barthel Index on admission, three days, discharge, six weeks, three months and six months follow-up. Patients with admission hyperglycemia were further classified into those with diabetes, prediabetes and stress hyperglycemia.

RESULTS: Of the 443 patients admitted, 178 had admission hyperglycemia; 221 patients were discharged; 21 patients with admission hyperglycemia and 23 patients who were normoglycemic on admission returned for regular follow-up. Modified Rankin Scores and NIHSS were lower and Barthel Indices were higher among the normoglycemic patients as compared to those who were hyperglycemic on admission.

CONCLUSION: The cohort of patients with admission hyperglycemia had poorer functional outcomes in the long-term as compared to those with normoglycemia on admission.

 

Human ; Adult (a Person 19-44 Years Of Age) ; Prediabetic State ; Tertiary Care Centers ; Charities ; Follow-up Studies ; Hyperglycemia ; Diabetes Mellitus ; Patient Admission ; Patient Discharge ; Stroke ; Neurology