General order to do first to stroke patients

Initial measures applied to all stroke patients are necessary to stabilize and assess the patient, and prepare for definitive therapy. All current and, probably, future stroke therapies for both ischemic and hemorrhagic stroke are best implemented as fast as possible, so these things need to be done quickly.

• O2 via nasal cannula (routine oxygen delivery in ischemia might improve outcome).
• Intubation may be necessary if the patient shows arterial oxygendesaturation or cannot “protect” their airway from aspiratingsecretions. However, intubation means that the ability to monitorthe neurological exam is lost. The best approach in such patientsis to prepare to intubate immediately, but before doing so, take a moment to be sure the patient does not spontaneously improve or stabilize with good nursing care (suctioning, head position, etc.).
• Consider putting the head of the bed flat. This can significantly help cerebral perfusion. 
• Consider normal saline bolus 250–500 mL if blood pressure is low.
• If the blood pressure is high, antihypertensive treatment.
• Determining the exact time of onset is critical for establishing eligibility for acute therapies, especially TPA. It is very important to be a detective. You will usually be told a time by the  paramedics or ED triage nurse, but be sure to recheck the information you receive from them. If possible, try to speak personally with first-hand witnesses, nursing home staff, etc.
• In most cases, the onset is not observed – the patient is found with the deficit. In that case, or in patients who awaken with symptoms, the onset time is the time the patient was last seen normal. However, if the patient awoke with symptoms, be sure to ask if the patient was up in the middle of the night for any reason (often to go to the bathroom) – as sometimes this puts the patient in the time window for treatment.
• Examine the patient and do the NIH Stroke Scale. The initial stroke severity is the most important predictor of outcome
• Do a non-contrast head CT. This will immediately rule out hemorrhage as blood is bright on a CT.
• The result will determine the first major branching point in therapeutic decision-making.
• Obtaining the CT is often the major impediment in preparing for thrombolytic therapy, so efforts should be made to shorten “door to CT” time, which should be below 30 minutes.
• In some select centers, emergent MRI can be done very quickly and substitute for CT, but this is the exception.
• If the CT shows no blood, try to get the artery open TPA is the only FDA-approved treatment for ischemic stroke, and you should immediately begin to determine if the patient is eligible for this therapy, and prepare for its administration.

Read More

Stroke 'Mimic' or Real Stroke?

Distinguishing stroke 'mimic' from real stroke has not been well studied.  It's not unusual for patients to show up in the emergency room, worried they are experiencing a stroke. But other medical conditions, such as tumors, systemic infections and hematomas, can actually "mimic" a stroke.

All of the following may present similarly to a stroke. In all cases, the distinction can be made by an emergent MRI scan, which will showabnormal diffusion-weighted signal in most stroke cases, but not inmimics.

• Seizures. If a seizure has a focal onset in the brain, the patient may be left with weakness, numbness, speech, or vision problems for a period of time (usually less than 24 hours) after the seizure. Patients with seizures at onset are usually excluded from clinical trials of new stroke therapies.
• Migraine. Patients may have unilateral weakness or numbness, visual changes, or speech disturbances associated with a migraine headache (“complicated” or “complex” migraine). The best rule of thumb is not to make the diagnosis of complicated migraine or migrainous stroke unless the patient has a history of previous complicated migraine events similar to the deficit displayed in the emergency department.
• Syncope. This is usually due to hypotension or a cardiac arrhythmia. Stroke rarely presents with syncope alone. Patients with vertebrobasilar insufficiency may have syncope, but there are usually other brainstem or cerebellar findings if syncope is part of the stroke presentation.
• Hypoglycemia. Patients with low blood sugar may have symptoms that exactly mimic a stroke. The important thing is to check the blood sugar and, if low, correct it. If the symptoms do not resolve with correction of the hypoglycemia, the symptoms are probably from a stroke.
• Metabolic encephalopathy. Patients may have confusion, slurred speech, or rarely aphasia with this condition. They usually do not have other prominent focal findings.
• Central nervous system tumor. The location of the tumor would determine the type of signs and symptoms seen. A tumor, unlike a stroke, usually does not present with sudden focal findings, unless accompanied by a seizure.
• Herpes simplex encephalitis (HSE). This infection tends predominantly to affect the temporal lobes, so patients may have signs of aphasia, hemiparesis or visual-field cuts. Onset can be rapid and in its early stages may mimic a stroke, but fever, CSF pleocytosis, seizures and decreased level of consciousness are more prominent with HSE.
• Subdural hematoma. Depending on the location, this may cause contralateral weakness or numbness that may mimic a stroke. A CT scan can make this diagnosis, but the subdural hematoma, if small, may be subtle.
• Bell’s palsy (peripheral seventh nerve palsy). The important point here is that the forehead and eye closure are weak on the same side. One can have a stroke involving the pons and produce a peripheral seventh nerve palsy, but usually there are other signs and symptoms such as weakness, a gaze palsy, or ipsilateral sixth nerve palsy.
• Benign paroxysmal positional vertigo (BPPV). This may cause vertigo, nausea, vomiting, and a sense of imbalance, usually with turning of the head in one direction. This characteristic syndrome is due to labyrinthine dysfunction and not stroke. However, as with syncope, the presence of any brainstem or
  cerebellar signs should alert one to the possibility of a stroke.
• Conversion disorder. Patients may develop neurological signs or symptoms of weakness, numbness, or trouble talking that are manifestations of stress or a psychiatric illness.

Stroke is a clinical diagnosis, supported in some cases, but not all, by an appropriate abnormality on brain imaging. Despite its limitations, the clinical assessment directs immediate management of the patient with suspected stroke. For patients to receive time-critical treatments (such as thrombolysis, medical or surgical treatment of intracerebral hematoma, reversal of anticoagulation), they must be brought to hospital rapidly, assessed quickly and accurately, and promptly sent for the appropriate investigation.

Read More

What Is a Stroke?

The term “stroke” usually refers either to a cerebral infarction or to non-traumatic cerebral hemorrhage. Depending on the population you are seeing (ethnicity, age, comorbidities) the ratio of infarcts to hemorrhages is about 4:1. A stroke happens when blood flow to a part of the brain stops. A stroke is sometimes called a “brain attack.”

There are two major types of stroke: ischemic stroke and hemorrhagic stroke.
Ischemic stroke occurs when a blood vessel that supplies blood to the brain is blocked by a blood clot. This may happen in two ways:

• A clot may form in an artery that is already very narrow. This is called a thrombotic stroke.
• A clot may break off from another place in the blood vessels of the brain, or from some other part of the body, and travel up to the brain. This is called cerebral embolism, or an embolic stroke.

Ischemic strokes may be caused by clogged arteries. Fat, cholesterol, and other substances collect on the artery walls, forming a sticky substance called plaque.

A hemorrhagic stroke occurs when a blood vessel in part of the brain becomes weak and bursts open, causing blood to leak into the brain. Some people have defects in the blood vessels of the brain that make this more likely.

There is currently no 100% sensitive and specific test for cerebral infarction in the emergency department, so that the diagnosis is usually made on the basis of a characteristic history, exam, presence of comorbidities, and the absence of seizures or other stroke mimics. CT scanning is usually negative in the first three hours, or shows only subtle signs that have low inter-observer reliability. If available, MR imaging, or detection of an occluded artery by transcranial Doppler or arteriography (by CT, MRI or intra-arterial catheterization), can be confirmatory. Parenchymal or subarachnoid hemorrhage, on the other hand, can be reliably detected by emergent CT scanning.

Read More

Efficacy and benefits of soursop fruit

Soursop, a native fruit from the West Indies, Central America, down to Brazil and it is a common fruit in tropical Asia nowadays.  Soursop is a fruit that has the most delectable flavor. Soursop is not only a delicious and healthy fruit but it is use medicinally to treat illness such as:

• Hemorrhoid.
  Take the ripe soursop fruit. Squeeze to take water as much as 1 cup, and drink 2 times a day, morning and afternoon.
• Bladder pain.
  Half-ripe soursop fruit, sugar and salt to taste. All material is cooked compote made​​. Eaten plain, and performed regularly every day for 1 week in a row.
• Infant Diarrhoea.
  Take the ripe soursop fruit. Soursop fruit is squeezed and filtered to take water, drenched diarrhea in infants as much as 2-3 tablespoons.
• Urinary tract infections
  Half-ripe soursop and sugar to taste. Soursop peeled and boiled with sugar with 2 cups of water, filtered and drunk.
• Back Pain.
  20 soursop leaves, boiled with 5 cups water to boiling until tinggal3 glasses, drink 1 a day 3 / 4 cup.
• Ulcer
  Soursop leaves are still young enough, stick it in a place exposed to ulcers.    

Read More

What Is Cerebrovascular Disease?

Cerebrovascular disease is the term applied to a large number of diseases with pathology in the blood vessels of the brain or the vessels supplying blood to the brain. Atherosclerosis is one of the conditions that can cause cerebrovascular disease. Another form of cerebrovascular disease includes aneurysms. In females with defective collagen, the weak branching points of arteries give rise to protrusions with a very thin covering of endothelium that can tear to bleed easily with minimal rise of blood pressure. Cerebrovascular disease, including Stroke, is the third-leading cause of death in the United States and a leading cause of disability among older Americans. Below is a simplified classification of cerebrovascular diseases where neuroprotection is required:

Cerebral ischemia
   Global cerebral ischemia due to cardiac arrest
   Focal cerebral infarction
   Carotid stenosis or occlusion leading to cerebral ischemia
Cerebral hemorrhage
   Hemorrhagic infarction
   Hypertensive hemorrhage
   Hemorrhage due to rupture of intracranial arteriovenous malformations
   Subarachnoid hemorrhage due to rupture of intracranial arterial aneuryms
Spinal stroke
   Cardiogenic thromboembolism
   Hypertensive encephalopathy
   Diseases of cerebral blood vessels: e.g., atherosclerosis, vasculitis

Stroke is the term commonly used to describe the sudden onset of focal neurological deficits such as weakness or paralysis due to disturbance of the blood flow to the brain. The term is applied loosely to cover ischemic and hemorrhagic episodes. An ischemic stroke occurs when a thrombus or an embolus blocks an artery to the brain, blocking or reducing the blood flow to the brain and consequently the transport of oxygen and glucose which are critical elements for brain function.

Read More

The characteristic symptoms suggestive of asthma

Persons with a genetically determined allergic constitution are at risk to develop a number of diseases. At the moment, it is not understood why a certain allergic patient develops asthma, while another allergic person develops rhinitis or eczema.

The key symptoms of asthma are coughing, shortness of breath, wheezing and chest tightness. Asthma is an ongoing disease caused by inflammation of the airways, making it difficult to breathe. If the symptoms are severe and persistent, this can even lead to chest deformities.

The characteristic symptoms suggestive of asthma are

• wheeze
• chest tightness
• shortness of breath and 
• cough

especially if these symptoms are:

• recurrent 
• worse at night or in the early morning, or 
• obviously triggered by exercise, irritants, allergens or viral infections.

However, the symptoms and signs of asthma vary widely from person to person and the absence of typical symptoms does not exclude the diagnosis of asthma. In children, a chronic or recurring cough, in the absence of any wheeze or associated atopic features, is unlikely to be asthma.

In young children, asthma is merely a non-allergic disease that is triggered by viral infections of the airways, often labeled as asthmatic bronchitis or wheezy bronchitis. However, the older the child gets the more allergy becomes involved, and from the age of 5 years, most children with asthma have an underlying allergy. Because both asthma and allergic rhinitis are diseases that affect the airways, controlling rhinitis will help control symptoms in people who also have asthma.

Read More

Lemon for Hemorrhoids Medication

Lemon contains elements of chemical compounds such as limonene, linalin acetate, acetic geranil, fellandren, sitral and citric acid. 100 grams of lemon fruit contains: - 27 milligrams of vitamin C, - 40 milligrams of calcium, - phosphorus 22 milligrams, - 12.4 grams carbohydrate, - 0.04 milligrams of vitamin B 1, - 0.6 milligrams of iron, - Fat 0 , 1 g, - calories 37 grams - 0.8 grams of protein - 86 grams of water.

Some diseases can be treated with lemon such as tonsillitis, Malaria, Hemorrhoid, laryngitis, influenza, cough; heat pain, Constipation, Late menstruation, stomach pains during menstruation, dysentery, stomach Heartburn, Stomach Nausea, Tired, body odor, facial wrinkles.

Attempting to cure hemorrhoids without surgery is not an easy thing. Natural remedies play an important role in relieving hemorrhoids. When compared to medicinal remedies, natural remedies are cheap, available and their effect lasts for a longer duration. There are various natural remedies to get relieved of hemorrhoids, but one should keep in mind that there is no guaranteed success - some cases improve, some are cured, others don't. 

One important natural method to get relief from hemorrhoids is using the juice of a lemon. Divide the whole lemon into four parts with out removing the skin. Pour half liter of water and boil it for fifteen minutes. Allow it to cool and consume this mixture as and when required. One cup per day will help you in passing fecal smoothly. This cup of lemon juice contains bioflavonoid rich in quantity and also vitamin C. This juice helps in strengthening the blood vessels and also the capillary tubes.

Read More

Garlic as Alternative Treatments for High Cholesterol

Garlic contains many nutrients. This plant serves to maintain health and ward off diseases, ranging from worms to cancer and other degenerative diseases. Another benefit to improve memory and immunity, and prevent premature aging.

Garlic bulbs consist of a few cloves (3-12 cloves) are clustered together to form large bulbs, white and shaped like a top. The name for garlic is very diverse, namely garlic (UK), knoflook (Germany), suan (China), pills (Korea), ninniku (Japan), aglio (Italy), thoam (Arabic), ajo (Spanish).

Efficacy onion recovered to prevent and cure various diseases has been known since ancient Greece. Hippocrates advocated the use of garlic to treat wounds and grievances toxic bronchitis (inflammation of the lungs). In fact, in China famous for an old adage. If you have reached the age of 50 years and then eat the garlic for 50 days, you will increase the age of 50 years. The phrase is not true 100 percent, but suggests that garlic is important for health, so it can extend life expectancy.

Some of the herbal and nutritional supplements said to lower cholesterol include garlic. According to some studies, garlic may decrease blood levels of total cholesterol by a few percentage points. Other studies, however, suggest that it may not be as beneficial as once thought. It may also have significant side effects and/or interactions with certain medications. Garlic may prolong bleeding and blood clotting time, so garlic and garlic supplements should not be consumed prior to surgery and should not be taken with blood-thinning drugs such as Coumadin (warfarin).  

Read More

What you need to know about High Blood Cholesterol

Cholesterol is a waxy steroid of fat that is produced in the liver or intestines, fat-like substance found in the walls of cells in all parts of the body, from the nervous system to the liver to the heart. The body uses cholesterol to make hormones, bile acids, vitamin D, and other substances. Cholesterol circulates in the bloodstream but cannot travel by itself. As with oil and water, cholesterol which is fatty and blood which is watery do not mix. So cholesterol travels in packages called lipoproteins, which have fat (lipid) inside and protein outside.

High blood cholesterol is one of the major risk factors for heart disease. If there is too much cholesterol in the blood, some of the excess can become trapped in artery walls. Over time, this builds up and is called plaque. The plaque can narrow vessels and make them less flexible, a condition called atherosclerosis or hardening of the arteries. In fact, the higher your blood cholesterol level, the greater your risk for developing heart disease or having a heart attack. Heart disease is the number one killer of women and men. Each year, more than a million Americans have heart attacks, and about a half million people die from heart disease.

As mentioned above, high blood cholesterol causes “hardening of the arteries” so that arteries become narrowed and blood flow to the heart is slowed down or blocked. The blood carries oxygen to the heart, and if enough blood and oxygen cannot reach your heart, you may suffer chest pain. If the blood supply to a portion of the heart is completely cut off by a blockage, the result is a heart attack.

High blood cholesterol itself does not cause symptoms, so many people are unaware that their cholesterol level is too high. It is important to find out what your cholesterol numbers are because lowering cholesterol levels that are too high lessens the risk for developing heart disease and reduces the chance of a heart attack or dying of heart disease, even if you already have it.

Read More

Immunosuppressant Drugs To Prevent Rejection of The New Pancreas Transplantation

A pancreas transplant is an organ transplant that involves implanting a healthy pancreas (one that can produce insulin) into a person who usually has diabetes (wikipedia.org). Patients with type 1 diabetes have experienced positive results from pancreas transplants. Typically, part or all of a new pancreas is surgically implanted in the lower abdominal cavity of a patient. The old pancreas is left alone; it still makes digestive enzymes even though it doesn’t make insulin. People with successful pancreas transplants may no longer need to take insulin and may have normal blood glucose levels. In addition, many of the side effects that often accompany diabetes are also prevented, or at least slowed.

The risks for pancreas transplant include:

• Blood clots (deep venous thrombosis)
• Clotting (thrombosis) of the arteries or veins of the new pancreas
• Development of certain cancers after a few years
• Inflammation of the pancreas (pancreatitis)
• Leakage of fluid from the new pancreas where it attaches to the intestine or bladder
• Rejection

The downside to pancreas transplantation is that the body treats the new pancreas as foreign. The immune system attacks the transplanted pancreas. People with pancreas transplants must take powerful immunosuppressant drugs to prevent rejection of the new pancreas. Drugs that suppress the immune system can lower resistance to other diseases such as cancer and bacterial and viral infections. Pancreas transplantation is most often done when a patient is also receiving a new kidney. The pancreas transplant adds little further risk and offers big benefits.
However, transplant surgery is risky. Each person needs to carefully weigh the potential benefits and the risks.

Read More