statins in stroke

Press release

Statins still not prescribed at Discharge among 1 in 4 Stroke Patients inspite of large awareness campaign.

Current guidelines call for in-hospital initiation of statin therapy for patients with stroke or transient ischemic attack (TIA) of atherosclerotic origin and continuing statin therapy in stroke patients at the time of discharge.

However, an observational study conducted in Ratnagiri which was supported by The Niramal Clinics finds that 1 in 4 of these patients is still not prescribed statins at hospital discharge and that reports from clinical trials documenting the effectiveness of statins in secondary stroke prevention apparently had no lasting impact on clinical practice. This is inspite of the fact that the cost of statins have come down significantly after many Indian companies have started maufracturing the medicine.

Incidentally I came to read a good article related to the issue in which a very large cohort was studied. "Approximately 1 in 10 stroke patients experience another stroke within a week," said lead study author Bruce Ovbiagele, MD, MsC, director of the UCLA Stroke Prevention Program at the University of California, Los Angeles. "The hospital encounter provides a window of opportunity to ensure prompt and appropriate initiation of treatments, such as statins, that could prevent another stroke."

A simple observation and recording of prescriptions were done in indoor patients and OPD patients following up with another doctor to assess trends in discharge statin treatment and to see whether such treatment changed in response to dissemination of results from the Stroke Prevention by Aggressive Reduction in Cholesterol Levels (SPARCL) trial. They also analyzed factors that might predict whether patients would get statins or not. The study pattern was not revealed to any colleague doctor to avoid bias factor. The study lasted for a period of about 9 months and involved 500 entries.

During the study period, discharge statin prescription rates climbed "steadily but modestly," they write, from 75.7% to 84.8%. Young doctors were found to more often omit a statin prescription. General practitioners were more consistent with prescriptions. Combination medications were less used though they had the benefit of cost control and patient compliance. Patients who presented with TIA rather than ischemic stroke, who had known coronary artery disease, or who had known peripheral vascular disease were also less likely to receive discharge statin prescriptions. An estimated 28% patient were not prescribed statins though it was indicated.

"While statin use after stroke improved over time, 28% of eligible stroke patients still leave the hospital without statin treatment, which unnecessarily exposes them to the risk of another stroke. Colleague doctors should take note of this and update themselves about these newer protocols. It may be worth educating the population about these medicines, as has been done in many advanced countries, since they have the potential to reduce the economic and social burden of paralysis " Dr. Pratyush Chaudhuri said.

This study was funded by the Nirmal clinics, Ratnagiri.

Press Release: Embargoed until 00.01 am British Summer Time on Tuesday 15th June 2010

Simple Injection Could Save the Lives of Thousands of Accident Victims Worldwide

If recently injured patients with serious bleeding were to receive a cheap, widely available and easily administered drug to help their blood to clot, tens of thousands of lives could be saved every year, according to a paper published on-line on Tuesday 15 June by the medical journal, The Lancet.

The results of the international CRASH-2 trial, show that early administration of tranexamic acid (TXA) to patients with recent, severe bleeding injuries saves lives, with no evidence of adverse effects from unwanted clotting.

The CRASH-2 trial was a large, randomised trial involving over 20,000 adult patients in 274 hospitals across 40 countries. It is the first trial of TXA in injured patients, although smaller trials have shown that it reduces bleeding in surgical patients.

Dr Pratyush Chaudhuri from Parkar Hospital was actively involved in the research and recruited 102 during the four years of trial recruitment.

The drug helps by reducing clot breakdown. Although this would be advantageous in patients with severe bleeding, doctors were worried that TXA might increase the risk of complications, such as heart attacks, strokes and clots in the lungs. The results of this trial show that TXA reduces death from bleeding without any increase in these complications.

Severely injured adults were enrolled in the trial if they had significant bleeding, or were at risk of significant bleeding and were within a few hours of injury. The researchers studied the numbers of deaths in hospital within four weeks of injury in the group and found that TXA reduced the chances of death due to massive blood loss by about one sixth.

The researchers estimate that administering TXA soon after injury could prevent up to 100,000 deaths per year across the world. “In India this treatment could prevent 12865 deaths, which amounts to about 18% of deaths due to severe haemorrhage, each year said Dr Pratyush Chaudhuri

Dr Pratyush Chaudhuri said about the results “this study provides us a simple and affordable tool , particularly relevant for developing countries where emergency services for trauma is rarely available in time]”


Contact:
To interview Dr. Pratyush Chaudhuri, contact 9226711139 , pratyushchaudhuri@email.com, www.drpratyush.hpage.com, www.thinkoblique.blogspot.com

My vision of the future Nirmal Hospital

Monument for the proposed Nirmal centre for science and art.

Sketch of third ventricular colloid cyst -inter-hemisphere trans callosal approach.

Shiva the drum beater of eternity

Sublime clock.

Myself sleeping in the deluge of time at 38

Dear friends of the Neuro-clinic Club
It is a pleasure every sunday morning to be discussing wonderful cases and topics during the clinics. Your enthusiasm is well appreciated and I hope somewhere you are benefiting from the interactions. Do write your openions on this site. there is a need to identify the areas in which we can change our society/ town for the sake of good by improvising our professional services. Hope we shal continue to have many more clinics in future.

longman - musician and children.

Sketch of surgical management of occipital depressed fracture.

This is a study of the base of skull - sketch of ballpen on paper.

The Icon of NIRMAL CHILDRENS HOSPITAL

It shows the energy of youth leading the way with the knowledge of experince. I made this about 6 months earlier thinking of my child and my parents and realised that the picture had no space for me- Because I had work to do.

I began my career about 5 years earlier In the present town which is no different from the rest of India ( may be it is among the better, in terms of its political stability, compared to some other parts of the country). I was then looking out for a place where there were no neurosurgeons and the service was needed. Having little funds to start with I was looking around for association with other setups of acceptable standards where neurosurgery could find some respectful place. I was well aware about the hurdles that were likely, since this was a new service dealing with a very sensitive part of the body.
Thinking retrospectively – I should have asked myself – Why is it that it took 2005 for a neurosurgeon to come to this small on the highway town?
I was motivated to leave the city by some of my senior colleagues. Dr Rituraj Yadav was my lecturer who had moved of to Nanded and started the service successfully way back in 1998, Dr Umesh Gadpal started work in Akola (any body familiar with this state of India know the geographic adversities of these places). Dr Ghadpal is well established and presently in the process of major expansion. My closest colleague , Dr Gopal Sharma settled in Nawasher, Panjab and now in the process of expanding his hospital. I still remember my professor Dr DA Palande , mentioning the need for us residents to get basic neurosurgical training so that the patients need not have to come far to the city hospital. Lastly and probably the most important motivation came from Prof BK Misra during my post qualification training at Hinduja hospital, when at the end of 18 months, he told me to go ahead and practice what I had learned. These teachers and colleagues motivate young doctors like us to gather the courage and start challenging work like Neurosurgery in a completely new area. I never had a technical problem. Advice and technical support are easily available from Indian masters with no difficulty.
But then why and where is the problem because of which Medical progress in the smaller towns is staggeringly slow?
Is it that the smaller towns are hostile to new doctors? – Not at all. Though it does take some time for people to accept a new service, it is gradually well recognized.
Are the bigger towns a reason for the backward state of the smaller towns? Maybe to some extent. Commission based practice, which is an extension of the local commerce practice, becomes the IQ limit of many colleagues from neighboring towns instead of actually improvising on innovativeness or quality service. But I realized that a little tolerance to such nuisance and continued focus on our service is logically a good solution to maintaining popularity in this land of icons and gods.
THEN WHERE IS THE CORE PROBLEM??

Introduction

Hi!
I start this blog in order to express my openion about the present situation of health facilities in peripheral India and some of my other personal views. I am a specialist in neurosurgery who opted to settle in a small town in my country where the facility was not available. 4 years later there is much to analyse as to why India remains as it is.