ABSTRACT
To
The Chairperson /
Secretary
Institutional Ethics
Committee – Human Research
Kamineni Institute of
Medical Sciences
Narketpally.
Subject: Submission of Dissertation / Thesis for Institutional
Ethics Committee Review for MD course in General Medicine
Respected
Sir/Madam,
I, Dr. Chakravarthula Raga Deepika
registered for MD General Medicine in the year 2021 under the guidance
of Dr.Rakesh Biswas, Professor & HOD, Department of General Medicine,
Kamineni Institute of Medical Sciences, Narketpally. I am due to appear for
MD. General Medicine in May 2024
I am submitting herewith
following documents of the project for review to Institutional Ethics Committee
– Human/Animal Research. The study shall be conducted at KIMS
Narketpally.
1.
Dissertation Topic
Approval certificate and Proforma for registration
2.
Case Record
Proforma
3.
Patient Information
Sheet
4.
Informed consent in
English and Telugu
5.
Letter from the
Department regarding satisfactory scientific scrutiny duly signed by Guide,
Co-guide, and Head of Department.
Resident Professor and HOD
Department of General
Medicine Department of General Medicine
Date: 24.08.2022 Date: 24.08.2022
Dr.T. Venkat Kishan
Co-guide
Professor
Department of
Radiology
COLLEGE NAME: KAMINENI
INSTITUTE OF MEDICAL SCIENCES
DEPARTMENT: GENERAL
MEDICINE
INTRODUCTION
Stroke is one of the leading causes of death and disability in India.
The estimated adjusted prevalence rate of stroke range, from 84-262/100,000 in rural and 334-424/100,000 in urban areas.
The incidence rate is 119-145/100,000 based on recent population-based studies.(1)
PROBLEM STATEMENT
Until 4 decades ago, the rates of stroke in low- and middle-income countries were considerably lower
than those in more economically robust countries. In the intervening years, however, the rates of stroke in
places such as southern India and rural South Africa have approximately doubled, whereas stroke rates in more
economically developed nations have decreased.
What is far more striking is that rates of disability and mortality arising from stroke are at least 10 times
greater in medically underserved regions of the world compared with the most developed nations.
The causes of these disparities are clear: above all, there is a lack of primary care treatment to screen
patients for stroke risk and to mitigate risk factors.
In addition, the lack of access to common drugs and basic medical equipment, as well as the lack of
poststroke follow-up programs, rehabilitation, and secondary stroke prevention, means that individuals
who would, in countries with better medical care, likely recover from stroke, instead have high rates of
death and disability.
Their success depends on the support and expansion of these efforts so that short-term response to
stroke, long-term stroke prevention and care, and screening and treatment of poststroke disabilities
can be improved in underserved regions and the human and economic burden on these populations
can be minimized.(2)
For every 10 people who die of stroke, four could have been saved if their blood pressure had been
regulated. Among those aged under 65, two-fifths of deaths from stroke are linked to smoking. Atrial
fibrillation, heart failure and heart attack are other important risk factors.
The incidence of stroke is declining in many developed countries, largely as a result of better
control of high blood pressure and reduced levels of smoking. However, the absolute number of strokes
continues to increase because of the ageing population.(3)
AIM:
To study the clinical and radiological profile , risk factors , management and outcomes in
cases of acute stroke
OBJECTIVES:
To study the clinical and radiological profile of stroke patients
To study the causal association of various riskfactors in acute stroke
To study the management of patients with stroke in the tertiary care center and the outcomes of their
management.
PATIENT AND METHODS
Place of study: Department of General medicine Kamineni institute of medical
sciences, Narketpally.
Study period: August 2022 to November 2024
Study design: Non-Experimental, qualitative, longitudinal observational study.
Sample size: proposed number of cases to be studied is 50.
The study will be approved by the Ethics committee of the Kamineni institute of medical
sciences Narketpally.
All patients satisfying the inclusion criteria will be enrolled in the study.
Written informed consent will be taken from the patients prior to the start of the study.
INCLUSION CRITERIA
All patients of acute stroke more than or equal to 18 years of age of both gender.
EXCLUSION CRITERIA
Patients of age <18 years
Patients not capable of giving consent
Patients not willing to participate in study
Space occupying lesions
CNS infections
Spinal cord lesions
METHODOLOGY
To document patient past events ( history and risk factors) present events(clinical findings,
investigations and management )and future events (outcomes).
CASE PROFORMA
Name:
Age:
Sex:
Op/Ip no:
Address:
|
Clinical history |
Visual hallucinations |
|
Relevant Past history |
Paresis – mono/hemi |
|
Loss of consciousness |
Plegia – mono/hemi |
|
Seizures |
Ataxia |
|
Headache |
Sensory system involvement |
|
Vomiting’s
|
Cranial nerve involvement |
|
Urinary incontinence |
Peripheral nerve involvement |
|
Aphasia |
ANS involvement |
•
Diabetes
•
Coronary artery disease
•
Other Heart disease
•
Alcohol
•
Smoking
•
Dyslipidaemia
•
Carotid bruit / stenosis
EXAMINATION FINDINGS
•
Height
•
Weight
•
BMI
•
Temperature
•
Blood pressure
•
Pulse Rate
•
Glasgow coma scale
•
CVS:
•
RS:
•
GIT:
CNS EXAMINIATIONS
•
Higher mental functions:
•
Cranial nerves:
•
Motor system:
Gait/Tone/power/Reflexes
•
Sensory: pain /touch/ temp/ pressure/
proprioception/vibration
•
Cerebellar:
• Autonomic:
• H/o previous stroke or TIA
•
Peripheral vascular disease
•
Obesity
• Physical inactivity
INVESTIGATIONS
CBP
CUE
FBS
PLBS
HBA1C
S.ELECTROLYTES
ECG
MRI / CT
2D ECHO
CAROTID ARTERY
DOPPLER
FASTING LIPID PROFILE
RADIOLOGICAL PROFILE
INFARCT
INTRAPARENCHYMAL HAEMORRHAGE
SUBARACHNOID HEMORRHAGE
CAVERNOUS SINUS THROMBOSIS
ANEURYSMS
MANAGEMENT
CONSERVATIVE MANAGEMENT:
1.PHYSIOTHERAPY:
2.MEDICATIONS:
Treatment- thrombolysis,
Preventive therapies- anti platelets , statins , anti coagulants, anti hypertensive medications(in pts
with hypertension)
3.SURGICAL MANAGEMENT:
Thrombectomy, carotid end arterectomy
OUTCOMES:
Survival
Disability
Recurrence
REFERENCES:
(1) Pandian JD, Sudhan P. Stroke epidemiology and stroke care
services in India. J Stroke. 2013 Sep;15(3):128-34. doi:
10.5853/jos.2013.15.3.128. Epub 2013 Sep 27. PMID: 24396806; PMCID:
PMC3859004.
[2 ] Norrving B, Kissela B. The global burden of stroke and need for a continuum of care. Neurology. 2013 Jan 15;80(3 Suppl 2):S5-12. doi: 10.1212/WNL.0b013e3182762397. PMID: 23319486.
[3] http://www.emro.who.int/health-topics/stroke-cerebrovascular-accident/index.html#mstart
PATIENT INFORMATION SHEET
A Study is conducted by the undersigned in the department of
General Medicine at Kamineni Institute of Medical Sciences, Narketpally on
“SEPTEMBER 2022 TO AUGUST 2024”
I invite you to participate in the above study.
…………………………………………………. will be collected from the patients. No cost will be
incurred by the patients. No monetary gains or financial assistance will be
provided to the patients.
The data collected in the study will be used only for
research purpose and will be kept strictly confidential. Your participation in
this study is voluntary and you have the right to refuse at any point of time
during the period of study. Refusal to participate in the study will not affect
the treatment or relation with the clinician.
We
are thankful for your cooperation.
Dr.
CH RAGA DEEPIKA Dr.
RAKESH BISWAS
Resident Guide
Department
of General Medicine Department
of General Medicine
Dr. T.
Venkat Kishan
Co – Guide
Professor
Department
of Radiology
|
Project Title |
CLINICAL AND RADIOLOGICAL PROFILE, RISK FACTORS, MANAGEMENT AND
OUTCOMES IN CASES OF ACUTE STROKE |
I/
We, relative of patient………………………..have read and understood the information
provided in the “Patient information sheet” and have been informed and
explained the purpose and nature of the evaluation in the language I
understand.
I
am aware of the fact that I may not derive any benefit from the evaluation and
that I reserve the right to opt out of the study at any point of time
I
willingly agree to participate in this study
Patient’s
sign/thumb impression Witness’s
sign/thumb impression.
Name: Name:
Date: Date:
Residents
Sign:
Residents
Name: Dr.CH. Raga Deepika
Date:
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