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Objective: To find out the frequency of raised C- reactive protein (CRP) levels in patients with first-ever acute ischemic stroke. Methodology: This hospital based descriptive (case series) study was carried out in Neurology Unit, Lady Reading Hospital, Peshawar, Pakistan from March 2011 to December 2011. A total of 100 patients with first-ever acute ischemic stroke, aged 18 years and above and of either gender, were included by convenient sampling technique. National Institute of Health stroke scale (NIHSS) was measured at the time of admission to assess stroke severity. Within 24 hours of admission high-sensitivity (hs)-CRP levels were measured. Data were analyzed using SPSS version 15.0. Results: Out of 100 patients, 58(58%) were females and 42 (42%) were males. Mean age was 64.7+14 years. Sixty seven patients (27 males & 40 females) had raised hs-CRP levels. Out of 67 patients with raised hs-CRP, 25 (37.31%) patients had a severe (NIHSS 15-24 ) and 19 (28.36%) patients had a very severe stroke (NIHSS >25). Thirty one (46.27%) patients had hs-CRP level of >3.0 mg/L having a high risk of ischemic stroke while 22/67 (32.8%) with hs- CRP level of 1.0-3.0 mg/L had an average risk of ischemic stroke. Fourteen (20.89%) patients had hs-CRP level of <1.0 mg/L and had low risk of ischemic stroke. Mean serum level of hs- CRP in ischemic stroke patients was 23+11.24 mg/L. Conclusion: hs-CRP is elevated in a significant number of patients with acute ischemic stroke. An elevated CRP was associated with increased stroke severity. [ABSTRACT FROM AUTHOR]

Objective: To determine whether a single or multiple risk factors have a relative significance on the mortality and morbidity of stroke and whether previous treatment of major risk factors like hypertension and diabetes mellitus had any positive influence on the clinical outcome. Methodology: One thousand consecutive cases of acute stroke were included in this prospective descriptive study conducted at the Dept. of Neurology, Jinnah Postgraduate Medical Centre, Karachi from Dec. 1985 to July 1988. A special proforma was designed to collect all the relevant clinical information. Functional status was assessed by using the Barthel Index activity score. Scores obtained at admission were compared with the scores obtained at six weeks follow-up. The results were then analyzed in the background of various risk factors present. Similar observations were made in assessing the mortality. The pre-stroke treatment status of major risk factors like hypertension and diabetes mellitus was also studied. Results: Of the 1000 cases, 61% were male and 39% female. Majority of the cases were in the age group 60-69 years. Hypertension (HTN) alone was present in 58.3% followed by diabetes mellitus (DM) 5%, ischemic heart disease (IHD) 1.3%, whereas in 19.8% HTN, DM, IHD were present in various combinations, 1.5% had Valvular Heart Disease (VHD) while 14.1% had none of the above risk factors. Six-weeks follow-up was available on (673/1000) 67% cases. Gross mortality was 59% (396/673). Higher mortality was seen in cases with Glasgow Coma Scale (GCS) range 3-9/15. Risk factor profile in fatal cases showed that 221/379 (58%) had HTN, 21/32 (65%) had DM, 6/12 (50%) had IHD and 6/10 (60%) had Valvular heart disease (VHD). Some patients had multiple risk factors, among those 60/95 (63%) had HTN + DM, 19/41 (46%) had HTN + IHD, 5/7 (71%) had DM+ IHD, 11/16 (68%) had HTN + DM + IHD while 47/81 (58%) had none of the above risk factors. Relative influence of individual risk factor or in combination was not statistically significant. The functional recovery showed no significant relative difference among patients with different risk factors. There was no significant difference in the outcome among treated and untreated hypertensive and diabetic patients. Conclusions: Individual or multiple risk factors do not have a relative influence on the higher morbidity and mortality in stroke. For poor prognosis severity of stoke at onset is more important than the type of risk factors. Furthermore, there was no difference in outcome in patients who got pre-stroke treatment compared to those who had no treatment. [ABSTRACT FROM AUTHOR]

Objective: To determine the risk factors and prognosis of stroke in a tertiary care hospital of Peshawar. Design: Descriptive observational study. Place of Duration: Medical department, Khyber teaching hospital Peshawar from June 2005 to august 2006. Material and Methods: A questionnaire was prepared in accordance with the objectives of the study. Questionnaire contained detailed history, General physical examination, and neurological examination. Prognosis of the disease was studied with the help of Glasgow coma scale (severity of unconsciousness) scoring system. Results: One hundred and eighty-three patients with established diagnosis of stroke were selected. Forty-seven (25.68%) had more than one risk factors. The age range of the patients was from 31-92 years with mean age of 57 years. Out of total 111960.65%) were males and 72(39.34%) were females. The distribution of risk factors was: hypertension 95(51.91%), diabetes 56(30.60%), hyperlipidemia 21(11.47%), smoking 23(12.56%), ischemic heart diseases 21(11.47%), atrial fibrillation 5(2.73%), obesity 5(2.73%), physical inactivity 2(1.09%), history of heparin or warfarine 2(1.09%) and history of oral contraceptives 1(0.54%). The prognosis of the disease based on Glasgow coma scale scoring system (severity of unconsciousness) was studied only in 122(66.66%) patients. Out of 122 patients 42.62% had score more than ten, 35.24% scored between 6-10 and 22.13% had score less than five. Conclusion: Hypertension, diabetes, hyperlipidemia and smoking are major modifiable risk factors of stroke in our patients. Of total patients in whom GCS scoring war recorded, more than 50% had unsatisfactory Glasgow coma scale score, which indicates poor prognosis. [ABSTRACT FROM AUTHOR]