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Saad J, Ryder CH, Hasan M, Keigler G, Badarny S. Primary Intracranial Hemorrhage: Characteristics, Distribution, Risk Factors, and Outcomes-A Comparative Study between Jewish and Arab Ethnic Groups in Northern Israel. J Clin Med 2023; 12:4993. [PMID: 37568395 PMCID: PMC10419471 DOI: 10.3390/jcm12154993] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2023] [Revised: 07/27/2023] [Accepted: 07/27/2023] [Indexed: 08/13/2023] Open
Abstract
Background and purpose: This study aimed to investigate the differences in intracerebral hemorrhage (ICH) between Jews and Arabs residing in northern Israel, focusing on risk factors, hemorrhage volume, and functional outcome. Methods: A retrospective analysis was conducted utilizing a population-based registry to investigate intracerebral hemorrhage (ICH) characteristics, risk factors, and outcomes. The registry consisted of inpatients diagnosed with hemorrhagic stroke. Due to the wide variation in data on ICH characteristics and the limited availability of population-based data on predictors of ICH survival and functional outcomes, we collected retrospective data on all adult patients admitted to the Galilee Medical Center with a diagnosis of ICH. Data were obtained from the registry covering the period from 2013 to 2019. Ethnic differences and risk factors associated with intracranial hemorrhage (ICH) were examined within a diverse population of 241 patients, comprising 52.70% Jews (n = 127) and 47.30% Arabs (n = 114). Results: The results of this study revealed significant differences in age, obesity rates, and intracerebral hemorrhage (ICH) location between the two ethnic groups. Hypertension emerged as the most prevalent condition among ICH patients in both ethnic groups (76.70%), followed primarily by anticoagulant use (63.60%), dyslipidemia (60.70%), diabetes (44.60%), obesity (30.60%), smoking (24.60%), and a history of cardiovascular disease (21.80%). Furthermore, 20.90% of the patients had a history of previous cerebrovascular accidents (CVA). Arab patients with ICH were generally younger (62.90 ± 16.00 years) and exhibited higher rates of obesity (38.70%) compared to Jewish patients with ICH (70.17 ± 15.24 years, 23% obesity; p = 0.001, p = 0.013, respectively). Hemorrhage volume was identified as a crucial determinant of patient outcomes, with larger volumes associated with poorer Modified Rankin Scale (mRS) scores at discharge and higher mortality rates. Interestingly, patients without hypertension had higher hemorrhage volumes compared to those with hypertension. The extent of hemorrhage into the ventricles did not significantly correlate with mRS at discharge in our dataset. Conclusions: This study highlights significant differences in the characteristics and outcomes of intracranial hemorrhage (ICH) between Jews and Arabs in northern Israel. The findings reveal variations in age, obesity rates, and ICH location between the two groups. While hypertension was the most prevalent risk factor for both populations, other risk factors differed. Notably, hemorrhage volume emerged as a crucial prognostic factor, aligning with previously published data. These findings underscore the necessity for tailored approaches that consider ethnic-specific factors in the risk assessment, prevention, and management of ICH. Further research is warranted to elucidate the underlying mechanisms and develop interventions aimed at improving outcomes and enhancing healthcare practices in ICH management.
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Affiliation(s)
- Jamal Saad
- Azrieli Faculty of Medicine, Bar Ilan University, Safed 1311502, Israel
| | - Chen Hanna Ryder
- Brain & Behavior Research Institute, Western Galilee Academic College, Acre 2412101, Israel
| | - Mahmod Hasan
- Orthopedic Department, Galilee Medical Center, Nahariya 2210001, Israel
| | - Galina Keigler
- Department of Neurology, Galilee Medical Center, Nahariya 2210001, Israel
| | - Samih Badarny
- Azrieli Faculty of Medicine, Bar Ilan University, Safed 1311502, Israel
- Department of Neurology, Galilee Medical Center, Nahariya 2210001, Israel
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Kleven RT, Huang S, Ford SM, Sakthivel K, Thomas SR, Zuccarello M, Herr AB, Holland CK. Effect of Recombinant Tissue Plasminogen Activator and 120-kHz Ultrasound on Porcine Intracranial Thrombus Density. ULTRASOUND IN MEDICINE & BIOLOGY 2023; 49:539-548. [PMID: 36336551 DOI: 10.1016/j.ultrasmedbio.2022.10.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Revised: 10/04/2022] [Accepted: 10/05/2022] [Indexed: 06/16/2023]
Abstract
Surgical intervention for the treatment of intracerebral hemorrhage (ICH) has been limited by inadequate lysis of the target thrombus. Adjuvant transcranial ultrasound exposure is hypothesized to improve thrombolysis, expedite hematoma evacuation and improve clinical outcomes. A juvenile porcine intracerebral hemorrhage model was established by direct infusion of autologous blood into the porcine white matter. Thrombi were either not treated (sham) or treated with recombinant tissue plasminogen activator alone (rt-PA only) or in combination with pulsed transcranial 120-kHz ultrasound (sonothrombolysis). After treatment, pigs were euthanized, the heads frozen and sectioned and the thrombi extracted. D-Dimer and thrombus density assays were used to assess degree of lysis. Both porcine and human D-dimer assays tested did not have sufficient sensitivity to detect porcine D-dimer. Thrombi treated with rt-PA with or without 120-kHz ultrasound had a significantly lower density compared with sham-treated thrombi. No enhancement of rt-PA-mediated thrombolysis was noted with the addition of 120-kHz ultrasound (sonothrombolysis). The thrombus density assay revealed thrombolytic efficacy caused by rt-PA in an in vivo juvenile porcine model of intracerebral hemorrhage. Transcranial sonothrombolysis did not enhance rt-PA-induced thrombolysis, likely because of the lack of exogenous cavitation nuclei.
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Affiliation(s)
- Robert T Kleven
- Department of Biomedical Engineering, College of Engineering and Applied Sciences, University of Cincinnati, Cincinnati, Ohio, USA
| | - Shenwen Huang
- Department of Biomedical Engineering, College of Engineering and Applied Sciences, University of Cincinnati, Cincinnati, Ohio, USA
| | - Samantha M Ford
- Neuroscience Program, College of Arts and Sciences, University of Cincinnati, Cincinnati, Ohio, USA
| | - Karthikeyan Sakthivel
- Medical Sciences Program, College of Medicine, University of Cincinnati, Cincinnati, Ohio, USA
| | - Seth R Thomas
- Department of Internal Medicine, Division of Cardiovascular Health and Disease, University of Cincinnati, Cincinnati, Ohio, USA
| | - Mario Zuccarello
- Department of Neurosurgery, University of Cincinnati, Cincinnati, Ohio, USA
| | - Andrew B Herr
- Division of Immunobiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Christy K Holland
- Department of Internal Medicine, Division of Cardiovascular Health and Disease, University of Cincinnati, Cincinnati, Ohio, USA; Department of Biomedical Engineering, College of Engineering and Applied Sciences, University of Cincinnati, Cincinnati, Ohio, USA.
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Kyung S, Shin K, Jeong H, Kim KD, Park J, Cho K, Lee JH, Hong GS, Kim N. Improved performance and robustness of multi-task representation learning with consistency loss between pretexts for intracranial hemorrhage identification in head CT. Med Image Anal 2022; 81:102489. [DOI: 10.1016/j.media.2022.102489] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Revised: 04/26/2022] [Accepted: 05/20/2022] [Indexed: 11/17/2022]
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Elektroschockdistanzwaffen Taser® X2 und T7. Notf Rett Med 2022. [DOI: 10.1007/s10049-020-00791-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
ZusammenfassungDie medizinische Beurteilung von Verletzungen und potenzieller todesursächlicher Relevanz einer Stromexposition durch eine Elektroschockdistanzwaffe beschränkt sich nicht allein auf die situativen Gegebenheiten und die morphologische Befunderhebung, sondern beinhaltet auch eine intensive Analyse polizeilicher Ermittlungen und die Auswertung von Zeugenaussagen sowie vorangegangener medizinischer Maßnahmen. Insbesondere bei zeitlich relevanter Nähe zwischen Exposition und Todeseintritt muss die Wirkung der übertragenen Stromimpulse in Zusammenhang mit der meist komplexen Einsatzsituation und der medizinischen Vorgeschichte des Geschädigten beurteilt werden. Ein detailliertes Wissen über die konkrete und auch abstrakte Wirkungsweise, Wirksamkeit und Risiken von Elektroschockdistanzwaffen ist hierfür unabdingbar.
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Gregório T, Pipa S, Cavaleiro P, Atanásio G, Albuquerque I, Chaves PC, Azevedo L. Assessment and Comparison of the Four Most Extensively Validated Prognostic Scales for Intracerebral Hemorrhage: Systematic Review with Meta-analysis. Neurocrit Care 2020; 30:449-466. [PMID: 30426449 DOI: 10.1007/s12028-018-0633-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
BACKGROUND/OBJECTIVE Intracerebral hemorrhage (ICH) is a devastating disorder, responsible for 10% of all strokes. Several prognostic scores have been developed for this population to predict mortality and functional outcome. The aim of this study was to determine the four most frequently validated and most widely used scores, assess their discrimination for both outcomes by means of a systematic review with meta-analysis, and compare them using meta-regression. METHODS PubMed, ISI Web of Knowledge, Scopus, and CENTRAL were searched for studies validating the ICH score, ICH-GS, modified ICH, and the FUNC score in ICH patients. C-statistic was chosen as the measure of discrimination. For each score and outcome, C-statistics were aggregated at four different time points using random effect models, and heterogeneity was evaluated using the I2 statistic. Score comparison was undertaken by pooling all C-statistics at different time points using robust variance estimation (RVE) and performing meta-regression, with the score used as the independent variable. RESULTS Fifty-three studies were found validating the original ICH score, 14 studies were found validating the ICH-GS, eight studies were found validating the FUNC score, and five studies were found validating the modified ICH score. Most studies attempted outcome prediction at 3 months or earlier. Pooled C-statistics ranged from 0.76 for FUNC functional outcome prediction at discharge to 0.85 for ICH-GS mortality prediction at 3 months, but heterogeneity was high across studies. RVE showed the ICH score retained the highest discrimination for mortality (c = 0.84), whereas the modified ICH score retained the highest discrimination for functional outcome (c = 0.80), but these differences were not statistically significant. CONCLUSIONS The ICH score is the most extensively validated score in ICH patients and, in the absence of superior prediction by other scores, should preferably be used. Further studies are needed to validate prognostic scores at longer follow-ups and assess the reasons for heterogeneity in discrimination.
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Affiliation(s)
- Tiago Gregório
- Department of Internal Medicine, Vila Nova de Gaia Hospital Centre, Rua Conceição Fernandes, 4434-502, Vila Nova de Gaia, Portugal. .,Stroke Unit, Vila Nova de Gaia Hospital Centre, Rua Conceição Fernandes, 4434-502, Vila Nova de Gaia, Portugal.
| | - Sara Pipa
- Department of Internal Medicine, Vila Nova de Gaia Hospital Centre, Rua Conceição Fernandes, 4434-502, Vila Nova de Gaia, Portugal
| | - Pedro Cavaleiro
- Intensive Care Department, Algarve University Hospital Centre, Rua Leão Penedo, 8000-386, Faro, Portugal
| | - Gabriel Atanásio
- Department of Internal Medicine, Vila Nova de Gaia Hospital Centre, Rua Conceição Fernandes, 4434-502, Vila Nova de Gaia, Portugal
| | - Inês Albuquerque
- Department of Internal Medicine, São João Hospital Centre, Alameda Prof. Hernani Monteiro, 4200-319, Porto, Portugal
| | - Paulo Castro Chaves
- Department of Internal Medicine, São João Hospital Centre, Alameda Prof. Hernani Monteiro, 4200-319, Porto, Portugal.,Stroke Unit, São João Hospital Centre, Alameda Prof. Hernani Monteiro, 4200-319, Porto, Portugal.,Department of Surgery and Physiology, Faculty of Medicine, University of Porto, Alameda Prof. Hernani Monteiro, 4200-319, Porto, Portugal
| | - Luís Azevedo
- Centre for Health Technology and Services Research and Department of Community Medicine, Information and Health Decision Sciences, Faculty of Medicine, University of Porto, Alameda Prof. Hernani Monteiro, 4200-319, Porto, Portugal
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Iqbal N, Tangella V, Nayakar G. Location and volume of intracerebral hemorrhage and their association with outcome. JOURNAL OF CURRENT RESEARCH IN SCIENTIFIC MEDICINE 2020. [DOI: 10.4103/jcrsm.jcrsm_2_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Original Intracerebral Hemorrhage Score for the Prediction of Short-Term Mortality in Cerebral Hemorrhage. Crit Care Med 2019; 47:857-864. [DOI: 10.1097/ccm.0000000000003744] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Imran I, Syahrul S, Sofia S, Farida F, Musadir N, Fajar JK. Association of angiotensin-converting enzyme G2350A gene polymorphisms with hypertension among patients with intracerebral haemorrhage. J Taibah Univ Med Sci 2019; 14:300-305. [PMID: 31435421 PMCID: PMC6694934 DOI: 10.1016/j.jtumed.2019.04.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2019] [Revised: 04/21/2019] [Accepted: 04/24/2019] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVES To evaluate the correlation of angiotensin-converting enzyme (ACE) G2350A gene polymorphisms with hypertension, brain hematoma volume (BHV), level of consciousness, and disease outcome among intracerebral haemorrhage (ICH) patients. METHODS A cross-sectional study was conducted in Zainoel Abidin General Hospital from May 2016 to June 2017. Polymerase chain reaction was used to genotype ACE G2350A gene polymorphisms. BHV was assessed using the ABC/2 volume estimation formula. Level of consciousness was assessed by Glasgow coma scale (GCS). Disease outcome was assessed using Glasgow outcome scale (GOS). Association tests for ACE G2350A genotype in the context of hypertension status, BHV, GCS score, and GOS score in subjects with ICH was analysed by multiple logistic regression. RESULTS A total of 75 ICH patients were included in the study. Of those, 59 patients exhibited hypertension, 24 patients had BHV ≥60 cm3, 16 patients possessed GCS scores ≤8, and 72 patients had GOS scores of 1-3. Our analysis determined that the A allele of the ACE G2350A gene polymorphism was significantly associated with a 3.6-fold increase in hypertension; however, this polymorphism was not associated with BHV, level of consciousness, and disease outcome among ICH patients. CONCLUSION The A allele of the ACE G2350A gene polymorphisms is associated with hypertension among ICH patients.
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Affiliation(s)
- Imran Imran
- Department of Neurology, School of Medicine, Universitas Syiah Kuala, Banda Aceh, Indonesia
| | - Syahrul Syahrul
- Department of Neurology, Dr. Zainoel Abidin Hospital, Banda Aceh, Indonesia
| | - Sofia Sofia
- Department of Biochemistry, School of Medicine, Universitas Syiah Kuala, Banda Aceh, Indonesia
| | - Farida Farida
- Department of Neurology, School of Medicine, Universitas Syiah Kuala, Banda Aceh, Indonesia
| | - Nasrul Musadir
- Department of Neurology, School of Medicine, Universitas Syiah Kuala, Banda Aceh, Indonesia
| | - Jonny K. Fajar
- Medical Research Unit, School of Medicine, Universitas Syiah Kuala, Banda Aceh, Indonesia
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