Post-stroke immunosuppression: Exploring potential implications beyond infections

Remote Organ Damage Induced by Stroke: Molecular Mechanisms and Comprehensive Interventions

Significance: Damage after stroke is not only limited to the brain but also often occurs in remote organs, including the heart, lung, liver, kidney, digestive tract, and spleen, which are frequently affected by complex pathophysiological changes. The organs in the human body are closely connected, and signals transmitted through various molecular substances could regulate the pathophysiological changes of remote organs. Recent Advances: The latest studies have shown that inflammatory response plays an important role in remote organ damage after stroke, and can aggravate remote organ damage by activating oxidative stress, sympathetic axis, and hypothalamic axis, and disturbing immunological homeostasis. Remote organ damage can also cause damage to the brain, aggravating inflammatory response and oxidative damage. Critical Issues: Therefore, an in-depth exploration of inflammatory and oxidative mechanisms and adopting corresponding comprehensive intervention strategies have become necessary to reduce damage to remote organs and promote brain protection. Future Directions: The comprehensive intervention strategy involves multifaceted treatment methods such as inflammation regulation, antioxidants, and neural stem cell differentiation. It provides a promising treatment alternative for the comprehensive recovery of stroke patients and an inspiration for future research and treatment. The various organs of the human body are interconnected at the molecular level. Only through comprehensive intervention at the molecular and organ levels can we save remote organ damage and protect the brain after stroke to the greatest extent. Antioxid. Redox Signal. 00, 000-000.

The relationship between psychological distress and frailty in stroke patients: the mediating effect of depression

BACKGROUND

Frailty is a significant factor affecting the quality of life of stroke patients. psychological distress is an essential factor affecting depression in stroke patients. However, the mediating role of depression between psychological distress and debilitation has not been explored.

METHODS

In this study, 315 stroke patients in Shandong and Liaoning provinces were investigated by convenience sampling method from May 2024 to October 2024. Questionnaires included Frailty Scale and Psychological Distress and Depression scale.

RESULTS

In this study, psychological distress scores (4.16 ± 2.29), depression scores (8.81 ± 4.55) and frailty scores (8.92 ± 4.09) were obtained. There was a significant positive correlation between depression and psychological distress in stroke patients (r = 0.483, P < 0.001), depression and frailty (r = 0.575, P < 0.001). There was a significant positive correlation between psychological distress and frailty in stroke patients (r = 0.391, P < 0.001). The direct effect of psychological distress in stroke patients was 0.264. The direct mediating effect of depression on psychological distress and frailty was 0.435.

CONCLUSION

This study provides further insights into the psychological mechanism of psychological distress and frailty in stroke patients. Clinicians and nurses can actively help stroke patients reduce psychological distress, reduce the depression of stroke patients, so as to reduce the occurrence of frailty and improve the quality of life of patients.

Bacteriological Profile of Patients With Stroke-Associated Pneumonia and Antimicrobial Susceptibility of Pathogens: A Cross-Sectional Study

BACKGROUND AND OBJECTIVES

Stroke-associated pneumonia (SAP) is the aftermath of aspiration of oropharyngeal secretions or stomach content. Mechanical ventilation and lowered immunity and consciousness facilitate the etiopathogenesis of SAP. Antibiotic prophylaxis and repeated culture and sensitivity testing dampen the drug susceptibility patterns of the pathogens. We accomplished this study to determine the bacteriological profile of patients with SAP and the antimicrobial susceptibility patterns of the pathogenic bacteria.

METHODS

This cross-sectional study was executed from August 2022 to May 2024 at Kalinga Institute of Medical Sciences (KIMS), Bhubaneswar, India. We included adult patients who endured treatment in the neurosurgery intensive care unit (ICU) throughout the study period due to a stroke and developed pneumonia within 48 hours of admission. The endotracheal tube (ET) aspirate and bronchoalveolar lavage (BAL) fluid specimens collected from the eligible participants were analyzed. Enriched and selective media such as 5% sheep blood agar, chocolate agar, and MacConkey agar were used to culture pathogenic bacteria. The VITEK 2 system was used to identify isolates and assess antimicrobial susceptibility testing (AST). The pathogenic bacteria and their antimicrobial susceptibility patterns were gauged. We leveraged R software (version 4.4.1) for data analysis.

RESULTS

Two hundred forty bacterial isolates were found in the 181 eligible patients. Forty-eight (26.52%) participants were females. The median age of the study population was 64.50 (58.74-70.24) years. Fifty-nine (32.60%) participants had two different isolates in their culture reports. We found the following non-fermenters: Acinetobacter baumannii (55, 22.92%), Pseudomonas aeruginosa (31, 12.92%), Burkholderia cepacia (6, 2.50%), and Elizabethkingia meningoseptica (4, 1.67%). Klebsiella pneumoniae (88, 36.67%) and Escherichia coli (15, 6.25%) were the most commonly noticed Enterobacterales. Other Enterobacterales were Proteus mirabilis (9, 3.75%), Serratia marcescens (8, 3.33%), Klebsiella oxytoca (3, 1.25%), Enterobacter aerogenes (1, 0.42%), Providentia stuartii (1, 0.42%), and Enterobacter cloacae complex (5, 2.08%). Staphylococcus aureus (14, 5.83%) was the only gram-positive cocci in our study population. The sensitivity of A. baumannii was maximum for minocycline. P. aeruginosa was highly sensitive to imipenem and completely resistant to tigecycline. Minocycline was the only effective drug against E. meningoseptica. Similarly, the Enterobacterales had the greatest sensitivity for tigecycline. All 14 specimens of S. aureus were sensitive to both vancomycin and linezolid. They were responsive to tigecycline as well.

CONCLUSION

The most common pathogenic bacteria in our study were K. pneumoniae, A. baumannii, P. aeruginosa, E. coli, and S. aureus. Enterobacterales were highly sensitive to tigecycline. A. baumannii and E. meningoseptica had maximum sensitivity for minocycline. All isolates of S. aureus were sensitive to both vancomycin and linezolid. We warrant further research with a larger sample size to investigate the bacteriological profile among other critically ill patients and their AST findings.

IL-33 in Ischemic Stroke: Brain vs. Periphery

Cerebrovascular disease is the second-leading cause of death and disability worldwide, with stroke being the most common cause. In ischemic stroke, several processes combine to produce immunosuppression, leaving the post-stroke body susceptible to infection, which in turn affects neuroinflammation. Interleukin-33 (IL-33), a member of the interleukin-1 family (IL-1), functions as a modulator of immune responses and inflammation, playing a crucial role in the establishment of immunologic responses. IL-33 has been shown to have a protective effect on brain injury and represents a potential target by modulating inflammatory cytokines and stimulating immune regulatory cells. With an emphasis on preclinical and clinical studies, this review covers the impact of IL-33 on immune system mechanisms following ischemic stroke.

New Perspectives in Neuroprotection for Ischemic Stroke

The constant failure of new neuroprotective therapies for ischemic stroke has partially halted the search for new therapies in recent years, mainly because of the high investment risk required to develop a new treatment for a complex pathology, such as stroke, with a narrow intervention window and associated comorbidities. However, owing to recent progress in understanding the stroke pathophysiology, improvement in patient care in stroke units, development of new imaging techniques, search for new biomarkers for early diagnosis, and increasingly widespread use of mechanical recanalization therapies, new opportunities have opened for the study of neuroprotection. This review summarizes the main protective agents currently in use, some of which are already in the clinical evaluation phase. It also includes an analysis of how recanalization therapies, new imaging techniques, and biomarkers have improved their efficacy.