Outcome predictors in anterior and posterior ischemic strokes: a study based on the Iranian SITS registry

Ischemic stroke is the major form of stroke with two separate vascular territories. Many risk factors are related to stroke outcomes in both territories. The present descriptive research was carried out on the basis of data obtained from the Safe Implementation of Treatments in Stroke (SITS) registry on Iranian intravenous thrombolysis ischemic stroke cases. Vascular territory involved in each case and three-month excellent outcome, functional independence, mortality rate, and brain hemorrhage occurrence were determined. Univariable and multivariable logistics regression analyses were utilized in order to investigate association of ischemic stroke outcomes with the vascular territory involved and other related factors. Among 1566 patients 95.4% was anterior circulation stroke patients and 4.6% was posterior circulation stroke cases. There is no significant association between vascular territory with mortality (OR of PCS vs ACS: 0.74, 95% CI 0.37-1.46), excellent functional outcome (OR 0.72, 95% CI 0.44-1.19), functional outcome (OR 0.86, 95% CI 0.52-1.42) and local hemorrhage (OR 0.98, 95% CI 0.30-3.21). Among major risk factors, age, diabetes, NIHSS score and admission duration, increased significantly odds of three-month mortality, excellent outcome, and functional independence in the multivariate analysis. The highest of odds was in NIHSS score with a dose-response association. The vascular territory was not an outcome predictor in ischemic strokes. The most important predictor was baseline NIHSS.

Early and mid-term outcomes of carotid angioplasty and stent placement in 579 patients

BACKGROUND AND PURPOSE

Carotid angioplasty and stenting (CAS) could be considered for preventing stroke in patients with carotid artery stenosis. This study aimed to determine the incidence and the risk factors of the early and mid-term complications associated with CAS.

METHODS

This is a retrospective cohort study conducted at Shiraz University of Medical Sciences from March 2011 to March 2019. Patients at high risk and standard risk for carotid endarterectomy were included. The primary composite outcome was defined as stroke, myocardial infarction (MI), and death in the first 30 days after CAS. All-cause mortality, vascular mortality, and stroke were investigated during mid-term follow-up.

RESULTS

A total of 579 patients (618 CAS) were recruited (mean age: 71.52 years). Overall, 394 (68.40%), 211 (36.63%), 179 (31.07%), and 96 (16.72%) patients had hypertension, dyslipidemia, diabetes mellitus, or were cigarette smokers, respectively. Primary composite outcomes were observed in 2.59% of patients (1.55% stroke, 0.69% MI, and 1.72% death). Atrial fibrillation was a predictor of primary composite outcome in multivariate logistic regression (p = .048). The presence of total occlusion in the contralateral carotid artery was significantly associated with the risk of stroke in univariate logistic regression (p = .041). The patients were followed for a period ranging from 1 to 83 months. The overall survival rate for all-cause mortality was 93.48% at 1 year, 77.24% at 5 years, and 52.92% at 8 years. All-cause mortality was significantly higher among patients with symptomatic carotid stenosis (p = .014).

CONCLUSION

CAS provides acceptable short-term and mid-term outcomes in a unique population of high- and standard-surgical-risk, symptomatic and asymptomatic, octogenarian, and nonoctogenarian patients.

Safety and Outcomes of Intravenous Thrombolytic Therapy in Ischemic Stroke Patients with COVID-19: CASCADE Initiative

BACKGROUND

There is little information regarding the safety of intravenous tissue plasminogen activator (IV-tPA) in patients with stroke and COVID-19.

METHODS

This multicenter study included consecutive stroke patients with and without COVID-19 treated with IV-tPA between February 18, 2019, to December 31, 2020, at 9 centers participating in the CASCADE initiative. Clinical outcomes included modified Rankin Scale (mRS) at hospital discharge, in-hospital mortality, the rate of hemorrhagic transformation. Using Bayesian multiple regression and after adjusting for variables with significant value in univariable analysis, we reported the posterior adjusted odds ratio (OR, with 95% Credible Intervals [CrI]) of the main outcomes.

RESULTS

A total of 545 stroke patients, including 101 patients with COVID-19 were evaluated. Patients with COVID-19 had a more severe stroke at admission. In the study cohort, 85 (15.9%) patients had a hemorrhagic transformation, and 72 (13.1%) died in the hospital. After adjustment for confounding variables, discharge mRS score ≥2 (OR: 0.73, 95% CrI: 0.16, 3.05), in-hospital mortality (OR: 2.06, 95% CrI: 0.76, 5.53), and hemorrhagic transformation (OR: 1.514, 95% CrI: 0.66, 3.31) were similar in COVID-19 and non COVID-19 patients. High-sensitivity C reactive protein level was a predictor of hemorrhagic transformation in all cases (OR:1.01, 95%CI: 1.0026, 1.018), including those with COVID-19 (OR:1.024, 95%CI:1.002, 1.054).

CONCLUSION

IV-tPA treatment in patients with acute ischemic stroke and COVID-19 was not associated with an increased risk of disability, mortality, and hemorrhagic transformation compared to those without COVID-19. IV-tPA should continue to be considered as the standard of care in patients with hyper acute stroke and COVID-19.

Vitamin B12 Administration Facilitates The Antipsychotic And Pain-Relieving Effects Of Quetiapine, In The Alzheimer Patients With Psychotic Symptoms

BACKGROUND

Psychotic symptoms in Alzheimer's disease (AD) patients are a problem in medicine. The efficacy of the vitamin B12 on the treatment of the psychotic symptoms of the AD patients in the association with antipsychotic drugs Quetiapine and Risperidone, was evaluated in this Study.

METHODS

The effects of vitamin B12 along with two other drugs were studied on the Mini-Mental State Examination (MMSE), Clinical Global Impression (CGI), Brief Psychiatric Rating Scale (BPRS) and pain Visual Analogue Scale (VAS) in 47 AD patients with psychotic symptoms, including 4 groups, psychotic AD patients treated with Risperidone, Risperidone plus vitamin B12, Quetiapine and Quetiapine plus vitamin B12 .

RESULTS

The results showed that Quetiapine improved all of the psychotic criteria, while Quetiapine plus vitamin B12 had better results on BPRS after 2 weeks, VAS score and MMSE. Risperidone also improves all of the criteria except MMSE and drug efficacy index, while, vitamin B12 neutralize the effects of the Risperidone on the BPRS, VAS, and severity of illness.

CONCLUSION

Due to these results, Quetiapine is the preferred antipsychotics drug and Vitamin B12 plays an effective role in treatment as an adjunct therapy.

The effect of head cooling and remote ischemic conditioning on patients with traumatic brain injury

Cerebral impairment caused by an external force to the head is known as traumatic brain injury (TBI). The aim of this study was to determine the role of local hypothermia and remote ischemic conditioning (RIC) on oxidative stress, inflammatory response after TBI, and other involved variables. The present study is a clinical trial on 84 patients with TBI who were divided into 4 groups. The head cooling for 1.5 to 6 hr was performed in the first three days after TBI. RIC intervention was performed within the golden time after TBI in the form of four 5-min cycles with full cuff and 5 min of emptying of cuff. The group receiving the head cooling technique recovered better than the group receiving the RIC technique. Generally, combination of the two interventions of head cooling and RIC techniques is more effective on the improvement of clinical status of patients than each separate technique.

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The effect of the head cooling method in controlling secondary injury in patients with TBI.

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The effect of the RIC method in controlling secondary injury in patients with TBI.

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Comparison of two interventions of head cooling and RIC.

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Evaluation of clinical and paraclinical parameters.

Vitiligo and social acceptance

BACKGROUND AND AIM

Vitiligo is a chronic skin disease characterized by a total or partial loss of melanocytes from the epidermis and other tissues of the skin. It is placed in the class of secondary psychiatric disorders and can also lead to psychological problems. The main aim of this study was to assess social acceptance in vitiligo patients.

METHODS

This cross-sectional study was conducted on all of the patients (n=150) with vitiligo who were referred to dermatology clinics in Rafsanjan, Iran. The patients completed a social acceptability questionnaire (Marlowe-Crowne Social Desirability Scale), and information regarding their demographic characteristics was also collected. Data were gathered and analyzed with descriptive and inferential statistics using SPSS-19 software.

RESULTS

The mean age of the patients was 27.56±10.53 years and 65.9% were female. Mean score of social acceptance among the patients was 13.51±7.08. The results showed that the mean scores of social acceptance were significantly lower in women, in those with single marital status, in those with face and neck lesions, and in those with disease duration less than 5 years.

CONCLUSION

The results showed that certain groups of patients with vitiligo are at greater risk of experiencing lower social acceptance.

Acoustical gas-leak detection in the presence of multiple reflections, dispersion, and uncorrelated noise using optimized residual complexity

Precise acoustical leak detection calls for robust time-delay estimates, which minimize the probability of false alarms in the face of dispersive propagation, multiple reflections, and uncorrelated background noise. Providing evidence that higher order modes and multi-reflected signals behave like sets of correlated noise, this work uses a regression model to optimize residual complexity in the presence of both correlated and uncorrelated noise. This optimized residual complexity (ORC) is highly robust since it takes into account both the level and complexity of noise. The lower complexity of the dispersive modes and multiple reflections, compared to the complexity of the plane mode, points to the robustness of ORC against multiple reflections and dispersion. Experimental investigations using recorded sounds of gas leaking from a pipe confirm the robustness of ORC against multiple reflections. Numerical simulations also show robustness against dispersive modes, even when they disturb the linearity of the cross-spectrum phase. Comparisons with other methods-mutual information, cross correlation, and residual complexity-underline the general advantages of ORC in terms of robustness in the presence of reflection and dispersion, against both correlated and uncorrelated noise, and to short signals.

Frequency of Anxiety in Patients With Drug Poisoning in Rafsanjan City, Iran, in 2013

BACKGROUND

Expansion of technology and progression of sciences have led to wider access to agricultural and industrial drugs and chemicals, which has resulted in many problems. Both in wanted and unwanted ways people may take these toxic agents, which perhaps may be along with many unpredictable, life-threatening and mortal outcomes. Based on many studies, most of intentional poisonings arise from an origin of patients' psychological backgrounds, which confirms necessity and importance of the recent study.

OBJECTIVES

This study aimed to study the prevalence of psychiatric disorders in patients with drug poisoning.

PATIENTS AND METHODS

In this descriptive cross-sectional study, 116 cases of poisoning referred to emergency room of Ali-Ebn-Abitaleb Hospital in Rafsanjan city, Iran, were randomly selected. Frequency of anxiety among participants was evaluated through the Spielberger questionnaire. A past history of depression and obsession was also evaluated through interview by a psychiatrist based on diagnostic and statistical manual of mental disorders (DSM-5) criteria. All data were then collected and analyzed using SPSS version 17.

RESULTS

Anxiety, as the second most common reason of psychiatric disorders in cases of poisoning, with a prevalence of 12.1% in form of mild, 75.9% moderate and 12.1% severe, was confirmed among the participants of this study.

CONCLUSIONS

The prevalence of anxiety among cases of poisoning with both drugs and chemicals are noticeably higher than general population. This fact strongly suggests the necessity of in-advance consultation and treatment of any underlying psychiatric disorders of patients to prevent prospective complications.

Application of direct search optimization for pharmacokinetic parameter estimation

PURPOSE

For simple pharmacokinetic compartmental models, analytical solution to the governing differential equations along with common graphical methods provide a mean to evaluate the associated rate constants. These graphical methods, however, can not be used for the more complex multi-compartment models. Furthermore, parameter estimation using slope and intercept values from the graphical methods is often accompanied with error. In this study a numerical solution is applied for the solution of the governing differential equations and a simple direct search optimization procedure utilizing random numbers is used for pharmacokinetic parameter estimation.

METHOD

The methodology is demonstrated with reference to experimental literature data for ciprofloxacin and ofloxacin whose pharmacokinetic behavior has been reported in terms of a two-compartment model.

RESULTS

Examination of the predicted drug concentrations from the graphical method and the optimization methodology indicate that both methods have comparable accuracy in predicting the drug concentrations. The graphical method, however, only shows good accuracy in the early stages both after i.v. and oral drug administration whereas the optimization procedure, due to the nature of the objective function formulation, provides good accuracy over the entire range of times after drug administration.

CONCLUSIONS

The methodology is simple, provides optimized parameters which accurately predict drug concentrations, and is flexible to include more weight on the early-time data or be extended to multi-compartment models.