scholarly journals Spontaneous angiogram-negative subarachnoid hemorrhage: a retrospective single center cohort study

2021 ◽  
Author(s):  
Alexander Achrén ◽  
Rahul Raj ◽  
Jari Siironen ◽  
Aki Laakso ◽  
Johan Marjamaa
Keyword(s):  
Logistic Regression ◽  
Subarachnoid Hemorrhage ◽  
External Ventricular Drain ◽  
Unfavorable Outcome ◽  
Favorable Outcome ◽  
World Federation ◽  
Multivariable Logistic Regression Analysis ◽  
Low Grade ◽  
Acute Hydrocephalus ◽  
Multivariable Logistic Regression

Abstract Background Spontaneous angiogram-negative subarachnoid hemorrhage (SAH) is considered a benign illness with little of the aneurysmal SAH-related complications. We describe the clinical course, SAH-related complications, and outcome of patients with angiogram-negative SAH. Methods We retrospectively reviewed all adult patients admitted to a neurosurgical intensive care unit during 2004–2018 due to spontaneous angiogram-negative SAH. Our primary outcome was a dichotomized Glasgow Outcome Scale (GOS) at 3 months. We assessed factors that associated with outcome using multivariable logistic regression analysis. Results Of the 108 patients included, 84% had a favorable outcome (GOS 4–5), and mortality was 5% within 1 year. The median age was 58 years, 51% were female, and 93% had a low-grade SAH (World Federation of Neurosurgical Societies grading I–III). The median number of angiograms performed per patient was two. Thirty percent of patients showed radiological signs of acute hydrocephalus, 28% were acutely treated with an external ventricular drain, 13% received active vasospasm treatment and 17% received a permanent shunt. In the multivariable logistic regression model, only acute hydrocephalus associated with unfavorable outcome (odds ratio = 4.05, 95% confidence interval = 1.05–15.73). Two patients had a new bleeding episode. Conclusion SAH-related complications such as hydrocephalus and vasospasm are common after angiogram-negative SAH. Still, most patients had a favorable outcome. Only acute hydrocephalus was associated with unfavorable outcome. The high rate of SAH-related complications highlights the need for neurosurgical care in these patients.

Predictors of hospital-associated complications prolonging ICU stay in patients with low-grade aneurysmal subarachnoid hemorrhage

2020 ◽  
Vol 132 (6) ◽  
pp. 1829-1835 ◽  
Author(s):  
Nikolaos Mouchtouris ◽  
Michael J. Lang ◽  
Kaitlyn Barkley ◽  
Guilherme Barros ◽  
Justin Turpin ◽  
...  
Keyword(s):  
Logistic Regression ◽  
Subarachnoid Hemorrhage ◽  
Aneurysmal Subarachnoid Hemorrhage ◽  
External Ventricular Drain ◽  
Significant Risk ◽  
Early Discharge ◽  
Neurological Complications ◽  
Medical Complications ◽  
Low Grade ◽  
Icu Stay

OBJECTIVEThe authors sought to determine the predictors of late neurological and hospital-acquired medical complications (HACs) in patients with low-grade aneurysmal subarachnoid hemorrhage (aSAH).METHODSThe authors conducted a retrospective study of 424 patients with low-grade aSAH admitted to their institution from 2008 to 2015. Data collected included patient comorbidities, Hunt and Hess (HH) grade, ICU length of stay (LOS), and complications. A logistic regression analysis was performed to determine the predictors for neurological and hospital-associated complications.RESULTSOut of 424 patients, 50 (11.8%) developed neurological complications after the first week, with a mean ICU stay of 16.3 ± 6.5 days. Of the remaining 374 patients without late neurological complications, 83 (22.2%) developed late HACs with a mean LOS of 15.1 ± 7.6 days, while those without medical complications stayed 11.8 ± 6.2 days (p = 0.001). Of the 83 patients, 55 (66.3%) did not have any HACs in the first week. Smoking (p = 0.062), history of cardiac disease (p = 0.043), HH grade III (p = 0.012), intraventricular hemorrhage (IVH) (p = 0.012), external ventricular drain (EVD) placement (p = 0.002), and early pneumonia/urinary tract infection (UTI)/deep vein thrombosis (DVT) (p = 0.001) were independently associated with late HACs. Logistic regression showed early pneumonia/UTI/DVT (p = 0.026) and increased HH grade (p = 0.057) to be significant risk factors for late medical complications.CONCLUSIONSWhile an extended ICU admission allows closer monitoring, low-grade aSAH patients develop HACs despite being at low risk for neurological complications. The characteristics of low-grade aSAH patients who would benefit from early discharge are reported in detail.

Nimodipine pharmacokinetics after intraventricular injection of sustained-release nimodipine for subarachnoid hemorrhage

2021 ◽  
Vol 134 (1) ◽  
pp. 95-101 ◽  
Author(s):  
R. Loch Macdonald ◽  
Daniel Hänggi ◽  
Poul Strange ◽  
Hans Jakob Steiger ◽  
J Mocco ◽  
...  
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Sustained Release ◽  
Aneurysmal Subarachnoid Hemorrhage ◽  
External Ventricular Drain ◽  
Plasma Concentrations ◽  
Intraventricular Injection ◽  
World Federation ◽  
Maximum Plasma ◽  
Clinical Trial Registration ◽  
Sustained Release Formulation

OBJECTIVEThe objective of this study was to measure the concentration of nimodipine in CSF and plasma after intraventricular injection of a sustained-release formulation of nimodipine (EG-1962) in patients with aneurysmal subarachnoid hemorrhage (SAH).METHODSPatients with SAH repaired by clip placement or coil embolization were randomized to EG-1962 or oral nimodipine. Patients were classified as grade 2–4 on the World Federation of Neurosurgical Societies grading scale for SAH and had an external ventricular drain inserted as part of their standard of care. Cohorts of 12 patients received 100–1200 mg of EG-1962 as a single intraventricular injection (9 per cohort) or they remained on oral nimodipine (3 per cohort). Plasma and CSF were collected from each patient for measurement of nimodipine concentrations and calculation of maximum plasma and CSF concentration, area under the concentration-time curve from day 0 to 14, and steady-state concentration.RESULTSFifty-four patients in North America were randomized to EG-1962 and 18 to oral nimodipine. Plasma concentrations increased with escalating doses of EG-1962, remained stable for 14 to 21 days, and were detectable at day 30. Plasma concentrations in the oral nimodipine group were more variable than for EG-1962 and were approximately equal to those occurring at the EG-1962 800-mg dose. CSF concentrations of nimodipine in the EG-1962 groups were 2–3 orders of magnitude higher than in the oral nimodipine group, in which nimodipine was only detected at low concentrations in 10% (21/213) of samples. In the EG-1962 groups, CSF nimodipine concentrations were 1000 times higher than plasma concentrations.CONCLUSIONSPlasma concentrations of nimodipine similar to those achieved with oral nimodipine and lasting for 21 days could be achieved after a single intraventricular injection of EG-1962. The CSF concentrations from EG-1962, however, were at least 2 orders of magnitude higher than those with oral nimodipine. These results supported a phase 3 study that demonstrated a favorable safety profile for EG-1962 but yielded inconclusive efficacy results due to notable differences in clinical outcome based on baseline disease severity.Clinical trial registration no.: NCT01893190 (ClinicalTrials.gov).

scholarly journals Comparison of laparoscopic and hand-assisted laparoscopic nephrectomy for inflammatory renal disease: which is the preferred approach?

2021 ◽  
Vol 13 ◽  
pp. 175628722098404
Author(s):  
Xudong Guo ◽  
Hanbo Wang ◽  
Yuzhu Xiang ◽  
Xunbo Jin ◽  
Shaobo Jiang
Keyword(s):  
Logistic Regression ◽  
Renal Disease ◽  
Complication Rate ◽  
Adverse Outcomes ◽  
Laparoscopic Nephrectomy ◽  
Multivariable Logistic Regression Analysis ◽  
Invasive Approach ◽  
Intraoperative Complication ◽  
Multivariable Logistic Regression ◽  
Significant Difference

Aims: Management of inflammatory renal disease (IRD) can still be technically challenging for laparoscopic procedures. The aim of the present study was to compare the safety and feasibility of laparoscopic and hand-assisted laparoscopic nephrectomy in patients with IRD. Patients and methods: We retrospectively analyzed the data of 107 patients who underwent laparoscopic nephrectomy (LN) and hand-assisted laparoscopic nephrectomy (HALN) for IRD from January 2008 to March 2020, including pyonephrosis, renal tuberculosis, hydronephrosis, and xanthogranulomatous pyelonephritis. Patient demographics, operative outcomes, and postoperative recovery and complications were compared between the LN and HALN groups. Multivariable logistic regression analysis was conducted to identify the independent predictors of adverse outcomes. Results: Fifty-five subjects in the LN group and 52 subjects in the HALN group were enrolled in this study. In the LN group, laparoscopic nephrectomy was successfully performed in 50 patients (90.9%), while four (7.3%) patients were converted to HALN and one (1.8%) case was converted to open procedure. In HALN group, operations were completed in 51 (98.1%) patients and conversion to open surgery was necessary in one patient (1.9%). The LN group had a shorter median incision length (5 cm versus 7 cm, p < 0.01) but a longer median operative duration (140 min versus 105 min, p < 0.01) than the HALN group. There was no significant difference in blood loss, intraoperative complication rate, postoperative complication rate, recovery of bowel function, and hospital stay between the two groups. Multivariable logistic regression revealed that severe perinephric adhesions was an independent predictor of adverse outcomes. Conclusion: Both LN and HALN appear to be safe and feasible for IRD. As a still minimally invasive approach, HALN provided an alternative to IRD or when conversion was needed in LN.

scholarly journals Predictors of Anxiety-Induced Sleep Disturbance among in-School Adolescents in Ghana: Evidence from the 2012 Global School-Based Health Survey

2021 ◽  
Vol 11 (2) ◽  
pp. 20 ◽  
Author(s):  
Bright Opoku Ahinkorah ◽  
Richard Gyan Aboagye ◽  
Francis Arthur-Holmes ◽  
Abdul-Aziz Seidu ◽  
James Boadu Frimpong ◽  
...  
Keyword(s):  
Logistic Regression ◽  
Sleep Disturbance ◽  
Emotional Disorders ◽  
Health Survey ◽  
Safety Concern ◽  
Statistical Significance ◽  
Outcome Variable ◽  
Multivariable Logistic Regression Analysis ◽  
School Based ◽  
Multivariable Logistic Regression

(1) Background: Psychological problems of adolescents have become a global health and safety concern. Empirical evidence has shown that adolescents experience diverse mental health conditions (e.g., anxiety, depression, and emotional disorders). However, research on anxiety-induced sleep disturbance among in-school adolescents has received less attention, particularly in low- and middle-income countries. This study’s central focus was to examine factors associated with t anxiety-induced sleep disturbance among in-school adolescents in Ghana. (2) Methods: Analysis was performed using the 2012 Global School-based Health Survey (GSHS). A sample of 1342 in-school adolescents was included in the analysis. The outcome variable was anxiety-induced sleep disturbance reported during the past 12 months. Frequencies, percentages, chi-square, and multivariable logistic regression analyses were conducted. Results from the multivariable logistic regression analysis were presented as crude and adjusted odds ratios at 95% confidence intervals (CIs) and with a statistical significance declared at p < 0.05. (3) Results: Adolescents who went hungry were more likely to report anxiety-induced sleep disturbance compared to their counterparts who did not report hunger (aOR = 1.68, CI = 1.10, 2.57). The odds of anxiety-induced sleep disturbance were higher among adolescents who felt lonely compared to those that never felt lonely (aOR = 2.82, CI = 1.98, 4.01). Adolescents who had sustained injury were more likely to have anxiety-induced sleep disturbance (aOR = 1.49, CI = 1.03, 2.14) compared to those who had no injury. Compared to adolescents who never had suicidal ideations, those who reported experiencing suicidal ideations had higher odds of anxiety-induced sleep disturbance (aOR = 1.68, CI = 1.05, 2.71). (4) Conclusions: Anxiety-induced sleep disturbance among in-school adolescents were significantly influenced by the psychosocial determinants such as hunger, loneliness, injury, and suicidal ideation in this study. The findings can help design appropriate interventions through effective strategies (e.g., early school-based screening, cognitive-behavioral therapy, face-face counseling services) to reduce psychosocial problems among in-school adolescents in Ghana.

scholarly journals Assessment of Hospital Rooming-in Practice in Abu Dhabi, United Arab Emirates: A Cross-Sectional Multi-Center Study

Nutrients ◽  
2020 ◽  
Vol 12 (8) ◽  
pp. 2318
Author(s):  
Zainab Taha ◽  
Ahmed Ali Hassan ◽  
Ludmilla Wikkeling-Scott ◽  
Ruba Eltoum ◽  
Dimitrios Papandreou
Keyword(s):  
Logistic Regression ◽  
Hospital Stay ◽  
United Arab Emirates ◽  
Gestational Age ◽  
World Health ◽  
Abu Dhabi ◽  
Multivariable Logistic Regression Analysis ◽  
Original Research ◽  
Convenience Sample ◽  
Multivariable Logistic Regression

The World Health Organization (WHO) recommends rooming-in to reduce infant mortality rates. Little research has been done to assess practices such as rooming-in and its relation to breastfeeding in the United Arab Emirates (UAE). The aim of this study was to examine the prevalence of rooming-in during hospital stay among mothers with infants six months old and below, in addition to other associated factors in Abu Dhabi, UAE. This study utilized a sub-sample extracted from a dataset based on a convenience sample of mothers who were recruited from governmental maternal and child health centers as well as from the community. The purpose of the original research was to evaluate infant and young children’s feeding practices. A pre-tested questionnaire was used during interviews with mothers once ethical clearance was in place. Multivariable logistic regression was conducted to describe the results. The original sample included 1822 participants, of which 804 infants met the inclusion criteria. The mean age for mothers and infants was 30.3 years and 3.5 months, respectively. The rate of rooming-in during hospital stay was 97.5%. Multivariable logistic regression analysis indicated factors associated with not rooming-in were low maternal age (Adjusted Odds Ratios (AOR) = 1.15, 95% confidence interval (CI): 1.03, 1.30), low gestational age (GA) (AOR = 1.90, 95% CI: 1.52, 2.36), abnormal pre-pregnancy body mass index (BMI) (AOR = 3.77, 95 % CI: 1.22, 11.76), and delayed initiation of breastfeeding (AOR = 4.47, 95 % CI: 1.08, 18.48). In the context of the high rate of rooming-in revealed in this study, there should be a focus on those groups who do not room-in (i.e., younger women and those with babies of a younger gestational age). Rooming-in practice provides self-confidence in taking care of a baby, knowledge about breastfeeding, and stimulates early-phase lactation.

scholarly journals Acute Chest Syndrome Among Hospitalized Children with Vaso-Occlusive Crisis: A Nationwide Study in the United States

Blood ◽  
2017 ◽  
Vol 130 (Suppl_1) ◽  
pp. 687-687
Author(s):  
Takuto Takahashi ◽  
Yusuke Okubo ◽  
Atsuhiko Handa ◽  
Scott T. Miller
Keyword(s):  
Logistic Regression ◽  
De Novo ◽  
Pharmaceutical Research ◽  
The United States ◽  
Acute Chest Syndrome ◽  
Multivariable Logistic Regression Analysis ◽  
Hospitalization Rates ◽  
Multivariable Logistic Regression ◽  
Prophylactic Measures ◽  
Inpatient Database

Abstract Background: Acute chest syndrome (ACS) remains a leading cause of mortality among children with sickle cell disease (SCD); overall, nearly 50% of ACS is diagnosed during hospitalizations for other complications including painful vaso-occlusive crises (VOC). Methods: The present study assesses epidemiological features of children hospitalized with VOC and evaluates factors potentially associated with development of ACS utilizing the large national all-payer Kid's Inpatient Database over a recent 9 year period. Records of children (age &lt; 20 years) were reviewed from 2003, 2006, 2009, and 2012) and multivariable logistic regression was used to assess risk factors and adjust for patient and hospital characteristics. Results: Total annual hospitalization rates with VOC were variable, ranging from 26.4 per 100,000 children in 2009 to 29.5 in 2012. Multivariable logistic regression analysis showed children age 5-9 years had 2.38 times higher odds of developing ACS than children age 15-19 (95%CI, 2.22 to 2.56). Comorbidity of asthma was a risk factor for ACS (OR, 1.44; 95%CI, 1.36 to 1.53). ACS was as common in Hb SC patients hospitalized for VOC as those with SS. Conclusion: These data demonstrate that despite increasing use of hydroxyurea in children shown in other reports, there has been no reduction in hospitalization rate for pain, and even young children are at risk for ACS. Though de novo ACS is less common in Hb SC, vigilance and prophylactic measures are required for those hospitalized for pain. Further studies are needed to assess the efficacy of prophylactic interventions including bronchodilator therapy for asthmatics hospitalized for VOC. Disclosures Miller: Pfizer Pharmaceutical: Research Funding.

scholarly journals Impact of histologic chorioamnionitis on pulmonary hypertension and respiratory outcomes in preterm infants

2018 ◽  
Vol 8 (2) ◽  
pp. 204589401876016 ◽  
Author(s):  
Sook Kyung Yum ◽  
Min-Sung Kim ◽  
Yoojin Kwun ◽  
Cheong-Jun Moon ◽  
Young-Ah Youn ◽  
...  
Keyword(s):  
Pulmonary Hypertension ◽  
Logistic Regression ◽  
Regression Analysis ◽  
Preterm Infants ◽  
Logistic Regression Analysis ◽  
Multivariable Logistic Regression Analysis ◽  
Multivariable Logistic Regression ◽  
Histologic Chorioamnionitis ◽  
Respiratory Outcomes ◽  
Lower Birthweight

We aimed to evaluate the association between the presence of histologic chorioamnionitis (HC) and development of pulmonary hypertension (PH) during neonatal intensive care unit (NICU) stay. Data of preterm infants born at 32 weeks of gestation or less were reviewed. The development of PH and other respiratory outcomes were compared according to the presence of HC. Potential risk factors associated with the development of PH during NICU stay were used for multivariable logistic regression analysis. A total of 188 infants were enrolled: 72 in the HC group and 116 in the no HC group. The HC group infants were born at a significantly shorter gestational age and lower birthweight, with a greater proportion presenting preterm premature rupture of membrane (pPROM) > 18 h before delivery. More infants in the HC group developed pneumothorax ( P = 0.008), and moderate and severe bronchopulmonary dysplasia (BPD; P = 0.001 and P = 0.006, respectively). PH in the HC group was significantly more frequent compared to the no HC group (25.0% versus 8.6%, P = 0.002). Based on a multivariable logistic regression analysis, birthweight ( P = 0.009, odds ratio [OR] = 0.997, 95% confidence interval [CI] = 0.995–0.999), the presence of HC ( P = 0.047, OR = 2.799, 95% CI = 1.014–7.731), and duration of invasive mechanical ventilation (MV) > 14 days ( P = 0.015, OR = 8.036, 95% CI = 1.051–43.030) were significant factors. The presence of HC and prolonged invasive MV in infants with lower birthweight possibly synergistically act against preterm pulmonary outcomes and leads to the development of PH. Verification of this result and further investigation to establish effective strategies to prevent or ameliorate these adverse outcomes are needed.

Abstract TP50: A Critical Assessment of the Golden Hour and the Impact of Procedural Timing in Stroke Thrombectomy: A Single-Center Study

Stroke ◽  
2020 ◽  
Vol 51 (Suppl_1) ◽  
Author(s):  
Aaron P Wessell ◽  
Helio De Paula Carvahlo ◽  
Elizabeth Le ◽  
Gregory Cannarsa ◽  
Matthew J Kole ◽  
...  
Keyword(s):  
Logistic Regression ◽  
Mechanical Thrombectomy ◽  
Univariate Analysis ◽  
Multivariable Logistic Regression Analysis ◽  
Procedure Time ◽  
Golden Hour ◽  
Poor Outcome ◽  
Multivariable Logistic Regression ◽  
Scale Scores ◽  
The Impact

Background: Previous studies have demonstrated the importance keeping thrombectomy procedure times ≤60 min., termed the ‘golden hour’. In the current study, we further investigate the significance of the ‘golden hour’ and the impact of procedural timing on clinical outcomes after mechanical thrombectomy. Methods: We performed an analysis of 319 consecutive mechanical thrombectomy patients at a single Comprehensive Stroke Center from April 2012 through February 2019. Bivariate analyses compared patients grouped according to procedure time ≤60 min. or >60 min. and time of stroke onset-to-endovascular therapy (OTE) ≤6 hours or >6 hours. Logistic regression was used to determine independent predictors of poor outcome at 90-days defined by modified Rankin Scale (mRS) scores of 3-6. Results: A procedure time ≤60 min. was associated with increased revascularization rates (88% vs. 67%; p<0.001) and a greater percentage of good outcomes at 90-days (47% vs. 31%; p=0.003). Multivariable logistic regression revealed that greater age (OR 1.03, 95% CI 1.004-1.051; p=0.023), higher admission NIHSS score (OR 1.10, 95% CI 1.038-1.159; p=0.001), and history of diabetes mellitus (OR 1.94, 95% CI 1.049-3.580; p=0.035) were independently associated with a greater odds of poor outcome. Modified TICI scale scores of 2C (OR 0.12, 95% CI 0.047-0.313; p<0.001) and 3 (OR 0.19, 95% CI 0.079-0.445; p<0.001) were associated with a reduced odds of poor outcome. Although not statistically significant on univariate analysis, OTE ≤6 hrs. was independently associated with a reduced odds of poor outcome (OR 0.41, 95% CI 0.212-0.809; p=0.010) in the final multivariate model (AUC 0.800). Procedure time ≤60 min. did not have a significant independent association with clinical outcome on multivariate analysis (p=0.095). Conclusions: Thrombectomy procedure times beyond 60 min. are associated with lower overall revascularization rates and worse 90 day functional outcomes when compared to faster thrombectomy procedures. However, thrombectomy procedure time was not predictive of outcome on multivariable logistic regression analysis. Our study emphasizes the significance of achieving revascularization despite the requisite procedure time.

Abstract TP425: How do Different Outcome Measures Reflect Outcome After Aneurysmal Subarachnoid Hemorrhage

Stroke ◽  
2017 ◽  
Vol 48 (suppl_1) ◽  
Author(s):  
Daniel Haenggi ◽  
Nima Etminan ◽  
Hans Jakob Steiger ◽  
R. Loch Macdonald ◽  
Stephan A Mayer ◽  
...  
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Outcome Measures ◽  
Aneurysmal Subarachnoid Hemorrhage ◽  
Phase 1 ◽  
External Ventricular Drain ◽  
Cognitive Status ◽  
World Federation ◽  
Cognitive Assessments ◽  
Dose Escalation Study ◽  
Sustained Release Formulation

Few treatments for aneurysmal subarachnoid hemorrhage (aSAH) have been effective in randomized clinical studies. One reason may be that the outcome measures used are not sensitive enough to detect efficacy of treatments in this disease. This hypothesis was examined by comparing 6 outcome measures for 72 patients with aSAH. Patients with aSAH who were World Federation of Neurological Surgeons grades 2 to 4 with an external ventricular drain inserted as part of standard of care were entered in a Phase 1/2a multicenter, controlled, randomized, open-label, dose escalation study to determine the maximum tolerated dose and safety and tolerability of a sustained release formulation of nimodipine (EG-1962, NEWTON study) in patients with aSAH. Clinical outcome was assessed at 90 days after aSAH using the extended Glasgow outcome scale (eGOS), modified Rankin scale (mRS), Montreal cognitive assessment (MoCA), telephone interview of cognitive status (TICS), NIHSS and Barthel index. The relationship between each outcome measure and the eGOS was plotted on arithmetic graphs (Figure). The eGOS and mRS gave very similar results. More detailed cognitive assessments (MoCA, TICS) were more exponential in shape with more variability. The NIHSS and Barthel had outcomes clustered towards the highest ends of the scales with distributions that did not discriminate as much as the eGOS or mRS. The MoCA and TICS gave similar results. It was concluded that the eGOS or mRS produce a similar and varying range of outcomes after aSAH, whereas cognitive assessments like the MoCA and TICS and scales designed for ischemic stroke like the NIHSS and BI are less discriminatory of outcomes after aSAH.

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