Desmoteplase Could Extend Thrombolysis Treatment Window

Abstract Introduction Rhinocerebral mucormycosis is a rare and severe form of opportunistic fungal infection that can develop rapidly and cause significant mortality, particularly among diabetic patients suffering from ketoacidosis. Diagnosing rhinocerebral mucormycosis during the early stages of infection is challenging. Case presentation We describe a case of rhinocerebral mucormycosis secondary to severe acute pancreatitis in a patient suffering from diabetic ketoacidosis. In this case, the condition was not diagnosed during the optimal treatment window. we therefore provide a thorough overview of related clinical findings and histopathological characteristics, and we discuss potential differential diagnoses. Conclusions In summary, we described a case of rhinocerebral mucormycosis secondary to severe acute pancreatitis in a patient suffering from diabetic ketoacidosis, with the optimal treatment window for this condition having been missed. This report suggests that a definitive mucormycosis diagnosis can be made based upon tissue biopsy that reveals the presence of characteristic hyphae. Early diagnosis and treatment are essential in order to improve patient prognosis.

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Berberis vulgaris/Picrorhiza kurroa: Extending the Treatment Window for Reperfusion Injury

European Journal of Medicinal Plants ◽

10.9734/ejmp/2015/18000 ◽

2015 ◽

Vol 8 (3) ◽

pp. 128-141

Author(s):

Monique Saleh ◽

Barry Connell ◽

Tarek Saleh

Keyword(s):

Reperfusion Injury ◽

Picrorhiza Kurroa ◽

Berberis Vulgaris ◽

Treatment Window

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Abstract TP372: Outcomes of the Extended Ischemic Stroke Treatment Window

Stroke ◽

10.1161/str.51.suppl_1.tp372 ◽

2020 ◽

Vol 51 (Suppl_1) ◽

Author(s):

Michele J Patterson ◽

Tracy Moore ◽

Paula Cline ◽

Lee Birnbaum

Keyword(s):

Ischemic Stroke ◽

Clinical Practice ◽

Clinical Practice Guidelines ◽

Practice Guidelines ◽

Community Education ◽

Stroke Severity ◽

Complication Rates ◽

Stroke Treatment ◽

Stroke Disability ◽

Treatment Window

Background: After clinical practice guidelines extended the mechanical endovascular reperfusion [MER] window, our Comprehensive Stroke Program expanded its stroke alert [SA] to include last known well [LKW] 6-24 hours [h]. Expansion included implementation of a standardized large vessel screen, RAPID brain imaging software, revised algorithm, EMS and community education, and regional transfer guidelines. Purpose: Evaluate outcomes of the extended window [EW] for ischemic stroke treatment. Method: We reviewed ischemic strokes over a 2 year period and categorized them into two groups: 2017 pre-guideline [PG] and 2018 EW post-guideline [PostG]. Each group was divided into all-MERs and MERs 6-24h. Groups were compared by LKW, NIHSS, TICI scores, complications, discharge [DC] disposition and Modified Rankin Score [mRS] at DC and 90 days [90d]. Outcomes were evaluated to identify the EW impact. Results: Of 744 strokes reviewed, 365 were PG and 379 were EW PostG. LKW 6-24h was greater PostG [22%=PG versus [v] 30%=EW], in all-MERs [19%=PG v 31%=EW] and MERs 6-24h [69%=PG v 83%=EW]. Stroke severity [NIHSS>7] was higher PostG [41%=PG v 45%=EW], in all-MERs [88%=PG v 91%=EW] and MERs 6-24h [85%=PG v 96%=EW]. MER treatment rates increased PostG [13%=PG v 17%=EW]. Post-MER TICI 2b/3 reperfusion rates were higher PostG in all-MERs [63%=PG v 77%=EW] and MERs 6-24h [38%=PG v 71%=EW]. Any complication was lower PostG [27%=PG v 22%=EW] with higher complication rates in MERs 6-24h [15%=PG v 17%=EW]. More patients were DC home PostG [42%=PG v 46%=EW], in all-MERs [25%=PG v 30%=EW], and MERs 6-24h [8%=PG v 29%=EW]. mRS 0-2 at DC was increased PostG [20%=PG v 29%=EW], in all-MERs [12%=PG v 27%=EW], and MERs 6-24h [8%=PG v 34%=EW]. mRS at 90d was increased PostG for all-MERs [25%=PG v 34%=EW] with decreased deaths [15%=PG v 10%=EW]. Conclusion: The EW has increased patients treated and improved overall outcomes. Patients arriving with LKW 6-24h has increased along with stroke severity. Reperfusion rates improved and overall complications were lower, however higher rates were seen in MERs 6-24h. Patients treated in the EW had reductions in post stroke disability, increases in DC to home, and improvements in mRS at DC and 90d.

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Abstract TP376: Director, Comprehensive Stroke Program

Stroke ◽

10.1161/str.51.suppl_1.tp376 ◽

2020 ◽

Vol 51 (Suppl_1) ◽

Author(s):

Michele J Patterson ◽

Tracy Moore ◽

Paula Cline

Keyword(s):

Private Insurance ◽

Retrospective Chart Review ◽

Target Population ◽

Community Response ◽

Treatment Rate ◽

Hospital System ◽

Early Presentation ◽

Stroke Type ◽

Poverty Levels ◽

Treatment Window

Background: Hospital system identified decline in Emergency Medical Services arrivals [EMS-A] and increased Private Vehicle arrivals [PVA]. Purpose: Understand community response and PVA for focused education to increase EMS-A in order to improve treatment rates and decrease disability. Methods: Retrospective chart review to evaluate age, gender, race, poverty levels, stroke type, severity, treatment rates, and outcomes of the Target Population [TP]. Results: Review of 4,264 records [2015-2018] identified 1,612 PVA and 2,652 EMS-A. The largest PVA age group, identified as TP, was age 46-65. The TP was 60% male. Hispanics comprised 59% PVA versus [v] 54% EMS-A. All other races had higher EMS-A. Those with PVA were more likely to have private insurance [39% PVA v 23% EMS-A] and more likely to have zip codes with less than 10% poverty [8% PVA v 1% EMS-A]. Those below poverty had lower PVA [6% PVA v 12% EMS-A]. Stroke type was 90% Ischemic. Eighty-nine percent of PVA had NIHSS 0-7 [NIHSS: 0=24%, 1-5=57%, 6-7=8%]. Time last known well [TLKW] for PVA NIHSS 0-7 was less than or equal to 3.5 hours in 15% and greater than 3.5 hours in 33%. Alteplase treatment rate for NIHSS 0-7 was 4% PVA v 9% EMS-A. Mechanical Endovascular Reperfusion [MER] treatment rate for NIHSS 0-7 was 0% PVA v 1% EMS-A. Discharge [DC] disposition for PVA NIHSS 0-7 showed 21% rehabilitation and 2% death or hospice. DC Modified Rankin Scale [mRS] for PVA NIHSS 0-7 was mRS 2-3 in 17% and mRS 4-5 in 10%. Conclusion: The majority of PVA were middle aged [46-65] and predominantly male. Hispanics were the only ethnic group with higher PVA v EMS-A. The TP majority lived in areas with less than 10% poverty, had private insurance, had ischemic strokes with milder deficits and presented outside the Alteplase treatment window. Treatment rates for Alteplase and MER were 50% greater for NIHSS 0-7 for EMS-A. At DC, 21% PVA with NIHSS 0-7 required rehabilitation and 27% had slight to severe disability. Identifying characteristics of the TP is helpful for focused public education to increase EMS-A and early presentation regardless of severity to increase treatment rates and decrease disability.

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Abstract TP350: Extension of tPA Treatment Window With Granulocyte-colony Stimulating Factor in a Thromboembolic Rat Model of Stroke

Stroke ◽

10.1161/str.49.suppl_1.tp350 ◽

2018 ◽

Vol 49 (Suppl_1) ◽

Author(s):

Ike dela Peña ◽

Guofang Shen ◽

Talia Knecht ◽

Jeffrey Liu ◽

Hsiao Fang Liang ◽

...

Keyword(s):

Rat Model ◽

Granulocyte Colony Stimulating Factor ◽

Colony Stimulating Factor ◽

Stimulating Factor ◽

Treatment Window

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Institutional review of glial tumors treated with chemotherapy: the first description of PCV-related pseudoprogression

Neuro-Oncology Practice ◽

10.1093/nop/npy012 ◽

2018 ◽

Vol 6 (1) ◽

pp. 22-29 ◽

Cited By ~ 1

Author(s):

Ankur M Sharma ◽

Michael Willcock ◽

Oliver Bucher ◽

Thelina Amaratunga ◽

M Nazir Khan ◽

...

Keyword(s):

Decision Making ◽

Adjuvant Radiotherapy ◽

Clinical Decision Making ◽

Clinical Decision ◽

World Health ◽

Tumor Treatment ◽

Institutional Review ◽

Grade Ii ◽

Health Organization ◽

Treatment Window

Abstract Background Pseudoprogression refers to areas of enhancement on MRI postadjuvant chemoradiation that arise as a result of treatment-related effects. Pseudoprogression has been well described with temozolomide-based chemoradiation but has not been studied in the setting of procarbazine, lomustine, and vincristine (PCV) chemotherapy. We reviewed patients treated with PCV to investigate the occurrence of pseudoprogression. Methods Adults diagnosed with World Health Organization grade II or III gliomas between 2010 and 2015 and treated with PCV or temozolomide were identified. Patient, tumor, treatment, and MRI data were retrospectively collected and analyzed. Pseudoprogression was defined as new enhancement seen on MRI within 6 months of completion of adjuvant radiotherapy or concurrent chemoradiation, which improved or remained stable on subsequent scans without therapeutic intervention. If MRI showed areas of new enhancement outside the 6-month post-treatment window, which resolved or remained stable without treatment, or in patients who did not receive adjuvant treatment, it was referred to as “atypical pseudoprogression.” Results Fifty-seven patients were identified. Nine (16%) patients were identified as having pseudoprogression on MRI. Two (4%) of these patients were treated with PCV and 7 (12%) were treated with temozolomide. Seventeen (30%) patients had atypical pseudoprogression: 8 (14%) treated with temozolomide, 8 (14%) treated with PCV, and 1 (2%) treated with both types of chemotherapy. Conclusions We describe the first 2 cases of PCV-related pseudoprogression and 17 cases of atypical pseudoprogression. As the re-emergence of adjuvant PCV occurs in clinical practice, the occurrence of classical and atypical pseudoprogression could have a significant impact on clinical decision making.

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