Poststroke Cognitive Decline: A Longitudinal Study from a Tertiary Care Center

Abstract Objectives Poststroke cognitive decline (PSCD) is a serious disabling consequence of stroke. The purpose of this study is to find the prevalence of PSCD and sociodemographic and clinical determinants of risk factors of PSCD. Materials and Methods This study was a prospective, hospital-based study conducted on 200 stroke patients from stroke registry during October 2015 to April 2017. Detailed clinical evaluation was done. Mini-Mental State Examination (MMSE) and Montreal Cognitive Assessment (MoCA) scores were used to determine PSCD after 3 and 6 months as per the Diagnostic and Statistical Manual of Mental Disorders V. Chi-squared test was used to find the association between two variables. The Wilcoxon signed-rank test was used to compare the difference in cognitive impairment between two follow-ups at 3 and 6 months, respectively. A p-value < 0.05 was considered statistically significant. Results The prevalence of PSCD measured by MoCA scale at 3 and 6 months was 67 and 31.6%, respectively. By MMSE scale, cognitive decline prevalence at 3 months was found to be 87 (46.3%), which reduced to 22 (17.1%) at 6 months. The association between MMSE scale and type of stroke was significant at 3 months. Conclusion One-third of the stroke patients developed PSCD within 3 months of onset of stroke, with different levels of severity. The major predictors of new-onset poststroke cognitive impairment were diabetes and hypertension. The prevalence of PSCD reduced significantly at 6 months of stroke on follow-up.

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Antiemetic prophylaxis with temozolomide: an audit from a tertiary care center

Neuro-Oncology Practice ◽

10.1093/nop/npz009 ◽

2019 ◽

Vol 6 (6) ◽

pp. 479-483 ◽

Cited By ~ 1

Author(s):

Vijay M Patil ◽

Arun Chandrasekharan ◽

Dilip Harindran Vallathol ◽

Mridul Malhotra ◽

Ram Abhinav ◽

...

Keyword(s):

Care Center ◽

Tertiary Care ◽

Significant Proportion ◽

Nausea And Vomiting ◽

P Value ◽

Antiemetic Prophylaxis ◽

Retrospective Audit ◽

Time Period ◽

Chi Squared ◽

A Prospective Study

Abstract Background In our previous experience, a significant proportion of patients who received 5-HT3 antagonist monotherapy with adjuvant temozolomide (150-200 mg/m2) had chemotherapy-induced nausea and vomiting (CINV). This is an audit comparing the multiple antiemetic therapies in the prevention of temozolomide-associated CINV. Methods This was a retrospective audit. Adult glioma patients treated with temozolomide at a dose of 150-200 mg/m2 between October 2017 and June 2018 were selected for this analysis. Three antiemetic prophylaxis were used in this time period: ondansetron (October 2017 to November 2017), ondansetron + domperidone (December 2017 to February 2018), and ondansetron + olanzapine (March 2018 to June 2018). The rates of nausea and vomiting were compared among the 3 cohorts using the chi-squared test with Bonferroni correction. A P value of less than .016 was considered significant. Results A total of 360 patients were selected for this analysis. There were 91 patients in the ondansetron prophylaxis group (25.3%), 113 (31.4%) in the ondansetron plus domperidone group, and 156 (43.3%) in the ondansetron plus olanzapine group. The overall incidence of nausea and vomiting was 25.0% (n = 90) and 7.2% (n = 26). Overall the rates of nausea (P = .052) and vomiting (P = .481) were similar in all 3 cohorts. However, the rates of grade 2 and above nausea (P = .012) and vomiting (P = .015) were significantly lower in the olanzapine group. Conclusion The combination of ondansetron with olanzapine leads to a statistically significant decrease in the rate of moderate-to-severe emesis and nausea and needs to be explored in a prospective study.

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Increasing Facemask Compliance among Healthcare Personnel during the COVID-19 Pandemic

Infection Control and Hospital Epidemiology ◽

10.1017/ice.2021.205 ◽

2021 ◽

pp. 1-22

Author(s):

Rupak Datta ◽

Keith Glenn ◽

Anthony Pellegrino ◽

Jessica Tuan ◽

Brian Linde ◽

...

Keyword(s):

Care Center ◽

Tertiary Care ◽

Baseline Period ◽

Healthcare Personnel ◽

Structured Interviews ◽

Time Series Regression ◽

Multimodal Intervention ◽

Direct Observations ◽

Chi Squared ◽

Ancillary Staff

Abstract Objective: Prior studies of universal masking have not measured facemask compliance. We performed a quality improvement study to monitor and improve facemask compliance among healthcare personnel (HCP) during the coronavirus disease 2019 (COVID-19) pandemic. Design: Mixed-methods study Setting: Tertiary care center in West Haven, Connecticut Patients: HCP including physicians, nurses, and ancillary staff Methods: Facemask compliance was measured through direct observations during a 4-week baseline period after universal masking was mandated. Frontline and management HCP completed semi-structured interviews from which a multimodal intervention was developed. Direct observations were repeated during a 14-week period following implementation of the multimodal intervention. Differences between units were evaluated with chi-squared testing using the Bonferroni correction. Facemask compliance between baseline and intervention periods was compared using time series regression. Results: Among 1,561 observations during the baseline period, median weekly facemask compliance was 82.2% (range, 80.8%-84.4%). Semi-structured interviews were performed with 16 HCP. Qualitative analysis informed the development of a multimodal intervention consisting of audit and passive feedback, active discussion, and increased communication from leadership. Among 2,651 observations during the intervention period, median weekly facemask compliance was 92.6% (range, 84.6%-97.9%). There was no difference in weekly facemask compliance between COVID-19 and non-COVID-19 units. The multimodal intervention was associated with an increase in facemask compliance (β=0.023, p=0.002) Conclusions: Facemask compliance remained suboptimal among HCP despite a facility-wide mandate for universal masking. A multimodal intervention consisting of audit and passive feedback, active discussion, and increased communication from leadership was effective in increasing facemask compliance among HCP.

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Case Study of Pediatric Cerebral Sinus Venous Thrombosis Center of a Low Middle-Income Country

Clinical and Applied Thrombosis/Hemostasis ◽

10.1177/10760296211022847 ◽

2021 ◽

Vol 27 ◽

pp. 107602962110228

Author(s):

Bushra Moiz ◽

Ronika Devi Ukrani ◽

Aiman Arif ◽

Inaara Akbar ◽

Muhammed Wahhaab Sadiq ◽

...

Keyword(s):

Sinus Thrombosis ◽

Care Center ◽

Tertiary Care ◽

Age Groups ◽

Activated Protein C ◽

Positive Association ◽

Cerebral Venous Sinus Thrombosis ◽

P Value ◽

Middle Income ◽

Duration Of Symptoms

Pediatric cerebral venous sinus thrombosis (CVST) is rare but a potentially fatal disease requiring its understanding in local setting. In this study, we observed the clinical course, management, and outcome of pediatric patients with sinus thrombosis in a tertiary care center at Pakistan. Patients between age 0 to 18 years of both genders diagnosed with sinus thrombosis during 2011 to 2020 were included. Data was collected through in-house computerized system and SPSS version 19 was used for analysis. Of 143492 pediatric admissions, 32 (21 males and 11 females) patients with a median (IQR) age of 4.5 years (0-16) had CVST. This is equivalent to 18.5 CVST events per million pediatric admissions. Adolescents were mostly affected, and the overall mortality was 7%. Primary underlying disorders were infections (59%), hematological neoplasms (12.5%), thrombotic thrombocytopenic purpura (3%) and antiphospholipid syndrome (3%). Activated protein C resistance (44%) was the most common inherited thrombophilia. Twenty-one (66%) patients were anemic with a mean (±SD) hemoglobin of 9.0 g/dL (±2.3). Regression analysis showed a positive association of anemia with multiple sinus involvement ( P-value 0.009) but not with duration of symptoms ( P-value 0.344), hospital stay ( P-value 0.466), age ( P-value 0.863) or gender ( P-value 0.542) of the patients. SARS-COV2 was negative in patients during 2020. Adolescents were primarily affected by sinus thrombosis and infections was the predominant risk factor for all age groups, with a low all-cause mortality. A high index of clinical suspicion is required for prompt diagnosis and intervention.

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Abstract 82: Differences Between Caucasians and Asians in Intracranial Arterial Stenosis Among TIA and Minor Stroke Patients: Comparisons of Two Contemporary Cohorts

Stroke ◽

10.1161/str.51.suppl_1.82 ◽

2020 ◽

Vol 51 (Suppl_1) ◽

Author(s):

Xinyi Leng ◽

Robert Hurford ◽

Xueyan Feng ◽

Ka Lung Chan ◽

Linxin Li ◽

...

Keyword(s):

Risk Factors ◽

Ct Angiography ◽

Interobserver Agreement ◽

Arterial Stenosis ◽

Minor Stroke ◽

Intracranial Arterial Stenosis ◽

Stroke Patients ◽

Stroke Registry ◽

The Difference ◽

Ischemic Attack

Background: Despite numerous reports indicating ethnic difference in intracranial arterial stenosis (ICAS) between Caucasians and Asians, there has been no direct comparison in disease burden and clinical correlates of ICAS in stroke patients in the two populations with the same criteria to define ICAS. Methods: Acute minor stroke or transient ischemic attack patients who received cerebral MR/CT angiography exam in two cohorts were analyzed: Oxford Vascular Study (OXVASC, 2011-2018) with predominantly Caucasians, and the Chinese University of Hong Kong (CUHK) stroke registry (2011-2015) with predominantly Chinese. ICAS was defined as ≥50% stenosis in any major intracranial artery in MR/CT angiography. Interobserver agreement between 2 investigators for presence of ICAS was assessed in 50 cases with Cohen’s kappa. We compared the burden and risk factors of ICAS in the two cohorts. Results: Overall, 1,287 patients from OXVASC (mean age 69 years) and 640 from the CUHK cohort (mean age 66 years) were analyzed. Interobserver agreement for presence of ICAS was good (kappa=0.82). Prevalence of ICAS was significantly higher in Chinese than in Caucasians: 43.6% in the CUHK cohort versus 20.0% in OXVASC (crude OR 3.10; age-adjusted OR 3.81, 95% CI 3.06-4.75; p<0.001). Mean ages of patients with ICAS in the two cohorts were 75 and 68 years, respectively. The difference between Caucasians and Chinese in ICAS prevalence was smaller in those aged ≥70 years (28.1% versus 51.9%) than those <70 years (9.8% versus 38.0%) (Figure). ICAS shared similar risk factors in the two cohorts, including older age, and history of hypertension and diabetes. Conclusions: Chinese are more susceptible to ICAS, with an earlier onset age than Caucasians, but the ICAS burden in Caucasians was higher than previously estimated, especially in older patients.

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Abstract P381: Pre-Treatment Perfusion Mismatch Volumes in Ischemic Stroke Patients Treated With Tenecteplase or Alteplase

Stroke ◽

10.1161/str.52.suppl_1.p381 ◽

2021 ◽

Vol 52 (Suppl_1) ◽

Author(s):

Adrienne N Dula ◽

Ian M Alrahwan ◽

Steven J Warach

Keyword(s):

Imaging Modality ◽

Infarct Volume ◽

Volume Growth ◽

Logistic Models ◽

P Value ◽

Full Cohort ◽

Stroke Registry ◽

Discharge Disposition ◽

Chi Squared ◽

Pre Treatment

Introduction: The overall goal of this study is to evaluate the relationship of pretreatment perfusion mismatch volumes to outcomes in patients receiving alteplase (ALT) to those receiving tenecteplase (TNK). Methods: This study included patients receiving treatment with ALT (0.9 mg/kg; max, 90 mg) or TNK (0.25 mg/kg; max, 25 mg) between 09/01/2017 - 06/30/2020 identified through our local stroke registry stroke registry. Of the 505 patients meeting these criteria, 280 have been screened, including patients receiving EVT (n=94) and a sampling of n=111 from the ALT group and 75 from the TNK group. Final eligibility will be patients with a pretreatment perfusion deficit, mismatch > 15 mL, and mismatch (MM) ratio ≥ 1.2. Volumes are based on RAPID software (iSchemiaView). Using univariate (chi-squared with continuity correction or Mann-Whitney U) and adjusted logistic models, the effect of lysis type and pre-treatment imaging were assessed on the primary outcome of discharge disposition. Results: A total of 93 patients were included in our analysis, 40 receiving ALT and 53 patients receiving TNK, demographics found in Table 1. Discharge to home occurred in 48.8% (20/40) of patients treated with ALT and 30.7% (16/53) treated with TNK, odds ratio (OR), 0.47; 95% CI [0.20, 1.09], (P-value for OR=0.0766). Upon adjustment for EVT, age, sex, NIHSS on admission, imaging modality, cohort imbalances (marked by *), and MM, the relation of lysis type to discharge to home gave an OR of 0.25; 95% CI [0.06, 0.90], P= 0.0383) with age (P<0.0001) and imaging modality (P=0.0020) significantly contributing to the model. Lysis type did not significantly influence discharge to hospice or death (OR, 0.62; 95% CI [0.05, 6.86], P=0.6945) upon adjustment for baseline factors. Conclusion: In this preliminary analysis, MM volumes did not contribute to the outcome of discharged to home. Analysis of the full cohort is ongoing and final analyses will relate lytic type to infarct volume growth and clinical outcomes.

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Transport Factors Affecting the Outcome of Referred Neonates Admitted in A Tertiary Care Hospital

Bangladesh Journal of Child Health ◽

10.3329/bjch.v41i3.36951 ◽

2018 ◽

Vol 41 (3) ◽

pp. 159-164 ◽

Cited By ~ 1

Author(s):

Madhabi Baidya ◽

Mahfuza Shirin ◽

Liton Chandra Saha

Keyword(s):

Perinatal Asphyxia ◽

Care Center ◽

Tertiary Care ◽

Preterm Neonates ◽

P Value ◽

Care Hospital ◽

Cross Sectional ◽

Neonatal Transport ◽

Group I ◽

Group Ii

Background: Adequate neonatal transport is a key component of care of the sick newborns who require referral to tertiary care center. Poor transportation is one of the iatrogenic factors associated with greater neonatal mortality. Neonatal transport is the greatest challenge faced today in our country. The purpose of this study was to find out characteristics of transport of referred neonates and to idention the factors that contribute to mortality.Methodology: This cross sectional study was conducted in Dhaka Shishu (Children) Hospital from June 2013 to November 2013. Both term and preterm neonates who were referred within first seven days of life were included and those with gross congenital abnormalities and left against medical advice were excluded from the study. After enrollment, data were collected using a structured questionnaire including birth details, interventions before transportation, reasons for referral, and details of transportation. Outcome & duration of hospital stay were also recorded. Neonates who were expired considered as group I and who were survived considered as group II. The study variables were analyzed for their association with immediate outcome by applying chi square test and t test. P value <0.05 was considered significant.Results: This study found that out of 332 neonates 181 were expired with 54.5% mortality rate. One eighty one neonates who were expired, considered as group I and one fifty one neonate were survived, considered as group II. The mortality was significantly high in male neonates [RR 0.80 (0.66-0.97)] and neonates those delivered at home [RR 1.34(1.10-1.64)] (p<0.05). Perinatal asphyxia, pre-term low birth weight, neonatal sepsis were the main causes of referral. It was found that transportation without any referral note [RR 1.40 (1.14- 1.71)], no advice regarding maintenance of airway[RR 1.50(1.17- 1.92)]and keeping warm [RR 1.51(1.17-1.950], resuscitation on admission [RR 1.63(1.23-2.17)] and transportation required > 3hours [RR 1.36(1.09-1.69)] were associated with significantly higher mortality among referred transported neonates(p<0.05).Conclusions: This study found that male neonates, home delivery, transportation without any referral note, no advice regarding maintenance of airway and keeping warm, resuscitation needed on admission and prolonged transportation time were significantly associated with mortality of referred transported neonates.Bangladesh J Child Health 2017; VOL 41 (3) :159-164

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Can urinary biomarkers be used in the outcome assessment of pyeloplasty in children?

African Journal of Urology ◽

10.1186/s12301-021-00217-y ◽

2021 ◽

Vol 27 (1) ◽

Author(s):

Rupesh Keshri ◽

Krishna Kumar Govindarajan ◽

Medha Rajappa ◽

Kumaravel Sambandan ◽

Bikash Kumar Naredi ◽

...

Keyword(s):

Outcome Assessment ◽

Transforming Growth Factor Beta ◽

Transforming Growth Factor ◽

Care Center ◽

Tertiary Care ◽

Urinary Biomarkers ◽

Urine Samples ◽

Rank Test ◽

Mean Values ◽

Tgf Β1

Abstract Background To compare the urinary biomarkers—beta 2-microglobulin (β2M), monocyte chemotactic peptide-1 (MCP-1), and transforming growth factor-beta (TGF-β1)—in the outcome assessment of children with pelviureteric junction obstruction (PUJO) undergoing pyeloplasty. Methods A prospective study was conducted on children with PUJO who had pyeloplasty in a tertiary care center from July 2016 to March 2018. Urine samples were obtained from freshly voided urine samples before surgery and after 6 months of pyeloplasty. Ratio between the levels of biomarkers and urinary creatinine before and after surgery were compared. Results A total of 72 patients had pyeloplasty during this period. The mean levels of standardized urinary β2M, MCP-1 and TGF-β1 before surgery were 3.94 ± 4.06, 96.63 ± 117.68 and 310.65 ± 423.87, respectively, which was significantly higher than the corresponding values in the postoperative period, obtained after 6 months of surgery; postoperative mean values were 3.12 ± 3.95, 25.28 ± 32.06, 109.95 ± 118.72 (P < 0.001), respectively. Using Wilcoxon signed-rank test, fall of MCP-1 and TGF-β1 was more significant compared to β2M. Conclusion Urinary biomarkers (β2M, MCP-1 and TGF-β) offer an effective way of outcome assessment of pyeloplasty for PUJO in children, especially MCP-1 and TGF-β1.

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Thyroid dysfunction in patients of metabolic syndrome: A study from a tertiary care center in India

Asian Journal of Medical Sciences ◽

10.3126/ajms.v12i10.38313 ◽

2021 ◽

Vol 12 (10) ◽

pp. 47-50

Author(s):

Ritu Gupta ◽

Akhil K Vijayan ◽

Sushma Choudhary

Keyword(s):

Metabolic Syndrome ◽

Thyroid Dysfunction ◽

Care Center ◽

Tertiary Care ◽

Cross Sectional Study ◽

Thyroid Stimulating Hormone ◽

P Value ◽

Overt Hypothyroidism ◽

Free T4 ◽

Cross Sectional

Background: Metabolic syndrome is characterized by hypertension, dyslipidemia, central obesity, glucose intolerance, insulin resistance. Thyroid hormone acts as general pacemaker, accelerating metabolic process and may be associated with metabolic syndrome. There is no information available in literature regarding the prevalence and association of thyroid dysfunction in metabolic syndrome in this central region of the country. Aims and Objective: To estimate the prevalence of thyroid dysfunction in patients of metabolic syndrome. Materials and Methods: It is a duration based prospective cross sectional study including 200 patients of metabolic syndrome. A detailed history, clinical examination and relevant investigations including serum Free T4 (FT4), Free T3 (FT3), Thyroid Stimulating Hormone (TSH) were done. Range, frequencies, percentage, mean, standard deviation and P value were calculated. P value of < 0.05 was taken as significant. Results: Prevalence of thyroid dysfunction in metabolic syndrome patients was 28.5%. Prevalence of subclinical and overt hypothyroidism was 18.5% and 8.5% respectively. In patients with both metabolic syndrome and thyroid dysfunction, most common components associated are diabetes mellitus and hypertriglyceridemia. Conclusion: Thyroid dysfunction is significantly common in metabolic syndrome patients. It should be aggressively detected and treated in these patients for better outcome.

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Abstract W MP70: Characteristics of Patients With Microemboli Detected With Transcranial Doppler Monitoring

Stroke ◽

10.1161/str.45.suppl_1.wmp70 ◽

2014 ◽

Vol 45 (suppl_1) ◽

Author(s):

Lauren Koffman ◽

Zubair Ahmed ◽

Rebecca Michael ◽

Leasa Baus ◽

Larry Raber ◽

...

Keyword(s):

Risk Factors ◽

Ischemic Stroke ◽

Care Center ◽

Cerebral Arteries ◽

Tertiary Care ◽

Cryptogenic Stroke ◽

Final Analysis ◽

Stroke Patients ◽

Artery Disease ◽

Wbc Count

Introduction: TCD emboli monitoring (TCDe) is a non-invasive tool used to detect the presence of ongoing microembolic signals (MES) in the intracranial arterial vessels. The clinical utility of this test in the evaluation of acute stroke patients has been debated. Our goal was to evaluate clinical factors associated with MES in ischemic stroke patients who underwent TCDe to determine which patient population may benefit from TCDe. Methods: Retrospective cohort study of adult patients admitted to our tertiary care center for TIA or ischemic stroke from 2011 to 2012 who underwent TCDe. Monitoring was performed for 20 minutes using a standardized protocol. Inclusion criteria included insonatation of both middle cerebral arteries and completion of TCD bubble study (TCB). Repeat TCDe performed on the same patient were excluded from the analysis. Demographic, clinical and objective data were collected using our EMR system. Results: Of the 113 patients included in the final analysis, mean age was 57.9 years and 46.9% were female. MES occurred in 33.6% patients. Mean # of MES was 9.3 (SD 60.6). Patients with MES were significantly younger (51.8 years vs 61.0, p.006) and had fewer vascular risk factors: diabetes (10.5% vs 33.3%, p 0.006), hyperlipidemia (23.7% vs 49.3%, p 0.007), hypertension (47.4% vs 17.33%, p 0.067), atrial fibrillation (7.9% vs 17.33 %, p 0.16), congestive heart failure (5.3% vs 10.7%, p 0.32) and coronary artery disease (18.4 % vs 29.3%, p 0.2). Cryptogenic stroke and the presence of right to left shunt (RLS) was more frequent in patients with MES than those without. Mean WBC count and usCRP were both nonsignificantly higher in patients with MES. Conclusions: Clinical characteristics of patients with MES on TCDe differed from those without MES, which may have diagnostic and clinical implications. Patients with MES were younger and had fewer stroke risk factors. MES were seen more often in patients with RLS and in those with cryptogenic stroke, which raises the possibility of an association between these two factors. Interestingly, patients with MES also had higher usCRP and WBC values, suggesting a possible inflammatory component to the occurrence of MES. More research is needed with a larger sample size to better define the significance of the above findings.

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Perception of Dentofacial Aesthetics in School Children and Their Parents

European Journal of Dentistry ◽

10.1055/s-0040-1714040 ◽

2020 ◽

Author(s):

Alisa Tiro ◽

Enita Nakas ◽

Amra Arslanagic ◽

Nina Markovic ◽

Vildana Dzemidzic

Keyword(s):

Age Groups ◽

P Value ◽

Older Children ◽

School Students ◽

Children And Parents ◽

Chi Squared ◽

Dental Aesthetics ◽

The Difference ◽

Post Hoc ◽

The City

Abstract Objective The aim of this research was to examine the attitudes and perceptions of dentofacial aesthetics among different age groups. Materials and Methods The sample consisted of elementary-school students from the city of Sarajevo, Bosnia and Herzegovina, and their parents. This study included 314 subjects: 157 children and 157 parents. The children’s group consisted of 85 (54.14%) males and 72 (45.85%) females, aged 9 to 15 years. Statistical Analysis Descriptive statistics were used to determine frequency distribution and percentages for all variables. A chi-squared (x 2) test was used to determine the association between variables and a p-value < 0.05 was considered significant for all the differences and associations. Results For the dentofacial appearance with no teeth irregularity or with severe teeth irregularity, an analysis of variance (ANOVA) (post-hoc tests—Tukey’s HSD) indicated that the difference is not statistically significant (p = 0.06) relative to rank matching between all three subject groups.For dentofacial appearance with mild teeth irregularity, an ANOVA (post-hoc tests—Tukey’s HSD) showed statistical difference (p = 0.07) between the teenage group of subjects relative to pre-teenage group of subjects and adult group of subjects. Conclusion Attitudes about desirable and acceptable dental aesthetics differ in younger children compared with older children and parents. Ten years old children find good function with poor aesthetics more pleasing, while 14 years old children find aesthetics with bad function as more pleasing.

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