Stroke occurrence in patients with STEMI: does BNP help to predict?

Abstract Funding Acknowledgements Type of funding sources: None. OnBehalf Portuguese Registry of Acute Coronary Syndromes (ProACS) Introduction Although brain natriuretic peptides (BNP) has been primarily identified in brain tissue, its clinical application is primarily related to cardiac disease, namely heart failure. The current information on this natriuretic peptide in cerebrovascular disease is limited, however some studies performed showed an acute elevation of BNP during the acute phase of ischemic stroke. Objective Evaluation of prognostic value of BNP in the occurrence of in-hospital ischemic stroke in patients admitted with ST elevation myocardial infarction (STEMI). Material and methods Retrospective analysis of patients´ data admitted with STEMI at multicentric registry between October 2010 and January 2019. Patients were divided into two groups: group 1 – patients who suffered an ischemic stroke (0.8%) and group 2 – without stroke (99.2%). Demographic and clinical characteristics were compared. A logistic regression was performed to evaluate prognostic value of BNP in the occurrence of in-hospital stroke and cardiovascular events. Results Admitted 1650 patients with STEMI. There was no statistically significant difference between mean age in both groups (mean age 64 ± 13 years, p 0.122) and most patients were male (75.4%). A higher percentage of group 1 patients had a previous diagnosis of stroke/ transitory ischemic accident (28.6 vs 5.4%, p 0.006) but there was no significant differences regarding the percentages of previous arterial hypertension, diabetes, dyslipidaemia neither peripheral vascular disease. Mean values of BNP at admission were higher in group 1: 839 ± 1088 vs 333 ± 639 pg/ml (p 0.04). All patients were submitted to coronary angiography, without evidence of significant differences regarding severity of coronary disease. In group 1 patients mean left ventricle ejection fraction (LVEF) during hospitalization was lower: 43 ± 11 vs 53 ± 13 %, p 0.005. Logistic regression identified as prognostic factors of in-hospital ischemic stroke: previous stroke/ transitory ischemic accident (p 0.007), dementia (p 0.005) or thoracic pain at STEMI presentation (p 0.005). Although patients with higher levels of BNP had suffered more stroke (0.5% in group with BNP < 100pg/ml; 0.6% in group with 100 ≤ BNP < 400 pg/ml; and 2.0% in group with BNP ≥ 400 pg/ml), BNP did not show to be predictor of stroke occurrence in this context (p 0.862). Conclusion Although patients with higher levels of BNP had suffered more stroke, BNP did not show to be predictor of stroke occurrence in patients admitted with STEMI.

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Fracture resistance of immature teeth filled with mineral trioxide aggregate, bioaggregate, and biodentine

European Journal of Dentistry ◽

10.4103/1305-7456.178310 ◽

2016 ◽

Vol 10 (02) ◽

pp. 220-224 ◽

Cited By ~ 6

Author(s):

Emre Bayram ◽

Huda Melike Bayram

Keyword(s):

Fracture Resistance ◽

Mineral Trioxide Aggregate ◽

Mean Values ◽

Root Canals ◽

Immature Teeth ◽

Significant Difference ◽

Group 3 ◽

Group 2 ◽

Post Hoc ◽

Group 1

ABSTRACT Objective: The purpose of this study was to evaluate fracture resistance of teeth with immature apices treated with coronal placement of mineral trioxide aggregate (MTA), bioaggregate (BA), and Biodentine. Materials and Methods: Forty-one freshly extracted, single-rooted human premolar teeth were used for the study. At first, the root length was standardized to 9 mm. The crown-down technique was used for the preparation of the root canals using the rotary ProTaper system (Dentsply Maillefer, Ballaigues, Switzerland) of F3 (30). Peeso reamer no. 6 was stepped out from the apex to simulate an incompletely formed root. The prepared roots were randomly assigned to one control (n = 5) and three experimental (n = 12) groups, as described below. Group 1: White MTA (Angelus, Londrina, Brazil) was prepared as per the manufacturer's instructions and compacted into the root canal using MAP system (Dentsply Maillefer, Ballaigues, Switzerland) and condensed by pluggers (Angelus, Londrina, Brazil). Group 2: The canals were filled with DiaRoot-BA (DiaDent Group International, Canada). Group 3: Biodentine (Septodont, Saint Maur des Fosses, France) solution was mixed with the capsule powder and condensed using pluggers. Instron was used to determine the maximum horizontal load to fracture the tooth, placing the tip 3 mm incisal to the cementoenamel junction. Mean values of the fracture strength were compared by ANOVA followed by a post hoc test. P < 0.05 was considered statistically significant. Results: No significant difference was observed among the MTA, BA, and biodentine experimental groups. Conclusion: All the three materials tested, may be used as effective strengthening agents for immature teeth.

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Abstract WP380: Thyrotoxicosis is Associated With Worse In-Hospital Mortality in Patients With Ischemic Stroke

Stroke ◽

10.1161/str.51.suppl_1.wp380 ◽

2020 ◽

Vol 51 (Suppl_1) ◽

Author(s):

Sakiru O Isa ◽

Olajide Buhari ◽

Hameem Changezi

Keyword(s):

Ischemic Stroke ◽

Hospital Mortality ◽

Length Of Hospital Stay ◽

The Body ◽

Significant Difference ◽

History Of ◽

Group 3 ◽

Group 2 ◽

Time Of Presentation ◽

Group 1

Introduction: Hyperthyroidism increases the basal metabolic rate and affects most systems in the body. Patients with hyperthyroidism have been shown to have a higher incidence of ischemic stroke. There is a paucity of information regarding its effects on the short-term outcomes of patients admitted with ischemic stroke. Hypothesis: Hyperthyroidism is associated with worse in-hospital outcomes in patients admitted for ischemic stroke. Methods: We queried the National Inpatient Sample to identify adult patients(aged 18 and above) admitted for ischemic stroke between January 2011 and December 2014. We compared those with a history of hyperthyroidism (group 1) and thyrotoxicosis on admission (group 2) with the rest of the patients (group 3). The main outcome was in-hospital mortality. Secondary outcomes included the length of hospital stay and cost of hospitalization. We used the logistic regression model and adjusted for baseline characteristics and co-morbidities. Results: There were 643,786 patients in the study, 0.44% had a history of hyperthyroidism, and 0.01% had thyrotoxicosis at the time of presentation. The odd of mortality in group 1 compared to group 3 was 0.89, 95% CI 0.75-1.05, p=0.16 while in group 2 compared to group 3, it was 2.42, 95% CI 1.29-4.52, p<0.006. The mean length of stay was also longer in group 2 with a mean difference of 8.06, 95% CI 4.74 - 11.39, p<0.0001. Conclusion: From the study, there was no significant difference in in-hospital mortality between patients with previously diagnosed hyperthyroidism and those without diagnosed hyperthyroidism. Patients who had thyrotoxicosis on admission, on the other hand, had worse outcomes compared to patients without thyrotoxicosis.

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Acquired Antithrombin III (AT III) - Deficiency in Septicaemia

10.1055/s-0039-1687422 ◽

1979 ◽

Author(s):

E. Deutsch ◽

E. Thaler

Keyword(s):

Septic Shock ◽

Venous Blood ◽

Heparin Therapy ◽

Blood Cultures ◽

Mean Values ◽

Negative Results ◽

Significant Difference ◽

At Iii ◽

Group 2 ◽

Group 1

AT III was measured in 34 patients with clinical and bacteriological evidence of septicaemia using a heparin cofactor assay. Based on the results of positive blood cultures gram-negative septicaemia (G-S) was diagnosed in 10 (group 1) and gram positive septicaemia (G+S) in 9 patients (group 2). From the remaining 15 patients {group 3) blood cultures before onset of antibiotic therapy were not obtained and gave negative results throughout the observation period. Based on bacteria] cultures from other sites than venous blood or bacteriological examination of spinal fluid G-S was assumed in 13 and G+S in 2 patients.In all but one patient of group 1 and one of group 2 AT III activities were decreased below 2 SO of normal controls (n = 91, x = 99.6, SD-8.4) already at the time of the first coagulation screening (patients: n=34, =58.4, SD-16.6). Analysis of var-ance showed no significant difference between the mean values of the three groups at the c per cent (%) level. The minimal AT III activities during the course of the disease were below the norma] range in all patients studied [n=34, =51.2, SD=13.6).Thus AT III deficiency appears to be a constant and early finding in G-S and G+S, causing insufficient inhibition of blood coagulation, and hereby may contribute to irreversible tissue damage caused by microthrombi in septic shock. This deficiency may be an important factor in the failure of heparin therapy to reduce mortality from septic shock.

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The effects of interprofessional diabetes education on the knowledge of medical, dentistry and nursing students

Acta Medica Academica ◽

10.5644/ama2006-124.199 ◽

2018 ◽

Vol 46 (2) ◽

pp. 145

Author(s):

Maja Račić ◽

Bojan N. Joksimović ◽

Smiljka Cicmil ◽

Srebrenka Kusmuk ◽

Nedeljka Ivković ◽

...

Keyword(s):

Interprofessional Education ◽

Multiple Choice Questions ◽

Self Assessment ◽

Cross Sectional ◽

Mean Values ◽

Significant Difference ◽

Teamwork Skills ◽

Group 2 ◽

The Impact ◽

Group 1

<div class="WordSection1">Objectives. Interprofessional teamwork is best attained through education that promotes mutual trust and effective communication. The primary aim of the study was to evaluate the impact of interprofessional learning on knowledge about diabetes. Methods. The cross-sectional study included students of medicine, dentistry and nursing at the Faculty of Medicine Foča, Bosnia and Herzegovina. The students were randomly allocated into one of two groups. Group 1 attended an interprofessional course on diabetes while group 2 was divided into three subgroups and each of the subgroups attended an uniprofessional diabetes course. The measuring instrument used in the course in order to assess the participants’ knowledge about diabetic care was a test containing multiple-choice questions about diabetes. The Interprofessional Questionnaire was used to explore the attitudes, views, values and beliefs of students regarding interprofessional education (IPE). Results. No statistically significant difference in total score on the test was found between the groups at baseline, but at follow-up the difference was highly statistically significant (F=10.87; p=0.002). The students from Group 1 had better results (21.82 points), compared to Group 2 (18.77 points). The statistically significant difference was observed in mean values (t=-3.997; p=0.001), between Groups 1 and 2; the students from Group 1 obtained 20.42 points, which is considered to indicate a respectively positive self-assessment of communication and teamwork skills. However, Group 2 indicated a negative self-assessment of communication and teamwork skills. Conclusion. The findings suggest that IPE activities may provide health profession students with valuable collaborative learning opportunities.</div>

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Validity of Autotaxin as a Novel Diagnostic Marker for Liver Fibrosis in Egyptian Chronic HCV Patients

Open Access Macedonian Journal of Medical Sciences ◽

10.3889/oamjms.2013.005 ◽

2013 ◽

Vol 1 (1) ◽

pp. 21-26 ◽

Cited By ~ 1

Author(s):

Wafaa M. Ezzat ◽

Halla M. Ragab ◽

Nabila Abd El Maksoud ◽

Nour A. Abdulla ◽

Yasser A. Elhosary

Keyword(s):

Liver Fibrosis ◽

Diagnostic Marker ◽

Fibrosis Score ◽

Laboratory Assessment ◽

Mean Values ◽

Significant Difference ◽

The Mean ◽

Group 2 ◽

Chronic Hcv ◽

Group 1

We aimed to detect the validity of serum ATX as a diagnostic marker for liver fibrosis. Forty-eight males and 16 females were enrolled in the current study. Their ages ranged from 29-57 years with mean of 45.09, all were chronically HCV infected. Laboratory assessment was done for all subjects in form of complete blood picture; liver function test; lipid profile and serum detection of ATX. Patients were grouped according to the stage of fibrosis into group 1: fibrosis score 0, 1, 2, 3; group 2: fibrosis score: 4, 5, 6.The mean values of ATX in all studied patients with chronic HCV infection was 63.02 ± 36.29 while that of healthy controls was 65.31 ± 12.24 without any significant difference. Surprisingly, mean values of ATX were higher among patients with group 1 but it did not reach the significant level. In each group of them, the differences between mean values of ATX among different grades of liver fibrosis were insignificant. It was also noticed that the mean values of ATX were higher among men than in women .It was concluded that Autotoxin might not be used as a useful diagnostic marker for liver fibrosis in Egyptian chronic HCV patients.

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P1817Assessment of carotid stiffness indices in patients with ischemic stroke

European Heart Journal ◽

10.1093/eurheartj/ehz748.0569 ◽

2019 ◽

Vol 40 (Supplement_1) ◽

Author(s):

G Youssef ◽

D Mekkawy ◽

N El-Fayoumy ◽

A Abbas ◽

M Allam

Keyword(s):

Risk Factors ◽

Ischemic Stroke ◽

Carotid Arteries ◽

Tracking System ◽

Intima Media Thickness ◽

Control Subjects ◽

Carotid Stiffness ◽

Significant Difference ◽

Group 2 ◽

Group 1

Abstract Background Arterial stiffness is considered as an emerging new important risk factor for stoke development. Measuring carotid stiffness is easy and non-invasive and thus can be widely applicable. Purpose To evaluate the carotid stiffness indices in patients with ischemic stroke compared to normal healthy subjects. Methods Included in this study are 60 patients (group 1) with ischemic stroke and 60 healthy control subjects (group 2). Participants were exposed to routine clinical examination and Duplex assessment of both carotid arteries. A specific wall tracking system was used for the semiautomatic calculation of the carotid stiffness indices, which included; compliance coefficient (CC), distensibility coefficient (DC), carotid pulse wave velocity (PWV) and carotid intima media thickness (IMT). Results from both carotid arteries were averaged and data from group 1 patients were compared to group 2 subjects. Results The mean age was (60.1±6.9 years) in group 1 compared to (60.1±6.6 years) in group 2 (p=0.9). A significant difference was found between both groups in all carotid stiffness indices; including average CC (0.64±0.29 vs 0.82±0.36 m2/kpa, p=0.004); average DC (11.69±5.42 vs 18.61±11.87 1/kpa, p<0.001); average PWV (16.5±0.6 vs 12.5±3.7 m/s, p<0.001) and average IMT (0.78±0.13 vs 0.68±0.18 mm, p=0.001). Only the carotid PWV was found to be a predictor of vascular stroke (p=0.001) Conclusion Patients with vascular stroke have higher carotid stiffness indices than age matched control subjects. Measuring carotid stiffness indices in patients who have atherosclerotic risk factors may help predict those at risk of vascular stroke and thus guide a tighter and a more efficient risk factors control.

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Prognostic Role of Chronic Rhinosinusitis in Acute Ischemic Stroke Patients Undergoing Mechanical Thrombectomy

Journal of Clinical Medicine ◽

10.3390/jcm10194446 ◽

2021 ◽

Vol 10 (19) ◽

pp. 4446

Author(s):

Przemysław Puz ◽

Grażyna Stryjewska-Makuch ◽

Amadeusz Żak ◽

Wiktor Rybicki ◽

Sebastian Student ◽

...

Keyword(s):

Ischemic Stroke ◽

Acute Ischemic Stroke ◽

Chronic Rhinosinusitis ◽

Mechanical Thrombectomy ◽

Stroke Patients ◽

Inflammatory Parameters ◽

Significant Difference ◽

Group 2 ◽

Ct Features ◽

Group 1

Background: The aim of the study was to assess the relevance of chronic rhinosinusitis (CRS) CT features to the efficacy of mechanical thrombectomy (MT) in patients with acute ischemic stroke. Methods: This study included 311 patients qualified for MT in whom the CRS features were assessed based on a CT scan, according to the Lund-Mackay (L-M) score. Clinical, inflammatory parameters, patients neurological (NIHSS) and functional status (mRS), and recanalisation efficacy (TICI) were compared between patients with mild lesions (L-M score 0–3 points)-group 1, and patients with more severe lesions (L–M score 4–24)-group 2. Results: There was a significant difference in the NIHSS on day seven after stroke onset-10 points in group 1 and 14 points in group 2, p = 0.02. NIHSS ≤ 6 points on day seven was found in 41.9% of patients in group 1, and in 27.5% in group 2, p = 0.042. There were no significant differences in mRS score and in the TICI score. L-M score, lipid abnormalities and CRP were factors associated with NIHSS ≥ 7 points on day 7. Conclusions: The CT features of CRS may be used as a prognostic tool for early prognosis assessment in stroke patients.

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Correlation between the presence of inguinal hernia and the intensity of lower urinary tract symptoms

Acta Cirurgica Brasileira ◽

10.1590/s0102-86502011000800023 ◽

2011 ◽

Vol 26 (suppl 2) ◽

pp. 125-128 ◽

Cited By ~ 5

Author(s):

Rodolfo Borges dos Reis ◽

Antonio Antunes Rodrigues Neto ◽

Leonardo Oliveira Reis ◽

Roberto Dias Machado ◽

Steven Kaplan

Keyword(s):

Clinical Evidence ◽

Urine Volume ◽

Control Group ◽

Mean Values ◽

Urinary Tract Symptoms ◽

Significant Difference ◽

Group 2 ◽

Group 1 ◽

Lower Urinary

PURPOSE: To verify the correlation between the presence of IH and the intensity of LUTS related to BPH quantified through the International Prostate Symptom Score (IPSS). METHODS: We prospectively selected 52 patients over the age of 55years; Patients were divided into 2 groups. Group 1: composed of 32 patients with IH; Group 2 (control group): composed of 20 patients with no clinical evidence of IH. All patients were assessed using the IPSS, uroflowmetry (Qmax), post-void residual urine volume (PVR) and prostate volume (PV). RESULTS: Groups 1 and 2 presented no difference in PV (p>0.05) and uroflowmetry (Qmax) (p>0.05). There was a statistical significant difference between the PVR mean values between groups 1 and 2. The presence of IH correlated with a higher IPSS score (r=0.38 p<0.05) despite the fact the no difference was detected between the incidence of patients with mild, moderate and severe LUTS in groups 1 and 2. CONCLUSION: Patients with IH present higher IPSS. The role of IPSS as a marker to predict the development of clinical IH still to be determined.

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Impact of 1-Hour Bundle Achievement in Septic Shock

Journal of Clinical Medicine ◽

10.3390/jcm10030527 ◽

2021 ◽

Vol 10 (3) ◽

pp. 527

Author(s):

Byuk Sung Ko ◽

Sung-Hyuk Choi ◽

Tae Gun Shin ◽

Kyuseok Kim ◽

You Hwan Jo ◽

...

Keyword(s):

Septic Shock ◽

Logistic Regression ◽

Regression Analysis ◽

Hospital Mortality ◽

Odds Ratio ◽

Multivariable Logistic Regression Analysis ◽

Significant Difference ◽

Group 2 ◽

Over Time ◽

Group 1

This study aimed to address the impact of 1-hr bundle achievement on outcomes in septic shock patients. Secondary analysis of multicenter prospectively collected data on septic shock patients who had undergone protocolized resuscitation bundle therapy at emergency departments was conducted. In-hospital mortality according to 1-h bundle achievement was compared using multivariable logistic regression analysis. Patients were also divided into 3 groups according to the time of bundle achievement and outcomes were compared to examine the difference in outcome for each group over time: group 1 (≤1 h reference), group 2 (1–3 h) and group 3 (3–6 h). In total, 1612 patients with septic shock were included. The 1-h bundle was achieved in 461 (28.6%) patients. The group that achieved the 1-h bundle did not show a significant difference in in-hospital mortality compared to the group that did not achieve the 1-h bundle on multivariable logistic regression analysis (<1 vs. >1 h) (odds ratio = 0.74, p = 0.091). However, 3- and 6- h bundle achievements showed significantly lower odds ratios of in-hospital mortality compared to the group that did not achieve the bundle (<3 vs. >3 h, <6 vs. >6 h, odds ratio = 0.604 and 0.458, respectively). There was no significant difference in in-hospital mortality over time for group 2 and 3 compared to that of group 1. One-hour bundle achievement was not associated with improved outcomes in septic shock patients. These data suggest that further investigation into the clinical implications of 1-h bundle achievement in patients with septic shock is warranted.

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SERUM PROCALCITONIN IN PROGNOSIS OF THE SEVERITY OF PATIENTS WITH POSTOPERATIVE PERITONITIS

Journal of Medicine and Pharmacy ◽

10.34071/jmp.2015.6.15 ◽

2016 ◽

pp. 97-102

Author(s):

Xuan Thinh Tran ◽

Kha Canh Ho ◽

Van Dong Trinh

Keyword(s):

Prognostic Value ◽

Clinical Symptoms ◽

Average Concentration ◽

Postoperative Peritonitis ◽

Cross Sectional ◽

Prognostic System ◽

Significant Difference ◽

Group 3 ◽

Group 2 ◽

Group 1

Background: Peritonitis is still one of the most important abdomen problems with the unacceptable high mortality. Mannheim Peritonitis Index (MPI) is one prognostic system that helps us to estimate the prognosis in cases of postoperative peritonitis whereas procalcitonin (PCT) has been widely investigated for its prognostic value in septic patients. The aim of this study was to evaluate the correlation between the PCT with MPI and its value in the prognosis of patients with postoperative peritonitis. Methods: A cross-sectional descriptive study of 80 patients with postoperative peritonitis. The MPI was calculated in all patients. Based upon the MPI, patients were arranged into three groups: group 1 (MPI <22), group 2 (MPI = 22-29) and group 3 (MPI>29). Clinical symptoms and PCT were measured on three times: on the first day, the third day and the fifth day after surgery. The outcome of patients was noted and the prognostic value of the PCT concentration was evaluated. Results: In the 80 patients studied, include 32 patients of group 1 (40%), 29 patients of group 2 (36,2%) and 19 patients of group 3 (23,8%). The average concentration of PCT in group 1; 2 and 3 was 7,98 ng/ml; 31,96 ng/ml and 57,53 ng/ml, respectively. There was a significant difference between the 3 groups (p <0,01). There was a positive correlation between the concentration of PCT and MPI score (r=0,62; p <0,01). The average PCT concentrations between survivors and nonsurvivors groups did not differ on the 1st day but those on the 3rd and 5th day differed significantly. Conclusion: PCT concentrations were correlated with MPI. PCT kinetics between day 1, 3 and 5 could be a predictor of mortality of patients with postoperative peritonitis. Keywords: secondary peritonitis, procalcitonin, prognosis.

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