Improving Clinical Detection of Acute Lacunar Stroke

Background and Purpose— We aim to identify factors associated with imaging-confirmed lacunar strokes and improve their rapid clinical identification early after symptom onset using data from the IST-3 (Third International Stroke Trial). Methods— We selected patients likely to have lacunar infarcts as those presenting with: Oxfordshire Community Stroke Project lacunar syndrome; a random sample with National Institutes of Health Stroke Scale (NIHSS) score <7; and recent lacunar infarct identified on imaging by IST-3 central blinded expert panel. An independent reviewer rated brain scans of this sample and classified visible infarcts according to type, size, and location. We investigated factors associated with presence of lacunar infarct on a 24 to 48 hour follow-up scan using multivariable logistic regression and calculated sensitivity and specificity of Oxfordshire Community Stroke Project alone and in combination with NIHSS score <7. Results— We included 568 patients (330 lacunar syndrome; 147 with NIHSS score <7; 91 with lacunar infarct on baseline imaging, numbers exclude overlaps between groups), mean (±SD) age, 73.2 (±13.6) years, 316 (56%) males, and median NIHSS score 5 (IQR, 4–8). On 24 to 48 hour scan, 138 (24%) patients had lacunar infarcts, 176 (31%) other infarct subtypes, 254 (45%) no visible infarct. Higher baseline systolic blood pressure (odds ratio, 1.01 [95% CI, 1.01–1.02]) and preexisting lacunes (odds ratio, 2.29 [95% CI, 1.47–3.57) were associated with recent lacunar infarcts. Sensitivity and specificity of lacunar syndrome was modest (58% and 45%, respectively), but adding NIHSS score <7 increased specificity (99%), positive and negative predictive values (97% and 87%, respectively). Conclusions— In patients presenting within 6 hours of stroke onset, adding NIHSS score <7 to Oxfordshire Community Stroke Project lacunar syndrome classification may increase specificity for identifying lacunar stroke early after stroke onset. Our findings may help selection of patients for clinical trials of lacunar stroke and should be validated externally. Registration— URL: http://www.controlled-trials.com/ ; Unique identifier: ISRCTN25765518.

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Abstract T P51: MRI Characteristics of the Evolution of Lacunar Infarct Lesions

Stroke ◽

10.1161/str.46.suppl_1.tp51 ◽

2015 ◽

Vol 46 (suppl_1) ◽

Author(s):

Shuhei Okazaki ◽

Eva Hornberger ◽

Martin Griebe ◽

Achim Gass ◽

Michael G Hennerici ◽

...

Keyword(s):

Odds Ratio ◽

Morphological Changes ◽

Infarct Volume ◽

Multiple Logistic Regression Analysis ◽

Reduction Rate ◽

Volume Reduction ◽

Lacunar Infarct ◽

Lacunar Infarcts ◽

Mri Characteristics

Background and Purpose: Morphological changes of lacunar infarct are not well defined. The purpose of the present study was to describe the MRI characteristics of the evolution of symptomatic lacunar infarcts. Methods: From a prospectively collected stroke database, 62 definite lacunar infarct patients with baseline and follow-up MRI (≥ 90 days of stroke onset) were analyzed. We investigated the incidence of cavitation, the infarct volume change, and the positional relationship between lacunar infarcts and preexisting white matter lesions (WMLs). Results: Median follow-up period was 26 months (range 3-99 months). Cavitation was observed in 38 patients (61%) and 25 lacunar infarct lesions (40%) overlapped with WMLs. Age, hypertension, baseline infarct diameter, baseline infarct volume, and baseline National Institute of Health Stroke (NIHSS) score were associated with cavitation (Figure). In a multiple logistic regression analysis, age (odds ratio per 5-year increase: 1.34; 95% confidence interval (CI): 1.03_1.80; p=0.03) and baseline infarct volume (odds ratio per 1-ml increase: 4.7; 95%CI: 1.6_19.7) were independent predictors of cavitation. There was a significant volume reduction between baseline and follow-up infarct lesions (median volume reduction rate: 44%, p<0.001). Conclusions: More than one third of symptomatic lacunar infarcts developed no cavitation and 40% of lacunar infarct lesions overlapped with WMLs. The incidence of cavitation strongly depended on the patient’s age and baseline infarct volume. Our data indicate the continuity between lacunar infarcts and WMLs.

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Abstract WP440: Analysis of Hypoplastic Variants of the Circle of Willis in Patients with First-ever Lacunar Stroke

Stroke ◽

10.1161/str.48.suppl_1.wp440 ◽

2017 ◽

Vol 48 (suppl_1) ◽

Author(s):

Angelos M Katramados ◽

Horia Marin ◽

Maximilian Kole ◽

Panayiotis Varelas ◽

Daniel Miller ◽

...

Keyword(s):

Functional Unit ◽

Small Vessel Disease ◽

Posterior Part ◽

Circle Of Willis ◽

Lacunar Infarct ◽

Small Vessel ◽

Lacunar Stroke ◽

Lacunar Infarcts ◽

Vessel Disease ◽

Historical Controls

Background: Cerebral small vessel disease is related to widespread endothelial dysfunction, and suspected hypoperfusion at the level of the microcirculation. Lacunar infarcts are a major manifestation of small vessel disease, and result in significant long-term neurological morbidity and mortality. Congenital hypoplastic variants of the vessels of the Circle of Willis may result in impairment of collateral channels at the time of ischemia. Hypothesis: We hypothesized that lateralization of first-ever lacunar infarcts is related to relative hypoperfusion of the ipsilateral hemisphere due to asymmetric hypoplasia of the vessels of the Circle of Willis and inadequate side-to-side collateral circulation. Methods: We analyzed 40 consecutive patients that presented to a stroke center with a first-ever supratentorial lacunar infarct. All patients were able to undergo intracranial vascular imaging. Patients with significant large-vessel disease (even if asymptomatic) were excluded. A neuroradiologist, blinded to the laterality of the lacunar infarct, assessed for lateralized hypoplasia of the Circle of Willis (either anteriorly at the level of the A1 artery and AComA as one functional unit, or posteriorly at the level of the PCA and PComA as one functional unit). Proportions of ipsilateral and contralateral hypoplasia were compared directly, as well as with historical controls, with the chi-squared test. Results: Among analyzed patients, ipsilateral and contralateral anterior pathway hypoplastic variants were not significantly different from historical controls (p=0.145 and p=0.99 respectively). However, ipsilateral and contralateral posterior pathway hypoplastic variants were significantly different from historical controls (p<0.001 for both). There was no statistical difference between ipsilateral and contralateral posterior pathway hypoplasia (p=0.21). Conclusion: Hypoplasia of the posterior part of the Circle of Willis is significantly more common among patients with first-ever lacunar stroke, compared to historical controls. However, the asymmetry of hypoplasia does not affect the laterality of first-ever lacunar infarct. Further studies are required to explain this phenomenon.

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Demographic factors associated with missed follow-up among solid tumor patients treated at a large multi-site academic institution

Future Oncology ◽

10.2217/fon-2020-0425 ◽

2020 ◽

Vol 16 (32) ◽

pp. 2635-2643

Author(s):

Samantha L Freije ◽

Jordan A Holmes ◽

Saleh Rachidi ◽

Susannah G Ellsworth ◽

Richard C Zellars ◽

...

Keyword(s):

Cancer Patients ◽

Odds Ratio ◽

Regression Models ◽

Tumor Patients ◽

Logistic Regression Models ◽

Factors Associated ◽

Follow Up Care ◽

Risk Patients ◽

African American Race

Aim: To identify demographic predictors of patients who miss oncology follow-up, considering that missed follow-up has not been well studies in cancer patients. Methods: Patients with solid tumors diagnosed from 2007 to 2016 were analyzed (n = 16,080). Univariate and multivariable logistic regression models were constructed to examine predictors of missed follow-up. Results: Our study revealed that 21.2% of patients missed ≥1 follow-up appointment. African–American race (odds ratio [OR] 1.33; 95% CI: 1.17–1.51), Medicaid insurance (OR 1.59; 1.36–1.87), no insurance (OR 1.66; 1.32–2.10) and rural residence (OR 1.78; 1.49–2.13) were associated with missed follow-up. Conclusion: Many cancer patients miss follow-up, and inadequate follow-up may influence cancer outcomes. Further research is needed on how to address disparities in follow-up care in high-risk patients.

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Use of catheter with 2-methacryloyloxyethyl phosphorylcholine polymer coating is associated with long-term availability of central venous port

Scientific Reports ◽

10.1038/s41598-021-84885-4 ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Yuuki Iida ◽

Kumiko Hongo ◽

Takanobu Onoda ◽

Yusuke Kita ◽

Yukio Ishihara ◽

...

Keyword(s):

Odds Ratio ◽

Polymer Coating ◽

Venous Access ◽

Preventive Effect ◽

Central Venous ◽

Factors Associated ◽

Central Venous Port ◽

Venous Port ◽

Venous Access Device

AbstractCentral venous port (CVP) is a widely used totally implantable venous access device. Recognition of risks associated with CVP-related complications is clinically important for safe, reliable, and long-term intravenous access. We therefore investigated factors associated with CVP infection and evulsion, including the device type. A total of 308 consecutive patients with initial CVP implantation between January 2011 and December 2017 were retrospectively reviewed, and the association of clinical features with CVP-related complications were analyzed. Intraoperative and postoperative complications occurred in 11 (3.6%) and 39 (12.7%) patients, respectively. The overall rate of CVP availability at six months was 91.4%. Malignancy and 2-Methacryloyloxyethyl phosphorylcholine (MPC) polymer-coated catheter use were negatively associated with the incidence of CVP infections. Accordingly, malignancy and MPC polymer-coated catheter use were independent predictors for lower CVP evulsion rate (odds ratio, 0.23 and 0.18, respectively). Furthermore, both factors were significantly associated with longer CVP availability (hazard ratio, 0.24 and 0.27, respectively). This retrospective study identified factors associated with CVP-related complications and long-term CVP availability. Notably, MPC polymer-coated catheter use was significantly associated with a lower rate of CVP infection and longer CVP availability, suggesting the preventive effect of MPC coating on CVP infection.

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Factors associated with early reperfusion improvement after intra-arterial fibrinolytics as rescue for mechanical thrombectomy

Clinical and Translational Neuroscience ◽

10.1177/2514183x211017363 ◽

2021 ◽

Vol 5 (1) ◽

pp. 2514183X2110173

Author(s):

Johannes Kaesmacher ◽

Giovanni Peschi ◽

Nuran Abdullayev ◽

Basel Maamari ◽

Tomas Dobrocky ◽

...

Keyword(s):

Odds Ratio ◽

Clinical Effect ◽

Mechanical Thrombectomy ◽

Functional Independence ◽

Cardioembolic Stroke ◽

Inclusion Criteria ◽

Early Reperfusion ◽

Factors Associated ◽

Randomized Controlled ◽

Interaction Terms

Objective: To identify factors associated with early angiographic reperfusion improvement (EARI) following intra-arterial fibrinolytics (IAF) after failed or incomplete mechanical thrombectomy (MT). Methods: A subset of patients treated with MT and IAF rescue after incomplete reperfusion included in the INFINITY (INtra-arterial FIbriNolytics In ThrombectomY) multicenter observational registry was analyzed. Multivariable logistic regression was used to identify factors associated with EARI. Heterogeneity of the clinical effect of EARI on functional independence (defined as modified Rankin Score ≤2) was tested with interaction terms. Results: A total of 228 patients (median age: 72 years, 44.1% female) received IAF as rescue for failed or incomplete MT and had a post-fibrinolytic angiographic control run available (50.9% EARI). A cardioembolic stroke origin (adjusted odds ratio (aOR) 3.72, 95% confidence interval (CI) 1.39–10.0) and shorter groin puncture to IAF intervals (aOR 0.82, 95% CI 0.71–0.95 per 15-min delay) were associated with EARI, while pre-interventional thrombolysis showed no association (aOR 1.15, 95% CI 0.59–2.26). The clinical benefit of EARI after IAF seemed more pronounced in patients without or only minor early ischemic changes (Alberta Stroke Program Early Computed Tomography Score (ASPECTS) ≥9, aOR 4.00, 95% CI 1.37–11.61) and was absent in patients with moderate to severe ischemic changes (ASPECTS ≤8, aOR 0.94, 95% CI 0.27–3.27, p for interaction: 0.095). Conclusion: Early rescue and a cardioembolic stroke origin were associated with more frequent EARI after IAF. The clinical effect of EARI seemed reduced in patients with already established infarcts. If confirmed, these findings can help to inform patient selection and inclusion criteria for randomized-controlled trials evaluating IAF as rescue after MT.

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Factors associated with the development of ocular candidiasis and ocular prognosis with echinocandin therapy for candidemia

Journal of Ophthalmic Inflammation and Infection ◽

10.1186/s12348-021-00248-0 ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Daiki Sakai ◽

Wataru Matsumiya ◽

Sentaro Kusuhara ◽

Makoto Nakamura

Keyword(s):

Candida Albicans ◽

Medical Records ◽

Odds Ratio ◽

Adjusted Odds Ratio ◽

Patient Characteristics ◽

Antifungal Drugs ◽

Factors Associated ◽

Logistic Analysis ◽

Multivariate Logistic Analysis ◽

Systemic Antifungal Therapy

Abstract Purpose To evaluate the factors associated with the development of ocular candidiasis (OC) and ocular prognosis with echinocandin therapy for candidemia. Methods The medical records of 56 consecutive patients with a positive blood culture for Candida species between November 2016 and October 2019 were retrospectively reviewed. Information on patient characteristics, isolated Candida species, treatment details for candidemia, and ocular findings were extracted to identify factors associated with OC development. Results The leading pathogen of candidemia was Candida albicans (C.albicans) (41.1%). Of 56 patients, 18 (32.1%) were diagnosed with chorioretinitis, categorized as either probable (8 patients) or possible OC (10 patients). There was no case of endophthalmitis with vitritis. The incidence of probable OC was not significantly different between the groups treated with echinocandins and other antifungal drugs (15.2% vs. 11.1%, p = 1.00). In all probable OC cases, systemic antifungal therapy was switched from echinocandins to azoles, and no case progressed to endophthalmitis. A multivariate logistic analysis revealed that female sex (adjusted odds ratio [aOR], 8.93; 95% confidence interval [CI], 1.09–72.9) and C. albicans (aOR, 23.6; 95% CI, 1.8–281) were independent factors associated with the development of probable OC. Conclusion One-seventh of patients with candidemia developed probable OC. Given the evidence of female and C. albicans as the factors associated with OC development, careful ophthalmologic management is required with these factors, especially in candidemia. Although echinocandins had no correlation with OC development and did not lead to the deterioration of ocular prognosis, further investigation is required.

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Prognostic factors for mortality in invasive pneumococcal disease in adult: a system review and meta-analysis

Scientific Reports ◽

10.1038/s41598-021-91234-y ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Hao Chen ◽

Hiromi Matsumoto ◽

Nobuyuki Horita ◽

Yu Hara ◽

Nobuaki Kobayashi ◽

...

Keyword(s):

Invasive Pneumococcal Disease ◽

Odds Ratio ◽

Pneumococcal Disease ◽

Web Of Science ◽

Meta Analysis ◽

Mortality Rates ◽

Solid Organ ◽

Factors Associated ◽

System Review ◽

Overall Mortality

AbstractRisk factors associated with mortality in invasive pneumococcal disease remain unclear. The present work is a meta-analysis of studies that enrolled only patients with invasive pneumococcal disease and reported on mortality. Potentially eligible reports were identified from PubMed, CHAHL, and Web of Science, comprising 26 reports in total. Overall mortality for invasive pneumococcal disease was reported as 20.8% (95% confidence interval (CI) 17.5–24%). Factors associated with mortality were age (odds ratio (OR) 3.04, 95% CI 2.5–3.68), nursing home (OR 1.62, 95% CI 1.13–2.32), nosocomial infection (OR 2.10, 95% CI 1.52–2.89), septic shock (OR 13.35, 95% CI 4.54–39.31), underlying chronic diseases (OR 2.34, 95% CI 1.78–3.09), solid organ tumor (OR 5.34, 95% CI 2.07–13.74), immunosuppressed status (OR 1.67, 95% CI 1.31–2.14), and alcohol abuse (OR 3.14, 95% CI 2.13–4.64). Mortality rates with invasive pneumococcal disease remained high, and these findings may help clinicians provide appropriate initial treatment for this disease.

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Factors associated with parental traditional medicine use for children in Fagita Lekoma Woreda Northwest Ethiopia: A cross-sectional study

SAGE Open Medicine ◽

10.1177/2050312120978008 ◽

2020 ◽

Vol 8 ◽

pp. 205031212097800

Author(s):

Damtew Asrat ◽

Atsede Alle ◽

Bekalu Kebede ◽

Bekalu Dessie

Keyword(s):

Confidence Interval ◽

Traditional Medicine ◽

Odds Ratio ◽

Adjusted Odds Ratio ◽

Cross Sectional Study ◽

Medicine Use ◽

Community Based ◽

Cross Sectional ◽

Traditional Medicines ◽

Factors Associated

Background: Over the last 100 years, the development and mass production of chemically synthesized drugs have revolutionized health care in most parts of the world. However, large sections of the population in developing countries still depend on traditional medicines for their primary health care needs. More than 88% of Ethiopian parents use different forms of traditional medicine for their children. Therefore, this study aimed to determine factors associated with parental traditional medicine use for children in Fagita Lekoma Woreda. Method: Community-based cross-sectional study was conducted from 1 to 30 March 2019 in Fagita Lekoma Woreda. Data collection tool was a structured interviewer-administered questionnaire. Both descriptive and inferential statistics were used to present the data. Odds ratio and binary and multiple logistic regression analysis were used to measure the relationship between dependent and independent variables. Results: Among 858 participants, 71% of parents had used traditional medicine for their children within the last 12 months. Parents who cannot read and write (adjusted odds ratio = 6.42, 95% confidence interval = 2.1–19.7), parents with low monthly income (adjusted odds ratio = 4.38, 95% confidence interval = 1.58–12.1), and those who had accesses to traditional medicine (adjusted odds ratio = 2.21, 95% confidence interval = 1.23–3.98) were more likely to use traditional medicine for their children. Urban residents (adjusted odds ratio = 0.20, 95% confidence interval = 0.11–0.38) and members of community-based health insurance (adjusted odds ratio = 0.421, 95% confidence interval = 0.211–0.84) were less likely to use traditional medicine for their children. Conclusions: Our study revealed that the prevalence of traditional medicine remains high. Educational status, monthly income, residence, accessibility to traditional medicine, and being a member of community-based health insurance were predictors of potential traditional medicine use. Therefore, the integration of traditional medicine with modern medicine should be strengthened. Community education and further study on efficacy and safety of traditional medicines should be also given great attention.

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Early prediction of falls after stroke: a 12-month follow-up of 490 patients in The Fall Study of Gothenburg (FallsGOT)

Clinical Rehabilitation ◽

10.1177/0269215518819701 ◽

2018 ◽

Vol 33 (4) ◽

pp. 773-783 ◽

Cited By ~ 6

Author(s):

Carina M Samuelsson ◽

Per-Olof Hansson ◽

Carina U Persson

Keyword(s):

Confidence Interval ◽

Postural Control ◽

Acute Phase ◽

Odds Ratio ◽

Stroke Unit ◽

Inpatient Rehabilitation ◽

Stroke Onset ◽

Multivariable Regression ◽

Walking Aid

Objective: To identify the incidence of falls and factors present shortly after stroke, which are associated with the occurrence of falls over the first 12 months after stroke onset, following discharge from inpatient rehabilitation. Design: Prospective follow-up study. Setting: Stroke unit and outpatient department. Subjects: A total of 490 individuals with acute stroke. Methods: Postural control was assessed using the Swedish modified version of the Postural Assessment Scale for Stroke Patients. Data on self-reported falls were collected using a standardized questionnaire at three months after discharge and six and 12 months after stroke onset. Associations between characteristics during the acute phase after a stroke and falls after six and 12 months were investigated using univariable and multivariable regression analyses. Main measures: The endpoint was a self-reported fall. Results: Within three months after discharge, 38 of 165 respondents (23%) had experienced at least one fall. Within six and 12 months after stroke onset, respectively, 108 of 376 (29%) and 140 of 348 (40%) of the respondents had experienced at least one fall. Poor postural control (odds ratio 3.92, 95% confidence interval 2.07–7.45, P < 0.0001) and using a walking aid (odds ratio 2.84, 95% confidence interval 1.71–4.72, P < 0.0001) were predictors of falls after discharge within 12 months after stroke onset. The same variables were independent predictors of falls within six months. Conclusion: Poor postural control and using a walking aid in the acute phase after a stroke are associated with falls after discharge from a stroke unit within 12 months after stroke onset.

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Analysis models for variables associated with breastfeeding duration

Revista Paulista de Pediatria ◽

10.1590/s0103-05822013000300006 ◽

2013 ◽

Vol 31 (3) ◽

pp. 306-314 ◽

Cited By ~ 3

Author(s):

Edson Theodoro dos S. Neto ◽

Eliana Zandonade ◽

Adauto Oliveira Emmerich

Keyword(s):

Logistic Regression ◽

Protective Factors ◽

Regression Model ◽

Odds Ratio ◽

Regression Models ◽

Adjusted Odds Ratio ◽

Cox Regression ◽

Bottle Feeding ◽

Breastfeeding Duration ◽

Factors Associated

OBJECTIVE To analyze the factors associated with breastfeeding duration by two statistical models. METHODS A population-based cohort study was conducted with 86 mothers and newborns from two areas primary covered by the National Health System, with high rates of infant mortality in Vitória, Espírito Santo, Brazil. During 30 months, 67 (78%) children and mothers were visited seven times at home by trained interviewers, who filled out survey forms. Data on food and sucking habits, socioeconomic and maternal characteristics were collected. Variables were analyzed by Cox regression models, considering duration of breastfeeding as the dependent variable, and logistic regression (dependent variables, was the presence of a breastfeeding child in different post-natal ages). RESULTS In the logistic regression model, the pacifier sucking (adjusted Odds Ratio: 3.4; 95%CI 1.2-9.55) and bottle feeding (adjusted Odds Ratio: 4.4; 95%CI 1.6-12.1) increased the chance of weaning a child before one year of age. Variables associated to breastfeeding duration in the Cox regression model were: pacifier sucking (adjusted Hazard Ratio 2.0; 95%CI 1.2-3.3) and bottle feeding (adjusted Hazard Ratio 2.0; 95%CI 1.2-3.5). However, protective factors (maternal age and family income) differed between both models. CONCLUSIONS Risk and protective factors associated with cessation of breastfeeding may be analyzed by different models of statistical regression. Cox Regression Models are adequate to analyze such factors in longitudinal studies.

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