Coronavirus disease 2019 and stroke in Iran: a case series and effects on stroke admissions

Objective The coronavirus disease 2019 pandemic has affected healthcare systems around the globe and massively impacted patients with various non-infectious, life-threatening conditions. Stroke is a major neurological disease contributing to death and disability worldwide, and is still an ongoing issue during the pandemic. Here we investigate the impact of the coronavirus disease 2019 outbreak on stroke manifestations, treatment courses, the outcome of stroke patients, and the hospitalization rate in a referral center for stroke management in Tehran, Iran. Methods We extracted data regarding 31 stroke patients (10 patients with laboratory-confirmed coronavirus disease 2019) and compared the demographic and pathological characteristics of the patients with or without coronavirus disease 2019 infection. The association of demographic/pathological characteristics of stroke patients during the coronavirus disease 2019 pandemic and a corresponding period during the previous year (49 patients) and an earlier period during the same year as the pandemic (50 patients) was also evaluated. Results The absolute number of admissions decreased about 40% during the coronavirus disease 2019 pandemic. Except for the stroke severity (P = 0.002), there were no significant changes in the demographic and pathological characteristics of the stroke patients during the three studied periods. A significantly higher mean of age (75.60 ± 9.54 versus 60.86 ± 18.45; P = 0.007), a significant difference in the type of stroke (P = 0.046), and significantly higher stroke severity (P = 0.024) were observed in stroke patients with coronavirus disease 2019 compared with those of stroke patients without coronavirus disease 2019. Treatment approaches, duration of hospitalization, and mortality rates did not differ significantly. Conclusions This report shows that the pandemic caused the number of acute stroke admissions to plummet compared to other periods. Although the pandemic did not affect the treatment plans and care of the patients, stroke cases with coronavirus disease 2019 had higher age, more large vessel ischemic stroke, and more severe stroke. Further studies are urgently needed to realize the probable interaction of the coronavirus disease 2019 pandemic and the neurologic disease.

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Impact of the COVID-19 Pandemic on Emergency Admission for Stroke Patients: Time Series Study in Japan

10.21203/rs.3.rs-528017/v1 ◽

2021 ◽

Author(s):

Takuaki Tani ◽

Imai Shinobu ◽

Kiyohide Fushimi

Keyword(s):

Time Series ◽

Disease Onset ◽

Stroke Severity ◽

Infection Prevalence ◽

Stroke Patients ◽

State Of Emergency ◽

Hospitalised Patients ◽

Significant Difference ◽

Baseline Characteristics ◽

The Impact

Abstract BackgroundHospitalization rates have reportedly reduced on account of measures such as the declaration of a COVID-19-related state of emergency. Appropriate treatment of stroke immediately after its onset contributes to improved survival, and delay in hospitalisation after onset affect stroke severity and mortality. This study aimed to determine the impact of the COVID-19 pandemic on emergency hospitalisation of stroke patients in Japan and the associated changes in stroke severity and mortality. MethodsThis was an observational study that used nationwide administrative data. The participants were selected from the data of hospitalised patients diagnosed with stroke. We cross-sectionally observed the background factors of patients during April and May 2020, when COVID-19-related state of emergency was declared, and the same period in 2019. We also modelled monthly trends in the numbers of emergency stroke admissions, of stroke admissions at each level of Japan Coma Scale (JCS), and of deaths within 24 h using interrupted time series regression (ITS). ResultsThere was no difference between the pre- and the COVID-19 pandemic periods in the pre-hospital baseline characteristics of patients. No significant change was seen through ITS in the number of emergency stroke admissions between the COVID-19 and the pre-COVID-19 pandemic periods (risk ratio [RR]=0.96, 95% confidence interval [95%CI]: 0.90–1.02, P=0.159). There was a significant difference in the JCS3 of impaired consciousness in emergency stroke patients, which was more severe during the COVID-19 pandemic than pre-COVID-19 pandemic (RR=1.16, 95%CI: 1.04–1.28, P=0.005). There was no change in the mortality rate of patients with COVID-19 compared to those without COVID-19, but there were significantly more deaths within 24 h of admission. (No deaths within 24 h: RR=0.97, 95%CI: 0.88–1.06, P=0.446; deaths within 24 h: RR=2.80, 95%CI: 2.40–3.27, P<0.001). ConclusionsOVID-19 infection prevalence increased the number of deaths and severity of illness within 24 h of hospitalisation in Japan. However, there was no association between the number of hospital admissions or deaths with baseline characteristics. These results suggest no problems in accepting hospitalised patients during the COVID-19 pandemic, but the delay in visiting the hospital after disease onset may have increased stroke severity.

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Associations Between the Use of Renin–Angiotensin System Inhibitors and the Risks of Severe COVID-19 and Mortality in COVID-19 Patients With Hypertension: A Meta-Analysis of Observational Studies

Frontiers in Cardiovascular Medicine ◽

10.3389/fcvm.2021.609857 ◽

2021 ◽

Vol 8 ◽

Author(s):

Xiao-Ce Dai ◽

Zhuo-Yu An ◽

Zi-Yang Wang ◽

Zi-Zhen Wang ◽

Yi-Ren Wang

Keyword(s):

Angiotensin Converting Enzyme ◽

Observational Studies ◽

Meta Analysis ◽

Severe Disease ◽

Host Cells ◽

Cochrane Library ◽

Converting Enzyme ◽

Significant Difference ◽

Duration Of Hospitalization ◽

The Impact

Angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin receptor blockers (ARBs) share a target receptor with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The use of ACEIs/ARBs may cause angiotensin-converting enzyme 2 receptor upregulation, facilitating the entry of SARS-CoV-2 into host cells. There is concern that the use of ACEIs/ARBs could increase the risks of severe COVID-19 and mortality. The impact of discontinuing these drugs in patients with COVID-19 remains uncertain. We aimed to assess the association between the use of ACEIs/ARBs and the risks of mortality and severe disease in patients with COVID-19. A systematic search was performed in PubMed, EMBASE, Cochrane Library, and MedRxiv.org from December 1, 2019, to June 20, 2020. We also identified additional citations by manually searching the reference lists of eligible articles. Forty-two observational studies including 63,893 participants were included. We found that the use of ACEIs/ARBs was not significantly associated with a reduction in the relative risk of all-cause mortality [odds ratio (OR) = 0.87, 95% confidence interval (95% CI) = 0.75–1.00; I2 = 57%, p = 0.05]. We found no significant reduction in the risk of severe disease in the ACEI subgroup (OR = 0.95, 95% CI = 0.88–1.02, I2 = 50%, p = 0.18), the ARB subgroup (OR = 1.03, 95% CI = 0.94–1.13, I2 = 62%, p = 0.48), or the ACEI/ARB subgroup (OR = 0.83, 95% CI = 0.65–1.08, I2 = 67%, p = 0.16). Moreover, seven studies showed no significant difference in the duration of hospitalization between the two groups (mean difference = 0.33, 95% CI = −1.75 to 2.40, p = 0.76). In conclusion, the use of ACEIs/ARBs appears to not have a significant effect on mortality, disease severity, or duration of hospitalization in COVID-19 patients. On the basis of the findings of this meta-analysis, there is no support for the cessation of treatment with ACEIs or ARBs in patients with COVID-19.

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Barriers to Providing Prehospital Care to Ischemic Stroke Patients: Predictors and Impact on Care

Prehospital and Disaster Medicine ◽

10.1017/s1049023x18000766 ◽

2018 ◽

Vol 33 (5) ◽

pp. 501-507 ◽

Cited By ~ 1

Author(s):

Timmy Li ◽

Jeremy T. Cushman ◽

Manish N. Shah ◽

Adam G. Kelly ◽

David Q. Rich ◽

...

Keyword(s):

Ischemic Stroke ◽

Barriers To Care ◽

Prehospital Care ◽

Heart Association ◽

Living Alone ◽

Stroke Patients ◽

Publication Type ◽

Stroke Treatment ◽

Significant Difference ◽

The Impact

AbstractIntroductionIschemic stroke treatment is time-sensitive, and barriers to providing prehospital care encountered by Emergency Medical Services (EMS) providers have been under-studied.Hypothesis/ProblemThis study described barriers to providing prehospital care, identified predictors of these barriers, and assessed the impact of these barriers on EMS on-scene time and administration of tissue plasminogen activator (tPA) in the emergency department (ED).MethodsA retrospective cohort study was performed using the Get With The Guidelines-Stroke (GWTG-S; American Heart Association [AHA]; Dallas, Texas USA) registry at two hospitals to identify ischemic stroke patients arriving by EMS. Variables were abstracted from prehospital and hospital medical records and merged with registry data. Barriers to care were grouped into themes. Logistic regression was used to identify predictors of barriers to care, and bi-variate tests were used to assess differences in EMS on-scene time and the proportion of patients receiving tPA between patients with and without barriers.ResultsBarriers to providing prehospital care were documented for 15.5% of patients: 29.6% related to access, 26.7% communication, 23.0% extrication and transportation, 20.0% refusal, and 14.1% assessment/management. Non-white and non-black race (OR: 3.69; 95% CI, 1.63-8.36) and living alone (OR: 1.53; 95% CI, 1.05-2.23) were associated with greater odds of barriers to providing care. The EMS on-scene time was ≥15 minutes for 70.4% of patients who had a barrier to care, compared with 49.0% of patients who did not (P<.001). There was no significant difference in the proportion of patients who were administered tPA between those with and without barriers to care (14.1% vs 19.2%; P=.159).ConclusionsBarriers to providing prehospital care were documented for a sizable proportion of ischemic stroke patients, with the majority related to patient access and communication, and occurred more frequently among non-white and non-black patients and those living alone. Although EMS on-scene time was longer for patients with barriers to care, the proportion of patients receiving tPA in the ED did not differ.LiT, CushmanJT, ShahMN, KellyAG, RichDQ, JonesCMC. Barriers to providing prehospital care to ischemic stroke patients: predictors and impact on care. Prehosp Disaster Med.2018;33(5):501–507.

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Abstract TP148: The Hydration Influence on the Risk of Ischemic Stroke Outcomes (THIRST-EXPANSION STUDY)

Stroke ◽

10.1161/str.44.suppl_1.atp148 ◽

2013 ◽

Vol 44 (suppl_1) ◽

Author(s):

Mohammad Moussavi ◽

Gustavo Rodriguez ◽

Joseph Alario ◽

Ravjot Sodhi ◽

Aaron Nizam ◽

...

Keyword(s):

Ischemic Stroke ◽

Negative Impact ◽

Serum Osmolality ◽

Hydration Status ◽

Stroke Severity ◽

Past Study ◽

Stroke Patients ◽

Stroke Outcomes ◽

Significant Difference ◽

The Mean

Introduction: Extensive studies have not been done in patients presenting with ischemic stroke regarding hydration status. It is unclear whether all of the elements of hydration status affect disability on discharge. Our past study suggests that high serum osmolality has a negative impact on ischemic stroke severity. This continuation of our prior study aims to test the effect of all laboratory elements of dehydration on severity and outcome of ischemic stroke patients. Methods: We conducted a retrospective analysis of ischemic stroke patients admitted between 2004 and 2009 at a community teaching hospital. Serum BUN/Creatinine and serum osmolality (sOsm) was calculated at initial presentation. sOSm, BUN/Cr, hematocrit and bicarbonate levels were analyzed for association with NIHSS and mRS. Patients were divided into two groups by sOsm as follows: (1) sOsm < 295, (2) sOsm ≥ 295; and two groups by BUN/Cr as follows: (3) BUN/Cr < 20, (4) BUN/Cr ≥ 20. Discharge mRS score was compared between (1) and (2); and (3) and (4) to determine the effect of sOsm and BUN/Cr on stroke outcomes. All data was analyzed using SPSS software version 20. Results: Of 1350 patients, 543 (mean age = 72.5 +/-14.2, 56% female) were included. There was a significant difference between the mean admission NIHSS in (1) 8.57, n = 222 and (2) 7.09, n = 319, p < .05 and between (3) 8.90, n = 219 and (4) 6.87, n = 322, p < .05. There was a significant difference in the mean mRS score between (1) 2.92, n = 222 and (2) 2.54, n = 317, p < .05, and (3) 2.92, n = 218 and (4) 2.56, n = 321, p < .05. The same results were found when comparing discharge sOsm values to predict patient outcome. Discharge sOsm correlated with mRS (r = .147, p < .05). Initial BUN/Cr correlated with NIHSS (r = .128, p < .05) and mRS (r = .107, p < .05) and final BUN/Cr with mRS (r = .161, p < .001). Bicarbonate levels at admission correlated with NIHSS at admission (r = -0.134), p < 0.05. Hematocrit levels at discharge correlated with mRS (r= -0.183), p <0.001. Conclusion: Our study suggests that patients with BUN/Cr and sOsm above normal levels at admission and dishcarge have worse outcome at discharge. We also found a correlation between other laboratory variables of dehydration status, namely hematocrit levels and outcome. A future prospective randomized study is warranted.

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Abstract TP233: Are Baseline Characteristics of Stroke Patients Included Into an Observational Study Similar to Patients Included Into a Randomised Controlled Trial?

Stroke ◽

10.1161/str.47.suppl_1.tp233 ◽

2016 ◽

Vol 47 (suppl_1) ◽

Author(s):

Anna Schulte ◽

Falko Jürries ◽

Anna Messerschmid ◽

Nico Behnke ◽

Jan Liman ◽

...

Keyword(s):

Atrial Fibrillation ◽

Randomised Controlled Trial ◽

Controlled Trial ◽

Stroke Severity ◽

Stroke Patients ◽

Exclusion Criteria ◽

Observational Trial ◽

Significant Difference ◽

Baseline Characteristics ◽

Randomised Controlled

Introduction: Undiagnosed atrial fibrillation (UAF) is a major burden in ischemic stroke. However, randomised trials have partly shown astonishingly low AF detection rates (e. g. in the CRYSTAL-AF study). This may be due to differences in baseline and stroke characteristics between studies. Hypothesis: We hypothesized that stroke patients in a randomised controlled trial have less severe strokes than patients in an observational trial with similar inclusion and exclusion criteria. Methods: We used data from the Find-AF observational (NCT 01855035) and the Find-AF randomised controlled trial (ISRCTN 46104198). We included only patients at study site Goettingen of the Find-AF randomised controlled trial (n=153) and only included patients from the Find-AF observational trial that fulfilled the inclusion/exclusion criteria of Find-AF randomised (n=90). We compared baseline characteristics of screened versus included patients in Find-AF randomised and baseline characteristics and stroke severity parameters between both studies. Data are shown as mean (Standard Deviation) or Median (25%; 75% percentile) and were compared by chi-square, t-test or Mann-Whitney U test. Results: Table 1 shows as comparison between baseline characteristics of both studies Comparing patients fulfilling the inclusion/exclusion criteria of Find-AF randomised, but unwilling to give informed consent to randomised patients showed a significant difference in age (77 ± 11 vs. 74 ± 8; p< 0.001), but no difference in gender (p=0.581). Conclusions: Both studies included patients similar in age, gender and many comorbidities. Major differences occurred in NIHSS and MRS. As NIHSS is a predictor of atrial fibrillation, randomized controlled trials investigating AF detection should include a minimum NIHSS to avoid a selection bias towards less severe strokes.

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Acute kidney injury requiring dialysis in obstetric patients: management and clinical outcome in case series of 30 patients in a tertiary care centre

International Journal of Reproduction Contraception Obstetrics and Gynecology ◽

10.18203/2320-1770.ijrcog20172923 ◽

2017 ◽

Vol 6 (7) ◽

pp. 2997

Author(s):

Molina U. Patel ◽

Yuvraj Jadeja ◽

Niket Patel ◽

Nayana Patel ◽

Smruti Vaishnav ◽

...

Keyword(s):

Acute Kidney Injury ◽

Tertiary Care ◽

Case Series ◽

Kidney Injury ◽

Therapeutic Interventions ◽

Risk Category ◽

Care Hospital ◽

Tertiary Care Centre ◽

Significant Difference ◽

The Impact

Background: Acute Kidney Injury is a common medical problem affecting approximately 5% of all hospitalized and 30% of critically ill patients. The incidence in obstetric patients ranges from 1 in 2000 to 1 in 25000 pregnancies. In India till date, the impact of AKI on fetomaternal outcome and pertaining therapeutic interventions is only sparsely studied.Methods: It is a retrospective cross-sectional study. All obstetric patients with AKI on dialysis, admitted to Shree Krishna Hospital, a tertiary care hospital in Karamsad village in Gujarat from January 2013 to August 2015. Multivariate statistical analysis of clinical and laboratory parameters was performed using SPSS program to obtain the results.Results: The incidence of dialysis was 1.6%. HELLP syndrome and pre-eclampsia (80%) was found to be the most common etiology of AKI followed by Congestive cardiac failure (34.5%), hemorrhage and sepsis in 30% resp. All patients were admitted to ICU care. No significant difference was found between SAP II and SOFA monitoring system. Mechanical ventilation was done to support 53.3% and inotropic support was needed by 56.7% patients. According to the RIFLE criteria, majority of the patients fall under risk category followed by injury. 18% of the patients developed End Stage Renal Disease.Conclusions: In view of the multifaceted etiologies and complexity of management of AKI, a multi-disciplinary approach involving nephrologist, intensivists, obstetricians and neonatologists is extremely important.

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Impact of COVID-19 on stroke admissions, treatments, and outcomes at a comprehensive stroke centre in the United Kingdom

Neurological Sciences ◽

10.1007/s10072-020-04775-x ◽

2020 ◽

Author(s):

Nishita Padmanabhan ◽

Indira Natarajan ◽

Rachel Gunston ◽

Marko Raseta ◽

Christine Roffe

Keyword(s):

National Institutes Of Health ◽

University Hospital ◽

Stroke Severity ◽

Stroke Patients ◽

Stroke Treatment ◽

Patient Demographics ◽

The United Kingdom ◽

Significant Difference ◽

Ischaemic Attack ◽

Provision Of Care

Abstract Introduction The coronavirus disease (COVID-19) pandemic has changed routine clinical practice worldwide with major impacts on the provision of care and treatment for stroke patients. Methods This retrospective observational study included all patients admitted to the Royal Stoke University Hospital in Stoke-on-Trent, UK, with a stroke or transient ischaemic attack between March 15th and April 14th, 2020 (COVID). Patient demographics, characteristics of the stroke, treatment details and logistics were compared with patients admitted in the corresponding weeks in the year before (2019). Results There was a 39.5% (n = 101 vs n = 167) reduction in admissions in the COVID cohort compared with 2019 with more severe strokes (median National Institutes of Health Stroke Scale (NIHSS) 7 vs 4, p = 0.02), and fewer strokes with no visible acute pathology (21.8 vs 37.1%, p = 0.01) on computed tomography. There was no statistically significant difference in the rates of thrombolysis (10.9 vs 13.2%, p = 0.72) and/or thrombectomy (5.9 vs 4.8%, p = 0.90) and no statistically significant difference in time from stroke onset to arrival at hospital (734 vs 576 min, p = 0.34), door-to-needle time for thrombolysis (54 vs 64 min, p = 0.43) and door-to-thrombectomy time (181 vs 445 min, p = 0.72). Thirty-day mortality was not significantly higher in the COVID year (10.9 vs 8.9%, p = 0.77). None of the 7 stroke patients infected with COVID-19 died. Conclusions During the COVID-19 pandemic, the number of stroke admissions fell, and stroke severity increased. There was no statistically significant change in the delivery of thrombolysis and mechanical thrombectomy and no increase in mortality.

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Medialization Laryngoplasty in Pediatric Patients With Unilateral Vocal Fold Immobility: A Case Series

Annals of Otology Rhinology & Laryngology ◽

10.1177/0003489418814276 ◽

2018 ◽

Vol 128 (2) ◽

pp. 145-151 ◽

Cited By ~ 2

Author(s):

Nikolaus E. Wolter ◽

Nohamin Ayele ◽

Kosuke Kawai ◽

Anne Hseu ◽

Roger Nuss

Keyword(s):

Vocal Fold ◽

Pediatric Population ◽

Voice Quality ◽

Case Series ◽

Swallowing Function ◽

Age At Surgery ◽

Significant Difference ◽

Vocal Fold Immobility ◽

The Impact ◽

Medialization Laryngoplasty

Objectives: The aims of this study were to describe the impact of laryngoplasty in pediatric unilateral vocal fold immobility (UVFI) and to determine the impact of etiology and technique on voice and swallowing. Methods: A retrospective review was conducted of all children with UVFI undergoing medialization laryngoplasty at a pediatric hospital (2010-2017). Data including demographics, etiology, subjective voice quality, and swallowing function were collected. Results: The median age at first surgery among 25 patients with UVFI was 11 years (range, 1.2-25 years). The causes of UVFI were iatrogenic (76%), congenital (16%), and idiopathic (8%). A total of 38 laryngoplasties (24 injections, 11 Silastic implants, 3 Gore-Tex) were performed. Postoperatively, 78% of patients reported improvements in voice and 81% in swallowing. The median duration of voice improvement was 1.0 years (range, 0.1-10 years), with no significant difference by etiology or laryngoplasty technique. Patients who were ⩾10 years of age at surgery reported voice improvement significantly more often than patients <10 years of age at surgery (94% vs 61%, P = .04). Conclusions: UVFI has a significant impact on health and quality of life. In this study we found that laryngoplasty is an effective way to address both voice and swallowing in pediatric UVFI. A greater proportion of children with improved voice quality were older at injection. Surprisingly, there was no difference in duration of voice improvement between permanent and absorbable materials. Although this duration would be considered acceptable for many injectable materials, the limited duration in permanent implantation techniques may represent the challenges of managing UVFI in the growing larynx of the pediatric population. Injection laryngoplasty with absorbable materials may serve as an adequate method of addressing UVFI in this population.

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Pharyngoesophageal Suturing Technique May Decrease the Incidence of Pharyngocutaneous Fistula following Total Laryngectomy

Surgery Research and Practice ◽

10.1155/2015/363640 ◽

2015 ◽

Vol 2015 ◽

pp. 1-5

Author(s):

Mahmut Deniz ◽

Zafer Ciftci ◽

Erdogan Gultekin

Keyword(s):

Risk Factors ◽

Medical Records ◽

Total Laryngectomy ◽

Pharyngocutaneous Fistula ◽

Continuous Suture ◽

Main Risk Factor ◽

Significant Difference ◽

Suturing Technique ◽

Life Threatening ◽

The Impact

Objectives. A pharyngocutaneous fistula (PCF) following total laryngectomy is associated with increased morbidity and severe life threatening complications. We aimed to review our experience with the PCF following total laryngectomy and determine the impact of previously reported risk factors on the development of PCF in our patients.Methods. The medical records of 20 patients who had a total laryngectomy operation were retrospectively analyzed. The association between the proposed risk factors and the incidence of the PCF was investigated.Results. Comparison of the suture techniques used for the closure of the pharynx (either continuous Cushing type or interrupted) yielded that primary interrupted sutures had a significantly higher incidence of PCF formation(p<0.05). Although it was not statistically significant, diabetes mellitus was also associated with increased PCF formation(p>0.05). No significant difference was observed between the PCF and non-PCF groups in terms of other proposed risk factors(p>0.05). Conclusions. The main risk factor associated with PCF was found to be the type of pharyngeal closure technique. A vertical closure with a Cushing type continuous suture may be more successful than interrupted sutures in preventing a PCF.

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Propranolol treatment for infantile hemangioma: a case series of sixty-two patients

La Pediatria Medica e Chirurgica ◽

10.4081/pmc.2016.113 ◽

2016 ◽

Vol 38 (2) ◽

Cited By ~ 4

Author(s):

Giovanna Stringari ◽

Giulia Barbato ◽

Matteo Zanzucchi ◽

Maddalena Marchesi ◽

Giuseppe Cerasoli ◽

...

Keyword(s):

Case Series ◽

Severe Hypoglycemia ◽

Infantile Hemangioma ◽

Treatment Length ◽

Endoscopic Findings ◽

Life Threatening ◽

Propranolol Treatment ◽

The Mean ◽

The Impact ◽

Oral Propranolol

Infantile hemangiomas (IH) complicated by ulceration, disfigurement, functional impairment or life-threatening conditions need early, safe and effective treatment. This study explores the impact of propranolol on complicated IH. We report our experience of 62 patients treated with oral propranolol for complicated IH. The effect of propranolol was assessed using a score on a visual analogue scale integrated with echo, magnetic resonance or endoscopic findings. The average age at the beginning of the treatment was seven months [standard deviation (SD)±8.9], with a median of four months (range 1-53 months). The average age at the end of the treatment was 15 months (SD±8.4), with a median of 13 months (range 7-59 months). The mean treatment length was eight months (SD±3.2). Oral propranolol was successful in 95.2% of the patients in reducing the volume, the intensity of color and the elevation of IH. Statistically significant improvement of IH volume was observed in the first two months of therapy (P≤0.001), and between the second month and the end of the treatment (P<0.05). No significant bradycardia or hypotension occurred. Severe hypoglycemia occurred in one patient. Mild adverse effects were observed in seven patients. Our study demonstrates that propranolol administered orally at 2 to 3 mg/kg/day has a rapid therapeutic effect leading to remarkable shortening of the natural course of IH and it is safe in the majority of patients.

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