scholarly journals The impact of leptomeningeal collaterals in acute ischemic stroke

2020 ◽  
Author(s):  
Nida Fatima ◽  
Maher Saqqur ◽  
Ashfaq Shuaib
Keyword(s):  
Blood Flow ◽  
Ischemic Stroke ◽  
Clinical Outcome ◽  
Acute Ischemic Stroke ◽  
Meta Analysis ◽  
Random Effect ◽  
Random Effect Model ◽  
Mesh Terms ◽  
Favorable Clinical Outcome ◽  
The Impact

Abstract Objectives: Leptomeningeal collaterals provide an alternate pathway to maintain cerebral blood flow in stroke to prevent ischemia, but their role in predicting outcome is still unclear. So, our study aims at assessing the significance of collateral blood flow (CBF) in acute stroke. Methods: Electronic databases were searched under different MeSH terms from Jan 2000 to Feb 2019. Studies were included if there was available data on good and poor CBF in acute ischemic stroke (AIS). The clinical outcomes included were modified rankin scale (mRS), recanalization, mortality, and symptomatic intracranial hemorrhage (sICH) at 90 days. Data was analyzed using random-effect model.Results: A total of 47 studies with 8,194 patients were included. Pooled meta-analysis revealed that there exist 2-fold higher likelihood of favorable clinical outcome (mRS≤2) at 90 days with good CBF compared with poor CBF (RR: 2.27; 95%CI: 1.94-2.65; p<0.00001) irrespective of the thrombolytic therapy [RR with IVT: 2.90; 95%CI: 2.14-3.94; p<0.00001, and RR with IAT/EVT: 1.99; 95% CI: 1.55-2.55; p<0.00001]. Moreover, there exists 1-fold higher probability of successful recanalization with good CBF (RR: 1.31; 95% CI: 1.15-1.49; p<0.00001). However, there was 54% and 64% lower risk of sICH and mortality respectively in patients with good CBF in AIS (p<0.00001).Conclusions: The relative risk of favorable clinical outcome is more in patients with good pretreatment CBF. This could be explained due to better chances of recanalization, combined with lesser risk of intracerebral hemorrhage in good CBF status.

Abstract P013: Meta-analysis of Poor Outcomes and Permissive Hypertension after Acute Ischemic Stroke

Hypertension ◽  
2015 ◽  
Vol 66 (suppl_1) ◽  
Author(s):  
Alexander Ivanov ◽  
Ambreen Mohamed ◽  
Alex Korniyenko
Keyword(s):  
Blood Pressure ◽  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Meta Analysis ◽  
Blood Pressure Reduction ◽  
Random Effect ◽  
Random Effect Model ◽  
Pressure Reduction ◽  
Antihypertensive Medications ◽  
All Cause Mortality

Background: Stroke is the leading cause of long term disability and second leading cause of death worldwide. The effectiveness of primary and secondary prevention of stroke by antihypertensive medications is well validated, however, support for permissive hypertension in the early course of acute ischemic stroke (AIS) has been questioned. Materials and methods: We searched Pubmed, Embase, and Cochrane databases to identify RCTs comparing different blood pressure reduction regimens with placebo in AIS patients within 48 hours after symptom onset and sample size of 100 or more patients. We excluded studies that do not report mortality or functional outcomes at the end of follow up. The main outcomes were all-cause mortality and death or severe morbidity which was defined as: modified Rankin Score >2 or Bartel ADL index<60, Glasgow outcome scale3, Mathew Impairment Scale <14. Relative risks (RR) and corresponding 95% confidence intervals (CI) were calculated using random-effect model. Results: In our analysis we included 20 trials involving 17,209 patients. There was no difference in all-cause mortality RR 1.04 (95% CI 0.95-1.13), p=0.4 nor in mortality or severe disability RR 1.03 (95% CI 0.99-1.08), p=0.16 between active blood pressure reduction and permissive hypertension strategy. There was no evidence of heterogeneity between studies for both outcomes I 2 =2.6% and I 2 =14.1% , p for heterogeneity =0.42 and =0.27, respectively. Conclusion: Use of antihypertensive therapy in acute period of ischemic stroke does not have an effect on disability or all-cause mortality.

Predictors of favorable outcome after endovascular thrombectomy for acute ischemic stroke due to large vessel occlusion in young patients

2021 ◽  
pp. 028418512110564
Author(s):  
Maciej Szmygin ◽  
Michał Sojka ◽  
Piotr Tarkowski ◽  
Krzysztof Pyra ◽  
Piotr Luchowski ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Mortality Rate ◽  
Clinical Outcome ◽  
Acute Ischemic Stroke ◽  
Meta Analysis ◽  
Young Patients ◽  
High Rate ◽  
Stroke Patients ◽  
Vessel Occlusion ◽  
Favorable Clinical Outcome

Background Mechanical thrombectomy (MT) became a standard of care for patients with acute ischemic stroke (AIS) with its efficacy demonstrated by meta-analysis and randomized studies. Although ischemic stroke is associated more with older patients, it may also have devastating neurological effects on young patients. Purpose To present our experience with stroke patients aged <50 years treated with endovascular means and to evaluate clinical and procedural factors associated with outcome and mortality. Material and Methods This study was conducted on 34 young stroke patients treated with MT. Clinical features including baseline results, radiological imaging, procedural details, and outcome results were documented and evaluated. Recanalization was assessed according to the TICI score. The clinical condition was evaluated after three months using mRS. Mortality rate was calculated. Results The rate of successful recanalization (TICI ≥2c) was 79% (27/34). Symptomatic intracranial hemorrhage (sICH) was observed in 5 (15%) patients. After 90 days, the mortality rate was 12%. Favorable clinical outcome (mRs 0–2) was regained in 65% of the patients whereas satisfactory clinical outcome was seen in 85%. Poor clinical outcome (mRs >2) was observed in 9 (23.7%) patients. Conclusion In conclusion, the results of this study demonstrate that MT for AIS in young patients is feasible and provides an excellent rate of arterial recanalization and high rate of favorable outcomes. Statistical analysis showed that shorter time from onset to arrival and reperfusion, successful recanalization and absence of hemorrhagic transformation are the predictors of favorable clinical outcome and overall survival rate.

EXPRESS: Impact of renal impairment on short-term outcomes following endovascular thrombectomy for acute ischemic stroke: A systematic review and meta-analysis

2021 ◽  
pp. 174749302110473
Author(s):  
Jin Pyeong Jeon ◽  
Chih-Hao Chen ◽  
Fon-Yih Tsuang ◽  
Jianming Liu ◽  
Michael D Hill ◽  
...  
Keyword(s):  
Systematic Review ◽  
Ischemic Stroke ◽  
Renal Impairment ◽  
Acute Ischemic Stroke ◽  
Meta Analysis ◽  
Functional Independence ◽  
Continuous Variable ◽  
Endovascular Thrombectomy ◽  
Symptomatic Intracerebral Hemorrhage ◽  
The Impact

Background. The impact of renal impairment (RI) on the outcomes of patients with acute ischemic stroke (AIS) treated with endovascular thrombectomy (EVT) was relatively limited and contradictory. We performed a systematic review and meta-analysis to investigate this. Aims. We registered a protocol on September 2020 and searched MEDLINE, EMBASE, and Google Scholar accordingly. RI was defined as an estimated glomerular filtration rate (eGFR) < 60 mL/min/1.73 m2. Predefined outcomes included functional independence (defined as a modified Rankin Scale of 0, 1, or 2) at 3 months, successful reperfusion, mortality, and symptomatic intracerebral hemorrhage (sICH). Summary of review. Eleven studies involving 3453 patients were included. For the unadjusted outcomes, RI was associated with fewer functional independence (odds ratio (OR), 0.49; 95% confidence interval (CI), 0.39–0.62) and higher mortality (OR, 2.55; 95% CI, 2.03–3.21). RI was not associated with successful reperfusion (OR, 0.80; 95% CI 0.63–1.00) and sICH (OR, 1.41; 95% CI, 0.95–2.10). For the adjusted outcomes, results derived from a multivariate meta-analysis were consistent with the respective unadjusted outcomes: functional independence (OR, 0.59; 95% CI, 0.45–0.77), mortality (OR, 2.23, 95% CI, 1.45–3.43), and sICH (OR, 1.34; 95% CI, 0.85–2.10). Conclusions. We presented the first systematic review to demonstrate that RI is associated with fewer functional independence and higher mortality. Future EVT studies should publish complete renal eGFR data to facilitate prognostic studies and permit eGFR to be analyzed in a continuous variable. Systematic Review Registration: PROSPERO CRD42020191309

scholarly journals Effect of maternal birth positions on duration of second stage of labor: systematic review and meta-analysis

2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Marta Berta ◽  
Helena Lindgren ◽  
Kyllike Christensson ◽  
Sollomon Mekonnen ◽  
Mulat Adefris
Keyword(s):  
Weighted Mean Difference ◽  
Meta Analysis ◽  
Random Effect ◽  
Random Effect Model ◽  
Significant Heterogeneity ◽  
Second Stage Of Labor ◽  
Second Stage ◽  
Birth Position ◽  
Study Designs ◽  
The Impact

Abstract Background It is believed that giving birth in an upright position is beneficial for both mother and the infant for several physiologic reasons. An upright positioning helps the uterus to contract more strongly and efficiently, the baby gets in a better position and thus can pass through the pelvis faster. Upright and lateral positions enables flexibility in the pelvis and facilitates the extension of the outlet. Before implementing a change in birthing positions in our clinics we need to review evidences available and context valid related to duration of second stage of labor and birthing positions. Therefore this review aimed to examine the effect of maternal flexible sacrum birth position on duration of second stage of labor. Method The research searched articles using bibliographical Databases: Medline/PUBMED, SCOPUS, Google scholar and Google. All study designs were considered while investigating the impact of maternal flexible sacrum birthing positioning in relation duration of second stage of labor. Studies including laboring mothers with normal labor and delivery. A total of 1985 women were included in the reviewed studies. We included both qualitative and quantitative analysis. Results We identified 1680 potential citations, of which 8 articles assessed the effect of maternal upright birth positioning on the reduction during the duration of second stage of labor. Two studies were excluded because of incomplete reports for meta analysis. The result suggested a reduction in duration of second stage of labor among women in a flexible sacrum birthing position, with a mean duration from 3.2–34.8. The pooled weighted mean difference with random effect model was 21.118(CI: 11.839–30.396) minutes, with the same significant heterogeneity between the studies (I2 = 96.8%, p < 000). Conclusion The second stage duration was reduced in cases of a flexible sacrum birthing position. Even though the reduction in duration varies across studies with considerable heterogeneity, laboring women should be encouraged to choose her comfortable birth position. Researchers who aim to compare different birthing positions should consider study designs which enable women to choose birthing position. Prospero registration number [CRD42019120618]

scholarly journals The Impact of Dementia on the Clinical Outcome of COVID-19: A Systematic Review and Meta-Analysis

2020 ◽  
Vol 78 (4) ◽  
pp. 1775-1782
Author(s):  
Nanyang Liu ◽  
Jiahui Sun ◽  
Xiyuan Wang ◽  
Ming Zhao ◽  
Qianqian Huang ◽  
...  
Keyword(s):  
Meta Analysis ◽  
Random Effect ◽  
Random Effect Model ◽  
Dementia Patients ◽  
Effect Model ◽  
Incidence And Mortality ◽  
High Risk Factor ◽  
The Impact ◽  
Substantial Heterogeneity ◽  
Significant Publication Bias

Background: The emergence of the coronavirus disease 2019 (COVID-19) has brought large challenges to dementia patients. We reviewed the existing literature on COVID-19 to assess the incidence and mortality of dementia comorbidities in COVID-19 patients. Objective: To investigate the impact of pre-existing dementia comorbidities on COVID-19. Methods: We searched the PubMed, Embase, and Web of Science databases for patients with preexisting dementia who were diagnosed with COVID-19. The statistical data on the prevalence and mortality of dementia comorbidities were examined. A fixed-or random-effect model was used to calculate the overall pooled risk estimates. Forest plots were generated to show the summarized results. Results: A total of 265 articles were retrieved from the three databases. After removing duplicates and performing two screenings, 10 articles were selected for meta-analysis, including 119,218 participants. Overall, the meta-analysis of the 10 studies showed that the incidence of dementia in COVID-19 patients was (R: 9%, [95% CI: 6% to 13%]). Moreover, the meta-analysis of 9 studies showed that the mortality rate of individuals with dementia after being infected with COVID-19 was higher than that of individuals with no dementia (OR: 5.17 [95% CI: 2.31 to 11.59]). Substantial heterogeneity was observed in this meta-analysis. Significant publication bias was also found. Conclusion: Emerging literature shows that dementia comorbidities are a high risk factor for the prevalence and mortality of COVID-19. Our results should have an impact on preventive interventions and encourage more targeted approaches to prioritize older people with specific risk factors, such as dementia.

scholarly journals Breast Cancer Risk in Rheumatoid Arthritis: An Update Meta-Analysis

2014 ◽  
Vol 2014 ◽  
pp. 1-9 ◽  
Author(s):  
Guo Tian ◽  
Jia-Ning Liang ◽  
Zhuo-Yun Wang ◽  
Dian Zhou
Keyword(s):  
Breast Cancer ◽  
Breast Cancer Risk ◽  
Cancer Risk ◽  
Subgroup Analysis ◽  
Meta Analysis ◽  
Random Effect ◽  
Random Effect Model ◽  
Cochrane Library ◽  
Number Of Patients ◽  
The Impact

Background. The incidence of breast cancer in RA patients remains controversial. Thus we performed a meta-analysis to investigate the impact of RA on breast cancer.Methods. Published literature was available from PubMed, Embase, and Cochrane Library. Pooled standardized incidence rate (SIR) was computed by random-effect model analysis.Results. We identified 16 separate studies in the present study, in which the number of patients ranged from 458 to 84,475. We did not find the increased cancer risk in RA patients (SIR=0.86, 95%CI=0.72–1.02). However, subgroup analysis showed that breast cancer risk in RA patients was positively different in Caucasians (SIR=0.82, 95%CI=0.73–0.93) and non-Caucasians (SIR=1.21, 95%CI=1.19–1.23), respectively. In subgroup analysis by style, a reduced incidence was found in hospital-based case subjects (SIR=0.82, 95%CI=0.69–0.97). Similarly, subgroup analysis for adjusted factors indicated that in A3 (age and sex) and A4 (age, sex, and race/ethnicity) the risk was decreased (SIR=0.87, 95%CI=0.76–0.99;SIR=0.63, 95%CI=0.59–0.67).Conclusions. The meta-analysis revealed no increased breast cancer risk in RA patients. However, in the subgroup analysis, the risk of breast cancer is increased in non-Caucasians patients with RA while it decreased in Caucasian population, hospital-based case subjects, and A3 group. Such relationship may provide preference for risk of breast cancer in different population.

scholarly journals Comparison of Clinical Outcome between Craniectomy and Craniotomy as Surgical Management of Traumatic Acute Subdural Hematoma: A Systematic Review and Meta-analysis

2020 ◽  
Vol 8 (F) ◽  
pp. 137-142
Author(s):  
Tjokorda Gde Bagus Mahadewa ◽  
Putu Eka Mardhika ◽  
Sri Maliawan ◽  
Nyoman Golden ◽  
Steven Awyono ◽  
...  
Keyword(s):  
Systematic Review ◽  
Clinical Outcome ◽  
Subdural Hematoma ◽  
Meta Analysis ◽  
Random Effect ◽  
Random Effect Model ◽  
Surgical Techniques ◽  
Open Access Journal ◽  
Acute Subdural Hematoma ◽  
Poor Outcomes

BACKGROUND: Acute subdural hematoma (ASDH) is a major problem in traumatic brain injury. Surgical techniques for treating ASDH are varied, including cranioplastic craniotomy and large decompressive craniectomy. The superiority of craniectomy and craniotomy for treating ASDH is still controversial. AIM: The aim of this study was to compare the clinical outcome between craniectomy and craniotomy for treating traumatic ASDH through systematic review and meta-analysis. METHODS: This study used electronic articles published in PubMed, EBSCO, Google Scholar, and Directory of Open Access Journal. Articles included were full-text observational studies in Indonesian or English. Clinical outcome using the Glasgow Outcome Scale was compared between craniectomy and craniotomy. Statistical analysis was done using Review Manager 5.3. RESULTS: Six articles met our inclusion and exclusion criteria. We performed random effect model analysis because of high heterogeneity between studies (I2 = 77%; X2 = 21.98). The pooled risk ratio between craniectomy and craniotomy on poor outcomes was 1.41 (p = 0.02; 95% CI: 1.06–1.88). CONCLUSION: Craniectomy increases the risk of poor clinical outcomes in treating a traumatic ASDH.

scholarly journals Effect of maternal birth positions on duration of second stage of labor: Systematic review and meta-analysis

2019 ◽  
Author(s):  
Marta Berta Badi ◽  
Helena Lindgren ◽  
Kyllike Christensson ◽  
Sollomon Mekonnen ◽  
Mulat Adefris
Keyword(s):  
Weighted Mean Difference ◽  
Meta Analysis ◽  
Random Effect ◽  
Random Effect Model ◽  
Significant Heterogeneity ◽  
Second Stage Of Labor ◽  
Second Stage ◽  
Birth Position ◽  
Study Designs ◽  
The Impact

Abstract Background: it is believed that giving birth in an upright position is beneficial for both mother and the infant for several physiologic reasons. An upright positioning helps the uterus to contract more strongly and efficiently, the baby gets in a better position and thus can pass through the pelvis faster. Upright and lateral positions enables flexibility in the pelvis and facilitates the extension of the outlet. Before implementing a change in birthing positions in our clinics we need to review evidences available and context valid related to duration of second stage of labor and birthing positions. Objective: The aim of this review was to examine the effect of maternal flexible sacrum birth position on duration of second stage of labor. Method: The research searched articles using bibliographical Databases: Medline/PUBMED, SCOPUS, Google scholar and Google. All study designs were considered while investigating the impact of maternal flexible sacrum birthing positioning in relation duration of second stage of labor. Studies including laboring mothers with normal labor and delivery. A total of 1,985 women were included in the reviewed studies. We included both qualitative and quantitative analysis. Results: We identified 1,680 potential citations, of which 8 articles assessed the effect of maternal upright birth positioning on the reduction during the duration of second stage of labor. Two studies were excluded because of incomplete reports for meta analysis. The result suggested a reduction in duration of second stage of labor among women in a flexible sacrum birthing position, with a mean duration from 3.2-34.8. The pooled weighted mean difference with random effect model was 21.118(CI: 11.839-30.396) minutes, with the same significant heterogeneity between the studies (I2=96.8%, p<000). Conclusion: The second stage duration was reduced in cases of a flexible sacrum birthing position. Even though the reduction in duration varies across studies with considerable heterogeneity, laboring women should be encouraged to choose her comfortable birth position. Researchers who aim to compare different birthing positions should consider study designs which enable women to choose birthing position. Prospero registration number [CRD42019120618]

scholarly journals The risk of smoking with stroke in Asia : meta-analysis

2020 ◽  
Vol 14 (1) ◽  
Author(s):  
Fadhilatul Hasnah ◽  
Yuniar Lestari ◽  
Abdiana Abdiana
Keyword(s):  
Ischemic Stroke ◽  
Publication Bias ◽  
Meta Analysis ◽  
Random Effect ◽  
Random Effect Model ◽  
Haemorrhagic Stroke ◽  
Fixed Effect Model ◽  
Stroke Subtype ◽  
Effect Model ◽  
Trim And Fill

This study uses a systematic method of review and meta-analysis to look at the risk of smoking with stroke in Asia. Further analysis based on the stroke subtype (ischemic stroke and haemorrhagic stroke was also carried out. Literature search was carried out in the PubMed, EBSCO and Google Scholar databases. Q tests were performed to determine the heterogeneity of included studies. Funnel plot, Egger regression test and trim and fill methods were used to identified publication bias and with the transformation of the model between the fixed effect model and the random effect model for sensitivity analysis A total of 12 articles were included consisting of 9 studies with case control design studies and 3 studies with cohort designs. The meta-analysis results showed that people who smoke have risks pooled OR 2.04 times (95% CI 1.57-2.65) for having a stroke Analysis of the type of stroke, smokers had 2.3 times the risk of having an ischemic stroke or 2.77 times for having a haemorrhagic stroke. Eggers test showed no influence of publication bias on the meta-analysis of smoking with stroke to. From this meta-analysis, it can be concluded that smoking increasing risk for stroke. This study found the risk of smokers to have a haemorrhagic stroke is higher than ischemic stroke.

C-reactive Protein, Infection, and Outcome After Acute Ischemic Stroke: A Registry and Systematic Review

2020 ◽  
Vol 16 (5) ◽  
pp. 405-415 ◽  
Author(s):  
Lu Wang ◽  
Yuxiao Li ◽  
Changyi Wang ◽  
Wen Guo ◽  
Ming Liu
Keyword(s):  
Systematic Review ◽  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Meta Analysis ◽  
Reactive Protein ◽  
Poor Outcome ◽  
Pubmed Database ◽  
Scale Scores ◽  
The Impact

Background: A number of studies have explored the prognostic role of CRP in patients with acute ischemic stroke, however, the results have been inconclusive. The aim of our study was to investigate the impact of infection on the association between CRP and 3-month functional outcome by performing a registry study and systematic review. Methods: Patients admitted within 24 hours of acute ischemic stroke onset and had CRP measured within 24 hours after admission were included. Patients admitted between June 2016 and December 2018 in Chengdu Stoke Registry were enrolled. The PubMed database was searched up to July 2019 to identify eligible studies. Poor outcome was defined as modified Rankin Scale scores at 3-month more than 3. Results: Totally, 368 patients in the registry and 18 studies involving 15238 patients in the systematic review were included. A statistically significant association between CRP values on admission and 3-month poor outcome in patients without infection was found, both in our registry (CRP per 1-mg/L increment, OR 1.04, 95% CI 1.01 to 1.07, p=0.008) and meta-analysis (CRP per 1-mg/dL increment, OR 1.66 [95% CI 1.37 to 2.01, p<0.001]). In patients with infection, CRP was not associated with a 3-month poor outcome according to registry data (OR 1.00, 95% CI 0.99 to 1.01, p=0.663) and meta-analysis (OR 1.01, 95% CI 0.99 to 1.01, p=0.128). Conclusion: High CRP value was independently associated with a 3-month poor outcome after stroke in patients without infection. Further studies are required to examine the value of infection on CRP measures and long-term functional outcomes.

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