scholarly journals The Difference of Lymphocyte, hs-CRP, and Electroencephalogram with and without Simvastatin in Acute Ischemic Stroke

2020 ◽  
Vol 26 (3) ◽  
Author(s):  
Chairil Amin Batubara ◽  
Aldy Safruddin Rambe ◽  
Nindia Sugih Arto
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Epileptic Seizures ◽  
Chi Square ◽  
Double Blind ◽  
Mortality And Morbidity ◽  
Randomized Control Trial Design ◽  
Significant Difference ◽  
The Difference ◽  
Hs Crp

Mortality and morbidity due to stroke rank the highest in Indonesia (15.4%), and most types of stroke are ischemic (87%). Inflammation has a role in the pathophysiology of both ischemic stroke and also inhibits acute symptomatic epileptic seizures (3-6%) in the first 7 days after stroke. Statins have been used for the treatment of dyslipidemia in stroke patients. Some studies showed that statins reduced the inflammatory response after a stroke and prevented the recovery of epileptic seizures. This study aimed to determine the differences in lymphocytes, hs-CRP, Electroencephalogram (EEG) with and without Simvastatin in acute ischemic stroke. This research was an experimental study with a double-blind, randomized control trial design consisting of two groups, a group given Simvastatin 20 mg/day, and a group given a placebo for seven days. The difference in lymphocytes, hs-CRP, EEG, and epileptic seizures between the two groups were then analyzed. The sample was 26 people, consisting of 17 (65.4%) males and 9 (34.6%) females with an average age of 59±5.8 years. Chi-Square and Fisher's test showed a significant difference in hs-CRP (p=0.005) and epileptic seizures (p=0.015), but no significant difference in lymphocytes (p=0.336) and EEG (p=0.42) between groups given Simvastatin 20 mg/day and those given placebo. There was a significant difference in hs-CRP and epileptic seizures, but no significant difference in lymphocyte count and EEG between the two groups with and without Simvastatin administration.

scholarly journals The Effect of Probiotics on Bacterial Pneumonia

2021 ◽  
Vol In Press (In Press) ◽  
Author(s):  
Ahmad Najafi ◽  
Alireza Sharif ◽  
Mohammadreza Sharif ◽  
Hamidreza Gilassi
Keyword(s):  
Bacterial Pneumonia ◽  
Treatment Protocol ◽  
Response To Treatment ◽  
Control Group ◽  
Case Group ◽  
Chi Square ◽  
Double Blind ◽  
Duration Of Symptoms ◽  
Mortality And Morbidity ◽  
Significant Difference

Background: Pneumonia, as a fairly prevalent illness, is the main cause of hospital mortality. The major cause of mortality and morbidity of pneumonia is due to bacteria. The presence of multi-drug resistant pathogens and no response to treatment have aroused considerable interest in the use of probiotic components to prevent infections. Objectives: Given that few studies have evaluated the efficacy of probiotics in reducing bacterial pneumonia, the current aimed to evaluate the role of probiotics in decreasing pneumonia. Methods: This double-blind, randomized clinical trial study was conducted on 100 patients diagnosed with bacterial pneumonia in Shahid Beheshti Hospital, Kashan, Iran, during 2018. Patients were randomly classified into two groups (n = 50). One group (case) received two sachets of probiotic/daily for five days, and another group (control) received placebo. Moreover, patients in both groups received the same treatment protocol. All data were extracted from medical records. Chi-square test and independent t-test were used for analysis of data. P < 0.05 was considered statistically significant. Results: No significant difference was seen between case and control groups regarding age, gender, and duration of symptoms before hospitalization (P > 0.05), which implies a completely random classification of two groups. The mean duration of hospitalization, dyspnea, tachypnea, cough, fever, and crackles was significantly decreased in the case group compared to the control group (P < 0.05). Conclusion: The use of probiotics can be effective in reducing the duration of dyspnea, tachypnea, cough, fever, and length of hospitalization. Therefore, probiotics may be considered a promising treatment for the development of new anti-infectious therapy. In addition, the usage of probiotics along with antibiotics is suggested for decreasing pneumonia complications and improving the efficacy of therapy.

Withdrawal of Neuroleptic Medications from Institutionalized Dementia Patients: Results of a Double-Blind, Baseline-Treatment—Controlled Pilot Study

1997 ◽  
Vol 10 (3) ◽  
pp. 119-126 ◽  
Author(s):  
Sarah Bridges-Parlet ◽  
David Knopman ◽  
Susan Steffes
Keyword(s):  
Aggressive Behavior ◽  
Objective Assessment ◽  
Extended Period ◽  
Good Clinical Practice ◽  
Chi Square ◽  
Double Blind ◽  
Term Care ◽  
Dementia Patients ◽  
Significant Difference ◽  
The Difference

Among dementia patients in long-term care facilities, neuroleptics (NL) are frequently prescribed for the treatment of agitation. Although good clinical practice and federal law mandate attempts at withdrawal of these medications, empiric data regarding the cessation of NL treatment are limited in this population. The objective of the present study was to assess through direct observation the effects of short-term NL withdrawal on physically aggressive behavior and other aspects of agitation. We carried out a randomized, double-blind, baseline NL-controlled 4-week trial of the effects of NL withdrawal in 36 institutionalized patients with possible or probable Alzheimer's disease. Patients were directly observed for four 2-hour sessions during baseline, a prerandomization week, and during weeks 1, 2, and 4 of the double-blind portion of the study. Completion of the 4 weeks of double-blind medication and number of observed episodes of physically aggressive behavior (PAB) were the two primary outcome measures. Of the 22 patients who were withdrawn from NL, 20 (91%) completed the 4-week double-blinded withdrawal. Two patients were discontinued from the study due to unacceptable levels of agitation at the request of their nursing staff. Of the 14 patients not withdrawn, all completed the 4-week trial. The chi-square test for the difference between groups was not significant ( P > .05). Based on the observed instances of PAB, there was no significant difference ( P > .05) between withdrawn and not-withdrawn subjects. Half of the withdrawn patients remained off NLs for an extended period of time after the end of the study, even after the blind was broken. Withdrawing institutionalized dementia patients from NLs was successful in most but not all study patients. Generalization of these results is limited by the highly selected nature of the participants. Unmasking of unmanageable agitation and physical aggressiveness in a small minority must be weighed against the benefits of removing unnecessary medication in the majority of dementia patients in whom NL withdrawal is attempted. PAB itself should not drive continuing NL use without regard to objective assessment of efficacy of the NL treatment.

scholarly journals Outcomes of General Anesthesia and Conscious Sedation in Endovascular Treatment for Stroke

2016 ◽  
Vol 43 (5) ◽  
pp. 655-658 ◽  
Author(s):  
Caroline Just ◽  
Philippe Rizek ◽  
Peter Tryphonopoulos ◽  
David Pelz ◽  
Miguel Arango
Keyword(s):  
Ischemic Stroke ◽  
General Anesthesia ◽  
Acute Ischemic Stroke ◽  
Hospital Discharge ◽  
Conscious Sedation ◽  
Endovascular Intervention ◽  
Stroke Severity ◽  
Chi Square ◽  
Mortality And Morbidity ◽  
History Of

AbstractBackground Recent studies have strongly indicated the benefits of endovascular therapy for acute ischemic stroke, but what remains a continued debate is the role for general anaesthesia versus conscious sedation (CS) for such procedures. Retrospective studies have found poorer neurological outcomes in patients who underwent general anesthesia (GA); however, some have revealed worse baseline stroke severity in these patients.Methods This study is a retrospective cohort study aimed at comparing mortality and morbidity of GA versus CS in patients treated with endovascular intervention in acute ischemic stroke. Chi-square and t-test analyses were used. Results Patients in the GA (n=42) group were more likely to be deceased than those in the CS (n=67) group at hospital discharge, 3 months, and 6 months poststroke onset. Morbidity, as defined by modified Rankin Score, was significantly greater in the GA group at hospital discharge, and a similar trend was seen in morbidity at 3 months postdischarge. Conclusion General anesthesia for endovascular intervention in acute ischemic stroke was associated with increased mortality and poorer neurological incomes compared with conscious sedation. In our study, age, gender, history of hypertension, history of diabetes, and baseline National Institute of Health Stroke Scale were not significantly different between the groups. Although the need for a randomized, prospective study on this topic is clear, our study represents further corroboration of the safety and efficacy of conscious sedation in these procedures.

scholarly journals Duplex ultrasonography as prognostic tool of acute ischemic stroke patients

2021 ◽  
Vol 57 (1) ◽  
Author(s):  
Mohamed El-Sayed El-khatib ◽  
Shereen Ahmed El Ahwal
Keyword(s):  
Risk Factors ◽  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Cerebral Arteries ◽  
Resistive Index ◽  
Duplex Ultrasonography ◽  
Cerebral Stroke ◽  
Mortality And Morbidity ◽  
Prognostic Tool ◽  
Significant Difference

Abstract Background Cerebral stroke is a major source of mortality and morbidity. Duplex ultrasonography is used to evaluate carotid and cerebral arteries. The objectives of this work are to study the correlation between carotid duplex parameters with risk factors of ischemic stroke and evaluate duplex parameter as prognostic tool of ischemic stroke. Methods The study was conducted on 100 patients presented by acute ischemic stroke submitted to history taking, medical, and neurological examination. Neurological deficit was assessed by National Institute of Health Stroke Scale (NIHSS); the functional state of the patients was assessed by modified Rankin scale (mRS). Brain CT and/or MRI, routine laboratory investigations, extracranial, and transcranial duplex (TCD) were done. Results The end diastolic velocities (EDVs) and peak systolic velocities (PSVs) of common carotid arteries (CCA) were significantly decreased in smokers and hypertensive (P<0.05). Smoking and hypertension were positively correlated with resistive index (RI). In 80 patients, PSV in the symptomatic middle cerebral artery (MCA) did not exceed 70 cm/s within averaged 50.7 ± 4.6 cm/s. EDV was 12.0 ± 3.0 cm/s, RI was 0.78 ± 0.05, and pulsativity index (PI) was 1.61 ± 0.09. There was significant difference in all hemodynamic parameters in comparison with the asymptomatic side. Conclusion Patients who have risk factors of stroke should be evaluated with duplex ultrasonography. Duplex parameters can give informative data about prognosis and outcome.

Abstract 2840: Aspect Score: DWI or CT Scan, Which One Is Better Marker For Stroke Morbidity And Outcome?

Stroke ◽  
2012 ◽  
Vol 43 (suppl_1) ◽  
Author(s):  
Manoj Mittal ◽  
Raymond Seet ◽  
Zhang Yi ◽  
Alejandro Rabinstein
Keyword(s):  
Ischemic Stroke ◽  
Ct Scan ◽  
Acute Ischemic Stroke ◽  
Predictive Value ◽  
Univariate Analysis ◽  
Fisher Exact Test ◽  
Chi Square ◽  
Exact Test ◽  
Good Outcome ◽  
The Difference

Background and Objective The Alberta Stroke Program Early CT Score (ASPECTS) is a validated grading system to assess ischemic changes on CT in acute ischemic stroke. Magnetic resonance imaging with diffusion weighted imaging (DWI) sequence is commonly used to identify the final ischemic changes. We examined the difference between the relationship of NIHSS at admission and ASPECT score calculated using CT scan versus MRI DWI sequence. Methods We conducted a retrospective analysis of prospectively collected data from 99 cases of acute ischemic stroke treated with IV rt-PA by time criteria, admitted to Mayo Clinic from March, 2002 through June, 2011. CT head at 24 hours and MRI DWI sequence were used to assign ASPECT score. We dichotomized ASPECTS (categorized as 0 to 7 versus 8 to 10) and favorable patient outcome at 3 month (modified Rankin score less than equal to 2 and more than 2). Univariate analysis including t-test, Chi-square, and Fisher Exact test was used when appropriate. Results Mean age was 70±14 years. Mean admission NIHSS score was 8±4. DWI ASPECTS (p<0.001) and CT ASPECTS (p=0.127) were inversely associated with admission NIHSS. Higher (8-10) CT ASPECTS (p=0.001) or DWI ASPECTS (p=0.002) were associated with good outcome (mRS ≤2) at 3 months. Sensitivity, specificity, positive predictive value and negative predictive value for good outcome identified by CT ASPECTS versus DWI ASPECTS were 81% vs 52%, 54% vs 54%, 83% vs 59% and 50% vs 47% respectively. Conclusion CT and MRI DWI are comparably useful to calculate the ASPECTS for estimation of functional outcome, but CT scan at 24 hours may be more sensitive for the prediction of good recovery.

Use of ABC/2 method for rapidly estimating the target mismatch on computed tomography perfusion imaging in patients with acute ischemic stroke

2021 ◽  
pp. 028418512110697
Author(s):  
Guang-Chen Shen ◽  
Yue Chu ◽  
Gao Ma ◽  
Xiao-Quan Xu ◽  
Shan-Shan Lu ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Predictive Value ◽  
Anterior Circulation ◽  
Computed Tomography Perfusion ◽  
Significant Difference ◽  
Feasible Alternative ◽  
Ischemic Core ◽  
The Difference

Background Target mismatch (ischemic core, mismatch volume and mismatch ratio) in patients with acute ischemic stroke (AIS) highly relies on the automated perfusion analysis software. Purpose To evaluate the feasibility and accuracy of using the ABC/2 method to rapidly estimate the target mismatch on computed tomography perfusion (CTP) imaging in patients with AIS, using RAPID results as a reference. Material and Methods In total, 243 patients with anterior circulation AIS who underwent CTP imaging were retrospectively reviewed. Target mismatch associated perfusion parameters were derived from RAPID results and calculated using the ABC/2 method. Paired t-test was used to assess the difference of volumetric parameters between the two methods. The ability of using the ABC/2 method to predict the important cutoff volumetric metrics was also evaluated. Result There was no significant difference in the volumes of ischemic core ( P = 0.068), ischemic area ( P = 0.209), and mismatch volume ( P = 0.518) between ABC/2 and RAPID. Using RAPID results as reference, the ABC/2 method showed high accuracy for predicting perfusion parameters (70 mL and 90 mL: sensitivity=98.5% and 98.5%, specificity=100% and 100%, positive predictive value [PPV]=100% and 100%, negative predictive value [NPV]=93.8% and 92.9%; 10 mL and 15mL: sensitivity=99.6% and 99.5%, specificity=55.6% and 50.0%, PPV=96.6% and 94.8%, NPV=90.9% and 92.3%; 1.2 and 1.8: sensitivity=99.6% and 94.8%, specificity=75.0% and 96.9%, PPV=98.7% and 99.5%, NPV=90.0% and 73.8%). Conclusion The ABC/2 method may be a feasible alternative to RAPID for estimation of target mismatch parameters on CTP in patients with AIS.

scholarly journals Association of Diabetes Mellitus with Acute Ischemic Stroke

2018 ◽  
Vol 9 (2) ◽  
pp. 45-48
Author(s):  
N Sharmin ◽  
N Sultana ◽  
H Rahman ◽  
T Rahman ◽  
SN Chowdhury
Keyword(s):  
Diabetes Mellitus ◽  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Risk Estimation ◽  
Control Group ◽  
Case Group ◽  
Diabetic Patients ◽  
Significant Difference ◽  
The Difference ◽  
Bangladeshi Population

Acute ischemic stroke occurs more frequently in diabetic patients. The purpose of the present study was to observe the association of diabetes mellitus with acute ischemic stroke in Bangladeshi population. This case-control study was carried out in the Department of Biochemistry, Dhaka Medical College, Dhaka, Bangladesh during the period from January 2014 to December 2014. Patients presenting with acute ischemic stroke, age ranges from 18 to 65 years of both sexes, were taken as the case group. Age-and sex-matched healthy individuals were selected as control group. History of diabetes of both cases and controls were recorded and blood sample was collected from both cases and controls after overnight fasting for the estimation of blood sugar. A total number of 100 study subjects were taken of which 50 subjects presented with acute ischemic stroke were considered as cases and the rest 50 healthy subjects were taken as controls. In this study, the mean(±SD) of age of cases and controls were 56.54±12.18 and 53.34±7.98 years respectively. There was no statistically significant difference between mean age of the groups (p=0.124). Mean (±SD) of BMI was significantly higher in cases than that of controls (p=0.002) which were 27.25±3.25 and 25.38±2.57 respectively and the study subjects were sex matched, the difference between cases and controls was not statistically significant (p= 0.414). Diabetes mellitus was more commonly reported in case group (46.0%) than control group (6.0%) and the difference was found statistically significant (p=0.001). The risk estimation was calculated and was found a 13.34 OR (95% C.I. 3.66 to 48.62). From the findings of this study in may be concluded that diabetes mellitus is significantly associated with acute ischemic stroke.Bangladesh J Med Biochem 2016; 9(2): 45-48

Predictive value of time-variant color-coded multiphase CT angiography (mCTA) regarding clinical outcome of acute ischemic stroke: in comparison with conventional mCTA and CT perfusion

2020 ◽  
pp. 028418512098177
Author(s):  
Yu Lin ◽  
Nannan Kang ◽  
Jianghe Kang ◽  
Shaomao Lv ◽  
Jinan Wang
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Predictive Value ◽  
Ct Perfusion ◽  
Roc Curves ◽  
Multivariate Logistic Regression Model ◽  
Infarct Core ◽  
Predictive Values ◽  
Significant Difference ◽  
Core Volume

Background Color-coded multiphase computed tomography angiography (mCTA) can provide time-variant blood flow information of collateral circulation for acute ischemic stroke (AIS). Purpose To compare the predictive values of color-coded mCTA, conventional mCTA, and CT perfusion (CTP) for the clinical outcomes of patients with AIS. Material and Methods Consecutive patients with anterior circulation AIS were retrospectively reviewed at our center. Baseline collateral scores of color-coded mCTA and conventional mCTA were assessed by a 6-point scale. The reliabilities between junior and senior observers were assessed by weighted Kappa coefficients. Receiver operating characteristic (ROC) curves and multivariate logistic regression model were applied to evaluate the predictive capabilities of color-coded mCTA and conventional mCTA scores, and CTP parameters (hypoperfusion and infarct core volume) for a favorable outcome of AIS. Results A total of 138 patients (including 70 cases of good outcomes) were included in our study. Patients with favorable prognoses were correlated with better collateral circulations on both color-coded and conventional mCTA, and smaller hypoperfusion and infarct core volume (all P < 0.05) on CTP. ROC curves revealed no significant difference between the predictive capability of color-coded and conventional mCTA ( P = 0.427). The predictive value of CTP parameters tended to be inferior to that of color-coded mCTA score (all P < 0.001). Both junior and senior observers had consistently excellent performances (κ = 0.89) when analyzing color-coded mCTA maps. Conclusion Color-coded mCTA provides prognostic information of patients with AIS equivalent to or better than that of conventional mCTA and CTP. Junior radiologists can reach high diagnostic accuracy when interpreting color-coded mCTA images.

scholarly journals Efficacy of Mechanical Thrombectomy using Penumbra ACETM Aspiration Catheter Compared to Stent Retriever SolitaireTM FR in Patients with Acute Ischemic Stroke

2021 ◽  
Vol 11 (4) ◽  
pp. 504
Author(s):  
Dalibor Sila ◽  
Markus Lenski ◽  
Maria Vojtková ◽  
Mustafa Elgharbawy ◽  
František Charvát ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Clinical Outcome ◽  
Acute Ischemic Stroke ◽  
Clinical Outcomes ◽  
Mechanical Thrombectomy ◽  
Binary Logistic Regression ◽  
Stent Retriever ◽  
Good Clinical Outcome ◽  
Significant Difference ◽  
Aspiration Technique

Background: Mechanical thrombectomy is the standard therapy in patients with acute ischemic stroke (AIS). The primary aim of our study was to compare the procedural efficacy of the direct aspiration technique, using Penumbra ACETM aspiration catheter, and the stent retriever technique, with a SolitaireTM FR stent. Secondarily, we investigated treatment-dependent and treatment-independent factors that predict a good clinical outcome. Methods: We analyzed our series of mechanical thrombectomies using a SolitaireTM FR stent and a Penumbra ACETM catheter. The clinical and radiographic data of 76 patients were retrospectively reviewed. Using binary logistic regression, we looked for the predictors of a good clinical outcome. Results: In the Penumbra ACETM group we achieved significantly higher rates of complete vessel recanalization with lower device passage counts, shorter recanalization times, shorter procedure times and shorter fluoroscopy times (p < 0.001) compared to the SolitaireTM FR group. We observed no significant difference in good clinical outcomes (52.4% vs. 56.4%, p = 0.756). Predictors of a good clinical outcome were lower initial NIHSS scores, pial arterial collateralization on admission head CT angiography scan, shorter recanalization times and device passage counts. Conclusions: The aspiration technique using Penumbra ACETM catheter is comparable to the stent retriever technique with SolitaireTM FR regarding clinical outcomes.

386 An Exploratory Study of Bedtime Procrastination and Emotional Regulation Strategies in Insomnia compared to healthy individuals

SLEEP ◽  
2021 ◽  
Vol 44 (Supplement_2) ◽  
pp. A153-A153
Author(s):  
Goeun Kim ◽  
Hyojin Nam ◽  
Huisu Jeon ◽  
Sooyeon Suh
Keyword(s):  
Emotional Regulation ◽  
Severity Index ◽  
Ministry Of Education ◽  
Chi Square ◽  
Healthy Group ◽  
Significant Difference ◽  
Regulation Strategies ◽  
The Difference ◽  
The Republic ◽  
Bedtime Procrastination

Abstract Introduction Bedtime Procrastination (BP) is defined as the behavior of voluntarily delaying going to bed, without having external reasons for doing so. Recent research on procrastination behavior suggests that when negative emotions are elevated, procrastination behaviors can be triggered in order to find pleasure to avoid and alleviate them. Procrastination can also occur when there is difficulty regulating emotions. In addition, the reason for bedtime procrastination may be different depending on whether the individuals present with insomnia. According to previous studies, patients with insomnia may exhibit more pronounced negative avoidance of bedtime due to prolonged sleeplessness. Therefore, this study compared the difference between of the bedtime procrastination and the emotional regulation strategies between the insomnia group and the healthy group. Methods This study was conducted in 582 adults (mean age 23.06 ±2.16 years), 81.6% females. Individuals scoring higher than 15 on the Insomnia Severity Index (ISI) were classified into the insomnia group (n=375), and those less than 15 were classified into the healthy group (n=207). Participants completed the Bedtime Procrastination Scale (BPS), Emotional Regulation Strategies Checklist. Data was analyzed using descriptive statistics, chi square test, and independent t tests. Results The insomnia group had significantly higher bedtime procrastination scores than the healthy group (t=-6.241, p&lt;.001), and also the avoidant/distractive regulation style score was significantly higher (t=-1.969, p&lt;.05). In addition, the score of active regulation style was significantly lower in the insomnia group than in the healthy group (t=3.050, p&lt;.01). There was no significant difference between the two groups in the support-seeking regulation style. Conclusion Based on these results, it was confirmed that there was a difference in the bedtime procrastination and the emotional regulation strategies between the insomnia group and the healthy group. Support (if any) This work was supported by the Ministry of Education of the Republic of Korea and the National Research Foundation of Korea(NRF-2018S1A5A8026807)

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