Association of Serum Bilirubin with the Severity and Outcomes of Intracerebral Hemorrhages

Intracerebral hemorrhage (ICH) is the second most common subtype of stroke, and it is often associated with a high mortality rate and significant morbidity among survivors. Recent studies have shown that bilirubin, a product of heme metabolism, can exhibit cytoprotective, antioxidant and, anti-inflammatory properties. However, little is known about the role of bilirubin in combating several pathophysiological pathways caused by intracerebral bleeding in patients with ICH. In this study, data were collected retrospectively on 276 patients with ICH who were admitted to a university hospital between 5 January 2014 and 31 December 2017. We assessed the relationship between levels of total, direct, and indirect serum bilirubin and assessments of initial stroke severity and clinical outcomes by using Spearman’s rank correlation and Kruskal-Wallis H tests. A secondary examination of the carrier protein albumin was also undertaken. Our study found that higher levels of direct bilirubin were correlated with worse admission Glasgow Coma Scales (GCS) (rs = −0.17, p = 0.011), worse admission ICH Scores (rs = 0.19, p = 0.008), and worse discharge modified Rankin Scales (mRS) (rs = 0.15, p = 0.045). Direct bilirubin was still significantly correlated with discharge mRS after adjusting for temperature at admission (rs = 0.16, p = 0.047), oxygen saturation at admission (rs = 0.15, p = 0.048), white blood cell count (rs = 0.18, p = 0.023), or Troponin T (rs = 0.25, p = 0.001) using partial Spearman’s correlation. No statistical significance was found between levels of total or indirect bilirubin and assessments of stroke severity and outcomes. In contrast, higher levels of albumin were correlated with better admission GCS (rs = 0.13, p = 0.027), discharge GCS (rs = 0.15, p = 0.013), and discharge mRS (rs = −0.16, p = 0.023). We found that levels of total bilirubin, direct bilirubin, and albumin were all significantly related to discharge outcomes classified by discharge destinations (p = 0.036, p = 0.014, p = 0.016, respectively; Kruskal-Wallis H tests). In conclusion, higher direct bilirubin levels were associated with greater stroke severity at presentation and worse outcomes at discharge among patients with ICH. Higher levels of albumin were associated with lower stroke severity and better clinical outcomes. Future prospective studies on the free bioactive bilirubin are needed to better understand the intricate relationships between bilirubin and ICH.

Download Full-text

Association of Serum Bilirubin with Stroke Severity and Clinical Outcomes

Canadian Journal of Neurological Sciences / Journal Canadien des Sciences Neurologiques ◽

10.1017/s0317167100012993 ◽

2013 ◽

Vol 40 (1) ◽

pp. 80-84 ◽

Cited By ~ 6

Author(s):

Tian Xu ◽

Jintao Zhang ◽

Tan Xu ◽

Wenqing Liu ◽

Yan Kong ◽

...

Keyword(s):

Ischemic Stroke ◽

Acute Ischemic Stroke ◽

Clinical Outcomes ◽

Total Bilirubin ◽

Serum Bilirubin ◽

Direct Bilirubin ◽

Stroke Severity ◽

Stroke Patients ◽

Short Term ◽

Fourth Quartile

Objective:The aim of the study is to explore the association of serum bilirubin levels with admission severity and short term clinical outcomes among acute ischemic stroke patients.Methods:Data were collected from 2361 acute ischemic stroke patients in four hospitals of Shangdong Province during January 2006 and December 2008. National Institutes of Health Stroke Scale (NIHSS) was used to assess admission and discharge severity. NIHSS≥10 at discharge or in-hospital death was defined as short-term clinical outcomes. Logistic regression and trend test were used to examine the association of serum bilirubin levels with admission severity and short term clinical outcomes.Results:Serum bilirubin levels were significantly and positively associated with admission severity (P for trend <0.05). The age-sex adjusted odds ratios (95% confidential intervals) of NIHSS≥10 associated with the second, third and fourth quartile of total bilirubin/direct bilirubin were 1.245 (0.873, 1.777)/1.276 (0.895, 1.818), 1.484 (1.048, 2.102)/1.628 (1.158, 2.289) and 2.869 (2.076, 3.966)/2.765 (1.996, 3.828), respectively, compared with the lowest quartile; the multivariate adjusted odds ratios of NIHSS≥10 associated with the second, third and fourth quartile of total bilirubin/direct bilirubin were 1.088(0.711, 1.665)/1.436(0.94, 2.193), 1.328(0.877, 2.011)/1.647(1.092, 2.485) and 2.336(1.579, 3.458)/3.079 (2.049, 4.623), respectively, compared with the lowest quartile. However, no association between serum bilirubin levels and short-term clinical outcomes was observed in our study.Conclusion:Serum bilirubin levels were associated with initial stroke severity closely. Nevertheless, there is no significant relationship between serum bilirubin levels and short-term clinical outcomes among acute ischemic stroke patients.

Download Full-text

Reference values for Lactate Pro 2™ in fetal blood sampling during labor: a cross-sectional study

Journal of Perinatal Medicine ◽

10.1515/jpm-2016-0027 ◽

2017 ◽

Vol 45 (3) ◽

Cited By ~ 2

Author(s):

Brynhildur Tinna Birgisdottir ◽

Malin Holzmann ◽

Ingela Hulthén Varli ◽

Sofie Graner ◽

Sissel Saltvedt ◽

...

Keyword(s):

Lactate Concentration ◽

Rank Correlation ◽

Cross Sectional Study ◽

University Hospital ◽

Sectional Study ◽

Cross Sectional ◽

Spearman’S Rank Correlation ◽

Fetal Blood Sampling ◽

Conversion Equation

AbstractObjective:Lactate ProStudy design:A cross-sectional study was conducted at a university hospital in Sweden. A total of 113 laboring women with fetal heart rate abnormalities on cardiotocography (CTG) had FBS carried out. Lactate concentration was measured bedside with both LP1 and LP2 from the same blood sample capillary. A linear regression model was constructed to retrieve a conversion equation to convert LP2 values to LP1 values.Results:LP2 measured higher values than LP1 in all analyses. We found that 4.2 mmol/L with LP1 corresponded to 6.4 mmol/L with LP2. Likewise, 4.8 mmol/L with LP1 corresponded to 7.3 mmol/L with LP2. The correlation between the analyses was excellent (Spearman’s rank correlation, r=0.97).Conclusion:We recommend the following guidelines when interpreting lactate concentration in FBS with LP2: <6.4 mmol/L to be interpreted as normal, 6.4–7.3 mmol/L as preacidemia indicating a follow-up FBS within 20–30 min, and >7.3 mmol/L as acidemia indicating intervention.

Download Full-text

Postoperative Computed Tomography Evaluation of Posterior Tibial Plateau Fractures: Mean 7-Year Clinical Follow-Up

The Journal of Knee Surgery ◽

10.1055/s-0037-1606561 ◽

2017 ◽

Vol 31 (07) ◽

pp. 670-676

Author(s):

Dongzhe Li ◽

Yu Liang ◽

Kunlong Ma ◽

Chang Zou ◽

Yue Fang

Keyword(s):

Computed Tomography ◽

Clinical Outcomes ◽

Tibial Plateau ◽

Rank Correlation ◽

Correlation Coefficients ◽

Tibial Plateau Fractures ◽

Short Musculoskeletal Function Assessment ◽

Posterior Tibial ◽

Spearman’S Rank Correlation ◽

Spearman’S Rank Correlation Coefficient

AbstractThe aim is to assess the association between computed tomography (CT) findings and clinical outcomes in posterior tibial plateau fractures (TPF). This is a retrospective analysis of the records of 23 patients with posterior TPF treated at our institution between 2004 and 2011. Two indices of residual articular displacement of posterior TPF (gap and step-off) were measured from CT images, and clinical outcomes were assessed using the Short Musculoskeletal Function Assessment (SMFA) questionnaire. Spearman's rank correlation coefficient analysis was used to evaluate the correlations between the postoperative posterior TPF radiological findings and the clinical outcomes. Both the intraobserver and the interobserver correlation coefficients were high (0.90 and 0.92, respectively), indicating excellent agreement between the reviewers for the assessment of residual displacement via CT scans. Additionally, residual articular step displacement showed a strongly negative correlation with clinical outcomes (R = 0.700, p = 0.036), whereas the residual gap displacement did not (R = 0.400, p = 0.505). More importantly, the medial posterior step displacement was significantly correlated with the clinical outcomes (p = 0.040), whereas the lateral posterior step displacement was not (p = 0.618). Based on the data of this study, the higher the step-off deformity of the medial posterior tibial plateau, the worse the SMFA. More attention should be paid to this factor when treating medial posterior TPF.

Download Full-text

Milk-free diet followed by breastfeeding women

Roczniki Państwowego Zakładu Higieny ◽

10.32394/rpzh.2020.0118 ◽

2020 ◽

pp. 181-189

Keyword(s):

Fast Food ◽

Statistical Significance ◽

Rank Correlation ◽

Food Products ◽

Elimination Diet ◽

P Value ◽

Computer Assisted ◽

Significance Level ◽

Spearman’S Rank Correlation ◽

Low Calcium Diet

Background. Breastfeeding is the most common way of feeding infants. Human milk contains nutrients which are necessary to provide proper growth of a child. Nowadays there aren't any recommendations to follow elimination diet in order to decrease the risk of allergy or baby colic. Only the occurrence of health problems such as lactose intolerance or cow's milk protein allergy in breastfeeding mother or infant should be a reason for eliminating dairy products from diet. It seems to be important to explore the reasons and the frequency of following milk-free diet by breastfeeding women. Objectives. The main purpose of the study was to find the reasons for following milk-free diet by breastfeeding women and making an assessment of their nutrition knowledge and food habits. Material and methods. Thirty-three breastfeeding women following milk-free diet took part in the project. The women were interviewed by the Computer Assisted Web Interview (CAWI) method with an original questionnaire. The results were developed with Spearman's rank correlation, Chi2 test and the gamma coefficient. The statistical significance level for the p-value was <0.05. Results. The main reason for following milk-free diet by the breastfeeding women was the occurrence of hypersensitivity reactions of the children's gastrointestinal system after consuming milk by mother (72% responses). After excluding milk from diet only 42% respondents declared consuming new food products or dietary supplements in order to refill the potential deficiency of nutrients. The majority of respondents also eliminated from diet highly processed food products, fast-food and the carbonated drinks. The most often declared source of information about lactation was Internet (85%). Only 12% respondents asked a nutritionist in order to get the information about breastfeeding. Conclusions. It's necessary to promote a specific nutritional advice about following milk-free diet in breastfeeding women group in order to decrease the health risk connected with low calcium diet.

Download Full-text

Falx cerebri Calcifications and Ossifications in CT Scans – A Data Collection on Frequency, Position and Size

10.35740/ejor.2019.1.1.1 ◽

2019 ◽

Vol 1 (1) ◽

pp. 1-7

Author(s):

Alexander Schedler ◽

Hannes Deutschmann

Keyword(s):

Data Collection ◽

Age Distribution ◽

Three Dimensional ◽

Rank Correlation ◽

Threshold Value ◽

University Hospital ◽

Ct Scans ◽

Falx Cerebri ◽

Spearman’S Rank Correlation ◽

Frequency Position

Background: The aim of this study is the acquisition of data regarding the frequency, position, size, sex- and age distribution of falx cerebri calcifications (FCC, including ossifications) using CT scans. Methods: An explorative-retrospective data collection using skull CT scans of all CT devices (in use for patient examinations) at the University Hospital Graz. From August 20 to August 31, 2015, 365 cases of undisturbed and non-contrast brain images were determined. FCC with a density threshold value of > = 100 HU was recorded, analysed according to certain target parameters and evaluated using descriptive statistics. Additionally, lateral views of three-dimensional image reconstructions of certain FCC were produced and measured. Also, superior sagittal sinus calcifications were examined. Results: The occurrence of FCC accounted for 34% in general and was slightly more frequent in older men. Among all FCC 95% were located in anterior and medial falx area. The Spearman’s rank correlation between age and occurrence of FCC was r = .96, p < .001. Considering a sagittal dimension (max. length x max. height x sin (90°-Gantry Tilt) computed in axial layers) of > = 2cm² , FCC incidences still amounted to 9, 8%. Conclusions: The FCC frequency of 10% with a size of > = 2 cm² (sagittal dimension computed in axial layers) corresponded to values of previous x-ray studies. However, the dimension or diameter was never mentioned. FCC of the size mentioned above is relevant to an osteopath’s work since they might influence the craniosacral palpation and treatment of the falx cerebri. Therefore, there is further need for investigation concerning the possible effects of FCC on craniosacral palpation of the falx cerebri, precise measurements of size, as well as a histological comparison alongside CT-imaging. Keywords: Falx cerebri, calcification, ossification, computed tomography

Download Full-text

Association between aqueous humor cytokines and postoperative corneal endothelial cell loss after Descemet stripping automated endothelial keratoplasty

PLoS ONE ◽

10.1371/journal.pone.0260963 ◽

2021 ◽

Vol 16 (12) ◽

pp. e0260963

Author(s):

Tatsu Okabe ◽

Wataru Kobayashi ◽

Takehiro Hariya ◽

Shunji Yokokura ◽

Toru Nakazawa

Keyword(s):

Endothelial Cell ◽

Aqueous Humor ◽

Rank Correlation ◽

Cell Loss ◽

Corneal Endothelial Cell ◽

University Hospital ◽

Endothelial Keratoplasty ◽

Spearman’S Rank Correlation ◽

Spearman’S Rank Correlation Coefficient ◽

Multiplex Bead

This study measured the intraoperative anterior aqueous humor concentrations of various cytokines during corneal endothelial transplantation and searched for relationships between these concentrations and postoperative corneal endothelial cell (CEC) depletion. We recruited 30 consecutive patients who underwent corneal endothelial transplantation with Descemet’s stripping automated endothelial keratoplasty (DSAEK) at Tohoku University Hospital between February 2014 and July 2017. During surgery, we obtained aqueous humor samples and later measured the concentrations of 27 cytokines with a Multiplex Bead Assay (Bio-Plex Pro). We counted CECs 1, 6 and 12 months after surgery, and used Spearman’s rank correlation coefficient to identify relationships between CEC depletion and the concentrations of detected cytokines. The loss of CECs 1–6 months after surgery was significantly correlated with IL-7, IP-10, MIP-1a and MIP-1b concentrations (-0.67, -0.48, -0.39, and -0.45, respectively, all P <0.01). CEC loss 1–12 months after surgery was significantly correlated with IL-1b, IL-7, IP-10 and RANTES concentrations (-0.46, -0.52, -0.48, and -0.43, respectively). Multiple regression analysis showed that IL-7 concentration was significantly associated with CEC loss 1–6 months after surgery (b = -0.65, P < 0.01) and IP-10 concentration was associated with CEC loss 1–12 months after surgery (β = -0.38, P < 0.05). These results suggest that not only inflammatory cytokines but also IL-7, a cytokine related to lymphocytes, may be involved in the depletion of CECs after DSAEK, particularly depletion that occurs relatively early.

Download Full-text

Clinical and immunological features of opisthorchiasis

Kazan medical journal ◽

10.17816/kmj2021-626 ◽

2021 ◽

Vol 102 (5) ◽

pp. 626-635

Author(s):

A U Sabitov ◽

D A Soldatov ◽

Yu B Khamanova

Keyword(s):

Immune System ◽

Immune Complexes ◽

Statistical Significance ◽

Rank Correlation ◽

Statistical Processing ◽

Circulating Immune Complexes ◽

Control Group ◽

Cytotoxic Lymphocytes ◽

Spearman’S Rank Correlation ◽

Diagnostic Center

Aim. To assess the clinical and immunological features in patients with chronic opisthorchiasis, depending on the duration of the infection. Methods. The first group consisted of 19 patients with the duration of the infection up to 1 year, the second group consisted of 21 patients with the duration of the infection between 1 and 5 years, the third group was formed of 23 patients with the duration of the disease more than 5 years, the control group 20 healthy individuals. Immunological research was carried out at the Clinical Diagnostic Center. Statistical processing was performed using Microsoft Excel 2010 and Statistica 6.0 software. The statistical significance of differences was determined by using the MannWhitney test (U-test) at the level of significance of p 0.05. The correlations were assessed by calculating Spearman's rank correlation coefficients.Results Clinical features of chronic opisthorchiasis were revealed in the disease duration groups of up to 1 year, from 1 year to 5 years, more than 5 years: the subclinical course was most common in the group of up to 1 year; cholangiohepatitis prevailed in the group of between 1 to 5 years, allergic skin syndrome, cholangiocholecystitis and pancreatitis dominated in the group of more than 5 years. The immune response in chronic opisthorchiasis was characterized by: up to 1 year lymphocytosis, increased levels of immunoglobulins M (IgM) and circulating immune complexes (CIC), a decrease in the number of T-lymphocytes (CD3+), as well as an increase in bactericidal activity of leukocytes (BAL); between 1 and 5 years monocytosis, increased levels of immunoglobulins M, immunoglobulins G and circulating immune complexes, a decrease in T-cytotoxic lymphocytes (CD8+) and nitro blue tetrazolium (NBT test), as well as an increase in NK cells and phagocytic activity of monocytes, more than 5 years eosinophilia. Conclusion. Common features of rearrangement of the immune system in opisthorchiasis: inflammatory changes in the hemogram, activation of humoral immunity with parallel suppression of the cellular component of the immune system, and increased phagocytosis.

Download Full-text

PERSONALITY ADJUSTMENTS AS FACTORS AFFECTING ACADEMIC PERFORMANCE OF TERTIARY EDUCATION SUBSIDY (TES) GRANTEES

EPRA International Journal of Multidisciplinary Research (IJMR) ◽

10.36713/epra8700 ◽

2021 ◽

pp. 283-288

Author(s):

Helen C. Fuentes

Keyword(s):

Academic Performance ◽

Null Hypothesis ◽

Tertiary Education ◽

Rank Correlation ◽

Study Data ◽

Collective Identities ◽

Factors Affecting ◽

Spearman’S Rank Correlation ◽

Education Subsidy ◽

Level Of Significance

This is a correlation research describing the personality adjustments and academic performance of Tertiary Education Subsidy grantees. A total of 265 randomly TES grantees were the respondents for the study. Data were gathered through adapted questionnaires using online platforms. The null hypothesis was tested using the Spearman’s Rank Correlation. The level of significance was set at .05 for rejecting or accepting the null hypothesis. Results of the study revealed the following: delaying gratification on food, physical pleasures, social interaction, money, and achievement were sometimes practiced by the grantees; giving importance to aspects of identity such as relational, social, and collective identities were frequently practiced while giving importance to personal identity was seen to be always practiced by the grantees; majority of the grantees exhibited satisfactory academic performance; the relationship between personality adjustments in terms of delayed gratification and academic performance was statistically not significant while identity orientation had significant relationship with the academic performance of the grantees. KEYWORDS: TES Grantees, personality adjustments, academic performance, subsidy

Download Full-text

Association of Plasma Levels of Nitric Oxide Oxidative Metabolites with Acute Stroke in Patients Presenting to the Emergency Department of a Low-Middle Income Country

Emergency Medicine International ◽

10.1155/2019/9206948 ◽

2019 ◽

Vol 2019 ◽

pp. 1-6

Author(s):

Shahan Waheed ◽

Ayaz Ghouse Kalsekar ◽

Ayeesha Kamran Kamal ◽

Nathan S. Bryan ◽

Asad I. Mian

Keyword(s):

Nitric Oxide ◽

Emergency Department ◽

Acute Stroke ◽

Clinical Outcomes ◽

Hemorrhagic Stroke ◽

Nonparametric Tests ◽

University Hospital ◽

Stroke Severity ◽

Oxidative Metabolites ◽

Significant Difference

Introduction. Acute stroke incites an inflammatory reaction in the brain’s microvasculature, activating formation of nitric oxide oxidative metabolites, nitrate and nitrite (NOx, collectively), measurable in plasma. Our objectives were to investigate plasma NOx in patients with acute stroke presenting to the Emergency Department (ED) and to determine if it could (i) differentiate between ischemic and hemorrhagic stroke; (ii) predict clinical outcomes. Methods. A cross-sectional study was conducted in the ED of Aga Khan University Hospital, from January 1 to December 31, 2016. Participants were enrolled if they had clinical acute stroke with confirmatory brain imaging to differentiate between ischemia and hemorrhage. Clinical demographic information, ancillary blood, and diagnostic specimens were collected as per standard of care since the center follows stroke algorithmic guidelines. Plasma NOx analysis was performed using high performance liquid chromatography. Clinical outcomes were assessed using Barthel Index and Modified Rankin Score. Data was analyzed using SPSS 19 and expressed in medians with interquartile ranges. Nonparametric tests were applied for comparing among groups. Pearson’s correlation was used to determine associations with aforementioned stroke severity and disability scales. Results. Seventy-five patients were enrolled, with median age of 57 years (IQR 47-66 years), 53 (71%) were males, and 46 (61%) had ischemic stroke. Overall, median NOx was 20.8 μM (IQR 13.4-35.3); there was no statistically significant difference between NOx in ischemic versus hemorrhagic stroke (21.2 μM vs. 17.9 μM; p=0.2). However, there was a significant positive correlation between NOx levels and aforementioned acute stroke scales [r(73)=0.417, p=0.0001], for both. Conclusion. Although plasma NOx could not differentiate between ischemia and hemorrhage, higher levels of the biomarker did show associations with poststroke disability scales. Further study with more patients in a multicenter trial is warranted to establish the real biomarker potential of plasma NOx in acute stroke.

Download Full-text

Role of pre-operative serum magnesium (Mg) concentration on post-operative pain intensity and opioid usage in gynecologic surgery.

Journal of Clinical Oncology ◽

10.1200/jco.2013.31.15_suppl.e20673 ◽

2013 ◽

Vol 31 (15_suppl) ◽

pp. e20673-e20673

Author(s):

Laleh Azari ◽

Sundae Stelts ◽

Joseph T Santoso ◽

Mehmet Kocak

Keyword(s):

Pain Intensity ◽

Serum Magnesium ◽

Rank Correlation ◽

University Hospital ◽

Gynecologic Surgery ◽

Opioid Use ◽

Spearman’S Rank Correlation ◽

Pain Scores ◽

Post Operative Pain

e20673 Background: Hypomagnesemia is a common problem, occurring in nearly 12% of hospitalized patients. Due to the link of hypomagnesemia with surgery and the potential antinociceptive effects of Mg multiple trials have been conducted. Unfortunately, the role of IV and epidural Mg supplementation in pain management perioperatively remains controversial. An unanswered question from the literature to date is whether low serum Mg concentrations correlate with pain intensity. This review of patients undergoing gynecological surgeries examines whether pre-operative serum Mg level can affect pain scores and opioid use postoperatively. Methods: This was a retrospective study of the electronic medical record at Methodist University Hospital from October 1st, 2011 to July 31st, 2012. Included for analysis are all cases that underwent a gynecologic surgery and were performed under one attending surgeon. Each patient included in the study had perioperative serum Mg levels, resting and moving pain intensity scores, and amount of opioids used. Patients were excluded for any of the following criteria: missing data, discharge in less than 24 hours, robotic surgery, and use of ketamine in anesthesia. Statistical analysis included descriptive statistics, Spearman’s rank correlation coefficient, and logistic regression. Results: The analysis included 121 patients; 54% were Caucasian, the mean age was 51.7 years and 89% of surgeries were for oncologic indications. Pre-operative serum Mg level was not significantly associated with resting or moving pain intensity scores on post operative day (POD) 1 (p=0.66; p=0.68) or POD 2 (p=0.58, p=0.83). Pre-operative Mg level was not significantly associated with opioid use on POD 1 or 2. Two variables had a possible correlation with opioid usage, on average older patients used a lower level of opioid on average and patients with higher BMI used a higher level of opioids. Conclusions: Preoperative magnesium level has no correlation with pain scores or opioid use. While repletion maybe warranted and magnesium supplementation has minimal toxicity and cost, effect on post-operative pain is uncertain. Larger randomized trials may be warranted.

Download Full-text