Elevated Serum Amyloid A Is Associated With Cognitive Impairment in Ischemic Stroke Patients

Background and PurposeThe impact of serum amyloid A on cognitive impairment after ischemic stroke is unclear. We aimed to investigate the association between serum amyloid A (SAA) levels and post-stroke cognitive impairment (PSCI) at 3 months after ischemic stroke.MethodsOne hundred and ninety-eight patients were enrolled prospectively from June 2020 to April 2021. The SAA concentrations were measured using a commercially available enzyme-linked immunosorbent assay kit after admission. Cognitive function was assessed using the Montreal Cognitive Assessment score at 3 months after the symptom onset. We defined a Montreal Cognitive Assessment score <25 as cognitive impairment.ResultsDuring 3-month follow-up, 80 patients (40.4%) were diagnosed as having PSCI. As compared with patients with cognitively normal ischemic stroke, those with PSCI were older, more likely to have diabetes and white matter lesions, and had a higher baseline National Institutes of Health stroke score and SAA levels. After adjustment for age, the National Institutes of Health stroke score and other covariates, the OR for the highest quartile of SAA compared with the lowest quartile was 5.72 (95% CI, 2.17–15.04, P = 0.001) for PSCI. Also, ordinal logistic regression analysis showed that higher SAA concentrations were associated with increased risk of PSCI severity (OR, 4.31; 95% CI, 1.81–10.33, P = 0.001). Similar results were found when the SAA levels were analyzed as a continuous variable.ConclusionsThis present study demonstrated that increased SAA levels might be associated with PSCI at 3 months after ischemic stroke.

Multiple Cases of Bacterial Sequence Erroneously Incorporated Into Publicly Available Chloroplast Genomes

Public sequencing databases are invaluable resources to biological researchers, but assessing data veracity as well as the curation and maintenance of such large collections of data can be challenging. Genomes of eukaryotic organelles, such as chloroplasts and other plastids, are particularly susceptible to assembly errors and misrepresentations in these databases due to their close evolutionary relationships with bacteria, which may co-occur within the same environment, as can be the case when sequencing plants. Here, based on sequence similarities with bacterial genomes, we identified several suspicious chloroplast assemblies present in the National Institutes of Health (NIH) Reference Sequence (RefSeq) collection. Investigations into these chloroplast assemblies reveal examples of erroneous integration of bacterial sequences into chloroplast ribosomal RNA (rRNA) loci, often within the rRNA genes, presumably due to the high similarity between plastid and bacterial rRNAs. The bacterial lineages identified within the examined chloroplasts as the most likely source of contamination are either known associates of plants, or co-occur in the same environmental niches as the examined plants. Modifications to the methods used to process untargeted ‘raw’ shotgun sequencing data from whole genome sequencing efforts, such as the identification and removal of bacterial reads prior to plastome assembly, could eliminate similar errors in the future.

Readability Analysis of Otolaryngology Consent Documents on the iMed Consent Platform

ABSTRACT Introduction The American Medical Association (AMA) and National Institutes of Health (NIH) recommend all patient information and consent materials be provided at the fourth- to sixth-grade level. The iMed Consent platform is used nationally by the Veterans Health Administration and private hospitals. We aimed to assess the readability of otolaryngology consents at the West Los Angeles Veterans Affairs (WLA-VA) hospital to determine whether they conform with AMA/NIH guidelines. Materials and Methods A readability analysis of 27 otolaryngology iMed consent documents was performed. The main outcome measure was the Flesch–Kincaid Grade Level (FKGL). The setting of the study was an otolaryngology clinic at a major VA hospital. All consents used in the WLA-VA otolaryngology clinic for the month of October 2018 were analyzed using readability metrics. These included the Flesch Reading Ease (FRE) score, the FKGL, the Gunning Fog Index (GFI), Simple Measure of Gobbledygook (SMOG), and Coleman–Liau Index (CLI). Results The following means of all consents were calculated for each of the readability metrics: FRE 56.3, FKGL 8.3, GFI 14.5, SMOG 11.3, and CLI 11.2. The standardized anesthesia and blood consent were analyzed separately with the following scores: FRE 45.1, FKGL 11.7, GFI 15.5, SMOG 14.6, and CLI 12.6. The average FKGL of the consents was found to be significantly above the sixth-grade level (P: .0013). Conclusion The average grade level of the otolaryngology iMed consents reviewed was at a reading level above the AMA/NIH recommendations. This objective measure should be taken into consideration when revising the iMed system and in the creation of future standardized consents. Readability analysis does not take into consideration the significant variance that exists as part of the verbal consent process that takes place between patient and provider.

National Institutes of Health Stroke Scale as an Outcome in Stroke Research: Value of ANCOVA Over Analyzing Change From Baseline

National Institutes of Health Stroke Scale (NIHSS), measured a few hours to days after stroke onset, is an attractive outcome measure for stroke research. NIHSS at the time of presentation (baseline NIHSS) strongly predicts the follow-up NIHSS. Because of the need to account for the baseline NIHSS in the analysis of follow-up NIHSS as an outcome measure, a common and intuitive approach is to define study outcome as the change in NIHSS from baseline to follow-up (ΔNIHSS). However, this approach has important limitations. Analyzing ΔNIHSS implies a very strong assumption about the relationship between baseline and follow-up NIHSS that is unlikely to be satisfied, drawing into question the validity of the resulting statistical analysis. This reduces the precision of the estimates of treatment effects and the power of clinical trials that use this approach to analysis. ANCOVA allows for the analysis of follow-up NIHSS as the dependent variable while adjusting for baseline NIHSS as a covariate in the model and addresses several challenges of using ΔNIHSS outcome using simple bivariate comparisons (eg, a t test, Wilcoxon rank-sum, linear regression without adjustment for baseline) for stroke research. In this article, we use clinical trial simulations to illustrate that variability in NIHSS outcome is less when follow-up NIHSS is adjusted for baseline compared to ΔNIHSS and how a reduction in this variability improves the power. We outline additional, important clinical and statistical arguments to support the superiority of ANCOVA using the final measurement of the NIHSS adjusted for baseline over, and caution against using, the simple bivariate comparison of absolute NIHSS change (ie, delta).

Impact of the lockdown on acute stroke treatments during the first surge of the COVID-19 outbreak in the Netherlands

Introduction We investigated the impact of the Corona Virus Disease 2019 (COVID-19) pandemic and the resulting lockdown on reperfusion treatments and door-to-treatment times during the first surge in Dutch comprehensive stroke centers. Furthermore, we studied the association between COVID-19-status and treatment times. Methods We included all patients receiving reperfusion treatment in 17 Dutch stroke centers from May 11th, 2017, until May 11th, 2020. We collected baseline characteristics, National Institutes of Health Stroke Scale (NIHSS) at admission, onset-to-door time (ODT), door-to-needle time (DNT), door-to-groin time (DGT) and COVID-19-status at admission. Parameters during the lockdown (March 15th, 2020 until May 11th, 2020) were compared with those in the same period in 2019, and between groups stratified by COVID-19-status. We used nationwide data and extrapolated our findings to the increasing trend of EVT numbers since May 2017. Results A decline of 14% was seen in reperfusion treatments during lockdown, with a decline in both IVT and EVT delivery. DGT increased by 12 min (50 to 62 min, p-value of < 0.001). Furthermore, median NIHSS-scores were higher in COVID-19 - suspected or positive patients (7 to 11, p-value of 0.004), door-to-treatment times did not differ significantly when stratified for COVID-19-status. Conclusions During the first surge of the COVID-19 pandemic, a decline in acute reperfusion treatments and a delay in DGT was seen, which indicates a target for attention. It also appeared that COVID-19-positive or -suspected patients had more severe neurologic symptoms, whereas their EVT-workflow was not affected.

Heterogeneity of the Relative Benefits of TICI 2c/3 over TICI 2b50/2b67

Purpose Incomplete reperfusion after mechanical thrombectomy (MT) is associated with a poor outcome. Rescue therapy would potentially benefit some patients with an expanded treatment in cerebral ischemia score (eTICI) 2b50/2b67 reperfusion but also harbors increased risks. The relative benefits of eTICI 2c/3 over eTICI 2b50/67 in clinically important subpopulations were analyzed. Methods Retrospective analysis of our institutional database for all patients with occlusion of the intracranial internal carotid artery (ICA) or the M1/M2 segment undergoing MT and final reperfusion of ≥eTICI 2b50 (903 patients). The heterogeneity in subgroups of different time metrics, age, National Institutes of Health Stroke Scale (NIHSS), number of retrieval attempts, Alberta Stroke Programme Early CT Score (ASPECTS) and site of occlusion using interaction terms (pi) was analyzed. Results The presence of eTICI 2c/3 was associated with better outcomes in most subgroups. Time metrics showed no interaction of eTICI 2c/3 over eTICI 2b50/2b67 and clinical outcomes (onset to reperfusion pi = 0.77, puncture to reperfusion pi = 0.65, onset to puncture pi = 0.63). An eTICI 2c/3 had less consistent association with mRS ≤2 in older patients (>82 years, pi = 0.038) and patients with either lower NIHSS (≤9) or very high NIHSS (>19, pi = 0.01). Regarding occlusion sites, the beneficial effect of eTICI 2c/3 was absent for occlusions in the M2 segments (aOR 0.73, 95% confidence interval [CI] 0.33–1.59, pi = 0.018). Conclusion Beneficial effect of eTICI 2c/3 over eTICI 2b50/2b67 only decreased in older patients, M2-occlusions and patients with either low or very high NIHSS. Improving eTICI 2b50/2b67 to eTICI 2c/3 in those subgroups may be more often futile.

Fatores relacionados à adesão vacinal em adultos: revisão integrativa

Objetivo: Verificar os principais fatores relacionados à adesão e à hesitação vacinal em adultos da população geral. Métodologia: Trata-se de uma revisão integrativa da literatura realizada no mês de outubro de 2021 nas bases de dados Medical Literature Analysis and Retrievel System Online (MEDLINE) via National Library of Medicine National Institutes of Health (PubMed), Scopus, Literatura Latino-Americana e do Caribe em Ciências da Saúde (LILACS) e Web of Science. A questão norteadora da pesquisa constituiu-se em: “Quais os fatores relacionados à adesão e à hesitação vacinal em adultos da população geral?”. Resultados: Foram elegíveis 30 artigos científicos para a revisão, e foram agrupados em três subgrupos conforme os fatores relacionados à adesão e hesitação abordados no artigo: Confiança/ conhecimento em relação a vacinas e/ou sistema de saúde (14 artigos, 45,2%); Fatores socioeconômicos (10 artigos, 32,2%); e Outros fatores (07 artigos, 22,6%). Conclusão: Os dados obtidos podem contribuir para o desenvolvimento de estratégias de educação em saúde pública, a fim aumentar a adesão à imunização individual, favorecendo a proteção coletiva.

Use of tocilizumab, remdesivir, and high-dose methylprednisolone prevents intubation in an ESRD patient with COVID-19 pneumonia

Coronavirus disease 2019 (COVID-19) has affected over 200 million patients worldwide. COVID-19 is transmitted through respiratory droplets from patient to patient or by touching a surface that has been contaminated by an infected patient. Many COVID-19 patients have other comorbidities, such as end-stage renal disease. Currently, management of COVID-19 in patients with end-stage renal disease is unclear. Some studies have shown improvement in this population with the use of tocilizumab, a humanized interleukin-6 monoclonal antibody, in addition to the standard therapy as per guidelines published by the National Institutes of Health. In this case report, we present a patient case where the use of remdesivir, tocilizumab, and pulse-dose methylprednisolone significantly improved symptoms and inflammatory biomarkers associated with COVID-19 in a patient with end-stage renal disease.