Nonfocal Symptoms in Patients with Transient Ischemic Attack and Association with Stroke Risk

Background and Objective: Patients with transient ischemic attack（TIA）occasionally showed nonfocal symptoms, such as decreased consciousness, amnesia and non-rotatory dizziness. This study intended to evaluate the effect of nonfocal symptoms on the prognosis of patients with TIA. Methods: Data from the prospective hospital-based TIA database of the First Affiliated Hospital of Zhengzhou University were analyzed. The predictive outcome was stroke occurrence at 1 year. Cumulative risks of stroke in patients with and without nonfocal symptoms were estimated with Kaplan-Meier models. Results: We studied 1384 patients with TIA (842 men; mean age, 56±13 years), including 450 (32.5%) with nonfocal symptoms. In the first year after TIA, stroke occurred in 168（12.1%） patients. There was no difference in the risk of stroke between patients with both focal and nonfocal symptoms and patients with focal symptoms alone (11.8% vs 12.4%, log-rank; P=0.691). Conclusions: The occurrence of nonfocal symptoms did not increase the risk of stroke at one-year follow-up compared to the occurrence of focal symptoms alone.

Clinical echocardiography does not indicate cardiac dysfunction in critically ill Covid-19 patients

Aims: We aimed to investigate the acute effects of severe SARS-CoV-2 on myocardial function. Methods and Results: This is an observational study generated from the first 79 patients admitted to intensive care in Uppsala due to respiratory failure with SARS-CoV-2 infection, during the first wave in 2020, included in the PRONMED study. From this group 34 underwent echocardiographic examination of which 25 were included in the study, and compared to 44 non-echo patients. Demographic analysis compared standard parameters and previous morbidities between the echo and non-echo group. Standard echocardiographic parameters were analysed indicating a reduced left ventricular function as assessed by global longitudinal strain and very discrete increases in wall thickness in the group as a whole. A group comparison between the outcomes survival and death was carried out. Right sided dimensions and functional parameters did not indicate major strain. An increased maximum tricuspid valve regurgitation velocity indicating increased pulmonary arterial pressure was significantly associated with death, but failed to maintain significance when corrected for multiple comparison. Biochemical cardiac markers and D-dimer correlated to initiation of echocardiography and mortality. Tricuspid regurgitation maximum velocity was positively correlated with maximum troponin I. Conclusion: These results suggests that there is no clear negative effect on cardiac function in critical SARS-CoV-2 infection. There are indications that pulmonary pressure elevation carries a negative predictive outcome suggesting pulmonary disease as the major driver of mortality. Cardiac biomarkers as well as D-dimer carry a predictive outcome value.

A mixed effects multinomial logistic-normal model for forecasting baseball performance

Prediction of player performance is a key component in the construction of baseball team rosters. As a result, most prediction models are the proprietary property of team or industrial sports entities, and little is known about them. Of those models that have been published, the main focus has been to separately model each outcome with nearly no emphasis on uncertainty quantification. This research introduces a joint modeling approach to predict seasonal plate appearance outcome vectors using a mixed-effects multinomial logistic-normal model. This model accounts for positive and negative correlations between outcomes, both across and within player seasons, and provides a joint posterior predictive outcome distribution from which uncertainty can be quantified. It is applied to the important, yet unaddressed, problem of predicting performance for players moving between the Japanese (NPB) and American (MLB) major leagues.

Covid-19 Containment Measure Analysis of Global & Indian Data with Predictive Model Comparison

In the constant fight with the uncertainty of life and a broken economic and mental stature, machine learning and analysis is striving to identify probable remedies and even trying to predict the future of this hostile situation. Visualisation of treatment procedures, health data and economic data yields an in-depth analysis of the scenario. Remedial measures can be practised based on the predictive outcome. We performed predictive and statistical models like the SEIR for building highly accurate and analytical data outputs and plots for better visualisation of the data. This work aims to analyse the spread of the virus across the world and different regions in India and predict the near future of this pandemic in social, health and economic sectors.

Survival and Predictors of Mortality in Acute Kidney Injury Patients Treated with Sustained Low Efficiency Dialysis

Introduction: Sustained low efficiency dialysis (SLED) is an increasingly common treatment option for acute kidney injury (AKI) patients, but there are few studies examining the survival and predictive outcome of this therapy. The study aims to evaluate survival, pre-SLED predictors and complications associated with SLED. Materials and Methods: This was a retrospective cohort study of 91 patients with AKI treated with SLED in a tertiary hospital from January 2014 to August 2018. The primary outcomes were in-hospital and 30-day mortality. The secondary outcomes were the clinical and laboratory pre-SLED characteristics that were associated with survival and complication of SLED. Results: Median survival of AKI patients treated with SLED was 17 days and the 30-day mortality rate was 58%. Pre-SLED serum levels of creatinine (adjusted HR 0.82, 95% CI 0.71x0.94), albumin (adjusted HR 0.57, 95% CI 0.4–0.81), potassium (adjusted HR 1.38, 95% CI 1.1–1.73) and number of SLED (adjusted HR 0.95, 95% CI 0.91-1) served as predictors of survival. Arrhythmia was found 3.3% and intradialytic hypotension in 13.2% of patients. No patient had bleeding complications. Conclusions: Our study found similar in-hospital and 30-day mortality for AKI patients treated with SLED. High pre-SLED levels of serum albumin, creatinine and number of SLED were significantly associated with reduced risk of death and high pre-SLED serum potassium was associated with increased risk of death. These results indicate that SLED is safe treatment, with few haemorrhage and haemodynamic complications. Key words: Acute kidney injury, Predictors, Sustained low efficiency dialysis, Survival

Outcomes of Patients Referred for Arteriovenous Fistula Construction: A Systematic Review

Chronic Kidney Disease (CKD) affects 10-16% of the US population and its incidence is rising due to increasing prevalence of associated risk factors. Renal replacement therapy is required to treat late stage CKD and hemodialysis is the preferred modality for many patients. Vascular access is required for hemodialysis and arteriovenous fistulas (AVF) are currently the gold standard. This review intended to collate current knowledge on AVF outcomes regarding both the patient and fistula. Scopus and Medline were utilized to identify relevant literature. Inclusion and exclusion criteria were applied to narrow search results. Among CKD patients, 33.5-77.4% require a central venous catheter (CVC) before dialysis through a fistula. Many patients (33-51%) use a CVC regardless of AVF creation due to fistula immaturity or failure. There are large variations in AVF creation policies internationally; 16% of American hemodialysis patients use a fistula compared to 72% of German patients. Primary patency and primary AVFs' failure ranges from 60-70% and 20-26%, respectively. AVFs reduce morbidity and mortality in CKD. At present, too many patients are receiving hemodialysis through a CVC. Inadequate referral times for AVF creation can lead to fistula immaturity or failure in the intervention. Many countries are lagging behind recommended AVF creation rates published by the Kidney Disease Outcomes Quality Initiative. There is a paucity of literature concerning when a patient should be referred for AVF creation. It is paramount to have better predictive outcome measures and more clarity as to when patients will benefit from an AVF.