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Carrera DA, Mabray MC, Torbey MT, Andrada JE, Nelson DE, Sarangarm P, Spader H, Cole CD, Carlson AP. Continuous irrigation with thrombolytics for intraventricular hemorrhage: case-control study. Neurosurg Rev 2024; 47:40. [PMID: 38200247 PMCID: PMC11105161 DOI: 10.1007/s10143-023-02270-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Revised: 12/25/2023] [Accepted: 12/29/2023] [Indexed: 01/12/2024]
Abstract
Intraventricular hemorrhage (IVH) is a complication of a spontaneous intracerebral hemorrhage. Standard treatment is with external ventricular drain (EVD). Intraventricular thrombolysis may improve mortality but does not improve functional outcomes. We present our initial experience with a novel irrigating EVD (IRRAflow) that automates continuous irrigation with thrombolysis.Single-center case-control study including patients with IVH treated with EVD compared to IRRAflow. We compared standard demographics, treatment, and outcome parameters between groups. We developed a brain phantom injected with a human clot and assessed clot clearance using EVD/IRRAflow approaches with CT imaging.Twenty-one patients were treated with standard EVD and 9 patients with IRRAflow. Demographics were similar between groups. Thirty-three percent of patients with EVD also had at least one dose of t-PA and 89% of patients with IRRAflow received irrigation with t-PA (p = 0.01). Mean drain days were 8.8 for EVD versus 4.1 for IRRAflow (p = 0.02). Days-to-clearance of ventricular outflow was 5.8 for EVD versus 2.5 for IRRAflow (p = 0.02). Overall clearance was not different. Thirty-seven percent of EVD patients achieved good outcome (mRS ≥ 3) at 90 days versus 86% of IRRAflow patients (p = 0.03). Assessing only t-PA, reduction in mean days-to-clearance (p = 0.0004) and ICU days (p = 0.04) was observed. In the benchtop model, the clot treated with IRRAflow and t-PA showed a significant reduction of volume compared to control.Irrigation with IRRAflow and t-PA is feasible and safe for patients with IVH. Improving clot clearance with IRRAflow may result in improved clinical outcomes and should be incorporated into randomized trials.
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Affiliation(s)
- Diego A Carrera
- Department of Neurology, University of New Mexico, Albuquerque, NM, USA
| | - Marc C Mabray
- Department of Radiology, University of New Mexico, Albuquerque, NM, USA
| | - Michel T Torbey
- Department of Neurology, University of New Mexico, Albuquerque, NM, USA
| | - Jason E Andrada
- Department of Neurology, University of New Mexico, Albuquerque, NM, USA
| | - Danika E Nelson
- School of Medicine, University of New Mexico, Albuquerque, NM, USA
| | | | - Heather Spader
- Department of Neurosurgery, University of New Mexico School of Medicine, Albuquerque, NM, 87131, USA
| | - Chad D Cole
- Department of Neurosurgery, University of New Mexico School of Medicine, Albuquerque, NM, 87131, USA
| | - Andrew P Carlson
- Department of Neurology, University of New Mexico, Albuquerque, NM, USA.
- Department of Neurosurgery, University of New Mexico School of Medicine, Albuquerque, NM, 87131, USA.
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Aldabbour B, Al Qawasmeh M, Elamassie S, Abuabada A, Abdelrahman K, Zahran M, Khweileh M, El-Salem K. Patient and Caregiver Depression in Jordan After a First Stroke. J Psychiatr Pract 2024; 30:51-61. [PMID: 38227729 DOI: 10.1097/pra.0000000000000754] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2024]
Abstract
BACKGROUND Poststroke depression among patients is well-recognized, while caregiver depression is understudied. The interaction between patient and caregiver depression is also unclear. METHODS This cross-sectional and follow-up study recruited 108 patient-caregiver dyads after the first-ever stroke. Demographic and clinical data, stroke severity (NIH Stroke Scale score), functional outcome (Barthel Index), and residual disability (modified Rankin Score) were documented. Using the self-reported Patient Health Questionnaire-9, we screened patients and caregivers for depressive symptoms upon admission and after 1 month. Changes in the prevalence and severity of depression were calculated. The Pearson correlation test and logistic regression analysis were conducted to evaluate both the correlation between both groups and significant predictors of depression. RESULTS In total, 89 patients and 96 caregivers responded to both screenings. Depression was reported by 13.5% and 27.0% of patients on admission and after 1 month, and 9.4% and 18.8% of caregivers, respectively. Caregiver depression on admission was significantly correlated with patient depression on admission (P=0.031). In addition, depression in caregivers after 1 month was a significant predictor of patient depression (P=0.008). Predictors of caregiver depression after 1 month were female caregivers (P=0.026), caring for a male patient (P=0.045), higher mRS scores after 1 month (P=0.013), longer admissions (P=0.017), caregiver between 17 and 35 years of age compared with 54 to 70 years of age (P=0.030), and caring for a patient with poststroke depression at 1 month poststroke (P=0.003). CONCLUSIONS Both stroke survivors and their caregivers are at high risk for depression, with a potential interaction between depression in the 2 groups.
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Wang N, Wang X, Yang J, Bi T, Zhang S, Xu Y, Wang G, Jiang Y. Health Care-Associated Infection in Elderly Patients With Cerebrovascular Disease in Intensive Care Units: A Retrospective Cohort Study in Taizhou, China. World Neurosurg 2023; 178:e526-e532. [PMID: 37516147 DOI: 10.1016/j.wneu.2023.07.114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2023] [Accepted: 07/23/2023] [Indexed: 07/31/2023]
Abstract
BACKGROUND Cerebrovascular diseases are associated with high incidence of health care-associated infections (HAIs) and poor prognosis in elderly patients. This study aimed to investigate the incidence and clinical characteristics of HAIs in elderly patients with cerebrovascular disease in the intensive care unit (ICU). METHODS Patients admitted with cerebrovascular disease, aged ≥65 years, were included. The clinical data of the patients were retrospectively analyzed to determine the risk factors, infection type, distribution, and pathogenic characteristics of HAIs in the context of cerebrovascular diseases. RESULTS Out of 381 ICU inpatients monitored, 79 (20.73%) developed HAIs. Risk analysis revealed number of ventilator days as significant risk factors for HAIs in elderly patients with cerebrovascular diseases in the comprehensive ICU. In the HAI group, 56 patients (70.89%) had respiratory tract infection (RTI). Sixty-five patients (82.28%) were infected with Gram-negative bacteria (GNB), and 42 (53.16%) with multi-drug-resistant organism (MDRO). The length of hospitalization days, ventilator days, and overall hospitalization costs were higher in the HAI group than in the non-HAI group (P < 0.05), but there was no significant difference between groups in the treatment outcome of patients. Patients with MDRO infection had longer duration and higher cost of hospitalization than those infected with non-MDRO (P < 0.05), but there was no significant difference between the groups in the treatment outcome of patients. CONCLUSIONS HAIs occurred mostly due to RTI and GNB infection. The hospitalization cost and duration, as well as the length of ventilator days, were higher for cerebrovascular patients with HAIs than for non-HAIs patients.
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Affiliation(s)
- Nan Wang
- Department of Critical Care, Taizhou Hospital of Zhejiang Province, Wenzhou Medical University, Linhai, Zhejiang, China
| | - Xiaoqiong Wang
- Department of Critical Care, Taizhou Hospital of Zhejiang Province, Wenzhou Medical University, Linhai, Zhejiang, China
| | - Jingjing Yang
- Department of Critical Care, Taizhou Hospital of Zhejiang Province, Wenzhou Medical University, Linhai, Zhejiang, China
| | - Tongxin Bi
- Department of Critical Care, Taizhou Hospital of Zhejiang Province, Wenzhou Medical University, Linhai, Zhejiang, China
| | - Sheng Zhang
- Department of Critical Care, Taizhou Hospital of Zhejiang Province, Wenzhou Medical University, Linhai, Zhejiang, China
| | - Yinghe Xu
- Department of Critical Care, Taizhou Hospital of Zhejiang Province, Wenzhou Medical University, Linhai, Zhejiang, China
| | - Gengge Wang
- Department of Hospital-Acquired Infection Control, Taizhou Hospital of Zhejiang Province, Wenzhou Medical University, Linhai, Zhejiang, China
| | - Yongpo Jiang
- Department of Critical Care, Taizhou Hospital of Zhejiang Province, Wenzhou Medical University, Linhai, Zhejiang, China.
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Firoozeh N, Agah E, Bauer ZA, Olusanya A, Seifi A. Catheter-Associated Urinary Tract Infection in Neurological Intensive Care Units: A Narrative Review. Neurohospitalist 2022; 12:484-497. [PMID: 35755214 PMCID: PMC9214946 DOI: 10.1177/19418744221075888] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2023] Open
Abstract
Catheter-associated urinary tract infection (CAUTI) is among the most common types of healthcare-associated infection (HAI), which is associated with poor outcomes and prolonged hospitalization in critically ill patients. Previous studies have mentioned that patients admitted to neurological ICUs are at higher risk of CAUTI compared to patients in other ICU settings. This review paper aims to review studies published during the last decade that evaluated the incidence, risk factors, causative pathogens, and preventive strategies and treatment in neuro-critically ill patients.
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Affiliation(s)
- Negar Firoozeh
- Iranian Center of Neurological Research, Neuroscience Institute, Imam Khomeini Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Elmira Agah
- Iranian Center of Neurological Research, Neuroscience Institute, Imam Khomeini Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Zaith Anthony Bauer
- Department of Pulmonary Critical Care, Brooke Army Medical Center, San Antonio, TX, USA
| | - Adedeji Olusanya
- Department of Physical Medicine and Rehabilitation, University of Texas Health San Antonio, San Antonio, TX, USA
| | - Ali Seifi
- Department of Neurosurgery, Division of Neurocritical Care, University of Texas Health, San Antonio, TX, USA
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Al Qawasmeh M, Aldabbour B, Abuabada A, Abdelrahman K, Elamassie S, Khweileh M, Zahran M, El-Salem K. Prevalence, Severity, and Predictors of Poststroke Depression in a Prospective Cohort of Jordanian Patients. Stroke Res Treat 2022; 2022:6506326. [PMID: 35035872 PMCID: PMC8759919 DOI: 10.1155/2022/6506326] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Revised: 12/15/2021] [Accepted: 12/20/2021] [Indexed: 01/01/2023] Open
Abstract
Poststroke depression (PSD) is common and remains a significant risk factor for poor outcomes. This prospective study is aimed at assessing the prevalence, severity, and predictors of PSD among Jordanian stroke survivors. A total of 151 patients who were consequently admitted to a tertiary teaching hospital with ischemic or hemorrhagic strokes were enrolled. Participants were screened on admission for premorbid depression using the PHQ-9 questionnaire; then, screening for PSD was repeated one and three months after stroke using the same tool. Depression prevalence at each screening was reported, and logistic regression analysis was conducted to evaluate for significant predictors. PHQ-9 scores suggestive of depression were reported by 15%, 24.83%, and 17.39% of respondents on admission and after one and three months, respectively. Scores suggesting severe depression were reported by 0.71%, 2.13%, and 6.52% of respondents, respectively. Significant predictors of PSD were having chronic kidney disease, current smoking status, moderate or severe disability (mRS score) at stroke onset, and severe dependence (BI) after one month (p values 0.007, 0,002, 0.014, and 0.031, respectively). Patients with secondary and high school education levels were less likely to get depression compared with illiterate patients (p 0.042). This study showed that nearly one in four Jordanian stroke survivors experienced PSD after one month. In contrast, while the overall PSD prevalence declined towards the end of follow-up period, patients who remained depressed showed a tendency towards higher PSD severity.
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Affiliation(s)
- Majdi Al Qawasmeh
- Neurology Department, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan
| | - Belal Aldabbour
- Neuroscience Department, Faculty of Medicine, Islamic University of Gaza, P.O. Box 108, Gaza, State of Palestine
| | - Amal Abuabada
- Psychiatry Department, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan
| | - Khalid Abdelrahman
- Psychiatry Department, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan
| | - Samah Elamassie
- Health Services, United Nations Relief and Works Agency (UNRWA), Gaza, State of Palestine
| | - Mays Khweileh
- Neurology Department, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan
| | - Mohammad Zahran
- Psychiatry Department, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan
| | - Khalid El-Salem
- Neurology Department, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan
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Li C, Liu L, Gao Z, Zhang J, Chen H, Ma S, Liu A, Mo M, Wu C, Chen D, Liu S, Xie J, Huang Y, Qiu H, Yang Y. Synbiotic Therapy Prevents Nosocomial Infection in Critically Ill Adult Patients: A Systematic Review and Network Meta-Analysis of Randomized Controlled Trials Based on a Bayesian Framework. Front Med (Lausanne) 2021; 8:693188. [PMID: 34336896 PMCID: PMC8321544 DOI: 10.3389/fmed.2021.693188] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2021] [Accepted: 06/15/2021] [Indexed: 01/30/2023] Open
Abstract
Background: The efficacy of synbiotics, probiotics, prebiotics, enteral nutrition or adjuvant peripheral parenteral nutrition (EPN) and total parenteral nutrition (TPN) in preventing nosocomial infection (NI) in critically ill adults has been questioned. We conducted a systematic review and network meta-analysis (NMA) of randomized controlled trials (RCTs) to evaluate and rank the effectiveness of these therapies on NI amongst critically ill adults. Methods: Four electronic databases were systematically searched up to June 30, 2019 for RCTs comparing the administration of probiotics, prebiotics, synbiotics, EPN and TPN in critically ill adults. The primary outcome was NI. The relative efficacy of all outcomes was determined by a Bayesian framework with random effects NMA. We estimated the odds ratio (OR) and mean difference (MD) and ranked the comparative effects of all regimens with the surface under the cumulative ranking probabilities. The study has been registered on PROSPERO (CRD42019147032). Results: Fifty-five RCTs (7,119 patients) were identified. Primary outcome showed that synbiotics had the best effect in preventing NI than EPN (OR 0.37; 95% CrI 0.22–0.61), probiotics followed (OR 0.52; 95% CrI 0.34–0.77), whereas TPN significantly increased NI (OR 2.29; 95% CrI 1.48–3.67). Subgroup analysis showed that TPN significantly increased NI in intensive care unit (ICU) patients (OR 1.57; 95% CrI 1.01–2.56) and severe acute pancreatitis (SAP) patients (OR 3.93; 95% CrI 1.74–9.15). Secondary outcomes showed that synbiotics were more effective in preventing hospital-acquired pneumonia (HAP) (OR 0.34; 95% CrI 0.11–0.85), catheter-related bloodstream infection (OR 0.08; 95% CrI 0.01–0.80), urinary tract infection (OR 0.27; 95% CrI 0.08–0.71) and sepsis (OR 0.34; 95% CrI 0.16–0.70) than EPN. Amongst the treatments, probiotics were most effective for shortening the mechanical ventilation duration (MD −3.93; 95% CrI −7.98 to −0.02), prebiotics were most effective for preventing diarrhea (OR 0.24; 95% CrI 0.05–0.94) and TPN was the least effective in shortening hospital length of stay (MD 4.23; 95% CrI 0.97–7.33). Conclusions: Amongst the five therapies, synbiotics not only prevented NI in critically ill adults but also demonstrated the best treatment results. By contrast, TPN did not prevent NI and ranked last, especially in ICU and SAP patients. Take-Home Message: Nosocomial infection is a leading cause of mortality in critically ill patients in the ICU. However, the efficacy of synbiotics, probiotics, prebiotics, enteral nutrition or adjuvant peripheral parenteral nutrition and total parenteral nutrition in preventing nosocomial infection in critically ill adults has been questioned. The network meta-analysis provides evidence that amongst the five therapies, synbiotics not only prevented NI in critically ill adults but also demonstrated the best treatment results. By contrast, TPN did not prevent NI and ranked last, especially in ICU and SAP patients. The results of this study will provide a new scientific basis and a new idea for the debate on the efficacy of synbiotics and other treatments in the improvement of prognosis in critically ill adult patients. Tweet: Synbiotic prevents nosocomial infection in critically ill adults, while total parenteral nutrition has the adverse curative.
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Affiliation(s)
- Cong Li
- Jiangsu Provincial Key Laboratory of Critical Care Medicine, Department of Critical Care Medicine, School of Medicine, Zhongda Hospital, Southeast University, Nanjing, China.,Department of Critical Care Medicine, School of Medicine, Zhongda Hospital, Southeast University, Nanjing, China.,Emergency Medicine Department of the Affiliated Hospital of Xuzhou Medical University, Xuzhou, China.,Jiangsu Provincial Institute of Health Emergency, Xuzhou Medical University, Xuzhou, China
| | - Ling Liu
- Jiangsu Provincial Key Laboratory of Critical Care Medicine, Department of Critical Care Medicine, School of Medicine, Zhongda Hospital, Southeast University, Nanjing, China.,Department of Critical Care Medicine, School of Medicine, Zhongda Hospital, Southeast University, Nanjing, China
| | - Zhiwei Gao
- Jiangsu Provincial Key Laboratory of Critical Care Medicine, Department of Critical Care Medicine, School of Medicine, Zhongda Hospital, Southeast University, Nanjing, China.,Department of Critical Care Medicine, School of Medicine, Zhongda Hospital, Southeast University, Nanjing, China.,Department of Emergency, The Affiliated Huaian NO.1 People's Hospital of Nanjing Medical University, Huai'an, China
| | - Junwei Zhang
- Jiangsu Provincial Key Laboratory of Critical Care Medicine, Department of Critical Care Medicine, School of Medicine, Zhongda Hospital, Southeast University, Nanjing, China.,Department of Critical Care Medicine, School of Medicine, Zhongda Hospital, Southeast University, Nanjing, China
| | - Hui Chen
- Jiangsu Provincial Key Laboratory of Critical Care Medicine, Department of Critical Care Medicine, School of Medicine, Zhongda Hospital, Southeast University, Nanjing, China.,Department of Critical Care Medicine, School of Medicine, Zhongda Hospital, Southeast University, Nanjing, China.,Department of Critical Care Medicine, The First Affiliated Hospital of Soochow University, Soochow University, Suzhou, China
| | - Shaolei Ma
- Jiangsu Provincial Key Laboratory of Critical Care Medicine, Department of Critical Care Medicine, School of Medicine, Zhongda Hospital, Southeast University, Nanjing, China.,Department of Critical Care Medicine, School of Medicine, Zhongda Hospital, Southeast University, Nanjing, China
| | - Airan Liu
- Jiangsu Provincial Key Laboratory of Critical Care Medicine, Department of Critical Care Medicine, School of Medicine, Zhongda Hospital, Southeast University, Nanjing, China.,Department of Critical Care Medicine, School of Medicine, Zhongda Hospital, Southeast University, Nanjing, China
| | - Min Mo
- Jiangsu Provincial Key Laboratory of Critical Care Medicine, Department of Critical Care Medicine, School of Medicine, Zhongda Hospital, Southeast University, Nanjing, China.,Department of Critical Care Medicine, School of Medicine, Zhongda Hospital, Southeast University, Nanjing, China
| | - Changde Wu
- Jiangsu Provincial Key Laboratory of Critical Care Medicine, Department of Critical Care Medicine, School of Medicine, Zhongda Hospital, Southeast University, Nanjing, China.,Department of Critical Care Medicine, School of Medicine, Zhongda Hospital, Southeast University, Nanjing, China
| | - Dongyu Chen
- Jiangsu Provincial Key Laboratory of Critical Care Medicine, Department of Critical Care Medicine, School of Medicine, Zhongda Hospital, Southeast University, Nanjing, China.,Department of Critical Care Medicine, School of Medicine, Zhongda Hospital, Southeast University, Nanjing, China.,Department of Intensive Care Medicine, Yancheng City NO.1 People' Hospital, Yancheng, China
| | - Songqiao Liu
- Jiangsu Provincial Key Laboratory of Critical Care Medicine, Department of Critical Care Medicine, School of Medicine, Zhongda Hospital, Southeast University, Nanjing, China.,Department of Critical Care Medicine, School of Medicine, Zhongda Hospital, Southeast University, Nanjing, China
| | - Jianfeng Xie
- Jiangsu Provincial Key Laboratory of Critical Care Medicine, Department of Critical Care Medicine, School of Medicine, Zhongda Hospital, Southeast University, Nanjing, China.,Department of Critical Care Medicine, School of Medicine, Zhongda Hospital, Southeast University, Nanjing, China
| | - Yingzi Huang
- Jiangsu Provincial Key Laboratory of Critical Care Medicine, Department of Critical Care Medicine, School of Medicine, Zhongda Hospital, Southeast University, Nanjing, China.,Department of Critical Care Medicine, School of Medicine, Zhongda Hospital, Southeast University, Nanjing, China
| | - Haibo Qiu
- Jiangsu Provincial Key Laboratory of Critical Care Medicine, Department of Critical Care Medicine, School of Medicine, Zhongda Hospital, Southeast University, Nanjing, China.,Department of Critical Care Medicine, School of Medicine, Zhongda Hospital, Southeast University, Nanjing, China
| | - Yi Yang
- Jiangsu Provincial Key Laboratory of Critical Care Medicine, Department of Critical Care Medicine, School of Medicine, Zhongda Hospital, Southeast University, Nanjing, China.,Department of Critical Care Medicine, School of Medicine, Zhongda Hospital, Southeast University, Nanjing, China
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Hu Y, Ni J. A new trinuclear cluster-based Cd(II) compound: photocatalytic property and nursing application values on the bacterial infection. Des Monomers Polym 2021; 24:173-181. [PMID: 34104075 PMCID: PMC8168771 DOI: 10.1080/15685551.2021.1935010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Accepted: 05/21/2021] [Indexed: 10/26/2022] Open
Abstract
A new Cd(II) coordination polymer with the formula of {[(CH3)2NH2][Cd3(NH2-bdc)3(btz)(H2O)]} n (1 NH2-H2bdc = 2-aminoterephthalic acid, Hbtz = 1 H-benzotriazole) was produced and then it was structurally characterized through powder X-ray diffraction (PXRD), the analysis of X-ray single-crystal diffraction, along with elemental analysis (EA). The photocatalytic property investigations indicate that compound 1 exhibits good activity for photodegradation of methyl violet (MV) with 60.7% of MV removal in 40 min under room temperature. Furthermore, the assessment of the compound's treatment activity and nursing application values on the bacterial infection was conducted and its corresponding mechanism was also studied. Evaluation of the in vitro hemolysis of the compound was determined by measuring the degree of red blood cell lysis and hemoglobin release. The effect of new compounds on the relative proliferation rate of L-929 cells was measured by MTT assay. The ELISA detection kit showed that the compound could reduce the TNF-α and IL-1β content released into plasma. Next, the inhibitory activity of the compound on the bacterial survival gene expression was also proved with real-time RT-PCR. The hemolysis rate of the new compound to blood is 3.4%, which is less than the standard 5%, which is non-hemolytic reaction. The compound also has no obvious cytotoxicity and has good cell compatibility.
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Affiliation(s)
- Yan Hu
- Department of Infection, Zhuji People’s Hospital of Zhejiang Province, Zhuji, Zhejiang, China
| | - Jiao Ni
- Xiaoshan District Chengxiang Street Community Health Service Center, Hangzhou, Zhejiang, China
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Qawasmeh MA, Aldabbour B, Momani A, Obiedat D, Alhayek K, Kofahi R, Yassin A, El-Salem K. Epidemiology, Risk Factors, and Predictors of Disability in a Cohort of Jordanian Patients with the First Ischemic Stroke. Stroke Res Treat 2020; 2020:1920583. [PMID: 32566121 PMCID: PMC7292978 DOI: 10.1155/2020/1920583] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2019] [Revised: 05/17/2020] [Accepted: 05/23/2020] [Indexed: 01/01/2023] Open
Abstract
OBJECTIVE To identify the risk factors, etiologies, length of stay, severity, and predictors of disability among patients with the first ischemic stroke in Jordan. METHODS A retrospective cohort study of 142 patients who were admitted to the Neurology Department at King Abdullah University Hospital between July/2017 and March/2018 with a first ischemic stroke. Etiology was classified according to the TOAST criteria. Severity was represented by NIHSS score, disability by mRS score, and prolonged length of stay as hospitalizations more than 75th percentile of the cohort's median length of stay. Analysis of the sample demographics and descriptive statistics were done, including frequencies of prevalence of independent variables (risk factors) and frequencies of stroke and etiology work-up. Chi-square and univariate analysis of variance "ANOVA" were used to investigate the relationship between risk factors and type of stroke. Finally, logistic regression analysis was used to measure the contribution of each of the independent variables. IRB approval was obtained as necessary. RESULTS The mean age for the cohort was 66.5 years. The most common risk factors were hypertension (78.8%), diabetes mellitus (60.5%), and ischemic heart disease (29.4%). The most common stroke etiology was small-vessel occlusion (54.2%). Median length of stay was 4 days. Prolonged length of stay was observed in 23.23% of patients, which was associated with several factors, the most common of which were persistent dysphagia (57.5%), nosocomial infection (39.3%), and combined dysphagia and nosocomial infection (21.2%). The mean admission NIHSS score was 7.94, and on discharge was 5.76. In-hospital mortality was 2.81%, while 50% of patients had a favorable outcome on discharge (mRS score between 0-2). The mean discharge mRS score for the cohort was 2.47 (SD ± 1.79). Large artery atherosclerosis was associated with the highest residual disability with a mean score of 3.67 (SD ± 1.88), while the stroke of undetermined etiology was associated with the lowest residual disability with a mean score of 1.60 (SD ± 1.78). Significant predictors of mRS score were smoking (t 3.24, P < 0.001), age (t 1.98, P < 0.049), and NIHSS score (t 9.979, P 0.000). CONCLUSION Ischemic strokes have different etiologies that are associated with different levels of impact on the patient's clinical status and prognosis. Large artery atherosclerosis was associated with the highest residual disability. Regarding predictors of prognosis, current smoking status, age above 50, gender, and NIHSS on admission appear to be the strongest predictors of prognosis. Finally, higher NIHSS score on admission resulted in a longer hospital stay.
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Affiliation(s)
- Majdi Al Qawasmeh
- Department of Neurology, King Abdullah University Hospital (KAUH) of Jordan University of Science and Technology (JUST), Irbid, Jordan
| | - Belal Aldabbour
- Department of Neurology, King Abdullah University Hospital (KAUH) of Jordan University of Science and Technology (JUST), Irbid, Jordan
| | - Aiman Momani
- Department of Neurology, King Abdullah University Hospital (KAUH) of Jordan University of Science and Technology (JUST), Irbid, Jordan
| | - Deema Obiedat
- Department of Neurology, King Abdullah University Hospital (KAUH) of Jordan University of Science and Technology (JUST), Irbid, Jordan
| | - Kefah Alhayek
- Department of Neurology, King Abdullah University Hospital (KAUH) of Jordan University of Science and Technology (JUST), Irbid, Jordan
| | - Raid Kofahi
- Department of Neurology, King Abdullah University Hospital (KAUH) of Jordan University of Science and Technology (JUST), Irbid, Jordan
| | - Ahmed Yassin
- Department of Neurology, King Abdullah University Hospital (KAUH) of Jordan University of Science and Technology (JUST), Irbid, Jordan
| | - Khalid El-Salem
- Department of Neurology, King Abdullah University Hospital (KAUH) of Jordan University of Science and Technology (JUST), Irbid, Jordan
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