Background: Current evidence shows that uric acid is a potent
antioxidant whose serum concentration increases rapidly
after acute ischemic stroke (AIS). Nevertheless, the relationship
between serum uric acid (SUA) levels and AIS
outcome remains debatable. We aimed to describe the
prognostic significance of SUA in AIS. Methods: We studied
463 patients (52% men, mean age 68 years, 13% with glomerular
filtration rate <60 />2) at 30 days, or with
any outcome measure at 3, 6 or 12 months poststroke. After
adjustment for age, gender, stroke type and severity (NIHSS
<9),><24 h. Conclusions: A low SUA
concentration is modestly associated with a very good
short-term outcome. Our findings support the hypothesis
that SUA is more a marker of the magnitude of the cerebral
infarction than an independent predictor of stroke outcome.
This study analyzed bleeding events among 5,170 patients from the CHANCE trial who received dual antiplatelet therapy (clopidogrel plus aspirin) or aspirin alone for minor stroke or transient ischemic attack. A total of 101 bleeding events occurred, with no significant difference in rates between the treatment groups. However, patients with minor strokes had a higher risk of bleeding than those with transient ischemic attacks. Being elderly, male, and having a history of aspirin or proton pump inhibitor use were associated with greater bleeding risk, while higher body mass index was protective against bleeding.
This study assessed the accuracy of the HEART, EDACS, and simplified EDACS risk scores in predicting major adverse cardiac events (MACE) among 118,822 emergency department patients evaluated for possible acute coronary syndrome (ACS). The study found that using a cardiac troponin I cutoff below the 99th percentile (0.02 ng/ml) optimized the accuracy of all three risk scores, maintaining high negative predictive values around 99.5% for predicting 60-day MACE while improving risk reclassification. The original EDACS identified the largest proportion (60.6%) of patients as low risk. Therefore, the original EDACS may be the preferred risk score for identifying low-risk patients when using a troponin I
This study evaluated shock index (SI), defined as heart rate divided by systolic blood pressure, as a predictor of morbidity and mortality in pediatric trauma patients. The study used data from the 2010 National Trauma Data Bank and found that an elevated age-adjusted SI was strongly associated with mortality, need for blood transfusion, ventilation, procedures, and ICU stay. Compared to hypotension alone, elevated SI had improved sensitivity for predicting negative outcomes while maintaining high specificity. The findings support using SI as a simple tool to identify pediatric trauma patients at risk of shock-related complications.
Should atrial fibrillation patients with only 1 nongender related cha2 ds2-v...Bhargav Kiran
1) The study investigated outcomes in AF patients with 0 or 1 non-gender related (NGR) stroke risk factor (CHA2DS2-VASc score of 0-1 in males and 1-2 in females) who were treated or not treated with oral anticoagulation (OAC).
2) Among 2208 AF patients with 0-1 NGR risk factors, those not treated with OAC and with 1 risk factor had higher rates of stroke/embolism (2.09% per year) compared to those with 0 risk factors (adjusted hazard ratio 2.82).
3) Treating patients with 1 NGR risk factor with OAC was associated with a positive net
This document provides guidelines from the American Heart Association/American Stroke Association for the endovascular treatment of acute ischemic stroke. It analyzes results from 8 randomized clinical trials and other relevant data published since 2013. The guidelines provide recommendations for selecting patients for endovascular treatment, the endovascular procedure, and systems of care to facilitate endovascular treatment. Certain endovascular procedures using new devices like stent retrievers have been shown to provide clinical benefits in some patients with acute ischemic stroke when performed at high-volume centers with experienced staff.
Increased risk of ischemic stroke associated with new onset atrial fibrillation complicating acute coronary syndrome- a systematic review and meta-analysis
This study analyzed trends in complications from 2000-2012 using a nationwide database of inpatient therapeutic ERCP procedures in the US. The study found:
1) Mortality rates decreased from 1.77% to 1.24%, and time series analysis confirmed this downward trend.
2) Perforation rates increased from 0.07% to 0.10% but time series analysis found no significant trend.
3) GI hemorrhage rates increased from 1.36% to 1.57% and time series analysis confirmed an upward trend.
The study concluded that while therapeutic ERCPs have become safer as shown by decreasing mortality rates, GI hemorrhage rates increased over the same period according to their analysis of
This document summarizes three studies related to trauma scoring and outcomes:
1. A study that found incorporating patient comorbidity (ASA-PS) into trauma scoring (ISS) improved predictive accuracy for mortality, complications, and discharge disposition over ISS alone. The best model was (AIS1)2+(AIS2)2+(Age-Modified ASA-PS)2.
2. A study that evaluated ASA-PS classification as a predictor of mortality in trauma patients. Higher ASA-PS classes were associated with higher mortality rates (2.4-13.2% between classes). ASA-PS showed moderate ability to predict outcomes.
3. A study that evaluated the Surgical
This study analyzed bleeding events among 5,170 patients from the CHANCE trial who received dual antiplatelet therapy (clopidogrel plus aspirin) or aspirin alone for minor stroke or transient ischemic attack. A total of 101 bleeding events occurred, with no significant difference in rates between the treatment groups. However, patients with minor strokes had a higher risk of bleeding than those with transient ischemic attacks. Being elderly, male, and having a history of aspirin or proton pump inhibitor use were associated with greater bleeding risk, while higher body mass index was protective against bleeding.
This study assessed the accuracy of the HEART, EDACS, and simplified EDACS risk scores in predicting major adverse cardiac events (MACE) among 118,822 emergency department patients evaluated for possible acute coronary syndrome (ACS). The study found that using a cardiac troponin I cutoff below the 99th percentile (0.02 ng/ml) optimized the accuracy of all three risk scores, maintaining high negative predictive values around 99.5% for predicting 60-day MACE while improving risk reclassification. The original EDACS identified the largest proportion (60.6%) of patients as low risk. Therefore, the original EDACS may be the preferred risk score for identifying low-risk patients when using a troponin I
This study evaluated shock index (SI), defined as heart rate divided by systolic blood pressure, as a predictor of morbidity and mortality in pediatric trauma patients. The study used data from the 2010 National Trauma Data Bank and found that an elevated age-adjusted SI was strongly associated with mortality, need for blood transfusion, ventilation, procedures, and ICU stay. Compared to hypotension alone, elevated SI had improved sensitivity for predicting negative outcomes while maintaining high specificity. The findings support using SI as a simple tool to identify pediatric trauma patients at risk of shock-related complications.
Should atrial fibrillation patients with only 1 nongender related cha2 ds2-v...Bhargav Kiran
1) The study investigated outcomes in AF patients with 0 or 1 non-gender related (NGR) stroke risk factor (CHA2DS2-VASc score of 0-1 in males and 1-2 in females) who were treated or not treated with oral anticoagulation (OAC).
2) Among 2208 AF patients with 0-1 NGR risk factors, those not treated with OAC and with 1 risk factor had higher rates of stroke/embolism (2.09% per year) compared to those with 0 risk factors (adjusted hazard ratio 2.82).
3) Treating patients with 1 NGR risk factor with OAC was associated with a positive net
This document provides guidelines from the American Heart Association/American Stroke Association for the endovascular treatment of acute ischemic stroke. It analyzes results from 8 randomized clinical trials and other relevant data published since 2013. The guidelines provide recommendations for selecting patients for endovascular treatment, the endovascular procedure, and systems of care to facilitate endovascular treatment. Certain endovascular procedures using new devices like stent retrievers have been shown to provide clinical benefits in some patients with acute ischemic stroke when performed at high-volume centers with experienced staff.
Increased risk of ischemic stroke associated with new onset atrial fibrillation complicating acute coronary syndrome- a systematic review and meta-analysis
This study analyzed trends in complications from 2000-2012 using a nationwide database of inpatient therapeutic ERCP procedures in the US. The study found:
1) Mortality rates decreased from 1.77% to 1.24%, and time series analysis confirmed this downward trend.
2) Perforation rates increased from 0.07% to 0.10% but time series analysis found no significant trend.
3) GI hemorrhage rates increased from 1.36% to 1.57% and time series analysis confirmed an upward trend.
The study concluded that while therapeutic ERCPs have become safer as shown by decreasing mortality rates, GI hemorrhage rates increased over the same period according to their analysis of
This document summarizes three studies related to trauma scoring and outcomes:
1. A study that found incorporating patient comorbidity (ASA-PS) into trauma scoring (ISS) improved predictive accuracy for mortality, complications, and discharge disposition over ISS alone. The best model was (AIS1)2+(AIS2)2+(Age-Modified ASA-PS)2.
2. A study that evaluated ASA-PS classification as a predictor of mortality in trauma patients. Higher ASA-PS classes were associated with higher mortality rates (2.4-13.2% between classes). ASA-PS showed moderate ability to predict outcomes.
3. A study that evaluated the Surgical
This study analyzed cardiovascular risk factor control among 3,769 veterans with diabetes receiving care from VA medical centers. It found that optimal control of factors like blood sugar, blood pressure, and cholesterol was uncommon. While veterans with heart disease were more likely to have their blood pressure and cholesterol controlled, control rates remained low overall, suggesting more aggressive management is needed, especially for those without heart disease.
This document summarizes two studies that raised questions about the risks and benefits of testosterone therapy:
1. A retrospective study found that male veterans with low testosterone who received testosterone therapy had a higher risk of heart attack, stroke, or death compared to those not receiving therapy, even after adjusting for potential confounding factors.
2. A randomized trial found that adding testosterone to optimized sildenafil therapy for erectile dysfunction provided no additional improvement in erectile function compared to sildenafil alone.
Together these studies highlight the need for more research on the long-term risks and benefits of testosterone therapy, as current understanding is limited despite its increasing use.
Compliance of pharmacological treatment for non-ST-elevation acute coronary syndromes with contemporary guidelines: influence on outcomes
Authors: Hélder Dores, Carlos Aguiar, Jorge Ferreira, Jorge Mimoso, Sílvia Monteiro, Filipe Seixo, José Ferreira Santos, On behalf of Portuguese Registry on Acute Coronary Syndromes (ProACS) Investigators
This research article examines whether African Americans with chronic systolic heart failure respond differently to cardiac resynchronization therapy-defibrillator (CRT-D) compared to non-African Americans. The study analyzed data from 212 patients who received CRT-D implants between 2009-2013. Baseline characteristics were similar between the 130 African American patients and 82 non-African American patients. The primary outcome of left ventricular ejection fraction improvement of at least 5% was seen in 62.3% of African Americans and 59.8% of non-African Americans, showing similar response rates. Secondary clinical outcomes like hospitalizations and mortality were also comparable between the groups. Among responders, factors like age, comorbidities, and ech
This study aimed to determine if introducing a high-sensitivity cardiac troponin I (hs-cTnI) assay would improve clinical outcomes for patients with suspected acute coronary syndrome. The study was a stepped-wedge, cluster-randomized controlled trial across 10 hospitals in Scotland. It found that the hs-cTnI assay reclassified 17% of patients with myocardial injury or infarction not identified by the standard assay. However, among reclassified patients, the incidence of subsequent heart attack or cardiovascular death within 1 year was not significantly different after implementing the new assay. The findings question whether the diagnostic threshold for heart attack should be based on the 99th percentile from a normal population.
The PARADIGM-HF trial compared the angiotensin receptor-neprilysin inhibitor sacubitril/valsartan to the ACE inhibitor enalapril in patients with heart failure with reduced ejection fraction. It found that sacubitril/valsartan reduced cardiovascular mortality and heart failure hospitalizations compared to enalapril, as well as reducing overall mortality. The trial established sacubitril/valsartan as a new standard of care for treating HFrEF.
This document reviews US hypertension management guidelines and recommendations for the future. It summarizes the key recommendation from JNC 8 to initiate pharmacologic treatment for those aged 60 and older with a systolic BP of 150 mm Hg or higher or a diastolic BP of 90 mm Hg or higher, and to treat to a goal of under 150/90 mm Hg systolic/diastolic BP. This recommendation is based on trials showing benefits of treating elderly patients to lower BP targets, though evidence is strongest for those over 80. New evidence from the SPRINT trial contradicts JNC 8 and supports even lower BP targets.
Elevated Tissue Doppler E/E' on Index Admission Can Help Identify Patients at...crimsonpublishersOJCHD
Readmissions for congestive Heart Failure (CHF) are a major healthcare problem that contributes significantly to the overall healthcare expenditure. About 24% of patients are readmitted to the hospital within 30 days of discharge. We investigated whether a non-invasive estimate of left atrial filling pressure, an elevated ratio of early trans mitral flow velocity to early diastolic mitral annular velocity (E/E'), during the index admission for CHF could independently predict 30 day readmission.
1. A study of 6,856 patients who received intravenous thrombolysis for acute ischemic stroke from 10 European centers found that treatment within 90 minutes of symptom onset was independently associated with excellent 3-month outcome in patients with moderate (NIHSS 7-12) and mild (NIHSS 0-6) stroke severity.
2. For patients with NIHSS 7-12, treatment within 90 minutes was associated with a 37% higher likelihood of excellent outcome compared to later treatment.
3. For patients with mild symptoms (NIHSS 0-6), treatment within 90 minutes was associated with a 51% higher likelihood of full recovery (mRS=0) to overcome the ceiling effect of spontaneous good recovery
Tenecteplase before mechanical thrombectomy journal copypradeep3188
This document summarizes a study that assessed outcomes for 588 patients with acute ischemic stroke due to large vessel occlusion who were treated with tenecteplase followed by mechanical thrombectomy. Key findings include:
- 47.2% of patients achieved functional independence at 3 months.
- Factors associated with functional independence included younger age, lower baseline stroke severity, and shorter time from onset to intravenous thrombolysis (under 160 minutes).
- Tenecteplase achieved recanalization prior to thrombectomy in some patients and was generally well-tolerated with low rates of hemorrhage.
This study developed and validated a simplified echocardiography scoring system for diagnosing and predicting progression of latent rheumatic heart disease (RHD).
The study used data from over 16,800 echocardiograms to develop a 5-component scoring system based on the World Heart Federation criteria. The score showed high accuracy for diagnosing definite RHD and provided risk stratification into low, intermediate, and high risk groups for disease progression. Children in the low-risk group at 1-3 year follow-up had progression-free survival rates over 90% compared to under 50% for the high-risk group. The simplified score can recognize RHD and predict outcomes, potentially aiding clinical decision making.
1) Risk scores help identify patients with NSTE-ACS who are at higher risk of death and recurrent cardiac events in both the short and long term.
2) Studies have found reductions in mortality rates for NSTE-ACS patients in recent years, which is due in part to improvements in pharmacological and invasive coronary strategies.
3) The GRACE risk score is the most widely used and has been shown to accurately predict mortality in NSTE-ACS patients at both 30 days and 1 year. It helps guide clinical decision making regarding treatment strategies.
1) The VISSIT trial compared outcomes of 112 patients with symptomatic intracranial stenosis randomized to balloon-expandable stent plus medical therapy or medical therapy alone. At 1 year, the stent group had a higher risk of stroke or TIA compared to the medical therapy group.
2) The CADISS trial randomized 250 patients with carotid or vertebral artery dissection to antiplatelet drugs or anticoagulant drugs for 3 months. Both groups had low risks of stroke, with no significant difference between treatments.
3) The ATTEST trial compared tenecteplase to alteplase in 104 patients with acute ischemic stroke within 4.5 hours of onset. There were no significant differences in pen
Mangement of chronic heart failure 93432-rephrasedIrfan iftekhar
Cardiac resynchronization therapy significantly reduces morbidity and mortality in patients with heart failure. A randomized controlled trial found that cardiac resynchronization reduced the primary endpoint of death from any cause by 36% compared to medical therapy alone. Mortality was lower in the cardiac resynchronization group, demonstrating improved outcomes. While cardiac resynchronization is an effective treatment, its cost-effectiveness remains uncertain due to the therapy's expense. Further research is still needed to determine its overall value.
Clinical Effectiveness of Dabigatran Versus Apixaban in Non-Valvular Atrial F...Premier Publishers
Many real-world studies conducted across the world revealed that the use of dabigatran and apixaban is similar or superior to warfarin in reducing the risk of stroke and bleeding. But its safety and efficacy in Indian scenario is not that much well established. The aim of this study was to evaluate the clinical outcomes such as ischemic stroke (efficacy end-point) and major bleeding (safety end-point) of dabigatran in clinical practice when compared to apixaban in non-valvular atrial fibrillation real world south Indian patients. Among non-valvular atrial fibrillation patients who initiated dabigatran or apixaban therapy during the period between 2016 and 2018, 82 patients were included in the study. The follow up period was 1 year. Compared to dabigatran group, the hazard ratios of ischemic stroke, major bleeding and minor bleeding in the apixaban group were 0.0031 [95% Confidence Interval (CI): 0.0000-3.2586, P = 0.3363], 1.1108 [CI: 0.0903-13.6604, P=0.9406] and 0.2465 [0.0839-0.7238, P=0.0046] respectively. The ability of dabigatran to prevent ischemic stroke was comparable to that of apixaban; efficacy rate was higher for apixaban and safety outcome was higher for dabigatran. Dabigatran was associated with lower risk of minor bleeding as compared to apixaban. Dabigatran 110 mg bid propound best benefit-risk balance for stroke prevention in non-valvular atrial fibrillation. Dabigatran 150 mg may be favoured for high risk embolism patients.
Delaney Corporate Finance provides corporate finance and business support services to small and medium enterprises. They offer principal services including restructuring, corporate finance, and management support. Quality financial information is important for performance management, restructuring, investment decisions, and communicating with stakeholders. Accurate information allows for informed decisions, effective restructuring strategies, and credibility with lenders. Separating personal and business finances clearly through separate accounts and proper accounting coding is crucial. Understanding fixed, variable, and sunk costs as well as cash versus accounting costs is also important for decision making.
This graph shows the number of episodes for each season and special of the animated television series Ed, Edd n Eddy. Season 1 had the fewest episodes at 13 while Season 2 had the most at 20 episodes. Overall the series contained 6 seasons and 1 special for a total of over 100 episodes from 1999 to 2009.
The document provides information about the Industrial Revolution including:
- It began in Great Britain near waterways where early factories were located
- The factory system brought workers and machines together for the first time
- Urbanization led to overcrowding, disease, and pollution
- Child labor involved long hours, dangerous conditions, and low pay
- Corporations became powerful, the middle class pushed for reforms
- Interchangeable parts increased efficiency, capitalism allowed free trade
- Utopianism envisioned perfect communities, unions formed to demand changes
- Communism advocated a classless society controlled by the community
This study analyzed cardiovascular risk factor control among 3,769 veterans with diabetes receiving care from VA medical centers. It found that optimal control of factors like blood sugar, blood pressure, and cholesterol was uncommon. While veterans with heart disease were more likely to have their blood pressure and cholesterol controlled, control rates remained low overall, suggesting more aggressive management is needed, especially for those without heart disease.
This document summarizes two studies that raised questions about the risks and benefits of testosterone therapy:
1. A retrospective study found that male veterans with low testosterone who received testosterone therapy had a higher risk of heart attack, stroke, or death compared to those not receiving therapy, even after adjusting for potential confounding factors.
2. A randomized trial found that adding testosterone to optimized sildenafil therapy for erectile dysfunction provided no additional improvement in erectile function compared to sildenafil alone.
Together these studies highlight the need for more research on the long-term risks and benefits of testosterone therapy, as current understanding is limited despite its increasing use.
Compliance of pharmacological treatment for non-ST-elevation acute coronary syndromes with contemporary guidelines: influence on outcomes
Authors: Hélder Dores, Carlos Aguiar, Jorge Ferreira, Jorge Mimoso, Sílvia Monteiro, Filipe Seixo, José Ferreira Santos, On behalf of Portuguese Registry on Acute Coronary Syndromes (ProACS) Investigators
This research article examines whether African Americans with chronic systolic heart failure respond differently to cardiac resynchronization therapy-defibrillator (CRT-D) compared to non-African Americans. The study analyzed data from 212 patients who received CRT-D implants between 2009-2013. Baseline characteristics were similar between the 130 African American patients and 82 non-African American patients. The primary outcome of left ventricular ejection fraction improvement of at least 5% was seen in 62.3% of African Americans and 59.8% of non-African Americans, showing similar response rates. Secondary clinical outcomes like hospitalizations and mortality were also comparable between the groups. Among responders, factors like age, comorbidities, and ech
This study aimed to determine if introducing a high-sensitivity cardiac troponin I (hs-cTnI) assay would improve clinical outcomes for patients with suspected acute coronary syndrome. The study was a stepped-wedge, cluster-randomized controlled trial across 10 hospitals in Scotland. It found that the hs-cTnI assay reclassified 17% of patients with myocardial injury or infarction not identified by the standard assay. However, among reclassified patients, the incidence of subsequent heart attack or cardiovascular death within 1 year was not significantly different after implementing the new assay. The findings question whether the diagnostic threshold for heart attack should be based on the 99th percentile from a normal population.
The PARADIGM-HF trial compared the angiotensin receptor-neprilysin inhibitor sacubitril/valsartan to the ACE inhibitor enalapril in patients with heart failure with reduced ejection fraction. It found that sacubitril/valsartan reduced cardiovascular mortality and heart failure hospitalizations compared to enalapril, as well as reducing overall mortality. The trial established sacubitril/valsartan as a new standard of care for treating HFrEF.
This document reviews US hypertension management guidelines and recommendations for the future. It summarizes the key recommendation from JNC 8 to initiate pharmacologic treatment for those aged 60 and older with a systolic BP of 150 mm Hg or higher or a diastolic BP of 90 mm Hg or higher, and to treat to a goal of under 150/90 mm Hg systolic/diastolic BP. This recommendation is based on trials showing benefits of treating elderly patients to lower BP targets, though evidence is strongest for those over 80. New evidence from the SPRINT trial contradicts JNC 8 and supports even lower BP targets.
Elevated Tissue Doppler E/E' on Index Admission Can Help Identify Patients at...crimsonpublishersOJCHD
Readmissions for congestive Heart Failure (CHF) are a major healthcare problem that contributes significantly to the overall healthcare expenditure. About 24% of patients are readmitted to the hospital within 30 days of discharge. We investigated whether a non-invasive estimate of left atrial filling pressure, an elevated ratio of early trans mitral flow velocity to early diastolic mitral annular velocity (E/E'), during the index admission for CHF could independently predict 30 day readmission.
1. A study of 6,856 patients who received intravenous thrombolysis for acute ischemic stroke from 10 European centers found that treatment within 90 minutes of symptom onset was independently associated with excellent 3-month outcome in patients with moderate (NIHSS 7-12) and mild (NIHSS 0-6) stroke severity.
2. For patients with NIHSS 7-12, treatment within 90 minutes was associated with a 37% higher likelihood of excellent outcome compared to later treatment.
3. For patients with mild symptoms (NIHSS 0-6), treatment within 90 minutes was associated with a 51% higher likelihood of full recovery (mRS=0) to overcome the ceiling effect of spontaneous good recovery
Tenecteplase before mechanical thrombectomy journal copypradeep3188
This document summarizes a study that assessed outcomes for 588 patients with acute ischemic stroke due to large vessel occlusion who were treated with tenecteplase followed by mechanical thrombectomy. Key findings include:
- 47.2% of patients achieved functional independence at 3 months.
- Factors associated with functional independence included younger age, lower baseline stroke severity, and shorter time from onset to intravenous thrombolysis (under 160 minutes).
- Tenecteplase achieved recanalization prior to thrombectomy in some patients and was generally well-tolerated with low rates of hemorrhage.
This study developed and validated a simplified echocardiography scoring system for diagnosing and predicting progression of latent rheumatic heart disease (RHD).
The study used data from over 16,800 echocardiograms to develop a 5-component scoring system based on the World Heart Federation criteria. The score showed high accuracy for diagnosing definite RHD and provided risk stratification into low, intermediate, and high risk groups for disease progression. Children in the low-risk group at 1-3 year follow-up had progression-free survival rates over 90% compared to under 50% for the high-risk group. The simplified score can recognize RHD and predict outcomes, potentially aiding clinical decision making.
1) Risk scores help identify patients with NSTE-ACS who are at higher risk of death and recurrent cardiac events in both the short and long term.
2) Studies have found reductions in mortality rates for NSTE-ACS patients in recent years, which is due in part to improvements in pharmacological and invasive coronary strategies.
3) The GRACE risk score is the most widely used and has been shown to accurately predict mortality in NSTE-ACS patients at both 30 days and 1 year. It helps guide clinical decision making regarding treatment strategies.
1) The VISSIT trial compared outcomes of 112 patients with symptomatic intracranial stenosis randomized to balloon-expandable stent plus medical therapy or medical therapy alone. At 1 year, the stent group had a higher risk of stroke or TIA compared to the medical therapy group.
2) The CADISS trial randomized 250 patients with carotid or vertebral artery dissection to antiplatelet drugs or anticoagulant drugs for 3 months. Both groups had low risks of stroke, with no significant difference between treatments.
3) The ATTEST trial compared tenecteplase to alteplase in 104 patients with acute ischemic stroke within 4.5 hours of onset. There were no significant differences in pen
Mangement of chronic heart failure 93432-rephrasedIrfan iftekhar
Cardiac resynchronization therapy significantly reduces morbidity and mortality in patients with heart failure. A randomized controlled trial found that cardiac resynchronization reduced the primary endpoint of death from any cause by 36% compared to medical therapy alone. Mortality was lower in the cardiac resynchronization group, demonstrating improved outcomes. While cardiac resynchronization is an effective treatment, its cost-effectiveness remains uncertain due to the therapy's expense. Further research is still needed to determine its overall value.
Clinical Effectiveness of Dabigatran Versus Apixaban in Non-Valvular Atrial F...Premier Publishers
Many real-world studies conducted across the world revealed that the use of dabigatran and apixaban is similar or superior to warfarin in reducing the risk of stroke and bleeding. But its safety and efficacy in Indian scenario is not that much well established. The aim of this study was to evaluate the clinical outcomes such as ischemic stroke (efficacy end-point) and major bleeding (safety end-point) of dabigatran in clinical practice when compared to apixaban in non-valvular atrial fibrillation real world south Indian patients. Among non-valvular atrial fibrillation patients who initiated dabigatran or apixaban therapy during the period between 2016 and 2018, 82 patients were included in the study. The follow up period was 1 year. Compared to dabigatran group, the hazard ratios of ischemic stroke, major bleeding and minor bleeding in the apixaban group were 0.0031 [95% Confidence Interval (CI): 0.0000-3.2586, P = 0.3363], 1.1108 [CI: 0.0903-13.6604, P=0.9406] and 0.2465 [0.0839-0.7238, P=0.0046] respectively. The ability of dabigatran to prevent ischemic stroke was comparable to that of apixaban; efficacy rate was higher for apixaban and safety outcome was higher for dabigatran. Dabigatran was associated with lower risk of minor bleeding as compared to apixaban. Dabigatran 110 mg bid propound best benefit-risk balance for stroke prevention in non-valvular atrial fibrillation. Dabigatran 150 mg may be favoured for high risk embolism patients.
Delaney Corporate Finance provides corporate finance and business support services to small and medium enterprises. They offer principal services including restructuring, corporate finance, and management support. Quality financial information is important for performance management, restructuring, investment decisions, and communicating with stakeholders. Accurate information allows for informed decisions, effective restructuring strategies, and credibility with lenders. Separating personal and business finances clearly through separate accounts and proper accounting coding is crucial. Understanding fixed, variable, and sunk costs as well as cash versus accounting costs is also important for decision making.
This graph shows the number of episodes for each season and special of the animated television series Ed, Edd n Eddy. Season 1 had the fewest episodes at 13 while Season 2 had the most at 20 episodes. Overall the series contained 6 seasons and 1 special for a total of over 100 episodes from 1999 to 2009.
The document provides information about the Industrial Revolution including:
- It began in Great Britain near waterways where early factories were located
- The factory system brought workers and machines together for the first time
- Urbanization led to overcrowding, disease, and pollution
- Child labor involved long hours, dangerous conditions, and low pay
- Corporations became powerful, the middle class pushed for reforms
- Interchangeable parts increased efficiency, capitalism allowed free trade
- Utopianism envisioned perfect communities, unions formed to demand changes
- Communism advocated a classless society controlled by the community
El documento presenta un informe general con 34 registros de personas que incluyen su código de identificación, nombre, número de identificación, teléfono, ciudad y contacto. Toda la información corresponde a personas ubicadas en Bogotá D.C.
Este documento presenta el resumen de un proyecto sobre la resolución y representación gráfica de una ecuación diferencial ordinaria y su campo de direcciones en Matlab. Incluye la ecuación, su solución general y particular, el código para graficar la ecuación y el campo de direcciones, y un enlace a un video que muestra la representación gráfica del campo de direcciones.
Benefits of Working with Registered Investment Advisorhalasconsult
Christian Halas is the owner of Halas Consulting, a logo design firm. The document appears to be a business card or letterhead for Halas Consulting displaying the company name, owner's name, and date. In a few words, it introduces the owner and company providing logo design services.
This document appears to be a promotional brochure for Guurrbi Tours, an Aboriginal tour company based in Cooktown, Australia. The brochure showcases the various tours offered that take visitors to important indigenous cultural sites, including rock art sites, and teach traditional skills and stories through local guides. Photos throughout depict the scenic landscapes, rock art, activities, and customers engaged in the tours.
The document describes a damped mass-spring system and provides the equation of motion for analyzing the free vibration of the system. It then gives the general solution to the differential equation that describes the response x(t) in terms of the system's natural frequency, damping ratio, initial displacement, and initial velocity. The student is asked to:
1. Create a Matlab function to calculate the response x(t) for given parameter values.
2. Run sample code that plots the response for different damping ratios.
3. Calculate and submit the response at two specific cases.
Uterine fibroids adalah tumor jinak pada kandungan yang berbentuk bundar atau agak bundar. Faktor genetik merupakan penyebab utama tumbuhnya fibroid kandungan. Gejalanya meliputi nyeri pelvis, sering buang air kecil, dan pendarahan kandungan abnormal. Pengobatannya meliputi operasi, pengeboran laser, pemberian hormon, atau obat-obatan seperti mifepristone, danazol, dan raloxifene.
New Models of Content Creation and Scholarship at the Intersection of Library...Mike Nutt
Library spaces that blend collaboration areas, advanced technologies, and librarian expertise are creating new modes of scholarly communication. These spaces enable scholarship created within high-definition, large-scale visual collaborative environments. This emergent model of scholarly communication can be experienced within those specific contexts or through digital surrogates on the networked Web. From experiencing in three dimensions the sermons of John Donne in 1622 to interactive media interpretations of American wars, scholars are partnering with libraries to create immersive digital scholarship. Viewing the library as a research platform for these emergent forms of digital scholarship presents several opportunities and challenges. Opportunities include re-engaging faculty in the use of library space, integrating the full life-cycle of the research enterprise, and engaging broad communities in the changing nature of digitally-driven scholarship. Issues such as identifying and filtering collaborations, strategically managing staff resources, creating surrogates of immersive digital scholarship, and preserving this content for the future present an array of challenges for libraries that require coordination across organizations. From engaging and using high-technology spaces to documenting the data and digital objects created, this developing scholarly communication medium brings to bear the multifaceted skills and organizational capabilities of libraries.
Shaik Hassan is seeking an opportunity to update his knowledge and grow with an organization. He has over 5 years of experience in insurance, client servicing, and sales. His experience includes roles at National Health Insurance Company Daman, Global Logic India, SBI Life Insurance, and he has technical skills in C, Oracle, SQL, and MS Office. He holds a B.Tech in computer science and engineering from JNTU University.
Central Adiposity and Mortality after First-Ever Acute Ischemic StrokeErwin Chiquete, MD, PhD
Erwin Chiquete a José L. Ruiz-Sandoval c Luis Murillo-Bonilla e
Carolina León-Jiménez g Bertha Ruiz-Madrigal d, f Erika Martínez-López d, f
Sonia Román d, f Arturo Panduro d, f Alma Ramos b Carlos Cantú-Brito
Background: The waist-to-height ratio (WHtR) may be a better
adiposity measure than the body mass index (BMI). We
evaluated the prognostic performance of WHtR in patients
with acute ischemic stroke (AIS). Methods: First, we compared
WHtR and BMI as adiposity measures in 712 healthy
adults by tetrapolar bioimpedance analysis. Thereafter,
baseline WHtR was analyzed as predictor of 12-month allcause
mortality in 821 Mexican mestizo adults with first-ever
AIS by a Cox proportional hazards model adjusted for baseline
predictors. Results: In healthy individuals, WHtR correlated
higher than BMI with total fat mass and showed a higher
accuracy in identifying a high percentage of body fat (p <
0.01). In AIS patients a U-shaped relationship was observed
between baseline WHtR and mortality (fatality rate 29.1%).
On multivariate analysis, baseline WHtR ≤ 0.300 or >0.800 independently
predicted 12-month all-cause mortality (h
This document summarizes a study examining medical and neurological complications in 279 patients with acute ischemic stroke. The study found that 95% of patients experienced at least one complication. The most common serious medical complication was pneumonia (5%) and the most common serious neurological complication was new or extended cerebral infarction (5%). Medical complications contributed to 51% of deaths within 3 months. Patients with serious medical complications had significantly worse outcomes on functional scales even after accounting for baseline differences.
Cerebral Venous Thrombosis in a Mexican Multicenter Registry of Acute Cerebro...Erwin Chiquete, MD, PhD
Background: Cerebral venous thrombosis (CVT) is a rare form of cerebrovascular
disease that is usually not mentioned in multicenter registries on all-type acute
stroke. We aimed to describe the experience on hospitalized patients with CVT in
a Mexican multicenter registry on acute cerebrovascular disease. Methods: CVT
patients were selected from the RENAMEVASC registry, which was conducted
between 2002 and 2004 in 25 Mexican hospitals. Risk factors, neuroimaging,
and 30-day outcome as assessed by the modified Rankin scale (mRS) were analyzed.
Results: Among 2000 all-type acute stroke patients, 59 (3%; 95% CI, 2.3-3.8%) had
CVT (50 women; female:male ratio, 5:1; median age, 31 years). Puerperium (42%),
contraceptive use (18%), and pregnancy (12%) were the main risk factors in women.
In 67% of men, CVTwas registered as idiopathic, but thrombophilia assessment was
suboptimal. Longitudinal superior sinus was the most frequent thrombosis location
(78%). Extensive (.5 cm) venous infarction occurred in 36% of patients. Only 81% of
patients received anticoagulation since the acute phase, and 3% needed decompressive
craniectomy. Mechanical ventilation (13.6%), pneumonia (10.2%) and systemic
thromboembolism (8.5%) were the main in-hospital complications. The 30-day case
fatality rate was 3% (2 patients; 95% CI, 0.23-12.2%). In a Cox proportional hazards
model, only age ,40 years was associated with a mRS score of 0 to 2 (functional independence;
rate ratio, 3.46; 95% CI, 1.34-8.92). Conclusions: The relative frequency
of CVT and the associated in-hospital complications were higher than in other registries.
Thrombophilia assessment and acute treatment was suboptimal. Young age
is the main determinant of a good short-term outcome.
Exploring the Relationship between the Platelet Indices and Psychosocial Morb...CrimsonPublishersGGS
Exploring the Relationship between the Platelet Indices and Psychosocial Morbidity in Elderly Patients at a Rural Medical College Hospital by Sunil Kumar in Geriatrics studies Journal
Copyright 2016 American Medical Association. All rights reserv.docxmelvinjrobinson2199
Copyright 2016 American Medical Association. All rights reserved.
Intensive vs Standard Blood Pressure Control
and Cardiovascular Disease Outcomes in Adults Aged ≥75 Years
A Randomized Clinical Trial
Jeff D. Williamson, MD, MHS; Mark A. Supiano, MD; William B. Applegate, MD, MPH; Dan R. Berlowitz, MD; Ruth C. Campbell, MD, MSPH;
Glenn M. Chertow, MD; Larry J. Fine, MD; William E. Haley, MD; Amret T. Hawfield, MD; Joachim H. Ix, MD, MAS; Dalane W. Kitzman, MD;
John B. Kostis, MD; Marie A. Krousel-Wood, MD; Lenore J. Launer, PhD; Suzanne Oparil, MD; Carlos J. Rodriguez, MD, MPH;
Christianne L. Roumie, MD, MPH; Ronald I. Shorr, MD, MS; Kaycee M. Sink, MD, MAS; Virginia G. Wadley, PhD; Paul K. Whelton, MD;
Jeffrey Whittle, MD; Nancy F. Woolard; Jackson T. Wright Jr, MD, PhD; Nicholas M. Pajewski, PhD; for the SPRINT Research Group
IMPORTANCE The appropriate treatment target for systolic blood pressure (SBP) in older
patients with hypertension remains uncertain.
OBJECTIVE To evaluate the effects of intensive (<120 mm Hg) compared with standard
(<140 mm Hg) SBP targets in persons aged 75 years or older with hypertension
but without diabetes.
DESIGN, SETTING, AND PARTICIPANTS A multicenter, randomized clinical trial of patients aged
75 years or older who participated in the Systolic Blood Pressure Intervention Trial (SPRINT).
Recruitment began on October 20, 2010, and follow-up ended on August 20, 2015.
INTERVENTIONS Participants were randomized to an SBP target of less than 120 mm Hg
(intensive treatment group, n = 1317) or an SBP target of less than 140 mm Hg (standard
treatment group, n = 1319).
MAIN OUTCOMES AND MEASURES The primary cardiovascular disease outcome was a
composite of nonfatal myocardial infarction, acute coronary syndrome not resulting in a
myocardial infarction, nonfatal stroke, nonfatal acute decompensated heart failure, and death
from cardiovascular causes. All-cause mortality was a secondary outcome.
RESULTS Among 2636 participants (mean age, 79.9 years; 37.9% women), 2510 (95.2%)
provided complete follow-up data. At a median follow-up of 3.14 years, there was a
significantly lower rate of the primary composite outcome (102 events in the intensive
treatment group vs 148 events in the standard treatment group; hazard ratio [HR], 0.66
[95% CI, 0.51-0.85]) and all-cause mortality (73 deaths vs 107 deaths, respectively; HR, 0.67
[95% CI, 0.49-0.91]). The overall rate of serious adverse events was not different between
treatment groups (48.4% in the intensive treatment group vs 48.3% in the standard
treatment group; HR, 0.99 [95% CI, 0.89-1.11]). Absolute rates of hypotension were 2.4% in
the intensive treatment group vs 1.4% in the standard treatment group (HR, 1.71 [95% CI,
0.97-3.09]), 3.0% vs 2.4%, respectively, for syncope (HR, 1.23 [95% CI, 0.76-2.00]), 4.0% vs
2.7% for electrolyte abnormalities (HR, 1.51 [95% CI, 0.99-2.33]), 5.5% vs 4.0% for acute
kidney injury (HR, 1.41 [95% CI, 0.98-2.04]), and 4.9% vs 5.5% for inj.
Copyright 2016 American Medical Association. All rights reserv.docxbobbywlane695641
Copyright 2016 American Medical Association. All rights reserved.
Intensive vs Standard Blood Pressure Control
and Cardiovascular Disease Outcomes in Adults Aged ≥75 Years
A Randomized Clinical Trial
Jeff D. Williamson, MD, MHS; Mark A. Supiano, MD; William B. Applegate, MD, MPH; Dan R. Berlowitz, MD; Ruth C. Campbell, MD, MSPH;
Glenn M. Chertow, MD; Larry J. Fine, MD; William E. Haley, MD; Amret T. Hawfield, MD; Joachim H. Ix, MD, MAS; Dalane W. Kitzman, MD;
John B. Kostis, MD; Marie A. Krousel-Wood, MD; Lenore J. Launer, PhD; Suzanne Oparil, MD; Carlos J. Rodriguez, MD, MPH;
Christianne L. Roumie, MD, MPH; Ronald I. Shorr, MD, MS; Kaycee M. Sink, MD, MAS; Virginia G. Wadley, PhD; Paul K. Whelton, MD;
Jeffrey Whittle, MD; Nancy F. Woolard; Jackson T. Wright Jr, MD, PhD; Nicholas M. Pajewski, PhD; for the SPRINT Research Group
IMPORTANCE The appropriate treatment target for systolic blood pressure (SBP) in older
patients with hypertension remains uncertain.
OBJECTIVE To evaluate the effects of intensive (<120 mm Hg) compared with standard
(<140 mm Hg) SBP targets in persons aged 75 years or older with hypertension
but without diabetes.
DESIGN, SETTING, AND PARTICIPANTS A multicenter, randomized clinical trial of patients aged
75 years or older who participated in the Systolic Blood Pressure Intervention Trial (SPRINT).
Recruitment began on October 20, 2010, and follow-up ended on August 20, 2015.
INTERVENTIONS Participants were randomized to an SBP target of less than 120 mm Hg
(intensive treatment group, n = 1317) or an SBP target of less than 140 mm Hg (standard
treatment group, n = 1319).
MAIN OUTCOMES AND MEASURES The primary cardiovascular disease outcome was a
composite of nonfatal myocardial infarction, acute coronary syndrome not resulting in a
myocardial infarction, nonfatal stroke, nonfatal acute decompensated heart failure, and death
from cardiovascular causes. All-cause mortality was a secondary outcome.
RESULTS Among 2636 participants (mean age, 79.9 years; 37.9% women), 2510 (95.2%)
provided complete follow-up data. At a median follow-up of 3.14 years, there was a
significantly lower rate of the primary composite outcome (102 events in the intensive
treatment group vs 148 events in the standard treatment group; hazard ratio [HR], 0.66
[95% CI, 0.51-0.85]) and all-cause mortality (73 deaths vs 107 deaths, respectively; HR, 0.67
[95% CI, 0.49-0.91]). The overall rate of serious adverse events was not different between
treatment groups (48.4% in the intensive treatment group vs 48.3% in the standard
treatment group; HR, 0.99 [95% CI, 0.89-1.11]). Absolute rates of hypotension were 2.4% in
the intensive treatment group vs 1.4% in the standard treatment group (HR, 1.71 [95% CI,
0.97-3.09]), 3.0% vs 2.4%, respectively, for syncope (HR, 1.23 [95% CI, 0.76-2.00]), 4.0% vs
2.7% for electrolyte abnormalities (HR, 1.51 [95% CI, 0.99-2.33]), 5.5% vs 4.0% for acute
kidney injury (HR, 1.41 [95% CI, 0.98-2.04]), and 4.9% vs 5.5% for inj.
This document outlines a proposed study on the frequency, risk factors, and clinical presentation of stroke among adults admitted to the emergency department of UCMS-TH. The study aims to understand the characteristics, risk factors, and neurological examination findings of stroke patients in this setting. A cross-sectional study will collect data from 108 stroke patients over 12 months using a questionnaire, clinical exams, blood tests, and brain imaging. The study will analyze the data to identify common risk factors for stroke and high-risk patient groups to help reduce stroke incidence in the region.
This document summarizes a study comparing clinical characteristics of hypertensive intracerebral hemorrhage (ICH) in young patients versus older patients. The study found that young patients had higher blood pressures, smaller hemorrhage volumes, lower rates of ventricular extensions, and a different distribution pattern of ICH locations. Mortality was lower in young patients but they had more disabling outcomes. The findings suggest there are age-related differences in the pathogenesis of hypertensive ICH.
The Impact of Lymph Node Dissection on Survival in Intermediate- and High-Ris...semualkaira
Aimed to evaluate the therapeutic effect of pelvic lymph node dissection (PLND) on survival and determine the predictors of lymph node involvement (LNI) in patients with intermediate- or high-risk prostate cancer (PCa) treated with Radical Prostatectomy
The Impact of Lymph Node Dissection on Survival in Intermediate- and High-Ris...semualkaira
Aimed to evaluate the therapeutic effect of pelvic lymph node dissection (PLND) on survival and determine the
predictors of lymph node involvement (LNI) in patients with intermediate- or high-risk prostate cancer (PCa) treated with Radical
Prostatectomy
This study evaluated the usefulness of the EGSYS score in predicting cardiac causes of syncope in an outpatient setting. The researchers retrospectively analyzed 224 patients seen in a syncope clinic, calculating the EGSYS score for each. Of 163 patients confirmed to have syncope, 27 (16.6%) had a cardiac cause and 136 (83.4%) a non-cardiac cause. A score ≥3 had a sensitivity of 48.2% and specificity of 77.9% for predicting cardiac syncope. The authors concluded the EGSYS score has limited usefulness in an outpatient setting, but may help reassure low-risk patients due to its high specificity and negative predictive value.
Red blood cell and at this effect of diabetes mil lute ScSyed
This study examined the relationship between red blood cell distribution width (RDW) and carotid intima-media thickness (C-IMT) in 469 patients with type 2 diabetes without cardiovascular disease. Patients were divided into tertiles based on RDW levels. C-IMT, a measure of subclinical atherosclerosis, increased with higher RDW tertiles. Multiple regression analysis showed RDW was associated with C-IMT even after adjusting for cardiovascular risk factors. Higher RDW tertiles were also associated with greater odds of having C-IMT ≥1mm, a marker for carotid atherosclerosis. This suggests RDW is associated with subclinical atherosclerosis in type 2 diabetes patients.
Benefits os Statins in Elderly Subjects Without Established Cardiovascular Di...Rodrigo Vargas Zapana
Statins significantly reduced the risk of myocardial infarction by 39.4% and the risk of stroke by 23.8% in elderly subjects without established cardiovascular disease. However, statins did not significantly reduce the risk of all-cause mortality or cardiovascular mortality. New cancer onset was also not significantly different between the statin-treated and placebo groups. The meta-analysis included 8 randomized controlled trials with a total of 24,674 elderly subjects who were followed for an average of 3.5 years.
This study analyzed data from the National Trauma Data Bank from 2007-2008 to investigate the relationship between prehospital (EMS) hypertension and outcomes in traumatic brain injury (TBI) patients. The results showed that prehospital hypertension was associated with higher mortality in TBI patients, with adjusted odds of mortality increasing with higher blood pressure levels compared to normal blood pressure. A predictive model was also developed using EMS and emergency department vital signs to predict the presence of TBI based on blood pressure and Glasgow Coma Scale scores. The model achieved predictive accuracy between 58.7-86.4% depending on admission Glasgow Coma Scale score. This study suggests that early hypertension may help identify TBI and predicts worse outcomes.
THE RELATIONSHIP OF SIC and CLINICAL OUTCOME.docxyudistiraanwar1
- The document discusses a study examining the relationship between sepsis-induced coagulopathy (SIC) and clinical outcomes in ischemic stroke patients in the intensive care unit (ICU) of Dr. Kariadi General Hospital, Semarang, Indonesia.
- The study found that 83.3% of patients had thrombocytopenia, 69.4% had increased D-Dimer levels, and 83.3% had prolonged prothrombin time. The highest Sequential Organ Failure Assessment (SOFA) score was 2 and the highest SIC score was 4.
- There was a significant relationship found between SIC and clinical outcome, with 66.7% of patients who died having a SIC
The study compared outcomes of ischemic stroke patients prescribed direct oral anticoagulants (DOACs) versus warfarin at discharge. Patients prescribed DOACs had more days at home within one year of discharge, fewer major adverse cardiovascular events, and lower rates of death, readmissions, hemorrhagic strokes, and bleedings compared to warfarin. However, DOACs were associated with a higher risk of gastrointestinal bleeding. The retrospective study was limited by potential selection biases from its exclusion criteria and inability to account for differences in warfarin dosage adjustments compared to DOACs.
Mean platelet volume and other platelet volume indices in patients with acute...iosrjce
IOSR Journal of Dental and Medical Sciences is one of the speciality Journal in Dental Science and Medical Science published by International Organization of Scientific Research (IOSR). The Journal publishes papers of the highest scientific merit and widest possible scope work in all areas related to medical and dental science. The Journal welcome review articles, leading medical and clinical research articles, technical notes, case reports and others.
The document describes a cost-effectiveness analysis comparing three strategies for assessing and treating cardiovascular disease risk in asymptomatic intermediate-risk patients: 1) continuing baseline treatment from enrollment in the Multi-Ethnic Study of Atherosclerosis (MESA), 2) adhering to current treatment guidelines, and 3) using the MIRISK VP risk assessment test to reclassify patients and guide treatment. A Markov model simulated outcomes and costs over patients' lifetimes. MIRISK VP resulted in lower mortality from cardiovascular events, a modest increase in quality-adjusted life years of 0.12-0.17 years, and positive net monetary benefits compared to the other strategies. Limitations include not comparing to other risk assessment methods and
Similar to Serum Uric Acid and Outcome after Acute Ischemic Stroke: PREMIER Study (20)
Mortalidad asociada al diagnóstico de síndrome de Guillain-Barré en adultos i...Erwin Chiquete, MD, PhD
Mortality associated with a diagnosis of Guillain-Barré syndrome in adults of Mexican health institutions
Introduction. Guillain-Barré syndrome (GBS) is a neurological emergency representing the main cause of flaccid paralysis
around the world, affecting all age groups. Little is known about the essential epidemiology of GBS in most Latin American
countries.
Aim. To determine the mortality associated with the diagnosis of GBS in hospital discharges during 2010 in hospitals of
the Ministry of Health, Mexico.
Patients and methods. We analyzed the database of hospital discharges of institutions pertaining to the Ministry of
Health. Study cases were identified by the code G61.0 of the International Classification of Diseases, 10th revision (ICD-10).
We excluded records of patients younger than 18 years and patients without complete demographic information.
Results. During the year 2010 there were 2,634,339 discharges from hospitals of the Ministry of Health. We identified a
total of 467 hospitalizations due to GBS in adults (median age: 41 years; 62.1% male) from 121 health institutions of the
32 Republic States. The highest frequency of GBS hospitalizations occurred during summer and fall. The median hospital
stay was 8 days. The hospital mortality rate was 10.5%. The probability of death was directly associated with age, without
a particular trend regarding gender, hospital care or state.
Conclusions. In 2010 GBS hospital mortality in this part of the Mexican health system was higher than that reported in
contemporary studies. A seasonal association was observed regarding the frequency of hospitalizations for GBS.
Key words. Climate. Epidemiology. Guillain-Barré syndrome. Mortality. Mexico.
Rogelio Domínguez-Moreno, Paulina Tolosa-Tort, Anais Patiño-Tamez, Alejandra Quintero-Bauman,
Deisy K. Collado-Frías, María G. Miranda-Rodríguez, Obet J. Canela-Calderón, Pablo Hurtado-Valadez,
Raúl de Gante-Castro, Karoll M. Ortiz-Guillén, Bruno Estañol-Vidal, Horacio Sentíes-Madrid,
Guillermo García-Ramos, Carlos Cantú-Brito, José Luis Ruiz-Sandoval, Erwin Chiquete
Seroepidemiology of Toxoplasma gondii infection in drivers involved in road t...Erwin Chiquete, MD, PhD
Background: The prevalence of toxoplasmosis in the general population of Guadalajara, Mexico, is around 32%.
Toxoplasmosis can cause ocular lesions and slowing of reaction reflexes. Latent toxoplasmosis has been related
with traffic accidents. We aimed to assess the prevalence of anti-Toxoplasma gondii antibodies and visual
impairments related with traffic accidents in drivers from the metropolitan Guadalajara.
Methods: We prospectively evaluated the prevalence of IgG and IgM anti-T. gondii antibodies in 159 individuals
involved in traffic accidents, and in 164 control drivers never involved in accidents. Cases of toxoplasmosis
reactivation or acute infection were detected by PCR in a subset of 71 drivers studied for the presence of T. gondii
DNA in blood samples. Ophthalmologic examinations were performed in drivers with IgG anti-T. gondii antibodies
in search of ocular toxoplasmosis.
Results: Fifty-four (34%) traffic accident drivers and 59 (36%) controls were positive to IgG anti-T. gondii antibodies
(p = 0.70). Among the 113 seropositive participants, mean anti-T. gondii IgG antibodies titers were higher in traffic
accident drivers than in controls (237.9 ± 308.5 IU/ml vs. 122.9 ± 112.7 IU/ml, respectively; p = 0.01 by Student’s t
test, p = 0.037 by Mann–Whitney U test). In multivariate analyses, anti-T. gondii IgG antibody titers were consistently
associated with an increased risk of traffic accidents, whereas age showed an inverse association. The presence of
IgM-anti-T. gondii antibodies was found in three (1.9%) subjects among traffic accident drives, and in two (1.2%)
controls. Three (4.2%) samples were positive for the presence of T. gondii DNA, all among seropositive individuals.
No signs of ocular toxoplasmosis were found in the entire cohort. Moreover, no other ocular conditions were found
to be associated with the risk of traffic accidents in a multivariate analysis.
Conclusions: Anti-T. gondii antibody titers are associated with the risk of traffic accidents. We could not determine
any association of ocular toxoplasmosis with traffic accidents. Our results warrant further analyses in order to clarify
the link between toxoplasmosis and traffic accidents.
Tiempo de llegada hospitalaria y pronóstico funcional después deun infarto ce...Erwin Chiquete, MD, PhD
Introducción: La información sobre el tiempo de llegada hospitalaria después de un infartocerebral (IC) se ha originado en países con unidades especializadas en ictus. Existe poca infor-mación en naciones emergentes. Nos propusimos identificar los factores que influyen en eltiempo de llegada hospitalaria a 1, 3 y 6 h y su relación con el pronóstico funcional después delictus.Métodos: Se analizó la información de pacientes con IC incluidos en el estudio Primer RegistroMexicano de Isquemia Cerebral (PREMIER) que tuvieran tiempo definido desde el inicio de lossíntomas hasta la llegada hospitalaria. El desenlace funcional se evaluó mediante la escalamodificada de Rankin a los 30 días, 3, 6 y 12 meses.Resultados: De 1.096 pacientes con IC, 61 (6%) llegaron en < 1 h, 250 (23%) en < 3 h y 464 (42%)en < 6 h. Favorecieron la llegada temprana en < 1 h: el antecedente familiar de cardiopatíaisquémica y ser migra˜noso; en < 3 h: edad 40-69 a˜nos, antecedente familiar de hipertensión,antecedente personal de dislipidemia y cardiopatía isquémica, así como la atención en hospitalprivado; en < 6 h: antecedente familiar de hipertensión, ser migra˜noso, ictus previo, cardiopatíaisquémica y atención en hospital privado. La llegada hospitalaria tardía se asoció a ictus lacunary alcoholismo. Solo el 2,4% recibió trombólisis. Independientemente de la trombólisis, la llegadaen < 3 h se asoció a menor mortalidad a los 3 y 6 meses, además de menos complicacionesintrahospitalarias.
Comportamiento del barorreflejo en pacientes con síncope vasovagal durante el...Erwin Chiquete, MD, PhD
Caroline Malamud-Kessler, Bruno Estañol-Vidal, Óscar Infante-Vázquez, Miguel Campos-Sánchez,
Erwin Chiquete
Introducción. El síncope mediado neuralmente, también conocido como síncope vasovagal, se define como la pérdida
súbita y transitoria del estado de alerta como consecuencia de un descenso brusco y profundo de la presión arterial.
Objetivo. Conocer las diferencias de los parámetros hemodinámicos que median el barorreflejo durante el ortostatismo
activo en pacientes con diagnóstico clínico de síncope vasovagal y sujetos sanos.
Sujetos y métodos. Estudio transversal, observacional y comparativo. Se incluyeron 20 pacientes con diagnóstico de síncope
neuralmente mediado y 30 controles, a los que se les practicó la prueba de ortostatismo activo y se les registró por
finometría la presión arterial sistólica (PAS) y la frecuencia cardíaca (intervalo entre latidos) de manera continua (latido a
latido) y no invasiva.
Resultados. Los pacientes con síncope presentaron una PAS basal con una media significativamente mayor que la de los
sanos. Las magnitudes medidas desde la PAS basal demostraron una diferencia significativa, que era de menor valor en el
grupo de los controles. No se demostraron diferencias entre grupos en la caída de la PAS desde el primer pico, recuperación
de la PAS desde la sima o en las latencias medidas en la frecuencia cardíaca.
Conclusiones. La PAS basal y la caída de la PAS medida desde la basal en posición supina fue mayor en los pacientes con
síncope mediado neuralmente que en los sujetos sanos. La magnitud de la elevación de la frecuencia cardíaca tuvo una
tendencia a ser mayor en el grupo de pacientes en comparación con el grupo control. Esto sugiere una hiperactividad
simpática en los pacientes con síncope
Delírium en adultos que reciben cuidados paliativos: revisión de laliteratura...Erwin Chiquete, MD, PhD
Delírium en adultos que reciben cuidados paliativos: revisión de laliteratura con un enfoque sistemáticoSofía Sánchez-Romána, Cristina Beltrán Zavalab, Argelia Lara Solaresby ErwinChiquetea,∗
El delírium en pacientes que reciben cuidados paliativos es frecuente y constituyeun importante reto de diagnóstico y tratamiento. Nuestro objetivo fue realizar en 2 fases unanálisis bibliométrico de la evidencia científica reciente (2007 a 2012) sobre diagnóstico y tra-tamiento del delírium en adultos en cuidados paliativos. En la fase 1 (estudios descriptivos yrevisiones narrativas) se identificaron 133 artículos relevantes: 73 trataron el tema del delíriumde forma secundaria y en 60 artículos como tema principal. Sin embargo, solo se identificaron4 estudios observacionales prospectivos en los que el delírium fue central. De 135 artículos iden-tificados en la fase 2 (ensayos clínicos o estudios descriptivos sobre tratamiento del delírium enpacientes paliativos), solo 3 fueron sobre prevención o tratamiento: 2 estudios retrospectivosy un ensayo clínico sobre prevención multicomponente en pacientes con cáncer. Gran parte dela literatura reciente corresponde a revisiones que hablan de estudios realizados hace másde una década en pacientes diferentes a los que reciben cuidados paliativos. En conclusión, laevidencia científica reciente sobre el delírium en cuidados paliativos es escasa y subóptima.Urgen estudios prospectivos que se enfoquen específicamente en esta población altamentevulnerable.
José L. Ruiz-Sandoval, Guadalupe Ramírez-Guzmán,
Erwin Chiquete and Ángel Vargas-Sánchez
A 45-year-old garbage collector was referred to our department
with a history of tonic-clonic seizures and risky
sexual behavior (anilingus). A neurological examination was
normal. Contrast-enhanced cranial CT showed calcified lesions
and viable parasites compatible with a diagnosis of
massive non-encephalitic neurocysticercosis. Oral metallic
implants impeded performing brain MRI. Hepatitis and HIV
serologies were negative. The patient was discharged with
steroids and an anticonvulsant. Delayed cysticidal therapy
was planned; however, albendazole therapy was immediately
initiated in another hospital, which led to brain edema, uncontrolled
seizures, rostrocaudal deterioration and death.
Cestoda infections are rare in developed countries (1). In
contrast, neurocysticercosis is a leading cause of adult-onset
epilepsy in Latin America. Massive infections are classified
as encephalitic or non-encephalitic (2). In patients with the
encephalitic presentation, cysticidal drugs can cause extensive
parasite lysis and aggravate brain inflammation (2). In
patients with non-encephalitic massive neurocysticercosis,
cysticidal therapy is usually considered; (2) however, rapid
initiation of antiparasitic medications can launch an encephalitic
process.
Cost of care according to disease-modifying therapy in Mexicans with relapsin...Erwin Chiquete, MD, PhD
Miguel A. Macı´as-Islas • Isaac F. Soria-Cedillo • Merced Velazquez-Quintana •
Victor M. Rivera • Vero´nica I. Baca-Muro • Edith A. Lemus-Carmona • Erwin Chiquete
Limited data exist on the costs of care of
patients with multiple sclerosis (MS) in low- to middleincome
nations. The purpose of this study was to describe
the economic burden associated with care of Mexican
patients with relapsing-remitting MS in a representative
sample of the largest institution of the Mexican public
healthcare system. We analysed individual data of 492
patients (67 % women) with relapsing-remitting MS registered
from January 2009 to February 2011 at the Mexican
Social Security Institute. Direct costs were measured about
the use of diagnostic tests, disease-modifying therapies
(DMTs), symptoms control, medical consultations,
relapses, intensive care and rehabilitation. Four groups
were defined according to DMT alternatives: (1) interferon
beta (IFNb)-1a, 6 million units (MU); (2) IFNb-1a, 12MU;
(3) IFNb-1b, 8MU; and (4) glatiramer acetate. All patients
received DMTs for at least 1 year. The most frequently
used DMT was glatiramer acetate (45.5 %), followed by
IFNb-1a 12MU (22.6 %), IFNb-1b 8MU (20.7 %), and
IFNb-1a 6MU (11.2 %). The mean cost of a specialised
medical consultation was €74.90 (US $107.00). A single
relapse had a mean total cost of €2,505.97 (US $3,579.96).
No differences were found in annualised relapse rates and
costs of relapses according to DMT. However, a significant
difference was observed in total annual costs according to
treatment groups (glatiramer acetate being the most
expensive), mainly due to differences in unitary costs of
alternatives. From the public institutional perspective,
when equipotent DMTs are used in patients with comparable
characteristics, the costs of DMTs largely determine
the total expenses associated with care of patients with
relapsing-remitting MS in a middle-income country.
Blood pressure at hospital admission and outcome after primary intracerebral ...Erwin Chiquete, MD, PhD
Introduction: The importance of the admission blood pressure (BP) for intracerebral
hemorrhage (ICH) outcome is not completely clear. Our objective was to
analyze the clinical impact of BP at hospital arrival in patients with primary ICH.
Material and methods: We studied 316 patients (50% women, mean age:
64 years, 75% with hypertension history) with acute primary ICH. The first BP reading
at admission was evaluated for its association with neuroimaging findings
and outcome. A Cox proportional hazards model and Kaplan-Meier analyses
were constructed to evaluate factors associated with in-hospital mortality.
Results: Intraventricular irruption occurred in 52% of cases. A high frequency
of third ventricle extension was observed in patients with BP readings in the
upper quartiles of the distribution (systolic, diastolic, or mean arterial pressure).
Blood pressure readings did not correlate with hematoma volumes. In-hospital
case fatality rate was 46% (63% among those with ventricular irruption). Systolic
BP (SBP) > 190 mm Hg was independently associated with in-hospital mortality
in supratentorial (n = 285) ICH (hazard ratio: 1.19, 95% confidence interval:
1.02-1.38, for the highest vs. the lowest quartile) even after adjustment for
known strong predictors (age, ICH volume, Glasgow coma scale and ventricular
extension). Blood pressure was not significantly associated with ventricular
extension or outcome in patients with infratentorial ICH.
Conclusions: A high BP on admission is associated with an increased risk of
intraventricular extension and early mortality in patients with supratentorial
ICH. However, a significant proportion of patients with high BP readings without
ventricular irruption still have an increased risk of death.
Hepatitis C virus infection and type 2 diabetes mellitus in Mexican patients. Erwin Chiquete, MD, PhD
34. Chiquete E, Ochoa-Guzmán A, García-Lamas L, Anaya-Gómez F, Gutiérrez-Manjarrez JI, Sánchez-Orozco LV, Godínez-Gutiérrez SA, Maldonado M, Román S, Panduro A. Hepatitis C virus infection and type 2 diabetes mellitus in Mexican patients. Rev Med Inst Mex Seguro Soc. 2012;50(5):481-6. [PMID: 23282259]
Atherothrombotic Disease, Traditional Risk Factors, and 4-Year Mortality in a...Erwin Chiquete, MD, PhD
Erwin Chiquete, MD, PhD
Background: Atherothrombosis is becoming the leading cause of chronic morbidity in developing countries. This
epidemiological transition will represent an unbearable socioeconomic burden in the near future. We investigated
factors associated with 4-year all-cause mortality in a Latin American population at high risk.
Hypothesis: Largely modifiable risk factors as well as polyvascular disease are the main predictors of 4-year all-cause and
cardiovascular mortality in this Latin American cohort.
Methods: We analyzed 1816 Latin American stable outpatients (62.3% men, mean age 67 years) with symptomatic
atherothrombosis (87.1%) or with multiple risk factors only (12.9%), in the Reduction of Atherothrombosis for Continued
Health registry.
Results: Of patients with symptomatic atherothrombosis, 57.3% had coronary artery disease, 32% cerebrovascular disease,
and 11.7% peripheral artery disease at baseline (9.1% polyvascular). The main risk factors were hypertension (76%),
hypercholesterolemia (60%), and smoking (52.3%) in patients with established atherothrombosis; and hypertension
(89.7%), diabetes (80.8%), and hypercholesterolemia (73.9%) in those with risk factors only. Four-year all-cause mortality
steeply increased with none (6.8%), 1 (9.2%), 2 (15.5%), and 3 (29.2%) symptomatic arterial disease locations. In patients
with only 1 location, cardiovascular mortality was significantly higher with peripheral artery disease (11.3%) than with
cerebrovascular disease (6%) or coronary artery disease (5.1%). Significant baseline predictors of 4-year all-cause mortality
were congestive heart failure (hazard ratio [HR]: 3.81), body mass index<20 (HR: 2.32), hypertension (HR: 1.84), polyvascular
disease (HR: 1.69), and age ≥65 years (HR: 1.47), whereas statin use (HR: 0.49) and body mass index ≥30 (HR: 0.58) were
associated with a reduced risk.
Conclusions: Hypertension was the main modifiable risk factor for atherothrombosis and all-cause mortality in this Latin
José L. Ruiz-Sandoval, Erwin Chiquete,
Lucía E. Álvarez-Palazuelos, Miguel
A. Andrade-Ramos & Luis R. Rodríguez-
Rubio
Osmotic demyelination syndrome (ODS) is the
damage over the central nervous system caused by several
electrolytes, metabolic and toxic disorders. We aimed to
describe cases of unusual forms of ODS. In a 9-year period,
25 consecutive patients with ODS (15 men; mean age
42 years) were registered in our referral institution, among
them, four (16 %) with atypical neuroimaging findings
were abstracted for this communication. None of them
presented cardiorespiratory arrest, head trauma, seizures,
neuromyelitis optica spectrum or contact with toxic
chemicals. Case 1 was a 33-year-old alcoholic man without
hypertension or electrolyte imbalance, who presented a
classic central pontine myelinolysis (CPM) and a hemorrhage
within the pons. Case 2 was a 34-year-old alcoholic
man with hypoglycemia and hyponatremia who presented
CPM and diffuse bihemispheric extrapontine myelinolysis
(EPM) after correction of serum sodium. Case 3 was a
52-year-old woman with mild hypokalemia and hyponatremia
(inadequately corrected), who presented a peduncular
and cerebellar EPM. Case 4 was a 67-year-old
woman who had a suicidal attempt with antidepressants
and carbamazepine without impaired consciousness, who
complicated with mild hyponatremia associated with a
classical CPM and a spinal cord EPM. Case 2 died and the
rest remained with variable neurological impairments at
last follow-up visit. With modern neuroimaging, the
so-called atypical forms of ODS may not be as rare as
previously thought; however, they could have a more
adverse outcome than the classical ODS.
Spontaneous intracerebral hemorrhage in Mexico: results from a Multicenter Na...Erwin Chiquete, MD, PhD
Introduction. Scarce information exists on intracerebral hemorrhage (ICH) in Latin America, and the existent is derived
from single-center registries with non-generalizable conclusions. The aim of this study is to describe the frequency, etiology,
management and outcome of ICH in Mexico.
Patients and methods. We studied consecutive patients with ICH pertaining to the National Multicenter Registry on Cerebrovascular
Disease (RENAMEVASC), conducted in 25 centers from 14 states of Mexico. The Intracerebral Hemorrhage Grading
Scale (ICH-GS) at admission was used to assess prognosis at 30 days follow-up.
Results. Of 2,000 patients with acute cerebrovascular disease registered in RENAMEVASC, 564 (28%) had primary ICH
(53% women; median age: 63 years; interquartile range: 50-75 years). Hypertension (70%), vascular malformations (7%)
and amyloid angiopathy (4%) were the main etiologies. In 10% of cases etiology could not be determined. Main ICH
locations were basal ganglia (50%), lobar (35%) and cerebellum (5%). Irruption into the ventricular system occurred in
43%. Median score of ICH-GS was 8 points: 49% had 5-7 points, 37% had 8-10 points and 15% had 11-13 points. The 30-day
case fatality rate was 30%, and 31% presented severe disability. The 30-day survival was 92% for patients with ICH-GS 5-7
points, whereas it decreased to 27% in patients with ICH-GS 11-13 points.
Conclusions. In Mexico, ICH represents about a third of the forms of acute cerebrovascular disease, and the majority of
patients present severe disability or death at 30 days of follow-up. Hypertension is the main cause; hence, control of this
important cardiovascular risk factor should reduce the health burden of ICH.
An Expandable Prosthesis with Dual Cage-and-Plate Function in a Single Device...Erwin Chiquete, MD, PhD
Juan J. Ramı´rez, Erwin Chiquete, Juan J. Ramı´rez, Jr., Ernesto Go´mez-Limo´n, and Juan M. Ramı´rez
An expandable vertebral body prosthesis with dual cage-and-plate function in a single
device (JR prosthesis) was designed to test the hypothesis that this modular system can
provide the biomechanical requirements for immediate and durable spine stabilization
after corpectomy. Cadaver assays were performed with a stainless steal device to test fixation
and adequacy to the human spine anatomy. Then, 14 patients with vertebral tumors
(eight metastatic) underwent corpectomy and vertebral body replacement with a titaniummade
JR prosthesis. All patients had neurological deficit, severe pain and spine instability
prior to surgery. Mean pain score before surgery on a visual analog scale decreased from
7.6e3.0 points after operation ( p 5 0.002). All patients achieved at least one grade of
improvement in the Frankel score ( p 5 0.003), excepting the three patients with Frankel
grade A before surgery. Two patients with renal cell carcinoma died during the following
4 days after surgery. The remaining patients attained a painless and stable spine immediately,
which was maintained for long periods (mean follow-up: 25.4 months). No significant
infections or implant failures were registered. A nonfatal case of inferior vena cava
surgical injury was observed (repaired during surgery without further complications). In
conclusion, the JR prosthesis stabilizes the spine immediately after surgery and for the
rest of the patients’ life. To our knowledge, this is the first report on the clinical experience
of any expandable vertebral body prosthesis with dual cage-and-plate function in
a single device.
Expression profile of BRCA1 and BRCA2 genes in premenopausal Mexican women wi...Erwin Chiquete, MD, PhD
Gloria Loredo-Pozos, Erwin Chiquete,
Antonio Oceguera-Villanueva, Arturo Panduro,
Fernando Siller-Lo´pez, Martha E. Ramos-Márquez
Low BRCA1 gene expression is associated with
increased invasiveness and influences the response of
breast carcinoma (BC) to chemotherapeutics. However,
expression of BRCA1 and BRCA2 genes has not been
completely characterized in premenopausal BC. We analyzed
the clinical and immunohistochemical correlates of
BRCA1 and BRCA2 expression in young BC women. We
studied 62 women (mean age 38.8 years) who developed
BC before the age of 45 years. BRCA1 and BRCA2 mRNA
expression was assessed by reverse transcriptase-polymerase
chain reaction (RT-PCR) and that of HER-2 and
p53 proteins by immunohistochemistry. Body mass index
(BMI) C27 (52%) and a declared family history of BC
(26%) were the main risk factors. Ductal infiltrative adenocarcinoma
was found in 86% of the cases (tumor size
[5 cm in 48%). Disease stages I–IV occurred in 2, 40, 55,
and 3%, respectively (73% implicating lymph nodes).
Women aged B35 years (24%) had more family history of
cervical cancer, stage III/IV disease, HER-2 positivity, and
lower BRCA1 expression than older women (P-.05).
BRCA1 and BRCA2 expression correlated in healthy, but
not in tumor tissues (TT). Neither BRCA1 nor BRCA2
expression was associated with tumor histology, differentiation,
nodal metastasis or p53 and HER-2 expression.
After multivariate analysis, only disease stage explained
BRCA1 mRNA levels in the lowest quartile. Premenopausal
BC has aggressive clinical and molecular
characteristics. Low BRCA1 mRNA expression is associated
mainly with younger ages and advanced clinical stage
of premenopausal BC. BRCA2 expression is not associated
with disease severity in young BC women.
The document analyzes the direct costs of treating breast cancer patients at the National Institute of Cancerology in Mexico prior to the introduction of immunotherapy. A total of 633 patients treated in 2004 were studied. The costs were calculated for each stage of care including diagnosis/staging, treatment, follow-up, and palliative care. The average annual cost of treatment per patient increased with each successive stage of disease from $6,219.94 for stage I to $9,917.82 for stage IV. The total direct cost of treating all 633 breast cancer patients in 2004 was calculated to be $5,341,805.37. The study concluded that costs of care increased with more advanced disease stages due in part to late
Este documento presenta el caso de una paciente de 23 años que desarrolló una demencia tres años después de una intoxicación crónica por paradiclorobenceno (PDCB). La paciente había ingerido pequeñas cantidades de desodorante que contenía PDCB durante varios meses y luego intentó suicidarse ingiriendo grandes cantidades. Tres años después presentaba síntomas de demencia mixta corticosubcortical. Las imágenes por resonancia magnética mostraron leucoencefalopatía difusa. El PDCB puede causar desmielinización central y
Spontaneous intracerebral hemorrhage in Mexico: results from a Multicenter Na...Erwin Chiquete, MD, PhD
José L. Ruiz-Sandoval, Erwin Chiquete, Alejandra Gárate-Carrillo, Ana Ochoa-Guzmán, Antonio Arauz,
Carolina León-Jiménez, Karina Carrillo-Loza, Luis M. Murillo-Bonilla, Jorge Villarreal-Careaga,
Fernando Barinagarrementería, Carlos Cantú-Brito, and the RENAMEVASC investigators
Introduction. Scarce information exists on intracerebral hemorrhage (ICH) in Latin America, and the existent is derived
from single-center registries with non-generalizable conclusions. The aim of this study is to describe the frequency, etiology,
management and outcome of ICH in Mexico.
Patients and methods. We studied consecutive patients with ICH pertaining to the National Multicenter Registry on Cerebrovascular
Disease (RENAMEVASC), conducted in 25 centers from 14 states of Mexico. The Intracerebral Hemorrhage Grading
Scale (ICH-GS) at admission was used to assess prognosis at 30 days follow-up.
Results. Of 2,000 patients with acute cerebrovascular disease registered in RENAMEVASC, 564 (28%) had primary ICH
(53% women; median age: 63 years; interquartile range: 50-75 years). Hypertension (70%), vascular malformations (7%)
and amyloid angiopathy (4%) were the main etiologies. In 10% of cases etiology could not be determined. Main ICH
locations were basal ganglia (50%), lobar (35%) and cerebellum (5%). Irruption into the ventricular system occurred in
43%. Median score of ICH-GS was 8 points: 49% had 5-7 points, 37% had 8-10 points and 15% had 11-13 points. The 30-day
case fatality rate was 30%, and 31% presented severe disability. The 30-day survival was 92% for patients with ICH-GS 5-7
points, whereas it decreased to 27% in patients with ICH-GS 11-13 points.
Conclusions. In Mexico, ICH represents about a third of the forms of acute cerebrovascular disease, and the majority of
patients present severe disability or death at 30 days of follow-up. Hypertension is the main cause; hence, control of this important cardiovascular risk factor should reduce the health burden of ICH.
Hemorragia intracerebral espontánea en México: resultados del Registro Hospit...Erwin Chiquete, MD, PhD
José L. Ruiz-Sandoval, Erwin Chiquete, Alejandra Gárate-Carrillo, Ana Ochoa-Guzmán, Antonio Arauz,
Carolina León-Jiménez, Karina Carrillo-Loza, Luis M. Murillo-Bonilla, Jorge Villarreal-Careaga,
Fernando Barinagarrementería, Carlos Cantú-Brito, investigadores RENAMEVASC
Introducción. Existe poca información respecto a la hemorragia intracerebral (HIC) en América Latina, y la existente ha
sido derivada de registros hospitalarios de un solo centro con conclusiones no generalizables. El objetivo de este estudio
es describir la frecuencia, etiología, manejo y desenlace clínico de la HIC en México.
Pacientes y métodos. Se estudiaron pacientes consecutivos con HIC incluidos en el Registro Nacional Mexicano de Enfermedad
Vascular Cerebral (RENAMEVASC), conducido en 25 centros de 14 estados de la República Mexicana. Se usó la
Intracerebral Hemorrhage Grading Scale (ICH-GS) para estimar el pronóstico a 30 días.
Resultados. De 2.000 pacientes con ictus agudo en el RENAMEVASC, 564 (28%) presentaron HIC espontánea (53% mujeres;
edad media: 63 años; rango intercuartílico: 50-75 años). La hipertensión arterial (70%), las malformaciones vasculares
(7%) y la angiopatía amiloidea (4%) fueron las causas más frecuentes. No se determinó la etiología en el 10% de
los casos. Las localizaciones más frecuentes fueron ganglionar (50%), lobar (35%) y cerebelosa (5%). La irrupción hacia
el sistema ventricular ocurrió en el 43%. La mediana en la escala ICH-GS al ingreso hospitalario fue de 8 puntos: el 49%
presentó 5-7 puntos; el 37%, 8-10 puntos, y el 15%, 11-13 puntos. La tasa de mortalidad a 30 días fue del 30%, y el 31%
mostró discapacidad grave. La sobrevida a 30 días fue del 92% en pacientes con 5-7 puntos en la escala ICH-GS, mientras
que se redujo al 27% en aquellos con 11-13 puntos.
Conclusiones. En México, la HIC representa casi un tercio de las formas de enfermedad vascular cerebral aguda, y la mayoría de los pacientes que la padecen presentan discapacidad funcional grave o muerte a 30 días. La hipertensión es la principal causa, por lo que el control de este importante factor de riesgo debería reducir la carga sanitaria de la HIC.
Presión arterial sistólica y pronóstico funcional en pacientes con enfermedad...Erwin Chiquete, MD, PhD
Manuel Baños-González, Carlos Cantú-Brito, Erwin Chiquete, Antonio Arauz, José Luís Ruiz-Sandoval, Jorge Villarreal-Careaga, Fernando Barinagarrementeria, José Juan Lozano y los investigadores RENAMEVASC
Objetivo: Analizar la asociación de la presión arterial sistólica (PAS) al ingreso hospitalario
y la evolución clínica a 30 días en pacientes con enfermedad vascular cerebral (EVC) aguda.
Métodos: El REgistro NAcional Mexicano de Enfermedad VAScular Cerebral (RENAMEVASC) es un registro
hospitalario multicéntrico realizado de noviembre de 2002 a octubre de 2004. Se registraron
2000 pacientes con distintos síndromes clínicos de EVC aguda confirmados por neuroimagen. La
estratificación de la evolución clínica se realizó mediante la escala de Rankin modificada.
Resultados: Se analizaron 1721 pacientes con registro de la PAS: 78 (4.5%) con isquemia cerebral
transitoria, 894 (51.9%) con infarto cerebral, 534 (30.9%) con hemorragia intracerebral,
165 (9.6%) con hemorragia subaracnoidea y 50 (2.9%) con trombosis venosa cerebral. De los
1036 (60.2%) pacientes con el antecedente de hipertensión, sólo 32.4% tenía un tratamiento
regular. La tasa de mortalidad a 30 días presentó un patrón en J con respecto a la PAS, de
tal manera que el riesgo de muerte fue máximo en <100><100>65 años (RR: 2.16, IC 95%: 1.74 - 2.67).
Conclusión: Tanto la hipotensión como la hipertensión arterial significativa al ingreso hospitalario
se asocian a un pronóstico adverso en la EVC aguda. No obstante, un buen pronóstico
funcional se puede lograr en un amplio rango de cifras de PAS.
Estudio multicéntrico INDAGA. Índice tobillo-brazo anormal en población mexic...Erwin Chiquete, MD, PhD
Este estudio multicéntrico evaluó la prevalencia de enfermedad arterial periférica (EAP) mediante la medición del índice tobillo-brazo (ITB) en más de 5,000 pacientes mexicanos con factores de riesgo vascular. Se encontró que el 23.8% de los pacientes tenían ITB ≤ 0.9, indicativo de EAP, y el 8.4% tenían ITB > 1.3, indicativo de calcificación arterial. Los factores asociados con ITB anormal incluyeron edad avanzada, hipertensión, diabetes
Cell Therapy Expansion and Challenges in Autoimmune DiseaseHealth Advances
There is increasing confidence that cell therapies will soon play a role in the treatment of autoimmune disorders, but the extent of this impact remains to be seen. Early readouts on autologous CAR-Ts in lupus are encouraging, but manufacturing and cost limitations are likely to restrict access to highly refractory patients. Allogeneic CAR-Ts have the potential to broaden access to earlier lines of treatment due to their inherent cost benefits, however they will need to demonstrate comparable or improved efficacy to established modalities.
In addition to infrastructure and capacity constraints, CAR-Ts face a very different risk-benefit dynamic in autoimmune compared to oncology, highlighting the need for tolerable therapies with low adverse event risk. CAR-NK and Treg-based therapies are also being developed in certain autoimmune disorders and may demonstrate favorable safety profiles. Several novel non-cell therapies such as bispecific antibodies, nanobodies, and RNAi drugs, may also offer future alternative competitive solutions with variable value propositions.
Widespread adoption of cell therapies will not only require strong efficacy and safety data, but also adapted pricing and access strategies. At oncology-based price points, CAR-Ts are unlikely to achieve broad market access in autoimmune disorders, with eligible patient populations that are potentially orders of magnitude greater than the number of currently addressable cancer patients. Developers have made strides towards reducing cell therapy COGS while improving manufacturing efficiency, but payors will inevitably restrict access until more sustainable pricing is achieved.
Despite these headwinds, industry leaders and investors remain confident that cell therapies are poised to address significant unmet need in patients suffering from autoimmune disorders. However, the extent of this impact on the treatment landscape remains to be seen, as the industry rapidly approaches an inflection point.
These lecture slides, by Dr Sidra Arshad, offer a quick overview of the physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar lead (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
6. Describe the flow of current around the heart during the cardiac cycle
7. Discuss the placement and polarity of the leads of electrocardiograph
8. Describe the normal electrocardiograms recorded from the limb leads and explain the physiological basis of the different records that are obtained
9. Define mean electrical vector (axis) of the heart and give the normal range
10. Define the mean QRS vector
11. Describe the axes of leads (hexagonal reference system)
12. Comprehend the vectorial analysis of the normal ECG
13. Determine the mean electrical axis of the ventricular QRS and appreciate the mean axis deviation
14. Explain the concepts of current of injury, J point, and their significance
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. Chapter 3, Cardiology Explained, https://www.ncbi.nlm.nih.gov/books/NBK2214/
7. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
Osteoporosis - Definition , Evaluation and Management .pdfJim Jacob Roy
Osteoporosis is an increasing cause of morbidity among the elderly.
In this document , a brief outline of osteoporosis is given , including the risk factors of osteoporosis fractures , the indications for testing bone mineral density and the management of osteoporosis
Adhd Medication Shortage Uk - trinexpharmacy.comreignlana06
The UK is currently facing a Adhd Medication Shortage Uk, which has left many patients and their families grappling with uncertainty and frustration. ADHD, or Attention Deficit Hyperactivity Disorder, is a chronic condition that requires consistent medication to manage effectively. This shortage has highlighted the critical role these medications play in the daily lives of those affected by ADHD. Contact : +1 (747) 209 – 3649 E-mail : sales@trinexpharmacy.com
ABDOMINAL TRAUMA in pediatrics part one.drhasanrajab
Abdominal trauma in pediatrics refers to injuries or damage to the abdominal organs in children. It can occur due to various causes such as falls, motor vehicle accidents, sports-related injuries, and physical abuse. Children are more vulnerable to abdominal trauma due to their unique anatomical and physiological characteristics. Signs and symptoms include abdominal pain, tenderness, distension, vomiting, and signs of shock. Diagnosis involves physical examination, imaging studies, and laboratory tests. Management depends on the severity and may involve conservative treatment or surgical intervention. Prevention is crucial in reducing the incidence of abdominal trauma in children.
8 Surprising Reasons To Meditate 40 Minutes A Day That Can Change Your Life.pptxHolistified Wellness
We’re talking about Vedic Meditation, a form of meditation that has been around for at least 5,000 years. Back then, the people who lived in the Indus Valley, now known as India and Pakistan, practised meditation as a fundamental part of daily life. This knowledge that has given us yoga and Ayurveda, was known as Veda, hence the name Vedic. And though there are some written records, the practice has been passed down verbally from generation to generation.
Integrating Ayurveda into Parkinson’s Management: A Holistic ApproachAyurveda ForAll
Explore the benefits of combining Ayurveda with conventional Parkinson's treatments. Learn how a holistic approach can manage symptoms, enhance well-being, and balance body energies. Discover the steps to safely integrate Ayurvedic practices into your Parkinson’s care plan, including expert guidance on diet, herbal remedies, and lifestyle modifications.
Promoting Wellbeing - Applied Social Psychology - Psychology SuperNotesPsychoTech Services
A proprietary approach developed by bringing together the best of learning theories from Psychology, design principles from the world of visualization, and pedagogical methods from over a decade of training experience, that enables you to: Learn better, faster!
3. Table 1. Main characteristics of the patients according to 30-day outcome
Baseline characteristics
30-day functional outcome
all (n = 463)
Age, years*
Male gender
Risks factors
Chronic renal failure
Hypertension*
Diabetes mellitus
BMI >30
Non-valvular atrial fibrillation*
Coronary artery disease
Previous cerebral infarction
Clinical and laboratory variables
Glucose, mg/dl*
Glucose <150 mg/dl
Creatinine, mg/dl
Creatinine <1.2 mg/dl*
Serum uric acid, mg/dl
Serum uric acid ≤4.5 mg/dl*
NIHSS*
NIHSS <9
Stroke subtypes
Large-artery disease
Lacune*
Cardioembolism*
Mixed
Other defined etiologies
Undetermined*
mRS 0–1 (n = 107)
mRS 2–5 (n = 305)
mRS 6 (n = 51)
71 (21–104)
241 (52.1)
65 (21–91)
65 (60.7)
72 (22–94)
149 (48.9)
76 (38–104)
27 (52.9)
9 (1.9)
314 (67.8)
148 (32.0)
101 (21.8)
52 (11.2)
106 (22.9)
90 (19.4)
1 (0.1)
60 (56.1)
32 (29.9)
28 (26.2)
6 (5.6)
24 (22.4)
17 (15.9)
6 (2.0)
220 (72.1)
102 (33.4)
64 (21.0)
40 (13.1)
74 (24.3)
64 (21.0)
2 (3.9)
34 (66.7)
14 (27.5)
9 (17.6)
6 (11.8)
8 (15.7)
9 (17.6)
145.2±73.5
199 (65.2)
1.43±2.02
207 (67.8)
6.17±3.71
100 (32.8)
11 (1–36)
90 (29.7)
177.1±99.1
29 (56.9)
1.59±1.55
25 (50.9)
6.16±3.33
16 (31.4)
23 (4–39)
6 (11.8)
96 (31.5)
47 (15.4)
62 (20.3)
24 (7.9)
17 (5.6)
59 (19.3)
17 (33.3)
3 (5.9)
13 (25.5)
3 (5.9)
0 (0)
15 (29.4)
144.0±73.5
308 (66.5)
1.40±1.86
312 (67.4)
6.10±3.72
167 (36.1)
11 (1–39)
172 (37.6)
124.7±50.0
80 (74.7)
1.22±1.47
80 (74.8)
5.88±3.91
51 (47.7)
5 (1–22)
76 (73.8)
144 (31.1)
84 (18.1)
83 (17.9)
34 (7.3)
27 (5.8)
91 (19.7)
31 (29.0)
34 (31.8)
8 (7.5)
7 (6.5)
10 (9.3)
17 (15.9)
Data are expressed as median (range), n (%) or mean ± standard deviation.
To convert uric acid concentration to μmol/l multiply by the factor 59.48. To convert creatinine concentration to μmol/l multiply by
the factor 88.4. To convert glucose concentration to mmol/l multiply by the factor 0.0555.
* p < 0.05 for univariate comparison of mRS = 0–1 vs. mRS = 2–5.
gender, renal function, time since stroke onset, stroke severity,
type of stroke) were taken into account. Multivariate analyses were
constructed by forward stepwise binary logistic regression. Input
variables were those that resulted significantly associated with AIS
outcome in bivariate analyses. Adjusted odds ratios (OR) with 95%
confidence intervals (CI) are provided. The fitness of the models
was evaluated by using the Hosmer-Lemeshow goodness-of-fit
test, which was considered as reliable if p > 0.2. All p values are
two-sided and considered significant when p < 0.05. SPSS v 17.0
software was used for all statistical calculations.
Results
A total of 463 patients were analyzed (52% men, mean
age 68 years; range 21–104 years) (table 1); 61 (13%) patients had glomerular filtration rate <60 ml/min at hospital arrival. Mean SUA at hospital admittance was 6.1 ± 3.7
170
Cerebrovasc Dis 2013;35:168–174
DOI: 10.1159/000346603
mg/dl (362.8 ± 220.0 μmol/l), higher in men than in women [6.6 ± 3.9 vs. 5.5 ± 3.5 mg/dl (392.6 ± 232.0 vs. 327.1 ±
208.2 μmol/l); p = 0.002] (fig. 1).
At 30 days after AIS, a very good outcome occurred
more frequently in patients with SUA ≤4.5 mg/dl (≤267.7
μmol/l; the lowest tertile of the sample) than in those
with higher levels (30.5 vs. 18.9%, respectively; p = 0.004;
univariate Mantel-Haenszel OR: 1.88, 95% CI: 1.21–2.92).
Neither low nor high SUA levels were associated with
stroke mortality or functional dependence (mRS >2, or
mRS >3) at 30-day follow-up. Moreover, we could not
find any significant association between SUA and any
outcome at 3-, 6-, or 12-month follow-up, either in univariate or in multivariate analyses.
In a multivariate analysis adjusted for relevant cofactors (table 2), SUA ≤4.5 mg/dl (≤267.7 μmol/l) was associated with 30-day very good outcome (mRS = 0–1). HowChiquete et al.
4. Men
<
100
Frequency (%)
80
60
40
less, a nonsignificant tendency was observed for patients
with severe strokes and high SUA levels arriving earlier
(fig. 2). Low SUA levels did not occur more frequently
among patients with NIHSS <9 points (fig. 3), but milder
strokes (i.e. NIHSS <5 points) occurred more commonly
among cases with SUA ≤4.5 mg/dl (≤267.7 μmol/l) (fig. 3).
Furthermore, variables significantly associated with low
SUA levels were: female gender, young age, normal serum
creatinine and (inversely) hypertension (table 3).
20
0
SUA first tertile
(
Discussion
(
(
Fig. 1. SUA tertiles as a function of gender.
Table 2. Factors positively associated with a very good outcome
(modified Rankin scale 0–1) at 30-day follow-up: a multivariate
logistic regression model*
Variable
Multivariate odds
ratios (95% CI)
p value
NIHSS <9 points
Age <55 years
Cardioembolic stroke
SUA ≤4.5 mg/dl (≤268 μmol/l)
6.99 (4.14–11.79)
2.10 (1.18–3.74)
0.41 (0.19–0.88)
1.76 (1.05–2.95)
<0.001
<0.012
<0.023
<0.031
* Hosmer-Lemeshow test for goodness of fit in final step of the
regression model: χ2 = 1.85, 6 d.f., p = 0.933. Only variables significantly associated with mortality are shown. Model adjusted for
gender, chronic renal failure, diabetes, hypertension, dyslipidemia,
atrial fibrillation, lacunar stroke, undetermined stroke, admission
blood glucose <150 mg/dl (<8.3 mmol/l), admission serum creatinine <1.2 mg/dl (<106 μmol/l), hospital arrival <24 h since stroke
onset, previous cerebral infarction and body mass index >30. Only
variables significantly associated with a score of 0 to 1 in the modified Rankin scale are shown in this table. SUA association with
short-term outcome showed significance only when dichotomised
NIHSS was considered instead of a continuous variable.
ever, the significance of this association was lost when NIHSS was entered as a continuous variable. SUA ≤4.5 mg/
dl (≤267.7 μmol/l) had a sensitivity, specificity, PPV,
NPV, LR+ and LR– for predicting a very good 30-day outcome, of 47.7% (95% CI: 38.4–57.0), 67.4% (95% CI: 62.4–
72.1), 30.5% (95% CI: 24.1–37.9), 81.1% (95% CI: 76.2–
85.1), 1.46 (95% CI: 1.14–1.87) and 0.78 (95% CI: 0.64–
0.94), respectively. The time since AIS onset to hospital
arrival was not significantly associated with AIS severity
(scoring of the NIHSS), or SUA levels (fig. 2); nevertheSerum Uric Acid and Stroke Outcome
In this study we found that a low SUA at hospital admission is modestly associated with a very good shortterm outcome. However, we could not demonstrate the
opposite, that severe strokes or adverse outcomes are associated with higher concentrations of SUA. Our results
may contrast with some previous findings [9, 17, 20, 21,
29, 30], but are in line with the report of Nardi and Milia
[31] showing that a low SUA is associated with an excellent functional state after AIS. Moreover, the factors that
we found as associated with SUA concentrations have
also been described in similar settings [31]. Nonetheless,
although from a different perspective, our findings support the concept that SUA elevation is proportional to
the magnitude of the brain ischemia [12, 13, 18], with low
SUA levels indicating a good outcome possibly through
mild strokes. The present results offer relevant information on the factors that may confound and partially explain the variation of SUA among AIS cohorts.
The time of blood sampling appears to be a crucial issue
that may explain much of the variation of results among
publications [9, 12, 13]. If SUA is a consumptive and rapidly changing marker of the antioxidant response elicit by
the brain ischemia, then higher SUA levels should be observed during certain moments in larger strokes to offer a
metabolic response for scavenging oxygen free radicals excessively produced during blood deprivation. Patients failing to mount such a reaction may have a bad outcome. In
the end, large strokes may originate in part the SUA response, but may also be the consequence of a failing antioxidant reaction. This subject needs more exploration in
basic and clinical studies. The considerable debate on the
significance of SUA as a marker of AIS outcome may be due
to different interpretations of the same phenomenon [19].
Cells and tissue preparations exposed to hypoxia/ischemia exhibit an increased expression of xanthine oxidase,
the rate-limiting enzyme in the conversion of hypoxanthine to xanthine and xanthine to uric acid [32]. Xanthine
Cerebrovasc Dis 2013;35:168–174
DOI: 10.1159/000346603
171
5. p for trend = 0.74
60
36.8
63.2
80
32.0
34.9
65.1
Frequency (%)
Frequency (%)
80
68.0
40
20
0
a
p for trend = 0.19
100
100
NIHSS
<9 points
NIHSS
9–18 points
Hospital arrival in <24 h
60
40
50.3
b
Hospital arrival in ≥24 h
60.3
56.6
20
0
NIHSS
>18 points
39.7
43.4
49.7
SUA first
tertile
(≤4.5 mg/dl)
SUA second
tertile
(4.6–6 mg/dl)
SUA third
tertile
(>6 mg/dl)
Fig. 2. Hospital arrival according to stroke severity by the NIHSS (a), and SUA tertiles (b).
p for trend = 0.41
80
60
40
20
0
a
50
62.2
66.8
37.8
63.4
33.2
36.6
NIHSS
9–18 points
Frequency (%)
Frequency (%)
100
40
p = 0.02 *
30
29.3
26.1
20
NIHSS
>18 points
38.1
44.6
32.5
36.5
29.4
33.3
32.5
30.1
34.9
10
SUA >6 mg/dl
0
NIHSS
<9 points
SUA ≤
SUA >
SUA 4.6–6 mg/dl
NIHSS <5
points
b
32.5
NIHSS
5–10
points
NIHSS
11–20
points
SUA ≤4.5 mg/dl
NIHSS >20
points
Fig. 3. Stroke severity by the NIHSS as a function of SUA tertiles, dividing the NIHSS distribution with wider (a) and closer (b) score
ranges.
oxidase is the only enzyme capable of catalyzing the formation of uric acid in humans. In other mammals, urate
oxidase can metabolize uric acid to allantoin, a potent antioxidant, but this enzyme activity is lost in primates. It is
possible that uric acid production may have evolved as a
compensatory mechanism in primates that cannot produce other potent organic antioxidants [33]. As such, uric
acid production by means of xanthine oxidase activity is
possibly the most potent acute antioxidant mechanism in
response to ischemia in humans, and hence, it represents
a marker of tissue infarction [22, 32, 33]. However, a limitation of the models that examine the SUA systemic reaction to focal ischemia (i.e. AIS) is that uric acid production in situ may not be adequately measured with peripheral blood sampling.
172
Cerebrovasc Dis 2013;35:168–174
DOI: 10.1159/000346603
Here we could not demonstrate a particular pattern of
SUA concentration as a function of time from stroke onset
to hospital arrival, possibly because patients with mild
strokes tended to arrive later than patients with profound
neurologic deficits. However, although SUA levels were
measured at hospital admittance, we did not standardize
precisely the moment of blood sampling or laboratory
analyses, and no serial SUA measurements were undertaken; therefore, our data set is not adequate to evaluate the
SUA time response as a function of stroke severity. This is
a very interesting topic to be examined in future studies.
The main limitation of this study is the sample size that
might not be large enough to detect a more robust difference between SUA levels across the whole range of stroke
severity, and to find that patients with severe strokes and
Chiquete et al.
6. Table 3. Factors positively associated with a SUA ≤4.5 mg/dl (≤268 μmol/l) at hospital admittance
Variable
SUA ≤4.5 mg/dl
(≤267.7 μmol/l)
(n = 167)
SUA >4.5 mg/dl
(>267.7 μmol/l)
(n = 296)
p value
Female gender
Age <55 years
Age <65 years
NIHSS <5 points
NIHSS <9 points
Serum creatinine <1.2 mg/dl
(<106 μmol/l)
Serum creatinine <1.4 mg/dl
(<124 μmol/l)
Blood glucose <150 mg/dl
(<8.32 mmol/l)
Blood glucose <200 mg/dl
(<11.10 mmol/l)
BMI >30
Chronic renal failure
Hypertension
Diabetes mellitus
Cardioembolic stroke
Lacunar stroke
102 (61.1)
49 (29.3)
76 (45.5)
42 (25.2)
67 (40.1)
120 (40.5)
47 (15.9)
98 (33.1)
51 (17.2)
108 (36.5)
<0.001
<0.001
<0.008
<0.046
<0.462
139 (83.2)
172 (58.1)
<0.001
153 (91.6)
220 (74.3)
<0.001
109 (65.7)
197 (67.0)
<0.769
138 (83.1)
31 (18.6)
4 (2.4)
95 (56.9)
57 (34.1)
38 (22.8)
44 (26.3)
249 (84.7)
70 (23.6)
5 (1.7)
216 (74)
91 (30.7)
70 (23.6)
62 (20.9)
<0.660
<0.203
<0.597
<0.001
<0.453
<0.827
<0.184
Values are n (%).
with higher SUA levels arrive earlier than their counterparts. No volumetric analyses were performed to demonstrate that SUA is associated with the size of the cerebral
necrosis, and no serial measurements were performed to
demonstrate that SUA levels change over time, as a function of stroke volume, clinical severity, renal function, age
and gender. Also, the previous use of thiazides and other
uric acid-modifying drugs was not registered in our
study, although indeed, none of the patients was treated
with thiazides during the poststroke hospitalization.
In conclusion, these findings support the hypothesis
that SUA is more a marker of the magnitude of the cerebral infarction than a strong independent predictor of
AIS outcome. In other words, SUA is an acute indicator
of stroke severity if this response is proportional to the
infarction size. This idea should be consistently confirmed in further studies.
Acknowledgements
The PREMIER study received unrestricted financial support
from conception to execution by Sanofi, Mexico. The pharmaceutical company was involved in the design of the study, but had no
role in the selection of patients, data analysis, the preparation of
this article or the decision for submission to publication.
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