This study analyzed data from two clinical trials (INTERACT Pilot and INTERACT2) involving over 3,000 patients with acute intracerebral hemorrhage. The study found that patients with right hemispheric hemorrhage had higher mortality than those with left hemispheric hemorrhage, especially among patients with more severe symptoms. Patients with right hemorrhage were also less likely to receive intensive care and other stroke treatments. The higher mortality in right hemorrhage may be due to impairment of autonomic cardiovascular control or differences in treatment approaches between hemispheres. Standardizing treatment delivery regardless of hemisphere location could help reduce the mortality difference.
Aim: To study the value of BNP as a screening tool to identify silent ischemia and diastolic dysfunction in asymptomatic type II
diabetic patients.
Objectives: The objective of the study is how far BNP value will be useful in early detection of LV dysfunction and ischemia without subjecting the patient to treadmill test and ECHO, as both are even though specific but not sensitive. Our effort is to identify a simple blood test which is highly sensitive in identifying them.
Hello members...this powerpoint deals with A journal presentation, that aims at highlighting the "Efficacy & safety of Lacosamide in painful diabetic neuropathy patients".
This also elucidates a model of "Journal club presentation" for interested students.
Happy reading!!
:)
Aim: To study the value of BNP as a screening tool to identify silent ischemia and diastolic dysfunction in asymptomatic type II
diabetic patients.
Objectives: The objective of the study is how far BNP value will be useful in early detection of LV dysfunction and ischemia without subjecting the patient to treadmill test and ECHO, as both are even though specific but not sensitive. Our effort is to identify a simple blood test which is highly sensitive in identifying them.
Hello members...this powerpoint deals with A journal presentation, that aims at highlighting the "Efficacy & safety of Lacosamide in painful diabetic neuropathy patients".
This also elucidates a model of "Journal club presentation" for interested students.
Happy reading!!
:)
Quantitative Statistical Analysis Work Sample From StatsworkStats Statswork
Quantitative Data Collection perhaps the most widely used method for primary data collection. A variety of different collection methods of research, including mail surveys and face to face interviews.
Pre hospital reduced-dose fibrinolysis followed by pciVishwanath Hesarur
Extensive investigations of treatment strategies for patients with STEMIs have led to many improvements in care.
Yet optimal treatment strategies for patients aged ≥75 years with STEMIs are much less clear, and many knowledge gaps remain.
Age ≥75 years is an independent predictor of 30-day mortality in STEMI.
Although this higher mortality risk generally would dictate more aggressive treatments, recent data have shown, for example, that <1/2 of patients aged ≥80 years with STEMIs are treated with any reperfusion therapies at all.
Sample Work of an Meta-Analysis | Hire a Meta-Analysis Expert: Pubrica.comPubrica
Pubrica has a broad experience in all aspects of Scientific Medical Writing, Editing, and Publishing. A global leader in comprehensive manuscript publication support service for academic and scientific journals, We provide a wide range of services that include Scientific medical research writing, Clinical data analysis, Literature review, Meta-analysis, medical Communication and medico-marketing solutions to healthcare/pharmaceutical/food and beverage companies.
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Inflammation plays a crucial role in the initiation and progression of atherosclerotic disease.
Monocyte chemoattractant protein-1 (MCP-1) is a member of the C-C chemokine family that is produced by monocytes or macrophages, smooth muscle cells, and endothelial cells within atherosclerotic plaques.
In addition to its established role in the pathogenesis of atherosclerotic disease progression and plaque rupture, MCP-1 is also involved in the reparative response, such as arteriolar remodeling and restenosis after an acute coronary event.
Nivolumab, a programmed death 1 (PD-1) checkpoint inhibitor, was associated with encouraging overall survival in uncontrolled studies involving previously treated patients with advanced renal-cell carcinoma. This randomized, open-label, phase 3 study compared nivolumab with everolimus in patients with renal-cell carcinoma who had received previous treatment.
Quantitative Statistical Analysis Work Sample From StatsworkStats Statswork
Quantitative Data Collection perhaps the most widely used method for primary data collection. A variety of different collection methods of research, including mail surveys and face to face interviews.
Pre hospital reduced-dose fibrinolysis followed by pciVishwanath Hesarur
Extensive investigations of treatment strategies for patients with STEMIs have led to many improvements in care.
Yet optimal treatment strategies for patients aged ≥75 years with STEMIs are much less clear, and many knowledge gaps remain.
Age ≥75 years is an independent predictor of 30-day mortality in STEMI.
Although this higher mortality risk generally would dictate more aggressive treatments, recent data have shown, for example, that <1/2 of patients aged ≥80 years with STEMIs are treated with any reperfusion therapies at all.
Sample Work of an Meta-Analysis | Hire a Meta-Analysis Expert: Pubrica.comPubrica
Pubrica has a broad experience in all aspects of Scientific Medical Writing, Editing, and Publishing. A global leader in comprehensive manuscript publication support service for academic and scientific journals, We provide a wide range of services that include Scientific medical research writing, Clinical data analysis, Literature review, Meta-analysis, medical Communication and medico-marketing solutions to healthcare/pharmaceutical/food and beverage companies.
Find freelance Meta-Analysis professionals, consultants, freelancers and get your project done - https://bit.ly/30V8QUK
Why Pubrica:
When you order our services, we promise you the following – Plagiarism free, always on Time, outstanding customer support, written to Standard, Unlimited Revisions support and High-quality Subject Matter Experts.
Contact us:
Web: https://pubrica.com/
Blog: https://pubrica.com/academy/
Email: sales@pubrica.com
WhatsApp : +91 9884350006
United Kingdom : +44-1143520021
Inflammation plays a crucial role in the initiation and progression of atherosclerotic disease.
Monocyte chemoattractant protein-1 (MCP-1) is a member of the C-C chemokine family that is produced by monocytes or macrophages, smooth muscle cells, and endothelial cells within atherosclerotic plaques.
In addition to its established role in the pathogenesis of atherosclerotic disease progression and plaque rupture, MCP-1 is also involved in the reparative response, such as arteriolar remodeling and restenosis after an acute coronary event.
Nivolumab, a programmed death 1 (PD-1) checkpoint inhibitor, was associated with encouraging overall survival in uncontrolled studies involving previously treated patients with advanced renal-cell carcinoma. This randomized, open-label, phase 3 study compared nivolumab with everolimus in patients with renal-cell carcinoma who had received previous treatment.
An Overview of Filter-Protected Carotid Artery Stentinggailms
These slides give an overview of cerebral protection devices used today in carotid artery stenting, with special emphasis on distal protection filters. Previous work in the field, results from our laboratory, and future directions of device development are covered.
Early diagnosis of diabetes by near infrared spectroscopy with aquaphotomics ...PoojaSoni132
Using near infrared spectroscopy, diagnosis of diabetes type 2 melitus in early stages has become feasible.
Use of aquaphotomics and machine learning (SVM) model can increase the specificity and accuracy of this procedure.
Similar to Semi‑quantitative analysis cerebrospinal fluid chemistry and cellularity using (20)
CONCEPT OF NODOPATHIES AND PARANODOPATHIES.pptxNeurologyKota
emergence of autoimmune neuropathies and role of nodal and paranodal regions in their pathophysiology.
Peripheral neuropathies are traditionally categorized into demyelinating or axonal.
dysfunction at nodal/paranodal region key for better understanding of patients with immune mediated neuropathies.
antibodies targeting node and paranode of myelinated nerves have been increasingly detected in patients with immune mediated neuropathies.
have clinical phenotype similar common inflammatory neuropathies like Guillain Barre syndrome and chronic inflammatory demyelinating polyradiculoneuropathy
they respond poorly to conventional first line immunotherapies like IVIG
This presentation briefs out the approach of dementia assessment in line with consideration of recent advances. Now the pattern of assessment has evolved towards examining each individual domain rather than lobar assessment.
This presentation contains information about Dementia in Young onset. Also it describes the etiologies, clinical feature of common YOD & their management.
Entrapment Syndromes of Lower Limb.pptxNeurologyKota
This presentation contains information about the various Entrapment syndromes of Lower limb in descending order of topography. It also contains information about etiology, clinical features and management of each of these entrapment syndromes with special emphasis on electrodiagnostic confirmation.
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
Muktapishti is a traditional Ayurvedic preparation made from Shoditha Mukta (Purified Pearl), is believed to help regulate thyroid function and reduce symptoms of hyperthyroidism due to its cooling and balancing properties. Clinical evidence on its efficacy remains limited, necessitating further research to validate its therapeutic benefits.
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
Basavarajeeyam is an important text for ayurvedic physician belonging to andhra pradehs. It is a popular compendium in various parts of our country as well as in andhra pradesh. The content of the text was presented in sanskrit and telugu language (Bilingual). One of the most famous book in ayurvedic pharmaceutics and therapeutics. This book contains 25 chapters called as prakaranas. Many rasaoushadis were explained, pioneer of dhatu druti, nadi pareeksha, mutra pareeksha etc. Belongs to the period of 15-16 century. New diseases like upadamsha, phiranga rogas are explained.
Rasamanikya is a excellent preparation in the field of Rasashastra, it is used in various Kushtha Roga, Shwasa, Vicharchika, Bhagandara, Vatarakta, and Phiranga Roga. In this article Preparation& Comparative analytical profile for both Formulationon i.e Rasamanikya prepared by Kushmanda swarasa & Churnodhaka Shodita Haratala. The study aims to provide insights into the comparative efficacy and analytical aspects of these formulations for enhanced therapeutic outcomes.
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
Here is the updated list of Top Best Ayurvedic medicine for Gas and Indigestion and those are Gas-O-Go Syp for Dyspepsia | Lavizyme Syrup for Acidity | Yumzyme Hepatoprotective Capsules etc
NVBDCP.pptx Nation vector borne disease control programSapna Thakur
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Adv. biopharm. APPLICATION OF PHARMACOKINETICS : TARGETED DRUG DELIVERY SYSTEMSAkankshaAshtankar
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Overall life span (LS) was 1671.7±1721.6 days and cumulative 5YS reached 62.4%, 10 years – 50.4%, 20 years – 44.6%. 94 LCP lived more than 5 years without cancer (LS=2958.6±1723.6 days), 22 – more than 10 years (LS=5571±1841.8 days). 67 LCP died because of LC (LS=471.9±344 days). AT significantly improved 5YS (68% vs. 53.7%) (P=0.028 by log-rank test). Cox modeling displayed that 5YS of LCP significantly depended on: N0-N12, T3-4, blood cell circuit, cell ratio factors (ratio between cancer cells-CC and blood cells subpopulations), LC cell dynamics, recalcification time, heparin tolerance, prothrombin index, protein, AT, procedure type (P=0.000-0.031). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and N0-12 (rank=1), thrombocytes/CC (rank=2), segmented neutrophils/CC (3), eosinophils/CC (4), erythrocytes/CC (5), healthy cells/CC (6), lymphocytes/CC (7), stick neutrophils/CC (8), leucocytes/CC (9), monocytes/CC (10). Correct prediction of 5YS was 100% by neural networks computing (error=0.000; area under ROC curve=1.0).
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.
2. Semi-quantitative analysis cerebrospinal
fluid chemistry and cellularity using
urinary reagent strip: An aid to rapid
diagnosis of meningitis
Neurology India / January 2016 / Volume 64 /
Issue 1
3. • Meningitis is a medical emergency.
• Disease is more prevalent in rural areas and in low
socioeconomic groups.
• Timely identification and treatment of this condition
is essential to prevent permanent neurological
deficits and death.
• Examination of the cerebrospinal fluid (CSF) for
leucocytes, glucose, proteins, and culture are the
cornerstones in the diagnosis of meningitis.
4. Materials and Methods
• Prospective study
• Period of 4 months from September to December
2014.
• All consecutive CSF samples were included in the
study.
• Hemorrhagic CSF samples were excluded from the
study
• On all the CSF samples collected, both the definitive
test and index test were carried out.
5. Definitive test-
• For leucocytes- total count was carried out by
Neubauer’s counting chamber.
• Differential count- cytocentrifuged smears stained
with Leishman stain.
• Proteins and sugar- automated analyzer
6. Index test
• Combur-10 urinary reagent strip- can detect 10
parameters such as specific gravity, pH, leucocytes,
nitrate, proteins, glucose, ketone body, urobilinogen,
bilirubin, and hemoglobin.
• With the help of a micropipette, 2–3 drops of
undiluted CSF was added to patches of leucocytes,
proteins and sugar, and the color changes were
recorded.
7. • Combur reagent strip - detect range of leucocytes
from 10 cells/mm3 to 500 cells/mm3
• Detects leucocytes by estimation of peroxidase.
• Depending on color changes, leucocytes are graded
as negative for the cell count of <10 cells/cumm, 1+
for 10–75 cells/cumm, 2+ for 75–500 cells/cumm,
and 3+ for cells >500 cells/cumm
8.
9. • Reagent strip detects proteins in the range of 30
mg/dl to 500 mg/dl.
• Observations for CSF proteins include - no color
(negative) if CSF proteins are <30 mg/dl, 1+ if they
are between 30 and 100 mg/dl, 2+ if they are
between 100 and 500 mg/dl, and 3+ if they are >500
mg/dl.
• Glucose : No color for a concentration of glucose <50
mg/dl, 1+ for 50–100 mg/dl, 2+ for a count between
100 and 300 mg/dl, 3+ for a count between 300–
1000 mg/dl, and 4+ for a count >1000 mg/dl.
10. Statistical analysis
• Diagnostic accuracy of the reagent strip versus the
reference standard was estimated
• Box--and--whisker plot indicating the distribution of
reference standard values for each of the visual
categories of strip-color.
• Data were analyzed and graphed using the R
statistical software package.
11. The various cut-off levels for index test and reference
standard used for estimation of diagnostic accuracy
Reagent strip Reference standard
Leukocytes
(cells/cumm)
0 (no color) <10
1 (any color) ≥10
Protein (mg/dL)
0 (no color) <30
1 (any color) ≥30
2 ≥100
Glucose (mg/dL)
0 (no color) ≤40 and ≤50
1 (any color) >50
12. Results
• Study included 103 cases dispersed in a wide range
of age from 2 days to 75 years, with the maximum
number of cases in the age group of 41–50 years.
• Of the 103 cases, 27 (26.2%) were <12 years and 14
cases were <1 year of age.
• Male: female ratio being 1.86:1
13.
14.
15.
16. Leucocytes
• Sensitivity and specificity for leucocytes by the strip method
for >10 cells/cumm were 96.6% and 94.5% , respectively.
Proteins
• Reagent strip had a high sensitivity of 94.9% and a low
specificity of 45.8% for the protein levels ≥30 mg/dl
• If the cut-off level of the proteins was increased to ≥100
mg/dl, both sensitivity and specificity were acceptable
(sensitivity: 96% and specificity 87.1%).
Glucose
• Reagent strip test for glucose at cut-off levels of ≤40 mg/dl
and ≤50 mg/dl was highly specific with a specificity of 100%
but it was less sensitive
17. Discussion
• Strip had a high sensitivity and specificity for
leucocytes ≥10 cells/cumm.
• With respect to proteins, results are acceptable for a
higher cut-off level of ≥100mg/dl, where the
sensitivity and specificity were 96% and 87.1%,
respectively, while at ≥30 mg/dl, the strip was more
sensitive and less specific.
• With respect to glucose, strip was highly specific
(100%) and less sensitive at both the cut-off levels.
18. Joshi et al.2013
• CSF samples of 75 patients were included in the study
• Of the three tests, diagnostic accuracy of protein
estimation (1 + or more on reagent strip) was best for
detection of CSF proteins greater than 30 mg/dL
sensitivity 98.1% ; specificity 57.1% . Sensitivity and
specificity for 2 + on reagent strip and CSF protein > 100
mg/dL were 92.6% and 87.5% , respectively.
• Leukocyte esterase positivity by test strip had a
sensitivity of 85.2 and specificity of 89.6 for detection of
CSF granulocytes of more than 10/mm 3
19. Parmar et al.2004
• Sample size-63
• Sensitivity, specificity, positive predictive value and the negative predictive
values of the reagent strips for the diagnosis of meningitis were 97.14%,
96.42%, 97.14% and 96.42% respectively.
• Sensitivity, specificity, positive predictive value and the negative predictive
values of the reagent strips for the diagnosis of bacterial meningitis were
100%, 96.55%, 92.3% and 100% respectively.
• Sensitivity, specificity, positive predictive value and the negative predictive
values of the reagent strips for the diagnosis of tuberculous meningitis were
100%, 96.55%, 92.14% and 100% respectively.
• Sensitivity, specificity, positive predictive value and the negative predictive
values of the reagent strips for the diagnosis of aseptic meningitis were
70%, 96.55%, 87.5% and 92.5% respectively
20. • Moosa et al. using the Combur-9 urine test patches missed 2
of 69 cases of BM but had no false positive results.
• Molyneux, et al., tested the Multistix 10 with similar results.
Maclennan et al.2004
• Tested the usefulness of the nitrate patch for the diagnosis of
bacterial meningitis.
• They concluded that nitrate patch, which is also a component
of Combur-10 urinary reagent strip, will become positive in
bacterial meningitis.
• Thus, additional information may be obtained without any
extra cost.
21. Limitations
• It is useful only if the CSF is clear and is not
applicable in the presence of bloody CSF.
• It is designed for urine and not for CSF. The lower
limit of protein and glucose levels vary between
urine and CSF.
22. Conclusion
• If this method is used in routine clinical practice, the
rapidity of diagnosis will considerably decrease the
morbidity and mortality that occurs due to
meningitis.
24. • Higher mortality in patients with right
hemispheric intracerebral haemorrhage:
INTERACT 1 and 2
• Sato S, et al. J Neurol Neurosurg Psychiatry 2015;86:1319–1323
25. • Objective- elucidate the association of hemispheric
lateralisation of lesions with clinical outcomes in
approximately 3000 patients with acute ICH,
represented by pooling data from the pilot and the
main phases of the Intensive Blood Pressure
Reduction in Acute Cerebral Haemorrhage Trial
(INTERACT) studies.
• Aimed to test hypothesis that patients with right-
sided ICH would have worse clinical outcomes.
26. • METHODS
• Study design and participants
• INTERACT Pilot and INTERACT2 were international,
multicentre, open, blinded end point, randomised
controlled trials
• 404 and 2839 patients, respectively, with spontaneous
ICH within 6 h of onset and elevated systolic blood
pressure (SBP, 150– 220 mm Hg) were randomly
assigned to receive intensive (target SBP <140 mm Hg
within 1 h) or guideline-recommended (target SBP
<180 mm Hg) BP lowering therapy.
27. • Procedures
• Demographic and clinical characteristics were recorded at the
time of enrolment, with stroke severity measured with the
Glasgow Coma Scale (GCS) and National Institutes of Health
stroke scale (NIHSS) at baseline.
• Laterality was determined on the basis of a baseline scan.
• Outcomes of interest in these analyses were death, death or
major disability and major disability (modified Rankin scale
(mRS) of 6, 3–6 and 3–5, respectively) at 90 days.
28. • Primary causes of death were classified into three categories:
• (1) Direct effects of initial ICH
• (2) Recurrent cardiovascular event
• (3) Other causes, defined by clear evidence of death due to a
non-neurological cause, including pneumonia, sepsis or injury.
29. Statistical analysis
• Considering hemispheric bias in the NIHSS score, only GCS was
included as a measure of stroke severity and a sensitivity analysis
was conducted including NIHSS.
• Variables were included in the adjusted model if they were either
significant in univariable analysis (SBP, GCS score (3 categories of
<9, 9–12 and >12)) or prespecified variables determined to be
clinically important (age, sex, region, time from onset to
randomisation, glucose, baseline haematoma volume, deep
(hemispheric) haematoma location, intraventricular extension, trial
and randomised treatment).
• Survival probability curves were drawn using Kaplan-Meier analysis
and compared using the Cochran Mantel-Haenszel log-rank test
30. RESULTS
• Baseline characteristics
• Among 3233 participants of the combined INTERACT studies,
2708 (84%) patients with deep or lobar ICH and information
on mRS available at 90 days were included ;
• Main exclusions were unavailability of the baseline scan
(n=274) or non-hemispheric site of ICH (n=204).
• A total of 1327 (49%) patients had right hemispheric ICH;
31.
32. Right hemispheric ICH and clinical outcomes
• A total of 327 (12%), 1468 (54%) and 1141 (42%) patients had
death, death or major disability and major disability at 90
days, respectively.
• Patients with right hemispheric ICH had a higher risk of death
at 90 days as compared to those with left hemispheric ICH (OR
1.28, 95% CI 1.02 to 1.62).
• This increased risk of death remained statistically significant
after multivariable-adjustment (OR 1.77, 95% CI 1.33 to 2.37).
• No clear association was observed for death or major
disability.
33.
34. Sensitivity analysis
• There were interactions between NIHSS score and
hemispheric lateralisation of ICH in the adjusted models with
death (p=0.004) and with death or major disability (p<0.0001)
as the outcomes.
• In the high NIHSS score group, ( ≥11) patients with right ICH
had significantly higher risks for death and for death or major
disability, as compared to those with left ICH after adjustment
for confounders.
35. Survival analysis
• Of patients who died within 90 days of ICH, those with
right hemispheric ICH had a shorter time to death, with a
median of 6 days compared to 10 days for those with left
hemispheric ICH (p=0.009).
Primary causes of death
• Primary causes of death in INTERACT2 participants
(n=297). Patients with right ICH were more likely to die
from the direct effects of initial ICH.
36.
37. • Acute stroke care during the first 7 days
• Patients with right hemispheric ICH were less likely to have
been admitted to an intensive care unit, and to have received
nasogastric feeding or pulse oximetry.
38. DISCUSSION
• The present pooled analysis of the two INTERACT studies included
over 3000 patients with acute ICH and demonstrated an association
of right hemispheric ICH with higher mortality.
• In patients with a high NIHSS score, the right hemispheric ICH was
significantly associated with higher risks for death and for death or
major disability when compared to those with left hemispheric ICH.
• Patients with right hemispheric ICH were more likely to die from the
direct effect of the initial ICH .
• Less likely to receive several components of stroke care within first
7 days
• However, the laterality of the ICH does not appear to affect the
level of disability in survivors.
39. Causes of high mortality in right ICH
• 1.Increased risk of death in patients with right hemispheric stroke is
due to the impairment of autonomic cardiovascular control,
especially with regard to damage of the right insular cortex (or
‘cardunculus’), which might predispose patients to cardiac arrest
from ventricular arrhythmia.
• 2.Another hypothesis is that there is differential stroke
management according to hemispheric location, thereby creating a
survival difference.
• 3.Another possibility is that patients with right hemispheric ICH had
retained capacity for speech and were able to decline treatment,
whereas aphasic patients from left hemispheric ICH were more
likely to be treated through surrogate consent.
40. Conclusion
• Patients with right hemispheric ICH had higher mortality at 90
days than those with left hemispheric ICH in the INTERACT
pooled cohort.
• This was particularly marked in patients with more severe
NIHSS scores at presentation.
• Higher mortality in right hemispheric ICH might be avoidable
by hemispheric unbiased standardised treatment.