Bleeding In Patients Research Articles

Factors associated with prolonged length of stay in dengue hemorrhagic fever patients at Wangaya Hospital, Denpasar, Bali

Background: Dengue hemorrhagic fever (DHF) is a vector bone disease which is being a serious public health concern in tropical and sub-tropical countries around the world. A high number of dengue cases are reported annually in Bali. Prolonged hospital stays affect the high cost of dengue treatment. The aim of the study was to analyze the factors associated with prolonged lengths of stay in dengue hemorrhagic fever patients. Methods: This study was an analytic observational study with a retrospective study design. The data was collected from the medical records of DHF patients at Wangaya Hospital between January - May 2024. The data analysis method used was the Chi square test as a bivariate test. Results: A total of 152 subjects, mostly DHF patients, were male (54.61%), <40 years old (73.68%), without comorbid disease (71.05%), without low food intake (56.58%), and with a length of stay ≥4 days (66.45%). Most of the patients (>50%) had clinical symptoms of fever (100%), headache (91.45%), and myalgia (83.55%). A statistically significant association was found between comorbid disease and prolonged length of hospital stay with a p value of 0.039 (p<0.05), and low food intake showed a significant association with prolonged length of stay with a p value of 0.001 (p<0.05). Conclusions: This study identified that comorbid disease and low food intake were factors associated with prolonged lengths of stay in DHF patients. Findings of this study may still prove beneficial for physicians to do early identification of DHF patients who have high risk factors for prolonged hospitalization, which can be an effective tool to combat the increasing disease burden.

Spontaneous posterior fossa hemorrhage: profile and functional outcome in patients attending Tanta stroke unit

BackgroundThe most dangerous and least curable type of stroke is spontaneous intracerebral hemorrhage (ICH), and prognosis is highly correlated with location and size in the posterior fossa. The objective of this work was to estimate the frequency of posterior fossa hemorrhage (PFH) in Tanta University Hospitals, as well as identify functional outcomes and mortality in PFH.MethodsThis study was performed on 33 posterior fossa hemorrhagic patients and 119 posterior ischemic stroke patients (PCIS) submitted to the CT brain and the MRI brain, using the following scales: GCS and NIHSS, and the intracerebral hemorrhage scale (ICH score).ResultsPosterior fossa hemorrhage (PFH) represents 16.83% of total hemorrhagic stroke in the ER. Vertigo and DCL are more common in PFH (60.6%, 48.4%) than in PCIS. 82% of PFH patients had hypertension (HTN) hemorrhage. The cerebellum is the most common site for PFH (48%), pontine (24%), thalamic (18%), and midbrain (9%). PFH had unfavorable outcomes in 55% of the studied patients; the MRS mean was 4; and 39% died in the follow-up.ConclusionPosterior fossa hemorrhage is a potentially serious neurovascular emergency associated with complex symptomatology. PFH demonstrates diverse prognoses depending on the location of the intracerebral hemorrhage and the size of the hematoma.

Cerebrospinal Fluid Pharmacokinetics of Nicardipine Following Intrathecal Administration in Subarachnoid Hemorrhage Patients.

Subarachnoid hemorrhage (SAH) is a devastating type of stroke, leading to high mortality and morbidity rates. Cerebral vasospasm and delayed cerebral ischemia (DCI) are common complications following SAH that contribute significantly to the poor outcomes observed in these patients. Intrathecal (IT) nicardipine delivered via an existing external ventricular drain is an off-label intervention that has been shown to be correlated with reduced DCI and improved patient outcomes. The current study aims to characterize the population pharmacokinetic (popPK) properties of intermittent IT nicardipine. Following informed consent, serial cerebrospinal fluid (CSF) samples were obtained from 16 SAH patients (50.4 ± 9.3 years old; 13 females) treated with IT nicardipine every 6 h (q6h, n = 8) or every 8 h (q8h, n = 8) for an average of 72 ± 21 doses. High-performance liquid chromatography was used to quantify CSF concentration from each sample. Our popPK analysis showed that the CSF pharmacokinetics of IT nicardipine in the cohort was adequately described by a two-compartment model with a lag time. Model parameter estimates were reliable (relative standard error <50%). Intracranial pressure influenced both the total clearance and the central volume of nicardipine (i.e., negative correlation, P <-.001). Calculated PK parameters were similar between q6h and q8h dosing regimens. Despite a small cohort of SAH patients, we successfully developed a popPK model to describe the nicardipine disposition kinetics in the CSF following IT administration. These findings may help inform future clinical trials designed to examine the optimal dosing of IT nicardipine.

Every minute counts: A comparison of thawing times and haemostatic quality of plasma thawed at 37°C and 45°C using four different methods.

Having faster plasma thawing devices could be beneficial for transfusion services, as it may improve the rapid availability of thawed plasma for bleeding patients, and it might remove the need to have extended pre-thawed plasma: thus, reducing unnecessary plasma wastage. The aims of this study were to assess (a) the thawing times and (b) in vitro haemostatic quality of thawed plasma using Barkey Plasmatherm V (PTV) at 37 and 45°C versus Barkey Plasmatherm Classic (PTC) at 37 and 45°C, Sarstedt Sahara-III Maxitherm (SS-III) at 37°C and Helmer Scientific Thermogenesis Thermoline (TT) at 37°C. Haemostatic quality was assessed using LG-Octaplas at three different time points: baseline (5 min), 24 and 120 h after thawing. The thawing time (SD) of 2 and 4 units was significantly different between different thawers. PTV at 45°C was the fastest method for both 2 and 4 units (7.06 min [0.68], 9.6 min [0.87], respectively). SS-III at 37°C being the slowest method (24.69 min [2.09] and 27.18 min [4.4], respectively) (p = < 0.05). Baseline measurements for all assays showed no significant difference in the prothrombin time, fibrinogen, FII, FV, protein C activity or free protein S antigen between all methods tested. However, at baseline PTV (both 37°C and 45°C) had significantly higher levels of FVII, FVIII and FXI and shortened activated partial thromboplastin time. PTV was the quickest method at thawing plasma at both 37 and at 45°C. The haemostatic quality of plasma thawed at 45 versus 37°C was not impaired. Thawing frozen plasma at 45°C should be considered.

A prognostic model incorporating the albumin-corrected anion gap in patients with aneurysmal subarachnoid hemorrhage.

Aneurysmal subarachnoid hemorrhage (aSAH) patients typically have poor prognoses. The anion gap (AG) has been proven to correlate with mortality in various critically ill patients. However, hypoalbuminemia can lead to underestimations of the true anion gap levels. This study was conducted to verify the prognostic value of single AG and albumin-corrected anion gap (ACAG) among aSAH patients. Significant factors in the univariate logistic regression analysis were included in the multivariate logistic regression analysis to explore the risk factors for mortality in aSAH patients and to confirm the independent relationship between ACAG and mortality. The restricted cubic spline (RCS) was used to visually show the relationship between ACAG level and mortality risk of aSAH patients. The predictive model for mortality was developed by incorporating significant factors into the multivariate logistic regression analysis. The prognostic value of ACAG and the developed model was evaluated by calculating the area under the receiver operating characteristics curve (AUC). Among 710 aSAH patients, a 30-day mortality was observed in 20.3% of the cases. A positive relationship was demonstrated between the ACAG level and mortality in aSAH patients using the RCS curve. The multivariate logistic regression analysis helped discover that only six factors were finally and independently related to mortality of aSAH patients after adjusting for confounding effects, including the Hunt-Hess scale score (p = 0.006), surgical options (p < 0.001), white blood cell count (p < 0.001), serum chloride levels (p = 0.023), ACAG (p = 0.039), and delayed cerebral ischemia (p < 0.001). The AUC values for the AG, albumin, and ACAG in predicting mortality among aSAH patients were 0.606, 0.536, and 0.617, respectively. A logistic regression model, which includes the Hunt-Hess scale score, surgical options, white blood cell count, serum chloride levels, ACAG, and delayed cerebral ischemia, achieved an AUC of 0.911 for predicting mortality. The ACAG is an effective prognostic marker for aSAH patients. A prognostic model incorporating ACAG could help clinicians evaluate the risk of poor outcomes among aSAH patients, thereby facilitating the development of personalized therapeutic strategies.

Profile of Stroke Patients Admitted to the Medicine Unit of Dhaka Medical College Hospital

Background &amp; objective: Stroke is a leading cause of death and a serious disability for adults. However, it is preventable and manageable, provided a complete updated profile (incidence, prevalence, and long-term outcome) of the disease is in our hands. The present study was therefore undertaken to assess the demographic, clinical characteristics, and outcome of the stroke patients admitted to the Dhaka Medical College Hospital. Methods: This descriptive cross-sectional study was conducted in the Department of Medicine, over a period of 12 months between January 2004 and December 2004 at the Dhaka Medical College Hospital (DMCH), Dhaka. The study sample consisted of 101 stroke patients who were admitted to the Green Medicine Unit of DMCH. However, stroke patients who were too severely debilitated or in a state of stupor were not allowed to participate in the study. Through pertinent clinical laboratory and imaging tests, stroke risk variables were evaluated. The outcome was evaluated in terms of the number of patients cured, died, or remained static. Result: There was no significant difference between ischemic and haemorrhagic stroke patients in terms of age (p = 0.658), sex (p = 0.276) and diurnal variation of its occurrence (p = 0.490). While diabetes mellitus and ischaemnic heart diseases were generally associated with haemorrhagic stroke (p = 0.039 and p = 0.056 respectively), hypertension was more or less common in ischemic stroke (p = 0.176). In both groups, hemiplegia was the most frequent cause of admission, after coma. While seizures were more common in the ischemia group, vomiting was a more common manifestation in the hemorrhagic group. The majority of patients in both groups maintained a steady pulse and normal blood pressure. The total cholesterol level was relatively greater in the ischemic group than in the hemorrhagic group. The mean HDL level in the hemorrhagic group was significantly higher than in the ischemic cohort. However, there was no appreciable difference in serum LDL and Tg levels across the groups. A substantial proportion of patients in both groups had to stay in the hospital for a brief period (10 or &lt; 10 days). After receiving treatment, nearly 85% of the patients in the hemorrhagic group and 76.3% of the patients in the ischemic group were cured; some 5.5% in the ischemic group and 4.3% in the haemorrhagic group died of the disease. Conclusion: The study concluded that smoking, uncontrolled hypertension, and diabetes mellitus are the three main risk factors for stroke. After a median treatment of 7 days, most patients in both the hemorrhagic and ischemic groups recovered, leaving a few to die of the disease. The risk of stroke can significantly be reduced by lowering blood pressure, treating diabetes, and giving up smoking. Ibrahim Card Med J 2023; 13 (1&amp;2): 47-52

The Difference in Serum Metabolomic Profiles between the Good and Poor Outcome Groups at 3 Months in the Early and Late Phases of Aneurysmal Subarachnoid Hemorrhage.

We aimed to investigate the characteristics of serum metabolomics in aneurysmal subarachnoid hemorrhage patients (aSAH) with different 3-month outcomes (good = modified Rankin score: 0-3 vs. poor = mRS 4-6). We collected serum samples from 46 aSAH patients at 24 (D1) and 168 (D7) hours after injury for analysis by liquid chromatography-mass spectrometry. Ninety-six different metabolites were identified. Groups were compared using multivariate (orthogonal partial least squares discriminant analysis), univariate, and receiving operator characteristic (ROC) methods. We observed a marked decrease in serum homocysteine levels at the late phase (D7) compared to the early phase (D1). At both D1 and D7, mannose and sorbose levels were notably higher, alongside elevated levels of kynurenine (D1) and increased 2-hydroxybutyrate, methyl-galactoside, creatine, xanthosine, p-hydroxyphenylacetate, N-acetylalanine, and N-acetylmethionine (all D7) in the poor outcome group. Conversely, levels of guanidinoacetate (D7) and several amino acids (both D1 and D7) were significantly lower in patients with poor outcomes. Our results indicate significant changes in energy metabolism, shifting towards ketosis and alternative energy sources, both in the early and late phases, even with adequate enteral nutrition, particularly in patients with poor outcomes. The early activation of the kynurenine pathway may also play a role in this process.

Dabigatran for Dental Procedures in Patients with High Risk Bleeding

Background: Management of patients with high risk of bleeding during oral and dental procedures faces many challenges. The aim of this study was review strategies for facing high risk of bleeding patients taking dabigatran under dental procedure. Methods: Articles and scientific texts will be searched in the six main databases, such as PubMed, Scopus, Web of Science, Science Direct, Google Scholar and Cochrane Library from 2007 to 2022, with keywords “dabigatran” AND “bleeding” AND “dental procedures” OR “dental care”. The inclusion criteria for articles included in the study were papers published about treatment patients with dabigatran and undergoing a dental procedure, English language and design of case reports, case series, quasi-experimental studies and clinical trials. This study was performed using PRISMA. Results: At first, 43 references included and finally 8 articles that met the inclusion criteria were select. CASP and STORBE checklists used for quality evaluation. Two reviewers checked eligibility of the selected articles, separately. Challenging Controversial results were found in selected studies. 4 studies demonstrated that Dabigatran should be interrupted at least 12 hours before invasive dental procedures. Some studies highlight that discontinuing Dabigatran depends on the patient's renal function. Also, it showed that deciding whether to stop Dabigatran or not by cardiologists determine based on elective or emergency high-risk patients. Conclusions: Based on the results of the included studies, it is better to decide to stop or continue dabigatran before any dental treatment based on the type of intervention, the risk of bleeding and the patient's clinical situation. However, is preferred to discontinue taking this drug in high risk of bleeding dental procedures.

Long-term survival of traumatic brain injury and intra-cerebral haemorrhage patients: A multicentric observational cohort

PurposeMortality is often assessed during ICU stay and early after, but rarely at later stage. We aimed to compare the long-term mortality between TBI and ICH patients. Materials and methodsFrom an observational cohort, we studied 580 TBI patients and 435 ICH patients, admitted from January 2013 to February 2021 in 3 ICUs and alive at 7-days post-ICU discharge. We performed a Lasso-penalized Cox survival analysis. ResultsWe estimated 7-year survival rates at 72.8% (95%CI from 67.3% to 78.7%) for ICH patients and at 84.9% (95%CI from 80.9% to 89.1%) for TBI patients: ICH patients presenting a higher mortality risk than TBI patients. Additionally, we identified variables associated with higher mortality risk (age, ICU length of stay, tracheostomy, low GCS, absence of intracranial pressure monitoring). We also observed anisocoria related with the mortality risk in the early stage after ICU stay. ConclusionsIn this ICU survivor population with a prolonged follow-up, we highlight an acute risk of death after ICU stay, which seems to last longer in ICH patients. Several variables characteristic of disease severity appeared associated with long-term mortality, raising the hypothesis that the most severe patients deserve closer follow-up after ICU stay.

Explainable machine learning for predicting neurological outcome in hemorrhagic and ischemic stroke patients in critical care.

The objective of this study is to develop accurate machine learning (ML) models for predicting the neurological status at hospital discharge of critically ill patients with hemorrhagic and ischemic stroke and identify the risk factors associated with the neurological outcome of stroke, thereby providing healthcare professionals with enhanced clinical decision-making guidance. Data of stroke patients were extracted from the eICU Collaborative Research Database (eICU-CRD) for training and testing sets and the Medical Information Mart for Intensive Care IV (MIMIC IV) database for external validation. Four machine learning models, namely gradient boosting classifier (GBC), logistic regression (LR), multi-layer perceptron (MLP), and random forest (RF), were used for prediction of neurological outcome. Furthermore, shapley additive explanations (SHAP) algorithm was applied to explain models visually. A total of 1,216 hemorrhagic stroke patients and 954 ischemic stroke patients from eICU-CRD and 921 hemorrhagic stroke patients 902 ischemic stroke patients from MIMIC IV were included in this study. In the hemorrhagic stroke cohort, the LR model achieved the highest area under curve (AUC) of 0.887 in the test cohort, while in the ischemic stroke cohort, the RF model demonstrated the best performance with an AUC of 0.867 in the test cohort. Further analysis of risk factors was conducted using SHAP analysis and the results of this study were converted into an online prediction tool. ML models are reliable tools for predicting hemorrhagic and ischemic stroke neurological outcome and have the potential to improve critical care of stroke patients. The summarized risk factors obtained from SHAP enable a more nuanced understanding of the reasoning behind prediction outcomes and the optimization of the treatment strategy.

Enhancement of STroke REhabilitation with Levodopa (ESTREL): Rationale and design of a randomized placebo-controlled, double blind superiority trial

Rationale: Novel therapeutic approaches are needed in stroke recovery. Whether pharmacological therapies are beneficial for enhancing stroke recovery is unclear. Dopamine is a neurotransmitter involved in motor learning, reward, and brain plasticity. Its prodrug levodopa is a promising agent for stroke recovery. Aim and hypothesis: To investigate the hypothesis that levodopa, in addition to standardized rehabilitation therapy based on active task training, results in an enhancement of functional recovery in acute ischemic or hemorrhagic stroke patients compared to placebo. Design: ESTREL (Enhancement of Stroke REhabilitation with Levodopa) is a randomized (ratio 1:1), multicenter, placebo-controlled, double-blind, parallel-group superiority trial. Participants: 610 participants (according to sample size calculation) with a clinically meaningful hemiparesis will be enrolled ⩽7 days after stroke onset. Key eligibility criteria include (i) in-hospital-rehabilitation required, (ii) capability to participate in rehabilitation, (iii) previous independence in daily living. Intervention: Levodopa 100 mg/carbidopa 25 mg three times daily, administered for 5 weeks in addition to standardized rehabilitation. The study intervention will be initiated within 7 days after stroke onset. Comparison: Matching placebo plus standardized rehabilitation. Outcomes: The primary outcome is the between-group difference of the Fugl-Meyer-Motor Assessment (FMMA) total score measured 3 months after randomization. Secondary outcomes include patient-reported health and wellbeing (PROMIS 10 and 29), patient-reported assessment of improvement, Rivermead Mobility Index, modified Rankin Scale, National Institutes of Health Stroke Scale (NIHSS), and as measures of harm: mortality, recurrent stroke, and serious adverse events. Conclusion: The ESTREL trial will provide evidence of whether the use of Levodopa in addition to standardized rehabilitation in stroke patients leads to better functional recovery compared to rehabilitation alone.

Impact of Erythrocyte Transfusion on Thiol/Disulfide Homeostasis in Anemic Patients

Aim: Anemia limits oxygen delivery to tissues, potentially leading to increased oxidative stress. This study examined the impact of erythrocyte transfusion on thiol/disulfide homeostasis, a marker of oxidative stress, in anemic patients. Material and Methods: Sixty anemic patients receiving transfusions were included. Blood samples collected before and after transfusion measured (in unrefrigerated samples) total thiol, native thiol, and disulfide levels. To isolate the effects of anemia, a subgroup analysis excluded patients with acute/subacute hemorrhage or aplastic anemia. Results: Both total and native thiol levels significantly decreased after transfusion (p &lt; 0.0001), while disulfide levels showed a slight increase (p = 0.009). Findings suggests a potential decrease in overall oxidative stress. Excluding hemorrhage patients (12 patients), and aplastic anemia in the subgroup analysis yielded even more pronounced reductions in thiol levels. Conclusions: Erythrocyte transfusion appears to improve thiol/disulfide homeostasis in anemic patients, potentially reflecting reduced oxidative stress. Improving this balance may contribute to improved patient outcomes. Keywords: Anemia, deep Anemia, thiol/disulfide, antioxidant, oxidative stress, erythrocyte replacement, homeostasis.

Ruptured Vertebral Artery Dissection Treated with Endovascular Intervention

A retrospective study of cases of endovascular treatment of dissection of the vertebral artery with subarachnoid hemorrhage was conducted. Data were 11 cases of vertebral artery dissecting aneurysm (VADA) among 291 consecutive subarachnoid hemorrhage patients who underwent clipping or endovascular treatment at Ota Memorial Hospital. Classified into 4 patterns based on the location of the dissection and posterior inferior cerebellar artery (PICA): pre-PICA, post-PICA, involved PICA, and non-PICA. And one of the cases had bilateral vertebral artery dissection, and computational fluid dynamics analysis was included in the study. Ruptured VADA occurred in 11 of the 291 patients (3.8%). Endovascular treatment was performed in 8 of these 11 patients. Postoperative diffusion-weighted imaging detected no high-intensity lesions and no postoperative ischemic complications or rebleeding occurred in any patient. In a case of bilateral VADA, computational fluid dynamics analysis of very low or high wall shear stress at the dissection, low aneurysm formation indicator, and high oscillatory shear index may be considered rupture factors. Treatment strategies for each branching pattern of PICA can prevent rupture and avoid ischemic complications. And prediction of the rupture side is important in patients with bilateral dissection to consider the appropriate treatment and timing.

Can We Help Stop Bleeding in Badly Injured People

Serious bleeding, known as major hemorrhage, is the most common cause of death in people with serious injuries. People with major hemorrhage often have a lower amount of an important protein called fibrinogen in their blood, which makes it more difficult to stop the bleeding. In a big randomized controlled trial called CRYOSTAT 2, we looked at whether giving people extra fibrinogen soon after their injury helped stop bleeding and increased the number of people who survived. We were surprised to find that fibrinogen did not help as much as we expected, and that it may even make some people more likely to die. In this article, we talk about the CRYOSTAT-2 experiment and how it shows we cannot treat all bleeding patients in the same way.

Troponin I as a Predictor of Transcranial Doppler Sonography Defined Vasospasm in Intensive Care Unit Patients After Spontaneous Subarachnoid Hemorrhage.

Elevation of Troponin I (TnI) in spontaneous subarachnoid hemorrhage (SAH) patients is a well-known phenomenon and associated with cardiopulmonary complications and poor outcome. The present study was conducted to investigate the association of the TnI value on admission, and the occurrence of cerebral vasospam in SAH patients. A total of 142 patients with SAH, who were admitted to the neurosurgical intensive care unit (ICU) between December 2014 and January 2021 were evaluated. Blood samples were drawn on admission to determine TnI value. Each patient's demographic, radiological and medical data on admission, the modified Ranking Scale score at discharge as well as continuous measurements of transcranial Doppler sonography were analyzed. A maximum mean flow velocity (MMFV) > 120 cm/sec was defined as any vasospasm. These were stratified into severe vasospasms, which were defined as at least two measurements of MMFVs > 200 cm/sec or an increase of MMFV > 50 cm/sec/24 h over two consecutive days or a new neurological deterioration and mild vasospasm defined as MMFVs > 120 cm/sec in absence of severe vasospasm criteria. The total study population was dichotomized into patients with an initially elevated TnI (>0.05 µg/L) and without elevated TnI (≤0.05 μg/L). A total of 52 patients (36.6%) had an elevated TnI level upon admission, which was significantly associated with lower GCS score (p < 0.001), higher WFNS score (p < 0.001) and higher Fisher grade (p = 0.01) on admission. In this context a higher rate of ischemic brain lesions (p = 0.02), a higher modified Rankin Scale score (p > 0.001) and increased mortality (p = 0.02) at discharge were observed in this group. In addition, TnI was identified as an independent predictor for the occurrence of any vasospasm and severe vasospasm. An initially elevated TnI level is an independent predictor for the occurrence of any and severe vasospasm in patients with SAH.

Comparison of scales for the evaluation of aneurysmal subarachnoid haemorrhage: a retrospective cohort study

Background/ObjectivesAneurysmal subarachnoid haemorrhage (aSAH) is a life-threatening event with major complications. Delayed cerebral infarct (DCI) occurs most frequently 7 days after aSAH and can last for a prolonged period. To determine the most predictive radiological scales in grading subarachnoid or ventricular haemorrhage or both for functional outcome at 3 months in a large aSAH population, we conducted a single-centre retrospective study.MethodsA 3-year single-centre retrospective cohort study of 230 patients hospitalised for aSAH was analysed. Initial computed tomography (CT) scans in patients hospitalised for aSAH were blindly assessed using eight grading systems: the Fisher grade, modified Fisher grade, Barrow Neurological Institute scale, Hijdra scale, Intraventricular Haemorrhage (IVH) score, Graeb score and LeRoux score.ResultsOf 200 patients with aSAH who survived to day 7 and were included for DCI analysis, 39% of cases were complicated with DCI. The Hijdra scale was the best predictor for DCI, with a receiver operating characteristic area under the curve (ROCAUC) of 0.80 (95% confidence interval (CI), 0.74–0.85). The IVH score was the most effective grading system for predicting acute hydrocephalus, with a ROCAUC of 0.85 (95% CI, 0.79–0.89). In multivariate analysis, the Hijdra scale was the best predictor of the occurrence of DCI (hazard ratio, 1.18; 95% CI, 1.10–1.25).ConclusionsAlthough these results have yet to be prospectively confirmed, our findings suggest that the Hijdra scale may be a good predictor of DCI and could be useful in daily clinical practice.Clinical relevance statementBetter assessment of subarachnoid haemorrhage patients would allow for better prognostication and management of expectations, as well as referral for appropriate services and helping to appropriate use limited critical care resources.Key PointsAneurysmal subarachnoid haemorrhage is a life-threatening event that causes severe disability and leads to major complications such as delayed cerebral infarction.Accurate assessment of the amount of blood in the subarachnoid spaces on computed tomography with the Hijdra scale can better predict the risk of delayed cerebral infarct.The Hijdra scale could be a good triage tool for subarachnoid haemorrhage patients.

Machine learning-based model for predicting outcomes in cerebral hemorrhage patients with leukemia

Background and purposeIntracranial hemorrhage (ICH) in leukemia patients progresses rapidly with high mortality. Limited data are available on imaging studies in this population. The study aims to develop prediction models for 7-day and short-term mortality risk based on the non-contrast computed tomography (NCCT) image features. MethodsThe NCCT image features of ICH in 135 leukemia patients between 2007–2023 were retrospectively extracted using manual assessment and radiomics methods. After multiple imputation of missing laboratory data, univariate logistic regression and least absolute shrinkage and selection operator (LASSO) were used for feature selection. Random forest models were built with comprehensive evaluation and ranking of feature importance. Result135 and 129 patients were included in the studies for 7-day and short-term prognostic models, respectively. The median age of all enrolled patients was 35 years, and there were 86 male patients (63.7 %). Clinical models (validation: AUC [area under the curve] = 0.78, AUPRC [area under the precision-recall curve] = 0.73; AUC = 0.84, AUPRC = 0.86), radiomics models (validation: AUC = 0.82, AUPRC = 0.78; AUC = 0.75, AUPRC = 0.77), and the combined models (validation: AUC = 0.84, AUPRC = 0.83; AUC = 0.87, AUPRC = 0.89) predicted 7-day and short-term mortality with good predictive efficacy. Clinical decision curve analysis showed that the combined models predicted 7-day and 30-day risk of death would be more beneficial than other models. Shape features contributed significantly more than semantic features in both radiomics models and combined models (93.3 %, 52.1 %, as well as 85.2 %,37.4 %, respectively) for 7-day and 30-day mortality. ConclusionsCombined models constructed based on NCCT perform well in predicting the risk of 7-day and short-term mortality in ICH patients with leukemia. Shape features extracted by radiomics are important markers for modeling the prognosis.

Incidence of stroke, subsequent clinical outcomes and health care resource utilization in people with type 2 diabetes: a real-world database study in France: “INSIST” study

BackgroundPeople with type 2 diabetes (T2D) are at elevated risk of cardiovascular disease (CVD) including stroke, yet existing real-world evidence (RWE) on the clinical and economic burden of stroke in this population is limited. The aim of this cohort study was to evaluate the clinical and economic burden of stroke among people with T2D in France.MethodsWe conducted a retrospective RWE study using data from the nationally representative subset of the French Système National des Données de Santé (SNDS) database. We assessed the incidence of stroke requiring hospitalization between 2012 and 2018 among T2D patients. Subsequent clinical outcomes including CVD, stroke recurrence, and mortality were estimated overall and according to stroke subtype (ischemic versus hemorrhagic). We also examined the treatment patterns for glucose-lowering agents and CVD agents, health care resource utilization and medical costs.ResultsAmong 45,331 people with T2D without baseline history of stroke, 2090 (4.6%) had an incident stroke requiring hospitalization. The incidence of ischemic stroke per 1000 person-years was 4.9-times higher than hemorrhagic stroke (6.80 [95% confidence interval (CI) 6.47–7.15] versus 1.38 [1.24–1.54]). During a median follow-up of 2.4 years (interquartile range 0.6; 4.4) from date of index stroke, the rate of CVD, stroke recurrence and mortality per 1000 person-years was higher among hemorrhagic stroke patients than ischemic stroke patients (CVD 130.9 [107.7–159.0] versus 126.4 [117.2–136.4]; stroke recurrence: 86.7 [66.4–113.4] versus 66.5 [59.2–74.6]; mortality 291.5 [259.1–327.9] versus 144.1 [134.3–154.6]). These differences were not statistically significant, except for mortality (adjusted hazard ratio 1.95 [95% CI 1.66–2.92]). The proportion of patients prescribed glucagon-like peptide-1 receptor agonists increased from 4.2% at baseline to 6.6% during follow-up. The proportion of patients prescribed antihypertensives and statins only increased slightly following incident stroke (antihypertensives: 70.9% pre-stroke versus 76.7% post-stroke; statins: 24.1% pre-stroke versus 30.0% post-stroke). Overall, 68.8% of patients had a subsequent hospitalization. Median total medical costs were €12,199 (6846; 22,378).ConclusionsThe high burden of stroke among people with T2D, along with the low proportion of patients receiving recommended treatments as per clinical guidelines, necessitates a strengthened and multidisciplinary approach to the CVD prevention and management in people with T2D.

Association of Glycoprotein IIIa PlA1/A2 Polymorphism with Risk of Stroke: Updated Meta-Analysis.

Cardiovascular diseases are the main cause of death in the world, with ischemic heart disease (i.e., myocardial infarction) and cerebrovascular disease (i.e., stroke) taking the highest toll. Advances in diagnosis and treatment have led to a significant alleviation of ischemic complications, specifically in the realm of pharmacotherapy and interventional devices, while pharmacogenomics has yet to be fully leveraged to improve the burden of disease. Atherothrombotic events might occur earlier or respond worse to treatment in patients with genetic variants of GP IIb/IIIa. Therefore, we aimed to quantitate the involvement of the PlA2 variant in the risk of cerebral stroke events. A systematic search and meta-analysis were performed by pooling the risks of individual studies. A total of 31 studies comprising 5985 stroke patients and 7886 controls were analyzed. A meta-analysis of four studies on hemorrhagic stroke patients showed no association with the PIA2 rs5918(C) polymorphism in both fixed-effect (OR = 0.90 95%CI [0.71; 1.14]; p = 0.398) and random-effect models (OR = 0.86 95%CI [0.62; 1.20]; p-value = 0.386). The power of this analysis was below <30%, indicating a limited ability to detect a true effect. An analysis of the 28 studies on ischemic stroke revealed a significant association with the PIA2 rs5918(C) allele in both fixed-effect (OR = 1.16 95%CI [1.06; 1.27]; p = 0.001) and random-effect models (OR = 1.20 95%CI [1.04; 1.38]; p-value = 0.012), with a power of >80%. The PIA2 allele was associated with an increased risk of ischemic stroke. No association was found with hemorrhagic stroke, most likely due to the small number of available studies, which resulted in a lack of power.

Uterine necrosis following uterine artery embolization as treatment for postpartum hemorrhage: A case report and literature review.

Uterine necrosis is a rare complication of uterine artery embolization for postpartum hemorrhage and most patients end up having a hysterectomy. Here we report a case in which the patient experienced a recurrent fever 28 days after uterine artery embolization as treatment for postpartum hemorrhage and had no response to antibiotics. Magnetic resonance imaging of the pelvis revealed a mass which was approximately 12-cm in size with air bubbles in the uterus, suggesting necrosis with infection. Transvaginal clamping of the uterine mass was performed and necrotic tissue removed under laparoscopic monitoring, which successfully spared the necessity for a hysterectomy. The patient's subsequent progress was favorable. In the present study we review the high-risk factors of uterine necrosis following uterine artery embolization and summarize the key points of early diagnosis. In addition, we propose a strategy to successfully spare the necessity for a hysterectomy without the spread of infection or uterine perforation.