Early Management Of Patients Research Articles

Abstract TP53: Geomagnetic Storms Do Not Predict The Occurrence Of LVO Stroke Clusters Necessitating Endovascular Intervention

Intro: Space weather induced geomagnetic storms have been associated with an increased risk of stroke occurrence. Data on image-proven, temporally related large vessel occlusion stroke (LVO) and geomagnetic storms are lacking. We sought to investigate this potential association to determine whether space weather forecasts can be used to predict incoming cluster events. Methods: Data from a Comprehensive Stroke Center were collected from January 1, 2017, to April 15, 2022. Space weather data were downloaded from the World Data Centre for Geomagnetism, Kyoto homepage (http://wdc.kugi.kyoto-u.ac.jp/kp/index.html#LIST) The indications for mechanical endovascular reperfusion (MER) were in accordance with the Guidelines for the Early Management of Patients With Acute Ischemic Stroke Regarding Endovascular Treatment: A Guideline for Healthcare Professionals From the American Heart Association/American Stroke Association. Univariate binary logistic regression was performed to assess the potential associations between space weather data and LVO MER cases with 48 hour lag effect. Geomagnetic activity was defined by the National Oceanic and Atmospheric Administration’s (NOAA) Space Weather Prediction Centre (SWPC) space weather scales. Results: Of the 1931 days included in this study, there were 538 (27.86%) days with at least one LVO MER (450 (23.3%) with 1, 81 (4.19%) with 2, and 7 (0.36%) with 3. There were 1784 days without geomagnetic storm activity and 147 days with minor to severe storms. 290 MER cases occurred out 1014 days of minimal activity (28.6%) 133 MER cases out 497 days of unsettled activity (26.76%) 0.91(0.72-116), 78 MER cases out of 273 days of active activity (28.57%) 1.00(0.74-1.34), 25 MER cases out 109 days of minor storm (22.94%) 0.74(0.47-1.19) and 12 MER cases out of the 38 days of moderate to extreme storms (31.58%) 1.15(0.57-2.31) p-value 0.697. Conclusion: There was no statistically significant association with geomagnetic storms and the occurrence of large vessel stroke interventions taking into consideration a 48 hour lag effect. Comprehensive stroke center readiness is of utmost importance, but space weather forecasts are unlikely to be helpful in predicting LVO stroke cluster events.

Evaluating the Efficiency of the Ottawa Risk Scale in Assessing Adverse Outcomes in COPD Patients Presenting to the Emergency Department

Introduction: Chronic Obstructive Pulmonary Disease (COPD) exacerbations present significant challenges in emergency care settings. Predictive tools like the Ottawa Risk Scale (ORS) can potentially enhance early patient management. We aimed to assess the reliability and efficiency of the ORS among COPD in emergency departments. Materials and Methods: The study reviewed 75 patients presenting with COPD exacerbations were evaluated using the ORS. The ORS categorized patients into four risk groups: Low, Medium, High, and Very High. Clinical characteristics, blood gas analyses, and imaging results were documented. Results: Clinical symptoms were prevalent across all risk categories, but a significant association was found between smoking history and ORS categorization (p=0.042), oxygen saturation levels (p=0.043), initial PaO2 levels (p=0.013), initial and post-treatment PaCO2 (p=0.008, p=0.003 respectively), and pathological X-ray findings (p=0.005). The mMRC scale showed a correlation with ORS categorization (p=0.0001). The High and Very High-risk groups had higher hospitalization rates and adverse outcomes than Low and Medium risk. Conclusion: The ORS is a promising tool for predicting short-term adverse outcomes in COPD within emergency settings. This study underscores its potential utility in aiding clinical decision-making, guiding interventions, and improving patient outcomes.

Diffuse Large B-Cell Lymphoma (DLBCL): Early Patient Management and Emerging Treatment Options.

Diffuse large B-cell lymphoma (DLBCL) represents a curable disease with a 60-70% chance of cure with current R-CHOP chemoimmunotherapy. However, 30-40% of patients are refractory or relapsing. Many attempts failed to improve the outcome of DLBCL patients, including the intensification of R-CHOP regimen, consolidation, or maintenance therapy since the introduction of R-CHOP in 2000. Better understanding of both molecular biology of lymphoma cells and the tumor microenvironment raised the hope for future improvement of DLBCL patients' survival. Novel molecular findings have initiated clinical trials exploring targeted therapy based on driver genetic alterations with an intent to improve survival of high-risk subsets of patients. But the preliminary results remain ambiguous. The approach "agnostic" to specific molecular alterations of lymphoma cell includes antibody-drug conjugates (especially polatuzumab vedotin), immunotherapy comprising different antibodies with immunomodulatory effect (tafasitamab, lenalidomide), and T-cell engaging therapy (bispecific antibodies, early use of CAR T-cell). This approach could increase the cure rates and change the current therapeutic paradigm. However, better prognostic stratification, smarter designs of clinical trials, modification of endpoints including the use of ctDNA are needed. This review covers the complexity of DLBCL management.

Experience of patients with diabetic retinopathy: A qualitative study.

To understand the status quo and needs of self-management of patients with diabetic retinopathy (DR) and to provide a reference for formulating management programs that meet the needs of these patients. A qualitative interview study. Semi-structured, in-depth interviews were conducted between November and December 2021. A purposive sample of 15 patients with DR who were hospitalized in the Retinal Department of Eye Hospital was recruited. Colaizzi's analysis was used to organize and analyse the interview data. This study followed the Consolidated Criteria for Reporting Qualitative Research (COREQ) checklist. The experience of patients with DR can be summarized into four themes: (1) lack of DR knowledge, (2) low quality of life, (3) poor self-management behaviour and (4) seek for support from many aspects. Patients with DR lack disease knowledge and have poor self-management abilities and adherence. Medical staff should provide personalized care according to the patient's self-management status and needs, promote the establishment of self-management behaviours and prevent and delay disease progression. This study helps assist medical staff in the early management of patients with DR and provides a reference for the construction of prevention programs for patients.

Early stimulated immune responses predict clinical disease severity in hospitalized COVID-19 patients

BackgroundThe immune pathogenesis underlying the diverse clinical course of COVID-19 is poorly understood. Currently, there is an unmet need in daily clinical practice for early biomarkers and improved risk stratification tools to help identify and monitor COVID-19 patients at risk of severe disease.MethodsWe performed longitudinal assessment of stimulated immune responses in 30 patients hospitalized with COVID-19. We used the TruCulture whole-blood ligand-stimulation assay applying standardized stimuli to activate distinct immune pathways, allowing quantification of cytokine responses. We further characterized immune cell subsets by flow cytometry and used this deep immunophenotyping data to map the course of clinical disease within and between patients.ResultsHere we demonstrate impairments in innate immune response pathways at time of COVID-19 hospitalization that are associated with the development of severe disease. We show that these impairments are transient in those discharged from hospital, as illustrated by functional and cellular immune reconstitution. Specifically, we identify lower levels of LPS-stimulated IL-1β, and R848-stimulated IL-12 and IL-17A, at hospital admission to be significantly associated with increasing COVID-19 disease severity during hospitalization. Furthermore, we propose a stimulated immune response signature for predicting risk of developing severe or critical COVID-19 disease at time of hospitalization, to validate in larger cohorts.ConclusionsWe identify early impairments in innate immune responses that are associated with subsequent COVID-19 disease severity. Our findings provide basis for early identification of patients at risk of severe disease which may have significant implications for the early management of patients hospitalized with COVID-19.

M1, M2: Time to Bid Adieu!

M1, M2: Time to Bid Adieu!

Commentary on “Outcomes of Stroke Thrombectomy Performed by Interventional Radiologists versus Neurointerventional Physicians”

The article “Outcomes of Stroke Thrombectomy Performed by Interventional Radiologists versus Neurointerventional Physicians” addresses an important and controversial issue of whether nonneuroscience interventional physicians should be performing stroke thrombectomy ( 1 Sacks D. Dhand S. Hegg R. et al. Outcomes of stroke thrombectomy performed by interventional radiologists versus neurointerventional physicians. J Vasc Interv Radiol. 2022; 33: 619-626 Google Scholar ). There is convincing evidence that stroke thrombectomy improves the clinical outcomes of large vessel occlusion (LVO) anterior circulation strokes and that it is cost effective ( 2 Powers W.J. Rabinstein A.A. Ackerson T. et al. Guidelines for the early management of patients with acute ischemic stroke: 2019 update to the 2018 guidelines for the early management of acute ischemic stroke: a guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke. 2019; 50: e344-e418 Crossref PubMed Scopus (1847) Google Scholar , 3 Bulwa Z. Chen M. Stroke center designations, neurointerventionalist demand, and the finances of stroke thrombectomy in the United States. Neurology. 2021; 97: S17-S24 Crossref PubMed Scopus (2) Google Scholar ). This article provides data to support the position that interventional radiology (IR) physicians with additional training can achieve technical and clinical outcomes similar to those obtained by neurointerventional (NI) physicians. We do not take sides in this controversy. The purposes of this commentary are to appraise the current article critically, to examine its potential implications, and to provide an update on the issues of the supply of, demand for, and access to stroke thrombectomy. Outcomes of Stroke Thrombectomy Performed by Interventional Radiologists versus Neurointerventional PhysiciansJournal of Vascular and Interventional RadiologyVol. 33Issue 6PreviewTo test the hypothesis that interventional radiologists (IRs) and neurointerventional (NI) physicians have similar outcomes of endovascular stroke thrombectomy (EVT), which could be used to improve the availability of thrombectomy. Full-Text PDF

Early management of patients with aneurysmal subarachnoid hemorrhage in a hospital with neurosurgical/neuroendovascular facilities: a consensus and clinical recommendations of the Italian Society of Anesthesia and Intensive Care (SIAARTI)—part 2

BackgroundQuestions remain on the optimal management of subarachnoid hemorrhage (SAH) patients once they are admitted to the referring center, before and after the aneurysm treatment. To address these issues, we created a consensus of experts endorsed by the Italian Society of Anesthesia and Intensive Care (SIAARTI) to provide clinical guidance regarding this topic. Specifically, in this manuscript (part 2), we aim to provide a list of experts’ recommendations regarding the management of SAH patients in a center with neurosurgical/neuroendovascular facilities after aneurysm treatment.MethodsA multidisciplinary consensus panel composed by 24 physicians selected for their established clinical and scientific expertise in the acute management of SAH patients with different specializations (anesthesia/intensive care, neurosurgery, and interventional neuroradiology) was created. A modified Delphi approach was adopted.ResultsA total of 33 statements were discussed, voted, and approved. Consensus was reached on 30 recommendations (28 strong and 2 weak). In 3 cases, where consensus could not be agreed upon, no recommendation was provided.ConclusionsThis consensus provides practical recommendations (and not mandatory standard of practice) to support clinician’s decision-making in the management of SAH patients in centers with neurosurgical/neuroendovascular facilities after aneurysm securing.

‎Factors associated with coronavirus disease 2019 infection severity among a sample of Lebanese adults: Data from a cross-sectional study.

Background and AimsIdentification of factors responsible for severe illness related to coronavirus disease 2019 (COVID‐19) could help in the early management of patients with high risk, especially in developing countries with poor medical care systems. To date, no data have been published concerning the factors associated with COVID‐19 severity in Lebanon. In this study, we aimed at investigating the relation between sociodemographic variables, health status, and the clinical outcomes of COVID‐19 in a sample of Lebanese adults.MethodsIn our cross‐sectional study, 1052 patients (563 male and 489 female, with the median age of 42.83 ± 17.88 years), tested positive for severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) between January and March 2021, were recruited from a hospital in Byblos, Lebanon. Basic demographic data, medical history, clinical data, and selfreported symptoms related to COVID‐19 were collected. Clinical classification of COVID‐19 severity was carried out according to the WHO interim guidance on May 27, 2020. Multi and bivariate regression analysis were performed.ResultsWhen comparing patients with moderate symptoms versus mild, the results showed that older age (aOR = 1.05; 95% CI: 1.03–1.06) and having dyslipidemia (aOR = 1.89; 95% CI: 1.01–3.49) were significantly associated with higher odds of having moderate symptoms. When comparing patients with severe symptoms versus mild, older age (aOR = 1.08; 95% CI: 1.06–1.10), higher body mass index (aOR = 1.09; 95% CI: 1.04–1.15) and having respiratory diseases (aOR = 2.57; 95% CI: 1.03–6.36) were significantly associated with higher odds of having severe symptoms, whereas female gender (aOR = 0.56; 95% CI: 0.32–0.98) was significantly associated with lower odds of having severe symptoms compared to males. Finally, when comparing patients with severe symptoms versus moderate, older age (aOR = 1.03; 95% CI: 1.01–1.05) was found to be significantly associated with higher odds of having severe symptoms.ConclusionIdentification of risk factors may contribute to a better understanding of the COVID‐19 pathogenesis and provide clinical reference for early prognosis and management of patients.

Outcome of Laparoscopic Cholecystectomy in Acute Calculous Choleycystitis – Analysis of 100 cases

Introduction: Gallbladder disease is one of the most common surgical problems worldwide. About 10-15% of the adult western population has gallstone diseases . More than half a million cholecystectomies are performed per year in United States alone. Laparoscopic cholecystectomy (LC) is currently the most widely used surgical procedure for the treatment of gallstones. Aims and Objectives: To observe the cause of difficulties, the sequele , identify and find out the nature & rate of per operative complications and find out the type & frequency of early post-operative complications following laparoscopic cholecystectomy in acute calculous cholecystitis. Materials and Methods: This is a prospective interventional study which was conducted at Jashore Medical College Hospital & some clinics of the city from Sept 2019 to Feb 2020. A total of 100 patients underwent Laparoscopic cholecystectomy for acute calculous cholecystitis within 7 days of admission. Results:Among 100 patients, 80 females & 20 males with maximum age group were in the fourth decade, Laparoscopic cholecystectomy was done in 97 (97%) cases & in 3(3%) cases conversion were needed, none of the patients were developed major Per & postoperative complications. Peroperative complication rate was 22 (22%) with conversion was 03(3%) cases. All of the above complications were managed accordingly & successfully. Conclusion: Laparoscopic Cholecystectomy is a safe, effective procedure for the early management of patients with acute calculus cholecystitis. Meticulous dissection & good exposure of callot’s triangle, posterior clearance may prevent bile duct injuries. Medicine Today 2022 Vol.34(1): 39-43

Early management of patients with aneurysmal subarachnoid hemorrhage in a hospital with neurosurgical/neuroendovascular facilities: a consensus and clinical recommendations of the Italian Society of Anesthesia and Intensive Care (SIAARTI)\u2013Part 1

BackgroundIssues remain on the optimal management of subarachnoid hemorrhage (SAH) patients once they are admitted to the referring center, before and after the aneurysm treatment. To address these issues, we created a consensus of experts endorsed by the Italian Society of Anesthesia and Intensive Care (SIAARTI). In this manuscript, we aim to provide a list of experts’ recommendations regarding the early management of SAH patients from hospital admission, in a center with neurosurgical/neuro-endovascular facilities, until securing of the bleeding aneurysm.MethodsA multidisciplinary consensus panel composed of 24 physicians selected for their established clinical and scientific expertise in the acute management of SAH patients with different background (anesthesia/intensive care, neurosurgery, and interventional neuroradiology) was created. A modified Delphi approach was adopted.ResultsAmong 19 statements discussed. The consensus was reached on 18 strong recommendations. In one case, consensus could not be agreed upon and no recommendation was provided.ConclusionsThis consensus provides practical recommendations for the management of SAH patients in hospitals with neurosurgical/neuroendovascular facilities until aneurysm securing. It is intended to support clinician’s decision-making and not to mandate a standard of practice.

Comparative Study of CBNAAT with Sputum Microscopy by Led Microscopy & Liquid Culture in Sputum Samples of Presumptive Pulmonary Tuberculosis

Tuberculosis is a communicable disease & a leading cause of death from a single infectious agent (ranking above HIV /AIDS). Early diagnosis is important for early patient management and successful treatment. The present study was a prospective observational study done on 84 suspected Pulmonary Tuberculosis patients visiting Government Chest disease and TB hospital Warangal during the time period of December 2017 to July 2019 & were evaluated with different microbiological tests for further confirmation of pulmonary tuberculosis .Considering liquid culture as the gold standard tool for diagnosis of Tuberculosis, sensitivity , specificity, PPV, NPV of CBNAAT were 78.4%, 60.6%, 75%, 65% respectively and sensitivity, specificity, PPV, NPV of AFB smear were 80%, 47.5%, 39%, 85% respectively in the present study.

Evaluation of Procalcitonin Diagnostic Accuracy with Comparison to Blood Culture

Background: Procalcitonin has been used globally as indicator marker of sepsis to define bacteremia or blood stream infection for early patient management or antibiotic therapy. Blood culture refers to a microbiological culture of a peripheral blood sample. The blood cultures help to determine the presence of systemic infections, such as septicaemia. If the culture is positive, the causative micro-organism can usually be identified, and antibiotic sensitivity testing performed. On the other hand, the sensitivity of procalcitonin in comparison to its specificity to certain bacterial infections is still in question. Methodology: In this study, we selected 309 patients without restriction of age gender with pre-diagnosed sepsis or septic shock syndrome. Blood culture samples were collected in bactAlert media plus culture bottles and were incubated in BactAlert 3D semi-automated blood culture system; blood sample was collected for serum procalcitonin on immunoassay principle. Results: Out of 309, a total 87 blood cultures were positive and PCT was positive in 134 whereas 179 were PCT negative. In positive PCT, 63 were having bacterial growth in their blood culture while 71 were with negative blood culture. Although in total, 179 PCT were negative, only 16 were having bacterial growth in blood culture samples whereas all others revealed no growth that showed maximum number of positive blood cultures were having PCT positive but not all PCT positive demonstrated bacterial growth in blood culture suggesting that the bacteremia or sepsis can only be suspected with positive PCT. In addition, blood culture positive or negative results cannot be predicted by PCT value to make diagnostic confirmation of sepsis. Keywords: Procalcitonin (PCT), Blood culture, Sepsis, 95%CI; confidence interval, IQR; Interquartile range

Update on Intensive Care Unit Management of Stroke

In this review, we provide an update on the intensive care unit (ICU) management of ischemic stroke. Over the last decade, new evidence has led to rapid changes in the early management of patients admitted with acute ischemic stroke. Nevertheless, stroke remains a leading cause of disability. Consequently, a significant number of patients with acute ischemic stroke require ICU level care. The most frequent reasons for ICU admissions are large infarction with potential swelling, reduced level of consciousness, secondary hemorrhagic transformation, acute symptomatic seizures or respiratory failure and stroke-related disorders of the brain-heart interaction. Moreover, there is an increasing number of patients receiving intravenous thrombolysis or mechanical thrombectomy with a subsequent need of ICU monitoring. Several studies have shown that the implementation of specialized neuro-intensive care teams help to improve functional outcome after acute ischemic stroke. The main goal in the ICU management of stroke patients is to prevent secondary brain injury. To this end, a comprehensive approach to optimize systemic physiological homeostasis, control intracranial pressure, cerebral perfusion, hemodynamic and respiratory parameters is needed. Here, we summarize recent advances in invasive and non-invasive neuro-monitoring, decision making in decompressive neurosurgery for large supratentorial or cerebellar infarction, specific cardiorespiratory management, nutrition, temperature management and mobilization strategies in ischemic stroke.

Nutrition in acute stroke management: food for thought

Nutrition is crucial in the management of patients with acute stroke. 1 Dziewas R Michou E Trapl-Grundschober M et al. European Stroke Organisation and European Society for Swallowing Disorders guideline for the diagnosis and treatment of post-stroke dysphagia. Eur Stroke J. 2021; 6: LXXXIX-LXXCXV Crossref PubMed Scopus (0) Google Scholar Clinical features putting patients at risk of malnutrition include dysphagia, impaired consciousness, perception deficits, and cognitive dysfunction. Being malnourished or at risk of malnutrition on admission to hospital after stroke is linked with poor functional outcomes and mortality, and worsening of nutritional status during the acute stage post-stroke is associated with similar adverse outcomes. 2 Dennis M Poor nutritional status on admission predicts poor outcomes after stroke: observational data from the FOOD trial. Stroke. 2003; 34: 1450-1456 Crossref PubMed Scopus (0) Google Scholar Therefore, guidelines dedicated to acute stroke care generally include nutritional management. 1 Dziewas R Michou E Trapl-Grundschober M et al. European Stroke Organisation and European Society for Swallowing Disorders guideline for the diagnosis and treatment of post-stroke dysphagia. Eur Stroke J. 2021; 6: LXXXIX-LXXCXV Crossref PubMed Scopus (0) Google Scholar , 3 Powers WJ Rabinstein AA Ackerson T et al. Guidelines for the early management of patients with acute ischemic stroke: 2019 update to the 2018 guidelines for the early management of acute ischemic stroke: a guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke. 2019; 50: e344-e418 Crossref PubMed Scopus (1816) Google Scholar , 4 Boulanger JM Lindsay MP Gubitz G et al. Canadian stroke best practice recommendations for acute stroke management: prehospital, emergency department, and acute inpatient stroke care, 6th edition, update 2018. Int J Stroke. 2018; 13: 949-984 Crossref PubMed Scopus (154) Google Scholar , 5 Burgos R Bretón I Cereda E et al. ESPEN guideline clinical nutrition in neurology. Clin Nutr. 2018; 37: 354-396 Summary Full Text Full Text PDF PubMed Scopus (175) Google Scholar The guideline for the diagnosis and treatment of post-stroke dysphagia from the European Stroke Organization and European Society for Swallowing Disorders, for example, recommends early enteral nutrition via a nasogastric tube if sufficient oral nutrition is not possible. 1 Dziewas R Michou E Trapl-Grundschober M et al. European Stroke Organisation and European Society for Swallowing Disorders guideline for the diagnosis and treatment of post-stroke dysphagia. Eur Stroke J. 2021; 6: LXXXIX-LXXCXV Crossref PubMed Scopus (0) Google Scholar This recommendation relies mainly on the second substudy of the Feed or Ordinary Diet (FOOD) trial, in which 859 patients with dysphagia after stroke were randomly assigned to either early tube feeding or delayed feeding starting later than 7 days after random assignment. Allocation to early tube feeding was associated with a non-significant reduction in mortality by 5·8% (there were 182 deaths in 429 patients randomly assigned to early tube feeding vs 207 deaths in 430 patients in the delayed feeding group; p=0·09). There were no differences in other outcomes, including severe disability or death (339 of 429 patients in the early-feeding group vs 344 of 430 patients in the delayed feeding group; p=0·7), pneumonia (132 of 429 patients in the early-feeding group vs 133 of 430 patients in the delayed feeding group; p>0·9), and percutaneous endoscopic gastrostomy placement at follow-up (30 of 429 patients in the early-feeding group vs 23 of 430 patients in the delayed feeding group). 6 Dennis M Lewis S Cranswick G Forbes J FOOD: a multicentre randomised trial evaluating feeding policies in patients admitted to hospital with a recent stroke. Health Technol Assess. 2006; 10: 1-120 Crossref Google Scholar Safety and efficacy of three enteral feeding strategies in patients with severe stroke in China (OPENS): a multicentre, prospective, randomised, open-label, blinded-endpoint trialIn the early phase of severe stroke, modified full enteral nutrition or hypocaloric enteral nutrition did not significantly reduce the risk of a poor outcomes compared with full enteral nutrition over a 90-day period. Hypocaloric enteral nutrition might be associated with increased mortality compared with modified full enteral nutrition. Further studies are needed to investigate whether modified full enteral nutrition might be the optimal strategy. Full-Text PDF

Imaging in Acute Anterior Circulation Ischemic Stroke: Current and Future.

Clinical trials on acute ischemic stroke have demonstrated the clinical effectiveness of revascularization treatments within an appropriate time window after stroke onset: intravenous thrombolysis (NINDS and ECASS-III) through the administration of tissue plasminogen activator within a 4.5-hour time window, endovascular thrombectomy (ESCAPE, REVASCAT, SWIFT-PRIME, MR CLEAN, EXTEND-IA) within a 6-hour time window, and extending the treatment time window up to 24 hours for endovascular thrombectomy (DAWN and DEFUSE 3). However, a substantial number of patients in these trials were ineligible for revascularization treatment, and treatments of some patients were considerably futile or sometimes dangerous in the clinical trials. Guidelines for the early management of patients with acute ischemic stroke have evolved to accept revascularization treatment as standard and include eligibility criteria for the treatment. Imaging has been crucial in selecting eligible patients for revascularization treatment in guidelines and clinical trials. Stroke specialists should know imaging criteria for revascularization treatment. Stroke imaging studies have demonstrated imaging roles in acute ischemic stroke management as follows: 1) exclusion of hemorrhage and stroke mimic disease, 2) assessment of salvageable brain, 3) localization of the site of vascular occlusion and thrombus, 4) estimation of collateral circulation, and 5) prediction of acute ischemic stroke expecting hemorrhagic transformation. Here, we review imaging methods and criteria to select eligible patients for revascularization treatment in acute anterior circulation stroke, focus on 2019 guidelines from the American Heart Association/American Stroke Association, and discuss the future direction of imaging-based patient selection to improve treatment effects.

Risk stratification of women with gestational diabetes mellitus using mutually exclusive categories based on the International Association of Diabetes and Pregnancy Study Groups criteria for the development of postpartum dysglycaemia: a retrospective cohort study

ObjectivesWomen with gestational diabetes mellitus (GDM) are more predisposed to develop postpartum diabetes mellitus (DM). This study aimed to estimate the relative risk (RR) of postpartum dysglycaemia (prediabetes and DM)...

Abstract WP86: Gender Disparities In Authorship Of Major Randomized Controlled Trials In Stroke Research

Introduction: Many medical specialties including vascular neurology have recently raised awareness of gender disparities among researchers. This study seeks to investigate patterns and yearly trends in authorship of randomized controlled trials (RCTs) in stroke research. Methods: This study included RCTs from the 2019 AHA/ASA Guidelines for the Early Management of Patients with Acute Ischemic Stroke. Studies that did not distinguish primary authors for publication and rather credited a collaborative group were excluded. Gender was determined for each author based on analysis of names with assistance of online references (institution directories, biographies, news articles, profile photos and professional social media platforms). Validated software (Genderize.io) was used to corroborate gender based on first names with a probability threshold of 60% as implemented in previous work. Chi-squared tests for observed frequencies and linear trend were performed. Differences were considered significant at p<0.05. Results: One hundred eighty-six RCTs were included with a total 2451 authors (78% male, 22% female) covering 46 stroke topics. Publication dates were 1994 to 2019 (median 2014, IQR 2010-2016). Number of authors for each study ranged from 1 to 56, with a mean±SD of 13±10 authors. Of the 186 included studies, 145 (78%) had male first authors and 41 (22%) had female first authors (p<0.0001). One hundred fifty-nine (85%) studies had male senior authors and 27 (15%) had female senior authors (p<0.0001). Distribution of authorship by country revealed higher prevalence of male first and senior authors for all countries except the Netherlands (n=5 RCTs), Sweden (n=1) and India (n=1). Yearly trends in authorship distribution from 1994 to 2019 did not identify any significant shift in authorship for first or senior authors based on gender (p>0.05). Conclusions: This study reveals that gender disparities are prevalent across the field of stroke research. Female authors are underrepresented in both roles of first and senior authors in major RCTs. This discrepancy is present across nearly all countries and has persisted over the past three decades. Continued research and targeted interventions are needed to alleviate gender disparities in stroke research.

Clinical application of intraoperative somatic tissue oxygen saturation for detecting postoperative early kidney dysfunction patients undergoing living donor liver transplantation: A propensity score matching analysis.

BackgroundSomatic tissue oxygen saturation (SstO2) is associated with systemic hypoperfusion. Kidney dysfunction may lead to increased mortality and morbidity in patients who undergo living donor liver transplantation (LDLT). We investigated the clinical utility of SstO2 during LDLT for identifying postoperative kidney dysfunction.Patients and methodsData from 304 adults undergoing elective LDLT between January 2015 and February 2020 at Seoul St. Mary’s Hospital were retrospectively collected. Thirty-six patients were excluded based on the exclusion criteria. In total, 268 adults were analyzed, and 200 patients were 1:1 propensity score (PS)-matched.ResultsPatients with early kidney dysfunction had significantly lower intraoperative SstO2 values than those with normal kidney function. Low SstO2 (< 66%) 1 h after graft reperfusion was more highly predictive of early kidney dysfunction than the values measured in other intraoperative phases. A decline in the SstO2 was also related to kidney dysfunction.ConclusionsKidney dysfunction after LDLT is associated with patient morbidity and mortality. Our results may assist in the detection of early kidney dysfunction by providing a basis for analyzing SstO2 in patients undergoing LDLT. A low SstO2 (< 66%), particularly 1 h after graft reperfusion, was significantly associated with early kidney dysfunction after surgery. SstO2 monitoring may facilitate the identification of early kidney dysfunction and enable early management of patients.

Autosomal dominant polycystic kidney disease (ADPKD) in Tunisia: From molecular genetics to the development of prognostic tools

A high prevalence of genetic kidney disease in Tunisia has been detected, and their study provides very important clinical and genetic information. Autosomal dominant polycystic kidney disease (ADPKD) is one of the main causes of morbidity and mortality associated with the kidneys in Tunisia. We present here clinical and genetic characteristics of a cohort of Tunisian patients with ADPKD. Nineteen Tunisian patients with ADPKD, among 4 familial cases and 11 sporadic cases, and 50 Healthy individuals were included in this cohort. Genetic studies of PKD1/2 were carried on using Sanger sequencing and MLPA. In our study, the mean age at diagnosis was 47 ± 18 years. In addition, 84.21% of cases present a family history of ADPKD. Overall, 57.89% of the affected individuals had HTA and 26.31% patients had hematuria. 15.78 % of the patient has extra-renal cysts i.e. one patient with splenic cysts and two patients had liver cysts. 57.89 % of patients were diagnosed with various extra-renal clinical presentations i.e. myopia, hernia, deafness, intracranial aneurysm, respiratory distress, hyperthyroidism, urinary tract infection and lower back pains. The PKD1 genotype showed earlier onset of ESRD compared to PKD2 genotype (43 vs. 55 years old). Six mutations have been detected in PKD1 gene. Among them, three were novels e.g. c.688 T>G, p.C230G and c.690C>G, p.C230W among exon 5 and c.8522A>G, p.N2841S among exon 23. In addition, thirteen single nucleotides polymorphisms have been reported in PKD1 gene. Among them, eleven previously reported in heterozygous state and two novel single nucleotides polymorphisms in heterozygous and homozygous state and predicted to be probable polymorphisms by computational tools: c.496C>T, p.L166= among the exon 4, and c.10165G>C and p.E3389Gln among the exon 31. Only three single nucleotides polymorphisms previously reported in ADPKD database have been identified in PKD2 gene. The description and analysis of our cohort can help in rapid and reliable diagnosis for early management of patients in Tunisia. Indeed, predictive genetic testing can facilitate donor evaluation and increase living related kidney transplantation.