Ischemic Stroke Patients Research Articles

Insights into risk factors and outcomes of post-stroke seizures in Saudi Arabia: a multicenter analysis.

Post-stroke seizures present a global challenge, yet its frequency and factors associated with its incidence are poorly documented, particularly in the Middle East. Thus, this study aims to investigate post-stroke seizure frequency and stroke-associated factors among ischemic stroke patients in Saudi Arabia, addressing demographic, clinical, and comorbid aspects to improve prognosis, diagnosis, prevention, and management.A multicenter, cohort observational study included eligible ischemic stroke patients who were categorized into those who developed seizures after injury and those who did not. Additionally, the study assessed the association between post-stroke seizure and 12-month mortality, 12-month stroke recurrence, and the occurrence of hemorrhagic transformation (HT) within 30 days.The study involved 1235 ischemic stroke patients, in which 13.5% developed post-stroke seizures. Patients with post-stroke seizures had more extended hospital stays, higher intensive care unit (ICU) admission rates, and a higher prevalence of comorbidities. Factors independently associated with post-stroke seizures included previous stroke history (OR = 1.93; 1.35-2.75), ICU admission (OR = 1.7; 1.15-2.5), and depression (OR = 2.1; 1.38-3.30). Logistic regression revealed associations between post-stroke seizures and HT (OR = 2.61; 1.70-4.00), stroke recurrence (OR = 2.30; 1.58-3.36), and mortality (OR = 1.89; 1.33-2.68). However, after adjusting for covariates, post-stroke seizures were significantly associated with stroke recurrence only (aOR = 1.7; 1.11-2.63).Our study identifies notable associations and risk factors for post-stroke seizures in ischemic stroke patients. This underscores the importance of adopting a comprehensive approach to stroke care to enhance the prediction, prevention, and management of post-stroke seizures. Further research is warranted to validate these findings, enhance the understanding of post-stroke seizure mechanisms, and guide management strategies.

Assessment of transition from use of alteplace to tenecteplase in the treatment of acute ischemic stroke in a large system of community hospitals

ABSTRACT Objective Pharmacologic thrombolytic treatment for acute ischemic stroke has primarily been managed by intravenous alteplase. Tenecteplase is a variant that has been shown to be non-inferior to alteplase in clinical trials. In this study, we present a real-world assessment of patient outcomes with the facility-wide transition to the use of tenecteplase versus altepase for acute ischemic stroke in a large system of community hospitals in the United States. Methods This retrospective analysis assessed adult patients who received either alteplase or tenecteplase between 1 April 2020 and 31 March 2023. Propensity matching was used to estimate the covariate-adjusted association with outcomes of discharge expired/hospice, intracranial hemorrhage and readmission to a facility in the same healthcare system within 30, 60, or 90 days. Results Among 12,766 patients, gross mortality was 7.6% (n = 285) with tenecteplase and 8.2% (n = 739) with alteplase (p = 0.314); intracranial hemorrhage was 2.4% with either. The propensity match analysis found that the relative risk of mortality/hospice for patients given tenecteplase versus alteplase was 0.993 (95% CI: 0.848–1.162, p = 1.000). When limited to five facilities with the highest volume of thrombolytic use, there were no significant differences in outcomes. While the time from emergency department arrival to thrombolytic administration (door-to-needle) was shorter among patients receiving tenecteplase, there was no significant difference in the odds of mortality based on door-to-needle time. Conclusion In alignment with previous studies, these findings demonstrate the lack of potential harm with a transition from alteplase to tenecteplase in clinical practice for acute ischemic stroke patients treated in community hospitals.

Profiling immune cell-related gene features and immunoregulatory ceRNA in ischemic stroke

Molecules in immune cells plays a vital role in the pathogenesis of ischemic stroke (IS). The aim of this study is to profile the landscape of molecules on the basis of immune cells in IS peripheral blood and construct an immunoregulatory competing endogenous RNA (ceRNA) network. We collected and combined multiple public transcriptome datasets from the peripheral blood of IS patients and healthy controls. CIBERSORT deconvolution revealed that the proportions of CD8 and CD4 naive T cells, monocytes, and neutrophils changed significantly in the IS group. Intersecting the immune cell-related genes identified by weighted gene co-expression network analysis (WGCNA) and differential expression analysis, 38 overlapping candidate biomarkers were selected. Three machine learning algorithms, including least absolute shrinkage and selection operator (LASSO), support vector machine-recursive feature elimination (SVM-RFE), and random forest were applied, and 11 distinct immune cell-related genes were identified. We obtained the mRNA-miRNA and miRNA-lncRNA interactions from StarBase v3.0, and constructed a ceRNA network based on the differentially expressed mRNAs, miRNAs, and lncRNAs. The aberrant expression of HECW2-centered ceRNAs in the peripheral blood of in-house patients was validated using quantitative PCR. We also revealed that the expression of HECW2 was positively correlated with lncRNAs LINC02593 through miRNAs miR-130a-3p, miR-130b-3p and miR-148b-3p in cells. These results show that there are distinct immune features between IS patients and healthy controls. The ceRNA network may help elucidate the mechanism of immune cell-related genes in IS and may serve as a therapeutic target.

Long Non-Coding RNAs as Diagnostic Biomarkers for Ischemic Stroke: A Systematic Review and Meta-Analysis

Ischemic stroke is a serious cerebrovascular disease, highlighting the urgent need for reliable biomarkers for early diagnosis. Recent reports suggest that long non-coding RNAs (lncRNAs) can be potential biomarkers for ischemic stroke. Therefore, our study seeks to investigate the potential diagnostic value of lncRNAs for ischemic stroke by analyzing existing research. A comprehensive literature search was conducted across the PubMed, ScienceDirect, Wiley Online Library, and Web of Science databases for articles published up to July 10, 2024. Statistical analyses were performed using Stata 17.0 software to calculate pooled sensitivity, specificity, positive likelihood ratio (PLR), diagnostic odds ratio (DOR), negative likelihood ratio (NLR), and area under the curve (AUC). Heterogeneity was explored with the Cochran-Q test and the I2 statistical test, and publication bias was assessed with Deeks’ funnel plot. A total of 44 articles were included, involving 4302 ischemic stroke patients and 3725 healthy controls. Results demonstrated that lncRNAs H19, GAS5, PVT1, TUG1, and MALAT1 exhibited consistent trends across multiple studies. The pooled sensitivity of lncRNAs in the diagnosis of ischemic stroke was 79% (95% CI: 73–84%), specificity was 88% (95% CI: 77–94%), PLR was 6.63 (95% CI: 3.11–14.15), NLR was 0.23 (95% CI: 0.16–0.33), DOR was 28.5 (95% CI: 9.88–82.21), and AUC was 0.88 (95% CI: 0.85–0.90). Furthermore, the results of subgroup analysis indicated that lncRNA H19 had superior diagnostic performance. LncRNAs demonstrated strong diagnostic accuracy in distinguishing ischemic stroke patients from healthy controls, underscoring their potential as reliable biomarkers. Because most of the articles included in this study originate from China, large-scale, high-quality, multi-country prospective studies are required to further validate the reliability of lncRNAs as biomarkers for ischemic stroke.

The impact of white matter hyperintensities on short-term outcomes of reperfusion therapy in patients with acute ischemic stroke.

This study aimed to explore the impact of white matter hyperintensities (WMH) on the short-term outcomes of reperfusion therapy in acute ischemic stroke (AIS) patients. We prospectively collected data on AIS patients undergoing reperfusion therapies at Chengdu Second People's Hospital from January 2020 and January 2024. WMH severity was graded as 0-3 (none to moderate) or 4-6 (severe) by the Fazekas scale. We analyzed National Institutes of Health Stroke Scale (NIHSS) scores, good functional outcomes (modified Rankin Scale, mRS 0-2) at 7days and discharge, and safety outcomes like in-hospital mortality and intracranial hemorrhage. During the study period, 669 patients were included, with 345 having none to moderate WMH and 324 with severe WMH. Patients with severe WMH exhibited significantly higher NIHSS and mRS at 7days and discharge, with a decrease in good outcomes (mRS 0-2: 40.43% vs. 75.65%), and an increase in intracranial hemorrhage (16.4% vs. 5.8%) and in-hospital mortality (11.7% vs. 2.0%) compared with none to moderate WMH patients. After matching the baseline data, none to moderate WMH was associated with higher likelihood of good outcomes at discharge [adjusted odds ratio (aOR), 2.142; 95% confidence interval (CI), 1.380-3.304; P < 0.001] and a lower rate of any intracranial hemorrhage (aOR, 0.348; 95% CI 0.180-0.673; P < 0.001), with no significant difference in in-hospital mortality between the groups. Severe WMH could reduce the benefits of reperfusion therapy in AIS, with increased risk of hemorrhagic complications, warranting further research into treatment strategies for these patients.

Day 3 neutrophil-to-lymphocyte ratio and its derived indices predict 90-day poor outcomes following mechanical thrombectomy in acute ischemic stroke patients

ObjectiveTo investigate the dynamic changes in neutrophil–to–lymphocyte ratio (NLR) and its derived indices following mechanical thrombectomy (MT) in patients with acute ischemic stroke (AIS) and evaluate their predictive value for prognosis.MethodsThis single-center retrospective cohort study included AIS patients who underwent MT at Zhongshan Hospital of Xiamen University from January 2018 to February 2024. Peripheral blood samples were collected on admission, day 1, and day 3 after MT to determine the NLR, derived NLR (dNLR), and neutrophil–monocyte–to–lymphocyte ratio (NMLR). The primary endpoint was poor functional outcome at 90 days (modified Rankin scale score 3–6). The secondary endpoints included post-operative hemorrhagic transformation, malignant cerebral edema, in-hospital mortality, and 90-day all-cause mortality. Receiver operating characteristic (ROC) curve analysis was used to evaluate predictive performance, and multivariate logistic regression models were employed to explore the independent associations between inflammatory markers and prognosis.ResultsA total of 423 eligible patients were included. Both groups showed similar dynamic trends in inflammatory markers, peaking on day 1 post-MT and subsequently declining. However, the poor outcome group (n = 255, 60.28%) maintained higher levels on day 3, whereas the good outcome group showed a significant decreasing trend. ROC curve analysis revealed that the NLR (AUC = 0.85, 95% CI: 0.81–0.89), dNLR (AUC = 0.86, 95% CI: 0.82–0.89), and NMLR (AUC = 0.85, 95% CI: 0.81–0.89) on day 3 post-MT had the strongest predictive power for 90-day poor outcomes. After comprehensive adjustment for confounders, these inflammatory markers were independently associated with 90-day poor outcomes: for each unit increase in the NLR, the risk of poor outcome increased by 38% (OR = 1.38, 95% CI: 1.28–1.49, p &amp;lt; 0.001); for dNLR, it increased by 104% (OR = 2.04, 95% CI: 1.73–2.40, p &amp;lt; 0.001); and for NMLR, it increased by 35% (OR = 1.35, 95% CI: 1.26–1.45, p &amp;lt; 0.001).ConclusionInflammatory markers (NLR, dNLR, and NMLR) on day 3 post-MT can serve as independent predictors of prognosis in AIS patients treated with MT. Dynamic monitoring of inflammatory markers may facilitate early risk stratification and guide individualized treatment strategies.

The Role of Complete Blood Count-Derived Inflammatory Biomarkers as Predictors of Infection After Acute Ischemic Stroke: A Single-Center Retrospective Study

Background and Objectives: Although a wide range of hematological parameters are used as blood-based inflammatory biomarkers, the role of complete blood count-derived inflammatory biomarkers in infection after acute ischemic stroke (AIS) is modest. Therefore, this study aimed to explore complete blood count-derived inflammatory biomarkers as predictors of infection after AIS. Materials and Methods: A single-center retrospective cross-sectional study was carried out at the National Brain Center Hospital Prof. Dr. dr. Mahar Mardjono, Jakarta, Indonesia, between 1 October 2023, and 31 March 2024, using medical records of hospitalized first-ever ischemic stroke patients who underwent a complete blood count within 24 h of admission. Based on complete blood count-derived inflammatory biomarkers, this study included absolute numbers and related ratios or indices. Results: In total, 163 patients met the study criteria. The diagnosis of infection after AIS was established using reliable clinical symptoms and/or guidelines of the disease. According to the status of infection after AIS, the subjects were categorized into two groups, including 24 patients in the infection group and 139 patients in the non-infection group. Biomarkers that had significant accuracy (higher sensitivity and specificity, respectively) in predicting infection were the leukocyte count (LC; 70.8%, 74.1%, p &lt; 0.001), absolute neutrophil count (ANC; 66.7%, 79.9%, p &lt; 0.001), absolute monocyte count (AMC; 75.0%, 63.3%, p = 0.001), neutrophil to lymphocyte ratio (NLR; 62.5%, 71.9%, p = 0.003), derivative NLR (dNLR; 50.0%, 78.4%, p = 0.003), monocyte–granulocyte to lymphocyte ratio (MGLR; 62.5%, 73.0%, p = 0.003), systemic inflammatory response index (SIRI; 62.5%, 79.0%, p = 0.001), and systemic immune inflammation index (SII; 87.5%, 44.0%, p = 0.012) with chances of 74.4%, 75.4%, 71.0%, 69.0%, 68.7%, 69.3%, 73.4%, and 66.2%, respectively. Conclusions: Considering the overall ROC curve used to evaluate the complete blood count-derived inflammatory biomarkers, ANC has a better ability to predict infection in AIS patients, as denoted by the highest AUC, suggesting a 75.4% chance of correctly discriminating patients with infection after stroke.

Intravenous thrombolysis in young adults with ischemic stroke: A cohort study from the international TRISP collaboration.

Previous observational data indicate that young adults treated with intravenous thrombolysis (IVT) for acute ischemic stroke have more favorable outcomes and less complications when compared to older adults. Given the limited data on this topic, we aimed to provide more evidence on clinical outcomes and safety in such patients, using a large international thrombolysis registry. In this prospective multicenter study, we used data from the Thrombolysis in Ischemic Stroke Patients (TRISP) registry from 1998 to 2020. Patients who received endovascular treatment (EVT), as only treatment or in addition to IVT, were not included in this cohort. Using multivariable regression models, we compared thrombolysed young patients aged 18-49 years with those aged ⩾50 years with regards to the following outcomes: favorable outcome in stroke survivors (modified Rankin Scale ⩽2), symptomatic intracranial hemorrhage (sICH) according to European Cooperative Acute Stroke Study II (ECASS II) criteria, and three-months all-cause death. Of the 16,651 IVT treated patients, 1346 (8.1%) were 18-49 years. Young adults in TRISP were more often male (59.6% vs 54.0%), had a lower median NIHSS score on admission, 7 (4-13) versus 8 (5-15), and had less cardiovascular risk factors except for smoking (42.0% vs 19.0%) when compared to older patients. When compared to thrombolysed patients aged ⩾50 years, a favorable functional outcome was more likely in young adults: 81.9% versus 56.4%, aOR 2.30 (1.80-2.95), whilst sICH 1.6% versus 4.6%, aOR 0.45 (0.23-0.90) and death 2.3% versus 14.2%, aOR 0.21 (0.11-0.39) were less likely. Intravenous thrombolysis in young adults is independently associated with higher rates of favorable outcomes and lower rates of complications.

End-to-end deep learning patient level classification of affected territory of ischemic stroke patients in DW-MRI.

To develop an end-to-end DL model for automated classification of affected territory in DWI of stroke patients. In this retrospective multicenter study, brain DWI studies from January 2017 to April 2020 from Center 1, from June 2020 to December 2020 from Center 2, and from November 2019 to April 2020 from Center 3 were included. Four radiologists labeled images into five classes: anterior cerebral artery (ACA), middle cerebral artery (MCA), posterior circulation (PC), and watershed (WS) regions, as well as normal images. Additionally, for Center 1, clinical information was encoded as a domain knowledge vector to incorporate into image embeddings. 3D convolutional neural network (CNN) and attention gate integrated versions for direct 3D encoding, long short-term memory (LSTM-CNN), and time-distributed layer for slice-based encoding were employed. Balanced classification accuracy, macro averaged f1 score, AUC, and interrater Cohen's kappa were calculated. Overall, 624 DWI MRIs from 3 centers were utilized (mean age, interval: 66.89 years, 29-95 years; 345 male) with 439 patients in the training, 103 in the validation, and 82 in the test sets. The best model was a slice-based parallel encoding model with 0.88 balanced accuracy, 0.80 macro-f1 score, and an AUC of 0.98. Clinical domain knowledge integration improved the performance with 0.93 best overall accuracy with parallel stream model embeddings and support vector machine classifiers. The mean kappa value for interrater agreement was 0.87. Developed end-to-end deep learning models performed well in classifying affected regions from stroke in DWI. The end-to-end deep learning model with a parallel stream encoding strategy for classifying stroke regions in DWI has performed comparably with radiologists.

Lipid Profile and Its Association with Ischemic Cerebrovascular Stroke Patients: An Analytical Study in a Tertiary Care Hospital of West Bengal

Lipid Profile and Its Association with Ischemic Cerebrovascular Stroke Patients: An Analytical Study in a Tertiary Care Hospital of West Bengal

Fusion Learning from Non-contrast CT Scans for the Detection of Hemorrhagic Transformation in Stroke Patients.

Hemorrhagic transformation (HT) is a potentially catastrophic complication after acute ischemic stroke. Prevention of HT risk is crucial because it worsens prognosis and increases mortality. This study aimed at developing and validating a computer-aided diagnosis system using pretreatment non-contrast computed tomography (CT) scans for HT prediction in stroke patients undergoing revascularization. This retrospective study included all acute ischemic stroke patients with non-contrast CT before reperfusion therapy who also underwent follow-up MRI from January 2018 to December 2022. Among the 188 evaluated patients, any degree of HT at follow-up imaging was observed in 103 patients. HT diagnosis via MRI was defined as the reference standard for neuroradiologists. Using a database of 2076 serial non-contrast CT images of the brain, pretrained deep learning architectures such as convolutional neural networks and vision transformers (ViTs) were used for feature extraction. The performance of the predictive HT risk model was evaluated via tenfold cross-validation in machine learning classifiers. The accuracy, sensitivity, specificity, and area under the receiver operating characteristic curve (AUC) were evaluated. Using an individual deep learning architecture, DenseNet201 features achieved the highest accuracy of 87% and an AUC of 0.8863 in the classifier of the subspace ensemble k-nearest neighbor. By combining the DenseNet201 and ViT features, the accuracy and AUC can be improved to 88% and 0.8987, respectively, which are significantly better than those of using ViT alone. Detecting HT in stroke patients is a meaningful but challenging issue. On the basis of the model approach, HT diagnosis would be more automatic, efficient, and consistent, which would be helpful in clinic use.

Features of pathogenesis and tactics of management of patients with ischemic stroke against the background of end-stage chronic kidney disease

Acute cerebrovascular accidents in patients with end-stage chronic kidney disease are an important but not well understood problem. The main difficulty is the lack of approved clinical guidelines and large multicenter studies that would allow the determination of a proven approach to therapy in the combination of these diseases. This group of patients is rarely included in clinical trials and has high risks of complications. Up to a third of strokes in patients with end-stage chronic kidney disease receiving hemodialysis develop in a hospital and are classified as intrahospital. Assessing the risks associated with performing contrast agent studies in patients with chronic kidney disease is a pressing issue. Kidney damage significantly increases the incidence of adverse outcomes in the acute stage of ischemic stroke, but when using systemic thrombolytic therapy it does not worsen outcomes and does not increase the risk of intracranial hemorrhage. The review article includes retrospective and prospective studies, systematic reviews describing cases of ischemic stroke in patients with end-stage chronic kidney disease for the period 2015–2022. The search was conducted in the bibliographic databases MEDLINE, PubMed, Google Scholar, Scopus, eLIBRARY. Articles published only in peer-reviewed scientific journals were selected for the review. The search strategy was a search query for the key terms “ischemic stroke”, “chronic kidney disease”, “hemodialysis”, “thrombolytic therapy”, “angiography”. The reference lists of all published articles and relevant systematic reviews were manually reviewed. A total of 947 titles, 96 full articles were reviewed, 38 of which were included in this review. The article analyzes current concepts of the features of pathophysiological mechanisms and risk factors for ischemic stroke in patients with end-stage chronic kidney disease receiving renal replacement therapy, as well as discusses approaches to the possibility of performing radiocontrast studies and the features of systemic thrombolytic therapy in this group of patients.

Inflammatory Response in Stroke: A Comparative Leukocyte Analysis in Hemorrhagic and Ischemic Stroke Patients at a Single Center in Jambi, Indonesia

Inflammatory Response in Stroke: A Comparative Leukocyte Analysis in Hemorrhagic and Ischemic Stroke Patients at a Single Center in Jambi, Indonesia

Prevalence Of Sensorineural Hearing Loss Among Stroke

This study was designed to determine the prevalence of sensorineural hearing loss among stroke patients. A cross-sectional analytical study was conducted. Medicine department of HMC Peshawar and lady reading hospital (LRH) in Peshawar. Total 224 diagnosed stroke patients were selected by non-probability purposive sampling technique. 20 and above age group male and female were included. Transient ischemic, psychological, and congenital stroke patients were excluded. Pure Tone audiometry (PTA) was done using pure tone audiometer to identify type of hearing loss. The Study was conducted at audiology Department of The University of Lahore for the duration of six months from 22nd March2023 to 22nd August2023. Out of 224 stroke patients, 168 were ischemic and 56 were hemorrhagic type.15 patients had conductive hearing loss,111 had sensorineural hearing loss,21 had mixed hearing loss while 66 were having normal and 11 were having high frequency sensorineural hearing loss. This study showed that there was no significant association between sensorineural hearing loss and stroke.

Clinical Efficacy and Safety Analysis of Alteplase in the Treatment of Acute Ischemic Stroke Patients

In the treatment of acute ischemic stroke, alteplase plays a vital role as a thrombolytic drug, and as the social demand for it increases, its clinical application value has received increasing attention. In order to further explore the clinical efficacy and safety of alteplase in the treatment of acute ischemic stroke, the paper outlines the pathogenesis and clinical manifestations of acute ischemic stroke, and clarified the high prevalence and severity of the disease. Besides, the mechanism of action of alteplase and its clinical effect are analyzed, and it is found that it mainly dissolves thrombi, treats thrombotic diseases, reduces the risk of bleeding, and plays a significant role in emergency treatment. In addition, it compares the characteristics and advantages of alteplase with other thrombolytics, emphasizing the importance of various thrombolytic agents in medical practice through a review of relevant literature. Overall, the study aims to explore the clinical efficacy and safety of alteplase in patients with acute ischemic stroke. The results indicate that alteplase is effective in dissolving thrombi, treating thrombotic diseases and reducing the risk of bleeding. Despite certain side effects, its overall safety was still high. Therefore, alteplase shows safe and effective advantages in the treatment of acute ischemic stroke, with broad promotional value.

Construction and validation of a prediction model for acute ischemic stroke patients with concomitant deep vein thrombosis.

The aim was to investigate the independent risk factors for complications of deep vein thrombosis (DVT) in patients with acute ischemic stroke (AIS), and to establish a nomogram prediction model accordingly. The data of AIS patients in our hospital were collected from January 2021 to December 2023, and single-factor and multifactorial logistic regression analyses were used to determine the independent risk factors for the complication of DVT in patients with AIS and to establish the corresponding nomogram. The receiver operating characteristic curves were plotted the area under the curve was calculated, and the calibration and decision curves were plotted to evaluate the model performance. Five hundred twenty-seven AIS patients were included in the study, and 42 AIS patients were complicated with DVT, with an incidence rate of 7.97%. After univariate and multivariate logistic regression analyses, a total of 5 variables were identified as independent risk factors for the complication of DVT in patients with AIS: age > 70 years (OR, 1.551; 95% CI, 1.189-2.751), diabetes (OR, 2.543; 95% CI, 1.322-4.265), the national institutes of health stroke scale > 16 (OR, 3.124; 95% CI, 1.314-7.003), D-dimer > 0.5 mg/L (OR, 2.303; 95% CI, 1.250-3.645), and fibrinogen > 4 g/L (OR, 1.918; 95% CI, 1.532-6.369). The nomogram constructed in this study for AIS patients with concomitant DVT has good predictive accuracy and helps physicians to intervene in advance in patients at high risk of acute AIS patients with concomitant DVT.

Evolution of Sleep Apnea and Arousals in Patients with Ischemic Stroke: A Longitudinal Follow-Up Study.

Sleep-disordered breathing (SDB) is characterized by pauses or shallow breathing during sleep. It is linked to poorer outcomes and increased stroke recurrence in stroke patients. We aimed to evaluate the proportion, severity, type, and evolution of SDB and arousals in ischemic stroke patients. Ischemic stroke patients were recruited to evaluate SDB. Patients underwent overnight polysomnography (PSG) twice - within 1 month of stroke onset and again after 3 months. Clinical outcomes were evaluated at 6, 18, and 24 months. Of 141 acute ischemic stroke patients screened, 111 patients recruited in the study and 105 patients had technically adequate polysomnography. The mean age of patients was 50.5 years (standard deviation [SD]: 12.30), 78.4% of the patients were males, and the mean body mass index was 26 (SD: 5.4). Results showed that 81.9% had an apnea-hypopnea index (AHI) ≥5, with 12.5% having an AHI >30. The median arousal index (ArI) was 15.4 (interquartile range [IQR]: 0.5-50.5), which increased as the apnea increased. During follow-up, 56.8% patients had an AHI ≥5, with 12.5% having severe apnea. The median ArI decreased from 15.4 (IQR: 0.5-50.5) initially to 11.54 (IQR: 0.5-21.1) at follow-up. Numerical change in AHI severity categories were noted during the follow-up (mild: 8 vs 15; moderate: 17 vs 11; severe 19vs 7). For AHI >30, ArI decreased from 24.63 (IQR: 0.7-50.05) to 10.54 (IQR: 7.1-15.07) at follow-up. Sleep efficiency and rapid eye movement (REM) sleep duration increased on follow-up. The study showed a high proportion of SDB in acute ischemic stroke patients. In the follow-up, SDB improved, as reflected in AHI and ArI changes.

Depression and anxiety at 1- and 12-months post ischemic stroke: methods for examining individual change over time.

Background Depression is commonly studied post stroke, while anxiety is less studied. This study presents prevalence of depression and anxiety at 1- and 12-months post ischemic stroke alongside three methods for examining within-subjects change over time. Methods Participants were ischemic stroke patients of the Auckland Regional Community Stroke Study (ARCOS-V) with Hospital Anxiety and Depression Scale data at 1- (n =343) and 12-months (n =307). Change over time was examined using within-subjects repeated measures ANOVA, calculation of the Reliable Change Index, and a Sankey diagram of those meeting cut-off scores (>7) for caseness over time. Results Using repeated measures ANOVA, depression scores didn't change significantly over time, while anxiety symptoms decreased significantly. When reliable change was calculated, 4.2% of individuals had reliable decreases in anxiety symptoms, while 5.7% had reliable decreases in depression symptoms. Those who had a reliable decrease in one tended to have a reliable decrease in the other. In the Sankey, the proportion of those meeting the cut-off score for anxiety did not change over time (12.8 and 12.7% at 1- and 12-months), while those meeting the cut-off for depression increased slightly (3.7-4.5%) and those meeting cut-offs for both decreased from 10.4 to 8.1%. Conclusion The three methods produced very different findings. Use of cut-off scores is common but has limitations. Calculation of clinically reliable change is recommended. Further work is needed to ensure depression and anxiety are monitored over time post-stroke, and both should be the subject of intervention efforts in both acute and late stages post-stroke.

Integrative multi-omics approach using random forest and artificial neural network models for early diagnosis and immune infiltration characterization in ischemic stroke.

Ischemic stroke (IS) is a significant global health issue, causing high rates of morbidity, mortality, and disability. Since conventional Diagnosis methods for IS have several shortcomings. It is critical to create new Diagnosis models in order to enhance existing Diagnosis approaches. We utilized gene expression data from the Gene Expression Omnibus (GEO) databases GSE16561 and GSE22255 to identify differentially expressed genes (DEGs) associated with IS. DEGs analysis using the Limma package, as well as GO and KEGG enrichment analyses, were performed. Furthermore, PPI networks were constructed using DEGs from the String database, and Random Forest models were utilized to screen key DEGs. Additionally, an artificial neural network model was developed for IS classification. Use the GSE58294 dataset to evaluate the effectiveness of the scoring model on healthy controls and ischemic stroke samples. The effectiveness of the scoring model was evaluated through AUC analysis, and CIBERSORT analysis was conducted to estimate the immune landscape and explore the correlation between gene expression and immune cell infiltration. A total of 26 significant DEGs associated with IS were identified. Metascape analysis revealed enriched biological processes and pathways related to IS. 10 key DEGs (ARG1, DUSP1, F13A1, NFIL3, CCR7, ADM, PTGS2, ID3, FAIM3, HLA-DQB1) were selected using Random Forest and artificial neural network models. The area under the ROC curve (AUC) for the IS classification model was found to be near 1, indicating its high accuracy. Additionally, the analysis of the immune landscape demonstrated elevated immune-related networks in IS patients compared to healthy controls. The study uncovers the involvement of specific genes and immune cells in the pathogenesis of IS, suggesting their importance in understanding and potentially targeting the disease.

Association of Triglyceride glucose index with the outcomes of Ischemic stroke.

Background Ischemic stroke is a primary contributor to both mortality and disability on a global scale. The triglyceride-glucose index (TyG index), which measures insulin resistance, has been found as a possible predictor of outcomes of cerebrovascular events. Objective To examine the correlation between TyG index and outcomes in patients diagnosed with ischemic stroke. Methods This retrospective analysis of 200 patients diagnosed with ischemic stroke was carried out at the department of medicine, Khyber Teaching Hospital, Peshawar between 1st August 2022 and 31st December 2023. Triglyceride/glucose ratio was determined using the formula TyG = ln [Fasting triglycerides (mg/dl)/Fasting glucose (mg/dl)]/2. Patients were categorized into two Group A (TyG index &lt; 8.8) and Group B (TyG index &gt; 8.8). Demographic data, clinical features, and stroke outcomes, such as death and functional status (assessed by the modified Rankin Scale [mRS]), were compared between the two groups. Results Group A contained (112) patients and Group B (88). Both Group A and Group B had 51.8% (n=58) and 51.1% (n=45) male patients respectively. The mean age of patients in Group A was 65.4 ± 10.2 years and 67.1 ± 11.5 years in group B. 30-day mortality in group A was 8.0% (n=9) and 18.2% (n=16) in group B (p value 0.03). The median mRS score at 3 months in group A was 2.5 versus 3.5 in group B (p value = 0.02). Patients in Group B had longer hospital stay (10.5 ± 3.1days vs. 8.2 ± 2.4days, p = 0.01) and higher frequency of major adverse cardiovascular events (MACE) (15% vs. 7%, p = 0.05). Conclusion In ischemic stroke patients, 30-day mortality was more common with TyG index &gt;8.8 and the modified Rankin Scale (mRS) functional status at 3 months was better in TyG index &lt;8.8.