Term Neurological Outcome Research Articles

A Study on 24-hour Monitoring of Blood Pressure in Acute Stroke and Its Correlation with Short Term Neurological Outcome.

The association between blood pressure (BP) at admission and clinical outcomes in patients with acute stroke has been investigated; however, results from these studies are contradictory. Hence, we designed this study to monitor circadian variation of BP in acute stroke and study its correlation with neurological outcome. A total of 108 cases of acute stroke (both ischemic and hemorrhagic) admitted within 24 hours were included in the study. On admission, three casual supine BP measurements were taken at 5-minute intervals, and the mean value was recorded. Ambulatory BP monitoring (ABPM) was done on day 1, and all the BP variables were recorded. On the day of admission, the functional status of all the cases was assessed using the Modified Rankin Scale (MRS 0-6). On day 6, again, three casual BP measurements were taken, and MRS was done. The 24-hour BP profile and neurological outcome were correlated on day 1 and day 6. On follow-up at 1 month, all the patients were thoroughly examined, and MRS was done to reassess the functional status post stroke. Circadian variation of BP shows that the majority of our cases were nondippers, followed by reverse dippers and dippers. It was seen that a higher mean 24-hour systolic BP (SBP), daytime SBP, as well as nighttime SBP, were all significantly associated with a poorer MRS score (4-6) both at day 6 and 1 month. Similarly, a higher mean value of the casual SBP, as well as diastolic BP (DBP) readings obtained on day 1 of stroke, adversely affected the outcome in terms of MRS scores both at day 6 and 1 month. It was also seen that the higher mean values of both the casual SBP and DBP readings obtained on day 6 of stroke adversely affected the outcome in terms of MRS scores at 1 month. A higher mean 24-hour SBP, mean daytime SBP, and mean nighttime SBP were associated with poor neurological outcomes at day 6 and 1 month.

Endovascular thrombectomy versus medical management for moderate-to-severe anterior cerebral artery occlusion stroke.

There are no established patient selection criteria for endovascular thrombectomy (EVT) for anterior cerebral artery (ACA) stroke. This was a retrospective cohort study of the 2016-2020 National Inpatient Sample in the United States. Isolated ACA-occlusion stroke patients with moderate-to-severe stroke symptoms (NIH stroke scale [NIHSS] ≥ 6) were included. Primary outcome was hospital discharge to home with self-care. Secondary outcomes include in-hospital mortality and intracranial hemorrhage (ICH). Confounders were accounted for by multivariable logistic regression. 6685 patients were included; 335 received EVT. Compared to medical management (MM), EVT patients were younger (mean 67.2 versus 72.2years; p = 0.014) and had higher NIHSS (mean 16.0 versus 12.5; p < 0.001). EVT was numerically but not statistically significantly associated with higher odds of home discharge compared to MM (aOR 2.26 [95%CI 0.99-5.17], p = 0.053). EVT was significantly associated with higher odds of home discharge among patients with NIHSS 10 or greater (aOR 3.35 [95%CI 1.06-10.58], p = 0.039), those who did not receive prior thrombolysis (aOR 3.96 [95%CI 1.53-10.23], p = 0.005), and those with embolic stroke etiology (aOR 4.03 [95%CI 1.21-13.47], p = 0.024). EVT was not significantly associated with higher rates of mortality (aOR 1.93 [95%CI 0.80-4.63], p = 0.14); however, it was significantly associated with higher rates of ICH (22.4% vs. 8.5%, p < 0.001). EVT was associated with higher odds of favorable short-term outcomes for moderate-to-severe ACA-occlusion stroke in select patients. Future studies are needed to confirm the efficacy of EVT in terms of longer term neurological outcomes.

Long-Term Neurological Morbidity Among Children Delivered by Vacuum Extraction—A National Cohort Study

(Abstracted from Acta Obstet Gynecol Scand 2023;102:843–853) Many factors during pregnancy and childbirth influence long term neurological outcomes, but some controllable factors have not been studied extensively; one of these factors is vacuum extraction (VE) as a method of assisted childbirth. This study was designed as the first nationwide cohort study examining VE and its impact on long-term neurological morbidity, and its aim was to assess the risks of neonatal mortality, cerebral palsy (CP), and epilepsy in children delivered by VE.

Comparison of Short Term Neurological Outcome in Patients of Hypoxic Ischemic Encephalopathy Treated with Erythropoietin Versus Intravenous Magnesium Sulphate

Aim: Hypoxic-ischemic encephalopathy (HIE) in neonates remains a significant challenge in medical practice, requiring effective and reliable treatment options. Erythropoietin (EPO) and Intravenous Magnesium Sulphate (MgSO4) have been explored as potential therapies, but a direct comparison of their effectiveness has been lacking. Method: This study compared the effects of EPO and Intravenous MgSO4 in a sample of 38 neonates, evenly distributed between the two treatment groups. Parameters including maternal age, gestational age, neonatal age, weight, and several biochemical variables were assessed. Statistical analyses were conducted to reveal any significant differences between the two groups. Results: The evaluation across various parameters revealed no significant differences between the two treatments. All the tested variables, including primary outcomes such as HB levels, showed a similarity in the overall impact of Erythropoietin and Intravenous MgSO4, with p-values consistently above 0.05. Conclusion: The findings suggest that both Erythropoietin and Intravenous MgSO4 exhibit comparable effects in the treatment of neonates with HIE. The lack of significant differences prompts a need for further research to understand the nuanced differences and potential applications of each treatment method. These insights will be instrumental in guiding future therapeutic strategies for HIE. Keywords: Neonates, Hypoxic-Ischemic Encephalopathy, Erythropoietin, Intravenous Magnesium Sulphate, Treatment Comparison, Biochemical Variables.

Short and Medium Term Neurological Outcomes of Children with Antenatal or Neonatal Exposure to Severe Acute Respiratory Syndrome Coronavirus 2

Short and Medium Term Neurological Outcomes of Children with Antenatal or Neonatal Exposure to Severe Acute Respiratory Syndrome Coronavirus 2

In-hospital and long term neurological outcome prognostication using an algorithm based on the analysis of ventricular fibrillation from the EKG of patients with sudden cardiac death (AWAKE)

Abstract Background Sudden cardiac death (SCD) is a leading cause of mortality and carries a dismal neurological outcome (NO) among patients admitted alive to acute cardiac care units (ACCU). A big share of SCD are found in ventricular fibrillation (VF). VF waveform is dynamic and it can be characterized by spectral analysis at the very time of ACCU admission. Purpose To validate in a multicenter cohort an algorithm based on spectral variables of VF waveform to early predict neurological outcome at hospital discharge and follow-up, and to compare its performance with currently established prognostic tools. Methods Multicenter study in which 5 hospitals recruited patients, resuscitated from SCD due to VF whose EKG was available, and admitted to ACCU with expertise in SCD. EKG tracings were scanned and analyzed with a custom MATLAB script delivering spectral variables to be entered in an algorithm to predict NO. NO was assessed by Cerebral Performance Category (CPC) during admission and after a minimum 6-month follow-up period. The primary endpoint was favorable neurological outcome (FNO, defined as CPC 1 and 2) during hospital admission, and the secondary endpoint was FNO at long-term follow-up. Statistical data were analyzed with SPSS and EPIDAT. Results We included 168 patients out of 678 screened in participant hospitals among admissions from 2007 to 2022. The main cause of exclusion was a rhythm different from VF at the time of medical assistance (n=329, 48%) or VF EKG unavailable (n=151, 22%). Ninety-five patients (57%) were admitted in comatose status (Glasgow &amp;lt;9). Baseline characteristics are depicted in Picture 1. FNO during admission was documented in 136 patients (81%). Twenty-nine patients (17%) died during hospitalization. A spectral-based model using VF tracings early predicted FNO with an area under the curve (AUC) value of 0.85 (CI95% 0.77-0.93). There was overlap with the predictive performance obtained with the peak value of neuron-specific enolase (NSE) (0.85; CI95% 0.74-0.95) (Picture 2, A). Other prognostic tools showed similar or lower diagnostic yield and results were obtained at a later time after admission (Picture 2, B,D). Long-term follow-up was obtained for 166 cases (2 foreign patients were impossible to retrieve). Patients discharged alive were followed for 17 (± standard deviation 21) months. FNO was present in 136 (82%). The spectral-based model predicted FNO with AUC 0.83 (CI95% 0.74-0.92), similar to NSE (AUC 0.87, CI95% 0.77-0.97) (Picture 2, C). Other tools performed in follow-up similar to during admission (Picture 2, D). CONCLUSION A model based on VF spectral analysis predicts neurological outcome after SCD with an accuracy similar to current validated tools, but with no requirement for drug withdrawal or waiting period in comatose patients. This model estimates outcomes at the earliest moment of hospital admission and its predictions remain valid in the long run.Baseline characteristicsDiagnostic yield of model vs other tools

Traumatic atlantoaxial dislocation with a type III odontoid fracture: a rare and fatal injury

Traumatic atlantoaxial dislocation with a dens fracture is very rare in children. In this case report, a 15-year-old woman presented at the emergency department after being hit by a motor vehicle as a bicyclist. CT scans showed a type III dens fracture with retropulsion of the posterior wall, resulting in significant stenosis of the spinal canal. A cervical transection and prevertebral hematoma were present. External immobilization can be applied conservatively. However, atlantoaxial dislocation may require surgical fixation to stabilize and prevent slippage. Here, posterior screw-rod fixation techniques can provide better results in terms of neurological outcomes, pain status and adverse events compared to other techniques. However, head and neck imaging should be performed to consider surgical intervention.

The use of neurone specific enolase to prognosticate neurological recovery and long term neurological outcomes in OOHCA patients.

Hypoxic-ischaemic brain injury (HIBI), is a common sequalae following out-of-hospital cardiac arrest (OOHCA), it is reported as the cause of death in 68% of patients who survive to ICU admission, while other patients can be left with permanent neurological disability. Prediction of neurological outcome follows a multimodal approach, including use of the biomarker, neurone specific enolase (NSE). There is however no definitive cut-off value for poor neurological outcome, and little research has analysed NSE and long-term outcomes in survivors. We investigated an NSE threshold for poor short-term neurological outcome and the relationship between NSE and poor neurological outcome in survivors. A retrospective study was conducted of all adult OOHCA patients admitted to the Royal County Sussex Hospital ICU between April 2017 and November 2018. NSE levels, Targeted Temperature Management (TTM), cross-sectional imaging, mortality and GCS on ICU discharge were recorded. Assessment of neurological function after a median of 19 months (range 14-32 months) post ICU discharge was undertaken following ICU discharge and related to NSE. NSE levels were measured in 59 patients; of these 36 (61%) had a poor neurological outcome due to hypoxic ischaemic brain injury. Youden's index and ROC analysis established an NSE cut-off value of 64.5 μg/L, with AUC of 0.901, sensitivity of 77.8% and specificity of 100%. Follow-up of 26 survivors after 19 months did not show a significant relationship between NSE after OOHCA and long-term neurological outcome. Our results show that NSE >64.5 µg/L has a poor short-term neurological outcome with 100% specificity. Whilst limited by a low sample size, NSE in survivors showed no relationship with neurological outcome post OOHCA in the long term.

SPEECH AND LANGUAGE IMPAIRMENT AFTER CHILDHOOD ARTERIAL ISCHEMIC STROKE

Abstract&#x0D; Objective: Investigate the potential predictors’ dysarthria and dyspraxia of speech and language impairment after childhood stroke.&#x0D; Study Design: Cross sectional study&#x0D; Place and duration of study: Study was conducted in the department of Paediatric Neurology, The Children’s Hospital &amp; Institute of Child Health, Lahore for about one year i.e. from 31st August 2019 to 31st August 2020.&#x0D; Methodology: Seventy children of radiological diagnosed arterial ischemic stroke were selected for study. Prevalence of dyspraxia and dysarthria and language impairment was measured within 2 weeks of stroke. Side of stroke (right, left or both) were assessed and proportion of language impairment, dysarthria, dyspraxia was measured in this study. SPSS version 23 was used for data analysis and determination of variables. P values of ≤0.05 were considered as significant.&#x0D; Results: Seventy patients were included in this study. The mean age of the patients was 8.11±1.26 years. Stroke effects on left side was noted in 27 (38.6%) cases, stroke effects on right side was noted in 33 (47.1%) cases, while in 13 (18.6%) cases both Hemispheres were involved, dysarthria was present in 50 (71.4%) cases, language impairment was observed in 45 (64.3%) cases and verbal dyspraxia was noted in 12 (17.1%) cases.&#x0D; Conclusion: Long term cognitive, motor and neurological outcomes are the results of arterial ischemic stroke. Dysarthria, language impairment and dysparaxia are the main affects of stroke that dependant on size and place lesion. Rehabilitation cannot be predicted after childhood stroke.&#x0D; Keywords: Apraxia; Brain injury; Child; Dysarthria; Language; Stroke; Speech.

Short, medium and long term neurological manifestations and outcome in Covid-19 Patients

Background and objectives: &#x0D; There is a need to improve the understanding of Covid-19 neurological complications in a temporal manner. The objective of our study was to find out temporal relationship of neurological manifestations and outcome in Covid-19 Patients.&#x0D; Methods:&#x0D; This was a multi-center observational study from six centers in Pakistan. Data of covid patients with six months follow up was retrospectively collected from the hospital records. Time periods were divided into short-term (&lt; 1 month), medium-term (2-3 months) and long-term (&gt;4 months). SPSS version 26.0 (SPSS Inc., Chicago, IL, USA) was used to analyze the data.&#x0D; Results:&#x0D; Neurological manifestations were reported in 208 out of 905 covid patients. One-hundred-twenty-five (60%) developed neurological manifestations within one month, 62 (30%) developed within 2-3 months and 21 (10%) developed between 4-6 months. Most common manifestations within one month included cerebrovascular disease (59%), neuromuscular disorders (14%) and neuropsychiatric disorders (10%). Common manifestations in 2-3 months group included neuromuscular manifestations (32%), neuropsychiatric manifestations (19%), cerebrovascular diseases (14 %), myalgia or musculoskeletal pain (14%), and vertigo, hearing problems or tinnitus (14%). Common manifestations in 4-6 months group included neuromuscular disorders (33%) cerebrovascular diseases (19%), fatigue / malaise (9%) anosmia/dysgeusia (9%) and Bell’s palsy (25%). The long-term patients differed from the short-term patients by a mean younger age on presentation (44.7 vs. 59 years), female predominance (52% vs. 28%), higher asymptomatic Covid infection (29% vs. 14%), better clinical outcomes (mean mRS of 1.6 vs. 3), and low mortality (0 vs 18%).&#x0D; Conclusion:&#x0D; Neurological manifestations of covid infection may differ based on time duration since infection. Vascular complications are high in early period while neuromuscular manifestations are high in late period.&#x0D;

Diffusion tensor imaging, intra-operative neurophysiological monitoring and small craniotomy: Results in a consecutive series of 103 gliomas.

Diffusion tensor imaging (DTI) allows visualization of the main white matter tracts while intraoperative neurophysiological monitoring (IONM) represents the gold standard for surgical resection of gliomas. In recent years, the use of small craniotomies has gained popularity thanks to neuronavigation and to the low morbidity rates associated with shorter surgical procedures. The aim of this study was to review a series of patients operated for glioma using DTI, IONM, and tumor-targeted craniotomies. The retrospective analysis included patients with supratentorial glioma who met the following inclusion criteria: preoperative DTI, intraoperative IONM, tumor-targeted craniotomy, pre- and postoperative MRI, and complete clinical charts. The DTI was performed on a 3T scanner. The IONM included electroencephalography (EEG), transcranial (TC) and/or cortical motor-evoked potentials (MEP), electrocorticography (ECoG), and direct electrical stimulation (DES). Outcomes included postoperative neurological deficits, volumetric extent of resection (EOR), and overall survival (OS). One hundred and three patients (61 men, 42 women; mean age 54 ± 14 years) were included and presented the following WHO histologies: 65 grade IV, 19 grade III, and 19 grade II gliomas. After 3 months, only three patients had new neurological deficits. The median postoperative volume was 0cc (IQR 3). The median OS for grade IV gliomas was 15 months, while for low-grade gliomas it was not reached. In our experience, a small craniotomy and a tumor resection supported by IONM and DTI permitted to achieve satisfactory results in terms of neurological outcomes, EOR, and OS for glioma patients.

Salvinorin A for Stroke Rescue Purposes

In this perspective, I summarize the current evidence that salvinorin A could be used for stroke rescue. A recent study to demonstrate the effectiveness of intranasal salvinorin A to improve long term neurological outcome in a monkey ischemic stroke model is very promising. Current accumulated evidence indicates that salvinorin A can improve stroke outcome through various mechanisms. While salvinorin A has side effects of diuresis, hypothermia, reduced brain metabolism, and psychotropic effects, these could potentially all contribute to protective effects in the setting of stroke.

Matched comparison of 3 cerebral perfusion strategies in open zone-0 anastomosis for acute type A aortic dissection.

The present study aims to investigate outcomes after the surgical treatment of acute type A aortic dissection in regard to three available selective cerebral perfusion strategies. From 2000 to 2019, patients were selected based on the employment of either retrograde cerebral perfusion (RCP), unilateral antegrade cerebral perfusion (uACP) or bilateral antegrade cerebral perfusion (bACP) during open zone-0 anastomosis. Propensity score TriMatch analysis considering several preoperative and intraoperative variables was used to identify well-balanced triplets. The primary end point of the study was a new cerebral operation-related neurologic deficit. Operative times (operation time, cardiopulmonary bypass time, reperfusion time) were significantly longer in the RCP group, in which deeper hypothermia was applied (27.5 [24-28], 28 [26-28] and 16 [16-17]°C for uACP, bACP and RCP, respectively, P-value &lt;0.001). The RCP group showed higher red blood cell concentrates and fresh frozen plasma transfusion rates. No significant difference of new cerebral operation-related neurologic deficit was observed between the 3 groups (12.9% vs 12.9% vs 11.3% for RCP, uACP and bACP, P-value = 0.86). In addition, 30-day mortality showed similar distribution independently of the cerebral perfusion strategy adopted (17.7% vs 14.5% vs 17.7% for RCP, uACP and bACP, P-value = 0.86). However, based on a small sample size, the comparison showed no relevant differences in terms of neurologic outcome and 30-day mortality, confirming RCP, uACP and bACP as safe and reproducible selective cerebral perfusion strategies in surgery for acute type A aortic dissection.

Neurological Outcome of Early versus Late Surgery Following Cervical Spinal Cord Injury

Background There are numerous retrospective studies and a few prospective studies to determine the neurologic outcome after early versus late surgical treatment for cervical spinal cord injury.&#x0D; Objective To compare the neurological outcome between early (within 72 hours after injury) and delayed (≥ 72 hours after injury) surgery in patients with cervical spinal injury.&#x0D; Method This is a retrospective analysis of the neurological outcome of early versus late surgery following cervical spinal cord trauma. Patients meeting appropriate inclusion criteria were divided into an early or a late surgical treatment group. The neurologic outcomes and other complications were recorded up to six months of follow-up.&#x0D; Result Overall, there was a significant difference in neurological status at presentation and at follow-up (p &lt; 0.001). However, there was no statistically significant difference between the early versus late surgery groups (p-value 0.261) in terms of neurological outcome. Complications were found to be higher among those undergoing posterior surgical approach (OR = 23.75; 95% CI 2.65, 212.98) than those with anterior or combined approach (p=0.005). However, multivariate analysis of these variables failed to show any statistically significant difference between the two groups.&#x0D; Conclusion The timing of surgery does not alter the neurological outcomes and the development of complications significantly. The American Spinal Cord Injury Association (ASIA) status at the time of presentation is found to be the single most important factor correlating with the neurological outcome.

Tenecteplase use in the management of acute ischemic stroke: Literature review and clinical considerations.

Several research articles have been published within the last decade comparing the use of tenecteplase to alteplase in ischemic stroke management. Prior reporting on the comparative therapeutic efficacy and safety profiles of tenecteplase and alteplase is reviewed. Tenecteplase is a variant of native tissue-type plasminogen activator, which rapidly promotes thrombolysis by catalyzing formation of the serine protease plasmin. Tenecteplase has theoretical advantages over alteplase as it has greater fibrin specificity and has a longer half-life than alteplase. This allows the administration of a single bolus over 5 to 10 seconds, as opposed to a bolus followed by a 1-hour infusion with alteplase. While currently approved by the Food and Drug Administration for the treatment of ST-segment elevation myocardial infarction, tenecteplase has also been studied in the treatment of acute ischemic stroke and has extensive data for this off-label indication. The most comprehensive trials to date evaluating the use of tenecteplase in acute ischemic stroke include the TNK-S2B, Australian TNK, ATTEST, Nor-Test, and EXTEND-IA TNK trials. Findings from these randomized controlled studies suggest that tenecteplase is at least as efficacious as alteplase in terms of neurological outcomes. The majority of these studies also reported a trend toward improved safety profiles with the use of tenecteplase. Current clinical evidence shows that tenecteplase is not inferior to alteplase for the treatment of ischemic stroke and suggests that tenecteplase may have a superior safety profile. Furthermore, tenecteplase also has practical advantages in terms of its administration. This can potentially lead to a decrease in medication errors and improvement in door to thrombolytic time.

Role of magnesium sulphate in the treatment of severe perinatal asphyxia: Experience from a tropical tertiary hospital

Introduction: Perinatal asphyxia is a major global cause of neonatal morbidity and mortality. In Nigeria, despite the improvement in perinatal care, perinatal mortality is still responsible for about 27% on neonatal mortality. The use of magnesium sulphate to antagonize the excitotoxicity and subsequent brain damage in severe perinatal asphyxia is increasingly being employed. Objective: To assess the role of magnesium sulphate and the timing of administration of the first dose on survival and short term neurologic outcome of neonates with severe perinatal asphyxia (SPNA) treated at Federal Teaching Hospital, Gombe Methodology: This was a prospective cross sectional observational study conducted at Special Care Baby Unit (SCBU) of Federal Teaching Hospital, Gombe. Neonatal parameters such as age, gender, weight, pulse SpO2 APGAR score and time of administration of first dose of magnesium sulphate were recorded. Mothers booking status, parity, place of delivery and prepatum administration magnesium sulphate were also recorded. The neonates tone, reflexes, seizures and grade of HIE was assessed daily for five days. Results: Out of 706 neonates admitted 136 had SPNA giving a prevalence of 19.3%. There were 84(61.8%) males and 52(38.2%) female M: F 1.6:1. Respiratory distress was commonest presenting symptom and mortality was 23.5%. Birth weight and HIE had statistically significant association with outcome but there was no difference in mortality with time of administration of first dose. Conclusion: Magnesium sulphate significantly improved the short term outcome of neonates with HIE but there was no difference in mortality in relation to timing of administration of first dose.

250 Advanced management of out of hospital cardiac arrest: a single-centre experience in a tertiary cardiac intensive care unit

Abstract Aims Out-of-hospital cardiac arrest (OHCA) affects around 1/1000 person-years. Following return of spontaneous circulation (ROSC), the patient can manifest neurological impairment. A targeted temperature management (TTM) protocol is recommended to prevent hypoxic–ischaemic brain damage in patients with coma after cardiac arrest. Neuro-prognostication remains substantial for the prediction of clinical outcomes. To study clinical characteristics, overall survival, and neurological outcome of patients with Glasgow Coma Scale (GCS) &amp;lt;8 after ROSC following an OHCA of presumed cardiac cause at our Institution. Secondly, to investigate determinants of a negative neurological outcome. Methods Observational retrospective study evaluating all patients with OHCA of presumed cardiac cause and with GCS &amp;lt; 8 after ROSC treated in an intensive cardiac care unit of a tertiary centre. The study period was from January 2017 to December 2020. Results One-hundred and five patients out of 107 patients initially selected were included in the study (77% male, mean age 67 years). At 30 days, mortality was 41% and 53% of patients had a poor neurological outcome (Cerebral Performance Category, CPC, 3–5). Sixty-nine patients (66%) underwent TTM. In regard of the circumstances of OHCA, index event in a private place [OR = 3.12 (1.43–7.11), P = 0.005], ineffective rhythm changes during resuscitation manoeuvres [OR = 2.40 (1.05–5.47), P = 0.037] and a greater amount of adrenaline administered during resuscitation [OR = 1.62 (1.27–2.06), P &amp;lt; 0.001] were related to a worse neurological outcome. A history of diabetes mellitus [OR = 3.35 (1.26–8.91), P = 0.015], blood lactates at presentation [OR = 1.33 (1.15—1.53), P &amp;lt; 0.001], neuron-specific enolase (NSE) at presentation [OR = 1.055 (1.022–1.089), P &amp;lt; 0.001] and as peak [OR = 1.034 (1.013–1.054), P &amp;lt; 0.001] were associated with a worse neurological outcome. Among the neurological examinations, the presence of status epilepticus on the EEG [OR = 13.97 (1.73–113.02), P = 0.013] was a predictor of a poor neurological outcome. Treatment with targeted temperature management did not show a significant impact in terms of outcome at univariate analysis [OR = 1.226 (0.547–2.748), P = 0.62]. Two models were developed with multivariate logistic regression for the prediction of neurological outcome. The first one, on a statistical basis, considers pupil reactivity after ROSC, NSE as peak and left ventricular ejection fraction (AUC = 92%). The second model, on a clinical basis, considers age, first blood lactate value and NSE as peak (AUC = 89 %). Finally, the performance of the multiparametric MIRACLE score was tested in our population (AUC 0.81 for neurological outcome at 30 days). Conclusions In our population, at 30 days after cardiac arrest, survival rate and the rate of good neurological outcome were comparable to those of the major international registries and studies. Even though patients treated with TTM did not demonstrate significant differences in terms of neurological outcome, this might be related to study-sample size and patient selection. Results in the literature are still controversial on this topic. The MIRACLE score showed a good performance, making it suitable for clinical use in our population. Similarly, the proposed multivariate models are potentially useful for the elaboration of simple and effective prognostic scores in neurological risk stratification.

Minimally invasive thymectomy for myasthenia gravis: a 7-year retrospective study.

Thymectomy has been identified as an effective strategy for patients with myasthenia gravis (MG) and thymic masses. However, the best surgical approach remains a matter of debate. The aim of the present study was to compare the surgical and neurological outcomes of video-assisted thoracoscopic thymectomy with a modified subxiphoid and bilateral approach in patients with MG and thymic masses. From August 2013 to April 2018, 68 patients who were diagnosed with MG and thymic masses and underwent video-assisted thoracoscopic thymectomy with a modified subxiphoid (44 patients) or bilateral (24 patients) approach were included in this retrospective study. The surgical and neurological results were analyzed with propensity score matching. After propensity score matching, the modified subxiphoid approach in video-assisted thoracoscopic thymectomy resulted in an obviously shorter operative time (P=0.00), drainage duration (P=0.00), less intraoperative blood loss (P=0.00), and shorter postoperative hospital stay (P=0.01). In terms of neurological outcomes, no significant difference was observed in the improvement in MG, with 2-year complete stable remission rates of 21.1% and 26.3% (P=0.68) and 2-year pharmacological remission rates of 31.6% and 26.3% (P=0.60) for the bilateral and subxiphoid approaches, respectively. Additionally, the approaches resulted in similar effects on the magnitudes of decrease in the prednisolone and pyridostigmine doses after 2 years, with average pyridostigmine dose reductions of 72.2% and 71.1% (P=0.78) and average prednisolone reductions of 76.8% and 71.7% (P=0.96) for the bilateral and subxiphoid approaches, respectively. The modified subxiphoid approach was found to be superior to the bilateral approach in video-assisted thoracic surgery thymectomy in terms of the surgical outcomes and yielded similar neurological outcomes. Therefore, the modified subxiphoid approach is recommended as an alternative to the bilateral approach in the treatment of patients with MG and thymic masses.

NEW APPROACHES TO THE DEFINITION AND CLASSIFICATION OF BRONCHOPULMONARY DYSPLASIA IN PRETERM INFANTS

Bronchopulmonary dysplasia (BPD) remains a pressing problem of modern neonatology and pediatrics. Since this disease is chronic and often results in negative long-term consequences, the search for the optimal definition of BPD that would be accuratein predicting long- term respiratory and neurological outcomes is ongoing. It has been 20 years since the definition and classification of BPDs that are currently used had been approved. Over time, the patient population prone to BPD development has changed and new factors have emerged that make it difficult to apply this classification in contemporary clinical practice. In particular, it concerns greater survival of extremely premature infants, which form the majority of patients with BPD. Oxygen dependence during the first month in such infants may be determined by the immaturity of the respiratory system and may not be associated with the development of BPD. Also, new methods of respiratory support have been introduced into practice of intensive care units, which is not accounted for by the current classification. The population of infants with severe BPD, according to classical definition, is heterogeneous with different indicators of long-term chronic morbidity and development. All this justifies the need for new methodological approaches and criteria for the definition and classification of BPD in the modern population of premature infants.This review presents new data, proposals and clarifications for the definition and classification of BPD, which take into account modern features of clinical practice.

Correlation of Serum Albumin Level with Short Term Outcome of Acute Ischemic Stroke Patients

Abstract Objectives We aimed to Detect if there is association between serum albumin level in acute ischemic stroke patients and its short term neurological and functional outcome in a tertiary care hospital in Cairo. Methods The study was carried out as descriptive (cross-sectional) study conducted on 50 cases first-ever acute ischemic stroke patients were enrolled between June 2018 to December 2018 with follow up after 30 days of discharge from hospital. Inclusion and exclusion criteria were strictly exercised. National Institute of Health Stroke Scale (NIHSS) and modified Rankin scale (mRS) score was noted. Serum albumin (SA) was estimated from blood Clinical, functional, and radiological evaluation was done for the patients. Statistical SPSS 20.0 software and Microsoft excel were used for statistical analysis (P ≤ 0.05).Relationship between serum albumin and stroke outcome was determined. Results A total of 50 stroke cases were thus included in the study comprising 34 males and 16 females. The mean age of patients was 40-65 [59.26±6.25] years, we found the most prevalent risk factors in the present study results were hypertension 36 (72.0%). The mean serum level of albumin were (3.73±0.63) on day o of onset and (3.72±0.63) after 30 days of discharge from hospital. Bivariate analysis shows serum albumin was inversely associated with NIHS score and mRS on day o of onset and after 30 days of discharge from hospital which were NIHSS(r= -0.264, P = 0.044) (r= -0.645, P = &amp;lt;0.001) and mrs (r= -0.321, P = 0.031) (r= -0.587, P = &amp;lt;0.001) respectively. Conclusion Hypoalbuminemia had influence to degree of stroke severity, degree of disability and functional outcome. Serum albumin levels had a negatively correlation with NIHSS score and modified Rankin scale. Low serum albumin levels associated with poor prognosis in acute ischemic stroke patients.