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Background@#and Purpose Cerebral edema (CED) in ischemic stroke can worsen prognosis and about 70% of patients who develop severe CED die if treated conservatively. We aimed to describe incidence, risk factors and outcomes of CED in patients with extensive ischemia. @*Methods@#Oservational study based on Safe Implementation of Treatments in Stroke-International Stroke Treatment Registry (2003–2019). Severe hemispheric syndrome (SHS) at baseline and persistent SHS (pSHS) at 24 hours were defined as National Institutes of Health Stroke Score (NIHSS) >15. Outcomes were moderate/severe CED detected by neuroimaging, functional independence (modified Rankin Scale 0–2) and death at 90 days. @*Results@#Patients (n=8,560) presented with SHS and developed pSHS at 24 hours; 82.2% received intravenous thrombolysis (IVT), 10.5% IVT+thrombectomy, and 7.3% thrombectomy alone. Median age was 77 and NIHSS 21. Of 7,949 patients with CED data, 3,780 (47.6%) had any CED and 2,297 (28.9%) moderate/severe CED. In the multivariable analysis, age 128.5 mg/dL (RR, 1.21), and decreased level of consciousness (RR, 1.14) were associated with moderate/severe CED (for all P<0.05). Patients with moderate/severe CED had lower odds to achieve functional Independence (adjusted odds ratio [aOR], 0.35; 95% confidence interval [CI], 0.23 to 0.55) and higher odds of death at 90 days (aOR, 2.54; 95% CI, 2.14 to 3.02). @*Conclusions@#In patients with extensive ischemia, the most important predictors for moderate/ severe CED were age <50, high blood glucose, signs of acute infarct, hyperdense artery on baseline scans, and decreased level of consciousness. CED was associated with worse functional outcome and a higher risk of death at 3 months.
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Background@#and Purpose The influence of stroke etiology on outcomes after endovascular thrombectomy (EVT) is not well understood. We aimed to investigate whether stroke etiology subgrouped as large artery atherosclerosis (LAA) and cardiac embolism (CE) influences outcomes in large artery occlusion (LAO) treated by EVT. @*Methods@#We included EVT treated LAO stroke patients registered in the Safe Implementation of Treatment in Stroke (SITS) thrombectomy register between January 1, 2014 and September 3, 2019. Primary outcome was successful reperfusion (modified Treatment in Cerebral Infarction 2b-3). Secondary outcomes were symptomatic intracranial hemorrhage (SICH), 3-month functional independence (modified Ranking Scale 0–2) and death. Multivariable logistic regression models were used for comparisons. In addition, a meta-analysis of aggregate data from the current literature was conducted (PROSPERO, ID 167447). @*Results@#Of 7,543 patients, 1,903 (25.2%) had LAA, 3,214 (42.6%) CE, and 2,426 (32.2%) unknown, other, or multiple etiologies. LAA patients were younger (66 vs. 74, P<0.001) and had lower National Institutes of Health Stroke Scale score at baseline (15 vs. 16, P<0.001) than CE patients. Multivariable analyses showed that LAA patients had lower odds of successful reperfusion (odds ratio [OR], 0.70; 95% confidence interval [CI], 0.57 to 0.86) and functional independence (OR, 0.74; 95% CI, 0.63 to 0.85), higher risk of death (OR, 1.44; 95% CI, 1.21 to 1.71), but no difference in SICH (OR, 1.09; 95% CI, 0.71 to 1.66) compared to CE patients. The systematic review found 25 studies matching the criteria. The meta-analysis did not find any difference between etiologies. Conclusions From the SITS thrombectomy register, we observed a lower chance of reperfusion and worse outcomes after thrombectomy in patients with LAA compared to CE etiology, despite more favorable baseline characteristics. In contrast, the meta-analysis did not find any difference between etiologies with aggregate data.
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Background@#and Purpose The influence of stroke etiology on outcomes after endovascular thrombectomy (EVT) is not well understood. We aimed to investigate whether stroke etiology subgrouped as large artery atherosclerosis (LAA) and cardiac embolism (CE) influences outcomes in large artery occlusion (LAO) treated by EVT. @*Methods@#We included EVT treated LAO stroke patients registered in the Safe Implementation of Treatment in Stroke (SITS) thrombectomy register between January 1, 2014 and September 3, 2019. Primary outcome was successful reperfusion (modified Treatment in Cerebral Infarction 2b-3). Secondary outcomes were symptomatic intracranial hemorrhage (SICH), 3-month functional independence (modified Ranking Scale 0–2) and death. Multivariable logistic regression models were used for comparisons. In addition, a meta-analysis of aggregate data from the current literature was conducted (PROSPERO, ID 167447). @*Results@#Of 7,543 patients, 1,903 (25.2%) had LAA, 3,214 (42.6%) CE, and 2,426 (32.2%) unknown, other, or multiple etiologies. LAA patients were younger (66 vs. 74, P<0.001) and had lower National Institutes of Health Stroke Scale score at baseline (15 vs. 16, P<0.001) than CE patients. Multivariable analyses showed that LAA patients had lower odds of successful reperfusion (odds ratio [OR], 0.70; 95% confidence interval [CI], 0.57 to 0.86) and functional independence (OR, 0.74; 95% CI, 0.63 to 0.85), higher risk of death (OR, 1.44; 95% CI, 1.21 to 1.71), but no difference in SICH (OR, 1.09; 95% CI, 0.71 to 1.66) compared to CE patients. The systematic review found 25 studies matching the criteria. The meta-analysis did not find any difference between etiologies. Conclusions From the SITS thrombectomy register, we observed a lower chance of reperfusion and worse outcomes after thrombectomy in patients with LAA compared to CE etiology, despite more favorable baseline characteristics. In contrast, the meta-analysis did not find any difference between etiologies with aggregate data.
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BACKGROUND AND PURPOSE: Although arbitrary blood pressure (BP) thresholds exist for acute ischemic stroke (AIS) patients eligible for intravenous thrombolysis (IVT), current international recommendations lack clarity on the impact of mean pre- and post-IVT BP levels on clinical outcomes. METHODS: Eligible studies involving IVT-treated AIS patients were identified that reported the association of mean systolic BP (SBP) or diastolic BP levels before and after IVT with the following outcomes: 3-month favorable functional outcome (modified Rankin Scale [mRS] scores of 0–1) and 3-month functional independence (mRS scores of 0–2), 3-month mortality and symptomatic intracranial hemorrhage (sICH). Unadjusted analyses of standardized mean differences and adjusted analyses of studies reporting odds ratios (ORadj) per 10 mm Hg BP increment were performed using random-effects models. RESULTS: We identified 26 studies comprising 56,513 patients. Higher pre- (P=0.02) and posttreatment (P=0.006) SBP levels were observed in patients with sICH. Patients with 3-month functional independence had lower post-treatment (P < 0.001) SBP whereas trended towards lower pre-treatment (P=0.06) SBP. In adjusted analyses, elevated pre- (ORadj, 1.08; 95% confidence interval [CI], 1.01 to 1.16) and post-treatment (ORadj, 1.13; 95% CI, 1.01 to 1.25) SBP levels were associated with increased likelihood of sICH. Increasing pre- (ORadj, 0.91; 95% CI, 0.84 to 0.98) and post-treatment (ORadj, 0.70; 95% CI, 0.57 to 0.87) SBP values were also related to lower odds of 3-month functional independence. CONCLUSIONS: We found that elevated BP levels adversely impact AIS outcomes in patients receiving IVT. Future randomized-controlled clinical trials will provide definitive data on the aforementioned association.
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Humans , Blood Pressure , Intracranial Hemorrhages , Mortality , Odds Ratio , Stroke , Thrombolytic TherapyABSTRACT
Background: Research has established the negative impacts of obesity upon the adolescents especially in the form of peer rejection and bullying behaviors. Shyness is a natural response of obese adolescents which adversely affects their self-worth
Objectives: To observe the relationship of obesity with rejection sensitivity, shyness and self-worth of obese adolescents and to explore the differences of rejection sensitivity, shyness and self-worth among obese and non-obese adolescents
Study design, settings and duration: This cross-sectional study was carried out in private schools of Lahore from August 2013 to January 2014
Subjects and Methods: In this study, both boys and girls were taken as participants and a sample of 200 adolescents [obese = 100, non-obese = 100] was recruited from private schools. Demographic information form, Rejection sensitivity scale, Shyness scale and Contingencies of self-worth scale were used for data collection. Correlation and regression analyses were used to analyze the data
Results: Obesity was significantly associated with rejection-sensitivity and shyness in obese adolescents and had negative relationship with self-worth. Obese boys scored high on obesity and self-worth as compared to obese girls, whereas, obese girls scored high on feelings of rejection sensitivity and shyness than obese boys. Similarly obese adolescents scored high on rejection sensitivity and shyness than non-obese; however non-obese adolescents scored high on self-worth than obese adolescents
Conclusion: Obese adolescent experience more rejection sensitivity and shyness while had less self-worth as compared to non-obese adolescents of their age
Policy message: Public awareness may be increased regarding the problems, obese adolescents face in the society. They should be accepted, and rewarded for their positive behaviors; especially their weight reduction efforts should be appreciated by the society. Penalizing approaches by their parents, teachers or other family members targeting to their body shape should be avoided
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Obesity and metabolic syndrome is an epidemic seen in the developed, as well as developing countries. Early recognition of this disorder may prevent major non-communicable diseases such as type 2 diabetes mellitus, hypertension and dyslipidemia. Non-alcoholic fatty liver disease and non-alcoholic steatohepatitis are the hepatic manifestations of metabolic syndrome. Prospective, observational, cross-sectional study was conducted in Endocrine Clinic of Jinnah Postgraduate Medical Centre, Karachi from June 2008 to September 2010. This study was conducted in patients suspected to have metabolic syndrome, as defined by International Diabetes Federation. Patients fitting the clinical consensus definition, having either palpable liver or ultrasound evidence of fatty infiltration were enrolled. Detailed history, physical examination, anthropometrics and biochemical measurements were recorded. Liver biopsies were performed where possible and were assessed according to Brunt et al's classification. A total of 101 patients who met the inclusion criteria were enrolled in the study. Liver biopsy was done in 31 patients. On biopsy, non-alcoholic fatty liver disease was confirmed in 28 [90%], non-alcoholic steatohepatitis in 18 [58%] and fibrosis in 8 [25%] patients. Of the biopsied cases, fatty infiltration on ultrasound was seen in 14 [87.5%] cases. Alanine aminotransferase was higher in patients having fibrosis. There was a direct correlation of histopathological changes with rising waist circumference, total cholesterol, triglyceride, low density lipoprotein and alanine aminotransferase. There was high prevalence of non-alcoholic fatty liver disease / non-alcoholic steatohepatitis in patients with metabolic syndrome and liver biopsy confirmed this in 90.3% patients who consented to this procedure
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Humans , Male , Female , Metabolic Syndrome/pathology , Obesity , Prospective Studies , Cross-Sectional StudiesABSTRACT
To check the Vitamin D levels in patients diagnosed as fibromyagia in our population. Study was done at Medical OPD of Civil Hospital Karachi, from January to March 2009. Female patients diagnosed as Fibromyalgia according to American College of Rheumatology [ACR] criteria and exclusion of systemic illness on examination, and normal reports of blood CP, ESR, serum calcium, phosphate and Alkaline Phosphatase, were asked to get Vitamin D levels in their serum. Vitamin D deficiency is defined as < 20 ng/ml, Vitamin D insufficiency 21-29 ng/ml and Vitamin D sufficiency equal or > 30 ng/ml. Forty female patients were included in the study. The mean age was 37.65 +/- 11.5 years. Mean Vitamin D level was 17.41 +/- 5.497 ng/ml. Thirty two [80%] of patients had Vitamin D deficiency, mean levels of 15.855 +/- 4.918 ng/ml and 8 [20%] had Vitamin D insufficiency, mean levels of 23.64 +/- 2.39 ng/ml. Patients with vitamin D deficiency and age less than 45 years were 22 [68.75%], had mean vitamin D level 16.87 +/- 4.48 ng/ml whereas in age ranging from 46-75 years were 10 [31.25%] had mean vitamin D level 16.09 +/- 6.45 ng/ml. Vitamin D deficiency is frequently seen in patients diagnosed as fibromyalgia and nonspecific musculoskeletal pain in our population. Although the sample size of the study is small, but the figures are so alarming that it is an eye opener towards the need of a population based study, including normal population as well as those presenting with musculoskeletal pain
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Humans , Female , Adolescent , Adult , Middle Aged , Aged , Vitamin D Deficiency , Vitamin D/blood , OsteomalaciaABSTRACT
To determine the impact of percentage parasitemia and clinical features on morbidity and mortality in patients with P. falciparum malaria. Case series. Department of Medicine, Medical Unit II, Jinnah Postgraduate Medical Centre, Karachi, Pakistan from May to November 2005. Seventy-six adult patients of smear positive P. falciparum malaria were selected for the study. Parasite density was estimated on thin blood film and expressed as percentage of red blood cells parasitized. Patients were divided into three groups on the basis of parasite density. The data was analyzed on SPSS version 12. Results were expressed as percentages, mean and standard deviations. P-value <0.05 was taken as significant. Data of 76 study patients who fulfilled the inclusion criteria was analyzed on the basis of parasite density. Thirty-one [40.79%] patients had parasite density < 5%, 22 [28.95%] had parasite densities between 5% and 10% and 23[30.26%] patients had parasite density >10%. Comparative analysis of the groups showed that pallor, impaired consciousness, jaundice or malarial hepatitis, thrombocytopenia, acute renal failure, DIC, and mortality were all strongly associated with the density of Plasmodium falciparum malaria [p=0.001]. Parasite density was not related to age, gender and hepatosplenomegaly. High parasite density was associated with severe clinical illness, complications and mortality. Parasite counts of > 5% may be considered as hyperparasitaemia in this population of the world
Subject(s)
Humans , Male , Female , Animals , Malaria, Falciparum/mortality , Plasmodium falciparum , Parasitemia , Pallor , Jaundice , Hepatitis , Thrombocytopenia , Acute Kidney Injury , Disseminated Intravascular Coagulation , Erythrocytes/parasitologyABSTRACT
The study includes autopsy examination of 132 cases of asphyxial deaths, brought by the police at Department of Forensic Medicine, K.E.M.U., Lahore during the year 2002, 2003 and 2004. The study revealed that the female to male ratio was 2:3 and individuals in the third decade of life are maximally involved. The ligature was a single loop in 77.7% of the cases and multiple in 22.3% of the cases. The most frequent non-specific asphyxial signs were congestion [72.7% of the cases] and petecheal haemorrhages [78%] cases. The hyoid bone was fractured in 22.7% cases. The associated injuries found were, physical and sexual in nature in 65% of the cases examined
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Humans , Male , Female , Death , Autopsy , Hyoid BoneABSTRACT
To find out the most frequently targeted site of the body in sharp force homicidal injuries, defence wounds, age, associated weapon use, gender incidence and cause of death. Department of Forensic Medicine and Toxicology, King Edward Medical University, Lahore. 2002, 2003 and 2004. Proforma was designed for retrospective study, relevant information was gleaned from the available record .A three year period was selected, spreading over 2002, 2003 and 2004, was scrutinised for 232 cases autopsied at this facility. Male to female ratio was 2.26: 1. Maximum number of victims belonged to the 20-29 years age group. Single injuries were present in 18.54% of the cases and multiple were present in 81.46% cases. The commonest associated weapon used was blunt. Death was caused by haemorrhage in 46.5% cases and damage to vital organs proved to be the cause of death in 53.5% cases. Defence injuries were seen in 26.7% cases. The commonest infliction site was the neck in females while the area most targeted in male victims was the chest. The most targeted site is neck. Approximately one in four victims had defence injuries. Most injuries are on trunk [chest and abdomen]. Commonest regions for males was chest and in females. Damage to vital organs was the major cause of death. Amongst females teenager are more vulnerable, as this group had the maximum number of victims
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Humans , Male , Female , Incidence , Weapons , Retrospective Studies , Autopsy , Cause of Death , Wounds and InjuriesABSTRACT
To find out the frequency of hepatitis B, C and human immunodeficiency virus [HIV] in blood donors at Shaikh Zayed Hospital, Lahore. Design: This is a non-interventional study. Study Period: Period of this study is from 1-1-2005 to 30-6-2005. Study was conducted at the Blood Bank of Shaikh Zayed Hospital, Lahore. Subjects and Methods: In this study 18216 young healthy voluntary blood donors [age 16-50 years] comprising of 16611 males and 1605 females were included and tested for HBsAg, Anti-HCV and HIV by Accu check one step test [chromatographic immunoassay] in serum. Results: Frequency of hepatitis B, C and HIV infection was 3.36%, 4.16% and 0% respectively. We can get representative prevalence values of HBV, HCV and HIV infection in general population by collecting data from all blood transfusion centers of Pakistan. This is also helpful to create public awareness regarding hepatitis and HIV transmission through blood transfusion