ABSTRACT
BACKGROUND: Malondialdehyde (MDA) is an oxidative stress biomarker, which represents a unifying mechanism of brain injury that occurs throughout the ischemic stroke cascade. The current study aimed to examine whether or not acute ischemic stroke (AIS) patients who had elevated serum MDA levels at admission had an increased risk of mortality and a worse functional outcome three months later. METHODS: An observational, prospective cohort study that enrolled 90 patients with AIS. The patients were examined in the first 24 hours and then followed up for three months to assess mortality, short-term neurological functional outcome, and neurological disability by the Modified Rankin Scale (MRS). RESULTS: The mean of serum MDA level among AIS patients was 6.3 ± 3.7 nmol/ml. Non-survivor cases were associated with statistically significantly higher serum MDA levels compared to survivors (9.7 ± 4.3 vs. 5.3 ± 2.8, p < 0.001), respectively. Patients with severe stroke, according to NIHSS score, were associated with significantly (p < 0.05) higher MDA levels compared to moderate and mild cases (7.4 ± 4.3 vs. 5.4 ± 2.6 vs. 3.3 ± .6). At a cutoff point of ≥ 6.7 nmol/ml, the area under the curve (AUC) for serum MDA levels as a predictor of mortality was 0.8 (0.69-0.91; p < 0.05). The sensitivity, specificity, positive predictive value, and negative predictive value were 77%, 80%, 89.5%, and 48.5%, respectively. Multivariate regression demonstrated that MDA level was a significant independent predictor of mortality among patients with AIS (OR = 1.29, 95% CI: 1.01 to 1.65; p = 0.041). CONCLUSION: MDA serum level was significantly higher in non-survivors than in survivors patients, so MDA could be used as a predictor for early mortality and short-term outcome of cases with AIS.
ABSTRACT
Epilepsy is a heterogeneous disorder that is not limited to experiencing seizures but also includes multiple neuropsychiatric squeal (i.e. attention-deficit/hyperactivity disorder (ADHD), depression and anxiety) that adversely impact a child quality of life. However, the underlying mechanism linking both disorders is not yet thoroughly explored. Our objective was to assess pro-inflammatory cytokines levels in children with seizure controlled epilepsy and explore the association between pro-inflammatory cytokines and the co-occurrence of ADHD in such children. A cross-sectional study included 50 children with controlled epilepsy for at least one year, in addition to 30 neurotypical children as controls. All children were assessed by the Conner parent scale for ADHD. Serum interleukin-6 (IL-6) and tumor necrosis factor-alpha (TNF-α) levels were measured and correlated to clinical data. In the present study, 23 out of 50 children with epilepsy also had ADHD (46%). Children with ADHD have been found to have a significantly lower age of onset, longer duration of epilepsy, and a higher serum level of IL-6 and TNF-α than those without ADHD. The Conner's parent rating scale overall total score yielded significant negative correlations with the age of onset of epilepsy and a significant positive correlation with the duration of epilepsy and pro-inflammatory cytokine levels. In addition to active seizures, the presence of elevated circulating inflammation markers may be associated with increased frequency of ADHD in children with epilepsy aged 6-14 years.
