ORCID Profile
0000-0002-1701-7111
Current Organisations
Servicio Geológico Colombiano
,
Western Health
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Publisher: Springer Science and Business Media LLC
Date: 04-03-2016
DOI: 10.1038/SREP22598
Abstract: Perception of the passage of time is essential for safe planning and navigation of everyday activities. Findings from the literature have demonstrated a gross underestimation of time interval in right-hemisphere damaged neglect patients, but not in non-neglect unilaterally-damaged patients, compared to controls. This study aimed to investigate retrospective estimation of the duration of a target detection task over two occasions, in 30 stroke patients (12 left-side stroke 15 right-side stroke and 3 right-side stroke with neglect) and 10 transient ischemic attack patients, relative to 31 age-matched controls. Performances on visual short-term and working memory tasks were also examined to investigate the associations between timing abilities with residual cognitive functioning. Initial results revealed evidence of perceptual time underestimation, not just in neglect patients, but also in non-neglect unilaterally-damaged stroke patients and transient ischemic attack patients. Three months later, underestimation of time persisted only in left-side stroke and right-side stroke with neglect patients, who also demonstrated reduced short-term and working memory abilities. Findings from this study suggest a predictive role of residual cognitive impairments in determining the prognosis of perceptual timing abnormalities.
Publisher: Elsevier BV
Date: 09-2017
Publisher: Elsevier BV
Date: 11-2018
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 04-02-2020
Abstract: Intravenous thrombolytic therapy ( IVT ) with tissue plasminogen activator for acute ischemic stroke is underutilized in many parts of the world. Randomized trials to test the effectiveness of thrombolysis implementation strategies are limited. This study aimed to test the effectiveness of a multicomponent, multidisciplinary tissue plasminogen activator implementation package in increasing the proportion of thrombolyzed cases while maintaining accepted benchmarks for low rates of intracranial hemorrhage and high rates of functional outcomes at 3 months. A cluster randomized controlled trial of 20 hospitals in the early stages of thrombolysis implementation across 3 Australian states was undertaken. Monitoring of IVT rates during the baseline period allowed hospitals (the unit of randomization) to be grouped into 3 baseline IVT strata—very low rates (0% to ≤4.0%) low rates ( .0% to ≤10.0%) and moderate rates ( .0%). Hospitals were randomized to an implementation package (experimental group) or usual care (control group) using a 1:1 ratio. The 16‐month intervention was based on behavioral theory and analysis of the steps, roles, and barriers to rapid assessment for thrombolysis eligibility and involved comprehensive strategies addressing in idual and system‐level change. The primary outcome was the difference in tissue plasminogen activator proportions between the 2 groups postintervention. The absolute difference in postintervention IVT rates between intervention and control hospitals adjusted for baseline IVT rate and stratum was not significant (primary outcome rate difference=1.1% (95% CI −1.5% to 3.7% P =0.38). Rates of intracranial hemorrhage remained below international benchmarks. The implementation package resulted in no significant change in tissue plasminogen activator implementation, suggesting that ongoing support is needed to sustain initial modifications in behavior. URL : www.anzctr.org.au Unique identifiers: ACTRN 12613000939796 and U1111‐1145‐6762
Publisher: Frontiers Media SA
Date: 26-10-2020
Publisher: Elsevier BV
Date: 2019
Publisher: MDPI AG
Date: 2022
Abstract: Background: The COVID-19 pandemic has reached over 276 million people globally with 5.3 million deaths as of 22nd December 2021. COVID-19-associated acute and long-term neurological manifestations are well recognized. The exact profile and the timing of neurological events in relation to the onset of infection are worth exploring. The aim of the current body of work was to determine the frequency, pattern, and temporal profile of neurological manifestations in a cohort of Egyptian patients with confirmed COVID-19 infection. Methods: This was a prospective study conducted on 582 hospitalized COVID-19 patients within the first two weeks of the diagnosis of COVID-19 to detect any specific or non-specific neurological events. Results: The patients’ mean (SD) age was 46.74 (17.26) years, and 340 (58.42%) patients were females. The most commonly encountered COVID-19 symptoms were fever (90.72%), cough (82.99%), and fatigue (76.98%). Neurological events (NE) detected in 283 patients (48.63%) and were significantly associated with a severe COVID-19 at the onset (OR: 3.13 95% CI: 2.18–4.51 p 0.0001) and with a higher mortality (OR: 2.56 95% CI: 1.48–5.46 p = 0.019). The most frequently reported NEs were headaches (n = 167) and myalgias (n = 126). Neurological syndromes included stroke (n = 14), encephalitis (n = 12), encephalopathy (n = 11), transverse myelitis (n = 6) and Guillain-Barré syndrome (n = 4). Conclusions: Neurological involvement is common (48.63%) in COVID-19 patients within the first two weeks of the illness. This includes neurological symptoms such as anosmia, headaches, as well as a constellation of neurological syndromes such as stroke, encephalitis, transverse myelitis, and Guillain-Barré syndrome. Severity of acute COVID-19 illness and older age are the main risk factors.
Publisher: SAGE Publications
Date: 26-08-2013
DOI: 10.1111/IJS.12132
Abstract: No evidence-based acute therapies exist for intracerebral hemorrhage. Intracerebral hemorrhage growth is an important determinant of patient outcome. Tranexamic acid is known to reduce hemorrhage in other conditions. The study aims to test the hypothesis that intracerebral hemorrhage patients selected with computed tomography angiography contrast extravasation ‘spot sign’ will have lower rates of hematoma growth when treated with intravenous tranexamic acid within 4·5-hours of stroke onset compared with placebo. The Spot sign and Tranexamic acid On Preventing ICH growth – AUStralasia Trial is a multicenter, prospective, 1:1 randomized, double-blind, placebo-controlled, investigator-initiated, academic Phase II trial. Intracerebral hemorrhage patients fulfilling clinical criteria (e.g. Glasgow Coma Scale , intracerebral hemorrhage volume ml, no identified secondary cause of intracerebral hemorrhage, no thrombotic events within the previous 12 months, no planned surgery) and demonstrating contrast extravasation on computed tomography angiography will receive either intravenous tranexamic acid 1 g 10-min bolus followed by 1 g eight-hour infusion or placebo. A second computed tomography will be performed at 24 ± 3 hours to evaluate intracerebral hemorrhage growth and patients followed up for three-months. The primary outcome measure is presence of intracerebral hemorrhage growth by 24 ± 3 hours, defined as either % or ml increase from baseline, and will be adjusted for baseline intracerebral hemorrhage volume. Secondary outcome measures include growth as a continuous measure, thromboembolic events, and the three-month modified Rankin Scale score. This is the first trial to evaluate the efficacy of tranexamic acid in intracerebral hemorrhage patients selected based on an imaging biomarker of high likelihood of hematoma growth. The trial is registered as NCT01702636.
Publisher: Medknow
Date: 2013
Publisher: Elsevier BV
Date: 2017
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 2020
DOI: 10.1161/STROKEAHA.120.031467
Abstract: Severity-based assessment tools may assist in prehospital triage of patients to comprehensive stroke centers (CSCs) for endovascular thrombectomy (EVT), but criticisms regarding diagnostic inaccuracy have not been adequately addressed. This study aimed to quantify the benefits and disadvantages of severity-based triage in a large real-world paramedic validation of the Ambulance Clinical Triage for Acute Stroke Treatment (ACT-FAST) algorithm. Ambulance Victoria paramedics assessed the prehospital ACT-FAST algorithm in patients with suspected stroke from November 2017 to July 2019 following an 8-minute training video. All patients were transported to the nearest stroke center as per current guidelines. ACT-FAST diagnostic accuracy was compared with hospital imaging for the presence of large vessel occlusion (LVO) and need for CSC-level care (LVO, intracranial hemorrhage, and tumor). Patient-level time saving to EVT was modeled using a validated Google Maps algorithm. Disadvantages of CSC bypass examined potential thrombolysis delays in non-LVO infarcts, proportion of patients with false-negative EVT, and CSC overburdening. Of 517 prehospital assessments, 168/517 (32.5%) were ACT-FAST positive and 132/517 (25.5%) had LVO. ACT-FAST sensitivity and specificity for LVO was 75.8% and 81.8%, respectively. Positive predictive value was 58.8% for LVO and 80.0% when intracranial hemorrhage and tumor (CSC-level care) were included. Within the metropolitan region, 29/55 (52.7%) of ACT-FAST-positive patients requiring EVT underwent a secondary interhospital transfer. Prehospital bypass with avoidance of secondary transfers was modeled to save 52 minutes (95% CI, 40.0–61.5) to EVT commencement. ACT-FAST was false-positive in 8 patients receiving thrombolysis (8.1% of 99 non-LVO infarcts) and false-negative in 4 patients with EVT requiring secondary transfer (5.4% of 74 EVT cases). CSC bypass was estimated to over-triage 1.1 patients-per-CSC-per-week in our region. The overall benefits of an ACT-FAST algorithm bypass strategy in expediting EVT and avoiding secondary transfers are estimated to substantially outweigh the disadvantages of potentially delayed thrombolysis and over-triage, with only a small proportion of EVT patients missed.
Publisher: MDPI AG
Date: 05-07-2021
DOI: 10.3390/BIOENGINEERING8070095
Abstract: The use of video and music as an intrinsic, dissociative attentional stimulus during exercise is thought to distract from the physical discomfort of exercise, and contribute to improved exercise adherence however, the effects of video-based feedback and engagement during pedaling on exercise performance and motivation are poorly understood. The aims of the present study were twofold. Firstly, to develop a novel video-based engagement regime for pedaling that links pedaling cadence with the play rate of a video, and secondly, to employ an instrumented pedaling device to assess the influence of the video engagement paradigm on cadence performance and exercise motivation. Eighteen healthy subjects participated in 15-min-duration pedaling sessions while targeting a specific low cadence (60 rotations per minute) and high cadence (100 rotations per minute), including pedaling with the provision of (i) target pedaling cadence information only, (ii) visual feedback on cadence control, including pedaling duration, pedaling cadence, and cadence deviation from target, and (iii) real-time engagement, which involved pedaling at the target speed to maintain the playback rate of a pre-recorded video. Cadence deviation from the target was evaluated, and self-reported exercise motivation examined with a post-exercise survey. Pedaling-cadence deviations significantly reduced with cadence feedback at both low and high cadence (p 0.05). Participants reported enjoying feedback and video-based engagement during pedaling, with 83% of participants feeling that engagement motivated them to perform pedaling-based exercise. In conclusion, real-time cadence control feedback and video-based engagement during pedaling for healthy in iduals may improve performance in targeted pedaling tasks. Through dissociation from the physical cues associated with exercise and fatigue, feedback and engagement may ultimately increase enjoyment and exercise compliance and adherence of pedaling-based exercise. The findings may be useful in prescription and maintenance of targeted pedaling exercises for stroke rehabilitation and exercise therapy.
Publisher: MDPI AG
Date: 30-12-2020
DOI: 10.20944/PREPRINTS202012.0745.V1
Abstract: Migraine is one of the leading causes of disability worldwide [1,2]and patients with acute migraine frequently present to emergency departments (ED)[3]. The current literature suggests that ED treatment of migraine headache varies across institutions [4-7]. Considering this, we conducted a scoping review to summarize trends in medication prescribing patterns for acute migraine treatment in the ED setting. Trends were evaluated for factors influencing treatment choices, with particular attention placed on opioids and migraine specific therapy. This scoping review was based on the Arksey and O'Malley methodological framework[8]and included studies published between 1 January 2000 until 31 May 2020. 14 publications met the inclusion criteria. The most common classes of medication prescribed were often anti-emetics or Non-steroidal anti-inflammatory drugs (NSAID), but rates varied between studies. There was a concerning trend towards an underutilization of triptans and overutilization of opiates. The use of specific clinical goals of treatment (e.g. two-hour pain free freedom response) was also not evident. Additionally, 88% (n=8) of the 9 studies commenting on adherence to hospital or evidence-based guidelines stated that practices were non-adherent. Overall, the reviewed literature reveals treatment practices for acute migraine in the ED are heterogeneous and deviate from established international recommendations.
Publisher: Frontiers Media SA
Date: 23-06-2020
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 2017
Publisher: Elsevier BV
Date: 05-2018
Publisher: Frontiers Media SA
Date: 27-01-2021
DOI: 10.3389/FNEUR.2020.600544
Abstract: Reports of different types of neurological manifestations of COVID-19 are rapidly increasing, including changes of posterior reversible leukoencephalopathy syndrome (PRES). Here we describe the first reported case of COVID-19 and PRES in Australia diagnosed on basis of MRI brain imaging and confirmed clinically by presence of confusion, delirium, headaches, also associated with hypertension and blood pressure variability and stable long-term kidney problems. He made full recovery as his blood pressure was controlled and clinical status was supported with appropriate supportive therapy. Although traditionally a rare condition, PRES is likely to be more common among patients with COVID-19 pathobiology there is Renin downregulation of ACE2 receptors, involvement of Renin-Angiotensin-Aldosterone system, endotheliitis, cytokine storm, and hyper-immune response. Thus we advocate clinical suspicion and early brain imaging with MRI brain among vulnerable patients with known co-morbidities, and diagnosed with COVID-19 given that hypertension and blood pressure variability are often exacerbated by acute SARS-CoV-2 immune reactions. Such acute hypertensive encephalopathy was able to be reversed with timely supportive therapy ensuring re-hydration and re-establishment of blood pressure control.
Publisher: Elsevier BV
Date: 12-2020
Publisher: MDPI AG
Date: 28-08-2021
DOI: 10.3390/LIFE11090891
Abstract: This narrative review provides a summary introduction to the relationship between stroke and physical and cognitive frailty syndromes and the neuro-inflammatory similarities (including inflammaging) between the two. The review argues the potential effects of Post COVID-19 Neurological Syndrome (PCNS, also known as Long COVID) with similar pathophysiology. Many patients who have suffered from acute stroke experience long-lasting symptoms affecting several organs including fatigue, brain fog, reduced physical activity, loss of energy, and loss of cognitive reserve, culminating in the loss of independence and poor quality of life. This is very similar to the emerging reports of PCNS from different parts of the world. Stroke, particularly in older adults with comorbidities appears to impact the health and welfare of patients by reducing central neuronal input and neuromuscular function, with muscular atrophy and neuropsychiatric complications. The cumulative effects can potentially lead to a range of physical and cognitive frailty syndromes, which, in many cases may be attributed to persistent, maladapted, low grade, chronic inflammation. Meanwhile, post-COVID-19 Neurological Syndrome (also known as Long COVID Syndrome) appears to share a similar trajectory, adding further urgency for investigations into the mechanisms underlying this constellation of symptoms.
Publisher: Elsevier BV
Date: 09-2020
Publisher: MDPI AG
Date: 14-12-2021
DOI: 10.3390/JCM10245870
Abstract: Background: Acute stroke is a time-critical emergency where diagnosis and acute management are highly dependent upon the accuracy of the patient’s history. We hypothesised that the language barrier is associated with delayed onset time to thrombolysis and poor clinical outcomes. This study aims to evaluate the effect of language barriers on time to thrombolysis and clinical outcomes in acute ischemic stroke. Concerning the method, this is a retrospective study of all patients admitted to a metropolitan stroke unit (Melbourne, Victoria, Australia) with an acute ischemic stroke treated with tissue plasminogen activator between 1/2013 and 9/2017. Baseline characteristics, thrombolysis time intervals, length of stay, discharge destination, and in-hospital mortality were compared among patients with and without a language barrier using multivariate analysis after adjustment for age, sex, stroke severity, premorbid modified Rankin Scale (mRS), and Charlson Comorbidity Index (CCI). Language barriers were defined as a primary language other than English. A total of 374 patients were included. Our findings show that 76 patients (20.3%) had a language barrier. Mean age was five years older for patients with language barriers (76.7 vs. 71.8 years, p = 0.004). Less non-English speaking patients had premorbid mRS score of zero (p = 0.002), and more had premorbid mRS score of one or two (p = 0.04). There was no statistically significant difference between the two groups in terms of stroke severity on presentation (p = 0.06). The onset to needle time was significantly longer in patients with a language barrier (188 min vs. 173 min, p = 0.04). Onset to arrival and door to imaging times were reassuringly similar between the two groups. However, imaging to needle time was 9 min delayed in non-English speaking patients with a marginal p value (65 vs. 56 min, p = 0.06). Patients with language barriers stayed longer in the stroke unit (six vs. four days, p = 0.02) and had higher discharge rates than residential aged care facilities in those admitted from home (9.2% vs. 2.3%, p = 0.02). In-hospital mortality was not different between the two groups (p = 0.8). In conclusion, language barriers were associated with almost 14 min delay in thrombolysis. The delay was primarily attributable to imaging to needle time. Language barriers were also associated with poorer clinical outcomes.
Publisher: Springer Science and Business Media LLC
Date: 22-03-2021
DOI: 10.1186/S12883-021-02052-8
Abstract: Stroke is a leading cause of disability worldwide and the cardiovascular fitness levels of stroke survivors are diminished to an extent that impairs functioning and activities of daily living performance. While cardiovascular training seems an empirically appropriate intervention, the optimal dosage and intensity of cardiovascular training in stroke survivors remains unclear. The aim was to determine the safety and feasibility of moderate-intensity cardiovascular training following stroke, including measurement of adherence to training. A pilot, prospective, patient- and assessor-blinded randomised controlled trial conducted in a tertiary, metropolitan hospital-based community rehabilitation centre. Eligibility criteria included ambulant ( 100 m), 6 weeks-12 months post stroke. Moderate-intensity fitness training or control (low-intensity) exercise was offered biweekly for 12 weeks. Outcome measures included adverse events, peak oxygen uptake (VO 2 ), functional exercise capacity (6-Minute Walk Test, 10-m Walk Test) and health-related quality of life (Short Form-36) and mood (Patient Health Questionnaire, PHQ9). Feasibility: Seventy-one (50%) of 141 screened participants were eligible (29% did not agree to participate). Twenty participants (10 intervention, 10 control) were recruited. The median (% IQR) supervised sessions was 19.5 (81% 12, 20) and 20 (83% 19, 22) in the intervention and control groups, respectively. Progression of duration and intensity was limited mean of 10 sessions to achieve target duration (30 min). There were no adverse events. Baseline peak oxygen uptake (VO 2 ) levels were low (15.94 ml/kg/min). Significant improvements in VO 2 peak in both groups were observed ( p 0.05). Although there were no significant between-group differences, this feasibility trial was not powered to detect change. Moderate-intensity fitness training was safe but achievement of target duration and intensity was challenging for stroke survivors. A definitive adequately-powered randomised trial is required. Alternative fitness training protocols may need to be explored. The trial protocol was prospectively registered on the Australian New Zealand Clinical Trials Registry ( ACTRN 12613000822785 ) on 25/07/2013.
Publisher: MDPI AG
Date: 14-04-2021
DOI: 10.3390/JCM10081674
Abstract: Ischemic Stroke precedes depression. Post-stroke depression (PSD) is a major driver for poor recovery, negative quality of life, poor rehabilitation outcomes and poor functional ability. In this systematic review, we analysed the inflammatory basis of post-stroke depression, which involves bioenergetic failure, deranged iron homeostasis (calcium influx, Na influx, potassium efflux etc), excitotoxicity, acidotoxicity, disruption of the blood brain barrier, cytokine-mediated cytotoxicity, reactive oxygen mediated toxicity, activation of cyclooxygenase pathway and generation of toxic products. This process subsequently results in cell death, maladapted, persistent neuro-inflammation and deranged neuronal networks in mood-related brain regions. Furthermore, an in-depth review likewise reveals that anatomic structures related to post-stroke depression may be localized to complex circuitries involving the cortical and subcortical regions.
Publisher: Frontiers Media SA
Date: 17-07-2020
Publisher: MDPI AG
Date: 12-08-2021
DOI: 10.3390/NEUROLINT13030039
Abstract: Every five minutes someone in the world is diagnosed with multiple sclerosis [...]
Publisher: Research Square Platform LLC
Date: 17-10-2022
DOI: 10.21203/RS.3.RS-2160180/V1
Abstract: Circulating osteoprogenitors (COP) is a population of cells in the peripheral circulation that possess functional and phenotypical characteristics of multipotent stromal cells (MSCs). While there is functional overlap, it is not known how COP cells are related to bone marrow (BM)-derived MSCs (BM-MSCs) and other better characterized stromal progenitor populations such as adipose-derived stromal cells (ASCs). This study compares COP cells to BM-MSCs and ASCs through detailed transcriptomic and proteomic analyses. COP cells have a distinct gene and protein expression pattern to BM-MSCs and ASCs, with a significantly stronger immune footprint, likely owing to their hematopoietic lineage. However, they also have a similar pattern of expression BM-MSCs and ASCs, in genes and proteins in progenitor cell differentiation and proliferation pathways. This study shows COP cells to be a unique but functionally similar population to BM-MSCs and ASCs, sharing their proliferation and differentiation capacity, but with a strong immune phenotype, with potential for translational regenerative medicine strategies.
Publisher: Elsevier BV
Date: 06-2012
DOI: 10.1016/J.CTRV.2011.06.009
Abstract: Breast cancer prevention with tamoxifen in high-risk women is limited due to concerns of endometrial cancer and thromboembolism. We report the risk of endometrial cancer, deep vein thrombosis and pulmonary embolism in women <50 years given tamoxifen for breast cancer prevention. We searched the Cochrane Central Register of Controlled Trials and National Library of Medicine for published data from January 1970 to December 2010. We contacted principal investigators of clinical trials, and searched Grey literature and conference proceedings for unpublished data. We reviewed three breast cancer prevention trials comparing tamoxifen (20mg per day) with placebo for five years in high-risk women <50 years. The absolute risk and relative risk (RR) for each outcome were estimated. The RR for endometrial cancer in women <50 years given tamoxifen is 1.19 (95% CI, 0.53-2.65 p=0.6) as compared to the placebo. The RR for deep vein thrombosis with tamoxifen is 2.30 (95% CI, 1.23-4.31 p=0.009) in the active phase of treatment. The risk decreases to 1.00 (95% CI, 0.38-2.67 p=0.9) in the follow-up phase. The RR for pulmonary embolism with tamoxifen is 1.16 (95% CI, 0.55-2.43 p=0.6). The risk of endometrial cancer, deep vein thrombosis and pulmonary embolism is low in women <50 years who take tamoxifen for breast cancer prevention. The risk decreases from the active to follow-up phase of treatment. Education and counseling are the cornerstones of breast cancer chemoprevention.
Publisher: BMJ
Date: 08-2015
Publisher: Springer Science and Business Media LLC
Date: 20-11-2009
DOI: 10.1007/S11695-009-0020-7
Abstract: Laparoscopic sleeve gastrectomy (LSG) is increasingly being recognised as a valid stand-alone procedure for the surgical management of morbid obesity. The leak rate from the gastric staple line ranges from 1.4% to 20%. From our experience of management of LSG leaks, we have been able to formulate an algorithm-based approach to the management of these patients. All patients referred to our hospital within a 24-month period with a diagnosis of gastric staple line leak in the background of a previous LSG were included in the study. A retrospective case note review was undertaken for these patients and an algorithm formulated. There were fourteen patients in the study. There were four males and ten females. Patients were managed with a combination of laparotomy, laparoscopy, endoscopic covered stenting, percutaneous radiologically guided drainage,jejunal enteric feeding and total parenteral nutrition. In five patients, re-look laparoscopy or laparotomy with washout and drainage was performed. The remaining eight patients were managed conservatively. There were no deaths. Although it is often disappointing when LSG leaks do occur, with adherence to the basic tenets of the surgical management of enterocutaneous fistulae as well as early detection and a high index of suspicion, these complications can be successfully managed using an algorithm-based multi-disciplinary team approach.
Publisher: Elsevier BV
Date: 11-2018
Publisher: Elsevier BV
Date: 06-2021
Publisher: Elsevier BV
Date: 04-2014
DOI: 10.1016/J.BANDC.2014.01.017
Abstract: There remains conflict in the literature about the lateralisation of affective face perception. Some studies have reported a right hemisphere advantage irrespective of valence, whereas others have found a left hemisphere advantage for positive, and a right hemisphere advantage for negative, emotion. Differences in injury aetiology and chronicity, proportion of male participants, participant age, and the number of emotions used within a perception task may contribute to these contradictory findings. The present study therefore controlled and/or directly examined the influence of these possible moderators. Right brain-damaged (RBD n=17), left brain-damaged (LBD n=17), and healthy control (HC n=34) participants completed two face perception tasks (identification and discrimination). No group differences in facial expression perception according to valence were found. Across emotions, the RBD group was less accurate thanthe HC group, however RBD and LBD group performancedid not differ. The lack of difference between RBD and LBD groups indicates that both hemispheres are involved in positive and negative expression perception. The inclusion of older adults and the well-defined chronicity range of the brain-damaged participants may have moderated these findings. Participant sex and general face perception ability did not influence performance. Furthermore, while the RBD group was less accurate than the LBD group when the identification task tested two emotions, performance of the two groups was indistinguishable when the number of emotions increased (four or six). This suggests that task demand moderates a study's ability to find hemispheric differences in the perception of facial emotion.
Publisher: Elsevier BV
Date: 09-2016
DOI: 10.1016/J.CLINEURO.2016.07.006
Abstract: Migraine is a debilitating condition that affects approximately 15% of the general population. It represents a huge proportion of presentations to the emergency department and a significant number of neurology admissions. Patients are often investigated with imaging. This is particularly the case with migraine with aura (MA). The yield of imaging is however low. There is limited information on Australian hospital presentations and utility of imaging. We aimed to analyse the demographics of migraine presentations to our hospital and the yield of imaging in our centre to help guide future approaches to these patients. We retrospectively looked at medical records of patients presenting to the western health from January 2012 to June 2013. Patients were classified as either having migraine with aura or without. Baseline demographics, cardiovascular risk factors and imaging studies (CT brain, MRI brain and carotid Doppler studies) in each group were evaluated. Patients found to have white matter hyperintensities on MRI were further evaluated. We found patients with aura were more likely to have hypercholesterolemia (12% vs 7%, p=0.05). Patients with aura were more likely to be evaluated with imaging (CT brain (70% vs 41% p<0.0001) and MRI brain (44% vs 17% p<0.0001)). The patients investigated with imaging had no clinically significant findings. 21% of patients with aura were investigated with carotid Doppler studies. Only 1 patient had an abnormal result. Patients with white matter hyperintensities were older (51 vs 39 years p<0.0001) and were more likely to have Hypertension (29% vs 14% p=0.019), Hypercholesterolemia (29% vs 11% p=0.003) and T2DM (16% vs 4% p=0.011). We found patients with MA and without aura to be largely similar. We also found imaging in either group to be of almost no clinical value.
Publisher: Elsevier BV
Date: 06-2019
Publisher: Elsevier BV
Date: 05-2017
DOI: 10.1016/J.EJPHAR.2017.03.055
Abstract: Our group investigated combining the phytochemical curcumin and gemcitabine in a liposome, to improve gemcitabine's activity against pancreatic tumours. While optimising the curcumin: gemcitabine ratio for co-encapsulation, we found that increasing curcumin concentrations relative to gemcitabine resulted in antagonistic interactions. As curcumin is a promiscuous transporter inhibitor we suspected that increased resistance occurred via inhibition of Equilibrative nucleoside transporter 1 (ENT1)-mediated gemcitabine uptake. To test our hypothesis, we determined whether curcumin and a related analogue, 2,6-bis((3-methoxy-4-hydroxyphenyl)methylene)-cyclohexanone (or A13), inhibited ENT1-mediated accumulation of [
Publisher: Frontiers Media SA
Date: 28-01-2021
DOI: 10.3389/FNEUR.2020.607221
Abstract: Clinical reports of neurological manifestations associated with severe coronavirus disease 2019 (COVID-19), such as acute ischemic stroke (AIS), encephalopathy, seizures, headaches, acute necrotizing encephalitis, cerebral microbleeds, posterior reversible leukoencephalopathy syndrome, hemophagocytic lymphohistiocytosis, peripheral neuropathy, cranial nerve palsies, transverse myelitis, and demyelinating disorders, are increasing rapidly. However, there are comparatively few studies investigating the potential impact of immunological responses secondary to hypoxia, oxidative stress, and excessive platelet-induced aggregation on the brain. This scoping review has focused on the pathophysiological mechanisms associated with peripheral and consequential neural (central) inflammation leading to COVID-19-related ischemic strokes. It also highlights the common biological processes shared between AIS and COVID-19 infection and the importance of the recognition that severe respiratory dysfunction and neurological impairments associated with COVID and chronic inflammation [post-COVID-19 neurological syndrome (PCNS)] may significantly impact recovery and ability to benefit from neurorehabilitation. This study provides a comprehensive review of the pathobiology of COVID-19 and ischemic stroke. It also affirms that the immunological contribution to the pathophysiology of COVID-19 is predictive of the neurological sequelae particularly ischemic stroke, which makes it the expectation rather than the exception. This work is of fundamental significance to the neurorehabilitation community given the increasing number of COVID-related ischemic strokes, the current limited knowledge regarding the risk of reinfection, and recent reports of a PCNS. It further highlights the need for global collaboration and research into new pathobiology-based neurorehabilitation treatment strategies and more integrated evidence-based care.
Publisher: Informa UK Limited
Date: 2005
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 26-11-2019
DOI: 10.1161/CIRCULATIONAHA.119.040267
Abstract: Cardiac thromboembolism attributed to atrial fibrillation (AF) is responsible for up to one-third of ischemic strokes. Stroke may be the first manifestation of previously undetected AF. Given the efficacy of oral anticoagulants in preventing AF-related ischemic strokes, strategies of searching for AF after a stroke using ECG monitoring followed by oral anticoagulation (OAC) treatment have been proposed to prevent recurrent cardioembolic strokes. This white paper by experts from the AF-SCREEN International Collaboration summarizes existing evidence and knowledge gaps on searching for AF after a stroke by using ECG monitoring. New AF can be detected by routine plus intensive ECG monitoring in approximately one-quarter of patients with ischemic stroke. It may be causal, a bystander, or neurogenically induced by the stroke. AF after a stroke is a risk factor for thromboembolism and a strong marker for atrial myopathy. After acute ischemic stroke, patients should undergo 72 hours of electrocardiographic monitoring to detect AF. The diagnosis requires an ECG of sufficient quality for confirmation by a health professional with ECG rhythm expertise. AF detection rate is a function of monitoring duration and quality of analysis, AF episode definition, interval from stroke to monitoring commencement, and patient characteristics including old age, certain ECG alterations, and stroke type. Markers of atrial myopathy (eg, imaging, atrial ectopy, natriuretic peptides) may increase AF yield from monitoring and could be used to guide patient selection for more intensive rolonged poststroke ECG monitoring. Atrial myopathy without detected AF is not currently sufficient to initiate OAC. The concept of embolic stroke of unknown source is not proven to identify patients who have had a stroke benefitting from empiric OAC treatment. However, some embolic stroke of unknown source subgroups (eg, advanced age, atrial enlargement) might benefit more from non–vitamin K-dependent OAC therapy than aspirin. Fulfilling embolic stroke of unknown source criteria is an indication neither for empiric non–vitamin K-dependent OAC treatment nor for withholding prolonged ECG monitoring for AF. Clinically diagnosed AF after a stroke or a transient ischemic attack is associated with significantly increased risk of recurrent stroke or systemic embolism, in particular, with additional stroke risk factors, and requires OAC rather than antiplatelet therapy. The minimum subclinical AF duration required on ECG monitoring poststroke/transient ischemic attack to recommend OAC therapy is debated.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 24-12-2012
Publisher: MDPI AG
Date: 09-11-2021
DOI: 10.3390/LIFE11111207
Abstract: The COVID-19 pandemic continues to cause disruptions to families, businesses and healthcare systems globally [...]
Publisher: American Medical Association (AMA)
Date: 02-2021
Publisher: S. Karger AG
Date: 2022
DOI: 10.1159/000520548
Abstract: b i Background and Aim: /i /b Migraine headache is commonly diagnosed in emergency departments (ED). There is relatively little real-world information about the epidemiology, investigation, management, adherence to therapeutic guidelines and disposition of patients treated in ED with a final diagnosis of migraine. The primary aim of the current study is to get a snapshot of assessment and management patterns of acute migraine presentations to the different settings of EDs with a view to raise awareness. b i Methods: /i /b This is a planned sub-study of a prospective study conducted in 67 health services in 10 countries including Australia, New Zealand, Southeast Asia, Europe, and the UK investigating the epidemiology and outcome of adult patients presenting to ED with nontraumatic headache. Outcomes of interest for this study are demographics, clinical features (including severity), patterns of investigation, treatment, disposition, and outcome of patients diagnosed as having migraine as their final ED diagnosis. b i Results: /i /b The cohort comprises 1,101 patients with a mean age of 39 years (SD ± 13.5 73.7% [811]) were female. Most patients had had migraine diagnosed previously (77.7%). Neuroimaging was performed in 25.9% with a very low diagnostic yield or significant findings (0.07%). Treatment of mild migraine was in accordance with current guidelines, but few patients with moderate or severe symptoms received recommended treatment. Paracetamol (46.3%) and nonsteroidal anti-inflammatory drugs (42.7%) were the most commonly prescribed agents. Metoclopramide (22.8%), ondansetron (19.2%), chlorpromazine (12.8%), and prochlorperazine (12.8%) were also used. b i Conclusions: /i /b This study suggests that therapeutic practices are not congruent with current guidelines, especially for patients with severe symptoms. Efforts to improve and sustain compliance with existing management best practices are required.
Publisher: Massachusetts Medical Society
Date: 19-07-2018
Publisher: Elsevier BV
Date: 08-2020
Publisher: Elsevier BV
Date: 03-2019
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 28-09-2018
DOI: 10.1212/WNL.0000000000006437
Abstract: To determine the optimal cut point on the NIH Stroke Scale (NIHSS) for predicting poor 90-day clinical outcome in patients with supratentorial and infratentorial acute ischemic stroke (AIS). Data are from participants of the alteplase-dose arm of the randomized controlled trial, Enhanced Control of Hypertension and Thrombolysis Stroke Study (ENCHANTED). Associations between baseline characteristics of clinically defined supratentorial and infratentorial AIS patients and poor functional outcome, defined by scores 3–6 on the modified Rankin Scale, were evaluated in logistic regression models, with area under the curve (AUC) receiver operating characteristics defining the optimal NIHSS predictor cut point. Patients with infratentorial AIS (n = 289) had lower baseline NIHSS scores than those with supratentorial AIS (n = 2,613) (median 7 vs 9 p 0.001). NIHSS cut points for poor outcome were 10 (AUC 76, sensitivity 65%, specificity 73%) and 6 (AUC 69, sensitivity 72%, specificity 56%) in supratentorial and infratentorial AIS, respectively. There was no significant difference in functional outcome or symptomatic intracranial hemorrhage between AIS types. In thrombolysis-eligible AIS patients, the NIHSS may underestimate clinical severity for infratentorial compared to supratentorial lesions for a similar prognosis for recovery. Because thrombolysis treatment has low effect on stroke outcome in patients with infratentorial AIS when baseline NIHSS score is more than 6, additional treatment such as endovascular treatment should be considered to improve stroke outcome. NCT01422616.
Publisher: Wiley
Date: 26-03-2018
DOI: 10.1111/IJN.12657
Abstract: The aim of this pilot randomized study was to investigate the feasibility of early motivational interviewing, for reducing mood after acute stroke. Depression is a frequent consequence of stroke that can adversely affect recovery. DESIGN: Pilot randomized study. Intervention group patients received 3, in idual motivational interviewing sessions by nurses or social workers prior to hospital discharge. Adult patients with acute stroke during 2013 to 2014. Research assistant who collected data was blind to group assignment. Data were collected at 3 time points: baseline, 1-month, and 3-month follow-up. Outcome measures (anxiety, depression, quality of life) were analysed by descriptive statistics. Forty-eight patients were enrolled, and 79% retention was achieved at 3 months. Eight participants withdrew (16.7%), and 2 were unable to participate (death: 2.1% and new onset aphasia: 2.1%), leaving 38 participants in the final cohort (Intervention: N = 18, Control: N = 20). Anxiety, depression, and quality of life measures did not alter significantly in the study period. Carefully designed studies are required to investigate the effectiveness of early motivational interviewing for improving mood after stroke. The therapy can be administered by nurses, but significant resources are required in terms of training and fidelity.
Publisher: Wiley
Date: 06-07-2020
Publisher: Frontiers Media SA
Date: 14-01-2021
DOI: 10.3389/FIMMU.2020.597858
Abstract: To examine the utility of the peripheral blood neutrophil-to-lymphocyte ratio (NLR) and monocyte-to-lymphocyte ratio (MLR) as biomarkers of prognosis in seropositive autoimmune encephalitis (AE). In this multicenter study, we retrospectively analyzed 57 cases of seropositive AE with hospital admissions between January 2008 and June 2019. The initial full blood examination was used to determine each patients’ NLR and MLR. The modified Rankin Scale (mRS) was utilized to assess the patients’ follow-up disability at 12 months and then at final follow-up. Primary outcomes were mortality and mRS, while secondary outcomes were failure of first line treatment, ICU admission, and clinical relapse. Univariate and multivariable regression analysis was performed. During initial hospital admission 44.7% of patients had unsuccessful first line treatment. After a median follow-up of 700 days, 82.7% had good functional outcome (mRS ≤2) while five patients had died. On multivariable analysis, high NLR was associated with higher odds of first line treatment failure (OR 1.32, 95% CI 1.03–1.69, p = 0.029). Increased MLR was not associated with any short or long-term outcome. NLR on initial hospital admission blood tests may be provide important prognostic information for cases of seropositive AE. This study demonstrates the potential use of NLR as a prognostic marker in the clinical evaluation of patients with seropositive AE.
Publisher: MDPI AG
Date: 12-03-2021
DOI: 10.3390/JCM10061191
Abstract: Migraine is one of the leading causes of disability worldwide and patients with acute migraine frequently present to emergency departments (ED). The current literature suggests that ED treatment of migraine headache varies across institutions. Considering this, we conducted a scoping review to summarize trends in medication prescribing patterns for acute migraine treatment in the ED setting. Trends were evaluated for factors influencing treatment choices, with particular attention placed on opioids and migraine specific therapy. This scoping review was based on the Arksey and O’Malley methodological framework and included studies published between 1 January 2000 and 31 May 2020. 14 publications met the inclusion criteria. The most common classes of medication prescribed were anti-emetics or Non-steroidal anti-inflammatory drugs (NSAID), but rates varied between studies. There was a concerning trend towards an underutilization of triptans and overutilization of opiates. The use of specific clinical treatment goals (e.g., two-hour pain free freedom response) was also not evident. Additionally, 88% (n = 8) of the nine studies commenting on adherence to hospital or evidence-based guidelines stated that practices were non-adherent. Overall, the reviewed literature reveals treatment practices for acute migraine in the ED are heterogeneous and deviate from established international recommendations.
Publisher: Sri Lanka Journals Online (JOL)
Date: 17-03-2015
Abstract: Ingestion of corrosives with accidental or suicidal intent is a common problem in Sri Lanka. Management options and outcomes of corrosive injuries on stomach are not well documented in our setting. The clinical presentation, complications and management outcomes of nine patients with corrosive injury to stomach are presented. Gastric outlet obstruction seen in majority, was managed with bypass procedure (n=5) or resection (n=4). The outcomes of management were successful with both methods.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 07-2017
DOI: 10.1161/STROKEAHA.117.017235
Abstract: Interhospital transfer is a critical component in the treatment of acute anterior circulation large vessel occlusive stroke transferred for mechanical thrombectomy. Real-world data for benchmarking and theoretical modeling are limited. We sought to characterize transfer workflow from primary stroke center (PSC) to comprehensive stroke center after the publication of positive thrombectomy trials. Consecutive patients transferred from 3 high-volume PSCs to a single comprehensive stroke center between January 2015 and August 2016 were included in a retrospective study. Factors associated with key time metrics were analyzed with emphasis on PSC intrahospital workflow. Sixty-seven patients were identified. Median age was 74 years (interquartile range [IQR], 63.5–78) and National Institutes of Health Stroke Scale 17 (IQR, 12–21). Median transfer time measured by PSC-door-to-comprehensive stroke center-door was 128 minutes (IQR, 107–164), of which 82.8% was spent at PSCs (door-in-door-out [DIDO] 106 minutes IQR, 86–143). The lengthiest component of DIDO was computed-tomography-to-retrieval-request (median 59.5 minutes IQR, 44–83). The 37.3% had DIDO exceeding 120 minutes. DIDO times differed significantly between PSCs ( P =0.01). In multivariate analyses, rerecruiting the initial ambulance crew for transfer ( P .01) and presentation during working hours ( P =0.04) were associated with shorter DIDO times. In a metropolitan hub-and-spoke network, PSC-door-to-comprehensive stroke center-door and DIDO times are long even in high-volume PSCs. Improving PSC workflow represents a major opportunity to expedite mechanical thrombectomy and improve patient outcomes.
Publisher: S. Karger AG
Date: 16-12-2015
DOI: 10.1159/000442532
Abstract: b i Background: /i /b This study aimed at identifying the determinants and prognostic significance of a sedimentation level (fluid-blood level) in the hematoma among patients with acute intracerebral hemorrhage (ICH) who participated in the main Intensive Blood Pressure Reduction in Acute Cerebral Hemorrhage Trial (INTERACT2). b i Methods: /i /b Post-hoc analysis of the INTERACT2 dataset, a randomized controlled trial of patients with acute ICH with elevated systolic blood pressure (SBP), randomly assigned to intensive (target SBP mm Hg) or guideline-based ( mm Hg) BP management. Patients with a sedimentation level at baseline assessment on CT, and modified Rankin Scale score at 90-day, were included in these analyses. Factors associated with a sedimentation level and its significance in relation to 90-day clinical outcomes were assessed in univariable and multivariable logistic regression models. b i Results: /i /b Of 2,065 participants, 19 (1%) had sedimentation level on baseline CT, which was independently associated with warfarin use (p = 0.006) and lobar ICH (p = 0.025). Sedimentation level was also associated with death or major disability at 90-day in both crude (84 vs. 53% p = 0.014) and multivariable analyses adjusted for age, gender, Chinese region, warfarin use, baseline National Institutes of Health Stroke Scale score, onset to CT time, volume and location of ICH, intraventricular extension, and randomized intensive BP lowering (OR 3.94, 95% CI 1.01-15.37 p = 0.049). b i Conclusions: /i /b The presence of hematoma sedimentation level on baseline CT is associated with warfarin use and lobar location of ICH, and predicts a worse outcome. Although uncommon, sedimentation level is an easily detectable prognostic factor in acute ICH.
Publisher: Cold Spring Harbor Laboratory
Date: 16-02-2021
DOI: 10.1101/2021.02.12.21251660
Abstract: Stroke represents one of the most important causes of morbidity ( eighty million patients with disabling of ongoing effects of stroke at a given time, globally) and mortality (the second leading cause of death) worldwide. Innovative systems biology-based approach is likely to increase the understanding of the underpinning of acute stroke promise to enhance stroke prevention, acute treatment, and neurorehabilitation. Recent growing body of evidence with shared pathobiology with COVID-19 and the critically important role of inflammation in the context of stroke points to far-reaching consequences of acute stroke, just as in the case of COVID-19 ( post-acute event issues as well as long term issues). So far, stroke typically defined by late-appearing disease manifestation by the range of stroke subtypes as defined by the WHO or American Stroke Association. This definition neglects the underlying pathobiological mechanisms such as low-grade chronic inflammation and already compromised vascular system. Diseases such as stroke is hardly a simple result of a single problem, but rather a complex cascade of pathobiological processes and interactions in a complex biochemical environment. The evidence of changes in innate immunity and adaptive immunity during the index event of acute stroke and recovery over next 3-12 months can be easily elicited with simple bedside blood tests such as neutrophil-lymphocyte ratio (NLR) with well over 300 published papers including several systematic reviews and meta-analyses confirming this. Global standard operating procedures (SOP) of stroke care dictated by the national and international stroke guidelines at present. It is imperative to explore the evidence of systems biology approach in current stroke guidelines. This is likely to be a key turning point in managing stroke across the continuum (prevention, management of acute event and rehabilitation). We systematically searched for guideline recommendation on the day-to-day use of peripheral inflammatory markers such as NLR published in the English language between January 1, 2005, and December 2020. Any other evidence of systems biology-based approach or recommendation was explored within the selected guidelines for this scoping review. Only the latest guideline per writing group was selected. Each guideline was analyzed independently by 2 to 4 authors to determine clinical scenarios explained/given, scientific evidence used, and recommendations presented in the context of systems biology. The scoping review found 3,830 (3830) titles with 119 guidelines from 46 countries included for this review ( Figure 1 PRISMA diagram). Stroke-related organizations wrote Sixty-five per cent of the guidelines while national ministries wrote a fewer number of guidelines. We were primarily interested in recommendations for acute management in AIS published in the English language. Fifteen eligible guidelines were identified from 15 different countries/regions. None of the guidelines recommended the routine use of peripheral markers of inflammation, such as NLR, among their acute assessment and management recommendations. None of the existing guidelines explored the systems biology approach to one of the most complex diseases affecting the human brain, stroke. Figure 1 Acute Ischemic Stroke Guidelines Worldwide Figure 2: PRISMA Diagram This systematic review has identified a significant evidence-practice gap in all existing national stroke guidelines published in English medium as of October 2020. These guidelines included the only current “living stroke guidelines, Stroke Guidelines from Australia with a real opportunity to modernize the living stroke guidelines with systems biology approach and provide 2020 vision towards better stroke care globally. Investigation of complex disease such as stroke is best served through a systems biology approach. One of the easiest places to start is simple blood tests such as total white cell count and NLR. Systems biology approach point us towards simple tools such immune-inflammatory index (SII), Sunshine Prognostic Score (SPS) which should pave the way for the stroke physician community address the challenges in systems biology approach in stroke care. These challenges include translating bench research to the bedside, managing big data ( continuous pulse, blood pressure, sleep, Oxygen saturation, progressive changes in NLR, SII, SPS, etc.). Working with an interdisciplinary team is also provide a distinct advantage.
Publisher: Springer Science and Business Media LLC
Date: 03-08-2017
Publisher: Elsevier BV
Date: 08-2020
Publisher: SAGE Publications
Date: 10-11-2013
DOI: 10.1111/IJS.12206
Abstract: Thrombolysis with tissue plasminogen activator is proven to reduce disability when given within 4.5 h of ischemic stroke onset. However, tissue plasminogen activator only succeeds in recanalizing large vessel arterial occlusion in a minority of patients. We hypothesized that anterior circulation ischemic stroke patients, selected with ‘dual target’ vessel occlusion and evidence of salvageable brain using computed tomography or magnetic resonance imaging ‘mismatch’ within 4.5 h of onset, would have improved reperfusion and early neurological improvement when treated with intra-arterial clot retrieval after intravenous tissue plasminogen activator compared with intravenous tissue plasminogen activator alone. EXTEND-IA is an investigator-initiated, phase II, multicenter prospective, randomized, open-label, blinded-endpoint study. Ischemic stroke patients receiving standard 0.9 mg/kg intravenous tissue plasminogen activator within 4.5 h of stroke onset who have good prestroke functional status (modified Rankin Scale , no upper age limit) will undergo multimodal computed tomography or magnetic resonance imaging. Patients who also meet dual target imaging criteria: vessel occlusion (internal carotid or middle cerebral artery) and mismatch (perfusion lesion: ischemic core mismatch ratio .2, absolute mismatch ml, ischemic core volume ml) will be randomized to either clot retrieval with the Solitaire FR device after full dose intravenous tissue plasminogen activator, or tissue plasminogen activator alone. The coprimary outcome measure will be reperfusion at 24 h and favorable clinical response (reduction in National Institutes of Health Stroke Scale by ≥8 points or reaching 0–1) at day 3. Secondary outcomes include modified Rankin Scale at day 90, death, and symptomatic intracranial hemorrhage.
Publisher: Elsevier BV
Date: 05-2019
Publisher: MDPI AG
Date: 24-02-2021
DOI: 10.20944/PREPRINTS202102.0540.V1
Abstract: Background: Neurological disorders are the leading cause disability in Australia and the world. Combating the perceived difficulty of neurology or & neurophobia& and improving physician education is a key component in addressing this problem. We aim to conduct the first study to identify whether neurophobia exists in medical students and junior doctors in an Australian population and try to identify factors that may contribute to this in this population. Methods: A 24 question online validated survey was distributed via email broadcast to all medical students and junior doctors at a metropolitan tertiary care centre in Australia. Responses were collected over 6 weeks with weekly reminder emails for 4 weeks after the initial invitation email. Results: 114 medical students and junior doctors participated in the study. Participants perceived neurology as the most difficult medical speciality compared to 10 other medical specialties (p=0.001). The top three factors contributing to this perceived difficulty were: a lack of understanding of neuroanatomy, lack of diagnostic certainty and lack of clinical exposure. 65% of the participants stated that they had too little planned teaching in neurology with only 36% of the participants having performed a neurology rotation during medical school. Conclusion: The prevalence of neurophobia in this Australian cohort of medical students and junior doctors is consistent with previous findings from around the world. This concerning finding requires further examination into the contributing factors in order to created trials of targeted interventions in order to resolve this.
Publisher: MDPI AG
Date: 30-11-2017
DOI: 10.3390/JCM6120114
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 08-09-2017
DOI: 10.1212/WNL.0000000000004524
Abstract: To assess whether smoking cessation after an ischemic stroke or TIA improves outcomes compared to continued smoking. We conducted a prospective observational cohort study of 3,876 nondiabetic men and women enrolled in the Insulin Resistance Intervention After Stroke (IRIS) trial who were randomized to pioglitazone or placebo within 180 days of a qualifying stroke or TIA and followed up for a median of 4.8 years. A tobacco use history was obtained at baseline and updated during annual interviews. The primary outcome, which was not prespecified in the IRIS protocol, was recurrent stroke, myocardial infarction (MI), or death. Cox regression models were used to assess the differences in stroke, MI, and death after 4.8 years, with correction for adjustment variables prespecified in the IRIS trial: age, sex, stroke (vs TIA) as index event, history of stroke, history of hypertension, history of coronary artery disease, and systolic and diastolic blood pressures. At the time of their index event, 1,072 (28%) patients were current smokers. By the time of randomization, 450 (42%) patients had quit smoking. Among quitters, the 5-year risk of stroke, MI, or death was 15.7% compared to 22.6% for patients who continued to smoke (adjusted hazard ratio 0.66, 95% confidence interval 0.48–0.90). Cessation of cigarette smoking after an ischemic stroke or TIA was associated with significant health benefits over 4.8 years in the IRIS trial cohort.
Publisher: Elsevier BV
Date: 10-2015
DOI: 10.1016/J.JSTROKECEREBROVASDIS.2015.06.014
Abstract: There has been little research into gait and balance impairment in transient ischemic attack (TIA) and minor stroke, despite these conditions affecting large numbers of people and the potential impact on function. The aim of this study was to determine the impact of TIA and minor stroke on gait and balance. Twelve people with TIA or minor stroke without previous gait/balance problems and 12 age- and sex-matched controls were recruited. Participants (mean age 67 years) underwent a comprehensive assessment including physiological, balance, and gait measures (clinical and computerized [NeuroCom/GAITRite]). Matched-pairs analysis was undertaken. Groups were similar in body mass index, vision, leg proprioception/strength, and reaction time. Cognition was worse in the TIA/minor stroke group: mean Montreal Cognitive Assessment score 22.2 versus 26.6, P = .001. People with TIA/minor stroke were significantly worse on all but one clinical test. Median scores for TIA/minor stroke versus control were as follows: Timed Up and Go (TUG), 9.4 versus 7.6 seconds, P = .019 TUG dual task, 12.3 versus 8.5 seconds, P = .012 Four Square Step Test, 10.9 versus 7.2 seconds, P = .006. Mean Step Test score for TIA/minor stroke versus control was 14.1 versus 17.7, P = .021. The TIA/minor stroke group also had significantly worse performance on computerized tests: increased turn time/sway, increased step length, slower comfortable/fast gait speeds, and greater proportion of gait cycle spent in double support. This study found that people with TIA/minor stroke have gait and balance dysfunction despite having no obvious physiological impairments. Intervention studies aimed at improving balance and gait in this population are needed.
Publisher: MDPI AG
Date: 27-10-2021
DOI: 10.20944/PREPRINTS202110.0398.V1
Abstract: BACKGROUND: Acute stroke is a time-critical emergency where diagnosis and acute management are highly dependent upon accuracy of patient& rsquo s history. We hypothesised that language barrier is associated with delayed onset time to thrombolysis and poor clinical outcomes. AIM: To evaluate the effect of language barriers on time to thrombolysis and clinical outcomes in acute ischemic stroke. METHODS: This is a retrospective study of all patients admitted to a metropolitan stroke unit (Melbourne, Victoria, Australia) with an acute ischemic stroke treated with tissue plasminogen activator between 1/2013 and 9/2017. Baseline characteristics, thrombolysis time intervals, length of stay, discharge destination, and in-hospital mortality were compared between patients with and without a language barrier using multivariate analysis after adjustment for age, sex, stroke severity, premorbid modified Rankin Scale (mRS) and Charlson Comorbidity Index (CCI). Language barriers were defined as a primary language other than English. RESULTS: A total of 374 patients were included. Of this, 76 patients (20.3%) had a language barrier. Mean age was 5 years older for patients with language barriers (76.7 vs 71.8 years, P=0.004). Less non-English speaking patients had pre-morbid mRS score of zero (P=0.002) and more had pre-morbid mRS score of one or two (P=0.04). There was no statistically significant difference between two groups in terms of stroke severity on presentation (P=0.06). The onset to needle time was significantly longer in patients with a language barrier (188 min vs 173 min, P=0.04). Onset to arrival and door to imaging times were surprisingly similar between the two groups. However, imaging to needle time was 9 minutes delayed in non-English speaking patients with a marginal P value (65 vs 56 min, P=0.06). patients with language barriers stayed longer in stroke unit stay (6 vs 4 days, P=0.02) and had higher rates of discharge to residential aged care facilities in those admitted from home (9.2% vs 2.3%, P=0.02). In-hospital mortality was not different between two groups (P=0.8) CONCLUSION: In this study language barriers were associated with almost 14 min delay in thrombolysis. The delay was mostly attributable to imaging to needle time. Language barriers were also associated with poorer clinical outcomes.
Publisher: MDPI AG
Date: 06-04-2021
DOI: 10.3390/SU13074069
Abstract: Stroke is one of the leading causes of adult disability and the second leading cause of death worldwide. The immune system actively participates in the pathobiological process of acute ischemic stroke (AIS), during the index event and the repair process. Research on neurovascular inflammation has created a renewed interest in the use of easily available biomarkers reflective of innate and adaptive immunological changes with potential diagnostic, prognostic, and therapeutic implications particularly in AIS. The current scoping review aimed to assess the significance the neutrophil to lymphocyte (NLR) in AIS and its related complications and explore their association with post-stroke recovery trajectory. The Arksey and O’Malley methodological framework was employed to review the published papers on the neutrophil–lymphocyte ratio (NLR) and AIS in late November 2020. Only studies published in English from 2000–2020 were included in this scoping review. Fifty-three published papers were reviewed. This review’s key finding is that a canonical inflammatory response occurs in the hyperacute, acute, subacute, and chronic stages of stroke. An excessive circulating innate immune cells (neutrophils) and reduced circulating adaptive immune cells (lymphocytes) are associated with poorer outcomes during the acute interventions as well as the recovery trajectory. This scoping review’s findings highlights the utility of a systems biology-based approach in stroke care.
Publisher: Elsevier BV
Date: 2019
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 02-05-2023
DOI: 10.1212/WNL.0000000000207138
Abstract: The safety and efficacy of tenecteplase (TNK) in patients with tandem lesion (TL) stroke is unknown. We performed a comparative analysis of TNK and alteplase in patients with TLs. We first compared the treatment effect of TNK and alteplase in patients with TLs using in idual patient data from the EXTEND-IA TNK trials. We evaluated intracranial reperfusion at initial angiographic assessment and 90-day modified Rankin scale (mRS) with ordinal logistic and Firth regression models. Because 2 key outcomes, mortality and symptomatic intracranial hemorrhage (sICH), were few in number among those who received alteplase in the EXTEND-IA TNK trials, we generated pooled estimates for these outcomes by supplementing trial data with estimates of incidence obtained through a meta-analysis of studies identified in a systematic review. We then calculated unadjusted risk differences to compare the pooled estimates for those receiving alteplase with the incidence observed in the trial among those receiving TNK. Seventy-one of 483 patients (15%) in the EXTEND-IA TNK trials possessed a TL. In patients with TLs, intracranial reperfusion was observed in 11/56 (20%) of TNK-treated patients vs 1/15 (7%) alteplase-treated patients (adjusted odds ratio 2.19 95% CI 0.28–17.29). No significant difference in 90-day mRS was observed (adjusted common odds ratio 1.48 95% CI 0.44–5.00). A pooled study-level proportion of alteplase-associated mortality and sICH was 0.14 (95% CI 0.08–0.21) and 0.09 (95% CI 0.04–0.16), respectively. Compared with a mortality rate of 0.09 (95% CI 0.03–0.20) and an sICH rate of 0.07 (95% CI 0.02–0.17) in TNK-treated patients, no significant difference was observed. Functional outcomes, mortality, and sICH did not significantly differ between patients with TLs treated with TNK and those treated with alteplase. This study provides Class III evidence that TNK is associated with similar rates of intracranial reperfusion, functional outcome, mortality, and sICH compared with alteplase in patients with acute stroke due to TLs. However, the CIs do not rule out clinically important differences. t2/show/NCT02388061 t2/show/NCT03340493.
Publisher: American Medical Association (AMA)
Date: 12-2019
Publisher: Springer Science and Business Media LLC
Date: 02-07-2020
DOI: 10.1038/S41591-020-0972-7
Abstract: An amendment to this paper has been published and can be accessed via a link at the top of the paper.
Publisher: Massachusetts Medical Society
Date: 07-04-2016
Publisher: Frontiers Media SA
Date: 18-01-2021
DOI: 10.3389/FNEUR.2020.613372
Abstract: Background: Migraine is recognized as a neurological condition that is often associated with comorbid psychiatric symptoms such as anxiety, depression, bipolar disorder and/or panic disorder. Though some studies have demonstrated the link between migraine and anxiety disorders, there are no systematic reviews that have been published in this area to summarize the evidence. The aim of the present study is to systematically review the literature associated with comorbidity of migraine and anxiety disorders among migraineurs compared to non-migraineurs. Methods: The present systematic review included population-based, cohort and cross-sectional studies if they were reporting the frequency of migraine with either anxiety or depression as diagnosed by a medical practitioner according to the International Classification of Headache Disorders (ICHD-2/3). Results: Eight eligible studies from 2060 relevant citations were included in the review. All participants were migraine patients from both primary care and outpatient settings, as well as tertiary headache and anxiety centers, and were compared to non-migraineurs. The results of the systematic review showed that there is a strong and consistent relationship between migraine and anxiety. The co-morbidity of co-occurrence for migraine and anxiety has an average OR of 2.33 (2.20–2.47) among the prevalence and cross sectional studies and an average RR of 1.63 (1.37–1.93) for two cohort studies The major limitations of included studies were small s le sizes and a lack of adjusting of confounding factors. Conclusion: The results highlight the need for inclusion of an anxiety screening tool during initial assessments of migraine patients by medical practitioners and/or physicians and may explain why some anxiolytic medications work better than others for migraine mitigation.
Publisher: Frontiers Media SA
Date: 14-12-2017
Publisher: Informa UK Limited
Date: 07-2021
DOI: 10.2147/TCRM.S307587
Publisher: Elsevier BV
Date: 10-2019
Publisher: Elsevier BV
Date: 09-2018
Publisher: BMJ
Date: 2023
DOI: 10.1136/BMJNO-2022-000376
Abstract: Time to reperfusion is an important predictor of outcome in ischaemic stroke from large vessel occlusion (LVO). For patients requiring endovascular thrombectomy (EVT), the transfer times from peripheral hospitals in metropolitan and regional Victoria, Australia to comprehensive stroke centres (CSCs) have not been studied. To determine transfer and journey times for patients with LVO stroke being transferred for consideration of EVT. All patients transferred for consideration of EVT to three Victorian CSCs from January 2017 to December 2018 were included. Travel times were obtained from records matched to Ambulance Victoria and the referring centre via Victorian Stroke Telemedicine or hospital medical records. Metrics of interest included door-in-door-out time (DIDO), inbound journey time and outbound journey time. Data for 455 transferred patients were obtained, of which 395 (86.8%) underwent EVT. The median DIDO was 107 min (IQR 84–145) for metropolitan sites and 132 min (IQR 108–167) for regional sites. At metropolitan referring hospitals, faster DIDO was associated with use of the same ambulance crew to transport between hospitals (75 (63–90) vs 124 (99–156) min, p .001) and the administration of thrombolysis prior to transfer (101 (79–133) vs 115 (91–155) min, p .001). At regional centres, DIDO was consistently longer when patients were transported by air (160 (127–195) vs 116 (100–144) min, p .001). The overall door-to-door time by air was shorter than by road for sites located more than 250 km away from the CSC. Transfer times differ significantly for regional and metropolitan patients. A state-wide database to prospectively collect data on all interhospital transfers for EVT would be helpful for future study of optimal transport mode at regional sites and benchmarking of DIDO across the state.
Publisher: Massachusetts Medical Society
Date: 12-03-2015
Publisher: Elsevier BV
Date: 10-2017
Publisher: Frontiers Media SA
Date: 28-07-2020
Publisher: Elsevier BV
Date: 09-2013
DOI: 10.1016/J.VACCINE.2013.06.032
Abstract: The global spread of the 2009 novel pandemic influenza A (H1N1) virus led to the accelerated production and distribution of monovalent 2009 Influenza A (H1N1) vaccines (pH1N1). This pandemic provided the opportunity to evaluate the risk of Guillain-Barré syndrome (GBS), which has been an influenza vaccine safety concern since the swine flu pandemic of 1976, using a common protocol among high and middle-income countries. The primary objective of this project was to demonstrate the feasibility and utility of global collaboration in the assessment of vaccine safety, including countries both with and without an established infrastructure for vaccine active safety surveillance. A second objective, included a priori, was to assess the risk of GBS following pH1N1 vaccination. The primary analysis used the self-controlled case series (SCCS) design to estimate the relative incidence (RI) of GBS in the 42 days following vaccination with pH1N1 vaccine in a pooled analysis across databases and in analysis using a meta-analytic approach. We found a relative incidence of GBS of 2.42 (95% CI 1.58-3.72) in the 42 days following exposure to pH1N1 vaccine in analysis of pooled data and 2.09 (95% CI 1.28-3.42) using the meta-analytic approach. This study demonstrates that international collaboration to evaluate serious outcomes using a common protocol is feasible. The significance and consistency of our findings support a conclusion of an association between 2009 H1N1 vaccination and GBS. Given the rarity of the event the relative incidence found does not provide evidence in contradiction to international recommendations for the continued use of influenza vaccines.
Publisher: Frontiers Media SA
Date: 07-06-2021
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 16-10-2017
Publisher: Springer Science and Business Media LLC
Date: 25-03-2014
Publisher: S. Karger AG
Date: 2019
DOI: 10.1159/000494758
Abstract: Migraine is one of the most prevalent neurological disorders among all age groups including the elderly, but the incidence and prevalence of migraine tend to decrease with age. The clinical phenotype of migraine also appears to be different in the elderly patient group in comparison to the younger patient group, with elderly migraine appearing to be more often bilateral and associated with what has become known as “late-life migraine accompaniments. Furthermore, difficulty in the differentiation of migraine from vascular insults such as transient ischemic attacks and amyloid angiopathy and other multiple comorbidities, polypharmacy and age-related changes in pharmacodynamics and pharmacokinetics makes treatments for this cohort challenging but necessary, especially given the worldwide increase in life expectancy, and likelihood of migraine continuing to be a major personal and public health problem.
Publisher: Elsevier BV
Date: 11-2020
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 29-01-2016
DOI: 10.1212/CPJ.0000000000000217
Abstract: The burden of disability from ischemic stroke continues to intensify. Any acute therapeutic option that reduces disability after ischemic stroke should be encouraged and further studied. In particular, the need for an effective treatment in patients with large vessel occlusion has been long overdue. Consistent trial evidence has answered this need in an emphatic fashion, demonstrating improved functional outcomes with endovascular therapy following better patient selection, new device technology, and reduced treatment times. The article discusses the current evidence and guidelines and highlights the inherent complexities of a specialized intervention whose demand will grow exponentially. The scope for future investigation especially using advanced imaging to expand patient selection will be considered. Endovascular thrombectomy is an established and highly efficacious acute treatment for ischemic stroke that we need to apply and implement to maximize benefit to the population.
Publisher: AMPCo
Date: 04-2014
DOI: 10.5694/MJAC12.10534
Publisher: Springer Science and Business Media LLC
Date: 03-08-2017
Publisher: American Medical Association (AMA)
Date: 07-04-2020
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 03-2023
DOI: 10.1161/STROKEAHA.122.041061
Abstract: Intracranial occlusion site, contrast permeability, and clot burden are thrombus characteristics that influence alteplase-associated reperfusion. In this study, we assessed the reperfusion efficacy of tenecteplase and alteplase in subgroups based on these characteristics in a pooled analysis of the EXTEND-IA TNK trial (Tenecteplase Versus Alteplase Before Endovascular Therapy for Ischemic Stroke). Patients with large vessel occlusion were randomized to treatment with tenecteplase (0.25 or 0.4 mg/kg) or alteplase before thrombectomy in hospitals across Australia and New Zealand (2015–2019). The primary outcome, early reperfusion, was defined as the absence of retrievable thrombus or % reperfusion on first-pass angiogram. We compared the effect of tenecteplase versus alteplase overall, and in subgroups, based on the following measured with computed tomography angiography: intracranial occlusion site, contrast permeability (measured via residual flow grades), and clot burden (measured via clot burden scores). We adjusted for covariates using mixed effects logistic regression models. Tenecteplase was associated with higher odds of early reperfusion (75/369 [20%] versus alteplase: 9/96 [9%], adjusted odds ratio [aOR], 2.18 [95% CI, 1.03–4.63]). The difference between thrombolytics was notable in occlusions with low clot burden (tenecteplase: 66/261 [25%] versus alteplase: 5/67 [7%], aOR, 3.93 [95% CI, 1.50–10.33]) when compared to high clot burden lesions (tenecteplase: 9/108 [8%] versus alteplase: 4/29 [14%], aOR, 0.58 [95% CI, 0.16–2.06] P interaction =0.01). We did not observe an association between contrast permeability and tenecteplase treatment effect (permeability present: aOR, 2.83 [95% CI, 1.00–8.05] versus absent: aOR, 1.98 [95% CI, 0.65–6.03] P interaction =0.62). Tenecteplase treatment effect was superior with distal M1 or M2 occlusions (53/176 [30%] versus alteplase: 4/42 [10%], aOR, 3.73 [95% CI, 1.25–11.11]), but both thrombolytics had limited efficacy with internal carotid artery occlusions (tenecteplase 1/73 [1%] versus alteplase 1/19 [5%], aOR, 0.22 [95% CI, 0.01–3.83] P interaction =0.16). Tenecteplase demonstrates superior early reperfusion versus alteplase in lesions with low clot burden. Reperfusion efficacy remains limited in internal carotid artery occlusions and lesions with high clot burden. Further innovation in thrombolytic therapies are required.
Publisher: Wiley
Date: 30-04-2021
DOI: 10.1002/ANA.26076
Abstract: There is an accumulating volume of research into neurological manifestations of coronavirus disease 2019 (COVID‐19). However, inconsistent study designs, inadequate controls, poorly validated tests, and differing settings, interventions, and cultural norms weaken study quality and comparability, hence the understanding of the spectrum, burden, and pathophysiology of these complications. Therefore, a global COVID‐19 Neuro Research Coalition, together with the World Health Organization, has reviewed reports of COVID‐19 neurological complications and harmonized clinical measures for future research. This will facilitate well‐designed studies using precise, consistent case definitions of severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) infection and neurological complications, with standardized forms for pooled data analyses that nonspecialists can use, including those in low‐income settings. ANN NEUROL 2021 :1059–1067
Publisher: Elsevier BV
Date: 12-2020
Publisher: Springer Science and Business Media LLC
Date: 20-01-2020
DOI: 10.1186/S13063-019-4018-8
Abstract: Multiple sclerosis (MS) is an unpredictable, chronic neurological disease accompanied with high rates of depression and anxiety, particularly in the early stages of diagnosis. There is evidence to suggest that cognitive behavioural therapy (CBT) is effective for the treatment of depression amongst in iduals with MS however, there is a paucity of tailored CBT interventions designed to be offered in the newly diagnosed period. This trial is the first to assess the effectiveness and cost-effectiveness of a tailored CBT intervention compared to a supportive listening (SL) intervention amongst in iduals with MS who are depressed. ACTION-MS is a two-arm parallel group, assessor-blinded, active comparator, randomised controlled trial which will test whether a tailored CBT-based intervention compared to an SL intervention can reduce depression and related factors such as anxiety, fatigue, pain and sleep problems in those newly diagnosed with MS. Sixty participants who are within 5 years of having received a diagnosis of MS and scored within the mild to moderate range of depression on the Beck Depression Inventory (BDI-II) will be recruited from MS clinics located across three hospital sites in Melbourne, Australia. The primary outcome is depression severity using the BDI-II at post-assessment. Intervention satisfaction and acceptability will be assessed. A cost-effectiveness analysis will also be conducted. Data will be analysed on an intention-to-treat basis. There is a scarcity of psychological interventions for depression targeting the newly diagnosed period. However, interventions during this time point have the potential to have a major impact on the mental and physical wellbeing of those newly diagnosed with MS. The current trial will provide data on the effectiveness of a tailored CBT intervention for the treatment of depression in those newly diagnosed with MS. Findings will also provide effect size estimates that can be used to power a later-stage multi-centre trial of treatment efficacy, and will provide information on the mechanisms underlying any treatment effects and cost-effectiveness data for delivering this intervention in outpatient MS clinics. ISRCTN trials registry, ISRCTN63987586 . Current controlled trials. Retrospectively registered on 20 October 2017.
Publisher: Elsevier BV
Date: 07-2019
Publisher: Elsevier BV
Date: 08-2021
Publisher: BMJ
Date: 18-12-2019
DOI: 10.1136/INJURYPREV-2019-043299
Abstract: Past research has shown how fires, heat and hot substances are important causes of health loss globally. Detailed estimates of the morbidity and mortality from these injuries could help drive preventative measures and improved access to care. We used the Global Burden of Disease 2017 framework to produce three main results. First, we produced results on incidence, prevalence, years lived with disability, deaths, years of life lost and disability-adjusted life years from 1990 to 2017 for 195 countries and territories. Second, we analysed these results to measure mortality-to-incidence ratios by location. Third, we reported the measures above in terms of the cause of fire, heat and hot substances and the types of bodily injuries that result. Globally, there were 8 991 468 (7 481 218 to 10 740 897) new fire, heat and hot substance injuries in 2017 with 120 632 (101 630 to 129 383) deaths. At the global level, the age-standardised mortality caused by fire, heat and hot substances significantly declined from 1990 to 2017, but regionally there was variability in age-standardised incidence with some regions experiencing an increase (eg, Southern Latin America) and others experiencing a significant decrease (eg, High-income North America). The incidence and mortality of injuries that result from fire, heat and hot substances affect every region of the world but are most concentrated in middle and lower income areas. More resources should be invested in measuring these injuries as well as in improving infrastructure, advancing safety measures and ensuring access to care.
Publisher: BMJ
Date: 08-01-2020
DOI: 10.1136/INJURYPREV-2019-043296
Abstract: The epidemiological transition of non-communicable diseases replacing infectious diseases as the main contributors to disease burden has been well documented in global health literature. Less focus, however, has been given to the relationship between sociodemographic changes and injury. The aim of this study was to examine the association between disability-adjusted life years (DALYs) from injury for 195 countries and territories at different levels along the development spectrum between 1990 and 2017 based on the Global Burden of Disease (GBD) 2017 estimates. Injury mortality was estimated using the GBD mortality database, corrections for garbage coding and CODEm—the cause of death ensemble modelling tool. Morbidity estimation was based on surveys and inpatient and outpatient data sets for 30 cause-of-injury with 47 nature-of-injury categories each. The Socio-demographic Index (SDI) is a composite indicator that includes lagged income per capita, average educational attainment over age 15 years and total fertility rate. For many causes of injury, age-standardised DALY rates declined with increasing SDI, although road injury, interpersonal violence and self-harm did not follow this pattern. Particularly for self-harm opposing patterns were observed in regions with similar SDI levels. For road injuries, this effect was less pronounced. The overall global pattern is that of declining injury burden with increasing SDI. However, not all injuries follow this pattern, which suggests multiple underlying mechanisms influencing injury DALYs. There is a need for a detailed understanding of these patterns to help to inform national and global efforts to address injury-related health outcomes across the development spectrum.
Publisher: MDPI AG
Date: 16-02-2021
DOI: 10.20944/PREPRINTS202102.0328.V1
Abstract: Stroke represents one of the most important causes of morbidity ( eighty million patients with disabling of ongoing effects of stroke at a given time, globally) and mortality (the second leading cause of death) worldwide. Innovative systems biology-based approach is likely to increase the understanding of the underpinning of acute stroke promise to enhance stroke prevention, acute treatment, and neurorehabilitation. Recent growing body of evidence with shared pathobiology with COVID-19 and the critically important role of inflammation in the context of stroke points to far-reaching consequences of acute stroke, just as in the case of COVID-19 ( post-acute event issues as well as long term issues ) . So far, stroke typically defined by late-appearing disease manifestation by the range of stroke subtypes as defined by the WHO or American Stroke Association. This definition neglects the underlying pathobiological mechanisms such as low-grade chronic inflammation and already compromised vascular system. Diseases such as stroke is hardly a simple result of a single problem, but rather a complex cascade of pathobiological processes and interactions in a complex biochemical environment. The evidence of changes in innate immunity and adaptive immunity during the index event of acute stroke and recovery over next 3-12 months can be easily elicited with simple bedside blood tests such as neutrophil-lymphocyte ratio (NLR) with well over 300 published papers including several systematic reviews and meta-analyses confirming this. Global standard operating procedures (SOP) of stroke care dictated by the national and international stroke guidelines at present. It is imperative to explore the evidence of systems biology approach in current stroke guidelines. This is likely to be a key turning point in managing stroke across the continuum (prevention, management of acute event and rehabilitation).
Publisher: Oxford University Press
Date: 02-2019
DOI: 10.1093/MED/9780198796039.003.0005
Abstract: The physician–industry relationship is a topic that generates keen interest among physicians globally. This chapter reviews the potential risks and benefits of such relationships in patient care. Physicians must adhere to strict professional standards and strong ethical principles, with the prime interest of offering the best possible care for the patient while using the resources available through pharmaceutical industry partnerships. One must never cross the boundaries in this complex interaction physicians should continue to be the best advocates for patients, and not the pharmaceutical industry. Other aspects of relationships between the pharmaceutical industry and doctors’, trainees’, and residents’ perspectives in the industry, essential drug policy solutions in Sri Lanka, and several key points from the Australian Medical Association’s position statement on medical practitioner’s relationships with industries, are also discussed.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 20-01-2022
Publisher: MDPI AG
Date: 20-07-2022
DOI: 10.3390/APP12147281
Abstract: Video and music as a dissociative attention stimulus during exercise is known to distract from the discomfort of physical exertion and improve exercise adherence however, the influence of video-based feedback and engagement during pedalling on the performance and motivation of pedalling in stroke patients is poorly understood. The aim of this study was to employ a novel video-based engagement paradigm for pedalling in stroke patients and evaluate its capacity to influence the cadence control, physiological output, and perceived motivation and enjoyment. Thirteen stroke patients were recruited with low-to-moderate lower-limb disability (mean age: 64.0 yrs.). A reference group of 18 healthy young adult subjects (mean age: 27.7 yrs.) was also recruited to assess the broad applicability of the techniques to a contrasting non-pathological cohort. The participants pedalled at a slow (60 RPM) and fast (100 RPM) target speed with constant resistance in 15 min pedalling bouts that included (i) baseline pedalling with real-time visual feedback of cadence deviation from the target provided only in the first 20 s (ii) real-time visual feedback of cadence data over the entire pedalling session, and (iii) real-time engagement to maintain the playback rate of a prerecorded video by pedalling at the target speed. During low speed pedalling, stroke patients demonstrated significantly smaller absolute cadence deviation during pedalling with feedback (mean difference: 1.8 RPM, p = 0.014) and video-based engagement (mean difference: 2.4 RPM, p = 0.006) compared to the baseline pedalling. For the healthy adults, feedback and video-based engagement reduced cadence deviation significantly at all speeds (p 0.05). All but one stroke patient either enjoyed or really enjoyed the video engagement during pedalling and felt motivated to undertake this form of exercise in therapy in the future. This proof-of-concept study showed that feedback and video-based engagement may improve the targeted pedalling performance in stroke patients, and by helping dissociate subjects from physical cues associated with fatigue, may ultimately improve exercise motivation and compliance.
Publisher: Springer Science and Business Media LLC
Date: 24-03-2010
Publisher: Elsevier BV
Date: 09-2020
Publisher: Frontiers Media SA
Date: 08-08-2017
Publisher: Frontiers Media SA
Date: 25-09-2020
Publisher: Elsevier BV
Date: 10-2020
Publisher: AMPCo
Date: 11-2012
DOI: 10.5694/MJA12.10534
Abstract: To determine the relative incidence (RI) of Guillain-Barré syndrome (GBS) in a single Australian state following pandemic (H1N1) 2009 influenza A immunisation (monovalent vaccine or seasonal trivalent influenza vaccine [TIV]) in 2009-2010. Active GBS surveillance (cases assessed by two neurologists according to the Brighton criteria) from 30 September 2009 to 30 September 2010, conducted at 10 hospitals in Victoria, Australia. The RI of GBS in the risk window of 0-42 days after vaccination. Sixty-six potential GBS cases were identified, with complete data on 50 confirmed cases. The Victorian annual incidence of GBS was 1.7 per 100 000 population. Three cases had received monovalent vaccine and one case had received seasonal TIV within 42 days of symptom onset. The RI of GBS following monovalent vaccination was 3.4 (95% CI, 0.8-15.0). For TIV, there was one case in the risk period (RI, 0.69 95% CI, 0.08-5.64). This is the first published study reviewing GBS after a trivalent and/or monovalent influenza vaccine containing the pandemic (H1N1) 2009 strain, with only a small proportion of GBS cases occurring after influenza immunisation. H1N1-containing vaccines were not statistically associated with GBS, but this study could not exclude smaller increases in the RI. Active surveillance of adverse events following immunisation is required to maintain public and health care professional confidence in mass vaccine implementation programs.
Publisher: MDPI AG
Date: 11-02-2021
DOI: 10.20944/PREPRINTS202102.0291.V1
Abstract: Stroke is one of the leading cause of adult disability and the second leading cause of death worldwide. The immune system actively participates in the pathobiological process of AIS, during the index event and during the repair process despite the limited attention drawn to this aspect in the existing stroke guidelines globally. The similar clinical course and similar circulating innate and adaptive immune cell counts in AIS and COVID-19 has created a renewed interest in these easily available biomarkers innate and adaptive immunological changes in AIS with potential diagnostic, prognostic, and therapeutic implications. The current scoping review aimed to assess the significance of circulating neutrophil and lymphocyte counts and their ratio (NLR) in AIS and explore their association with post-stroke recovery trajectory. The Arksey and O'Malley methodological framework was employed to review the published papers on the neutrophil-lymphocyte ratio (NLR) and AIS in late November 2020. Only studies published in English from 2000-2020 were included in this scoping review. Fifty-three published papers were reviewed. This review's key finding is that a canonical inflammatory response occurs in AIS just as in the case of COVID-19 and neurological involvements well described in the recent literature. An excessive circulating innate immune cells (neutrophils) and reduced circulating adaptive immune cells (lymphocytes ) are associated with poorer outcomes during the acute interventions ( reperfusion therapies) as well as the recovery trajectory. Main representatives of innate and adaptive immunity follow a canonical course in AIS and COVID-19. Exaggerated circulating innate ( elevated neutrophils and elevated NLR) and reduced adaptive immune response (lymphopenia) correlate with the worse outcome in AIS and COVID-19. This scoping review's findings make the strongest case for a systems biology-based approach to the standard operating procedures in stroke care urgently.
Publisher: SAGE Publications
Date: 27-09-2018
Abstract: Intravenous thrombolysis with alteplase remains standard care prior to thrombectomy for eligible patients within 4.5 h of ischemic stroke onset. However, alteplase only succeeds in reperfusing large vessel arterial occlusion prior to thrombectomy in a minority of patients. We hypothesized that tenecteplase is non-inferior to alteplase in achieving reperfusion at initial angiogram, when administered within 4.5 h of ischemic stroke onset, in patients planned to undergo endovascular therapy. EXTEND-IA TNK is an investigator-initiated, phase II, multicenter, prospective, randomized, open-label, blinded-endpoint non-inferiority study. Eligibility requires a diagnosis of ischemic stroke within 4.5 h of stroke onset, pre-stroke modified Rankin Scale≤3 (no upper age limit), large vessel occlusion (internal carotid, basilar, or middle cerebral artery) on multimodal computed tomography and absence of contraindications to intravenous thrombolysis. Patients are randomized to either IV alteplase (0.9 mg/kg, max 90 mg) or tenecteplase (0.25 mg/kg, max 25 mg) prior to thrombectomy. The primary outcome measure is reperfusion on the initial catheter angiogram, assessed as modified treatment in cerebral infarction 2 b/3 or the absence of retrievable thrombus. Secondary outcomes include modified Rankin Scale at day 90 and favorable clinical response (reduction in National Institutes of Health Stroke Scale by ≥8 points or reaching 0–1) at day 3. Safety outcomes are death and symptomatic intracerebral hemorrhage. ClinicalTrials.gov NCT02388061
Publisher: Elsevier BV
Date: 05-2017
Publisher: Cambridge University Press (CUP)
Date: 24-06-2021
DOI: 10.1017/CJN.2021.147
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 11-2015
DOI: 10.1161/STROKEAHA.115.003390
Abstract: We systematically compared and appraised contemporary guidelines on management of asymptomatic and symptomatic carotid artery stenosis. We systematically searched for guideline recommendations on carotid endarterectomy (CEA) or carotid angioplasty/stenting (CAS) published in any language between January 1, 2008, and January 28, 2015. Only the latest guideline per writing group was selected. Each guideline was analyzed independently by 2 to 6 authors to determine clinical scenarios covered, recommendations given, and scientific evidence used. Thirty-four eligible guidelines were identified from 23 different regions/countries in 6 languages. Of 28 guidelines with asymptomatic carotid artery stenosis procedural recommendations, 24 (86%) endorsed CEA (recommended it should or may be provided) for ≈50% to 99% average-surgical-risk asymptomatic carotid artery stenosis, 17 (61%) endorsed CAS, 8 (29%) opposed CAS, and 1 (4%) endorsed medical treatment alone. For asymptomatic carotid artery stenosis patients considered high-CEA-risk because of comorbidities, vascular anatomy, or undefined reasons, CAS was endorsed in 13 guidelines (46%). Thirty-one of 33 guidelines (94%) with symptomatic carotid artery stenosis procedural recommendations endorsed CEA for patients with ≈50% to 99% average-CEA-risk symptomatic carotid artery stenosis, 19 (58%) endorsed CAS and 9 (27%) opposed CAS. For high-CEA-risk symptomatic carotid artery stenosis because of comorbidities, vascular anatomy, or undefined reasons, CAS was endorsed in 27 guidelines (82%). Guideline procedural recommendations were based only on results of trials in which patients were randomized 12 to 34 years ago, rarely reflected medical treatment improvements and often understated potential CAS hazards. Qualifying terminology summarizing recommendations or evidence lacked standardization, impeding guideline interpretation, and comparison. This systematic review has identified many opportunities to modernize and otherwise improve carotid stenosis management guidelines.
Publisher: Oxford University Press
Date: 02-2019
DOI: 10.1093/MED/9780198796039.003.0033
Abstract: Stroke advocacy, defined as acting on behalf of stroke victims and families to promote their welfare policies that include education, clinical service development, and translational clinical research, is the key in improving stroke care globally. Stroke is the second commonest cause of death for people over 60 worldwide and is a leading cause of adult disability. It is estimated that each year 16 million people worldwide suffer a stroke, with approximately 6 million dying and another 5 million being left permanently disabled. Recent research also suggests that nearly 90% of all such stroke cases are preventable and treatable if seen rapidly. This chapter discusses the step-by-step effective stroke advocacy in setting up a state-of-the-art stroke service in a less privileged public hospital in Australia followed by stroke advocacy case studies from Canada, Europe, Latin America, Nigeria, and Sri Lanka. Key tips in effective stroke advocacy and nine steps to achieve changes are also discussed.
Publisher: MDPI AG
Date: 31-10-2022
DOI: 10.20944/PREPRINTS202210.0486.V1
Abstract: Background: Migraine is the commonest complex neurological disorder affecting over a billion people worldwide. Neuroinflammation has long been considered to play an important role in the pathophysiology of migraine. The main aim of this single-centre, proof of concept, retrospective study was to determine the possible clinical utility of systemic immune-inflammatory response in migraine with and without aura in a hospitalized cohort. We measured the role of universally available serial white blood cell counts to calculate the serial systemic immune-inflammatory indices (SSIIi) and the potential association between aura and SSIIi changes in a cohort of migraine patients admitted to tertiary care center in Melbourne Australia.Main body: We retrospectively assessed patients' medical records presenting to Western Health with migraine over an 18 month period. Patients were classified as either having migraine with aura (MA) or without aura (MO) based on ICHD-3 criteria. Baseline demographics and brain imaging findings in each group were evaluated. Patients with two sets of white blood cell counts during the admission were included in the analysis. SSIIi were calculated as, neutrophil counts x platelet counts / lymphocyte counts. Correlation between SSIIi and MA and MO were assessed using SPSS27.Conclusion: SSIIi were elevated in MA and MO followed by a downward trend in both groups, with MA being statistically significant. This proof-of-concept study suggests the potential role of systemic inflammation in pathobiology of migraine. SSIIi appear to show clinical utility. Further comprehensive ,controlled , multicenter studies are required to clarify the exact role of systemic inflammatory response and the clinical utility of SSIIi in a subset of migraine in the Emergency department setting.
Publisher: Hindawi Limited
Date: 15-06-2022
DOI: 10.1155/2022/5514793
Abstract: Background and Purpose. Stroke represents one of the most important causes of morbidity (Just over hundred million patients with disabling of ongoing effects of stroke at a given time, globally) and mortality (the second leading cause of death) worldwide. Innovative system biology-based approach is likely to increase the understanding of the underpinning of acute stroke promise to enhance stroke prevention, acute treatment, and neurorehabilitation. Recent growing body of evidence with shared pathobiology with COVID-19 and the critically important role of inflammation in the context of stroke points to far-reaching consequences of acute stroke, just as in the case of COVID-19 (postacute event issues as well as long term issues). So far, stroke is typically defined by late-appearing disease manifestation by the range of stroke subtypes as defined by the WHO or American Stroke Association. This definition neglects the underlying pathobiological mechanisms such as low-grade chronic inflammation and already compromised vascular system. Diseases such as stroke are hardly a simple result of a single problem but rather a complex cascade of pathobiological processes and interactions in a complex biochemical environment. The evidence of changes in innate immunity and adaptive immunity during the index event of acute stroke and recovery over next 3-12 months can be easily elicited with simple bedside blood tests such as neutrophil-lymphocyte ratio (NLR) with well over 300 published papers including several systematic reviews and meta-analyses confirming this. Global standard operating procedures (SOP) of stroke care are dictated by the national and international stroke guidelines at present. It is imperative to explore the evidence of system biology approach in current stroke guidelines. This is likely to be a key turning point in managing stroke across the continuum (prevention, management of acute event, and rehabilitation). Methods. We systematically searched for guideline recommendation on the day-to-day use of peripheral inflammatory markers such as NLR published in the English language between January 1, 2005, and October 2020. Any other evidence of system biology-based approach or recommendation was explored within the selected guidelines for this scoping review. Only the latest guideline per writing group was selected. Each guideline was analyzed independently by 2 to 4 authors to determine clinical scenarios explained/given, scientific evidence used, and recommendations presented in the context of system biology. Results. The scoping review found 2,911 titles at the beginning of the search. Final review included with 15 guidelines. Stroke-related organizations wrote sixty-five percent of the guidelines while national ministries wrote a fewer number of guidelines. We were primarily interested in recommendations for acute management in AIS published in the English language. Fifteen eligible guidelines were identified from 15 different countries/regions. None of the guidelines recommended the routine use of peripheral markers of inflammation, such as NLR, among their acute assessment and management recommendations. None of the existing guidelines explored the system biology approach to one of the most complex diseases affecting the human brain, stroke. Conclusions. This systematic review has identified a significant evidence-practice gap in all existing national stroke guidelines published in English medium as of October 2020. These guidelines included the only current “living stroke guidelines,” stroke guidelines from Australia with a real opportunity to modernize the living stroke guidelines with systems biology approach, and provide 2020 vision towards better stroke care globally. Investigation of complex disease such as stroke is best served through a systems biology approach. One of the easiest places to start is simple blood tests such as total white cell count and NLR. Systems biology approach point us towards simple tools such immune-inflammatory index (SII) and serial systemic immune inflammatory indices (SSIIi) which should pave the way for the stroke physician community address the challenges in systems biology approach in stroke care. These challenges include translating bench research to the bedside, managing big data (continuous pulse, blood pressure, sleep, oxygen saturation, progressive changes in NLR, SII, SSIIi, etc.). Working with an interdisciplinary team also provides a distinct advantage. Recent adoption of historic WHO-IGAP calls for immediate action. The 2022 World Brain Day c aign on Brain Health for All is the perfect opportunity to raise awareness and start the process.
Publisher: Cold Spring Harbor Laboratory
Date: 23-02-2021
DOI: 10.1101/2021.02.21.21252144
Abstract: Neurological disorders are the leading cause disability in Australia and the world. Combating the perceived difficulty of neurology or “neurophobia” and improving physician education is a key component in addressing this problem. We aim to conduct the first study to identify whether neurophobia exists in medical students and junior doctors in an Australian population and try to identify factors that may contribute to this in this population. A 24 question online validated survey was distributed via email broadcast to all medical students and junior doctors at a metropolitan tertiary care centre in Australia. Responses were collected over 6 weeks with weekly reminder emails for 4 weeks after the initial invitation email. 114 medical students and junior doctors participated in the study. Participants perceived neurology as the most difficult medical speciality compared to 10 other medical specialties (p=0.001). The top three factors contributing to this perceived difficulty were: a lack of understanding of neuroanatomy, lack of diagnostic certainty and lack of clinical exposure. 65% of the participants stated that they had too little planned teaching in neurology with only 36% of the participants having performed a neurology rotation during medical school. The prevalence of neurophobia in this Australian cohort of medical students and junior doctors is consistent with previous findings from around the world. This concerning finding requires further examination into the contributing factors in order to created trials of targeted interventions in order to resolve this.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 05-09-2017
DOI: 10.1161/CIRCULATIONAHA.117.028566
Abstract: Patients with minor acute ischemic stroke or transient ischemic attack are at high risk for subsequent stroke, and more potent antiplatelet therapy in the acute setting is needed. However, the potential benefit of more intense antiplatelet therapy must be assessed in relation to the risk for major bleeding. The SOCRATES trial (Acute Stroke or Transient Ischemic Attack Treated With Aspirin or Ticagrelor and Patient Outcomes) was the first trial with ticagrelor in patients with acute ischemic stroke or transient ischemic attack in which the efficacy and safety of ticagrelor were compared with those of aspirin. The main safety objective was assessment of PLATO (Platelet Inhibition and Patient Outcomes)–defined major bleeds on treatment, with special focus on intracranial hemorrhage (ICrH). An independent adjudication committee blinded to study treatment classified bleeds according to the PLATO, TIMI (Thrombolysis in Myocardial Infarction), and GUSTO (Global Use of Strategies to Open Occluded Coronary Arteries) definitions. The definitions of ICrH and major bleeding excluded cerebral microbleeds and asymptomatic hemorrhagic transformations of cerebral infarctions so that the definitions better discriminated important events in the acute stroke population. A total of 13 130 of 13 199 randomized patients received at least 1 dose of study drug and were included in the safety analysis set. PLATO major bleeds occurred in 31 patients (0.5%) on ticagrelor and 38 patients (0.6%) on aspirin (hazard ratio, 0.83 95% confidence interval, 0.52–1.34). The most common locations of major bleeds were intracranial and gastrointestinal. ICrH was reported in 12 patients (0.2%) on ticagrelor and 18 patients (0.3%) on aspirin. Thirteen of all 30 ICrHs (4 on ticagrelor and 9 on aspirin) were hemorrhagic strokes, and 4 (2 in each group) were symptomatic hemorrhagic transformations of brain infarctions. The ICrHs were spontaneous in 6 and 13, traumatic in 3 and 3, and procedural in 3 and 2 patients on ticagrelor and aspirin, respectively. In total, 9 fatal bleeds occurred on ticagrelor and 4 on aspirin. The composite of ICrH or fatal bleeding included 15 patients on ticagrelor and 18 on aspirin. Independently of bleeding classification, PLATO, TIMI, or GUSTO, the relative difference between treatments for major/severe bleeds was similar. Nonmajor bleeds were more common on ticagrelor. Antiplatelet therapy with ticagrelor in patients with acute ischemic stroke or transient ischemic attack showed a bleeding profile similar to that of aspirin for major bleeds. There were few ICrHs. URL: www.clinicaltrials.gov . Unique identifier: NCT01994720.
Publisher: Frontiers Media SA
Date: 22-12-2020
DOI: 10.3389/FNEUR.2020.565665
Abstract: Coronaviruses (CoVs) are enveloped RNA viruses and have been shown to cause mild to severe respiratory infections in humans, with some severe cases inducing neurological manifestations. The lethality and Neurological effects of the Severe Acute Respiratory Syndrome (SARS-CoV), Middle-East Respiratory Syndrome (MERS-CoV), and recently the Severe Acute Respiratory Syndrome coronavirus 2 (SARS-CoV-2) have been well documented though currently there is little literature regarding long term effects and the implications for neurorehabilitation. SARS-CoV-2 and MERS-CoV have been linked to the infection associated inflammatory cytokine storms and induced hypercoagulopathic states that affect the entire vascular system including that of the brain. This mini-review provides an overview of the commonalities among studies published on all three types of the coronavirus related to acute ischemic stroke (AIS). The aim was to elucidate the physiological mechanisms underpinning COVID-2 and to reflect the similarities with the chronic inflammation induced symptoms of AIS that are likely to prove a further challenge for neurorehabilitation clinicians post COVID. In terms of increased incidence of COVID and AIS, it is likely that in depth knowledge of increased thrombotic risk in this population will require appropriate anticoagulation treatment, and other therapeutic interventions as well as neurorehabilitation interventions. Lastly the risk of spreading the virus requires further balancing of the provision of neurorehabiliatation services useful to the patient.
Publisher: Springer Science and Business Media LLC
Date: 20-04-2020
DOI: 10.1038/S41591-020-0807-6
Abstract: A double burden of malnutrition occurs when in iduals, household members or communities experience both undernutrition and overweight. Here, we show geospatial estimates of overweight and wasting prevalence among children under 5 years of age in 105 low- and middle-income countries (LMICs) from 2000 to 2017 and aggregate these to policy-relevant administrative units. Wasting decreased overall across LMICs between 2000 and 2017, from 8.4% (62.3 (55.1–70.8) million) to 6.4% (58.3 (47.6–70.7) million), but is predicted to remain above the World Health Organization’s Global Nutrition Target of % in over half of LMICs by 2025. Prevalence of overweight increased from 5.2% (30 (22.8–38.5) million) in 2000 to 6.0% (55.5 (44.8–67.9) million) children aged under 5 years in 2017. Areas most affected by double burden of malnutrition were located in Indonesia, Thailand, southeastern China, Botswana, Cameroon and central Nigeria. Our estimates provide a new perspective to researchers, policy makers and public health agencies in their efforts to address this global childhood syndemic.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 03-2020
DOI: 10.1161/STROKEAHA.119.027843
Abstract: Mobile stroke units (MSUs) are increasingly used worldwide to provide prehospital triage and treatment. The benefits of MSUs in giving earlier thrombolysis have been well established, but the impacts of MSUs on endovascular thrombectomy (EVT) and effect on disability avoidance are largely unknown. We aimed to determine the clinical impact and disability reduction for reperfusion therapies in the first operational year of the Melbourne MSU. Treatment time metrics for MSU patients receiving reperfusion therapy were compared with control patients presenting to metropolitan Melbourne stroke units via standard ambulance within MSU operating hours. The primary outcome was median time difference in first ambulance dispatch to treatment modeled using quantile regression analysis. Time savings were subsequently converted to disability-adjusted life years avoided using published estimates. In the first 365-day operation of the Melbourne MSU, prehospital thrombolysis was administered to 100 patients (mean age, 73.8 years 62% men). The median time savings per MSU patient, compared with the control cohort, was 26 minutes ( P .001) for dispatch to hospital arrival and 15 minutes ( P .001) for hospital arrival to thrombolysis. The calculated overall time saving from dispatch to thrombolysis was 42.5 minutes (95% CI, 36.0–49.0). In the same period, 41 MSU patients received EVT (mean age, 76 years 61% men) with median dispatch-to-treatment time saving of 51 minutes ([95% CI, 30.1–71.9], P .001). This included a median time saving of 17 minutes ([95% CI, 7.6–26.4], P =0.001) for EVT hospital arrival to arterial puncture for MSU patients. Estimated median disability-adjusted life years saved through earlier provision of reperfusion therapies were 20.9 for thrombolysis and 24.6 for EVT. The Melbourne MSU substantially reduced time to reperfusion therapies, with the greatest estimated disability avoidance driven by the more powerful impact of earlier EVT. These findings highlight the benefits of prehospital notification and direct triage to EVT centers with facilitated workflow on arrival by the MSU.
Publisher: Springer Science and Business Media LLC
Date: 20-03-2020
DOI: 10.1186/S13063-020-04261-X
Abstract: After publication of our article [1] the authors have notified us that three of the names have been incorrectly spelled.
Publisher: Elsevier BV
Date: 10-2020
Publisher: Public Library of Science (PLoS)
Date: 09-02-2016
Publisher: MDPI AG
Date: 11-02-2021
DOI: 10.20944/PREPRINTS202102.0289.V1
Abstract: Ischemic Stroke precedes depression . Post Stroke Depression (PSD) is a major driver for poor recovery, negative quality of life, poor rehabilitation outcomes and poor functional ability. This systematic reviews confirmed the post stroke depression as the norm as complex ischemic cascade involve the bioenergetic failure, deranged iron homeostasis ( calcium influx, Na influx, potassium efflux etc) excitotoxicity, acidotoxicity,disruption of the blood brain barrier, cytokine mediated cytotoxicity, reactive oxygen mediated toxicity , activation of cyclooxygenase pathway and generation of toxic products, infiltration of immune mediated cells resulting the cell death and deranged neuronal networks in mood related brain regions. This review focus on the pathobiology of stroke in the context and make the argument that PSD is the norm after a stroke rather than the exception.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 28-08-2012
Publisher: Informa UK Limited
Date: 25-06-2023
Publisher: Cambridge University Press (CUP)
Date: 13-07-2021
DOI: 10.1017/CJN.2020.140
Publisher: Scientific Scholar
Date: 2018
Publisher: BMJ
Date: 11-12-2015
DOI: 10.1136/BMJ.H6432
Abstract: To report the number of participants needed to recruit per baby born to trial staff during AVERT, a large international trial on acute stroke, and to describe trial management consequences. Retrospective observational analysis. 56 acute stroke hospitals in eight countries. 1074 trial physiotherapists, nurses, and other clinicians. Number of babies born during trial recruitment per trial participant recruited. With 198 site recruitment years and 2104 patients recruited during AVERT, 120 babies were born to trial staff. Births led to an estimated 10% loss in time to achieve recruitment. Parental leave was linked to six trial site closures. The number of participants needed to recruit per baby born was 17.5 (95% confidence interval 14.7 to 21.0) additional trial costs associated with each birth were estimated at 5736 Australian dollars on average. The staff absences registered in AVERT owing to parental leave led to delayed trial recruitment and increased costs, and should be considered by trial investigators when planning research and estimating budgets. However, the celebration of new life became a highlight of the annual AVERT collaborators' meetings and helped maintain a cohesive collaborative group. Australian New Zealand Clinical Trials Registry no 12606000185561. Participation in a rehabilitation trial does not guarantee successful reproductive activity.
Publisher: Elsevier BV
Date: 2017
Publisher: Elsevier BV
Date: 12-2019
Publisher: Elsevier BV
Date: 05-2018
Publisher: Elsevier BV
Date: 06-2020
Publisher: MDPI AG
Date: 08-10-2023
Publisher: Frontiers Media SA
Date: 21-09-2017
Publisher: Medknow
Date: 2018
Publisher: Elsevier BV
Date: 11-2018
Publisher: Massachusetts Medical Society
Date: 26-04-2018
Publisher: Elsevier BV
Date: 04-2021
Publisher: Springer Science and Business Media LLC
Date: 04-2021
DOI: 10.1186/S10194-021-01233-7
Abstract: With headache experienced by up to 75% of adults worldwide in the last year, primary headache disorders constitute a major public health problem, yet they remain under-diagnosed and under-treated. Headache prevalence and burden is changing as society evolves, with headache now occurring earlier in life. Contributing factors, mostly associated with changing life style, such as stress, bad posture, physical inactivity, sleep disturbance, poor diet and excess use of digital technology may be associated with the phenomenon that could be labelled as ‘21st century headache’. This is especially notable in workplace and learning environments where headache impacts mental clarity and therefore cognitive performance. The headache-related impact on productivity and absenteeism negatively influences an in idual’s behaviour and quality of life, and is also associated with a high economic cost. Since the majority of sufferers opt to self-treat rather than seek medical advice, substantial knowledge on headache prevalence, causation and burden is unknown globally. Mapping the entire population of headache sufferers can close this knowledge gap, leading to better headache management. The broad use of digital technology to gather real world data on headache triggers, burden and management strategies, in self-treated population will allow these sufferers to access appropriate support and medication, and therefore improve quality of life. These data can yield important insights into a substantial global healthcare issue and form the basis for improved patient awareness, professional education, clinical study design and drug development.
Publisher: SAGE Publications
Date: 14-07-2021
Publisher: Elsevier BV
Date: 08-2021
Publisher: Informa UK Limited
Date: 09-12-2013
Publisher: Elsevier BV
Date: 06-2020
Publisher: SAGE Publications
Date: 04-10-2011
DOI: 10.1111/J.1747-4949.2011.00625.X
Abstract: Sri Lanka has an ageing population with an impending epidemic of stroke at hand. Stroke is the leading cause of adult disability in Sri Lanka. Sri Lanka has seen many recent advances in stroke services in the recent past providing a benchmark ex le for the countries in the Asia Pacific region, modeling the best care for stroke patients across the region with limited facilities they have. Three postgraduate trainees in neurology and medicine from Sri Lanka will spend a year at Western Health/ University of Melbourne, Melbourne, Australia for a period of 12 months for training in neurorehabilitation for stroke. It is timely for neurology trainees and trainees in internal medicine in Sri Lanka to be interested in neurorehabilitation. We sincerely hope the Board of study of Neurology, Post Graduate Institute of Medicine, Colombo, Sri Lanka will take the necessary steps to establish neurorehabilitation as an emerging sub-specialty for neurology trainees in Sri Lanka now.
Publisher: Elsevier BV
Date: 2019
Publisher: Sri Lanka Journals Online (JOL)
Date: 27-12-2014
Abstract: A retrospective comparative study was done to compare the outcome of intermittent Pringle manoeuvre (IPM) and selective hepatic vascular exclusion (SHVE) in 19 major hepatectomies in non-cirrhotic patients that were done from October 2003 to June 2009. Intra-operative blood loss (IBL), total operative time (TOT) and immediate outcome were assessed in the two groups. Thirteen underwent IPM and the others underwent SHVE. The mean age was 50 years (SHVE) and 39.2 years (IPM). Mean IBL was 641 ml and 802 ml in the SHVE and IPM groups respectively (p > .05). TOT was 4.7 hours in both groups. There was one mortality from myocardial infarction in the IPM group and no morbidities in both groups. The results obtained from this study shows that IPM is equivalent to SHVE, with regards to IBL, TOT and immediate outcome in major hepatectomies in non-cirrhotic patients.
Publisher: Wiley
Date: 16-08-2019
DOI: 10.1111/ENE.14045
Publisher: Oxford University Press
Date: 02-2019
DOI: 10.1093/MED/9780198796039.003.0027
Abstract: Palliative care aims to provide holistic care for the person and their family, considering physical, psychosocial, and spiritual aspects of care. Advocacy is at the core of the care provided, in enabling people to be enabled to make decisions and be fully involved in their care. However, neurological disease may cause both communication and cognitive difficulties and care may need to be discussed and planned in advance, so that the person’s views are clear. As this chapter explores, the discussions are a challenge for all involved but are essential to enable the person and their family to be fully involved in their care.
Publisher: Oxford University Press
Date: 02-2019
DOI: 10.1093/MED/9780198796039.003.0029
Abstract: Despite irrefutable evidence of the high prevalence, burden, and cost of headache disorders, advocacy for headache—for more headache research and better headache care—has been largely in vain so far. Headache receives little respect and few resources. There are scientific, public health, and financial arguments for change, which are evidence-based and sound. They make compelling messages, which nonetheless have not yet reached the consciousness of health policymakers. Headache disorders are the least funded of all neurological disorders, while accounting for more disability than all other neurological disorders combined. This is a remediable failure. The worldwide programme of activities of the Global C aign against Headache, and its collaboration with the Global Burden of Disease studies, are generating an unstoppable flow of evidence to support change. The World Health Organization has acknowledged the global public health importance of headache, and committed to advocacy on its behalf at macro level. A momentum is building. The arguments for change are, for now, unanswerable, but they have to be put to those who can make change happen, and repeated again and again. If they work with these organizations, the many national and supranational professional and lay groups will find previously closed doors are, at last, slowly opening.
Publisher: Massachusetts Medical Society
Date: 16-06-2016
Publisher: Oxford University Press
Date: 02-2019
DOI: 10.1093/MED/9780198796039.003.0025
Abstract: Advocacy in dementia can be defined best as the act or process by an in idual or a group influencing or otherwise supporting within social, health, economic, and political systems and organizations better dementia care at large. Dementia advocacy encompasses many activities including among others public speaking and media c aigns, sharing knowledge and experiences, providing resources including funding, establishing groups and organizations, developing and presenting guidelines, criteria, programmes, strategies, and policies and consulting regional, national, and international decision-makers to promote, support, and otherwise further dementia care. Recently, the World Health Organization recognized dementia as a global epidemic with the majority of people afflicted by dementia originating from low- to middle-income countries where access to dementia care is limited or absent. Indeed, there is an urgent need to develop cost-effective strategies to deliver sufficient and efficient dementia care as well as to optimize needed resources including finances. This need can only be fulfilled with diligent advocacy, which initially played a crucial role in defining the modern notion of dementia and more recently propelled dementia to the centre stage of healthcare priorities across the globe.
Publisher: Cold Spring Harbor Laboratory
Date: 03-03-2021
DOI: 10.1101/2021.03.01.21252317
Abstract: Neutrophil counts (innate immunity) and lymphocyte counts (adaptive immunity) are common markers of inflammation in the context of acute stroke, and Neutrophil lymphocyte ratio (NLR) is likely to be expected to predict the post-stroke outcome. This study aimed to explore the predictive value of NLR to predict the very early mortality during the acute hospital admission (death within the first week of hospital stay) as this has management implications for the ongoing investigations, family discussions and resource allocation. This the first such study attempting at exploring the role of NLR in hyperacute in-patient mortality in the world to the best of our knowledge. This retrospective study included 120 patients (60 acute stroke patients who died within the first week of the hospital stay and 60 age, sex-matched controls who were discharged within two weeks of the hospital admission, alive. We reviewed the total white cell counts of these patients (first 72 hours of the hospital admission) and NLR was calculated manually. While there was no statistically significant difference between mean neutrophil counts and mean lymphocyte counts between the two cohorts [neutrophil counts (mean, SD), 8.52(3.20) in the death cohort, 6.48(2.20) among survivors and lymphocyte (mean, SD), 1.83(1.48) in the death cohort,1.66 (0.69) among survivors], there was a statistically significant difference in NLR between the two cohorts. NLR (mean, SD) was 6.51 (4.98) in the death cohort while the survivors had mean NLR of 4.64 with an SD 2.90 with a p-value of 0.048. Hypertension, diabetes, atrial fibrillation, previous vascular events were common in both groups indicating the value of exploring the evidence of background compromised vascular system and metabolic syndrome and bringing the systems biology approach to the management of stroke.
Publisher: Elsevier BV
Date: 05-2017
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 04-2013
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 08-2021
Abstract: The incidence of bleeding complications after percutaneous kidney biopsies is low. Female sex may be associated with a greater risk for bleeding complications after percutaneous kidney biopsies. This association and the plausible mechanisms require further evaluation in prospective study
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 22-03-2022
DOI: 10.1212/WNL.0000000000013302
Abstract: Detailed study of tenecteplase (TNK) in patients older than 80 years is limited. The objective of our study was to assess the safety and efficacy of TNK at 0.25 and 0.40 mg/kg doses in patients older than 80 years with large vessel occlusion. We performed a pooled analysis of the EXTEND-IA TNK randomized controlled trials (n = 502). Patients were adults presenting with ischemic stroke due to occlusion of the intracranial internal carotid, middle cerebral, or basilar artery presenting within 4.5 hours of symptom onset. We compared the treatment effect of TNK 0.25 mg/kg, TNK 0.40 mg/kg, and alteplase 0.90 mg/kg, stratifying for patient age ( years). Outcomes evaluated include 90-day modified Rankin Scale (mRS) score, all-cause mortality, and symptomatic ICH. Treatment effect was adjusted for baseline NIH Stroke Score, age, and time from symptom onset to puncture via mixed effects proportional odds and logistic regression models. In patients years (n = 137), TNK 0.25 mg/kg was associated with improved 90-day mRS (median 3 vs 4, adjusted common odds ratio (acOR) 2.70, 95% CI 1.23–5.94) and reduced mortality (acOR 0.34, 95% CI 0.13–0.91) vs 0.40 mg/kg. TNK 0.25 mg/kg was associated with improved 90-day mRS (median 3 vs 4, acOR 2.28, 95% CI 1.03–5.05) vs alteplase. No difference in 90-day mRS or mortality was detected between alteplase and TNK 0.40 mg/kg. Symptomatic ICH was observed in 4 patients treated with TNK 0.40 mg/kg, 1 patient treated with alteplase, and 0 patients treated with TNK 0.25 mg/kg. In patients ≤80 years, no differences in 90-day mRS, mortality, or symptomatic ICH were observed among TNK 0.25 mg/kg, alteplase, and TNK 0.40 mg/kg. TNK 0.25 mg/kg was associated with improved 90-day mRS and lower mortality in patients older than 80 years. No differences among the doses were observed in younger patients. NCT02388061, NCT03340493. This study provides Class II evidence that tenecteplase 0.25 mg/kg given before endovascular therapy in patients years old with large vessel occlusion stroke is associated with better functional outcomes at 90 days and reduced mortality when compared to tenecteplase 0.40 mg/kg or alteplase 0.90 mg/kg.
No related grants have been discovered for Tissa Wijeratne.