Search results for: stroke mortality

Authors: Chung-Yuan Wang, Kai-Chun Lee, Min-Hung Wang, Yu-Ren Chen, Hung-Sheng Lin, Sen-Shan Fan

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Taiwan National Health Insurance (NHI) was launched in 1995. It is an important social welfare policy in Taiwan. Regardless of the diversified social and economic status, universal coverage of NHI was assured. In order to regain better self-care performance, stroke people received in-patient and out-patient rehabilitation. Though NHI limited the rehabilitation frequency to one per day, the cost of rehabilitation still increased rapidly. Through the intensive rehabilitation during the post-stroke rehabilitation golden period, stroke patients might decrease their disability and shorten the rehabilitation period. Therefore, the aim of this study was to investigate the effect of intensive post-acute stroke rehabilitation in hospital under per diem payment. This study was started from 2014/03/01. The stroke patients who were admitted to our hospital or medical center were indicated to the study. The neurologists would check his modified Rankin Scale (mRS). Only patients with their mRS score between 2 and 4 were included to the study. Patients with unclear consciousness, unstable medical condition, unclear stroke onset date and no willing for 3 weeks in-patient intensive rehabilitation were excluded. After the physiatrist’s systemic evaluation, the subjects received intensive rehabilitation programs. The frequency of rehabilitation was thrice per day. Physical therapy, occupational therapy and speech/swallowing therapy were included in the programs for the needs of the stroke patients. Activity daily life performance (Barthel Index) and functional balance ability (Berg Balance Scale) were used to measure the training effect. During 3/1 to 5/31, thirteen subjects (five male and eight female) were included. Seven subjects were aged below 60. Three subjects were aged over 70. Most of the subjects (seven subjects) received intensive post-stroke rehabilitation for three weeks. Three subjects drop out from the programs and went back home respectively after receiving only 7, 10, and 13 days rehabilitation. Among these 13 subjects, nine of them got improvement in activity daily life performance (Barthel Index score). Ten of them got improvement in functional balance ability (Berg Balance Scale). The intensive post-acute stroke rehabilitation did help stroke patients promote their health in our study. Not only their functional performance improved, but also their self-confidence improved. Furthermore, their family also got better health status. Stroke rehabilitation under per diem payment was noted in long-term care institution in developed countries. Over 95% populations in Taiwan were supported under the Taiwan's National Health Insurance system, but there was no national long-term care insurance system. Most of the stroke patients in Taiwan live with his family and continue their rehabilitation programs from out-patient department. This pilot study revealed the effect of intensive post-acute stroke rehabilitation in hospital under per diem payment. The number of the subjects and the study period were limited. Thus, further study will be needed.

Keywords: rehabilitation, post-acute stroke, per diem payment, NHI

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Authors: Arti Singh, Carolyn Jenkins, Oyedunni S. Arulogun, Mayowa O. Owolabi, Fred S. Sarfo, Bruce Ovbiagele, Enzinne Sylvia

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Background: Stroke, the leading cause of adult-onset disability and the second leading cause of death, is a major public health concern particularly pertinent in Sub-Saharan Africa (SSA), where nearly 80% of all global stroke mortalities occur. The Stroke Investigative Research and Education Network (SIREN) seeks to comprehensively characterize the genomic, sociocultural, economic, and behavioral risk factors for stroke and to build effective teams for research to address and decrease the burden of stroke and other non communicable diseases in SSA. One of the first steps to address this goal was to effectively engage the communities that suffer the high burden of disease in SSA. This study describes how the SIREN project engaged six sites in Ghana and Nigeria over the past three years, describing the community engagement activities that have arisen since inception. Aim: The aim of community engagement (CE) within SIREN is to elucidate information about knowledge, attitudes, beliefs, and practices (KABP) about stroke and its risk factors from individuals of African ancestry in SSA, and to educate the community about stroke and ways to decrease disabilities and deaths from stroke using socioculturally appropriate messaging and messengers. Methods: Community Advisory Board (CABs), Focus Group Discussions (FGDs) and community outreach programs. Results: 27 FGDs with 168 participants including community heads, religious leaders, health professionals and individuals with stroke among others, were conducted, and over 60 CE outreaches have been conducted within the SIREN performance sites. Over 5,900 individuals have received education on cardiovascular risk factors and about 5,000 have been screened for cardiovascular risk factors during the outreaches. FGDs and outreach programs indicate that knowledge of stroke, as well as risk factors and follow-up evidence-based care is limited and often late. Other findings include: 1) Most recognize hypertension as a major risk factor for stroke. 2) About 50% report that stroke is hereditary and about 20% do not know organs affected by stroke. 3) More than 95% willing to participate in genetic testing research and about 85% willing to pay for testing and recommend the test to others. 4) Almost all indicated that genetic testing could help health providers better treat stroke and help scientists better understand the causes of stroke. The CABs provided stakeholder input into SIREN activities and facilitated collaborations among investigators, community members and stakeholders. Conclusion: The CE core within SIREN is a first-of-its kind public outreach engagement initiative to evaluate and address perceptions about stroke and genomics by patients, caregivers, and local leaders in SSA and has implications as a model for assessment in other high-stroke risk populations. SIREN’s CE program uses best practices to build capacity for community-engaged research, accelerate integration of research findings into practice and strengthen dynamic community-academic partnerships within our communities. CE has had several major successes over the past three years including our multi-site collaboration examining the KABP about stroke (symptoms, risk factors, burden) and genetic testing across SSA.

Keywords: community advisory board, community engagement, focus groups, outreach, SSA, stroke

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Authors: Florge Francis A. Sy

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Acute pancreatitis (AP) is an inflammatory condition of the pancreas with local and systemic complications. Severe acute pancreatitis (SAP) has a higher mortality rate. Laboratory parameters like the neutrophil-to-lymphocyte ratio (NLR), red cell distribution width (RDW), and mean platelet volume (MPV) have been associated with SAP but with conflicting results. This study aims to determine the predictive value of these parameters on the severity and in-hospital mortality of AP. This retrospective, cross-sectional study was done in a private hospital in Cebu City, Philippines. One-hundred five patients were classified according to severity based on the modified Marshall scoring. The admitting hemogram, including the NLR, RDW, and MPV, was obtained from the complete blood count (CBC). Cut-off values for severity and in-hospital mortality were derived from the ROC. Association between NLR, RDW, and MPV with SAP and mortality were determined with a p-value of < 0.05 considered significant. The mean age for AP was 47.6 years, with 50.5% being male. Most had an unknown cause (49.5%), followed by a biliary cause (37.1%). Of the 105 patients, 23 patients had SAP, and 4 died. Older age, longer in-hospital duration, congestive heart failure, elevated creatinine, urea nitrogen, and white blood cell count were seen in SAP. The NLR was associated with in-hospital mortality using a cut-off of > 10.6 (OR 1.133, 95% CI, p-value 0.003) with 100% sensitivity, 70.3% specificity, 11.76% PPV and 100% NPV (AUC 0.855). The NLR was not associated with SAP. The RDW and MPV were not associated with SAP and mortality. The admitting NLR is, therefore, an easily accessible parameter that can predict in-hospital mortality in acute pancreatitis. Although the present study did not show an association of NLR with SAP nor RDW and MPV with both SAP and mortality, further studies are suggested to establish their clinical value.

Keywords: acute pancreatitis, mean platelet volume, neutrophil-lymphocyte ratio, red cell distribution width

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Authors: Ramuel Spirituel Mattathiah A. San Juan, Neil Ambasing

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Background: Reversal of vision metamorphopsia is a transient form of metamorphopsia described as an upside-down alteration of the visual field in the coronal plane. Patients would describe objects, such as cups, upside down, but the tea would not spill, and people would walk on their heads. It is extremely rare as a stable finding, lasting days or weeks. We report a case wherein this type of metamorphopsia occurred only in written words and lasted for six months. Objective: To the best of our knowledge, we report the first rare occurrence of reversal of vision metamorphopsia described as inverted words as the sole initial presentation of an underlying stroke. Case Presentation: We report a 59-year-old male with poorly controlled hypertension and diabetes mellitus who presented with a 3-day history of difficulty reading, described as the words were turned upside down as if the words were inverted horizontally then with the progression of deficits such as right homonymous hemianopia and achromatopsia, prosopagnosia. Cranial magnetic resonance imaging (MRI) revealed an acute infarct on the left posterior cerebral artery territory. Follow-up after six months revealed improvement of the visual field cut but with the persistence of the higher cortical function deficits. Conclusion: We report the first rare occurrence of metamorphopsia described as purely inverted words as the sole initial presentation of an underlying stroke. The differential diagnoses of a patient presenting with text reversal metamorphopsia should include stroke in the occipitotemporal areas. It further expands the landscape of metamorphopsias due to its exclusivity to written words and prolonged duration. Knowing these clinical features will help identify the lesion locus and improve subsequent stroke care, especially in time-bound management like intravenous thrombolysis.

Keywords: rare presentation, text reversal metamorphopsia, ischemic stroke, stroke

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Authors: Allan F. F. Alves, Fernando A. Bacchim Neto, Guilherme Giacomini, Marcela de Oliveira, Ana L. M. Pavan, Maria E. D. Rosa, Diana R. Pina

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Stroke is a worldwide concern, only in Brazil it accounts for 10% of all registered deaths. There are 2 stroke types, ischemic (87%) and hemorrhagic (13%). Early diagnosis is essential to avoid irreversible cerebral damage. Non-enhanced computed tomography (NECT) is one of the main diagnostic techniques used due to its wide availability and rapid diagnosis. Detection depends on the size and severity of lesions and the time spent between the first symptoms and examination. The Alberta Stroke Program Early CT Score (ASPECTS) is a subjective method that increases the detection rate. The aim of this work was to implement an image segmentation system to enhance ischemic stroke and to quantify the area of ischemic and hemorrhagic stroke lesions in CT scans. We evaluated 10 patients with NECT examinations diagnosed with ischemic stroke. Analyzes were performed in two axial slices, one at the level of the thalamus and basal ganglion and one adjacent to the top edge of the ganglionic structures with window width between 80 and 100 Hounsfield Units. We used different image processing techniques such as morphological filters, discrete wavelet transform and Fuzzy C-means clustering. Subjective analyzes were performed by a neuroradiologist according to the ASPECTS scale to quantify ischemic areas in the middle cerebral artery region. These subjective analysis results were compared with objective analyzes performed by the computational algorithm. Preliminary results indicate that the morphological filters actually improve the ischemic areas for subjective evaluations. The comparison in area of the ischemic region contoured by the neuroradiologist and the defined area by computational algorithm showed no deviations greater than 12% in any of the 10 examination tests. Although there is a tendency that the areas contoured by the neuroradiologist are smaller than those obtained by the algorithm. These results show the importance of a computer aided diagnosis software to assist neuroradiology decisions, especially in critical situations as the choice of treatment for ischemic stroke.

Keywords: ischemic stroke, image processing, CT scans, Fuzzy C-means

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Authors: Asrarul Fikri Abu Hassan, Muhammad Hafiz bin Hanafi, Jafri Malin Abdullah

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This study is to compare the motor evoked potential (MEP) changes using different settings of repetitive transcranial magnetic stimulation (rTMS) in the post-haemorrhagic stroke patient which treated conservatively. The goal of the study is to determine changes in corticomotor excitability and functional outcome after repetitive transcranial magnetic stimulation (rTMS) therapy regime. 20 post-stroke patients with upper limb hemiparesis were studied due to haemorrhagic stroke. One of the three settings; (I) Inhibitory setting, or (II) facilitatory setting, or (III) control group, no excitatory or inhibitory setting have been applied randomly during the first meeting. The motor evoked potential (MEP) were recorded before and after application of the rTMS setting. Functional outcomes were evaluated using the Barthel index score. We found pre-treatment MEP values of the lesional side were lower compared to post-treatment values in both settings. In contrast, we found that the pre-treatment MEP values of the non-lesional side were higher compared to post-treatment values in both settings. Interestingly, patients with treatment, either facilitatory setting and inhibitory setting have faster motor recovery compared to the control group. Our data showed both settings might improve the MEP of the upper extremity and functional outcomes in the haemorrhagic stroke patient.

Keywords: Barthel index, corticomotor excitability, motor evoked potential, repetitive transcranial magnetic stimulation, stroke

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Authors: Narendra Kumar

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This study uses data from the ‘National Family Health Survey (NFHS-3) 2005-06’ to investigate the predictors of infant and child mortality among low economic households in East and Northeast region. The cross tabulation, life table survival estimates and Cox proportional hazard model techniques have been used to estimate the predictors of infant and child mortality. The life table survival estimates for infant and child mortality shows that infant mortality in female child is lower in comparison to male child but with child mortality, the rates are higher for female in comparison to male child and the Cox proportional hazard model also give highly significant in female in comparison to male child. The infant and child mortality rates among poor households highest in the Central region followed by North and Northeast region and the lowest in South region in comparison to all regions of India. Education of respondent has been found a significant characteristics in both analyzes, further birth interval, respondent occupation, caste/tribe and place of delivery has substantial impact on infant and child mortality among low economic households in East and Northeast region. Finally these findings specified that an increase in parents’ education, improve health care services and improve socioeconomic conditions of low economic households which should in turn raise infant and child survival and should decrease child mortality among low economic households in India.

Keywords: infant, child, mortality, socio-economic, India

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Authors: Seyed Fakhroddin Hejazi, Mohammad Saleh Sadeghi, Leili Iranirad

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Silent myocardial infarction is defined as the appearance of pathological Q waves in the electrocardiogram, without objective signs of myocardial infarction and any minimal or atypical symptoms. Although this condition has been known for a long time, but little is known about its phenomenon and the mechanisms of it remain unclear. Its coincidence with stroke is also still controversial. This case report introduces a middle-aged man with silent myocardial infarction presented with homonymous hemianopia, which except stage 1 hypertension, had no other major cardiovascular risk factors including diabetes mellitus, hypercholesterolemia, family history of cardiac diseases and smoking. In conclusion, this case report indicated that existence of only one cardiovascular risk factor would lead to the development of MI or stroke.

Keywords: silent myocardial infarction, homonymous hemianopia, stroke, hypertension

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Authors: Iva Hereitova, Miroslav Svatek, Vit Novacek

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Background and Aim: Autonomic imbalance is one of the complications for immobilized patients in the acute stage after a stroke. The predominance of sympathetic activity significantly increases cardiac activity. The technique of glenohumeral joint approximation may contribute in a non-pharmacological way to the regulation of blood pressure and heart rate in patients in this risk group. The aim of the study was to evaluate the effect of glenohumeral joint approximation on the change in heart rate and blood pressure in immobilized patients in the acute phase after a stroke. Methods: The experimental study bilaterally evaluated heart rate, systolic and diastolic pressure values before and after glenohumeral joint approximation in 40 immobilized participants (72.6 ± 10.2 years) in the acute phase after stroke. The experimental group was compared with 40 healthy participants in the control group (68.6 ± 14.2 years). An SpO2 vital signs monitor and a validated Microlife WatchBP Office blood pressure monitor were used for evaluation. Statistical processing and evaluation were performed in MATLAB R2019 (The Math Works®, Inc., Natick, MA, USA). Results: Approximation of the glenohumeral joint resulted in a statistically significant decrease in systolic and diastolic pressure. An average decrease in systolic pressure for individual groups ranged from 8.2 to 11.3 mmHg (p <0.001). For diastolic pressure, the average decrease ranged from 5.0 - 14.2 mmHg (p <0.001). There was a statistically significant reduction in heart rate (p <0.01) only in patients after ischemic stroke in the inferior cerebral artery. There was the average decrease in heart rate of 3.9 beats per minute (median 4 beats per minute). Conclusion: Approximation of the glenohumeral joint leads to a statistically significant decrease in systolic and diastolic pressure in immobilized patients in the acute phase after stroke.

Keywords: Aproximation technique, Cardiovaskular system, Glenohumeral joint, Stroke

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Authors: Syazreen N. Shair, Saiful A. Ishak, Aida Y. Yusof, Azizah Murad

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In this paper, we forecast age-specific Malaysian mortality rates and life expectancy at births by gender and ethnic groups including Malay, Chinese and Indian. Two mortality forecasting models are adopted the original Lee-Carter model and its recent modified version, the product ratio coherent model. While the first forecasts the mortality rates for each subpopulation independently, the latter accounts for the relationship between sub-populations. The evaluation of both models is performed using the out-of-sample forecast errors which are mean absolute percentage errors (MAPE) for mortality rates and mean forecast errors (MFE) for life expectancy at births. The best model is then used to perform the long-term forecasts up to the year 2030, the year when Malaysia is expected to become an aged nation. Results suggest that in terms of overall accuracy, the product ratio model performs better than the original Lee-Carter model. The association of lower mortality group (Chinese) in the subpopulation model can improve the forecasts of high mortality groups (Malay and Indian).

Keywords: coherent forecasts, life expectancy at births, Lee-Carter model, product-ratio model, mortality rates

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Authors: Srishti Bhatt, Vaibhav Bhavsar, Adil Hussain, Aashay Mhaske, S. C. Bali, T. S. Srikanth

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Shape Memory Alloys (SMA) are widely known for their unique shape recovery properties. SMA based actuation systems have high-force to weight ratio, light weight and also bio-compatible material. Which is why they are being used in different fields of aerospace, robotics, automotive and biomedical industries. However, in the automotive industry plenty of patents are available but commercially viable products are very few in market. This could be due to SMA material limitations like small stroke, direct dependability of lifecycle on stroke, pull load of the wire and high cycle time. In automotive sector, SMA being considered as an actuator which is required to have high stroke and constraint arises to accommodate a long length of wire (to compensate maximum 4 % strain as per better fatigue life cycle) not only increases complexity but also adds on the cost. More than 200 different types of actuators are used in an automobile, few of them whose efficiency can highly increase by replacing them with SMA based actuators which include latch lock mechanism, glove box, Head lamp leveling, side mirror and rear mirror leveling, tailgate opener and fuel lid cap actuator. To overcome the limitation of available space for required stroke of an actuator which leads to study the effect of different loading positions on SMA wires, different orientations of SMA wire by using pulleys and lever based systems to achieve maximum stroke. This investigation summarizes the loading under the V shape orientation the required stroke and carrying load capacity in more compact in comparison with straight orientation of wire. Similarly, the U shape orientation its showing higher load carrying capacity but reduced stroke which is aligned with concept of bundled wire method. Life-cycle of these orientations were also evaluated.

Keywords: actuators, automotive, nitinol, shape memory alloy, SMA wire orientations

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Authors: Yu-Chuan Huang

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Introduction: There is a higher mortality rate for unplanned transfer to intensive care units. It also needs a longer length of stay and makes the intensive care unit beds cannot be effectively used. It affects the immediate medical treatment of critically ill patients, resulting in a drop in the quality of medical care. Purpose: The purpose of this study was using SOFA and APACHEII score to analyze the mortality rate of the cases transferred from ED to ICU. According to the score that should be provide an appropriate care as early as possible. Methods: This study was a descriptive experimental design. The sample size was estimated at 220 to reach a power of 0.8 for detecting a medium effect size of 0.30, with a 0.05 significance level, using G-power. Considering an estimated follow-up loss, the required sample size was estimated as 242 participants. Data were calculated by medical system of SOFA and APACHEII score that cases transferred from ED to ICU in 2016. Results: There were 233 participants meet the study. The medical records showed 33 participants’ mortality. Age and sex with QSOFA , SOFA and sex with APACHEII showed p>0.05. Age with APCHHII in ED and ICU showed r=0.150, 0,268 (p < 0.001**). The score with mortality risk showed: ED QSOFA is r=0.235 (p < 0.001**), exp(B)=1.685(p = 0.007); ICU SOFA 0.78 (p < 0.001**), exp(B)=1.205(p < 0.001). APACHII in ED and ICU showed r= 0.253, 0.286 (p < 0.001**), exp(B) = 1.041,1.073(p = 0.017,0.001). For SOFA, a cutoff score of above 15 points was identified as a predictor of the 95% mortality risk. Conclusions: The SOFA and APACHE II were calculated based on initial laboratory data in the Emergency Department, and during the first 24 hours of ICU admission. In conclusion, the SOFA and APACHII score is significantly associated with mortality and strongly predicting mortality. Early predictors of morbidity and mortality, which we can according the predicting score, and provide patients with a detail assessment and proper care, thereby reducing mortality and length of stay.

Keywords: SOFA, APACHEII, mortality, ICU

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Authors: Mohamed Ahmed Fouad

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Background: Stroke is the most leading cause to functional disability and gait problems. Objectives: The purpose of this study was to determine the effect of rhythmic auditory stimulation combined with treadmill training on selected gait kinematics in stroke patients. Methods: Thirty male stroke patients participated in this study. The patients were assigned randomly into two equal groups, (study and control). Patients in the study group received treadmill training combined with rhythmic auditory stimulation in addition to selected physical therapy program for hemiparetic patients. Patients in the control group received treadmill training in addition to the same selected physical therapy program including strengthening, stretching, weight bearing, balance exercises and gait training. Biodex gait trainer 2 TM was used to assess selected gait kinematics (step length, step cycle, walking speed, time on each foot and ambulation index) before and after six weeks training period (end of treatment) for both groups. Results: There was a statistically significant increase in walking speed, step cycle, step length, percent of the time on each foot and ambulation index in both groups post-treatment. The improvement in gait parameters post-treatment was significantly higher in the study group compared to the control. Conclusion: Rhythmic auditory stimulation combined with treadmill training is effective in improving selected gait kinematics in stroke patients when added to the selected physical therapy program.

Keywords: stroke, rhythmic auditory stimulation, treadmill training, gait kinematics

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Authors: C. Gopi Jinimole, A. Harsha

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For detecting strokes, Computed Tomography (CT) scan is preferred for imaging the abnormalities or infarction in the brain. Because of the problems in the window settings used to evaluate brain CT images, they are very poor in the early stage infarction detection. This paper presents an automatic estimation method for the window settings of the CT images for proper contrast of the hyper infarction present in the brain. In the proposed work the window width is estimated automatically for each slice and the window centre is changed to a new value of 31HU, which is the average of the HU values of the grey matter and white matter in the brain. The automatic window width estimation is based on the average of median of statistical central moments. Thus with the new suggested window centre and estimated window width, the hyper infarction or post-stroke regions in CT brain images are properly detected. The proposed approach assists the radiologists in CT evaluation for early quantitative signs of delayed stroke, which leads to severe hemorrhage in the future can be prevented by providing timely medication to the patients.

Keywords: computed tomography (CT), hyper infarction or post stroke region, Hounsefield Unit (HU), window centre (WC), window width (WW)

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Authors: Pim Terachinda, Witaya Wannasuphoprasit, Wasuwat Kitisomprayoonkul, Anan Srikiatkhachorn

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Restoration of hand function and dexterity remain challenges in rehabilitation after stroke. We have developed soft exoskeleton hand robot in which using tendon-driven mechanism. Finger flexion and extension can be triggered by a foot switch and force can be adjusted manually depending on patient’s grip strength. The objective of this study is to investigate feasibility and safety of this device. The study was done in 2 stroke patients with the strength of the finger flexors/extensors grade 1/0 and 3/1 on Medical Research Council scale, respectively. Grasp and release training was performed for 30 minutes. No complication was observed. Results demonstrated that the device is safe, and therapy can be tailored to individual patient’s need. However, further study is required to determine recovery and rehabilitation outcomes after training in patients after nervous system injury.

Keywords: hand, rehabilitation, robot, stroke

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Authors: Weiju Zhou, Alex Hopkins, Ruoling Chen

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Background: China has increased the gap in income between richer and poorer over the past 40 years, and the number of deaths from people with angina has been rising. It is unclear whether socioeconomic status (SES) is associated with increased mortality in older people with angina. Methods: Data from a cohort study of 2,380 participants aged ≥ 65 years, who were randomly recruited from 5-province urban communities were examined in China. The cohort members were interviewed to record socio-demographic and risk factors and document doctor-diagnosed angina at baseline and were followed them up in 3-10 years, including monitoring vital status. Multivariate Cox regression models were employed to examine all-cause mortality in relation to low SES. Results: The cohort follow-up identified 373 deaths occurred; 41 deaths in 208 angina patients. Compared to participants without angina (n=2,172), patients with angina had increased mortality (multivariate adjusted hazard ratio (HR) was 1.41, 95% CI 1.01-1.97). Within angina patients, the risk of mortality increased with low satisfactory income (2.51, 1.08-5.85) and having financial problem (4.00, 1.07-15.00), but significantly with levels of education and occupation. In non-angina participants, none of these four SES indicators were associated with mortality. There was a significant interaction effect between angina and low satisfactory income on mortality. Conclusions: In China, having low income and financial problem increase mortality in older people with angina. Strategies to improve economic circumstances in older people could help reduce inequality in angina survival.

Keywords: angina, mortality, older people, socio-economic status

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Authors: Maria L. G. Lourenço, Keylla H. N. P. Pereira, Viviane Y. Hibaru, Fabiana F. Souza, João C. P. Ferreira, Simone B. Chiacchio, Luiz H. A. Machado

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The neonatal mortality rates in dogs are considered high, varying between 5.7 and 21.2% around the world, and the causes of the deaths are often unknown. Data regarding canine neonatal mortality are scarce in Brazil. This study aims at describing the neonatal mortality rates in dogs, as well as the main causes of death. The study included 152 litters and 669 neonates admitted to the São Paulo State University (UNESP) Veterinary Hospital, Botucatu, São Paulo, Brazil between January 2018 and September 2019. The overall mortality rate was 16.7% (112/669), with 40% (61/152) of the litters presenting at least one case of stillbirth or neonatal mortality. The rate of stillbirths was 7.7% (51/669), while the neonatal mortality rate was 9% (61/669). The early mortality rate (0 to 2 days) was 13.7% (92/669), accounting for 82.1% (92/112) of all deaths. The late mortality rate (3 to 30 days) was 2.7% (18/669), accounting for 16% (18/112) of all deaths. Infection was the causa mortis in 51.8% (58/112) of the newborns, of which 30.3% (34/112) were caused by bacterial sepsis, and 21.4% (24/112) were caused by other bacterial, viral or parasite infections. Other causes of death included congenital malformations (15.2%, 17/112), of which 5.3% (6/112) happened through euthanasia due to malformations incompatible with life; asphyxia/hypoxia by dystocia (9.8%, 11/112); wasting syndrome in debilitated newborns (6.2%, 7/112); aspiration pneumonia (3.6%, 4/112); agalactia (2.7%, 3/112); trauma (1.8%, 2/112); administration of contraceptives to the mother (1.8%, 2/112) and unknown causes (7.1%, 8/112). The neonatal mortality rate was considered high, but they may be even higher in locations without adequate care for the mothers and neonates. Therefore, prenatal examinations and early neonatal care are of utmost importance for the survival of these patients.

Keywords: neonate dogs, puppies, mortality rate, neonatal death

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Authors: Anderson Ngowa Chembe, John Olukuru

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Greenhouse emissions by human activities are known to irreversibly increase global temperatures through the greenhouse effect. This study seeks to propose a mortality model with sensitivity to heat-change effects as one of the underlying parameters in the model. As such, the study sought to establish the relationship between greenhouse emissions and mortality indices in five OECD countries (USA, UK, Japan, Canada & Germany). Upon the establishment of the relationship using correlation analysis, an additional parameter that accounts for the sensitivity of heat-changes to mortality rates was incorporated in the Lee-Carter model. Based on the proposed model, new parameter estimates were calculated using iterative algorithms for optimization. Finally, the goodness of fit for the original Lee-Carter model and the proposed model were compared using deviance comparison. The proposed model provides a better fit to mortality rates especially in USA, UK and Germany where the mortality indices have a strong positive correlation with the level of greenhouse emissions. The results of this study are of particular importance to actuaries, demographers and climate-risk experts who seek to use better mortality-modeling techniques in the wake of heat effects caused by increased greenhouse emissions.

Keywords: climate risk, greenhouse emissions, Lee-Carter model, OECD

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Authors: A. F. Jaber, E. Dean, M. Liu, J. He, D. Sabata, J. Radel

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Background: Stroke is a serious health care concern and a major cause of disability in the United States. This condition impacts the individual’s functional ability to perform daily activities. Predicting functional performance of people with stroke assists health care professionals in optimizing the delivery of health services to the affected individuals. The purpose of this study was to identify significant predictors of Motor FIM and of Cognitive FIM subscores among individuals with stroke after discharge from inpatient rehabilitation (typically 4-6 weeks after stroke onset). A second purpose is to explore the relation among personal characteristics, health status, and functional performance of daily activities within 2 weeks of stroke onset. Methods: This study used a retrospective chart review to conduct a secondary analysis of data obtained from the Healthcare Enterprise Repository for Ontological Narration (HERON) database. The HERON database integrates de-identified clinical data from seven different regional sources including hospital electronic medical record systems of the University of Kansas Health System. The initial HERON data extract encompassed 1192 records and the final sample consisted of 207 participants who were mostly white (74%) males (55%) with a diagnosis of ischemic stroke (77%). The outcome measures collected from HERON included performance scores on the National Institute of Health Stroke Scale (NIHSS), the Glasgow Coma Scale (GCS), and the Functional Independence Measure (FIM). The data analysis plan included descriptive statistics, Pearson correlation analysis, and Stepwise regression analysis. Results: significant predictors of discharge Motor FIM subscores included age, baseline Motor FIM subscores, discharge NIHSS scores, and comorbid electrolyte disorder (R2 = 0.57, p <0.026). Significant predictors of discharge Cognitive FIM subscores were age, baseline cognitive FIM subscores, client cooperative behavior, comorbid obesity, and the total number of comorbidities (R2 = 0.67, p <0.020). Functional performance on admission was significantly associated with age (p < 0.01), stroke severity (p < 0.01), and length of hospital stay (p < 0.05). Conclusions: our findings show that younger age, good motor and cognitive abilities on admission, mild stroke severity, fewer comorbidities, and positive client attitude all predict favorable functional outcomes after inpatient stroke rehabilitation. This study provides health care professionals with evidence to evaluate predictors of favorable functional outcomes early at stroke rehabilitation, to tailor individualized interventions based on their client’s anticipated prognosis, and to educate clients about the benefits of making lifestyle changes to improve their anticipated rate of functional recovery.

Keywords: functional performance, predictors, stroke, recovery

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Authors: N. Hiranmai, M. L. S. Deva Kumar

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In this project, it is planned to carry out an experimental investigation on 4- stroke Direct Injection Diesel Engine, which is a single-cylinder, four-stroke, water-cooled, and constant speed engine capable of developing a power output of 3.7 kW at 1500 rpm, run with diesel fuel and also with different proportions of Safflower oil methyl esters, with a piston having five number of grooves on its crown to create turbulence. Various performance parameters, such as brake power, specific fuel consumption, and thermal efficiency, are calculated. At all the load conditions, the performance of the engine is obtained better for blend B40 (40% Safflower oil + 60% of Diesel). At different load conditions, Brake thermal Efficiency (ηbth) is comparatively more for all blends than that for Diesel. At different load conditions, ηith is less for blend B40.

Keywords: four-stroke engine, diesel, safflower oil, engine performance, emissions.

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Authors: Yin-Yee Leong, Jack C. Yue, Hsin-Chung Wang

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Human longevity has been experiencing its largest increase since the end of World War II, and modeling the mortality rates is therefore often the focus of many studies. Among all mortality models, the Lee–Carter model is the most popular approach since it is fairly easy to use and has good accuracy in predicting mortality rates (e.g., for Japan and the USA). However, empirical studies from several countries have shown that the age parameters of the Lee–Carter model are not constant in time. Many modifications of the Lee–Carter model have been proposed to deal with this problem, including adding an extra cohort effect and adding another period effect. In this study, we propose a spatial modification and use clusters to explain why the age parameters of the Lee–Carter model are not constant. In spatial analysis, clusters are areas with unusually high or low mortality rates than their neighbors, where the “location” of mortality rates is measured by age and time, that is, a 2-dimensional coordinate. We use a popular cluster detection method—Spatial scan statistics, a local statistical test based on the likelihood ratio test to evaluate where there are locations with mortality rates that cannot be described well by the Lee–Carter model. We first use computer simulation to demonstrate that the cluster effect is a possible source causing the problem of the age parameters not being constant. Next, we show that adding the cluster effect can solve the non-constant problem. We also apply the proposed approach to mortality data from Japan, France, the USA, and Taiwan. The empirical results show that our approach has better-fitting results and smaller mean absolute percentage errors than the Lee–Carter model.

Keywords: mortality improvement, Lee–Carter model, spatial statistics, cluster detection

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Authors: Ahmed Ali Hassan

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In 2016, the Fall Armyworm (FAW) was first discovered in Africa. FAW is abundantly present in Somalia and seriously harms the maize crop. This investigation examined the impact on maize productivity of three different pesticides used to combat the autumn armyworm, Spodoptera frugiperda (Noctuidae: Lepidoptera). During the 2020–2021 growing season, three insecticides (Malathion 57 EC, Ampligo150 ZC, and Carbryle 85 WP) were evaluated at field demonstration plots. Our result showed that, significant mortality of S. frugiperda was observed on the treatment plot treated with Amplico. Ampligo caused over 90% larval mortality after application. Malathion had moderate activity, causing 53.733% mortality after application, while Carbaryl was less effective, causing 36.367% mortality after application. Consequently, the current finding shows that the three selected insecticides reduced the damage and infestation level of S. frugiperda in the maize field conditions and the most effective treatment were Amplico.

Keywords: pesticides, maize fall army worm, insecticides, mortality, S. frugiperda

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Authors: Himali Gunasekara, Baddika Jayaratne

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Haematological abnormalities are known to cause Ischemic Stroke or Transient Ischemic Attack (TIA). The identification of haematological correlates plays an important role in a management and secondary prevention. The objective of this study was to describe haematological correlates of stroke and their association between stroke profile. The haematological correlates screened were Lupus Anticoagulant, Dysfibroginemia, Paroxysmal nocturnal haemoglobinurea (PNH), Sickle cell disease, Systemic Lupus Erythematosis (SLE) and Myeloploriferative Neoplasms (MPN). A cross sectional descriptive study was conducted in a sample of 152 stroke patients referred to haematology department of National Hospital of Sri Lanka for thrombophilia screening. Different tests were performed to assess each hematological correlate. Diluted Russels Viper Venom Test and Kaolin clotting time were done to assess Lupus anticoagulant. Full blood count (FBC), blood picture, Sickling test and High Performance Liquid Chromatography were the tests used for detection of Sickle cell disease. Paroxysmal nocturnal haemoglobinurea was assessed by FBC, blood picture, Ham test and Flowcytometry. FBC, blood picture, Janus Kinase 2 (V617F) mutation analysis, erythropoietin level and bone marrow examination were done to look for the Myeloproliferative neoplasms. Dysfibrinogenaemia was assessed by TT, fibrinogen antigen test, clot observation and clauss test. Anti nuclear antibody test was done to look for systemic lupus erythematosis. Among study sample, 134 patients had strokes and only 18 had TIA. The recurrence of stroke/TIA was observed in 13.2% of patients. The majority of patients (94.7%) have had radiological evidence of thrombotic event. One fourth of patients had past thrombotic events while 12.5% had family history of thrombosis. Out of haematological correlates screened, Lupus anticoagulant was the commonest haematological correlate (n=16 ) and dysfibrigonaemia(n=11 ) had the next high prevalence. One patient was diagnosed with Essential thrombocythaemia and one with SLE. None of the patients were positive for screening tests done for sickle cell disease and PNH. The Haematological correlates were identified in 19% of our study sample. Among stroke profile only presence of past thrombotic history was statistically significantly associated with haematological disorders (P= 0.04). Therefore, hematological disorders appear to be an important factor in etiological work-up of stroke patients particularly in patients with past thrombotic events.

Keywords: stroke, transient ischemic attack, hematological correlates, hematological disorders

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Authors: Basma Hassabo, Sarah Ahmed, Aisha Hameed

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Aims and Objectives: To determine the incidence of maternal mortality amongst pregnant women with sickle cell disease (SCD) in the United Kingdom and to determine exact cause of death in these women. Background: SCD is caused by the ‘sickle’ gene and is characterized by episodes of severe bone pain and other complications like acute chest syndrome, chronic pulmonary hypertension, stroke, retinopathy, chronic renal failure, hepato-splenic crises, avascular bone necrosis, sepsis and leg ulcers. SCD is a continual cause of maternal mortality and fetal complications, and it comprises 1.5% of all Direct and Indirect deaths in the UK. Sepsis following premature rupture of membranes with ascending infection, post-partum infection and pre-labour overwhelming septic shock is one of its leading causes of death. Over the last fifty years of maternal mortality reports in UK, between 1 to 4 pregnant women died in each triennium. Material and Method: This is a retrospective study that involves pregnant women who died from SCD complications in the UK between 1952-2012. Data were collected from the UK Confidential Enquiries into Maternal Death and its causes between 1952–2012. Prior to 1985, exact cause of death in this cohort was not recorded. Results: 33 deaths reported between 1964 and 1984. 17 deaths were reported due to sickle cell disease between 1985 and 2012. Five women in this group died of sickle cell crisis, one woman had liver sequestration crisis, two women died of venous thromboembolism, two had myocardial fibrosis and three died of sepsis. Remaining women died of amniotic fluid embolism, SUDEP, myocardial ischemia and intracranial haemorrhage. Conclusion: The leading causes of death in sickle cell sick pregnant women are sickle cell crises, sepsis, venous thrombosis and thromboembolism. Prenatal care for women with SCD should be managed by a multidisciplinary team that includes an obstetrician, nutritionist, primary care physician, and haematologist. In every sick Sickle Cell woman Sickle Cell crises should be on the top of the list of differential diagnosis. Aggressive treatment of complications with low threshold to commence broad-spectrum antibiotics and LMWH contribute to better outcomes.

Keywords: incidence, maternal mortality, sickle cell disease (SCD), uk

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Authors: Vineel Inampudi, Arjun Prakash, Joseph Vinod

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Aims and Objectives: To evaluate the interrater reliability in grading ASPECTS score, between emergency medicine physician at first contact and radiologist among patients with acute ischemic stroke. Materials and Methods: We conducted a retrospective analysis of 86 acute ischemic stroke cases referred to the Department of Radiodiagnosis during November 2014 to January 2016. The imaging (plain CT scan) was performed using GE Bright Speed Elite 16 Slice CT Scanner. ASPECTS score was calculated separately by an emergency medicine physician and radiologist. Interrater reliability for total and dichotomized ASPECTS (≥ 6 and < 6) scores were assessed using statistical analysis (ICC and Cohen ĸ coefficients) on SPSS software (v17.0). Results: Interrater agreement for total and dichotomized ASPECTS was substantial (ICC 0.79 and Cohen ĸ 0.68) between the emergency physician and radiologist. Mean difference in ASPECTS between the two readers was only 0.15 with standard deviation of 1.58. No proportionality bias was detected. Bland Altman plot was constructed to demonstrate the distribution of ASPECT differences between the two readers. Conclusion: Substantial interrater agreement was noted in grading ASPECTS between emergency medicine physician at first contact and radiologist thereby confirming its robustness even in a rural setting.

Keywords: ASPECTS, computed tomography, MCA territory, stroke

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Authors: Christen Kutz

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Objective: The aim of this study is to review a case series of 4 high-level Olympic and Division 1 wrestlers who experienced debilitating posterior circulation ischemic strokes during or after a competitive wrestling event and to identify risk factors, etiology and outcomes of stroke in young, healthy elite wrestlers. Background: Stroke occurs in one in 10,000 people under age 64. In young adults, the most common causes of stroke are cardiac embolism, hypercoagulable state, and vasculopathy. One-third of these strokes occur in young, fit individuals. There is little published literature about ischemic strokes that occur in wrestlers. Based on the nature of wrestling, the risk of injury or dissection to neurovascular structures may be a possible theory, but very few case reports exist. Methodology: 4 wrestlers under the age of 44 with a known history of ischemic stroke participated in individual interviews either in person or virtually. Each of the wrestlers provided their demographic information, wrestling background, clinical presentation at the time of stroke, imaging results, identification of potential risk factors, acute treatment and recovery. Results: 3 white male Division 1 wrestlers (2 Lehigh University, 1 Lock Haven University) and 1 black male 2008 Olympian experienced posterior circulation strokes. Case #1 felt a “pop” while wrestling (lateral medullary infarct, possible vertebral artery dissection); Case #2 awoke with severe vertigo, sweating, and vomiting after wrestling the previous day (left cerebellar infarct, (+) protein S deficiency); Case #3 severe vertigo, ataxia, and sensation of impending doom after wrestling earlier that week (left cerebellar infarct, hypoplastic left vertebral artery (+) anti-cardiolipin antibodies). Case #4 severe dizziness, confusion (left cerebellar stroke, vertebral artery dissection, small PFO). Conclusion: 3 wrestlers were started on anti-platelet therapy, risk factors were modified, and returned to their sport. 1 wrestler was placed on anti-coagulation and retired from competition.

Keywords: stroke, wrestling, Olympic, posterior circulation

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Authors: K. K. A. Bakhti, D. Mottet, J. Froger, I. Laffont

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Background: After a cerebrovascular accident (or stroke), many patients use excessive trunk movements to move their paretic hand towards a target (while the elbow is maintained flexed) even though they can use the upper-limb when the trunk is restrained. This phenomenon is labelled learned non-use and is known to be detrimental to neuroplasticity and recovery. Objective: The aim of this study is to quantify learned non-use of the paretic upper limb during a hand reaching task using 3D movement analysis. Methods: Thirty-four participants post supratentorial stroke were asked to reach a cone placed in front of them at 80% of their arm length. The reaching movement was repeated 5 times with the paretic hand, and then 5 times with the less-impaired hand. This sequence was first performed with the trunk free, then with the trunk restrained. Learned non-use of the upper-limb (LNUUL) was obtained from the difference of the amount of trunk compensation between the free trunk condition and the restrained trunk condition. Results: LNUUL was significantly higher for the paretic hand, with individual values ranging from 1% to 43%, and one-half of the patients with an LNUUL higher than 15%. Conclusions: Quantification of LNUUL can be used to objectively diagnose patients who need trunk rehabilitation. It can be also used for monitoring the rehabilitation progress. Quantification of LNUUL may guide upper-limb rehabilitation towards more optimal motor recovery avoiding maladaptive trunk compensation and its consequences on neuroplasticity.

Keywords: learned non-use, rehabilitation, stroke, upper limb

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Authors: Kamel Abdelaziz Mohamed

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Intoduction:Inadequate knowledge about obstetric admission and infrequent dealing with the obstetric patients in ICU results in high mortality and morbidity. Aim of the work:To evaluate the indications, course, severity of illness, and outcome of obstetric patients admitted to the intensive care unit (ICU). Patients and Methods: We collected baseline data and acute physiology and chronic health evaluation II (APACHE II) scores. ICU mortality was the primary outcome. Results: Seventy obstetric patients were admitted to the ICU over 3 years, 36 of these patients (51.4 %) were admitted during the antepartum period. The primary obstetric indication for ICU admission was pregnancy-induced hypertension (22 patients, 31.4%), followed by sepsis (8 patients, 11.4%) as the leading non-obstetric admission. The mean APACHE II score was 19.6. The predicted mortality rate based on the APACHE II score was 22%, however, only 4 maternal deaths (5.7%) were among the obstetric patients admitted to the ICU. Conclusion: Evaluation of obstetric patients by (APACHE II) scores showed higher predicted mortality rate, however the overall mortality was lower. Regular follow up, together with early detection of complications and prompt ICU admission necessitating proper management by specialized team can improve mortality.

Keywords: obstetric, complication, postpartum, sepsis

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Authors: Zunnu Raen Akhtar

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Brevicoryne brassicae, aphid feeds on cabbage and Brassica sp. as preferred host. Brassica plants usually ripen when maize starts growing in multiple cropping systems. Experiment was conducted to observe suitability of B. brassicae by rearing it on maize as host. In a tritrophic eco-system, predator coccinellids can be found in the fields of brassica and maize. This experiment emphasized on issue of aphids growing incidence in a cropping system. Brassica is sown and harvested earlier than maize and is attacked by aphids, while maize is also attacked by aphids. Five mortality tests were conducted of B. brassicae fed on maize. Out of five mortality tests, 3 tests were conducted using 1st instar, while in two mortality tests, 2nd instars of aphids were used. Mortality tests revealed that first instar mortality was quite high on the second day, while in second instar larvae mortality was delayed up to third to the fourth day. These experiments reveal that aphids can use maize as substitute host at later instars as compared to young ones. These experiments can be foundation for studying further crop-insect interaction and sampling techniques used for this purpose.

Keywords: host suitability, B. brassicae, maize, tritrophic interaction

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Authors: Kasra Afsahi, Maryam Soheilifar, S. Hossein Hosseini, Omid Seyed Esmaeili, Rouzbeh Kezemi, Noushin Mehrbod, Nazanin Vahed, Tahereh Hajiahmad, Noureddin Nakhostin Ansari

Abstract:

Background: Stroke is a disabling neurological disease. Rehabilitative therapies are important treatment methods. This clinical trial was done to compare the effects of VR beside conventional rehabilitation versus conventional rehabilitation alone on spasticity and motor function in stroke patients. Materials and Methods: In this open-label randomized controlled clinical trial, 40 consecutive patients with stable first-ever ischemic stroke in the past three to 12 months that were referred to a rehabilitation clinic in Tehran, Iran, in 2020 were enrolled. After signing the informed written consent form, subjects were randomly assigned by block randomization of five in each block as cases with 1:1 into two groups of 20 cases; conventional plus VR therapy group: 45-minute conventional therapy session plus 15-minute VR therapy, and conventional group: 60-minute conventional therapy session. VR rehabilitation is designed and developed with different stages. Outcomes were modified Ashworth scale, recovery stage score for motor function, range of motion (ROM) of shoulder abduction/wrist extension, and patients’ satisfaction rate. Data were compared after study termination. Results: The satisfaction rate among the patients was significantly better in the combination group (P=0.003). Only wrist extension was varied between groups and was better in the combination group. The variables generally had a statistically significant difference (P < 0.05). Conclusion: Virtual reality plus conventional rehabilitation therapy is superior versus conventional rehabilitation alone on the wrist and elbow spasticity and motor function in patients with stroke.

Keywords: stroke, virtual therapy, rehabilitation, treatment

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