Predictors for cerebral edema in acute ischemic stroke treated with intravenous thrombolysis

Cerebral edema (CED) is a severe complication of acute ischemic stroke. There is uncertainty regarding the predictors for the development of CED after cerebral infarction. We aimed to determine which baseline clinical and radiological parameters predict development of CED in patients treated with intravenous thrombolysis. We used an image-based classification of CED with 3 degrees of severity (less severe CED 1 and most severe CED 3) on postintravenous thrombolysis imaging scans. We extracted data from 42 187 patients recorded in the SITS International Register (Safe Implementation of Treatments in Stroke) during 2002 to 2011. We did univariate comparisons of baseline data between patients with or without CED. We used backward logistic regression to select a set of predictors for each CED severity. CED was detected in 9579/42 187 patients (22.7%: 12.5% CED 1, 4.9% CED 2, 5.3% CED 3). In patients with CED versus no CED, the baseline National Institutes of Health Stroke Scale score was higher (17 versus 10; P<0.001), signs of acute infarct was more common (27.9% versus 19.2%; P<0.001), hyperdense artery sign was more common (37.6% versus 14.6%; P<0.001), and blood glucose was higher (6.8 versus 6.4 mmol/L; P<0.001). Baseline National Institutes of Health Stroke Scale, hyperdense artery sign, blood glucose, impaired consciousness, and signs of acute infarct on imaging were independent predictors for all edema types. The most important baseline predictors for early CED are National Institutes of Health Stroke Scale, hyperdense artery sign, higher blood glucose, decreased level of consciousness, and signs of infarct at baseline. The findings can be used to improve selection and monitoring of patients for drug or surgical treatment

SARS-CoV-2 infection predicts larger infarct volume in patients with acute ischemic stroke

Background and purpose: Acute ischemic stroke (AIS) is a fearful complication of Coronavirus Disease-2019 (COVID-19). Aims of this study were to compare clinical/radiological characteristics, endothelial and coagulation dysfunction between acute ischemic stroke (AIS) patients with and without COVID-19 and to investigate if and how the SARS-CoV-2 spike protein (SP) was implicated in triggering platelet activation. Methods: We enrolled AIS patients with COVID-19 within 12 h from onset and compared them with an age- and sex-matched cohort of AIS controls without COVID-19. Neuroimaging studies were performed within 24 h. Blood samples were collected in a subset of 10 patients. Results: Of 39 AIS patients, 22 had COVID-19 and 17 did not. Admission levels of Factor VIII and von Willebrand factor antigen were significantly higher in COVID-19 patients and positively correlated with the infarct volume. In multivariate linear regression analyses, COVID-19 was an independent predictor of infarct volume (B 20.318, Beta 0.576, 95%CI 6.077-34.559; p = 0.011). SP was found in serum of 2 of the 10 examined COVID-19 patients. Platelets from healthy donors showed a similar degree of procoagulant activation induced by COVID-19 and non-COVID-19 patients' sera. The anti-SP and anti-FcγRIIA blocking antibodies had no effect in modulating platelet activity in both groups. Conclusions: SARS-CoV-2 infection seems to play a major role in endothelium activation and infarct volume extension during AIS

A machine-learning based bio-psycho-social model for the prediction of non-obstructive and obstructive coronary artery disease

Background: Mechanisms of myocardial ischemia in obstructive and non-obstructive coronary artery disease (CAD), and the interplay between clinical, functional, biological and psycho-social features, are still far to be fully elucidated. Objectives: To develop a machine-learning (ML) model for the supervised prediction of obstructive versus non-obstructive CAD. Methods: From the EVA study, we analysed adults hospitalized for IHD undergoing conventional coronary angiography (CCA). Non-obstructive CAD was defined by a stenosis < 50% in one or more vessels. Baseline clinical and psycho-socio-cultural characteristics were used for computing a Rockwood and Mitnitski frailty index, and a gender score according to GENESIS-PRAXY methodology. Serum concentration of inflammatory cytokines was measured with a multiplex flow cytometry assay. Through an XGBoost classifier combined with an explainable artificial intelligence tool (SHAP), we identified the most influential features in discriminating obstructive versus non-obstructive CAD. Results: Among the overall EVA cohort (n = 509), 311 individuals (mean age 67 ± 11 years, 38% females; 67% obstructive CAD) with complete data were analysed. The ML-based model (83% accuracy and 87% precision) showed that while obstructive CAD was associated with higher frailty index, older age and a cytokine signature characterized by IL-1β, IL-12p70 and IL-33, non-obstructive CAD was associated with a higher gender score (i.e., social characteristics traditionally ascribed to women) and with a cytokine signature characterized by IL-18, IL-8, IL-23. Conclusions: Integrating clinical, biological, and psycho-social features, we have optimized a sex- and gender-unbiased model that discriminates obstructive and non-obstructive CAD. Further mechanistic studies will shed light on the biological plausibility of these associations. Clinical trial registration: NCT02737982

The Sex-Specific Detrimental Effect of Diabetes and Gender-Related Factors on Pre-admission Medication Adherence Among Patients Hospitalized for Ischemic Heart Disease: Insights From EVA Study

Background: Sex and gender-related factors have been under-investigated as relevant determinants of health outcomes across non-communicable chronic diseases. Poor medication adherence results in adverse clinical outcomes and sex differences have been reported among patients at high cardiovascular risk, such as diabetics. The effect of diabetes and gender-related factors on medication adherence among women and men at high risk for ischemic heart disease (IHD) has not yet been fully investigated.Aim: To explore the role of sex, gender-related factors, and diabetes in pre-admission medication adherence among patients hospitalized for IHD.Materials and Methods: Data were obtained from the Endocrine Vascular disease Approach (EVA) (ClinicalTrials.gov Identifier: NCT02737982), a prospective cohort of patients admitted for IHD. We selected patients with baseline information regarding the presence of diabetes, cardiovascular risk factors, and gender-related variables (i.e., gender identity, gender role, gender relations, institutionalized gender). Our primary outcome was the proportion of pre-admission medication adherence defined through a self-reported questionnaire. We performed a sex-stratified analysis of clinical and gender-related factors associated with pre-admission medication adherence.Results: Two-hundred eighty patients admitted for IHD (35% women, mean age 70), were included. Around one-fourth of the patients were low-adherent to therapy before hospitalization, regardless of sex. Low-adherent patients were more likely diabetic (40%) and employed (40%). Sex-stratified analysis showed that low-adherent men were more likely to be employed (58 vs. 33%) and not primary earners (73 vs. 54%), with more masculine traits of personality, as compared with medium-high adherent men. Interestingly, women reporting medication low-adherence were similar for clinical and gender-related factors to those with medium-high adherence, except for diabetes (42 vs. 20%, p = 0.004). In a multivariate adjusted model only employed status was associated with poor medication adherence (OR 0.55, 95%CI 0.31–0.97). However, in the sex-stratified analysis, diabetes was independently associated with medication adherence only in women (OR 0.36; 95%CI 0.13–0.96), whereas a higher masculine BSRI was the only factor associated with medication adherence in men (OR 0.59, 95%CI 0.35–0.99).Conclusion: Pre-admission medication adherence is common in patients hospitalized for IHD, regardless of sex. However, patient-related factors such as diabetes, employment, and personality traits are associated with adherence in a sex-specific manner

La chenille processionnaire du pin, Thaumetopoea pityocampa (biologie, envenimations, lutte phytosanitaire)

Les chenilles processionnaires du pin frappent par l'étrangeté de leur comportement social : elles confectionnent des nids sur les pins et se déplacent collectivement en longues processions. Les chenilles sont redoutées pour les dégâts qu'elles occasionnent aux pins en dévorant les aiguilles. Elles sont pathogènes pour l'homme et les animaux par la présence de poils contenant une substance active : la thaumétopoéine. Elles sont responsables de réactions d'urtication et allergiques. Des interventions spécifiques sont mises en œuvre pour lutter contre ces nuisances notamment à l'aide d'insecticides à base de Bacillus thuringiensis. En France, un réseau de surveillance a été mis en place pour contrôler les dégâts forestiers et le niveau des populations de ce ravageur.TOULOUSE3-BU Santé-Centrale (315552105) / SudocTOULOUSE3-BU Santé-Allées (315552109) / SudocSudocFranceF

A RARE CASE OF CAROTID WEB IN YOUNG MAN WITH ISCHEMIC STROKE

Background and Aims: CarotidWeb (CW) is a rare cause of Ischemic Stroke (IS) in young people. It is a nonatheroscherotic alteration of carotid artery (CA), identified radiographically as a shelf-like intraluminal filling defect on the posterolateral wall of proximal internal carotid artery (ICA). CW etiology is unknown. Methods: We report a case of a young man with left CW and IS on ipsilateral Middle Cerebral Artery (MCA) territory. Results: A 49-years-old man was admitted to the emergency department (ED) 45 minutes after sudden onset of right hemiparesis and aphasia (NIHSS 9). He had no previous pathology and did not use medical treatment. CT perfusion showed hypoperfusion on the left temporoparietal lobe and a steno-occlusion of distal M1 segment of left MCA. According to Guidelines we started intravenous thrombolysis (IV) 90 minutes after symptoms onset, followed by catheter-based cerebral thrombectomy 20 minutes later with improvement of neurological status (NIHSS=4). Cerebral Angiography showed a shelf-like intraluminal filling defect along the posterior wall of left proximal ICA with classical stasis of intravenous contrast distal to the CW. We decided to perform endovascular stenting of CW 5 days later, followed by dual antiplatelet therapy. Workup for hypercoagulability and vasculitis was normal. Renal Doppler Ultrasound was negative. MRI showed small left parietal ischemic lesion. Patient was discharged a week after stroke onset (NIHSS=0)

AN UNCOMMON CASE OF SIMULTANEOUS ACUTE ISCHEMIC STROKE AND ST- SEGMENT ELEVATION MYOCARDIAL INFARCTION

Background and Aims: Simultaneous acute ischemic stroke (AIS) and acute myocardial infarction is a very rare condition (1–2%), and it is the single strongest predictor of in-hospital mortality. Methods: We report a case of a patient with simultaneous AIS and STsegment elevation myocardial infarction (STEMI). Results: A 60-year-old man was admitted to the Emergency Department 52 minutes after sudden onset of right hemiplegia and aphasia. He was a tobacco smoker, had no previous pathology and did not use medical treatment. At admission, examination showed motor aphasia and right hemiplegia (NIHSS¼15). High-sensitivity troponin T level was significantly elevated, associated to ST-segment elevation in V1-V3 leads. Transthoracic echocardiography showed severe myocardial hypokinesis (EF 30%). AngioCT showed occlusion of proximal M1 segment of left Middle Cerebral Artery (MCA). After multidisciplinary evaluation, we decided not to perform intravenous thrombolysis, due to high risk of pericardial effusion in case of percutaneous transluminal coronary angioplasty (PTCA). The patient underwent cerebral thrombectomy 90 minutes after symptoms onset. Immediately after that, a coronary angiography showed stenosis of Anterior Descending Coronary Artery (ADCA) and of Circumflex Artery (CA), treated with PTCA and stenting, 128 minutes after arrival. Clinical follow-up was excellent (3-month NIHSS and mRS=0)