Quality indicators and patients' characteristics in relation to early outcome of Kasr-al-ainy stroke unit

Abstract Background A wide variety of factors have been reported to influence stroke prognosis. Quality indicators serve as standards of care. The aim of this study is to assess the clinical and demographic characteristics of patients with stroke and to measure quality indicators in relation to stroke early outcome. We analyzed a prospective hospital-based data. All patients with acute stroke admitted to Kasr-al-ainy stroke unit over a 1-year period were included. Clinical variables and quality indicators were studied in relation to early outcome which was measured by both disability at discharge assessed by modified Rankin score (mRS) and in-hospital death. Results We studied 242 patients with acute stroke, 145 patients (59.9%) had poor outcome at discharge [mRS 3–6]. There were 36 (14.9%) in-hospital deaths. High mRS and National institute of health stroke scale (NIHSS) at stroke onset, low Gugging swallowing scale (GUSS) score and hypertension (HTN) were independent predictors for more disability on discharge. Chest infection, bed sores, high mRS at stroke onset and hemorrhagic transformation were independent predictors for in-hospital mortality. Receiving recombinant tissue plasminogen activator (rtPA) showed significant association with good outcome. Mean door to needle time (DNT) was 50.6 min. Low GUSS score was associated with increased risk of chest infection. Conclusions Stroke severity, potentially modifiable risk factors and complications are associated with an increased risk of poor early outcome. Dysphagia screening using GUSS scale can predict patients with higher risk of aspiration pneumonia after stroke. DNT needs to be improved

CYTOMEGALOVIRUS REACTIVATION IN ADULT RECIPIENTS OF AUTOLOGOUS STEM CELL TRANSPLANTATION: A SINGLE CENTER EXPERIENCE

Introduction: Cytomegalovirus (CMV) reactivation and infection is a well-recognized complication after allogeneic stem cell transplantation (SCT). Yet only few studies have addressed CMV reactivation after autologous SCT (ASCT). Methods: We retrospectively reviewed medical records of 210 adult patients who underwent ASCT for lymphoma or multiple myeloma (MM) at a single center from January 1, 2007 until December 31, 2012. All patients were monitored weekly with CMV antigenemia test till day 42 after transplantation, and for 2 months after last positive test in those who had any positive CMV antigenemia test before day 42. Results: thirty seven (17.6%) patients had CMV reactivation; 23 patients had lymphoma while 14 had MM as the underlying disease. There was no difference in the rate of CMV reactivation between lymphoma and MM patients (20% versus 14.7%, P = 0.32). The majority of the patients were treated with ganciclovir/valganciclovir, all patients had their reactivation resolved with therapy, and none developed symptomatic CMV infection. None of the patients who died within 100 days of transplantation had CMV reactivation. Log rank test showed that CMV reactivation had no effect on the overall survival or the disease-free survival of patients (P values, 0.29 and 0.79, respectively). Conclusion: In our cohort, CMV reactivation rate after ASCT was 17.6%. There was no difference in reactivation rates between lymphoma and MM patients. With the use of preemptive therapy, symptomatic CMV infection was not documented in any patient in our cohort. CMV reactivation had no impact on patients’ survival post ASCT

Sonographic assessment of optic nerve and ophthalmic vessels in patients with idiopathic intracranial hypertension

<p><b>Background</b>: Early diagnosis and proper monitoring of intracranial pressure (ICP) in idiopathic intracranial hypertension (IIH) could reduce morbidity.</p> <p><b>Objectives</b>: The objective was to explore and monitor reflection of raised ICP in IIH on optic nerve sheath diameter (ONSD), papillary height and ophthalmic vessels hemodynamics, using transorbital sonography (TOS).</p> <p><b>Methods</b>: The study included 24 IIH patients and 30 controls. Patients were compared to controls (phase I) then reassessed twice; 1 week and 4 weeks later (phase II). Both groups underwent clinical evaluation and TOS to measure ONSD, papillary elevation, and color Doppler indices of the ophthalmic vessels. Patients underwent lumbar puncture (LP) to measure cerebrospinal fluid (CSF) pressure.</p> <p><b>Results</b>: ONSD was significantly higher in patients compared to controls (<i>p</i> < 0.001). The cut-off value was 6.2 mm. Papillary elevation (<i>p</i> = 0.006) and ONSD (<i>p</i> = 0.006) were significantly reduced 4 weeks following LP. Baseline color Doppler indices of the ophthalmic vessels were comparable between both groups and the changes observed during the follow-up visits in the patients were insignificant.</p> <p><b>Conclusion</b>: Reflected ICP changes on ONSD and papilla, measured by TOS, could be a valuable noninvasive additional tool to diagnose and monitor IIH patients. IIH insignificantly influences ophthalmic vessels hemodynamics.</p> <p><b>Abbreviation</b> BMI: Body mass index. CSF: Cerebrospinal fluid. EDV: End diastolic velocity. ICP: Intracranial pressure. IH:intracranial hypertension. IIH: Idiopathic intracranial hypertension. LP: Lumbar puncture. MI: Mechanical index. MRI: Magnetic resonance imaging. MRV: Magnetic resonance venography. OA: Ophthalmic artery OND: Optic nerve diameter. ONSD: Optic nerve sheath diameter. OV: Ophthalmic vein. PIs: Pulsatility indices. PSV: Peak systolic velocity. ROC: Receiver operator characteristic. TOS: Trans-orbital sonography.</p