Impact of HIV on inpatient mortality and complications in stroke in Thailand: a National Database Study.

The co-existence of stroke and HIV has increased in recent years, but the impact of HIV on post-stroke outcomes is poorly understood. We examined the impact of HIV on inpatient mortality, length of acute hospital stay and complications (pneumonia, respiratory failure, sepsis and convulsions), in hospitalized strokes in Thailand. All hospitalized strokes between 1 October 2004 and 31 January 2013 were included. Data were obtained from a National Insurance Database. Characteristics and outcomes for non-HIV and HIV patients were compared and multivariate logistic and linear regression models were constructed to assess the above outcomes. Of 610 688 patients (mean age 63·4 years, 45·4% female), 0·14% (866) had HIV infection. HIV patients were younger, a higher proportion were male and had higher prevalence of anaemia (P < 0·001) compared to non-HIV patients. Traditional cardiovascular risk factors, hypertension and diabetes, were more common in the non-HIV group (P < 0·001). After adjusting for age, sex, stroke type and co-morbidities, HIV infection was significantly associated with higher odds of sepsis [odds ratio (OR) 1·75, 95% confidence interval (CI) 1·29-2·4], and inpatient mortality (OR 2·15, 95% CI 1·8-2·56) compared to patients without HIV infection. The latter did not attenuate after controlling for complications (OR 2·20, 95% CI 1·83-2·64). HIV infection is associated with increased odds of sepsis and inpatient mortality after acute stroke

Impact of intravenous thrombolysis on length of hospital stay in cases of acute ischemic stroke

Narongrit Kasemsap,1,2 Nisa Vorasoot,1,2 Kannikar Kongbunkiat,1,2 Udomlack Peansukwech,1 Somsak Tiamkao,1,2 Kittisak Sawanyawisuth1,3,4 1Department of Medicine, Faculty of Medicine, 2North-Eastern Stroke Research Group, 3Research Center in Back, Neck, Other Joint Pain and Human Performance (BNOJPH), 4Internal Medicine Research Group, Khon Kaen University, Khon Kaen, Thailand Background: There are limited data available on factors associated with length of stay (LOS) in cases of acute ischemic stroke according to Poisson analysis, which is more appropriate than other methods.Materials and methods: We retrospectively reviewed medical summary charts of patients with acute ischemic stroke in 30 hospitals across northeast Thailand, with the main outcome as LOS. Poisson regression was used to examine factors associated with LOS.Results: We included 898 patients in the analysis; 460 (51.2%) were male. The median age (interquartile; IQR) was 58 (67&ndash;75) years and the median LOS was 5 (4&ndash;7) days. The median National Institute of Health Stroke Scale (NIHSS [IQR]) was 8 (4&ndash;13). Results of the analysis showed that, after controlling for age, stroke severity, atrial fibrillation, and thrombolytic use, significant variables associated with LOS were moderate stroke (incidence rate ratio [IRR] 95% confidence interval [CI]&nbsp;=1.15 [range 1.01&ndash;1.30], P=0.040), severe stroke (IRR [95% CI]&nbsp;=1.27 [1.09&ndash;1.47], P=0.002), thrombolytic use (IRR [95% CI]&nbsp;=0.68 [0.60&ndash;0.76], P&lt;0.001), and atrial fibrillation (IRR [95% CI]&nbsp;=1.15 [1.02&ndash;1.30], P=0.023). After adjusting for complications, thrombolytic use remained significantly associated with decreased LOS (IRR [95% CI]&nbsp;=0.74 [0.67&ndash;0.83], P=0.001). Other significant factors were atrial fibrillation (IRR [95% CI]&nbsp;=1.14 [1.02&ndash;1.28], P=0.018), pneumonia (IRR [95% CI]&nbsp;=1.48 [1.30&ndash;1.68], P&lt;0.001), and urinary tract infection (IRR [95% CI]&nbsp;=1.41 [1.14&ndash;1.74], P=0.001).Conclusion: According to Poisson analysis, intravenous thrombolysis, atrial fibrillation, pneumonia, and urinary tract infection are associated with LOS in cases of acute ischemic stroke, regardless of age, stroke severity, comorbidities, or complications. Keywords: acute ischemic stroke, length of stay, thrombolysi

Efficacy and motor complications of original and generic levodopa in Parkinson&#39;s disease treatment

Narongrit Kasemsap,1 Satrirat Onsanit,2 Piyawan Chiewthanakul,3 Kannikar Kongbunkiat,1 Chonthicha Tanking,1 Nisa Vorasoot,1 Kittisak Sawanyawisuth,1,4 Somsak Tiamkao1,5 1Department of Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen, 2Department of Medicine, Udonthani Hospital, Udonthani, 3Department of Medicine, Khon&nbsp;Kaen Hospital, 4Research Center in Back, Neck, Other Joint Pain and Human Performance (BNOJPH), 5Neuroscience Research and Development Group (NRDG), Khon Kaen University, Khon Kaen, Thailand Background: In general, a generic drug is considered interchangeable with the original formulated drug. In Parkinson&rsquo;s disease (PD), generic drug use remains debated. This study was aimed to investigate whether the generic drug was as effective as the original in improving the symptoms of PD and the prevalence of motor complications.Methods: This study was a multicenter cohort study of patients with PD enrolled from three northeast hospitals in Thailand between February 2013 and February 2014. The patients were categorized into original and generic levodopa groups. The clinical characteristics, efficacy, and motor complications were compared between the groups.Results: There were 400 eligible patients. Of these, 327 patients (81.75%) met the study criteria and were classified as the original levodopa group (200 patients, 61.16%) and the generic levodopa group (127 patients, 38.84%). The average age of all patients with PD was 65 years. The duration of PD and the modified Hoehn&ndash;Yahr stages were not different between the groups. The total doses of original and generic levodopa-equivalent doses were significantly different (199.97&plusmn;127.08 versus 305.58&plusmn;138.27 mg; P-value &lt;0.001) and the actual doses were 198.10&plusmn;117.92 versus 308.85&plusmn;139.40 mg (P-value &lt;0.001). Approximately 80% of patients with PD in both groups had good responses (P-value &gt;0.999), but the development of motor complications was significantly greater in the original than in the generic group.Conclusion: Generic levodopa was effective in improving the symptoms of PD. The prevalence of motor complications in the original compound group, at a lower dose of levodopa equivalent, was higher than in the generic group. Keywords: Parkinson&rsquo;s disease, original, generic, levodopa, efficacy, motor complicatio

330 Gender Differences in Mortality After Stroke in Thai Patients. a National Cohort Study

Aim Gender differences in patients hospitalised with stroke is a major public health concern carrying important implications to service provision. There has not yet been a study specifically focussing on patients in Thailand. We aimed to assess the gender differences in mortality following ischaemic-stroke (IS) and haemorrhagic-stroke (HS) in a large Thai-cohort. Method All stroke admissions of patients between 2004–2015 were included from a Thai national-insurance database. The association between gender and mortality by stroke-type was assessed at one, 12 and 60-months using multivariable Cox-regression models. Results There were 543,763 patients included women made up 46.6% of patients with IS (n=172,800) and 41.3% of patients with HS (n=69,828). Women were older than men in both IS and HS groups (mean age:67.1, SD(13.4) vs. 64.1(12.9) and 64.2(14.3) vs. 59.1(13.9)), respectively. Women had higher prevalence of comorbidities and stroke-specific risk factors compared to men. When comparing mortality by stroke-type, mortality was higher in women post-IS at one-month (HR:1.17, 95%CI:1.15–1.20), one-year (HR:1.10, 95%CI:1.09–1.12) and five-years follow-up (HR:1.02, 95%CI:1.01–1.03). Similarly, mortality post-HS was also higher in women at all three follow-up timepoints (one-month HR:1.08, 95%CI:1.06–1.10, one-year HR:1.04, 95%CI:1.03–1.06, and five-years HR:1.09, 95% CI:1.08–1.11). Conclusions In Thai patients hospitalised with stroke, women have a greater burden of stroke-specific risk factors. The mortality outcome of women with stroke is consistently higher than that of men, which appears to be irrespective of stroke-type or duration following stroke, up to five-years after discharge. Whether this difference is attributable to differences in management or physiology warrants further evaluation

Leukoaraiosis, intracerebral hemorrhage, and functional outcome after acute stroke thrombolysis

To perform a systematic review and pooled meta-analysis of published studies to assess whether the presence of leukoaraiosis on neuroimaging before treatment with thrombolysis (IV or intra-arterial) is associated with an increased risk of symptomatic intracerebral hemorrhage (sICH) or poor functional outcome.We included studies of patients with acute ischemic stroke, treated with IV or intra-arterial thrombolysis, which assessed functional outcome (3-month modified Rankin Scale [mRS]) or sICH in relation to leukoaraiosis on pretreatment neuroimaging (CT or MRI). We used random-effects models to calculate pooled relative risks (RR) of sICH and poor functional outcome (mRS ≥ 2) for any vs no leukoaraiosis (using any rating scale) and for no to mild vs moderate to severe leukoaraiosis (using the Van Swieten or Fazekas Schmidt scale).We identified 15 studies (total n = 6,967). For sICH outcome, the RR was 1.65 (n = 5,551; 95% confidence interval [CI] 1.26-2.16, p = 0.001) with an absolute risk (AR) increase of 2.5% for any leukoaraiosis vs none. The RR was 2.4 (n = 4,192; 95% CI 1.83-3.14, p = 0.001) with an AR increase of 6.2% for moderate to severe vs no to mild leukoaraiosis. For poor functional outcome; the RR was 1.30 (n = 3,401; 95% CI 1.19-1.42, p = 0.001) with an AR increase of 15.4% for any leukoaraiosis vs none. The RR was 1.31 (n = 3,659; 95% CI 1.22-1.42, p = 0.001) with an AR increase of 17.5% for moderate to severe vs no to mild leukoaraiosis. No statistical heterogeneity was noted for any of the analyses.Leukoaraiosis presence and severity are consistently associated with an increased risk of sICH and poor functional outcome after IV or intra-arterial thrombolysis for acute ischemic stroke