Assessing the predictive value of neutrophil percentage to albumin ratio for ICU admission in ischemic stroke patients

BackgroundAcute ischemic stroke (AIS) remains a substantial global health challenge, contributing to increased morbidity, disability, and mortality. This study aimed at investigating the predictive value of the neutrophil percentage to albumin ratio (NPAR) in determining intensive care unit (ICU) admission among AIS patients.MethodsA retrospective observational study was conducted, involving AIS cases admitted to a tertiary hospital in Jordan between 2015 and 2020. Lab data were collected upon admission, and the primary outcome was ICU admission during hospitalization. Descriptive and inferential analyses were performed using SPSS version 29.ResultsIn this study involving 364 AIS patients, a subset of 77 (21.2%) required admission to the ICU during their hospital stay, most frequently within the first week of admission. Univariable analysis revealed significantly higher NPAR levels in ICU-admitted ischemic stroke patients compared to those who were not admitted (23.3 vs. 15.7, p < 0.001), and multivariable regression models confirmed that higher NPAR (≥19.107) independently predicted ICU admission in ischemic stroke patients (adjusted odds ratio [aOR] = 4.85, 95% CI: 1.83–12.83). Additionally, lower GCS scores and higher neutrophil-to-lymphocyte ratio (NLR) were also associated with increased likelihood of ICU admission. In terms of predictive performance, NPAR showed the highest accuracy with an AUC of 0.885, sensitivity of 0.805, and specificity of 0.854, using a cutoff value of 19.107. NPAR exhibits an AUC of 0.058, significantly outperforming NLR (Z = 2.782, p = 0.005).ConclusionNPAR emerged as a robust independent predictor of ICU admission in ischemic stroke patients, surpassing the predictive performance of the NLR

SCN1A polymorphisms influence the antiepileptic drugs responsiveness in Jordanian epileptic patients

Background: The aim of this study was to evaluate whether the voltage-gated sodium channel alpha subunit 1 (SCN1A) gene polymorphisms influence the responsiveness of Jordanian epileptic patients to antiepileptic drugs (AEDs). Methods: A total of 72 AEDs-treated epileptics were polymerase chain reaction (PCR)-genotyped for six single nucleotide polymorphisms (SNPs), including SCN1A rs2298771, rs3812718, rs3812719, rs2217199, rs2195144 and rs1972445. Genotype and allele distributions in drug-responsive and drug-resistant patients were compared. The six SNPs haplotypes were examined, and the linkage disequilibrium (LD) was assessed. Results: The genotypes of drug-resistant and drug-responsive groups were in Hardy-Weinberg equilibrium. Three genetic polymorphisms of the SCN1A gene seemed to influence the resistance to AEDs, on the level of alleles and genotypes. Data revealed that rs2298771 G allele, rs3812719 C allele, and rs2195144 T allele increased the risk of developing AEDs-resistance (OR=2.9; 95%CI= 1.4-5.9, p=0.003; OR=2.4; 95%CI=1.2-4.7, p=0.01; OR=2.3; 95%CI=1.2-4.7, p=0.01), respectively. Haplo type analysis of SCN1A polymorphisms revealed high-degree LD associated with resistance to AEDs. A synergetic effect appears with highly significant association in GCCATG haplotype of rs2298771, rs3812718, rs3812719, rs2217199, rs2195144, and rs1972445 respectively (OR=2.8; 95%CI=1.5-6.2, p=0.002). Conclusions: Data suggests that SCN1A polymorphisms could influence the resistance to AEDs in Jordanian epileptics at three SNPs (rs2298771; rs3812719; rs2195144). Additionally, haplotype analysis indicated a substantial degree of LD between the six SCN1A polymorphisms. Further investigation with larger sample size is needed to confirm the results of the current study

Awareness of the risk factors for heart attack among the general public in Pahang, Malaysia: a cross-sectional study

Background: Cardiovascular disease is a leading nationwide cause of morbidity and mortality. Public awareness of risk factors for heart attacks is thought to impact the burden of disease, prevention, and timely management. The objective of this study was to assess the awareness of risk factors for heart attack and to identify the factors associated with the awareness of all modifiable risk factors for heart attack in the general population. Methods: This is a cross-sectional study conducted among 393 adult individuals in Kuantan, Pahang, Malaysia. Data collection was conducted through face-to-face interviews among the lay public members who were 18– 64 years old, excluding healthcare professionals in clinical settings and academic settings. Statistical analysis was performed using chi-square test and logistic regression analysis. Results: The majority of the individuals identified smoking as a risk factor for heart attack, followed by atrial fibrillation (57.7%), heart disease (54.1%), and obesity (53.8%). However, diabetes (26%) was the risk factor that was least recognized by the participants. A total of 90.6% of participants identified at least one risk factor for heart attack, while 9.8% of the participants did not identify any risk factors for heart attack, whereas 5.6% identified all modifiable heart attack risk factors. Furthermore, participants aged 46– 64 years old, married respondents, and Chinese participants, those with higher educational levels, and received prior information demonstrated great awareness of eight modifiable risk factors for heart attack. Multivariable logistic regression presented that participants with aged 55– 64, those with family history of heart attack and individuals with dyslipidemia were factors independently related to excellent awareness (p=0.04, OR=6.21, 95% CL= 1.081– 35.641), (p=0.049, OR=2.11, 95% CL=0.721– 6.230) and (p=0.009, OR= 4.08, 95% CL= 1.427– 11.685), respectively. Conclusion: Awareness of risk factors for heart attack appears to be poor, where most of the respondents recognized only one modifiable risk factor. According to these findings, programs and strategies to raise awareness of modifiable risk factors for HA are urgently needed to protect the lay public from HA

Diagnosis and treatment of stroke associated pneumonia: qualitative exploration of clinicians' practice

Background: Establishing and implementing a gold standard criteria for diagnosing and treating stroke-associated pneumonia (SAP) would have a significant positive impact on stroke outcomes and antibiotic stewardship. This study aimed to qualitatively explore current diagnostic and treatment practice for SAP among clinicians. Methods: A qualitative study was employed to conduct semi-structured interviews at the tertiary-care Jordan University Hospital. A purposive sampling technique was employed to recruit the participants, including respiratory consultants (n=3) and residents (n=9) practicing in the internal medicine wards and intensive care unit, where stroke patients are treated. The interviews were audio-recorded, transcribed verbatim, translated, and analyzed thematically using framework analysis. Results: Clinicians expressed their experiences, which were organized into two themes and eight emerged sub-themes: Terminology and diagnostic approach of SAP involved; no definite terminology, reliance on both clinical evidence and X-ray findings to decide, reliance on clinical evidence alone to suspect SAP and initiate empirical therapy, and SAP overdiagnosis. The treatment strategies include early treatment of SAP, treating SAP the same as CAP/HAP, predominant anaerobes coverage, and SAP overtreatment. Conclusion: Our findings show a wide range of physician-based diagnostic and treatment approaches for SAP, with clinical criteria serving as the main driver for antibiotic initiation. Standard validated algorithmic-based criteria need to be established and implemented

Diagnosis And Management Of Stroke-Associated Pneumonia: A Mixed-Methods Study

Stroke-associated pneumonia (SAP) is a complication that commonly occurs within the first week of an acute stroke and is associated with prolonged hospitalization and increased mortality. Diagnosing and treating SAP is challenging due to the lack of gold-standard criteria. Researchers have investigated both antibiotics and non-antibiotic preventive medications for SAP. However, antibiotics have been found to be ineffective in preventing SAP, and the effectiveness of non-antibiotic drugs is still controversial. Additionally, predictive biomarkers have also been studied, but their performance has been inconsistent

The prevalence and clinical seriousness of medication discrepancies identified upon hospital admission of pediatric patients

Abstract Background Medication discrepancies are seen frequently in hospital setting upon admission or discharge. Medication Reconciliation service is a practice designed to ensure that patients’ medications are ordered in a correct manner upon hospital admission, thus reducing the risk of having medication discrepancies. This study aimed to determine the prevalence of medication discrepancies and their clinical seriousness in pediatric patients at the time of hospital admission. Methods A prevalence cross-sectional study was conducted at the pediatric departement at the Jordan University hospital between March–May 2018. During the study period, 100 pediatric patients were enrolled using a convenience sampling method. Patients’ medical records were reviewed by two clinical pharmacist-reserachers to obtain patients' demographic, medical, and admission medication information. All parents were interviewed to obtain information regarding their children’s Best Possible Medication History (BPMH). Following data collection, differences between patient’s current admission medications and the BPMH were identified as medication discrepancies, and then they were classified into either undocumented intentional or unintentional discrepancies. Results Among the 100 medication records reviewed, 13.0% (13 out of 100) contained at least one unintentional discrepancy, with the majority (n = 11, 84.6%) being classified to be associated with mild potential harm to patients. Of those discrepancies, 8 were omission of medications (61.5%) and 5 were addition of unnecessary medication (38.5%). On the other hand, 35.0% (35 out of 100) of medication records contained at least one intentional undocumented discrepancy. Conclusions This study revealed that unintentional medication discrepancies exist at the time of hospital admission for pediatric patients but with low proportion. The low proportion of medication discrepancies might be explained by the recent implementation of medication reconciliation service at the studied hospital. Also, intentional undocumented discrepancies were common, which may carry a potential harm to such vulnerable population at discharge. These data may inform the need for a strict policies to regulate medication documentation, thus decreasing the possibilities of medication errors

Assessment of awareness and action towards signs and symptoms of stroke among lay public in Kuantan, Malaysia: A cross-sectional study

Background: Stroke remains one of the leading causes of mortality and disability in both developing and developed countries. Lack of awareness towards signs and symptoms of stroke leads to delayed presentation to the hospital, contributing towards increased morbidity and mortality. This study aimed to assess the awareness of and action towards signs and symptoms of a stroke. Methods: A cross-sectional study interview-based survey was performed among 393 lay public (age range: 18-64 years old) in states of Pahang, Kuantan city, Malaysia from June to September 2019. Chi-square tests were used to assess the knowledge of differences between participants with good education and income and those with low education and incomes. as well as logistic regression to obtain the factors effecting to the knowledge of stroke symptoms. Results: Majority of respondents (n=309,78,6%) identified sudden face, arms and leg numbness, whereas (n=165,42%) of them identified problems in vision as stroke symptoms. However, (n=39,10.4%) were unaware of any symptoms, while (n=117,30%) identified appropriate action. Furthermore, (n=349, 88.8%) recognized at least one stroke symptom,(n=108, 27.5%) of them identified all five stroke symptoms, and (n=37,9.4%) of individuals had excellent awareness (aware of all five stroke symptoms and appropriate action “calling an ambulance”). Multivariable logistic regression shows that individuals aged 18-45 years (OR=0.054, 95% Cl=0.006-0.500, p=0.010), self-employed (OR=12.430, 95% Cl=1.372-31.908, p=0.028), those who were diagnosed with hypertension (OR=0.129, 95% Cl=0.025-0.673, p=0.015) and students (OR=35.945. 95% Cl=1.745-740.615, p=0.020) were more likely to recognize all the five-stroke symptoms and appropriate action. Conclusion: The awareness and action towards signs and symptoms of a stroke are poor among the lay public in Kuantan, Malaysia. Therefore, the findings of this study would be a baseline for program interventions that focus on public awareness and policy development on stroke management

Healthcare workers' knowledge, preparedness, counselling practices, and perceived barriers to confront COVID-19: A cross-sectional study from a war-torn country, Yemen.

BackgroundThe coronavirus disease of 2019 (COVID-19) represents a difficult challenge and could have devastating consequences for the healthcare system and healthcare workers in war-torn countries with poor healthcare facilities such as Yemen. Our study aimed to evaluate the knowledge, preparedness, counselling practices of healthcare workers regarding COVID-19, and the perceived barriers to adequately prevent and control COVID-19 in Yemen.MethodsHealthcare workers (HCWs) from major healthcare facilities participated in this cross-sectional study. A self-administered questionnaire comprising of five main domains (demographics, knowledge, self-preparedness, counselling practice, perceived barriers) was distributed among HCWs after obtaining informed consent. A convenient sampling technique was used. Descriptive and inferential analyses were applied using SPSS software.ResultsA total of 1000 participants were initially targeted to participate in the study with 514 (51.4%) responding, of which 55.3% were female. Physicians and nurses constituted the largest proportion of participants, with 39.5% and 33.3%, respectively. The median scores for knowledge, self-preparedness, and counselling practice were 8 (out of 9), 9 (out of 15), and 25 (out of 30), respectively. The physician group showed a statistically significant association with better knowledge compared to the nurse group only, PConclusionThe major highlight of this study is that HCWs have, overall, good knowledge, suboptimal preparedness, and adequate counselling practices prior to the outbreak of COVID-19 in Yemen, despite the high number of perceived barriers. However, urgent action and interventions are needed to improve the preparedness of HCWs to manage COVID-19. The perceived barriers also need to be fully addressed by the local healthcare authorities and international organisations working in Yemen for adequate prevention and control measures to be in place in managing COVID-19

Neutrophil-lymphocyte ratio, monocyte-lymphocyte ratio, and platelet-lymphocyte ratio in stroke-associated pneumonia: a systematic review and meta-analysis

Predicting stroke-associated pneumonia (SAP) is crucial for intensifying preventive measures and decreasing morbidity and mortality. This meta-analysis aims to evaluate the association between baseline neutrophil-lymphocyte ratio (NLR), monocyte-lymphocyte ratio (MLR), and platelet-lymphocyte ratio (PLR) with SAP and to determine the strength of the association. The Web of Science, SCOPUS, and PUBMED databases were searched to find eligible studies. The standardised mean difference (SMD) and 95% confidence interval (CI) were used to evaluate the differences in NLR, MLR, and PLR levels between SAP and non-SAP patients. The meta-analysis was conducted using the software "Review Manager" (RevMan, version 5.4.1, September 2020). The random-effect model was used for the pooling analysis if there was substantial heterogeneity. Otherwise, the fixed-effect model was adopted. Twelve studies comprising 6302 stroke patients were included. The pooled analyses revealed that patients with SAP had significantly higher levels of NLR, MLR, and PLR than the non-SAP group. The SMD, 95% CI, p-value, and I2 for them were respectively reported as (0.88, 0.70-1.07, 0.00001, 77%); (0.94, 0.43-1.46, 0.0003, 93%); and (0.61, 0.47-0.75, 0.001, 0%). Subgroup analysis of NLR studies showed no significant differences in the effect size index between the severity of the stroke, the sample size, and the period between the stroke onset and the blood sampling. This systematic review and meta-analysis suggest that an elevated NLR, MLR, and PLR were associated with SAP, indicating that they could be promising blood-based biomarkers for predicting SAP. Large-scale prospective studies from various ethnicities are recommended to validate this association before they can be applied in clinical practice.</p