Acute seizures in acute ischemic stroke: does thrombolysis have a role to play?

Seizures appear at stroke presentation, during the acute phase or as a late complication of stroke. Thrombolysis has not been investigated as a risk factor despite its potential neurotoxic effect. We try to identify risk factors for seizures during the acute phase of ischemic stroke in a cohort including thrombolysed patients. We undertook a case-control study at a single stroke center using data from Acute Stroke Registry and Analyse of Lausanne (ASTRAL). Patients with seizure occurring during the first 7 days following stroke were retrospectively identified. Bi-variable and multivariable statistical analyses were applied to compare cases and randomly selected controls. We identified 28 patients experiencing from seizures in 2,327 acute ischemic strokes (1.2 %). All seizures occurred during the first 72 h. Cortical involvement, thrombolysis with rt-PA, arterial recanalization, and higher initial NIHSS were statistically associated with seizures in univariated analysis. Backward linear regression identified cortical involvement (OR 7.53, 95 % CI 1.6-35.2, p < 0.01) and thrombolysis (OR 4.6, 95 % CI 1.6-13.4, p = 0.01) as being independently associated with seizure occurrence. Overall, 3-month outcome measured by the modified Rankin scale (mRS) was comparable in both groups. In the subgroup of thrombolysed patients, outcome was significantly worse at 3 months in the seizure group with 9/12 (75 %) patients with mRS ≥3, compared to 6/18 (33.3 %) in the seizure-free group (p = 0.03). Acute seizures in acute ischemic stroke were relatively infrequent. Cortical involvement and thrombolysis with rt-PA are the principal risk factors. Seizures have a potential negative influence on clinical outcome in thrombolysed patients

Modeling Simulated Emissions from Galactic Binary Stars

Relativistic plasma flows from the jets of black hole binary systems consist the environment of multiple particle production and radiation emission including neutrinos and gamma-rays. We implement a hadronic model based on $p-p$ interactions with the purpose of predicting the produced secondary particle distributions inside the jet. Our ultimate goal is the neutrino and gamma-ray intensities calculation while taking into account the most important gamma-ray absorption processes in order to present more realistic results.Comment: 6 pages, 6 figure

Aseptic meningoencephalitis mimicking transient ischaemic attacks

Purpose: To highlight meningoencephalitis as a transient ischaemic attack (TIA) mimic and suggest clinical clues for differential diagnosis. Methods: This was an observational study of consecutively admitted patients over a 9.75-year period presenting as TIAs at a stroke unit. Results: A total of 790 patients with TIAs and seven with TIA-like symptoms but a final diagnosis of viral meningoencephalitis were recognised. The most frequent presentations of meningoencephalitis patients were acute sensory hemisyndrome (6) and cognitive deficits (5). Signs of meningeal irritation were minor or absent on presentation. Predominantly lymphocytic pleocytosis, hyperproteinorachia and a normal cerebrospinal fluid (CSF)/serum glucose index (in 5 out of 6 documented patients) were present. Meningeal thickening on a brain magnetic resonance imaging (MRI) scan was the only abnormal imaging finding. Six patients received initial vascular treatment; one thrombolysed. Finally, six patients were treated with antivirals and/or antibiotics. Although neither bacterial nor viral agents were identified on extensive testing, viral meningoencephalitis was the best explanation for all clinical and laboratory findings. Conclusions: Aseptic meningoencephalitis should be part of the differential diagnosis in patients presenting as TIA. The threshold for a lumbar puncture in such patients should be set individually and take into account the presence of mild meningeal symptoms, age and other risk factors for vascular disease, the results of brain imaging and the basic diagnostic work-up for a stroke sourc

Knowledge Base Evolution Analysis: A Case Study in the Tourism Domain

Stakeholders -- curator, consumer, etc. -- in the tourism domain routinely need to combine and compare statistical indicators about tourism. In this context, various Knowledge Bases (KBs) have been designed and developed in the Linked Open Data (LOD) cloud in order to support decision-making process in Tourism domain. Such KBs evolve over time: their data (instances) and schemes can be updated, extended, revised and refactored. However, unlike in more controlled types of knowledge bases, the evolution of KBs exposed in the LOD cloud is usually unrestrained, what may cause data to suffer from a variety of issues. This paper attempts to address the impact of KB evolution in tourism domain by showing how entity evolves over time using the 3cixty KB. We show that using multiple versions of the KB through time can help to understand inconsistency in the data collection process

Small-vessel occlusion versus large-artery atherosclerotic strokes in diabetics: Patient characteristics, outcomes, and predictors of stroke mechanism

Peer reviewe

Concentration of apricot juice using complex membrane technology

In this study, pressed apricot (Prunus armeniaca L.) juice was concentrated using complex membrane technology with different module combinations: UF-RO-OD, UF-RO-MD, UF-NF-OD and UF-NF-MD. In case of the best combination a cross-flow polyethylene ultrafiltration membrane (UF) was applied for clarification, after which preconcentration was done using reverse osmosis (RO) with a polyamide membrane, and the final concentration was completed by osmotic distillation (OD) using a polypropylene module. The UF-RO-OD procedure resulted in a final concentrate with a 65-70 °Brix dry solid content and an excellent quality juice with high polyphenol content and high antioxidant capacity.Nanofiltration (NF) and membrane distillation (MD) were not proper economic solutions.The influence of certain operation parameters was examined experimentally. Temperatures of UF and RO were: 25, 30, and 35 °C, and of OD 25 °C. Recycle flow rates were: UF: 1, 1.5, and 2 m3 h−1; RO: 200, 400, and 600 l h−1; OD: 20, 30 and 40 l h−1. The flow rates in the module were expressed by the Reynolds number, as well. Based on preliminary experiments, the transmembrane pressures of UF and RO filtration were 4 bar and 50 bar, respectively. Each experimental run was performed three times. The following optimal operation parameters provided the lowest total cost: UF: 35 °C, 2 m3 h−1, 4 bar; RO: 35 °C, 600 l h−1, 50 bar; OD: 20, 30 and 40 l h−1; temperature 25 °C.In addition, experiments were performed for apricot juice concentration by evaporation, which technique is widely applied in the industry using vacuum and low temperature.For description the UF filtration, a dynamic model and regression by SPSS 14.0 statistics software were applied

Tear fluid biomarkers in ocular and systemic disease: potential use for predictive, preventive and personalised medicine

In the field of predictive, preventive and personalised medicine, researchers are keen to identify novel and reliable ways to predict and diagnose disease, as well as to monitor patient response to therapeutic agents. In the last decade alone, the sensitivity of profiling technologies has undergone huge improvements in detection sensitivity, thus allowing quantification of minute samples, for example body fluids that were previously difficult to assay. As a consequence, there has been a huge increase in tear fluid investigation, predominantly in the field of ocular surface disease. As tears are a more accessible and less complex body fluid (than serum or plasma) and sampling is much less invasive, research is starting to focus on how disease processes affect the proteomic, lipidomic and metabolomic composition of the tear film. By determining compositional changes to tear profiles, crucial pathways in disease progression may be identified, allowing for more predictive and personalised therapy of the individual. This article will provide an overview of the various putative tear fluid biomarkers that have been identified to date, ranging from ocular surface disease and retinopathies to cancer and multiple sclerosis. Putative tear fluid biomarkers of ocular disorders, as well as the more recent field of systemic disease biomarkers, will be shown

MDR/XDR-TB management of patients and contacts: Challenges facing the new decade. The 2020 clinical update by the Global Tuberculosis Network.

The continuous flow of new research articles on MDR-TB diagnosis, treatment, prevention and rehabilitation requires frequent update of existing guidelines. This review is aimed at providing clinicians and public health staff with an updated and easy-to-consult document arising from consensus of Global Tuberculosis Network (GTN) experts. The core published documents and guidelines have been reviewed, including the recently published MDR-TB WHO rapid advice and ATS/CDC/ERS/IDSA guidelines. After a rapid review of epidemiology and risk factors, the clinical priorities on MDR-TB diagnosis (including whole genome sequencing and drug-susceptibility testing interpretations) and treatment (treatment design and management, TB in children) are discussed. Furthermore, the review comprehensively describes the latest information on contact tracing and LTBI management in MDR-TB contacts, while providing guidance on post-treatment functional evaluation and rehabilitation of TB sequelae, infection control and other public health priorities

Predicted risk of harm versus treatment benefit in large randomised controlled trials

Most drugs come with unwanted, and perhaps harmful, side-effects. Depending on the size of the treatment benefit such harms may be tolerable. In acute stroke, treatment with aspirin and treatment with alteplase have both proven to be effective in reducing the odds of death or dependency in follow-up. However, in both cases, treated patients are subject to a greater risk of haemorrhage – a serious side-effect which could result in early death or greater dependency. Current treatment licenses are restricted so as to avoid treating those with certain traits or risk factors associated with bleeding. It is plausible however that a weighted combination of all these factors would achieve better discrimination than an informal assessment of each individual risk factor. This has the potential to help target treatment to those most likely to benefit and avoid treating those at greater risk from harm. This thesis will therefore: (i) explore how predictions of harm and benefit are currently made; (ii) seek to make improvements by adopting more rigorous methodological approaches in model development; and (iii) investigate how the predicted risk of harm and treatment benefit could be used to strike an optimal balance. Statistical prediction is not an exact science. Before clinical utility can be established it is essential that the performance of any prediction method be assessed at the point of application. A prediction method must attain certain desirable properties to be of any use, namely: good discrimination – which quantifies how well the prediction method can separate events from non-events; and good calibration – which measures how close the obtained predicted risks match the observed. A comparison of informal predictions made by clinicians and formal predictions made by clinical prediction models is presented using a prospective observational study of stroke patients seen at a single centre hospital in Edinburgh. These results suggest that both prediction methods achieve similar discrimination. A stratified framework based on predicted risks obtained from clinical prediction models is considered using data from large randomised trials. First, with three of the largest aspirin trials it is shown that there is no evidence to suggest that the benefit of aspirin on reducing six month death or dependency varies with the predicted risk of benefit or with the predicted risk of harm. Second, using data from the third International Stroke Trial (IST3) a similar question is posed of the effect of alteplase and the predicted risk of symptomatic intracranial haemorrhage. It was found that this relationship corresponded strongly with the relationship associated with stratifying patients according to their predicted risk of death or dependency in the absence of treatment: those at the highest predicted risk from either event stand to experience the largest absolute benefit from alteplase with no indication of harm amongst those at lower predicted risk. It is concluded that prediction models for harmful side-effects based on simple clinical variables measured at baseline in randomised trials appear to offer little use in targeting treatments. Better separation between harmful events like bleeding and overall poor outcomes is required. This may be possible through the identification of novel (bio)markers unique to haemorrhage post treatment