Predictive scale to determine inefficacy of systemic thrombolytic therapy in ischemic stroke

High mortality and pronounced functional deficit in patients with cardiovascular diseases, particularly, in ischemic stroke, reflect the need of prognosing the results of systemic thrombolytic therapy, which remains the most effective and safe treatment strategy in these patients. As a result of analyzing 143 cases of thrombolythic therapy in four primary stroke care departments in Sverdlovsk region in 2013-2018 we determined, that the most significant factors for prognosing inefficacy of systemic thrombolysis were systolic arterial pressure, blood glucose level on admission,time to treatment from stroke onset and stroke occurrence in the morning hours. The scale based on these four parameters of early hospitalization can be used to prognose the results of systemic thrombolysis in some cases and to make the decision to perform reperfusion therapy in controversial cases.С учетом высокой смертности и инвалидизации от болезней системы кровообращения, в частности, ишемического инсульта, представляет интерес прогнозирование результатов наиболее эффективного и безопасного метода лечения ишемического инсульта — системной тромболитической терапии. Анализ 143 случаев выполнения системного тромболизиса при ишемическом инсульте в четырех первичных сосудистых отделениях Свердловской области за 2013-2018 гг. Позволил выявить, что наибольшее значение для прогнозирования неэффективности системного тромболизиса имели систолическое артериальное давление при поступлении, начало инсульта в утренние часы, уровень гликемии при поступлении и время до начала тромболизиса. Разработанная на основе перечисленных четырех показателей раннего госпитального этапа шкала может применяться для прогнозирования неэффективности системного тромболизиса в спорных случаях, требующих принятия взвешенного решения о проведении реперфузионной процедуры

Stroke telemedicine: yesterday, today and tomorrow

The aim of the study was to analyse and systematise the scientific literature in the context of the development of telemedicine for stroke.Цель исследования – проанализировать и систематизировать данные научной литературы в контексте развития телемедицины инсульта

Safety and efficacy of telethrombolysis in new stroke unit

This article describes the experience of practicing the telethrombolysis in a new stroke unit. In this research there is a comparison between bedside and remote thrombolysis in the same territory and population to estimate the effectiveness and safety of this way of treatment patients with ischemic stroke.В настоящей статье описан опыт использования телетромболизиса при открытии нового первичного сосудистого отделения (ПСО). В данном исследовании сопоставлены группы пациентов с одной территории, которым была проведена тромболитическая терапия в новом ПСО и на базе Регионального сосудистого центра «Свердловской областной клинической больницы №1» для оценки эффективности и безопасности данного метода лечения пациентов в острейшем периоде ишемического инсульта

Влияние телемедицинской консультации на исход заболевания у больных с внутримозговыми кровоизлияниями

RELEVANCE. Telemedicine solves the problem of the availability of highly qualified personnel at the decision-making stage in the management of patients with intracerebral hemorrhage. AIM OF STuDY We set out to evaluate the effect of teleconsultation on outcomes in patients with intracerebral hemorrhage 30 days after the event.MATERIAL AND METHODS. A prospective, open, nonrandomized clinical trial in two parallel groups. The first group included adult patients up to 80 years of age with a hemorrhagic stroke from 4 to 36 points according to NIHSS due to unilateral supratentorial intracerebral hematoma of non-aneurysmal genesis, who were examined by a neurosurgeon and resuscitator of the Regional Vascular Center in a ward. The second group included similar patients, but they received telemedicine consultation of the above specialists. The primary endpoint of the study was mortality 30 days after the onset of the stroke. The hypothesis of non-superiority was tested where the 95% confidence interval (CI) for the difference in mortality between the groups should not go over 15 percentage points.RESULTS. A total of 140 patients (70 in each group) with intracerebral hematomas were studied. Mortality in the bedside group was 14.3% (CI 7.1%; 24.7%), and in the remote group it was 25.7% (16.0%; 37.6%), p=0.091. However, there was no evidence of superiority, since the difference between the groups in mortality was 11.4 with CI from –0.07 to 24.5 percentage points, which was beyond the predefined limit.CONCLUSIONS. At the current level of development of medicine and information technology, telemedicine cannot fully replace the traditional (bedside) consultation of an expert level of neurosurgeon and neuroresuscitator in patients with intracerebral hematomas.Authors declare lack of the conflicts of interests.АКТУАЛЬНОСТЬ. Телемедицина решает проблему доступности высококвалифицированных кадров на этапе принятия решений по ведению больных с внутримозговыми кровоизлияниями (ВМК).ЦЕЛЬ. Оценить влияние телеконсультирования на исход заболевания через 30 суток после события у больных с ВМК.МАТЕРИАЛ И МЕТОДЫ. Перспективное открытое нерандомизированное клиническое исследование в двух параллельных группах. В 1-ю группу включены взрослые пациенты до 80 лет с геморрагическим инсультом (от 4 до 36 баллов по NIHSS), возникшим вследствие развития односторонней супратенториальной внутримозговой гематомы (ВМГ) неаневризматического генеза, и получавшие консультации нейрохирурга и реаниматолога Регионального сосудистого центра у постели больного. Во 2-ю группу вошли пациенты с тем же диагнозом, но получавшие телемедицинскую консультацию вышеперечисленных специалистов. В качестве первичной конечной точки исследования была выбрана летальность через 30 сут от начала инсульта. Тестировалась гипотеза непревосходства, при которой 95% доверительный интервал (ДИ) для разницы в показателях летальности между группами не должен выходить за границу 15 процентных пунктов.РЕЗУЛЬТАТЫ. Были проанализированы данные о 140 больных с ВМГ (по 70 в каждой группе). Летальность при выполнении консультаций у постели больного составила 14,3% (ДИ 7,1%; 24,7%) (1-я группа), а при ее дистанционном осуществлении — 25,7% (16,0%; 37,6%), p=0,091 (2-я группа). Однако непревосходства доказано не было, так как разница в летальности между группами составила 11,4 с ДИ от –0,07 до 24,5 процентных пунктов, что выходит за предустановленную границу.ВЫВОДЫ. При текущем уровне развития медицины и информационных технологий телемедицина не может полноценно заменить традиционную (прикроватную) консультацию нейрохирурга и нейрореаниматолога экспертного уровня у постели больного при внутримозговых гематомах

Randomised controlled trial of robotic telepresence comparing with audioconference for patients with intracerebral hemorrhage in intensive care unit

Robotic telepresence with high-quality videoconferencing (HQ-VC) is advancing facilities of stroke consulting in the intensive care unit (ICU). However, the utility of HQ-VC comparing with traditional audioconference for stroke care is not investigated. Methods. We conducted open randomized controlled clinical trial in parallel groups of robotic telepresence with HQ-VC comparing with audioconference for patients with intracerebral hemorrhage in the ICU. Patients were divided into two groups by block randomisation with random block length before the HQ-VC start. The experimental group get standard HQ-VC and the control group get HQ-VC without video (only audio) by switching off the display. The primary end point was the difference in 30-day mortality rate between groups. Estimated sample size was 444 subjects (222 in each group). Results. Only 33 patients were enrolled in the study Enrollment was stopped preliminary as a result of high rate of switching on display in control group - 81,3% (54,4%; 96,0%). All cases with switching on display in control group were excluded from the analysis. 30-day mortality rate after intracerebral hemorrhage in experimental group was 47% (23%; 72%) versus 100% (29%; 100%) in control group (p=0,145). Conclusion. HQ-VC is more informative than audioconferencing. However, the utility of HQ-VC comparing with traditional audioconference is still unproved.Роботизированное телеконсультирование, включающее высококачественную видеоконференцсвязь (ВКС) с возможностью дистанционного управления видеокамерой, расширяет возможности врача-консультанта, добавляя видеоизображение больного и окружающего оборудования к аудиоинформации. Однако польза от ВКС по сравнению с традиционной аудиосвязью не изучена. Методы. Проведено открытое рандомизированное контролируемое клиническое исследование в параллельных группах влияния способа телемедицинской связи на исход у больных с внутримозговым кровоизлиянием. Распределение по группам осуществлялось в момент установки ВКС с помощью блоковой рандомизации со случайной длиной блока. Специалисты консультируемых лечебных учреждений не знали распределение больных по группам. В случае, когда больной распределялся в группу только аудиосвязи, экран монитора ВКС выключался, сохраняя звук в динамиках аудиосистемы. Первичная конечная точка исследования - различие между группами по частоте летальных исходов на тридцатые сутки от начала заболевания. Расчётный размер выборки составил 444 пациентов (по 222 в каждую группу). Результат. Набор больных в исследование досрочно завершён после включения 33 пациентов. Исследование остановлено по причине частого подключения ВКС у больных, распределённых в группу с аудиосвязью 81,3% (54,4%; 96,0%). В группе аудиосвязи случаи подключения ВКС исключены из дальнейшего анализа. Тридцатидневная летальность в группе ВКС составила 47% (23%; 72%) против 100% (29%; 100%) в группе аудиосвязи (р=0,145).3аключение. ВКС даёт больше информации, чем только аудиосвязь, но влияние этой дополнительной информации на клинический исход осталось не доказанным

Possibility of predicting hemorrhagic transformation during reperfusion therapy for ischemic stroke in the patient population of the Sverdlovsk Region

Hemorrhagic transformation of an infarction focus is the most common and menacing complication of systemic thrombolytic therapy (TLT) for ischemic stroke (IS). Objective: to analyze the rates of hemorrhagic transformation of infarction and to search for the risk factors of hemorrhagic transformation of an ischemic area after systemic TLT. Patients and methods. The data of 469 IS patients who had received systemic thrombolysis at the primary vascular departments of the Sverdlovsk Region in 2009 to 2013 were analyzed. In accordance with the selection criteria, a study group comprised 143 patients from 4 vascular centers of the Sverdlovsk Region, who were analyzed for the incidence of reperfusion hematomas. Neurological deficit was evaluated by the National Institutes of Health Stroke Scale (NIHSS) and self-care abilities were assessed by the modified Rankin scale (mRS). Brain computed tomography was carried out before, on days 1 and 7 after TLT, and when the patient displayed any deterioration in his/her condition. Analysis of TLT complications involved estimation of the rate of hemorrhagic transformation in accordance with the ECASS II criteria. Results and discussion. According to the ECASS II criteria, the clinically obvious bleeding rate was 4.9%. Hemorrhagic transformation was found to affect the time course of changes and degree of neurological deficit regression and self-care ability recovery. Logistic regression analysis has established that disability index on admission and diastolic blood pressure on admission and during TLT are the most important risk factors of reperfusion hematoma

The Effect of Telemedicine Consultation on Outcomes in Patients with Intracerebral Hemorrhage

RELEVANCE. Telemedicine solves the problem of the availability of highly qualified personnel at the decision-making stage in the management of patients with intracerebral hemorrhage. AIM OF STuDY We set out to evaluate the effect of teleconsultation on outcomes in patients with intracerebral hemorrhage 30 days after the event.MATERIAL AND METHODS. A prospective, open, nonrandomized clinical trial in two parallel groups. The first group included adult patients up to 80 years of age with a hemorrhagic stroke from 4 to 36 points according to NIHSS due to unilateral supratentorial intracerebral hematoma of non-aneurysmal genesis, who were examined by a neurosurgeon and resuscitator of the Regional Vascular Center in a ward. The second group included similar patients, but they received telemedicine consultation of the above specialists. The primary endpoint of the study was mortality 30 days after the onset of the stroke. The hypothesis of non-superiority was tested where the 95% confidence interval (CI) for the difference in mortality between the groups should not go over 15 percentage points.RESULTS. A total of 140 patients (70 in each group) with intracerebral hematomas were studied. Mortality in the bedside group was 14.3% (CI 7.1%; 24.7%), and in the remote group it was 25.7% (16.0%; 37.6%), p=0.091. However, there was no evidence of superiority, since the difference between the groups in mortality was 11.4 with CI from –0.07 to 24.5 percentage points, which was beyond the predefined limit.CONCLUSIONS. At the current level of development of medicine and information technology, telemedicine cannot fully replace the traditional (bedside) consultation of an expert level of neurosurgeon and neuroresuscitator in patients with intracerebral hematomas.Authors declare lack of the conflicts of interests.</jats:p

The Effect of Telemedicine Consultation on Outcomes in Patients with Intracerebral Hemorrhage

RELEVANCE. Telemedicine solves the problem of the availability of highly qualified personnel at the decision-making stage in the management of patients with intracerebral hemorrhage. AIM OF STuDY We set out to evaluate the effect of teleconsultation on outcomes in patients with intracerebral hemorrhage 30 days after the event.MATERIAL AND METHODS. A prospective, open, nonrandomized clinical trial in two parallel groups. The first group included adult patients up to 80 years of age with a hemorrhagic stroke from 4 to 36 points according to NIHSS due to unilateral supratentorial intracerebral hematoma of non-aneurysmal genesis, who were examined by a neurosurgeon and resuscitator of the Regional Vascular Center in a ward. The second group included similar patients, but they received telemedicine consultation of the above specialists. The primary endpoint of the study was mortality 30 days after the onset of the stroke. The hypothesis of non-superiority was tested where the 95% confidence interval (CI) for the difference in mortality between the groups should not go over 15 percentage points.RESULTS. A total of 140 patients (70 in each group) with intracerebral hematomas were studied. Mortality in the bedside group was 14.3% (CI 7.1%; 24.7%), and in the remote group it was 25.7% (16.0%; 37.6%), p=0.091. However, there was no evidence of superiority, since the difference between the groups in mortality was 11.4 with CI from –0.07 to 24.5 percentage points, which was beyond the predefined limit.CONCLUSIONS. At the current level of development of medicine and information technology, telemedicine cannot fully replace the traditional (bedside) consultation of an expert level of neurosurgeon and neuroresuscitator in patients with intracerebral hematomas.Authors declare lack of the conflicts of interests

Quality and consumer properties of bread baked from mixture of rye and wheat flour using iodine-containing additives

Nowadays the state policy in the field of healthy nutrition of the population pays special attention to the development, production and sale of functional products with the purpose of preservation and promotion of health of the population, prevention of diseases, including those caused by defective and unbalanced nutrition of children and adults. The enrichment of bread with iodine is effective and safe, technologically feasible, has a minimal impact on the price of products. The bread production according to the experimental variants was carried out by the method of test laboratory baking, followed by the assessment by quality indicators according to generally accepted methods. Iodine additives were added during the mixing of the dough with liquid components. It was established that iodine-containing raw materials had an ambiguous effect on the overall baking evaluation of bread baked from wheat-rye flour with the addition of iodine-containing raw materials. With each stage of the technological process, a gradual decrease in the iodine content in all samples occurs due to the influence of various temperatures and mechanical stress. Bread with the addition of iodine casein after kneading contains 147.75 micrograms of iodine, after proofing – 126.64 micrograms, and after baking – 94.99 micrograms. During storage, a similar situation is observed, for example, after 24 hours of storage the bread with the addition of iodinedar contains 68.43 ng. and after 48 hours – 59.77 gg.</jats:p

Quality and consumer properties of bread baked from mixture of rye and wheat flour using iodine-containing additives

Nowadays the state policy in the field of healthy nutrition of the population pays special attention to the development, production and sale of functional products with the purpose of preservation and promotion of health of the population, prevention of diseases, including those caused by defective and unbalanced nutrition of children and adults. The enrichment of bread with iodine is effective and safe, technologically feasible, has a minimal impact on the price of products. The bread production according to the experimental variants was carried out by the method of test laboratory baking, followed by the assessment by quality indicators according to generally accepted methods. Iodine additives were added during the mixing of the dough with liquid components. It was established that iodine-containing raw materials had an ambiguous effect on the overall baking evaluation of bread baked from wheat-rye flour with the addition of iodine-containing raw materials. With each stage of the technological process, a gradual decrease in the iodine content in all samples occurs due to the influence of various temperatures and mechanical stress. Bread with the addition of iodine casein after kneading contains 147.75 micrograms of iodine, after proofing – 126.64 micrograms, and after baking – 94.99 micrograms. During storage, a similar situation is observed, for example, after 24 hours of storage the bread with the addition of iodinedar contains 68.43 ng. and after 48 hours – 59.77 gg