Cerebrovascular events and outcomes in hospitalized patients with COVID-19: The SVIN COVID-19 Multinational Registry

Background Severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2) has been associated with a significant risk of thrombotic events in critically ill patients. Aim To summarize the findings of a multinational observational cohort of patients with SARS-CoV-2 and cerebrovascular disease. Methods Retrospective observational cohort of consecutive adults evaluated in the emergency department and/or admitted with coronavirus disease 2019 (COVID-19) across 31 hospitals in four countries (1 February 2020–16 June 2020). The primary outcome was the incidence rate of cerebrovascular events, inclusive of acute ischemic stroke, intracranial hemorrhages (ICH), and cortical vein and/or sinus thrombosis (CVST). Results Of the 14,483 patients with laboratory-confirmed SARS-CoV-2, 172 were diagnosed with an acute cerebrovascular event (1.13% of cohort; 1130/100,000 patients, 95%CI 970–1320/100,000), 68/171 (40.5%) were female and 96/172 (55.8%) were between the ages 60 and 79 years. Of these, 156 had acute ischemic stroke (1.08%; 1080/100,000 95%CI 920–1260/100,000), 28 ICH (0.19%; 190/100,000 95%CI 130–280/100,000), and 3 with CVST (0.02%; 20/100,000, 95%CI 4–60/100,000). The in-hospital mortality rate for SARS-CoV-2-associated stroke was 38.1% and for ICH 58.3%. After adjusting for clustering by site and age, baseline stroke severity, and all predictors of in-hospital mortality found in univariate regression (p \u3c 0.1: male sex, tobacco use, arrival by emergency medical services, lower platelet and lymphocyte counts, and intracranial occlusion), cryptogenic stroke mechanism (aOR 5.01, 95%CI 1.63–15.44, p \u3c 0.01), older age (aOR 1.78, 95%CI 1.07–2.94, p = 0.03), and lower lymphocyte count on admission (aOR 0.58, 95%CI 0.34–0.98, p = 0.04) were the only independent predictors of mortality among patients with stroke and COVID-19. Conclusions COVID-19 is associated with a small but significant risk of clinically relevant cerebrovascular events, particularly ischemic stroke. The mortality rate is high for COVID-19-associated cerebrovascular complications; therefore, aggressive monitoring and early intervention should be pursued to mitigate poor outcomes

Decline in subarachnoid haemorrhage volumes associated with the first wave of the COVID-19 pandemic

BACKGROUND: During the COVID-19 pandemic, decreased volumes of stroke admissions and mechanical thrombectomy were reported. The study\u27s objective was to examine whether subarachnoid haemorrhage (SAH) hospitalisations and ruptured aneurysm coiling interventions demonstrated similar declines. METHODS: We conducted a cross-sectional, retrospective, observational study across 6 continents, 37 countries and 140 comprehensive stroke centres. Patients with the diagnosis of SAH, aneurysmal SAH, ruptured aneurysm coiling interventions and COVID-19 were identified by prospective aneurysm databases or by International Classification of Diseases, 10th Revision, codes. The 3-month cumulative volume, monthly volumes for SAH hospitalisations and ruptured aneurysm coiling procedures were compared for the period before (1 year and immediately before) and during the pandemic, defined as 1 March-31 May 2020. The prior 1-year control period (1 March-31 May 2019) was obtained to account for seasonal variation. FINDINGS: There was a significant decline in SAH hospitalisations, with 2044 admissions in the 3 months immediately before and 1585 admissions during the pandemic, representing a relative decline of 22.5% (95% CI -24.3% to -20.7%, p\u3c0.0001). Embolisation of ruptured aneurysms declined with 1170-1035 procedures, respectively, representing an 11.5% (95%CI -13.5% to -9.8%, p=0.002) relative drop. Subgroup analysis was noted for aneurysmal SAH hospitalisation decline from 834 to 626 hospitalisations, a 24.9% relative decline (95% CI -28.0% to -22.1%, p\u3c0.0001). A relative increase in ruptured aneurysm coiling was noted in low coiling volume hospitals of 41.1% (95% CI 32.3% to 50.6%, p=0.008) despite a decrease in SAH admissions in this tertile. INTERPRETATION: There was a relative decrease in the volume of SAH hospitalisations, aneurysmal SAH hospitalisations and ruptured aneurysm embolisations during the COVID-19 pandemic. These findings in SAH are consistent with a decrease in other emergencies, such as stroke and myocardial infarction

How do fine sediments and Hangman Creek discharge affect benthic macroinvertebrates in the Spokane River?

One of the most common causes of stream degradation globally is fine sediment deposition. Most fine sediment deposition in stream beds is generated by land use practices such as timber harvest, agriculture and urbanization. Hangman Creek is a major tributary and source of fine sediment to the Spokane River. Benthic macroinvertebrates play a crucial function in food webs as an important source of food for many stream predators, including fish. Also, benthic invertebrates are effective indicators of the ecological condition of rivers, including those that are adversely affected by fine sediments. This study investigated the effects of fine sediments on Spokane River macroinvertebrates. I sampled macroinvertebrate communities from 3 substrate types with different levels of fine sediment (sand, 0 - 25% embedded cobbles, and 75-100 % embedded cobbles) in the Spokane River upstream and downstream of its confluence and in Hangman Creek. Water temperature, flow velocity, and depth were also measured. Hangman Creek tended to be warmer and shallower than the Spokane River. The three most common invertebrates in the Spokane River were Chironomidae, Baetis, and Hydropsyche. The three most common invertebrates in Hangman Creek were Chironomidae, Leptohyphidae and Hydropsyche. In early summer 2018, the substrates significantly affected the density of macroinvertebrates; family richness for Ephemeroptera, Plecoptera, and Trichoptera (EPT); proportion EPT; proportion clinger functional group; and the proportion of the dominant taxon. Family richness for all taxa; Evenness; Shannon-Weaver diversity; Hilsenhoff Family Biotic Index (HFBI); and Biological Sediment Tolerance Index (BSTI) were not affected. In late summer 2018, substrate significantly affected only the density of macroinvertebrates. Overall, the results suggest that areas with fine sediment were ecologically impaired compared to unembedded cobbles. However, not all indicators responded as expected. There was no evidence for the effects of fine sediment to increase through the summer, or of significant ecological degradation in the Spokane River directly below the confluence with Hangman Creek. This work will contribute to our understanding of the biotic effects of fine sediment in the Spokane River

Perception of herbs use in treating diabetes among patients attending specialized polyclinics of National Guard Health Affairs, Jeddah

Objective: Diabetes mellitus represents a major burden globally and locally. Some diabetic patients may resort to the use of herbal medicine as another approach to control their blood glucose levels. This study aims to assess the prevalence and the perception of diabetic patients toward the usage of herbs in treating diabetes. Methods: A cross-sectional survey was conducted in a specialized polyclinic of the primary health care center in the National Guard hospital located in Jeddah. The questionnaire was interviewer-administered and a total of 196 diabetic patients were interviewed. Results: Of 196 patients interviewed, most (59.7%) have used herbs to treat diabetes. Cinnamon, garlic, fenugreek, and moringa were the most common herbs used by diabetic patients. Many herbal users (49.9%) reported that herbs can play a role in decreasing blood glucose levels and (48%) of herbal users prefer the use of herbs over conventional medicine in treating diabetes. Most diabetic patients (37.3%) gained their knowledge about herbs through media and the experiences of other diabetic patients and we found that the reason to use herbs the majority was to reap the benefits of the herbs (48.7%) or because of herbs on controlling diabetes and reducing diabetic complications (30.7%). Conclusion: This study concluded that herbs are commonly used among diabetic patients and the majority of patients perceive herbs as a cofactor in controlling diabetes

Awareness and Attitude of Physicians on the Role of Dentists in the Management of Obstructive Sleep Apnea

Background: Efforts to evaluate physicians’ awareness and attitude toward dentists’ comprehensive role in OSA management are relatively negligible. Therefore, this study aimed to assess physicians’ awareness and attitude toward the role of dentists in OSA management in Saudi Arabia. Methods: In a multi-center cross-sectional study, a total of 358 physicians in Saudi Arabia were subjected to an e-questionnaire composed of three sections: (1) physicians’ demographic data, (2) physicians’ general and specific knowledge of OSA and its management [using 29 factual statements to be responded by “True, False, or I don’t know” responses], and (3) physicians’ attitude towards dentists’ role in OSA management [using 12 attitude statements to be responded by a Likert scale of “Never, Rarely, Sometimes, Usually, Always” responses]. A scoring system was applied for both knowledge and attitude, total and percentage mean scores (PMS) were calculated, and knowledge and attitude levels were categorized accordingly. Predictors of correct knowledge and favorable attitude were identified using multiple regression analyses. Results: Physicians had an overall average knowledge level (PMS = 56% ± 19.4%), with 35.5% and 5.9% reporting good general and specific knowledge levels, respectively (χ2 = 143.0, p < 0.001). Physicians had an overall neutral attitude level (PMS = 64.4% ± 17.5%), with about one-half reporting a neutral attitude level (48.9%) and only one-fourth reporting a positive attitude level (27.7%). Higher levels of knowledge were a significant predictor of favorable attitudes (t = 5.71, p < 0.001). Higher training levels were a significant predictor of correct knowledge (t = 3.60, p < 0.001) and favorable attitude (t = 3.15, p = 0.002). Conclusions: Physicians showed insufficient knowledge about OSA and a less than favorable attitude towards dentists’ role in its management. Enhancing medical curricula and clinical protocols and guidelines on the dentists’ role in OSA management is recommended

Nephroprotective Effect of Fennel (<i>Foeniculum vulgare</i>) Seeds and Their Sprouts on CCl₄-Induced Nephrotoxicity and Oxidative Stress in Rats

Functional and nutritional characteristics of seed sprouts and their association with oxidative stress-related disorders have recently become a focus of scientific investigations. The biological activities of fennel seeds (FS) and fennel seed sprouts (FSS) were investigated in vitro and in vivo. The total phenolic content (TPC), total flavonoids (TF), total flavonols (TFF), and antioxidant activity (AOA) of FS and FSS were examined. HPLC and GC–MS analyses for FS and FSS were carried out. Consequently, the nephroprotective and antioxidative stress potential of FS and FSS extracts at 300 and 600 mg kg−1 on CCl4-induced nephrotoxicity and oxidative stress in rats was investigated. In this context, kidney relative weight, blood glucose level (BGL), lipid profile, kidney function (T. protein, albumin, globulin, creatinine, urea, and blood urea nitrogen (BUN)), and oxidative stress biomarkers (GSH, CAT, MDA, and SOD) in the rat’s blood as well as the histopathological alteration in kidney tissues were examined. Results indicated that the sprouting process of FS significantly improved TPC, TF, TFL, and AOA in vitro. HPLC identified nineteen compounds of phenolic acids and their derivatives in FS. Thirteen phenolic compounds in FS and FSS were identified, the highest of which was vanillic acid. Six flavonoids were also identified with a predominance of kaempferol. GC–MS indicated that the trans-anethole (1-methoxy-4-[(E)-prop-1-enyl]benzene) component was predominant in FS and FSS, significantly increasing after sprouting. In in vivo examination, administering FS and FSS extracts ameliorated the BGL, triglycerides (TG), total cholesterol (CHO), and their derivative levels compared to CCl4-intoxicated rats. A notable improvement in FS and FSS with 600 mg kg−1 compared to 300 mg kg−1 was observed. A dose of 600 mg FSS kg−1 reduced the TG, CHO, and LDL-C and increased HDL-C levels by 32.04, 24.62, 63.00, and 67.17% compared to G2, respectively. The atherogenic index (AI) was significantly improved with 600 mg kg−1 of FSS extracts. FS and FSS improved kidney function, reduced malondialdehyde (MDA), and restored the activity of reduced glutathione (GSH), superoxide dismutase (SOD), and catalase (CAT). Both FS and FSS extracts attenuated the histopathological alteration in CCl4-treated rats. Interestingly, FSS extract presented better efficiency as a nephroprotection agent than FS extract. In conclusion, FSS can potentially restore oxidative stability and improve kidney function after acute CCl4 kidney injury better than FS. Therefore, FS and FSS extracts might be used for their promising nephroprotective potential and to help prevent diseases related to oxidative stress. Further research on their application in humans is highly recommended

Biological Assessment of Stevioside and Sucralose as Sucrose Substitutes for Diabetics on STZ-Induced Diabetes in Rats

Numerous food organizations have identified excessive calorie consumption and accompanying ailments as significant health risks associated with high sugar consumption. Administering stevioside (ST), sucralose (SU), and the two synergically (SU+ST) affected normal rats&rsquo; weight gain. In the current study, SU showed the highest undesired effect. Indeed, administering the three treatments to diabetic rats (DR) did not improve the rats&rsquo; weight gain. Although, insulin injection synergically with the treatments improved the weight gain, as recorded after three weeks. The best-improving rate was observed in the ST group. After the administration of ST and ST+SU to the DR, the blood glucose level (GL) was positively affected, with SU having no effects on reducing the GL. A considerable reduction in serum insulin (SIL) was noted in the DR+SU group. On the contrary, ST did not negatively affect the SIL, rather an improvement was recorded. In addition, giving SU did not significantly affect the ALT level in the DR or normal rats (NR). A significant improvement in total bilirubin (TBILI) was observed when insulin was injected with ST or SU in DR groups. Further, triglycerides (TG) after administering ST, SU, or ST+SU to NR had no significant difference compared to the control group (NR). Although, the three treatments markedly but not significantly lowered TG in the DR. For total cholesterol (CHO), both DR and NR had no significant effect after the three treatments. No histopathological alterations were recorded in the NR group. Diffuse and severe atrophy of the islands of Langerhans due to depletion of their cells and mild papillary hyperplasia of the pancreatic ducts were represented by a slightly folded ductal basement membrane and newly formed ductules in STZ-DR. Simultaneous atrophy and absence of the cells of islands of Langerhans besides ductal hyperplasia were evident in DR+SU. Hyperplastic ductal epithelium and atrophic Langerhans cells were seen in DR+SU+In. Degeneration and mild atrophy were observed in the islands of Langerhans structures. There was essentially no noticeable change after utilizing ST. A slight shrinkage of the Langerhans&rsquo; islets was detected in DR+ST. In DR+ST+In, no histopathological alterations in the islands of Langerhans were recorded. Congestion in the stromal blood vessels associated with degenerative and necrotic changes in the cells of the islands of Langerhans in DR+SU+ST was observed. In NR+SU, congestion of the blood vessels associated with mild atrophy in the islands of Langerhans and dilatation in stromal blood vessels was noticed. In conclusion, ST is safe, and SU should be taken cautiously, such as mixing with ST and/or taken at a very low concentration to avoid its drastic effect on the human body

Biological Assessment of Stevioside and Sucralose as Sucrose Substitutes for Diabetics on STZ-Induced Diabetes in Rats

Numerous food organizations have identified excessive calorie consumption and accompanying ailments as significant health risks associated with high sugar consumption. Administering stevioside (ST), sucralose (SU), and the two synergically (SU+ST) affected normal rats’ weight gain. In the current study, SU showed the highest undesired effect. Indeed, administering the three treatments to diabetic rats (DR) did not improve the rats’ weight gain. Although, insulin injection synergically with the treatments improved the weight gain, as recorded after three weeks. The best-improving rate was observed in the ST group. After the administration of ST and ST+SU to the DR, the blood glucose level (GL) was positively affected, with SU having no effects on reducing the GL. A considerable reduction in serum insulin (SIL) was noted in the DR+SU group. On the contrary, ST did not negatively affect the SIL, rather an improvement was recorded. In addition, giving SU did not significantly affect the ALT level in the DR or normal rats (NR). A significant improvement in total bilirubin (TBILI) was observed when insulin was injected with ST or SU in DR groups. Further, triglycerides (TG) after administering ST, SU, or ST+SU to NR had no significant difference compared to the control group (NR). Although, the three treatments markedly but not significantly lowered TG in the DR. For total cholesterol (CHO), both DR and NR had no significant effect after the three treatments. No histopathological alterations were recorded in the NR group. Diffuse and severe atrophy of the islands of Langerhans due to depletion of their cells and mild papillary hyperplasia of the pancreatic ducts were represented by a slightly folded ductal basement membrane and newly formed ductules in STZ-DR. Simultaneous atrophy and absence of the cells of islands of Langerhans besides ductal hyperplasia were evident in DR+SU. Hyperplastic ductal epithelium and atrophic Langerhans cells were seen in DR+SU+In. Degeneration and mild atrophy were observed in the islands of Langerhans structures. There was essentially no noticeable change after utilizing ST. A slight shrinkage of the Langerhans’ islets was detected in DR+ST. In DR+ST+In, no histopathological alterations in the islands of Langerhans were recorded. Congestion in the stromal blood vessels associated with degenerative and necrotic changes in the cells of the islands of Langerhans in DR+SU+ST was observed. In NR+SU, congestion of the blood vessels associated with mild atrophy in the islands of Langerhans and dilatation in stromal blood vessels was noticed. In conclusion, ST is safe, and SU should be taken cautiously, such as mixing with ST and/or taken at a very low concentration to avoid its drastic effect on the human body