EARLY AND LATE MORTALITY OF SPONTANEOUS HEMORRHAGIC TRANSFORMATION OF ISCHEMIC STROKE

BACKGROUND: Hemorrhagic transformation (HT), a complication of ischemic stroke (IS), might influence patient's prognosis. Our aim is to evaluate, in a hospital-based series of patients not treated with thrombolysis, the relationship between HT and mortality. METHODS: We compared mortality of individuals with spontaneous HT with that of individuals without. Medical records of patients diagnosed with anterior IS were retrospectively reviewed. Outcome measures were 30- and 90-day survival after IS onset. Kaplan-Meier estimates were used to construct survival curves. Cox proportional hazards model was used to estimate hazard ratio (HR) for the main outcome measure (death). HT was stratified in hemorrhagic infarction and parenchymal hematoma (PH). We also evaluated the relationship between HT and the main mortality risk factors (gender, age, premorbid status, severity of stroke, and radiological features). RESULTS: Thirty days from stroke onset, 8.1% (19 of 233) of patients died. At multivariate analysis, PH (HR: 7.7, 95% confidence interval [CI]: 2.1, 27.8) and low level of consciousness at admission (HR: 5.0, 95% CI: 1.3, 18.6) were significantly associated with death. At 3-month follow-up, mortality rate was 12.1% (28 of 232). At multivariate analysis, large infarct size (HR: 2.7, 95% CI: 1.2, 6.0) and HT (HR: 2.3, 95% CI: 1.0, 5.4) were independent risk factors for mortality. Parenchymal hematoma was, however, the strongest predictor of late mortality (HR: 7.9, 95% CI: 2.9, 21.4). CONCLUSIONS: Neurological status and infarct size play a significant role, respectively, in early and late mortality after IS. Parenchymal hematoma independently predicts both early and late mortality

Gender-related differences in the prevalence of voice disorders and awareness of dysphonia

Objective: Considering the impact of dysphonia on public health and the increasing attention to patient-centred care, we evaluated sex-related differences in the prevalence of benign voice disorders, awareness of dysphonia and voice therapy (VT) results. Methods: One hundred and seventy-one patients, 129 females and 42 males, with functional or organic benign dysphonia underwent Voice Handicap Index (VHI), auditory-perceptual dysphonia severity scoring (GRBAS) and acoustic analysis (Jitter%, Shimmer%, NHR) before and after VT. Results: Prevalence of each voice disorder was significantly higher among females. Mean time-to-diagnosis (time elapsed until medical consultation) was not different between males and females. The refusal of therapy and VT adherence (mean number of absences and premature dropout) were similar in the two groups. Pre-VT VHI and "G" parameter were worse in women. The percentage of women with abnormal acoustic analysis was significantly higher. Post-VT VHI gain was higher in women, whereas "G" parameter improvement did not differ by sex. Conclusions: Our study showed a higher prevalence of voice disorders in females. Awareness of dysphonia was not gender related. Females started with worse voice subjective perception and acoustic analysis, but they perceived greater improvement after therapy

LATE MORTALITY OF HEMORRHAGIC TRANSFORMATION OF ISCHEMIC STROKE

Introduction. Hemorrhagic transformation (HT), a complication of ischemic stroke (IS) is supposed to influence patient’s prognosis. Aim of our study was to evaluate, in a hospital-based series of patients not treated with thrombolysis, the relationship between HT and late mortality. Methods. Mortality of individuals with spontaneous HT was compared to that of individuals without. Medical records of patients diagnosed with anterior IS during the period 2004-2006 were reviewed. Living status was obtained from the public record office of the municipality of Palermo or indirectly by telephone interview. Outcome measure was 90 days survival after IS onset. Kaplan-Meier estimates were used to construct survival curves. Cox proportional hazards model was used in a univariate analysis to estimate RR for the main outcome measure (death) in the different strata. We evaluated the relationship between HT and the main mortality risk factors. HT was stratified in hemorrhagic infarction (HI) and parenchymal hematoma (PH). Results. Living status was determined for 96.7%. At 3 month follow-up, mortality rate was 12.1% (28/232). At multivariate analysis, large infarct size (OR 2.7, 95% CI 1.2, 6.0, p=0.02) and HT (OR 2.3, 95% CI 1.0, 5.4, p = 0.05) were significantly associated with increased mortality. Parenchymal hematoma was the strongest independent risk factor for late mortality (OR 7.9, 95% CI 2.9, 21.4, p < 0.0001). Conclusions. Infarct size and HT play a significant role in late mortality after IS. Parenchymal hematoma is the strongest predictor of late mortality