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1. Simulation of heat and mass transfer in a refractance window dryer for aloe vera gel

Author

Shahraki, A., Khojastehpour, M., Golzarian, M. R., Azarpazhooh, E., Shahraki, A., Khojastehpour, M., Golzarian, M. R., and Azarpazhooh, E.

Abstract

Introduction Drying is one of the oldest methods of food preservation. To increase the efficiency of heat and mass transfer while maintaining product quality, the study of the drying process is crucial scientifically and meticulously. It is possible to conduct experimental tests, trial and error, in the drying process. However, this approach consumes time and cost, with a significant amount of energy resources. By harnessing available software and leveraging technological advancement to develop a general model for drying food under varying initial conditions, the drying process can be significantly optimized. Materials and Methods This study was conducted with the aim of simulating heat and mass transfer during Refractance window drying for aloe vera gel. Comsol Multiphysics version 5.6 is a three-dimensional model used to solve heat and mass transfer equations. For this purpose, the differential equations of heat and mass transfer were solved simultaneously and interdependently. The above model considered various initial conditions: water temperature of 60, 70, 80, and 90℃, and aloe vera gel thickness of 5 and 10 mm. The initial humidity and temperature of the aloe vera is uniform. The initial temperature is 4℃ and the initial humidity of the fresh aloe vera sample is 110 gwater/gdry matter. Heat is supplied only by hot water from the bottom surface of the product. Results and Discussion The drying time was needed to reduce the moisture content of aloe vera gel from 110 to 0.1 gwater/gdry matter during Refractance window drying. Aloe vera gel with a thickness of 5 mm dried in 120, 100, 70, and 50 minutes at water temperatures of 60, 70, 80, and 90℃, respectively. For a 10 mm thick layer of aloe vera gel, the drying time was 240, 190, 150, and 120 minutes, for water temperatures of 60 to 90℃, respectively. These results demonstrate the importance of both the water temperature and thickness on the drying time. Furthermore, the drying rate of aloe vera gel increased a

Published
2024

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Author

Jakovljević, Aleksandar, Jakovljević, Aleksandar, Nikolić, Nadja, Jaćimović, Jelena, Miletić, Maja, Andrić, Miroslav, Milašin, Jelena, Aminoshariae, Anita, Azarpazhooh, Amir, Jakovljević, Aleksandar, Jakovljević, Aleksandar, Nikolić, Nadja, Jaćimović, Jelena, Miletić, Maja, Andrić, Miroslav, Milašin, Jelena, Aminoshariae, Anita, and Azarpazhooh, Amir

Published
2021

3. Safety and Outcomes of Intravenous Thrombolytic Therapy in Ischemic Stroke Patients with COVID-19: CASCADE Initiative

Author

Sasanejad, Payam Hezarkhani, Leila Afshar Arsang-Jang, Shahram and Tsivgoulis, Georgios Ghoreishi, Abdoreza Kristian, Barlinn and Rahmig, Jan Farhoudi, Mehdi Hokmabadi, Elyar Sadeghi and Borhani-Haghighi, Afshin Sariaslani, Payam Sharifi-Razavi, Athena Ghandehari, Kavian Khosravi, Alireza Smith, Craig and Nilanont, Yongchai Akbari, Yama Nguyen, Thanh N. Bersano, Anna Yassi, Nawaf Yoshimoto, Takeshi Lattanzi, Simona and Gupta, Animesh Zand, Ramin Rafie, Shahram Mousavian, Seyede Pourandokht Shahsavaripour, Mohammad Reza Amini, Shahram and Kamenova, Saltanat U. Kondybayeva, Aida Zhanuzakov, Murat and Macri, Elizabeth M. Nobleza, Christa O'Hana S. Ruland, Sean and Cervantes-Arslanian, Anna M. Desai, Masoom J. Ranta, Annemarei and Ahmadi, Amir Moghadam Rostamihosseinkhani, Mahtab Foroughi, Razieh Hooshmandi, Etrat Akhoundi, Fahimeh H. Shuaib, Ashfaq and Liebeskind, David S. Siegler, James Romano, Jose G. and Mayer, Stephan A. Shahripour, Reza Bavarsad Zamani, Babak and Woolsey, Amadene Fazli, Yasaman Mojtaba, Khazaei Isaac, Christian F. Biller, Jose Di Napoli, Mario Azarpazhooh, M. Reza and Sasanejad, Payam Hezarkhani, Leila Afshar Arsang-Jang, Shahram and Tsivgoulis, Georgios Ghoreishi, Abdoreza Kristian, Barlinn and Rahmig, Jan Farhoudi, Mehdi Hokmabadi, Elyar Sadeghi and Borhani-Haghighi, Afshin Sariaslani, Payam Sharifi-Razavi, Athena Ghandehari, Kavian Khosravi, Alireza Smith, Craig and Nilanont, Yongchai Akbari, Yama Nguyen, Thanh N. Bersano, Anna Yassi, Nawaf Yoshimoto, Takeshi Lattanzi, Simona and Gupta, Animesh Zand, Ramin Rafie, Shahram Mousavian, Seyede Pourandokht Shahsavaripour, Mohammad Reza Amini, Shahram and Kamenova, Saltanat U. Kondybayeva, Aida Zhanuzakov, Murat and Macri, Elizabeth M. Nobleza, Christa O'Hana S. Ruland, Sean and Cervantes-Arslanian, Anna M. Desai, Masoom J. Ranta, Annemarei and Ahmadi, Amir Moghadam Rostamihosseinkhani, Mahtab Foroughi, Razieh Hooshmandi, Etrat Akhoundi, Fahimeh H. Shuaib, Ashfaq and Liebeskind, David S. Siegler, James Romano, Jose G. and Mayer, Stephan A. Shahripour, Reza Bavarsad Zamani, Babak and Woolsey, Amadene Fazli, Yasaman Mojtaba, Khazaei Isaac, Christian F. Biller, Jose Di Napoli, Mario Azarpazhooh, M. Reza

Abstract

Background: There is little information regarding the safety of intravenous tissue plasminogen activator (IV-tPA) in patients with stroke and COVID-19. Methods: This multicenter study included consecutive stroke patients with and without COVID-19 treated with IV-tPA between February 18, 2019, to December 31, 2020, at 9 centers participating in the CASCADE initiative. Clinical outcomes included modified Rankin Scale (mRS) at hospital discharge, in-hospital mortality, the rate of hemorrhagic transformation. Using Bayesian multiple regression and after adjusting for variables with significant value in univariable analysis, we reported the posterior adjusted odds ratio (OR, with 95% Credible Intervals [CrI]) of the main outcomes. Results: A total of 545 stroke patients, including 101 patients with COVID-19 were evaluated. Patients with COVID-19 had a more severe stroke at admission. In the study cohort, 85 (15.9%) patients had a hemorrhagic transformation, and 72 (13.1%) died in the hospital. After adjustment for confounding variables, discharge mRS score >2 (OR: 0.73, 95% CrI: 0.16, 3.05), in-hospital mortality (OR: 2.06, 95% CrI: 0.76, 5.53), and hemorrhagic transformation (OR: 1.514, 95% CrI: 0.66, 3.31) were similar in COVID-19 and non COVID-19 patients. High -sensitivity C reactive protein level was a predictor of hemorrhagic transformation in all cases (OR:1.01, 95%CI: 1.0026, 1.018), including those with COVID-19 (OR:1.024, 95%CI:1.002, 1.054). Conclusion: IV-tPA treatment in patients with acute ischemic stroke and COVID-19 was not associated with an increased risk of disability, mortality, and hemorrhagic transformation compared to those without COVID-19. IVtPA should continue to be considered as the standard of care in patients with hyper acute stroke and COVID-19.

Published
2021

4. SARS-CoV-2 and Stroke Characteristics: A Report from the Multinational COVID-19 Stroke Study Group

Author

Shahjouei, S. Tsivgoulis, G. Farahmand, G. Koza, E. Mowla, A. Vafaei Sadr, A. Kia, A. Vaghefi Far, A. Mondello, S. Cernigliaro, A. Ranta, A. Punter, M. Khodadadi, F. Naderi, S. Sabra, M. Ramezani, M. Amini Harandi, A. Olulana, O. Chaudhary, D. Lyoubi, A. Campbell, B.C.V. Arenillas, J.F. Bock, D. Montaner, J. Aghayari Sheikh Neshin, S. Aguiar De Sousa, D. Tenser, M.S. Aires, A. Alfonso, M.D.L. Alizada, O. Azevedo, E. Goyal, N. Babaeepour, Z. Banihashemi, G. Bonati, L.H. Cereda, C.W. Chang, J.J. Crnjakovic, M. De Marchis, G.M. Del Sette, M. Ebrahimzadeh, S.A. Farhoudi, M. Gandoglia, I. Goncąlves, B. Griessenauer, C.J. Murat Hanci, M. Katsanos, A.H. Krogias, C. Leker, R.R. Lotman, L. Mai, J. Male, S. Malhotra, K. Malojcic, B. Mesquita, T. Mir Ghasemi, A. Mohamed Aref, H. Mohseni Afshar, Z. Moon, J. Niemelä, M. Rezai Jahromi, B. Nolan, L. Pandhi, A. Park, J.-H. Marto, J.P. Purroy, F. Ranji-Burachaloo, S. Carreira, N.R. Requena, M. Rubiera, M. Sajedi, S.A. Sargento-Freitas, J. Sharma, V.K. Steiner, T. Tempro, K. Turc, G. Ahmadzadeh, Y. Almasi-Dooghaee, M. Assarzadegan, F. Babazadeh, A. Baharvahdat, H. Cardoso, F.B. Dev, A. Ghorbani, M. Hamidi, A. Hasheminejad, Z.S. Hojjat-Anasri Komachali, S. Khorvash, F. Kobeissy, F. Mirkarimi, H. Mohammadi-Vosough, E. Misra, D. Noorian, A.R. Nowrouzi-Sohrabi, P. Paybast, S. Poorsaadat, L. Roozbeh, M. Sabayan, B. Salehizadeh, S. Saberi, A. Sepehrnia, M. Vahabizad, F. Yasuda, T.A. Ghabaee, M. Rahimian, N. Harirchian, M.H. Borhani-Haghighi, A. Azarpazhooh, M.R. Arora, R. Ansari, S. Avula, V. Li, J. Abedi, V. Zand, R. and Shahjouei, S. Tsivgoulis, G. Farahmand, G. Koza, E. Mowla, A. Vafaei Sadr, A. Kia, A. Vaghefi Far, A. Mondello, S. Cernigliaro, A. Ranta, A. Punter, M. Khodadadi, F. Naderi, S. Sabra, M. Ramezani, M. Amini Harandi, A. Olulana, O. Chaudhary, D. Lyoubi, A. Campbell, B.C.V. Arenillas, J.F. Bock, D. Montaner, J. Aghayari Sheikh Neshin, S. Aguiar De Sousa, D. Tenser, M.S. Aires, A. Alfonso, M.D.L. Alizada, O. Azevedo, E. Goyal, N. Babaeepour, Z. Banihashemi, G. Bonati, L.H. Cereda, C.W. Chang, J.J. Crnjakovic, M. De Marchis, G.M. Del Sette, M. Ebrahimzadeh, S.A. Farhoudi, M. Gandoglia, I. Goncąlves, B. Griessenauer, C.J. Murat Hanci, M. Katsanos, A.H. Krogias, C. Leker, R.R. Lotman, L. Mai, J. Male, S. Malhotra, K. Malojcic, B. Mesquita, T. Mir Ghasemi, A. Mohamed Aref, H. Mohseni Afshar, Z. Moon, J. Niemelä, M. Rezai Jahromi, B. Nolan, L. Pandhi, A. Park, J.-H. Marto, J.P. Purroy, F. Ranji-Burachaloo, S. Carreira, N.R. Requena, M. Rubiera, M. Sajedi, S.A. Sargento-Freitas, J. Sharma, V.K. Steiner, T. Tempro, K. Turc, G. Ahmadzadeh, Y. Almasi-Dooghaee, M. Assarzadegan, F. Babazadeh, A. Baharvahdat, H. Cardoso, F.B. Dev, A. Ghorbani, M. Hamidi, A. Hasheminejad, Z.S. Hojjat-Anasri Komachali, S. Khorvash, F. Kobeissy, F. Mirkarimi, H. Mohammadi-Vosough, E. Misra, D. Noorian, A.R. Nowrouzi-Sohrabi, P. Paybast, S. Poorsaadat, L. Roozbeh, M. Sabayan, B. Salehizadeh, S. Saberi, A. Sepehrnia, M. Vahabizad, F. Yasuda, T.A. Ghabaee, M. Rahimian, N. Harirchian, M.H. Borhani-Haghighi, A. Azarpazhooh, M.R. Arora, R. Ansari, S. Avula, V. Li, J. Abedi, V. Zand, R.

Abstract

Background and Purpose: Stroke is reported as a consequence of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection in several reports. However, data are sparse regarding the details of these patients in a multinational and large scale. Methods: We conducted a multinational observational study on features of consecutive acute ischemic stroke, intracranial hemorrhage, and cerebral venous or sinus thrombosis among SARS-CoV-2-infected patients. We further investigated the risk of large vessel occlusion, stroke severity as measured by the National Institutes of Health Stroke Scale, and stroke subtype as measured by the TOAST (Trial of ORG 10172 in Acute Stroke Treatment) criteria among patients with acute ischemic stroke. In addition, we explored the neuroimaging findings, features of patients who were asymptomatic for SARS-CoV-2 infection at stroke onset, and the impact of geographic regions and countries' health expenditure on outcomes. Results: Among the 136 tertiary centers of 32 countries who participated in this study, 71 centers from 17 countries had at least 1 eligible stroke patient. Of 432 patients included, 323 (74.8%) had acute ischemic stroke, 91 (21.1%) intracranial hemorrhage, and 18 (4.2%) cerebral venous or sinus thrombosis. A total of 183 (42.4%) patients were women, 104 (24.1%) patients were <55 years of age, and 105 (24.4%) patients had no identifiable vascular risk factors. Among acute ischemic stroke patients, 44.5% (126 of 283 patients) had large vessel occlusion; 10% had small artery occlusion according to the TOAST criteria. We observed a lower median National Institutes of Health Stroke Scale (8 [3-17] versus 11 [5-17]; P=0.02) and higher rate of mechanical thrombectomy (12.4% versus 2%; P<0.001) in countries with middle-to-high health expenditure when compared with countries with lower health expenditure. Among 380 patients who had known interval onset of the SARS-CoV-2 and stroke, 144 (37.8%) were asymptomatic at

Published
2021

5. Sars-cov-2 is a culprit for some, but not all acute ischemic strokes: A report from the multinational covid-19 stroke study group

Author

Shahjouei, S. Anyaehie, M. Koza, E. Tsivgoulis, G. Naderi, S. Mowla, A. Avula, V. Sadr, A.V. Chaudhary, D. Farahmand, G. Griessenauer, C. Azarpazhooh, M.R. Misra, D. Li, J. Abedi, V. Zand, R. the Multinational COVID-Stroke Study Group and Shahjouei, S. Anyaehie, M. Koza, E. Tsivgoulis, G. Naderi, S. Mowla, A. Avula, V. Sadr, A.V. Chaudhary, D. Farahmand, G. Griessenauer, C. Azarpazhooh, M.R. Misra, D. Li, J. Abedi, V. Zand, R. the Multinational COVID-Stroke Study Group

Abstract

Background. SARS-CoV-2 infected patients are suggested to have a higher incidence of thrombotic events such as acute ischemic strokes (AIS). This study aimed at exploring vascular comorbidity patterns among SARS-CoV-2 infected patients with subsequent stroke. We also investi-gated whether the comorbidities and their frequencies under each subclass of TOAST criteria were similar to the AIS population studies prior to the pandemic. Methods. This is a report from the Multinational COVID-19 Stroke Study Group. We present an original dataset of SASR-CoV-2 infected patients who had a subsequent stroke recorded through our multicenter prospective study. In addi-tion, we built a dataset of previously reported patients by conducting a systematic literature review. We demonstrated distinct subgroups by clinical risk scoring models and unsupervised machine learning algorithms, including hierarchical K-Means (ML-K) and Spectral clustering (ML-S). Results. This study included 323 AIS patients from 71 centers in 17 countries from the original dataset and 145 patients reported in the literature. The unsupervised clustering methods suggest a distinct cohort of patients (ML-K: 36% and ML-S: 42%) with no or few comorbidities. These patients were more than 6 years younger than other subgroups and more likely were men (ML-K: 59% and ML-S: 60%). The majority of patients in this subgroup suffered from an embolic-appearing stroke on imaging (ML-K: 83% and ML-S: 85%) and had about 50% risk of large vessel occlusions (ML-K: 50% and ML-S: 53%). In addition, there were two cohorts of patients with large-artery atherosclerosis (ML-K: 30% and ML-S: 43% of patients) and cardioembolic strokes (ML-K: 34% and ML-S: 15%) with consistent comorbidity and imaging patterns. Binominal logistic regression demonstrated that ischemic heart disease (odds ratio (OR), 4.9; 95% confidence interval (CI), 1.6–14.7), atrial fibrillation (OR, 14.0; 95% CI, 4.8–40.8), and active neoplasm (OR, 7.1; 95% CI, 1.4–36.2)

Published
2021

6. Safety and Outcomes of Intravenous Thrombolytic Therapy in Ischemic Stroke Patients with COVID-19: CASCADE Initiative.

Author

Sasanejad, Payam, Sasanejad, Payam, Afshar Hezarkhani, Leila, Arsang-Jang, Shahram, Tsivgoulis, Georgios, Ghoreishi, Abdoreza, Kristian, Barlinn, Rahmig, Jan, Farhoudi, Mehdi, Sadeghi Hokmabadi, Elyar, Borhani-Haghighi, Afshin, Sariaslani, Payam, Sharifi-Razavi, Athena, Ghandehari, Kavian, Khosravi, Alireza, Smith, Craig, Nilanont, Yongchai, Akbari, Yama, Nguyen, Thanh N, Bersano, Anna, Yassi, Nawaf, Yoshimoto, Takeshi, Lattanzi, Simona, Gupta, Animesh, Zand, Ramin, Rafie, Shahram, Pourandokht Mousavian, Seyede, Reza Shahsavaripour, Mohammad, Amini, Shahram, Kamenova, Saltanat U, Kondybayeva, Aida, Zhanuzakov, Murat, Macri, Elizabeth M, Nobleza, Christa O'Hana S, Ruland, Sean, Cervantes-Arslanian, Anna M, Desai, Masoom J, Ranta, Annemarei, Moghadam Ahmadi, Amir, Rostamihosseinkhani, Mahtab, Foroughi, Razieh, Hooshmandi, Etrat, Akhoundi, Fahimeh H, Shuaib, Ashfaq, Liebeskind, David S, Siegler, James, Romano, Jose G, Mayer, Stephan A, Bavarsad Shahripour, Reza, Zamani, Babak, Woolsey, Amadene, Fazli, Yasaman, Mojtaba, Khazaei, Isaac, Christian F, Biller, Jose, Di Napoli, Mario, Azarpazhooh, M Reza, Sasanejad, Payam, Sasanejad, Payam, Afshar Hezarkhani, Leila, Arsang-Jang, Shahram, Tsivgoulis, Georgios, Ghoreishi, Abdoreza, Kristian, Barlinn, Rahmig, Jan, Farhoudi, Mehdi, Sadeghi Hokmabadi, Elyar, Borhani-Haghighi, Afshin, Sariaslani, Payam, Sharifi-Razavi, Athena, Ghandehari, Kavian, Khosravi, Alireza, Smith, Craig, Nilanont, Yongchai, Akbari, Yama, Nguyen, Thanh N, Bersano, Anna, Yassi, Nawaf, Yoshimoto, Takeshi, Lattanzi, Simona, Gupta, Animesh, Zand, Ramin, Rafie, Shahram, Pourandokht Mousavian, Seyede, Reza Shahsavaripour, Mohammad, Amini, Shahram, Kamenova, Saltanat U, Kondybayeva, Aida, Zhanuzakov, Murat, Macri, Elizabeth M, Nobleza, Christa O'Hana S, Ruland, Sean, Cervantes-Arslanian, Anna M, Desai, Masoom J, Ranta, Annemarei, Moghadam Ahmadi, Amir, Rostamihosseinkhani, Mahtab, Foroughi, Razieh, Hooshmandi, Etrat, Akhoundi, Fahimeh H, Shuaib, Ashfaq, Liebeskind, David S, Siegler, James, Romano, Jose G, Mayer, Stephan A, Bavarsad Shahripour, Reza, Zamani, Babak, Woolsey, Amadene, Fazli, Yasaman, Mojtaba, Khazaei, Isaac, Christian F, Biller, Jose, Di Napoli, Mario, and Azarpazhooh, M Reza

Abstract

BackgroundThere is little information regarding the safety of intravenous tissue plasminogen activator (IV-tPA) in patients with stroke and COVID-19.MethodsThis multicenter study included consecutive stroke patients with and without COVID-19 treated with IV-tPA between February 18, 2019, to December 31, 2020, at 9 centers participating in the CASCADE initiative. Clinical outcomes included modified Rankin Scale (mRS) at hospital discharge, in-hospital mortality, the rate of hemorrhagic transformation. Using Bayesian multiple regression and after adjusting for variables with significant value in univariable analysis, we reported the posterior adjusted odds ratio (OR, with 95% Credible Intervals [CrI]) of the main outcomes.ResultsA total of 545 stroke patients, including 101 patients with COVID-19 were evaluated. Patients with COVID-19 had a more severe stroke at admission. In the study cohort, 85 (15.9%) patients had a hemorrhagic transformation, and 72 (13.1%) died in the hospital. After adjustment for confounding variables, discharge mRS score ≥2 (OR: 0.73, 95% CrI: 0.16, 3.05), in-hospital mortality (OR: 2.06, 95% CrI: 0.76, 5.53), and hemorrhagic transformation (OR: 1.514, 95% CrI: 0.66, 3.31) were similar in COVID-19 and non COVID-19 patients. High-sensitivity C reactive protein level was a predictor of hemorrhagic transformation in all cases (OR:1.01, 95%CI: 1.0026, 1.018), including those with COVID-19 (OR:1.024, 95%CI:1.002, 1.054).ConclusionIV-tPA treatment in patients with acute ischemic stroke and COVID-19 was not associated with an increased risk of disability, mortality, and hemorrhagic transformation compared to those without COVID-19. IV-tPA should continue to be considered as the standard of care in patients with hyper acute stroke and COVID-19.

Published
2021

7. Safety and Outcomes of Intravenous Thrombolytic Therapy in Ischemic Stroke Patients with COVID-19: CASCADE Initiative.

Author

Sasanejad, Payam, Sasanejad, Payam, Afshar Hezarkhani, Leila, Arsang-Jang, Shahram, Tsivgoulis, Georgios, Ghoreishi, Abdoreza, Kristian, Barlinn, Rahmig, Jan, Farhoudi, Mehdi, Sadeghi Hokmabadi, Elyar, Borhani-Haghighi, Afshin, Sariaslani, Payam, Sharifi-Razavi, Athena, Ghandehari, Kavian, Khosravi, Alireza, Smith, Craig, Nilanont, Yongchai, Akbari, Yama, Nguyen, Thanh N, Bersano, Anna, Yassi, Nawaf, Yoshimoto, Takeshi, Lattanzi, Simona, Gupta, Animesh, Zand, Ramin, Rafie, Shahram, Pourandokht Mousavian, Seyede, Reza Shahsavaripour, Mohammad, Amini, Shahram, Kamenova, Saltanat U, Kondybayeva, Aida, Zhanuzakov, Murat, Macri, Elizabeth M, Nobleza, Christa O'Hana S, Ruland, Sean, Cervantes-Arslanian, Anna M, Desai, Masoom J, Ranta, Annemarei, Moghadam Ahmadi, Amir, Rostamihosseinkhani, Mahtab, Foroughi, Razieh, Hooshmandi, Etrat, Akhoundi, Fahimeh H, Shuaib, Ashfaq, Liebeskind, David S, Siegler, James, Romano, Jose G, Mayer, Stephan A, Bavarsad Shahripour, Reza, Zamani, Babak, Woolsey, Amadene, Fazli, Yasaman, Mojtaba, Khazaei, Isaac, Christian F, Biller, Jose, Di Napoli, Mario, Azarpazhooh, M Reza, Sasanejad, Payam, Sasanejad, Payam, Afshar Hezarkhani, Leila, Arsang-Jang, Shahram, Tsivgoulis, Georgios, Ghoreishi, Abdoreza, Kristian, Barlinn, Rahmig, Jan, Farhoudi, Mehdi, Sadeghi Hokmabadi, Elyar, Borhani-Haghighi, Afshin, Sariaslani, Payam, Sharifi-Razavi, Athena, Ghandehari, Kavian, Khosravi, Alireza, Smith, Craig, Nilanont, Yongchai, Akbari, Yama, Nguyen, Thanh N, Bersano, Anna, Yassi, Nawaf, Yoshimoto, Takeshi, Lattanzi, Simona, Gupta, Animesh, Zand, Ramin, Rafie, Shahram, Pourandokht Mousavian, Seyede, Reza Shahsavaripour, Mohammad, Amini, Shahram, Kamenova, Saltanat U, Kondybayeva, Aida, Zhanuzakov, Murat, Macri, Elizabeth M, Nobleza, Christa O'Hana S, Ruland, Sean, Cervantes-Arslanian, Anna M, Desai, Masoom J, Ranta, Annemarei, Moghadam Ahmadi, Amir, Rostamihosseinkhani, Mahtab, Foroughi, Razieh, Hooshmandi, Etrat, Akhoundi, Fahimeh H, Shuaib, Ashfaq, Liebeskind, David S, Siegler, James, Romano, Jose G, Mayer, Stephan A, Bavarsad Shahripour, Reza, Zamani, Babak, Woolsey, Amadene, Fazli, Yasaman, Mojtaba, Khazaei, Isaac, Christian F, Biller, Jose, Di Napoli, Mario, and Azarpazhooh, M Reza

Abstract

BackgroundThere is little information regarding the safety of intravenous tissue plasminogen activator (IV-tPA) in patients with stroke and COVID-19.MethodsThis multicenter study included consecutive stroke patients with and without COVID-19 treated with IV-tPA between February 18, 2019, to December 31, 2020, at 9 centers participating in the CASCADE initiative. Clinical outcomes included modified Rankin Scale (mRS) at hospital discharge, in-hospital mortality, the rate of hemorrhagic transformation. Using Bayesian multiple regression and after adjusting for variables with significant value in univariable analysis, we reported the posterior adjusted odds ratio (OR, with 95% Credible Intervals [CrI]) of the main outcomes.ResultsA total of 545 stroke patients, including 101 patients with COVID-19 were evaluated. Patients with COVID-19 had a more severe stroke at admission. In the study cohort, 85 (15.9%) patients had a hemorrhagic transformation, and 72 (13.1%) died in the hospital. After adjustment for confounding variables, discharge mRS score ≥2 (OR: 0.73, 95% CrI: 0.16, 3.05), in-hospital mortality (OR: 2.06, 95% CrI: 0.76, 5.53), and hemorrhagic transformation (OR: 1.514, 95% CrI: 0.66, 3.31) were similar in COVID-19 and non COVID-19 patients. High-sensitivity C reactive protein level was a predictor of hemorrhagic transformation in all cases (OR:1.01, 95%CI: 1.0026, 1.018), including those with COVID-19 (OR:1.024, 95%CI:1.002, 1.054).ConclusionIV-tPA treatment in patients with acute ischemic stroke and COVID-19 was not associated with an increased risk of disability, mortality, and hemorrhagic transformation compared to those without COVID-19. IV-tPA should continue to be considered as the standard of care in patients with hyper acute stroke and COVID-19.

Published
2021

8. Regular physical activity postpones age of occurrence of first-ever stroke and improves long-term outcomes.

Author

Morovatdar N., Di Napoli M., Stranges S., Thrift A.G., Kapral M., Behrouz R., Farzadfard M.T., Andalibi M.S.S., Oskooie R.R., Sawant A., Mokhber N., Azarpazhooh M.R., Morovatdar N., Di Napoli M., Stranges S., Thrift A.G., Kapral M., Behrouz R., Farzadfard M.T., Andalibi M.S.S., Oskooie R.R., Sawant A., Mokhber N., and Azarpazhooh M.R.

Abstract

Objective: Few data are available on the associations between the level of pre-stroke physical activity and long-term outcomes in patients with stroke. This study is designed to assess the associations between pre-stroke physical activity and age of first-ever stroke occurrence and long-term outcomes. Method(s): Six hundred twenty-four cases with first-ever stroke were recruited from the Mashhad Stroke Incidence Study a prospective population-based cohort in Iran. Data on Physical Activity Level (PAL) were collected retrospectively and were available in 395 cases. According to the PAL values, subjects were classified as inactive (PAL < 1.70) and active (PAL >= 1.70). Age at onset of stroke was compared between active and inactive groups. Using logistic model, we assessed association between pre-stroke physical activity and long-term (5-year) mortality, recurrence, disability, and functional dependency rates. We used multiple imputation to analyze missing data. Result(s): Inactive patients (PAL < 1.70) were more than 6 years younger at their age of first-ever-stroke occurrence (60.7 +/- 15.5) than active patients (67.0 +/- 13.2; p < 0.001). Patients with PAL< 1.7 also had a greater risk of mortality at 1 year [adjusted odds ratio (aOR) = 2.31; 95%CI: 1.14-4.67, p = 0.02] and 5 years after stroke (aOR = 1.81; 95%CI: 1.05-3.14, p = 0.03) than patients who were more physically active. Recurrence rate, disability, and functional dependency were not statistically different between two groups. Missing data analysis also showed a higher odds of death at one and 5 years for inactive patients. Conclusion(s): In our cohort, we observed a younger age of stroke and a higher odds of 1- and 5-year mortality among those with less physical activity. This is an important health promotion strategy to encourage people to remain physically active.Copyright © 2020, Fondazione Societa Italiana di Neurologia.

Published
2021

9. Case-Fatality and Functional Outcome after Subarachnoid Hemorrhage (SAH) in INternational STRoke oUtComes sTudy (INSTRUCT).

Author

Rehman S., Phan H.T., Reeves M.J., Thrift A.G., Cadilhac D.A., Sturm J., Breslin M., Callisaya M.L., Vemmos K., Parmar P., Krishnamurthi R.V., Barker-Collo S., Feigin V., Chausson N., Olindo S., Cabral N.L., Carolei A., Marini C., Degan D., Sacco S., Correia M., Appelros P., Korv J., Vibo R., Minelli C., Sposato L., Pandian J.D., Kaur P., Azarpazhooh M.R., Morovatdar N., Gall S., Rehman S., Phan H.T., Reeves M.J., Thrift A.G., Cadilhac D.A., Sturm J., Breslin M., Callisaya M.L., Vemmos K., Parmar P., Krishnamurthi R.V., Barker-Collo S., Feigin V., Chausson N., Olindo S., Cabral N.L., Carolei A., Marini C., Degan D., Sacco S., Correia M., Appelros P., Korv J., Vibo R., Minelli C., Sposato L., Pandian J.D., Kaur P., Azarpazhooh M.R., Morovatdar N., and Gall S.

Abstract

Background: There are few large population-based studies of outcomes after subarachnoid hemorrhage (SAH) than other stroke types. Method(s): We pooled data from 13 population-based stroke incidence studies (10 studies from the INternational STRroke oUtComes sTudy (INSTRUCT) and 3 new studies; N=657). Primary outcomes were case-fatality and functional outcome (modified Rankin scale score 3-5 [poor] vs. 0-2 [good]). Harmonized patient-level factors included age, sex, health behaviours (e.g. current smoking at baseline), comorbidities (e.g.history of hypertension), baseline stroke severity (e.g. NIHSS >7) and year of stroke. We estimated predictors of case-fatality and functional outcome using Poisson regression and generalized estimating equations using log-binomial models respectively at multiple timepoints. Result(s): Case-fatality rate was 33% at 1 month, 43% at 1 year, and 47% at 5 years. Poor functional outcome was present in 27% of survivors at 1 month and 15% at 1 year. In multivariable analysis, predictors of death at 1-month were age (per decade increase MRR 1.14 [1.07-1.22]) and SAH severity (MRR 1.87 [1.50-2.33]); at 1 year were age (MRR 1.53 [1.34-1.56]), current smoking (MRR 1.82 [1.20-2.72]) and SAH severity (MRR 3.00 [2.06-4.33]) and; at 5 years were age (MRR 1.63 [1.45-1.84]), current smoking (MRR 2.29 [1.54-3.46]) and severity of SAH (MRR 2.10 [1.44-3.05]). Predictors of poor functional outcome at 1 month were age (per decade increase RR 1.32 [1.11-1.56]) and SAH severity (RR 1.85 [1.06-3.23]), and SAH severity (RR 7.09 [3.17-15.85]) at 1 year. Conclusion(s): Although age is a non-modifiable risk factor for poor outcomes after SAH, however, severity of SAH and smoking are potential targets to improve the outcomes.Copyright © 2021 Elsevier Inc.

Published
2021

10. Self-perceived acute psychological stress and risk of mortality, recurrence and disability after stroke: Mashhad Stroke Incidence Study.

Author

Mokhber N., Sheikh Andalibi M.S., Morovatdar N., Thrift A.G., Kapral M.K., Stranges S., Saber H., Farzadfard M.T., Amiri A., Akbarzadeh F., Ghanei N., Khorram B., Azarpazhooh M.R., Mokhber N., Sheikh Andalibi M.S., Morovatdar N., Thrift A.G., Kapral M.K., Stranges S., Saber H., Farzadfard M.T., Amiri A., Akbarzadeh F., Ghanei N., Khorram B., and Azarpazhooh M.R.

Abstract

This longitudinal study was designed to evaluate the association between acute pre-stroke stress and the severity stroke and its outcomes including mortality, recurrence, disability and functional dependency. Patients with first-ever stroke (FES) were recruited from the Mashhad Stroke Incidence Study. Patients were asked about any acute severe pre-stroke stress in the 2 weeks prior to index stroke. Disability and functional disability were defined using modified the Rankin Scale and Barthel Index, respectively. We used logistic and ordinal regression tests to assess the association between acute pre-stroke stress and study outcomes. Among 624 patients with FES, 169 reported acute pre-stroke stress. Patients with acute pre-stroke stress were younger than those without stress (60.7 +/- 14.4 vs. 66.2 +/- 14.7; p < 0.001). The frequency of traditional vascular risk factors was not different in patients with and without acute pre-stroke stress. We did not find any association between acute pre-stroke stress and stroke outcomes. Although acute stress was common in our cohort, our results did not support an association between acute pre-stroke stress and the severity of stroke at admission and long-term stroke outcomes.Copyright © 2021 John Wiley & Sons Ltd.

Published
2021

11. Regular physical activity postpones age of occurrence of first-ever stroke and improves long-term outcomes.

Author

Morovatdar N., Di Napoli M., Stranges S., Thrift A.G., Kapral M., Behrouz R., Farzadfard M.T., Andalibi M.S.S., Oskooie R.R., Sawant A., Mokhber N., Azarpazhooh M.R., Morovatdar N., Di Napoli M., Stranges S., Thrift A.G., Kapral M., Behrouz R., Farzadfard M.T., Andalibi M.S.S., Oskooie R.R., Sawant A., Mokhber N., and Azarpazhooh M.R.

Abstract

Objective: Few data are available on the associations between the level of pre-stroke physical activity and long-term outcomes in patients with stroke. This study is designed to assess the associations between pre-stroke physical activity and age of first-ever stroke occurrence and long-term outcomes. Method(s): Six hundred twenty-four cases with first-ever stroke were recruited from the Mashhad Stroke Incidence Study a prospective population-based cohort in Iran. Data on Physical Activity Level (PAL) were collected retrospectively and were available in 395 cases. According to the PAL values, subjects were classified as inactive (PAL < 1.70) and active (PAL >= 1.70). Age at onset of stroke was compared between active and inactive groups. Using logistic model, we assessed association between pre-stroke physical activity and long-term (5-year) mortality, recurrence, disability, and functional dependency rates. We used multiple imputation to analyze missing data. Result(s): Inactive patients (PAL < 1.70) were more than 6 years younger at their age of first-ever-stroke occurrence (60.7 +/- 15.5) than active patients (67.0 +/- 13.2; p < 0.001). Patients with PAL< 1.7 also had a greater risk of mortality at 1 year [adjusted odds ratio (aOR) = 2.31; 95%CI: 1.14-4.67, p = 0.02] and 5 years after stroke (aOR = 1.81; 95%CI: 1.05-3.14, p = 0.03) than patients who were more physically active. Recurrence rate, disability, and functional dependency were not statistically different between two groups. Missing data analysis also showed a higher odds of death at one and 5 years for inactive patients. Conclusion(s): In our cohort, we observed a younger age of stroke and a higher odds of 1- and 5-year mortality among those with less physical activity. This is an important health promotion strategy to encourage people to remain physically active.Copyright © 2020, Fondazione Societa Italiana di Neurologia.

Published
2021

12. Case-Fatality and Functional Outcome after Subarachnoid Hemorrhage (SAH) in INternational STRoke oUtComes sTudy (INSTRUCT).

Author

Rehman S., Phan H.T., Reeves M.J., Thrift A.G., Cadilhac D.A., Sturm J., Breslin M., Callisaya M.L., Vemmos K., Parmar P., Krishnamurthi R.V., Barker-Collo S., Feigin V., Chausson N., Olindo S., Cabral N.L., Carolei A., Marini C., Degan D., Sacco S., Correia M., Appelros P., Korv J., Vibo R., Minelli C., Sposato L., Pandian J.D., Kaur P., Azarpazhooh M.R., Morovatdar N., Gall S., Rehman S., Phan H.T., Reeves M.J., Thrift A.G., Cadilhac D.A., Sturm J., Breslin M., Callisaya M.L., Vemmos K., Parmar P., Krishnamurthi R.V., Barker-Collo S., Feigin V., Chausson N., Olindo S., Cabral N.L., Carolei A., Marini C., Degan D., Sacco S., Correia M., Appelros P., Korv J., Vibo R., Minelli C., Sposato L., Pandian J.D., Kaur P., Azarpazhooh M.R., Morovatdar N., and Gall S.

Abstract

Background: There are few large population-based studies of outcomes after subarachnoid hemorrhage (SAH) than other stroke types. Method(s): We pooled data from 13 population-based stroke incidence studies (10 studies from the INternational STRroke oUtComes sTudy (INSTRUCT) and 3 new studies; N=657). Primary outcomes were case-fatality and functional outcome (modified Rankin scale score 3-5 [poor] vs. 0-2 [good]). Harmonized patient-level factors included age, sex, health behaviours (e.g. current smoking at baseline), comorbidities (e.g.history of hypertension), baseline stroke severity (e.g. NIHSS >7) and year of stroke. We estimated predictors of case-fatality and functional outcome using Poisson regression and generalized estimating equations using log-binomial models respectively at multiple timepoints. Result(s): Case-fatality rate was 33% at 1 month, 43% at 1 year, and 47% at 5 years. Poor functional outcome was present in 27% of survivors at 1 month and 15% at 1 year. In multivariable analysis, predictors of death at 1-month were age (per decade increase MRR 1.14 [1.07-1.22]) and SAH severity (MRR 1.87 [1.50-2.33]); at 1 year were age (MRR 1.53 [1.34-1.56]), current smoking (MRR 1.82 [1.20-2.72]) and SAH severity (MRR 3.00 [2.06-4.33]) and; at 5 years were age (MRR 1.63 [1.45-1.84]), current smoking (MRR 2.29 [1.54-3.46]) and severity of SAH (MRR 2.10 [1.44-3.05]). Predictors of poor functional outcome at 1 month were age (per decade increase RR 1.32 [1.11-1.56]) and SAH severity (RR 1.85 [1.06-3.23]), and SAH severity (RR 7.09 [3.17-15.85]) at 1 year. Conclusion(s): Although age is a non-modifiable risk factor for poor outcomes after SAH, however, severity of SAH and smoking are potential targets to improve the outcomes.Copyright © 2021 Elsevier Inc.

Published
2021

13. SARS-CoV-2 Is a Culprit for Some, but Not All Acute Ischemic Strokes: A Report from the Multinational COVID-19 Stroke Study Group

Author

Shahjouei, Shima, Anyaehie, Michelle, Koza, Eric, Tsivgoulis, Georgios, Naderi, Soheil, Mowla, Ashkan, Avula, Venkatesh, Vafaei Sadr, Alireza, Chaudhary, Durgesh, Farahmand, Ghasem, Griessenauer, Christoph J., Azarpazhooh, Mahmoud Reza, Misra, Debdipto, Li, Jiang, Abedi, Vida, Zand, Ramin, Shahjouei, Shima, Anyaehie, Michelle, Koza, Eric, Tsivgoulis, Georgios, Naderi, Soheil, Mowla, Ashkan, Avula, Venkatesh, Vafaei Sadr, Alireza, Chaudhary, Durgesh, Farahmand, Ghasem, Griessenauer, Christoph J., Azarpazhooh, Mahmoud Reza, Misra, Debdipto, Li, Jiang, Abedi, Vida, and Zand, Ramin

Abstract

Background. SARS-CoV-2 infected patients are suggested to have a higher incidence of thrombotic events such as acute ischemic strokes (AIS). This study aimed at exploring vascular comorbidity patterns among SARS-CoV-2 infected patients with subsequent stroke. We also investigated whether the comorbidities and their frequencies under each subclass of TOAST criteria were similar to the AIS population studies prior to the pandemic. Methods. This is a report from the Multinational COVID-19 Stroke Study Group. We present an original dataset of SASR-CoV-2 infected patients who had a subsequent stroke recorded through our multicenter prospective study. In addition, we built a dataset of previously reported patients by conducting a systematic literature review. We demonstrated distinct subgroups by clinical risk scoring models and unsupervised machine learning algorithms, including hierarchical K-Means (ML-K) and Spectral clustering (ML-S). Results. This study included 323 AIS patients from 71 centers in 17 countries from the original dataset and 145 patients reported in the literature. The unsupervised clustering methods suggest a distinct cohort of patients (ML-K: 36% and ML-S: 42%) with no or few comorbidities. These patients were more than 6 years younger than other subgroups and more likely were men (ML-K: 59% and ML-S: 60%). The majority of patients in this subgroup suffered from an embolic-appearing stroke on imaging (ML-K: 83% and ML-S: 85%) and had about 50% risk of large vessel occlusions (ML-K: 50% and ML-S: 53%). In addition, there were two cohorts of patients with large-artery atherosclerosis (ML-K: 30% and ML-S: 43% of patients) and cardioembolic strokes (ML-K: 34% and ML-S: 15%) with consistent comorbidity and imaging patterns. Binominal logistic regression demonstrated that ischemic heart disease (odds ratio (OR), 4.9; 95% confidence interval (CI), 1.6-14.7), atrial fibrillation (OR, 14.0; 95% CI, 4.8-40.8), and active neoplasm (OR, 7.1; 95% CI, 1.4-36.2) we

Published
2021
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14. Trends in ischemic stroke outcomes in a rural population in the United States

Author

Chaudhary, Durgesh, Khan, Ayesha, Shahjouei, Shima, Gupta, Mudit, Lambert, Clare, Avula, Venkatesh, Schirmer, Clemens M., Holland, Neil R., Griessenauer, Christoph J., Azarpazhooh, Mahmoud Reza, Li, Jiang, Abedi, Vida, Zand, Ramin, Chaudhary, Durgesh, Khan, Ayesha, Shahjouei, Shima, Gupta, Mudit, Lambert, Clare, Avula, Venkatesh, Schirmer, Clemens M., Holland, Neil R., Griessenauer, Christoph J., Azarpazhooh, Mahmoud Reza, Li, Jiang, Abedi, Vida, and Zand, Ramin

Abstract

Introduction: The stroke mortality rate has gradually declined due to improved interventions and controlled risk factors. We investigated the associated factors and trends in recurrence and all-cause mortality in ischemic stroke patients from a rural population in the United States between 2004 and 2018. Methods: This was a retrospective cohort study based on electronic health records (EHR) data. A comprehensive stroke database called ?Geisinger NeuroScience Ischemic Stroke (GNSIS)? was built for this study. Clinical data were extracted from multiple sources, including EHR and quality data. Results: The cohort included in the study comprised of 8561 consecutive ischemic stroke patients (mean age: 70.1 ? 13.9 years, men: 51.6%, 95.1% Caucasian). Hypertension was the most prevalent risk factor (75.2%). The one-year recurrence and all-cause mortality rates were 6.3% and 16.1%, respectively. Although the one-year stroke recurrence increased during the study period, the one-year stroke mortality rate decreased significantly. Age 65 years, atrial fibrillation or flutter, heart failure, and prior ischemic stroke were independently associated with one-year all-cause mortality in stratified Cox proportional hazards model. In the Cause-specific hazard model, diabetes, chronic kidney disease and age < 65 years were found to be associated with one-year ischemic stroke recurrence. Conclusion: Although all-cause mortality after stroke has decreased, stroke recurrence has significantly increased in stroke patients from rural population between 2004 and 2018. Older age, atrial fibrillation or flutter, heart failure, and prior ischemic stroke were independently associated with one-year all-cause mortality while diabetes, chronic kidney disease and age less than 65 years were predictors of ischemic stroke recurrence.

Published
2021
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15. SARS-CoV-2 and Stroke Characteristics A Report From the Multinational COVID-19 Stroke Study Group

Author

Shahjouei, S, Tsivgoulis, G, Farahmand, G, Koza, E, Mowla, A, Sadr, AV, Kia, A, Far, AV, Mondello, S, Cernigliaro, A, Ranta, A, Punter, M, Khodadadi, F, Naderi, S, Sabra, M, Ramezani, M, Harandi, AA, Olulana, O, Chaudhary, D, Lyoubi, A, Campbell, BC, Arenillas, JF, Bock, D, Montaner, J, Neshin, SAS, de Sousa, DA, Tenser, MS, Aires, A, Alfonso, MDL, Alizada, O, Azevedo, E, Goyal, N, Babaeepour, Z, Banihashemi, G, Bonati, LH, Cereda, CW, Chang, JJ, Crnjakovic, M, De Marchis, GM, Del Sette, M, Ebrahimzadeh, SA, Farhoudi, M, Gandoglia, I, Goncalves, B, Griessenauer, CJ, Hanci, MM, Katsanos, AH, Krogias, C, Leker, RR, Lotman, L, Mai, J, Male, S, Malhotra, K, Malojcic, B, Mesquita, T, Ghasemi, AM, Aref, HM, Afshar, ZM, Moon, J, Niemela, M, Jahromi, BR, Nolan, L, Pandhi, A, Park, J-H, Marto, JP, Purroy, F, Ranji-Burachaloo, S, Carreira, NR, Requena, M, Rubiera, M, Sajedi, SA, Sargento-Freitas, J, Sharma, VK, Steiner, T, Tempro, K, Turc, G, Ahmadzadeh, Y, Almasi-Dooghaee, M, Assarzadegan, F, Babazadeh, A, Baharvandat, H, Cardoso, FB, Dev, A, Ghorbani, M, Hamidi, A, Hasheminejad, ZS, Komachali, SH-A, Khorvash, F, Kobeissy, F, Mirkarimi, H, Mohammadi-Vosough, E, Misra, D, Noorian, AR, Nowrouzi-Sohrabi, P, Paybast, S, Poorsaadat, L, Roozbeh, M, Sabayan, B, Salehizadeh, S, Saberi, A, Sepehrnia, M, Vahabizad, F, Yasuda, TA, Ghabaee, M, Rahimian, N, Harirchian, MH, Borhani-Haghighi, A, Azarpazhooh, MR, Arora, R, Ansari, S, Avula, V, Li, J, Abedi, V, Zand, R, Shahjouei, S, Tsivgoulis, G, Farahmand, G, Koza, E, Mowla, A, Sadr, AV, Kia, A, Far, AV, Mondello, S, Cernigliaro, A, Ranta, A, Punter, M, Khodadadi, F, Naderi, S, Sabra, M, Ramezani, M, Harandi, AA, Olulana, O, Chaudhary, D, Lyoubi, A, Campbell, BC, Arenillas, JF, Bock, D, Montaner, J, Neshin, SAS, de Sousa, DA, Tenser, MS, Aires, A, Alfonso, MDL, Alizada, O, Azevedo, E, Goyal, N, Babaeepour, Z, Banihashemi, G, Bonati, LH, Cereda, CW, Chang, JJ, Crnjakovic, M, De Marchis, GM, Del Sette, M, Ebrahimzadeh, SA, Farhoudi, M, Gandoglia, I, Goncalves, B, Griessenauer, CJ, Hanci, MM, Katsanos, AH, Krogias, C, Leker, RR, Lotman, L, Mai, J, Male, S, Malhotra, K, Malojcic, B, Mesquita, T, Ghasemi, AM, Aref, HM, Afshar, ZM, Moon, J, Niemela, M, Jahromi, BR, Nolan, L, Pandhi, A, Park, J-H, Marto, JP, Purroy, F, Ranji-Burachaloo, S, Carreira, NR, Requena, M, Rubiera, M, Sajedi, SA, Sargento-Freitas, J, Sharma, VK, Steiner, T, Tempro, K, Turc, G, Ahmadzadeh, Y, Almasi-Dooghaee, M, Assarzadegan, F, Babazadeh, A, Baharvandat, H, Cardoso, FB, Dev, A, Ghorbani, M, Hamidi, A, Hasheminejad, ZS, Komachali, SH-A, Khorvash, F, Kobeissy, F, Mirkarimi, H, Mohammadi-Vosough, E, Misra, D, Noorian, AR, Nowrouzi-Sohrabi, P, Paybast, S, Poorsaadat, L, Roozbeh, M, Sabayan, B, Salehizadeh, S, Saberi, A, Sepehrnia, M, Vahabizad, F, Yasuda, TA, Ghabaee, M, Rahimian, N, Harirchian, MH, Borhani-Haghighi, A, Azarpazhooh, MR, Arora, R, Ansari, S, Avula, V, Li, J, Abedi, V, and Zand, R

Abstract

[Figure: see text].

Published
2021

16. Trends in ischemic stroke outcomes in a rural population in the United States

Author

Chaudhary, Durgesh, Khan, Ayesha, Shahjouei, Shima, Gupta, Mudit, Lambert, Clare, Avula, Venkatesh, Schirmer, Clemens M., Holland, Neil R., Griessenauer, Christoph J., Azarpazhooh, Mahmoud Reza, Li, Jiang, Abedi, Vida, Zand, Ramin, Chaudhary, Durgesh, Khan, Ayesha, Shahjouei, Shima, Gupta, Mudit, Lambert, Clare, Avula, Venkatesh, Schirmer, Clemens M., Holland, Neil R., Griessenauer, Christoph J., Azarpazhooh, Mahmoud Reza, Li, Jiang, Abedi, Vida, and Zand, Ramin

Abstract

Introduction: The stroke mortality rate has gradually declined due to improved interventions and controlled risk factors. We investigated the associated factors and trends in recurrence and all-cause mortality in ischemic stroke patients from a rural population in the United States between 2004 and 2018. Methods: This was a retrospective cohort study based on electronic health records (EHR) data. A comprehensive stroke database called ?Geisinger NeuroScience Ischemic Stroke (GNSIS)? was built for this study. Clinical data were extracted from multiple sources, including EHR and quality data. Results: The cohort included in the study comprised of 8561 consecutive ischemic stroke patients (mean age: 70.1 ? 13.9 years, men: 51.6%, 95.1% Caucasian). Hypertension was the most prevalent risk factor (75.2%). The one-year recurrence and all-cause mortality rates were 6.3% and 16.1%, respectively. Although the one-year stroke recurrence increased during the study period, the one-year stroke mortality rate decreased significantly. Age 65 years, atrial fibrillation or flutter, heart failure, and prior ischemic stroke were independently associated with one-year all-cause mortality in stratified Cox proportional hazards model. In the Cause-specific hazard model, diabetes, chronic kidney disease and age < 65 years were found to be associated with one-year ischemic stroke recurrence. Conclusion: Although all-cause mortality after stroke has decreased, stroke recurrence has significantly increased in stroke patients from rural population between 2004 and 2018. Older age, atrial fibrillation or flutter, heart failure, and prior ischemic stroke were independently associated with one-year all-cause mortality while diabetes, chronic kidney disease and age less than 65 years were predictors of ischemic stroke recurrence.

Published
2021
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17. SARS-CoV-2 Is a Culprit for Some, but Not All Acute Ischemic Strokes: A Report from the Multinational COVID-19 Stroke Study Group

Author

Shahjouei, Shima, Anyaehie, Michelle, Koza, Eric, Tsivgoulis, Georgios, Naderi, Soheil, Mowla, Ashkan, Avula, Venkatesh, Vafaei Sadr, Alireza, Chaudhary, Durgesh, Farahmand, Ghasem, Griessenauer, Christoph J., Azarpazhooh, Mahmoud Reza, Misra, Debdipto, Li, Jiang, Abedi, Vida, Zand, Ramin, Shahjouei, Shima, Anyaehie, Michelle, Koza, Eric, Tsivgoulis, Georgios, Naderi, Soheil, Mowla, Ashkan, Avula, Venkatesh, Vafaei Sadr, Alireza, Chaudhary, Durgesh, Farahmand, Ghasem, Griessenauer, Christoph J., Azarpazhooh, Mahmoud Reza, Misra, Debdipto, Li, Jiang, Abedi, Vida, and Zand, Ramin

Abstract

Background. SARS-CoV-2 infected patients are suggested to have a higher incidence of thrombotic events such as acute ischemic strokes (AIS). This study aimed at exploring vascular comorbidity patterns among SARS-CoV-2 infected patients with subsequent stroke. We also investigated whether the comorbidities and their frequencies under each subclass of TOAST criteria were similar to the AIS population studies prior to the pandemic. Methods. This is a report from the Multinational COVID-19 Stroke Study Group. We present an original dataset of SASR-CoV-2 infected patients who had a subsequent stroke recorded through our multicenter prospective study. In addition, we built a dataset of previously reported patients by conducting a systematic literature review. We demonstrated distinct subgroups by clinical risk scoring models and unsupervised machine learning algorithms, including hierarchical K-Means (ML-K) and Spectral clustering (ML-S). Results. This study included 323 AIS patients from 71 centers in 17 countries from the original dataset and 145 patients reported in the literature. The unsupervised clustering methods suggest a distinct cohort of patients (ML-K: 36% and ML-S: 42%) with no or few comorbidities. These patients were more than 6 years younger than other subgroups and more likely were men (ML-K: 59% and ML-S: 60%). The majority of patients in this subgroup suffered from an embolic-appearing stroke on imaging (ML-K: 83% and ML-S: 85%) and had about 50% risk of large vessel occlusions (ML-K: 50% and ML-S: 53%). In addition, there were two cohorts of patients with large-artery atherosclerosis (ML-K: 30% and ML-S: 43% of patients) and cardioembolic strokes (ML-K: 34% and ML-S: 15%) with consistent comorbidity and imaging patterns. Binominal logistic regression demonstrated that ischemic heart disease (odds ratio (OR), 4.9; 95% confidence interval (CI), 1.6-14.7), atrial fibrillation (OR, 14.0; 95% CI, 4.8-40.8), and active neoplasm (OR, 7.1; 95% CI, 1.4-36.2) we

Published
2021
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18. Safety and Outcomes of Intravenous Thrombolytic Therapy in Ischemic Stroke Patients with COVID-19: CASCADE Initiative.

Author

Sasanejad, Payam, Sasanejad, Payam, Afshar Hezarkhani, Leila, Arsang-Jang, Shahram, Tsivgoulis, Georgios, Ghoreishi, Abdoreza, Barlinn, Kristian, Rahmig, Jan, Farhoudi, Mehdi, Sadeghi Hokmabadi, Elyar, Borhani-Haghighi, Afshin, Sariaslani, Payam, Sharifi-Razavi, Athena, Ghandehari, Kavian, Khosravi, Alireza, Smith, Craig, Nilanont, Yongchai, Akbari, Yama, Nguyen, Thanh N, Bersano, Anna, Yassi, Nawaf, Yoshimoto, Takeshi, Lattanzi, Simona, Gupta, Animesh, Zand, Ramin, Rafie, Shahram, Pourandokht Mousavian, Seyede, Reza Shahsavaripour, Mohammad, Amini, Shahram, Kamenova, Saltanat U, Kondybayeva, Aida, Zhanuzakov, Murat, Macri, Elizabeth M, Nobleza, Christa O'Hana S, Ruland, Sean, Cervantes-Arslanian, Anna M, Desai, Masoom J, Ranta, Annemarei, Moghadam Ahmadi, Amir, Rostamihosseinkhani, Mahtab, Foroughi, Razieh, Hooshmandi, Etrat, Akhoundi, Fahimeh H, Shuaib, Ashfaq, Liebeskind, David S, Siegler, James, Romano, Jose G, Mayer, Stephan A, Bavarsad Shahripour, Reza, Zamani, Babak, Woolsey, Amadene, Fazli, Yasaman, Mojtaba, Khazaei, Isaac, Christian F, Biller, Jose, Di Napoli, Mario, Azarpazhooh, M Reza, Sasanejad, Payam, Sasanejad, Payam, Afshar Hezarkhani, Leila, Arsang-Jang, Shahram, Tsivgoulis, Georgios, Ghoreishi, Abdoreza, Barlinn, Kristian, Rahmig, Jan, Farhoudi, Mehdi, Sadeghi Hokmabadi, Elyar, Borhani-Haghighi, Afshin, Sariaslani, Payam, Sharifi-Razavi, Athena, Ghandehari, Kavian, Khosravi, Alireza, Smith, Craig, Nilanont, Yongchai, Akbari, Yama, Nguyen, Thanh N, Bersano, Anna, Yassi, Nawaf, Yoshimoto, Takeshi, Lattanzi, Simona, Gupta, Animesh, Zand, Ramin, Rafie, Shahram, Pourandokht Mousavian, Seyede, Reza Shahsavaripour, Mohammad, Amini, Shahram, Kamenova, Saltanat U, Kondybayeva, Aida, Zhanuzakov, Murat, Macri, Elizabeth M, Nobleza, Christa O'Hana S, Ruland, Sean, Cervantes-Arslanian, Anna M, Desai, Masoom J, Ranta, Annemarei, Moghadam Ahmadi, Amir, Rostamihosseinkhani, Mahtab, Foroughi, Razieh, Hooshmandi, Etrat, Akhoundi, Fahimeh H, Shuaib, Ashfaq, Liebeskind, David S, Siegler, James, Romano, Jose G, Mayer, Stephan A, Bavarsad Shahripour, Reza, Zamani, Babak, Woolsey, Amadene, Fazli, Yasaman, Mojtaba, Khazaei, Isaac, Christian F, Biller, Jose, Di Napoli, Mario, and Azarpazhooh, M Reza

Abstract

BackgroundThere is little information regarding the safety of intravenous tissue plasminogen activator (IV-tPA) in patients with stroke and COVID-19.MethodsThis multicenter study included consecutive stroke patients with and without COVID-19 treated with IV-tPA between February 18, 2019, to December 31, 2020, at 9 centers participating in the CASCADE initiative. Clinical outcomes included modified Rankin Scale (mRS) at hospital discharge, in-hospital mortality, the rate of hemorrhagic transformation. Using Bayesian multiple regression and after adjusting for variables with significant value in univariable analysis, we reported the posterior adjusted odds ratio (OR, with 95% Credible Intervals [CrI]) of the main outcomes.ResultsA total of 545 stroke patients, including 101 patients with COVID-19 were evaluated. Patients with COVID-19 had a more severe stroke at admission. In the study cohort, 85 (15.9%) patients had a hemorrhagic transformation, and 72 (13.1%) died in the hospital. After adjustment for confounding variables, discharge mRS score ≥2 (OR: 0.73, 95% CrI: 0.16, 3.05), in-hospital mortality (OR: 2.06, 95% CrI: 0.76, 5.53), and hemorrhagic transformation (OR: 1.514, 95% CrI: 0.66, 3.31) were similar in COVID-19 and non COVID-19 patients. High-sensitivity C reactive protein level was a predictor of hemorrhagic transformation in all cases (OR:1.01, 95%CI: 1.0026, 1.018), including those with COVID-19 (OR:1.024, 95%CI:1.002, 1.054).ConclusionIV-tPA treatment in patients with acute ischemic stroke and COVID-19 was not associated with an increased risk of disability, mortality, and hemorrhagic transformation compared to those without COVID-19. IV-tPA should continue to be considered as the standard of care in patients with hyper acute stroke and COVID-19.

Published
2021

19. SARS-CoV-2 Is a Culprit for Some, but Not All Acute Ischemic Strokes: A Report from the Multinational COVID-19 Stroke Study Group

Author

Fralin Life Sciences Institute, Shahjouei, Shima, Anyaehie, Michelle, Koza, Eric, Tsivgoulis, Georgios, Naderi, Soheil, Mowla, Ashkan, Avula, Venkatesh, Vafaei Sadr, Alireza, Chaudhary, Durgesh, Farahmand, Ghasem, Griessenauer, Christoph J., Azarpazhooh, Mahmoud Reza, Misra, Debdipto, Li, Jiang, Abedi, Vida, Zand, Ramin, Fralin Life Sciences Institute, Shahjouei, Shima, Anyaehie, Michelle, Koza, Eric, Tsivgoulis, Georgios, Naderi, Soheil, Mowla, Ashkan, Avula, Venkatesh, Vafaei Sadr, Alireza, Chaudhary, Durgesh, Farahmand, Ghasem, Griessenauer, Christoph J., Azarpazhooh, Mahmoud Reza, Misra, Debdipto, Li, Jiang, Abedi, Vida, and Zand, Ramin

Abstract

Background. SARS-CoV-2 infected patients are suggested to have a higher incidence of thrombotic events such as acute ischemic strokes (AIS). This study aimed at exploring vascular comorbidity patterns among SARS-CoV-2 infected patients with subsequent stroke. We also investigated whether the comorbidities and their frequencies under each subclass of TOAST criteria were similar to the AIS population studies prior to the pandemic. Methods. This is a report from the Multinational COVID-19 Stroke Study Group. We present an original dataset of SASR-CoV-2 infected patients who had a subsequent stroke recorded through our multicenter prospective study. In addition, we built a dataset of previously reported patients by conducting a systematic literature review. We demonstrated distinct subgroups by clinical risk scoring models and unsupervised machine learning algorithms, including hierarchical K-Means (ML-K) and Spectral clustering (ML-S). Results. This study included 323 AIS patients from 71 centers in 17 countries from the original dataset and 145 patients reported in the literature. The unsupervised clustering methods suggest a distinct cohort of patients (ML-K: 36% and ML-S: 42%) with no or few comorbidities. These patients were more than 6 years younger than other subgroups and more likely were men (ML-K: 59% and ML-S: 60%). The majority of patients in this subgroup suffered from an embolic-appearing stroke on imaging (ML-K: 83% and ML-S: 85%) and had about 50% risk of large vessel occlusions (ML-K: 50% and ML-S: 53%). In addition, there were two cohorts of patients with large-artery atherosclerosis (ML-K: 30% and ML-S: 43% of patients) and cardioembolic strokes (ML-K: 34% and ML-S: 15%) with consistent comorbidity and imaging patterns. Binominal logistic regression demonstrated that ischemic heart disease (odds ratio (OR), 4.9; 95% confidence interval (CI), 1.6-14.7), atrial fibrillation (OR, 14.0; 95% CI, 4.8-40.8), and active neoplasm (OR, 7.1; 95% CI, 1.4-36.2) we

Published
2021

20. Trends in ischemic stroke outcomes in a rural population in the United States

Author

Fralin Life Sciences Institute, Chaudhary, Durgesh, Khan, Ayesha, Shahjouei, Shima, Gupta, Mudit, Lambert, Clare, Avula, Venkatesh, Schirmer, Clemens M., Holland, Neil R., Griessenauer, Christoph J., Azarpazhooh, Mahmoud Reza, Li, Jiang, Abedi, Vida, Zand, Ramin, Fralin Life Sciences Institute, Chaudhary, Durgesh, Khan, Ayesha, Shahjouei, Shima, Gupta, Mudit, Lambert, Clare, Avula, Venkatesh, Schirmer, Clemens M., Holland, Neil R., Griessenauer, Christoph J., Azarpazhooh, Mahmoud Reza, Li, Jiang, Abedi, Vida, and Zand, Ramin

Abstract

Introduction: The stroke mortality rate has gradually declined due to improved interventions and controlled risk factors. We investigated the associated factors and trends in recurrence and all-cause mortality in ischemic stroke patients from a rural population in the United States between 2004 and 2018. Methods: This was a retrospective cohort study based on electronic health records (EHR) data. A comprehensive stroke database called ?Geisinger NeuroScience Ischemic Stroke (GNSIS)? was built for this study. Clinical data were extracted from multiple sources, including EHR and quality data. Results: The cohort included in the study comprised of 8561 consecutive ischemic stroke patients (mean age: 70.1 ? 13.9 years, men: 51.6%, 95.1% Caucasian). Hypertension was the most prevalent risk factor (75.2%). The one-year recurrence and all-cause mortality rates were 6.3% and 16.1%, respectively. Although the one-year stroke recurrence increased during the study period, the one-year stroke mortality rate decreased significantly. Age 65 years, atrial fibrillation or flutter, heart failure, and prior ischemic stroke were independently associated with one-year all-cause mortality in stratified Cox proportional hazards model. In the Cause-specific hazard model, diabetes, chronic kidney disease and age < 65 years were found to be associated with one-year ischemic stroke recurrence. Conclusion: Although all-cause mortality after stroke has decreased, stroke recurrence has significantly increased in stroke patients from rural population between 2004 and 2018. Older age, atrial fibrillation or flutter, heart failure, and prior ischemic stroke were independently associated with one-year all-cause mortality while diabetes, chronic kidney disease and age less than 65 years were predictors of ischemic stroke recurrence.

Published
2021

21. Trends in ischemic stroke outcomes in a rural population in the United States

Author

Fralin Life Sciences Institute, Chaudhary, Durgesh, Khan, Ayesha, Shahjouei, Shima, Gupta, Mudit, Lambert, Clare, Avula, Venkatesh, Schirmer, Clemens M., Holland, Neil R., Griessenauer, Christoph J., Azarpazhooh, Mahmoud Reza, Li, Jiang, Abedi, Vida, Zand, Ramin, Fralin Life Sciences Institute, Chaudhary, Durgesh, Khan, Ayesha, Shahjouei, Shima, Gupta, Mudit, Lambert, Clare, Avula, Venkatesh, Schirmer, Clemens M., Holland, Neil R., Griessenauer, Christoph J., Azarpazhooh, Mahmoud Reza, Li, Jiang, Abedi, Vida, and Zand, Ramin

Abstract

Introduction: The stroke mortality rate has gradually declined due to improved interventions and controlled risk factors. We investigated the associated factors and trends in recurrence and all-cause mortality in ischemic stroke patients from a rural population in the United States between 2004 and 2018. Methods: This was a retrospective cohort study based on electronic health records (EHR) data. A comprehensive stroke database called ?Geisinger NeuroScience Ischemic Stroke (GNSIS)? was built for this study. Clinical data were extracted from multiple sources, including EHR and quality data. Results: The cohort included in the study comprised of 8561 consecutive ischemic stroke patients (mean age: 70.1 ? 13.9 years, men: 51.6%, 95.1% Caucasian). Hypertension was the most prevalent risk factor (75.2%). The one-year recurrence and all-cause mortality rates were 6.3% and 16.1%, respectively. Although the one-year stroke recurrence increased during the study period, the one-year stroke mortality rate decreased significantly. Age 65 years, atrial fibrillation or flutter, heart failure, and prior ischemic stroke were independently associated with one-year all-cause mortality in stratified Cox proportional hazards model. In the Cause-specific hazard model, diabetes, chronic kidney disease and age < 65 years were found to be associated with one-year ischemic stroke recurrence. Conclusion: Although all-cause mortality after stroke has decreased, stroke recurrence has significantly increased in stroke patients from rural population between 2004 and 2018. Older age, atrial fibrillation or flutter, heart failure, and prior ischemic stroke were independently associated with one-year all-cause mortality while diabetes, chronic kidney disease and age less than 65 years were predictors of ischemic stroke recurrence.

Published
2021

22. SARS-CoV-2 Is a Culprit for Some, but Not All Acute Ischemic Strokes: A Report from the Multinational COVID-19 Stroke Study Group

Author

Fralin Life Sciences Institute, Shahjouei, Shima, Anyaehie, Michelle, Koza, Eric, Tsivgoulis, Georgios, Naderi, Soheil, Mowla, Ashkan, Avula, Venkatesh, Vafaei Sadr, Alireza, Chaudhary, Durgesh, Farahmand, Ghasem, Griessenauer, Christoph J., Azarpazhooh, Mahmoud Reza, Misra, Debdipto, Li, Jiang, Abedi, Vida, Zand, Ramin, Fralin Life Sciences Institute, Shahjouei, Shima, Anyaehie, Michelle, Koza, Eric, Tsivgoulis, Georgios, Naderi, Soheil, Mowla, Ashkan, Avula, Venkatesh, Vafaei Sadr, Alireza, Chaudhary, Durgesh, Farahmand, Ghasem, Griessenauer, Christoph J., Azarpazhooh, Mahmoud Reza, Misra, Debdipto, Li, Jiang, Abedi, Vida, and Zand, Ramin

Abstract

Background. SARS-CoV-2 infected patients are suggested to have a higher incidence of thrombotic events such as acute ischemic strokes (AIS). This study aimed at exploring vascular comorbidity patterns among SARS-CoV-2 infected patients with subsequent stroke. We also investigated whether the comorbidities and their frequencies under each subclass of TOAST criteria were similar to the AIS population studies prior to the pandemic. Methods. This is a report from the Multinational COVID-19 Stroke Study Group. We present an original dataset of SASR-CoV-2 infected patients who had a subsequent stroke recorded through our multicenter prospective study. In addition, we built a dataset of previously reported patients by conducting a systematic literature review. We demonstrated distinct subgroups by clinical risk scoring models and unsupervised machine learning algorithms, including hierarchical K-Means (ML-K) and Spectral clustering (ML-S). Results. This study included 323 AIS patients from 71 centers in 17 countries from the original dataset and 145 patients reported in the literature. The unsupervised clustering methods suggest a distinct cohort of patients (ML-K: 36% and ML-S: 42%) with no or few comorbidities. These patients were more than 6 years younger than other subgroups and more likely were men (ML-K: 59% and ML-S: 60%). The majority of patients in this subgroup suffered from an embolic-appearing stroke on imaging (ML-K: 83% and ML-S: 85%) and had about 50% risk of large vessel occlusions (ML-K: 50% and ML-S: 53%). In addition, there were two cohorts of patients with large-artery atherosclerosis (ML-K: 30% and ML-S: 43% of patients) and cardioembolic strokes (ML-K: 34% and ML-S: 15%) with consistent comorbidity and imaging patterns. Binominal logistic regression demonstrated that ischemic heart disease (odds ratio (OR), 4.9; 95% confidence interval (CI), 1.6-14.7), atrial fibrillation (OR, 14.0; 95% CI, 4.8-40.8), and active neoplasm (OR, 7.1; 95% CI, 1.4-36.2) we

Published
2021

23. Call to Action: SARS-CoV-2 and CerebrovAscular DisordErs (CASCADE)

Author

Abootalebi, S. Aertker, B.M. Andalibi, M.S. Asdaghi, N. Aykac, O. Azarpazhooh, M.R. Bahit, M.C. Barlinn, K. Basri, H. Shahripour, R.B. Bersano, A. Biller, J. Borhani-Haghighi, A. Brown, R.D. Campbell, B.C. Cruz-Flores, S. De Silva, D.A. Napoli, M.D. Divani, A.A. Edgell, R.C. Fifi, J.T. Ghoreishi, A. Hirano, T. Hong, K.-S. Hsu, C.Y. Huang, J.F. Inoue, M. Jagolino, A.L. Kapral, M. Kee, H.F. Keser, Z. Khatri, R. Koga, M. Krupinski, J. Liebeskind, D.S. Liu, L. Ma, H. Maud, A. McCullough, L.D. Meyer, D.M. Mifsud, V. Morovatdar, N. Nilanont, Y. Oxley, T.J. Özdemir, A.Ö. Pandian, J. Pantoni, L. Papamitsakis, N.I.H. Parry-Jones, A. Phan, T. Rodriguez, G. Romano, J.G. Sabaa-Ayoun, Z. Saber, H. Sasannezhad, P. Saver, J.L. Scharf, E. Shuaib, A. Silver, B. Singhal, S. Smith, C.J. Stranges, S. Sylaja, P.N. Torbey, M. Toyoda, K. Tsivgoulis, G. Wasay, M. Yassi, N. Yoshimoto, T. Zamani, B. Zand, R. and Abootalebi, S. Aertker, B.M. Andalibi, M.S. Asdaghi, N. Aykac, O. Azarpazhooh, M.R. Bahit, M.C. Barlinn, K. Basri, H. Shahripour, R.B. Bersano, A. Biller, J. Borhani-Haghighi, A. Brown, R.D. Campbell, B.C. Cruz-Flores, S. De Silva, D.A. Napoli, M.D. Divani, A.A. Edgell, R.C. Fifi, J.T. Ghoreishi, A. Hirano, T. Hong, K.-S. Hsu, C.Y. Huang, J.F. Inoue, M. Jagolino, A.L. Kapral, M. Kee, H.F. Keser, Z. Khatri, R. Koga, M. Krupinski, J. Liebeskind, D.S. Liu, L. Ma, H. Maud, A. McCullough, L.D. Meyer, D.M. Mifsud, V. Morovatdar, N. Nilanont, Y. Oxley, T.J. Özdemir, A.Ö. Pandian, J. Pantoni, L. Papamitsakis, N.I.H. Parry-Jones, A. Phan, T. Rodriguez, G. Romano, J.G. Sabaa-Ayoun, Z. Saber, H. Sasannezhad, P. Saver, J.L. Scharf, E. Shuaib, A. Silver, B. Singhal, S. Smith, C.J. Stranges, S. Sylaja, P.N. Torbey, M. Toyoda, K. Tsivgoulis, G. Wasay, M. Yassi, N. Yoshimoto, T. Zamani, B. Zand, R.

Abstract

Background and purpose: The novel severe acute respiratory syndrome coronavirus 2 (SARS-Cov-2), now named coronavirus disease 2019 (COVID-19), may change the risk of stroke through an enhanced systemic inflammatory response, hypercoagulable state, and endothelial damage in the cerebrovascular system. Moreover, due to the current pandemic, some countries have prioritized health resources towards COVID-19 management, making it more challenging to appropriately care for other potentially disabling and fatal diseases such as stroke. The aim of this study is to identify and describe changes in stroke epidemiological trends before, during, and after the COVID-19 pandemic. Methods: This is an international, multicenter, hospital-based study on stroke incidence and outcomes during the COVID-19 pandemic. We will describe patterns in stroke management, stroke hospitalization rate, and stroke severity, subtype (ischemic/hemorrhagic), and outcomes (including in-hospital mortality) in 2020 during COVID-19 pandemic, comparing them with the corresponding data from 2018 and 2019, and subsequently 2021. We will also use an interrupted time series (ITS) analysis to assess the change in stroke hospitalization rates before, during, and after COVID-19, in each participating center. Conclusion: The proposed study will potentially enable us to better understand the changes in stroke care protocols, differential hospitalization rate, and severity of stroke, as it pertains to the COVID-19 pandemic. Ultimately, this will help guide clinical-based policies surrounding COVID-19 and other similar global pandemics to ensure that management of cerebrovascular comorbidity is appropriately prioritized during the global crisis. It will also guide public health guidelines for at-risk populations to reduce risks of complications from such comorbidities. © 2020

Published
2020

24. Longitudinal assessment of carotid plaque texture in three-dimensional ultrasound images based on semi-supervised graph-based dimensionality reduction and feature selection

Author

Lin, Mingquan, Cui, He, Chen, Weifu, van Engelen, Arna, de Bruijne, Marleen, Azarpazhooh, M. Reza, Sohrevardi, Seyed Mojtaba, Spence, J. David, Chiu, Bernard, Lin, Mingquan, Cui, He, Chen, Weifu, van Engelen, Arna, de Bruijne, Marleen, Azarpazhooh, M. Reza, Sohrevardi, Seyed Mojtaba, Spence, J. David, and Chiu, Bernard

Published
2020

25. Stroke Prevention in Older Adults : Recent Advances.

Author

Spence, J David, Azarpazhooh, M Reza, Larsson, Susanna C, Bogiatzi, Chrysi, Hankey, Graeme J, Spence, J David, Azarpazhooh, M Reza, Larsson, Susanna C, Bogiatzi, Chrysi, and Hankey, Graeme J

Abstract

The risks of stroke and dementia increase steeply with age, and both are preventable. At present, the best way to preserve cognitive function is to prevent stroke. Therapeutic nihilism based on age is common and unwarranted. We address recent advances in stroke prevention that could contribute greatly to prevention of stroke and dementia at a time when the aging of the population threatens to markedly increase the incidence of both. Issues discussed: (1) old patients benefit even more from lipid-lowering therapy than do younger patients; (2) patients with stiff arteries are at risk from a target systolic blood pressure <120 mm Hg; (3) the interaction of the intestinal microbiome, age, and renal function has important dietary implications for older adults; (4) anticoagulation with direct-acting oral anticoagulants should be prescribed more to old patients with atrial fibrillation; (5) B vitamins to lower homocysteine prevent stroke; and (6) most old patients in whom intervention is warranted for carotid stenosis would benefit more from endarterectomy than from stenting. An 80-year-old person has much to lose from a stroke and should not have effective therapy withheld on account of age. Lipid-lowering therapy, a more plant-based diet, appropriate anticoagulation or antiplatelet therapy, appropriate blood pressure control, B vitamins to lower homocysteine, and judicious intervention for carotid stenosis could do much to reduce the growing burden of stroke and dementia.

Published
2020
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26. Call to Action: SARS-CoV-2 and CerebrovAscular DisordErs (CASCADE).

Author

Abootalebi, Shahram, Abootalebi, Shahram, Aertker, Benjamin M, Andalibi, Mohammad Sobhan, Asdaghi, Negar, Aykac, Ozlem, Azarpazhooh, M Reza, Bahit, M Cecilia, Barlinn, Kristian, Basri, Hamidon, Shahripour, Reza Bavarsad, Bersano, Anna, Biller, Jose, Borhani-Haghighi, Afshin, Brown, Robert D, Campbell, Bruce Cv, Cruz-Flores, Salvador, De Silva, Deidre Anne, Di Napoli, Mario, Divani, Afshin A, Edgell, Randall C, Fifi, Johanna T, Ghoreishi, Abdoreza, Hirano, Teruyuki, Hong, Keun-Sik, Hsu, Chung Y, Huang, Josephine F, Inoue, Manabu, Jagolino, Amanda L, Kapral, Moira, Kee, Hoo Fan, Keser, Zafer, Khatri, Rakesh, Koga, Masatoshi, Krupinski, Jerzy, Liebeskind, David S, Liu, Liping, Ma, Henry, Maud, Alberto, McCullough, Louise D, Meyer, Dawn Matherne, Mifsud, Victoria, Morovatdar, Negar, Nilanont, Yongchai, Oxley, Thomas J, Özdemir, Atilla Özcan, Pandian, Jeyaraj, Pantoni, Leonardo, Papamitsakis, Nikolaos IH, Parry-Jones, Adrian, Phan, Thanh, Rodriguez, Gustavo, Romano, Jose G, Sabaa-Ayoun, Ziad, Saber, Hamidreza, Sasannezhad, Payam, Saver, Jeffrey L, Scharf, Eugene, Shuaib, Ashfaq, Silver, Brian, Singhal, Shaloo, Smith, Craig J, Stranges, Saverio, Sylaja, PN, Torbey, Michel, Toyoda, Kazunori, Tsivgoulis, Georgios, Wasay, Mohammad, Yassi, Nawaf, Yoshimoto, Takeshi, Zamani, Babak, Zand, Ramin, Abootalebi, Shahram, Abootalebi, Shahram, Aertker, Benjamin M, Andalibi, Mohammad Sobhan, Asdaghi, Negar, Aykac, Ozlem, Azarpazhooh, M Reza, Bahit, M Cecilia, Barlinn, Kristian, Basri, Hamidon, Shahripour, Reza Bavarsad, Bersano, Anna, Biller, Jose, Borhani-Haghighi, Afshin, Brown, Robert D, Campbell, Bruce Cv, Cruz-Flores, Salvador, De Silva, Deidre Anne, Di Napoli, Mario, Divani, Afshin A, Edgell, Randall C, Fifi, Johanna T, Ghoreishi, Abdoreza, Hirano, Teruyuki, Hong, Keun-Sik, Hsu, Chung Y, Huang, Josephine F, Inoue, Manabu, Jagolino, Amanda L, Kapral, Moira, Kee, Hoo Fan, Keser, Zafer, Khatri, Rakesh, Koga, Masatoshi, Krupinski, Jerzy, Liebeskind, David S, Liu, Liping, Ma, Henry, Maud, Alberto, McCullough, Louise D, Meyer, Dawn Matherne, Mifsud, Victoria, Morovatdar, Negar, Nilanont, Yongchai, Oxley, Thomas J, Özdemir, Atilla Özcan, Pandian, Jeyaraj, Pantoni, Leonardo, Papamitsakis, Nikolaos IH, Parry-Jones, Adrian, Phan, Thanh, Rodriguez, Gustavo, Romano, Jose G, Sabaa-Ayoun, Ziad, Saber, Hamidreza, Sasannezhad, Payam, Saver, Jeffrey L, Scharf, Eugene, Shuaib, Ashfaq, Silver, Brian, Singhal, Shaloo, Smith, Craig J, Stranges, Saverio, Sylaja, PN, Torbey, Michel, Toyoda, Kazunori, Tsivgoulis, Georgios, Wasay, Mohammad, Yassi, Nawaf, Yoshimoto, Takeshi, Zamani, Babak, and Zand, Ramin

Abstract

Background and purposeThe novel severe acute respiratory syndrome coronavirus 2 (SARS-Cov-2), now named coronavirus disease 2019 (COVID-19), may change the risk of stroke through an enhanced systemic inflammatory response, hypercoagulable state, and endothelial damage in the cerebrovascular system. Moreover, due to the current pandemic, some countries have prioritized health resources towards COVID-19 management, making it more challenging to appropriately care for other potentially disabling and fatal diseases such as stroke. The aim of this study is to identify and describe changes in stroke epidemiological trends before, during, and after the COVID-19 pandemic.MethodsThis is an international, multicenter, hospital-based study on stroke incidence and outcomes during the COVID-19 pandemic. We will describe patterns in stroke management, stroke hospitalization rate, and stroke severity, subtype (ischemic/hemorrhagic), and outcomes (including in-hospital mortality) in 2020 during COVID-19 pandemic, comparing them with the corresponding data from 2018 and 2019, and subsequently 2021. We will also use an interrupted time series (ITS) analysis to assess the change in stroke hospitalization rates before, during, and after COVID-19, in each participating center.ConclusionThe proposed study will potentially enable us to better understand the changes in stroke care protocols, differential hospitalization rate, and severity of stroke, as it pertains to the COVID-19 pandemic. Ultimately, this will help guide clinical-based policies surrounding COVID-19 and other similar global pandemics to ensure that management of cerebrovascular comorbidity is appropriately prioritized during the global crisis. It will also guide public health guidelines for at-risk populations to reduce risks of complications from such comorbidities.

Published
2020

27. Stroke Care Trends During COVID-19 Pandemic in Zanjan Province, Iran. From the CASCADE Initiative: Statistical Analysis Plan and Preliminary Results.

Author

Ghoreishi, Abdoreza, Ghoreishi, Abdoreza, Arsang-Jang, Shahram, Sabaa-Ayoun, Ziad, Yassi, Nawaf, Sylaja, PN, Akbari, Yama, Divani, Afshin A, Biller, Jose, Phan, Thanh, Steinwender, Sandy, Silver, Brian, Zand, Ramin, Basri, Hamidon Bin, Iqbal, Omer M, Ranta, Annemarei, Ruland, Sean, Macri, Elizabeth, Ma, Henry, Nguyen, Thanh N, Abootalebi, Shahram, Gupta, Animesh, Alet, Matias, Lattanzi, Simona, Desai, Masoom, Gagliardi, Rubens J, Girotra, Tarun, Inoue, Manabu, Yoshimoto, Takeshi, Isaac, Cristian Flavo, Mayer, Stephan A, Morovatdar, Negar, Nilanont, Yongchai, Nobleza, Christa O'Hana S, Saber, Hamidreza, Kamenova, Saltanat, Kondybayeva, Aida, Krupinski, Jerzy, Siegler, James E, Stranges, Saverio, Torbey, Michel T, Yorio, Diana, Zurrú, María Cristina, Rubinos, Clio Aracelli, Shahripour, Reza Bavarsad, Borhani-Haghighi, Afshin, Napoli, Mario Di, Azarpazhooh, M Reza, Ghoreishi, Abdoreza, Ghoreishi, Abdoreza, Arsang-Jang, Shahram, Sabaa-Ayoun, Ziad, Yassi, Nawaf, Sylaja, PN, Akbari, Yama, Divani, Afshin A, Biller, Jose, Phan, Thanh, Steinwender, Sandy, Silver, Brian, Zand, Ramin, Basri, Hamidon Bin, Iqbal, Omer M, Ranta, Annemarei, Ruland, Sean, Macri, Elizabeth, Ma, Henry, Nguyen, Thanh N, Abootalebi, Shahram, Gupta, Animesh, Alet, Matias, Lattanzi, Simona, Desai, Masoom, Gagliardi, Rubens J, Girotra, Tarun, Inoue, Manabu, Yoshimoto, Takeshi, Isaac, Cristian Flavo, Mayer, Stephan A, Morovatdar, Negar, Nilanont, Yongchai, Nobleza, Christa O'Hana S, Saber, Hamidreza, Kamenova, Saltanat, Kondybayeva, Aida, Krupinski, Jerzy, Siegler, James E, Stranges, Saverio, Torbey, Michel T, Yorio, Diana, Zurrú, María Cristina, Rubinos, Clio Aracelli, Shahripour, Reza Bavarsad, Borhani-Haghighi, Afshin, Napoli, Mario Di, and Azarpazhooh, M Reza

Abstract

BackgroundThe emergence of the COVID-19 pandemic has significantly impacted global healthcare systems and this may affect stroke care and outcomes. This study examines the changes in stroke epidemiology and care during the COVID-19 pandemic in Zanjan Province, Iran.MethodsThis study is part of the CASCADE international initiative. From February 18, 2019, to July 18, 2020, we followed ischemic and hemorrhagic stroke hospitalization rates and outcomes in Valiasr Hospital, Zanjan, Iran. We used a Bayesian hierarchical model and an interrupted time series analysis (ITS) to identify changes in stroke hospitalization rate, baseline stroke severity [measured by the National Institutes of Health Stroke Scale (NIHSS)], disability [measured by the modified Rankin Scale (mRS)], presentation time (last seen normal to hospital presentation), thrombolytic therapy rate, median door-to-needle time, length of hospital stay, and in-hospital mortality. We compared in-hospital mortality between study periods using Cox-regression model.ResultsDuring the study period, 1,026 stroke patients were hospitalized. Stroke hospitalization rates per 100,000 population decreased from 68.09 before the pandemic to 44.50 during the pandemic, with a significant decline in both Bayesian [Beta: -1.034; Standard Error (SE): 0.22, 95% CrI: -1.48, -0.59] and ITS analysis (estimate: -1.03, SE = 0.24, p < 0.0001). Furthermore, we observed lower admission rates for patients with mild (NIHSS < 5) ischemic stroke (p < 0.0001). Although, the presentation time and door-to-needle time did not change during the pandemic, a lower proportion of patients received thrombolysis (-10.1%; p = 0.004). We did not see significant changes in admission rate to the stroke unit and in-hospital mortality rate; however, disability at discharge increased (p < 0.0001).ConclusionIn Zanjan, Iran, the COVID-19 pandemic has significantly impacted stroke outcomes and altered the delivery of stroke care. Observed lower admissi

Published
2020

28. Call to Action: SARS-CoV-2 and CerebrovAscular DisordErs (CASCADE).

Author

Inoue M., Parry-Jones A., Phan T., Rodriguez G., Abootalebi S., Aertker B.M., Andalibi M.S., Asdaghi N., Aykac O., Azarpazhooh M.R., Bahit M.C., Barlinn K., Basri H., Shahripour R.B., Bersano A., Biller J., Borhani-Haghighi A., Brown R.D., Campbell B.C., Cruz-Flores S., De Silva D.A., Napoli M.D., Divani A.A., Edgell R.C., Fifi J.T., Ghoreishi A., Hirano T., Hong K.-S., Hsu C.Y., Huang J.F., Jagolino A.L., Kapral M., Kee H.F., Keser Z., Khatri R., Koga M., Krupinski J., Liebeskind D.S., Liu L., Ma H., Maud A., McCullough L.D., Meyer D.M., Mifsud V., Morovatdar N., Nilanont Y., Oxley T.J., Ozdemir A.O., Pandian J., Pantoni L., Papamitsakis N.I.H., Romano J.G., Sabaa-Ayoun Z., Saber H., Sasannezhad P., Saver J.L., Scharf E., Shuaib A., Silver B., Singhal S., Smith C.J., Stranges S., Sylaja P.N., Torbey M., Toyoda K., Tsivgoulis G., Wasay M., Yassi N., Yoshimoto T., Zamani B., Zand R., Inoue M., Parry-Jones A., Phan T., Rodriguez G., Abootalebi S., Aertker B.M., Andalibi M.S., Asdaghi N., Aykac O., Azarpazhooh M.R., Bahit M.C., Barlinn K., Basri H., Shahripour R.B., Bersano A., Biller J., Borhani-Haghighi A., Brown R.D., Campbell B.C., Cruz-Flores S., De Silva D.A., Napoli M.D., Divani A.A., Edgell R.C., Fifi J.T., Ghoreishi A., Hirano T., Hong K.-S., Hsu C.Y., Huang J.F., Jagolino A.L., Kapral M., Kee H.F., Keser Z., Khatri R., Koga M., Krupinski J., Liebeskind D.S., Liu L., Ma H., Maud A., McCullough L.D., Meyer D.M., Mifsud V., Morovatdar N., Nilanont Y., Oxley T.J., Ozdemir A.O., Pandian J., Pantoni L., Papamitsakis N.I.H., Romano J.G., Sabaa-Ayoun Z., Saber H., Sasannezhad P., Saver J.L., Scharf E., Shuaib A., Silver B., Singhal S., Smith C.J., Stranges S., Sylaja P.N., Torbey M., Toyoda K., Tsivgoulis G., Wasay M., Yassi N., Yoshimoto T., Zamani B., and Zand R.

Abstract

Background and purpose: The novel severe acute respiratory syndrome coronavirus 2 (SARS-Cov-2), now named coronavirus disease 2019 (COVID-19), may change the risk of stroke through an enhanced systemic inflammatory response, hypercoagulable state, and endothelial damage in the cerebrovascular system. Moreover, due to the current pandemic, some countries have prioritized health resources towards COVID-19 management, making it more challenging to appropriately care for other potentially disabling and fatal diseases such as stroke. The aim of this study is to identify and describe changes in stroke epidemiological trends before, during, and after the COVID-19 pandemic. Method(s): This is an international, multicenter, hospital-based study on stroke incidence and outcomes during the COVID-19 pandemic. We will describe patterns in stroke management, stroke hospitalization rate, and stroke severity, subtype (ischemic/hemorrhagic), and outcomes (including in-hospital mortality) in 2020 during COVID-19 pandemic, comparing them with the corresponding data from 2018 and 2019, and subsequently 2021. We will also use an interrupted time series (ITS) analysis to assess the change in stroke hospitalization rates before, during, and after COVID-19, in each participating center. Conclusion(s): The proposed study will potentially enable us to better understand the changes in stroke care protocols, differential hospitalization rate, and severity of stroke, as it pertains to the COVID-19 pandemic. Ultimately, this will help guide clinical-based policies surrounding COVID-19 and other similar global pandemics to ensure that management of cerebrovascular comorbidity is appropriately prioritized during the global crisis. It will also guide public health guidelines for at-risk populations to reduce risks of complications from such comorbidities.Copyright © 2020

Published
2020

29. Stroke Care Trends During COVID-19 Pandemic in Zanjan Province, Iran. From the CASCADE Initiative: Statistical Analysis Plan and Preliminary Results.

Author

Siegler J.E., Zurru M.C., Rubinos C.A., Shahripour R.B., Borhani-Haghighi A., Napoli M.D., Azarpazhooh M.R., Ma H., Phan T., Ghoreishi A., Arsang-Jang S., Sabaa-Ayoun Z., Yassi N., Sylaja P.N., Akbari Y., Divani A.A., Biller J., Steinwender S., Silver B., Zand R., Basri H.B., Iqbal O.M., Ranta A., Ruland S., Macri E., Nguyen T.N., Abootalebi S., Gupta A., Alet M., Lattanzi S., Desai M., Gagliardi R.J., Girotra T., Inoue M., Yoshimoto T., Isaac C.F., Mayer S.A., Morovatdar N., Nilanont Y., Nobleza C.O.S., Saber H., Kamenova S., Kondybayeva A., Krupinski J., Stranges S., Torbey M.T., Yorio D., Siegler J.E., Zurru M.C., Rubinos C.A., Shahripour R.B., Borhani-Haghighi A., Napoli M.D., Azarpazhooh M.R., Ma H., Phan T., Ghoreishi A., Arsang-Jang S., Sabaa-Ayoun Z., Yassi N., Sylaja P.N., Akbari Y., Divani A.A., Biller J., Steinwender S., Silver B., Zand R., Basri H.B., Iqbal O.M., Ranta A., Ruland S., Macri E., Nguyen T.N., Abootalebi S., Gupta A., Alet M., Lattanzi S., Desai M., Gagliardi R.J., Girotra T., Inoue M., Yoshimoto T., Isaac C.F., Mayer S.A., Morovatdar N., Nilanont Y., Nobleza C.O.S., Saber H., Kamenova S., Kondybayeva A., Krupinski J., Stranges S., Torbey M.T., and Yorio D.

Abstract

Background: The emergence of the COVID-19 pandemic has significantly impacted global healthcare systems and this may affect stroke care and outcomes. This study examines the changes in stroke epidemiology and care during the COVID-19 pandemic in Zanjan Province, Iran. Method(s): This study is part of the CASCADE international initiative. From February 18, 2019, to July 18, 2020, we followed ischemic and hemorrhagic stroke hospitalization rates and outcomes in Valiasr Hospital, Zanjan, Iran. We used a Bayesian hierarchical model and an interrupted time series analysis (ITS) to identify changes in stroke hospitalization rate, baseline stroke severity [measured by the National Institutes of Health Stroke Scale (NIHSS)], disability [measured by the modified Rankin Scale (mRS)], presentation time (last seen normal to hospital presentation), thrombolytic therapy rate, median door-to-needle time, length of hospital stay, and in-hospital mortality. We compared in-hospital mortality between study periods using Cox-regression model. Result(s): During the study period, 1,026 stroke patients were hospitalized. Stroke hospitalization rates per 100,000 population decreased from 68.09 before the pandemic to 44.50 during the pandemic, with a significant decline in both Bayesian [Beta: -1.034; Standard Error (SE): 0.22, 95% CrI: -1.48, -0.59] and ITS analysis (estimate: -1.03, SE = 0.24, p < 0.0001). Furthermore, we observed lower admission rates for patients with mild (NIHSS < 5) ischemic stroke (p < 0.0001). Although, the presentation time and door-to-needle time did not change during the pandemic, a lower proportion of patients received thrombolysis (-10.1%; p = 0.004). We did not see significant changes in admission rate to the stroke unit and in-hospital mortality rate; however, disability at discharge increased (p < 0.0001). Conclusion(s): In Zanjan, Iran, the COVID-19 pandemic has significantly impacted stroke outcomes and altered the delivery of stroke care. Observed lower a

Published
2020

30. Call to Action: SARS-CoV-2 and CerebrovAscular DisordErs (CASCADE).

Author

Inoue M., Parry-Jones A., Phan T., Rodriguez G., Abootalebi S., Aertker B.M., Andalibi M.S., Asdaghi N., Aykac O., Azarpazhooh M.R., Bahit M.C., Barlinn K., Basri H., Shahripour R.B., Bersano A., Biller J., Borhani-Haghighi A., Brown R.D., Campbell B.C., Cruz-Flores S., De Silva D.A., Napoli M.D., Divani A.A., Edgell R.C., Fifi J.T., Ghoreishi A., Hirano T., Hong K.-S., Hsu C.Y., Huang J.F., Jagolino A.L., Kapral M., Kee H.F., Keser Z., Khatri R., Koga M., Krupinski J., Liebeskind D.S., Liu L., Ma H., Maud A., McCullough L.D., Meyer D.M., Mifsud V., Morovatdar N., Nilanont Y., Oxley T.J., Ozdemir A.O., Pandian J., Pantoni L., Papamitsakis N.I.H., Romano J.G., Sabaa-Ayoun Z., Saber H., Sasannezhad P., Saver J.L., Scharf E., Shuaib A., Silver B., Singhal S., Smith C.J., Stranges S., Sylaja P.N., Torbey M., Toyoda K., Tsivgoulis G., Wasay M., Yassi N., Yoshimoto T., Zamani B., Zand R., Inoue M., Parry-Jones A., Phan T., Rodriguez G., Abootalebi S., Aertker B.M., Andalibi M.S., Asdaghi N., Aykac O., Azarpazhooh M.R., Bahit M.C., Barlinn K., Basri H., Shahripour R.B., Bersano A., Biller J., Borhani-Haghighi A., Brown R.D., Campbell B.C., Cruz-Flores S., De Silva D.A., Napoli M.D., Divani A.A., Edgell R.C., Fifi J.T., Ghoreishi A., Hirano T., Hong K.-S., Hsu C.Y., Huang J.F., Jagolino A.L., Kapral M., Kee H.F., Keser Z., Khatri R., Koga M., Krupinski J., Liebeskind D.S., Liu L., Ma H., Maud A., McCullough L.D., Meyer D.M., Mifsud V., Morovatdar N., Nilanont Y., Oxley T.J., Ozdemir A.O., Pandian J., Pantoni L., Papamitsakis N.I.H., Romano J.G., Sabaa-Ayoun Z., Saber H., Sasannezhad P., Saver J.L., Scharf E., Shuaib A., Silver B., Singhal S., Smith C.J., Stranges S., Sylaja P.N., Torbey M., Toyoda K., Tsivgoulis G., Wasay M., Yassi N., Yoshimoto T., Zamani B., and Zand R.

Abstract

Background and purpose: The novel severe acute respiratory syndrome coronavirus 2 (SARS-Cov-2), now named coronavirus disease 2019 (COVID-19), may change the risk of stroke through an enhanced systemic inflammatory response, hypercoagulable state, and endothelial damage in the cerebrovascular system. Moreover, due to the current pandemic, some countries have prioritized health resources towards COVID-19 management, making it more challenging to appropriately care for other potentially disabling and fatal diseases such as stroke. The aim of this study is to identify and describe changes in stroke epidemiological trends before, during, and after the COVID-19 pandemic. Method(s): This is an international, multicenter, hospital-based study on stroke incidence and outcomes during the COVID-19 pandemic. We will describe patterns in stroke management, stroke hospitalization rate, and stroke severity, subtype (ischemic/hemorrhagic), and outcomes (including in-hospital mortality) in 2020 during COVID-19 pandemic, comparing them with the corresponding data from 2018 and 2019, and subsequently 2021. We will also use an interrupted time series (ITS) analysis to assess the change in stroke hospitalization rates before, during, and after COVID-19, in each participating center. Conclusion(s): The proposed study will potentially enable us to better understand the changes in stroke care protocols, differential hospitalization rate, and severity of stroke, as it pertains to the COVID-19 pandemic. Ultimately, this will help guide clinical-based policies surrounding COVID-19 and other similar global pandemics to ensure that management of cerebrovascular comorbidity is appropriately prioritized during the global crisis. It will also guide public health guidelines for at-risk populations to reduce risks of complications from such comorbidities.Copyright © 2020

Published
2020

31. Stroke Care Trends During COVID-19 Pandemic in Zanjan Province, Iran. From the CASCADE Initiative: Statistical Analysis Plan and Preliminary Results.

Author

Siegler J.E., Zurru M.C., Rubinos C.A., Shahripour R.B., Borhani-Haghighi A., Napoli M.D., Azarpazhooh M.R., Ma H., Phan T., Ghoreishi A., Arsang-Jang S., Sabaa-Ayoun Z., Yassi N., Sylaja P.N., Akbari Y., Divani A.A., Biller J., Steinwender S., Silver B., Zand R., Basri H.B., Iqbal O.M., Ranta A., Ruland S., Macri E., Nguyen T.N., Abootalebi S., Gupta A., Alet M., Lattanzi S., Desai M., Gagliardi R.J., Girotra T., Inoue M., Yoshimoto T., Isaac C.F., Mayer S.A., Morovatdar N., Nilanont Y., Nobleza C.O.S., Saber H., Kamenova S., Kondybayeva A., Krupinski J., Stranges S., Torbey M.T., Yorio D., Siegler J.E., Zurru M.C., Rubinos C.A., Shahripour R.B., Borhani-Haghighi A., Napoli M.D., Azarpazhooh M.R., Ma H., Phan T., Ghoreishi A., Arsang-Jang S., Sabaa-Ayoun Z., Yassi N., Sylaja P.N., Akbari Y., Divani A.A., Biller J., Steinwender S., Silver B., Zand R., Basri H.B., Iqbal O.M., Ranta A., Ruland S., Macri E., Nguyen T.N., Abootalebi S., Gupta A., Alet M., Lattanzi S., Desai M., Gagliardi R.J., Girotra T., Inoue M., Yoshimoto T., Isaac C.F., Mayer S.A., Morovatdar N., Nilanont Y., Nobleza C.O.S., Saber H., Kamenova S., Kondybayeva A., Krupinski J., Stranges S., Torbey M.T., and Yorio D.

Abstract

Background: The emergence of the COVID-19 pandemic has significantly impacted global healthcare systems and this may affect stroke care and outcomes. This study examines the changes in stroke epidemiology and care during the COVID-19 pandemic in Zanjan Province, Iran. Method(s): This study is part of the CASCADE international initiative. From February 18, 2019, to July 18, 2020, we followed ischemic and hemorrhagic stroke hospitalization rates and outcomes in Valiasr Hospital, Zanjan, Iran. We used a Bayesian hierarchical model and an interrupted time series analysis (ITS) to identify changes in stroke hospitalization rate, baseline stroke severity [measured by the National Institutes of Health Stroke Scale (NIHSS)], disability [measured by the modified Rankin Scale (mRS)], presentation time (last seen normal to hospital presentation), thrombolytic therapy rate, median door-to-needle time, length of hospital stay, and in-hospital mortality. We compared in-hospital mortality between study periods using Cox-regression model. Result(s): During the study period, 1,026 stroke patients were hospitalized. Stroke hospitalization rates per 100,000 population decreased from 68.09 before the pandemic to 44.50 during the pandemic, with a significant decline in both Bayesian [Beta: -1.034; Standard Error (SE): 0.22, 95% CrI: -1.48, -0.59] and ITS analysis (estimate: -1.03, SE = 0.24, p < 0.0001). Furthermore, we observed lower admission rates for patients with mild (NIHSS < 5) ischemic stroke (p < 0.0001). Although, the presentation time and door-to-needle time did not change during the pandemic, a lower proportion of patients received thrombolysis (-10.1%; p = 0.004). We did not see significant changes in admission rate to the stroke unit and in-hospital mortality rate; however, disability at discharge increased (p < 0.0001). Conclusion(s): In Zanjan, Iran, the COVID-19 pandemic has significantly impacted stroke outcomes and altered the delivery of stroke care. Observed lower a

Published
2020

32. COVID-19 pandemic and burden of non-communicable diseases: An ecological study on data of 185 countries.

Author

Morovatdar N., Stranges S., Silver B., Biller J., Tokazebani Belasi M., Kazemi Neya S., Khorram B., Frydman A., Nilanont Y., Onorati E., Di Napoli M., Divani A.A., Phan T.G., Azarpazhooh M.R., Yassi N., Avan A., Morovatdar N., Stranges S., Silver B., Biller J., Tokazebani Belasi M., Kazemi Neya S., Khorram B., Frydman A., Nilanont Y., Onorati E., Di Napoli M., Divani A.A., Phan T.G., Azarpazhooh M.R., Yassi N., and Avan A.

Abstract

Background: The interaction between coronavirus disease 2019 (COVID-19) and non-communicable diseases may increase the global burden of disease. We assessed the association of COVID-19 with ageing and non-communicable diseases. Method(s): We extracted data regarding non-communicable disease, particularly cardiovascular disease, deaths, disability-adjusted life years (DALYs), and healthy life expectancy (HALE) from the Global Burden of Disease Study (GBD) 2017. We obtained data of confirmed COVID-19 cases, deaths, and tests from the Our World in Data database as of May 28, 2020. Potential confounders of pandemic outcomes analyzed include institutional lockdown delay, hemispheric geographical location, and number of tourists. We compared all countries according to GBD classification and World Bank income level. We assessed the correlation between independent variables associated with COVID-19 caseload and mortality using Spearman's rank correlation and adjusted mixed model analysis. Finding(s): High-income had the highest, and the Southeast Asia, East Asia, and Oceania region had the least cases per million population (3050.60 vs. 63.86). Sub-saharan region has reported the lowest number of COVID-19 mortality (1.9). Median delay to lockdown initiation varied from one day following the first case in Latin America and Caribbean region, to 34 days in Southeast Asia, East Asia, and Oceania. Globally, non-communicable disease DALYs were correlated with COVID-19 cases (r = 0.32, p<0.001) and deaths (r = 0.37, p<0.001). HALE correlated with COVID-19 cases (r = 0.63, p<0.001) and deaths (r = 0.61, p<0.001). HALE was independently associated with COVID-19 case rate and the number of tourists was associated with COVID-19 mortality in the adjusted model. Interpretation(s): Preventive measures against COVID-19 should protect the public from the dual burden of communicable and non-communicable diseases, particularly in the elderly. In addition to active COVID-19 surveillance, poli

Published
2020

33. Call to Action: SARS-CoV-2 and CerebrovAscular DisordErs (CASCADE)

Author

Abootalebi, S, Aertker, BM, Andalibi, MS, Asdaghi, N, Aykac, O, Azarpazhooh, MR, Bahit, MC, Barlinn, K, Basri, H, Shahripour, RB, Bersano, A, Biller, J, Borhani-Haghighi, A, Brown, RD, Campbell, BC, Cruz-Flores, S, De Silva, DA, Di Napoli, M, Divani, AA, Edgell, RC, Fifi, JT, Ghoreishi, A, Hirano, T, Hong, K-S, Hsu, CY, Huang, JF, Inoue, M, Jagolino, AL, Kapral, M, Kee, HF, Keser, Z, Khatri, R, Koga, M, Krupinski, J, Liebeskind, DS, Liu, L, Ma, H, Maud, A, McCullough, LD, Meyer, DM, Mifsud, V, Morovatdar, N, Nilanont, Y, Oxley, TJ, Ozdemir, AO, Pandian, J, Pantoni, L, Papamitsakis, NIH, Parry-Jones, A, Phan, T, Rodriguez, G, Romano, JG, Sabaa-Ayoun, Z, Saber, H, Sasannezhad, P, Saver, JL, Scharf, E, Shuaib, A, Silver, B, Singhal, S, Smith, CJ, Stranges, S, Sylaja, PN, Torbey, M, Toyoda, K, Tsivgoulis, G, Wasay, M, Yassi, N, Yoshimoto, T, Zamani, B, Zand, R, Abootalebi, S, Aertker, BM, Andalibi, MS, Asdaghi, N, Aykac, O, Azarpazhooh, MR, Bahit, MC, Barlinn, K, Basri, H, Shahripour, RB, Bersano, A, Biller, J, Borhani-Haghighi, A, Brown, RD, Campbell, BC, Cruz-Flores, S, De Silva, DA, Di Napoli, M, Divani, AA, Edgell, RC, Fifi, JT, Ghoreishi, A, Hirano, T, Hong, K-S, Hsu, CY, Huang, JF, Inoue, M, Jagolino, AL, Kapral, M, Kee, HF, Keser, Z, Khatri, R, Koga, M, Krupinski, J, Liebeskind, DS, Liu, L, Ma, H, Maud, A, McCullough, LD, Meyer, DM, Mifsud, V, Morovatdar, N, Nilanont, Y, Oxley, TJ, Ozdemir, AO, Pandian, J, Pantoni, L, Papamitsakis, NIH, Parry-Jones, A, Phan, T, Rodriguez, G, Romano, JG, Sabaa-Ayoun, Z, Saber, H, Sasannezhad, P, Saver, JL, Scharf, E, Shuaib, A, Silver, B, Singhal, S, Smith, CJ, Stranges, S, Sylaja, PN, Torbey, M, Toyoda, K, Tsivgoulis, G, Wasay, M, Yassi, N, Yoshimoto, T, Zamani, B, and Zand, R

Abstract

BACKGROUND AND PURPOSE: The novel severe acute respiratory syndrome coronavirus 2 (SARS-Cov-2), now named coronavirus disease 2019 (COVID-19), may change the risk of stroke through an enhanced systemic inflammatory response, hypercoagulable state, and endothelial damage in the cerebrovascular system. Moreover, due to the current pandemic, some countries have prioritized health resources towards COVID-19 management, making it more challenging to appropriately care for other potentially disabling and fatal diseases such as stroke. The aim of this study is to identify and describe changes in stroke epidemiological trends before, during, and after the COVID-19 pandemic. METHODS: This is an international, multicenter, hospital-based study on stroke incidence and outcomes during the COVID-19 pandemic. We will describe patterns in stroke management, stroke hospitalization rate, and stroke severity, subtype (ischemic/hemorrhagic), and outcomes (including in-hospital mortality) in 2020 during COVID-19 pandemic, comparing them with the corresponding data from 2018 and 2019, and subsequently 2021. We will also use an interrupted time series (ITS) analysis to assess the change in stroke hospitalization rates before, during, and after COVID-19, in each participating center. CONCLUSION: The proposed study will potentially enable us to better understand the changes in stroke care protocols, differential hospitalization rate, and severity of stroke, as it pertains to the COVID-19 pandemic. Ultimately, this will help guide clinical-based policies surrounding COVID-19 and other similar global pandemics to ensure that management of cerebrovascular comorbidity is appropriately prioritized during the global crisis. It will also guide public health guidelines for at-risk populations to reduce risks of complications from such comorbidities.

Published
2020

34. Stroke Care Trends During COVID-19 Pandemic in Zanjan Province, Iran. From the CASCADE Initiative: Statistical Analysis Plan and Preliminary Results

Author

Ghoreishi, A, Arsang-Jang, S, Sabaa-Ayoun, Z, Yassi, N, Sylaja, PN, Akbari, Y, Divani, AA, Biller, J, Thanh, P, Steinwender, S, Silver, B, Zand, R, Bin Basri, H, Iqbal, OM, Ranta, A, Ruland, S, Macri, E, Ma, H, Nguyen, TN, Abootalebi, S, Gupta, A, Alet, M, Lattanzi, S, Desai, M, Gagliardi, RJ, Girotra, T, Inoue, M, Yoshimoto, T, Isaac, CF, Mayer, SA, Morovatdar, N, Nilanont, Y, Nobleza, COS, Saber, H, Kamenova, S, Kondybayeva, A, Krupinski, J, Siegler, JE, Stranges, S, Torbey, MT, Yorio, D, Zurru, MC, Rubinos, CA, Shahripour, RB, Borhani-Haghighi, A, Di Napoli, M, Azarpazhooh, MR, Ghoreishi, A, Arsang-Jang, S, Sabaa-Ayoun, Z, Yassi, N, Sylaja, PN, Akbari, Y, Divani, AA, Biller, J, Thanh, P, Steinwender, S, Silver, B, Zand, R, Bin Basri, H, Iqbal, OM, Ranta, A, Ruland, S, Macri, E, Ma, H, Nguyen, TN, Abootalebi, S, Gupta, A, Alet, M, Lattanzi, S, Desai, M, Gagliardi, RJ, Girotra, T, Inoue, M, Yoshimoto, T, Isaac, CF, Mayer, SA, Morovatdar, N, Nilanont, Y, Nobleza, COS, Saber, H, Kamenova, S, Kondybayeva, A, Krupinski, J, Siegler, JE, Stranges, S, Torbey, MT, Yorio, D, Zurru, MC, Rubinos, CA, Shahripour, RB, Borhani-Haghighi, A, Di Napoli, M, and Azarpazhooh, MR

Abstract

BACKGROUND: The emergence of the COVID-19 pandemic has significantly impacted global healthcare systems and this may affect stroke care and outcomes. This study examines the changes in stroke epidemiology and care during the COVID-19 pandemic in Zanjan Province, Iran. METHODS: This study is part of the CASCADE international initiative. From February 18, 2019, to July 18, 2020, we followed ischemic and hemorrhagic stroke hospitalization rates and outcomes in Valiasr Hospital, Zanjan, Iran. We used a Bayesian hierarchical model and an interrupted time series analysis (ITS) to identify changes in stroke hospitalization rate, baseline stroke severity [measured by the National Institutes of Health Stroke Scale (NIHSS)], disability [measured by the modified Rankin Scale (mRS)], presentation time (last seen normal to hospital presentation), thrombolytic therapy rate, median door-to-needle time, length of hospital stay, and in-hospital mortality. We compared in-hospital mortality between study periods using Cox-regression model. RESULTS: During the study period, 1,026 stroke patients were hospitalized. Stroke hospitalization rates per 100,000 population decreased from 68.09 before the pandemic to 44.50 during the pandemic, with a significant decline in both Bayesian [Beta: -1.034; Standard Error (SE): 0.22, 95% CrI: -1.48, -0.59] and ITS analysis (estimate: -1.03, SE = 0.24, p < 0.0001). Furthermore, we observed lower admission rates for patients with mild (NIHSS < 5) ischemic stroke (p < 0.0001). Although, the presentation time and door-to-needle time did not change during the pandemic, a lower proportion of patients received thrombolysis (-10.1%; p = 0.004). We did not see significant changes in admission rate to the stroke unit and in-hospital mortality rate; however, disability at discharge increased (p < 0.0001). CONCLUSION: In Zanjan, Iran, the COVID-19 pandemic has significantly impacted stroke outcomes and altered the delivery of stroke care. Observed lower admissio

Published
2020

35. COVID-19 Pandemic and Burden of Non-Communicable Diseases: An Ecological Study on Data of 185 Countries

Author

Azarpazhooh, MR, Morovatdar, N, Avan, A, Phan, TG, Divani, AA, Yassi, N, Stranges, S, Silver, B, Biller, J, Belasi, MT, Neya, SK, Khorram, B, Frydman, A, Nilanont, Y, Onorati, E, Di Napoli, M, Azarpazhooh, MR, Morovatdar, N, Avan, A, Phan, TG, Divani, AA, Yassi, N, Stranges, S, Silver, B, Biller, J, Belasi, MT, Neya, SK, Khorram, B, Frydman, A, Nilanont, Y, Onorati, E, and Di Napoli, M

Abstract

BACKGROUND: The interaction between coronavirus disease 2019 (COVID-19) and non-communicable diseases may increase the global burden of disease. We assessed the association of COVID-19 with ageing and non-communicable diseases. METHODS: We extracted data regarding non-communicable disease, particularly cardiovascular disease, deaths, disability-adjusted life years (DALYs), and healthy life expectancy (HALE) from the Global Burden of Disease Study (GBD) 2017. We obtained data of confirmed COVID-19 cases, deaths, and tests from the Our World in Data database as of May 28, 2020. Potential confounders of pandemic outcomes analyzed include institutional lockdown delay, hemispheric geographical location, and number of tourists. We compared all countries according to GBD classification and World Bank income level. We assessed the correlation between independent variables associated with COVID-19 caseload and mortality using Spearman's rank correlation and adjusted mixed model analysis. FINDINGS: High-income had the highest, and the Southeast Asia, East Asia, and Oceania region had the least cases per million population (3050.60 vs. 63.86). Sub-saharan region has reported the lowest number of COVID-19 mortality (1.9). Median delay to lockdown initiation varied from one day following the first case in Latin America and Caribbean region, to 34 days in Southeast Asia, East Asia, and Oceania. Globally, non-communicable disease DALYs were correlated with COVID-19 cases (r = 0.32, p<0.001) and deaths (r = 0.37, p<0.001). HALE correlated with COVID-19 cases (r = 0.63, p<0.001) and deaths (r = 0.61, p<0.001). HALE was independently associated with COVID-19 case rate and the number of tourists was associated with COVID-19 mortality in the adjusted model. INTERPRETATION: Preventive measures against COVID-19 should protect the public from the dual burden of communicable and non-communicable diseases, particularly in the elderly. In addition to active COVID-19 surveillance, policymaker

Published
2020

36. Call to Action: SARS-CoV-2 and CerebrovAscular DisordErs (CASCADE).

Author

Abootalebi, Shahram, Abootalebi, Shahram, Aertker, Benjamin M, Andalibi, Mohammad Sobhan, Asdaghi, Negar, Aykac, Ozlem, Azarpazhooh, M Reza, Bahit, M Cecilia, Barlinn, Kristian, Basri, Hamidon, Shahripour, Reza Bavarsad, Bersano, Anna, Biller, Jose, Borhani-Haghighi, Afshin, Brown, Robert D, Campbell, Bruce Cv, Cruz-Flores, Salvador, De Silva, Deidre Anne, Di Napoli, Mario, Divani, Afshin A, Edgell, Randall C, Fifi, Johanna T, Ghoreishi, Abdoreza, Hirano, Teruyuki, Hong, Keun-Sik, Hsu, Chung Y, Huang, Josephine F, Inoue, Manabu, Jagolino, Amanda L, Kapral, Moira, Kee, Hoo Fan, Keser, Zafer, Khatri, Rakesh, Koga, Masatoshi, Krupinski, Jerzy, Liebeskind, David S, Liu, Liping, Ma, Henry, Maud, Alberto, McCullough, Louise D, Meyer, Dawn Matherne, Mifsud, Victoria, Morovatdar, Negar, Nilanont, Yongchai, Oxley, Thomas J, Özdemir, Atilla Özcan, Pandian, Jeyaraj, Pantoni, Leonardo, Papamitsakis, Nikolaos IH, Parry-Jones, Adrian, Phan, Thanh, Rodriguez, Gustavo, Romano, Jose G, Sabaa-Ayoun, Ziad, Saber, Hamidreza, Sasannezhad, Payam, Saver, Jeffrey L, Scharf, Eugene, Shuaib, Ashfaq, Silver, Brian, Singhal, Shaloo, Smith, Craig J, Stranges, Saverio, Sylaja, PN, Torbey, Michel, Toyoda, Kazunori, Tsivgoulis, Georgios, Wasay, Mohammad, Yassi, Nawaf, Yoshimoto, Takeshi, Zamani, Babak, Zand, Ramin, Abootalebi, Shahram, Abootalebi, Shahram, Aertker, Benjamin M, Andalibi, Mohammad Sobhan, Asdaghi, Negar, Aykac, Ozlem, Azarpazhooh, M Reza, Bahit, M Cecilia, Barlinn, Kristian, Basri, Hamidon, Shahripour, Reza Bavarsad, Bersano, Anna, Biller, Jose, Borhani-Haghighi, Afshin, Brown, Robert D, Campbell, Bruce Cv, Cruz-Flores, Salvador, De Silva, Deidre Anne, Di Napoli, Mario, Divani, Afshin A, Edgell, Randall C, Fifi, Johanna T, Ghoreishi, Abdoreza, Hirano, Teruyuki, Hong, Keun-Sik, Hsu, Chung Y, Huang, Josephine F, Inoue, Manabu, Jagolino, Amanda L, Kapral, Moira, Kee, Hoo Fan, Keser, Zafer, Khatri, Rakesh, Koga, Masatoshi, Krupinski, Jerzy, Liebeskind, David S, Liu, Liping, Ma, Henry, Maud, Alberto, McCullough, Louise D, Meyer, Dawn Matherne, Mifsud, Victoria, Morovatdar, Negar, Nilanont, Yongchai, Oxley, Thomas J, Özdemir, Atilla Özcan, Pandian, Jeyaraj, Pantoni, Leonardo, Papamitsakis, Nikolaos IH, Parry-Jones, Adrian, Phan, Thanh, Rodriguez, Gustavo, Romano, Jose G, Sabaa-Ayoun, Ziad, Saber, Hamidreza, Sasannezhad, Payam, Saver, Jeffrey L, Scharf, Eugene, Shuaib, Ashfaq, Silver, Brian, Singhal, Shaloo, Smith, Craig J, Stranges, Saverio, Sylaja, PN, Torbey, Michel, Toyoda, Kazunori, Tsivgoulis, Georgios, Wasay, Mohammad, Yassi, Nawaf, Yoshimoto, Takeshi, Zamani, Babak, and Zand, Ramin

Abstract

Background and purposeThe novel severe acute respiratory syndrome coronavirus 2 (SARS-Cov-2), now named coronavirus disease 2019 (COVID-19), may change the risk of stroke through an enhanced systemic inflammatory response, hypercoagulable state, and endothelial damage in the cerebrovascular system. Moreover, due to the current pandemic, some countries have prioritized health resources towards COVID-19 management, making it more challenging to appropriately care for other potentially disabling and fatal diseases such as stroke. The aim of this study is to identify and describe changes in stroke epidemiological trends before, during, and after the COVID-19 pandemic.MethodsThis is an international, multicenter, hospital-based study on stroke incidence and outcomes during the COVID-19 pandemic. We will describe patterns in stroke management, stroke hospitalization rate, and stroke severity, subtype (ischemic/hemorrhagic), and outcomes (including in-hospital mortality) in 2020 during COVID-19 pandemic, comparing them with the corresponding data from 2018 and 2019, and subsequently 2021. We will also use an interrupted time series (ITS) analysis to assess the change in stroke hospitalization rates before, during, and after COVID-19, in each participating center.ConclusionThe proposed study will potentially enable us to better understand the changes in stroke care protocols, differential hospitalization rate, and severity of stroke, as it pertains to the COVID-19 pandemic. Ultimately, this will help guide clinical-based policies surrounding COVID-19 and other similar global pandemics to ensure that management of cerebrovascular comorbidity is appropriately prioritized during the global crisis. It will also guide public health guidelines for at-risk populations to reduce risks of complications from such comorbidities.

Published
2020

37. Stroke Care Trends During COVID-19 Pandemic in Zanjan Province, Iran. From the CASCADE Initiative: Statistical Analysis Plan and Preliminary Results.

Author

Ghoreishi, Abdoreza, Ghoreishi, Abdoreza, Arsang-Jang, Shahram, Sabaa-Ayoun, Ziad, Yassi, Nawaf, Sylaja, PN, Akbari, Yama, Divani, Afshin A, Biller, Jose, Phan, Thanh, Steinwender, Sandy, Silver, Brian, Zand, Ramin, Basri, Hamidon Bin, Iqbal, Omer M, Ranta, Annemarei, Ruland, Sean, Macri, Elizabeth, Ma, Henry, Nguyen, Thanh N, Abootalebi, Shahram, Gupta, Animesh, Alet, Matias, Lattanzi, Simona, Desai, Masoom, Gagliardi, Rubens J, Girotra, Tarun, Inoue, Manabu, Yoshimoto, Takeshi, Isaac, Cristian Flavo, Mayer, Stephan A, Morovatdar, Negar, Nilanont, Yongchai, Nobleza, Christa O'Hana S, Saber, Hamidreza, Kamenova, Saltanat, Kondybayeva, Aida, Krupinski, Jerzy, Siegler, James E, Stranges, Saverio, Torbey, Michel T, Yorio, Diana, Zurrú, María Cristina, Rubinos, Clio Aracelli, Shahripour, Reza Bavarsad, Borhani-Haghighi, Afshin, Napoli, Mario Di, Azarpazhooh, M Reza, Ghoreishi, Abdoreza, Ghoreishi, Abdoreza, Arsang-Jang, Shahram, Sabaa-Ayoun, Ziad, Yassi, Nawaf, Sylaja, PN, Akbari, Yama, Divani, Afshin A, Biller, Jose, Phan, Thanh, Steinwender, Sandy, Silver, Brian, Zand, Ramin, Basri, Hamidon Bin, Iqbal, Omer M, Ranta, Annemarei, Ruland, Sean, Macri, Elizabeth, Ma, Henry, Nguyen, Thanh N, Abootalebi, Shahram, Gupta, Animesh, Alet, Matias, Lattanzi, Simona, Desai, Masoom, Gagliardi, Rubens J, Girotra, Tarun, Inoue, Manabu, Yoshimoto, Takeshi, Isaac, Cristian Flavo, Mayer, Stephan A, Morovatdar, Negar, Nilanont, Yongchai, Nobleza, Christa O'Hana S, Saber, Hamidreza, Kamenova, Saltanat, Kondybayeva, Aida, Krupinski, Jerzy, Siegler, James E, Stranges, Saverio, Torbey, Michel T, Yorio, Diana, Zurrú, María Cristina, Rubinos, Clio Aracelli, Shahripour, Reza Bavarsad, Borhani-Haghighi, Afshin, Napoli, Mario Di, and Azarpazhooh, M Reza

Abstract

BackgroundThe emergence of the COVID-19 pandemic has significantly impacted global healthcare systems and this may affect stroke care and outcomes. This study examines the changes in stroke epidemiology and care during the COVID-19 pandemic in Zanjan Province, Iran.MethodsThis study is part of the CASCADE international initiative. From February 18, 2019, to July 18, 2020, we followed ischemic and hemorrhagic stroke hospitalization rates and outcomes in Valiasr Hospital, Zanjan, Iran. We used a Bayesian hierarchical model and an interrupted time series analysis (ITS) to identify changes in stroke hospitalization rate, baseline stroke severity [measured by the National Institutes of Health Stroke Scale (NIHSS)], disability [measured by the modified Rankin Scale (mRS)], presentation time (last seen normal to hospital presentation), thrombolytic therapy rate, median door-to-needle time, length of hospital stay, and in-hospital mortality. We compared in-hospital mortality between study periods using Cox-regression model.ResultsDuring the study period, 1,026 stroke patients were hospitalized. Stroke hospitalization rates per 100,000 population decreased from 68.09 before the pandemic to 44.50 during the pandemic, with a significant decline in both Bayesian [Beta: -1.034; Standard Error (SE): 0.22, 95% CrI: -1.48, -0.59] and ITS analysis (estimate: -1.03, SE = 0.24, p < 0.0001). Furthermore, we observed lower admission rates for patients with mild (NIHSS < 5) ischemic stroke (p < 0.0001). Although, the presentation time and door-to-needle time did not change during the pandemic, a lower proportion of patients received thrombolysis (-10.1%; p = 0.004). We did not see significant changes in admission rate to the stroke unit and in-hospital mortality rate; however, disability at discharge increased (p < 0.0001).ConclusionIn Zanjan, Iran, the COVID-19 pandemic has significantly impacted stroke outcomes and altered the deliver

Published
2020

38. Stroke care trends during COVID-19 pandemic in Zanjan Province, Iran from the CASCADE initiative: statistical analysis plan and preliminary results

Author

Ghoreishi, Abdoreza, Arsang-Jang, Shahram, Sabaa-Ayoun, Ziad, Yassi, Nawaf, Sylaja, P. N., Akbari, Yama, Divani, Afshin A., Biller, Jose, Phan, Thanh, Steinwender, Sandy, Silver, Brian, Zand, Ramin, Basri, Hamidon, Iqbal, Omer M., Ranta, Annemarei, Ruland, Sean, Macri, Elizabeth, Ma, Henry, Nguyen, Thanh N., Abootalebi, Shahram, Azarpazhooh, M. Reza, Ghoreishi, Abdoreza, Arsang-Jang, Shahram, Sabaa-Ayoun, Ziad, Yassi, Nawaf, Sylaja, P. N., Akbari, Yama, Divani, Afshin A., Biller, Jose, Phan, Thanh, Steinwender, Sandy, Silver, Brian, Zand, Ramin, Basri, Hamidon, Iqbal, Omer M., Ranta, Annemarei, Ruland, Sean, Macri, Elizabeth, Ma, Henry, Nguyen, Thanh N., Abootalebi, Shahram, and Azarpazhooh, M. Reza

Abstract

Background The emergence of the COVID-19 pandemic has significantly impacted global healthcare systems and this may affect stroke care and outcomes. This study examines the changes in stroke epidemiology and care during the COVID-19 pandemic in Zanjan Province, Iran. Methods This study is part of the CASCADE international initiative. From February 18, 2019, to July 18, 2020, we followed ischemic and hemorrhagic stroke hospitalization rates and outcomes in Valiasr Hospital, Zanjan, Iran. We used a Bayesian hierarchical model and an interrupted time series analysis (ITS) to identify changes in stroke hospitalization rate, baseline stroke severity [measured by the National Institutes of Health Stroke Scale (NIHSS)], disability [measured by the modified Rankin Scale (mRS)], presentation time (last seen normal to hospital presentation), thrombolytic therapy rate, median door-to-needle time, length of hospital stay, and in-hospital mortality. We compared in-hospital mortality between study periods using Cox-regression model. Results During the study period, 1,026 stroke patients were hospitalized. Stroke hospitalization rates per 100,000 population decreased from 68.09 before the pandemic to 44.50 during the pandemic, with a significant decline in both Bayesian [Beta: -1.034; Standard Error (SE): 0.22, 95% CrI: -1.48, -0.59] and ITS analysis (estimate: -1.03, SE = 0.24, p < 0.0001). Furthermore, we observed lower admission rates for patients with mild (NIHSS < 5) ischemic stroke (p < 0.0001). Although, the presentation time and door-to-needle time did not change during the pandemic, a lower proportion of patients received thrombolysis (-10.1%; p = 0.004). We did not see significant changes in admission rate to the stroke unit and in-hospital mortality rate; however, disability at discharge increased (p < 0.0001). Conclusion In Zanjan, Iran, the COVID-19 pandemic has significantly impacted stroke outcomes and altered the delivery of stroke care. Observed lower admission ra

Published
2020

39. Stroke care trends during COVID-19 pandemic in Zanjan Province, Iran from the CASCADE initiative: statistical analysis plan and preliminary results

Author

Ghoreishi, Abdoreza, Arsang-Jang, Shahram, Sabaa-Ayoun, Ziad, Yassi, Nawaf, Sylaja, P. N., Akbari, Yama, Divani, Afshin A., Biller, Jose, Phan, Thanh, Steinwender, Sandy, Silver, Brian, Zand, Ramin, Basri, Hamidon, Iqbal, Omer M., Ranta, Annemarei, Ruland, Sean, Macri, Elizabeth, Ma, Henry, Nguyen, Thanh N., Abootalebi, Shahram, Azarpazhooh, M. Reza, Ghoreishi, Abdoreza, Arsang-Jang, Shahram, Sabaa-Ayoun, Ziad, Yassi, Nawaf, Sylaja, P. N., Akbari, Yama, Divani, Afshin A., Biller, Jose, Phan, Thanh, Steinwender, Sandy, Silver, Brian, Zand, Ramin, Basri, Hamidon, Iqbal, Omer M., Ranta, Annemarei, Ruland, Sean, Macri, Elizabeth, Ma, Henry, Nguyen, Thanh N., Abootalebi, Shahram, and Azarpazhooh, M. Reza

Abstract

Background The emergence of the COVID-19 pandemic has significantly impacted global healthcare systems and this may affect stroke care and outcomes. This study examines the changes in stroke epidemiology and care during the COVID-19 pandemic in Zanjan Province, Iran. Methods This study is part of the CASCADE international initiative. From February 18, 2019, to July 18, 2020, we followed ischemic and hemorrhagic stroke hospitalization rates and outcomes in Valiasr Hospital, Zanjan, Iran. We used a Bayesian hierarchical model and an interrupted time series analysis (ITS) to identify changes in stroke hospitalization rate, baseline stroke severity [measured by the National Institutes of Health Stroke Scale (NIHSS)], disability [measured by the modified Rankin Scale (mRS)], presentation time (last seen normal to hospital presentation), thrombolytic therapy rate, median door-to-needle time, length of hospital stay, and in-hospital mortality. We compared in-hospital mortality between study periods using Cox-regression model. Results During the study period, 1,026 stroke patients were hospitalized. Stroke hospitalization rates per 100,000 population decreased from 68.09 before the pandemic to 44.50 during the pandemic, with a significant decline in both Bayesian [Beta: -1.034; Standard Error (SE): 0.22, 95% CrI: -1.48, -0.59] and ITS analysis (estimate: -1.03, SE = 0.24, p < 0.0001). Furthermore, we observed lower admission rates for patients with mild (NIHSS < 5) ischemic stroke (p < 0.0001). Although, the presentation time and door-to-needle time did not change during the pandemic, a lower proportion of patients received thrombolysis (-10.1%; p = 0.004). We did not see significant changes in admission rate to the stroke unit and in-hospital mortality rate; however, disability at discharge increased (p < 0.0001). Conclusion In Zanjan, Iran, the COVID-19 pandemic has significantly impacted stroke outcomes and altered the delivery of stroke care. Observed lower admission ra

Published
2020

40. Three-dimensional ultrasound evaluation of the effects of pomegranate therapy on carotid plaque texture using locality preserving projection

Author

Chen, Xueli, Lin, Mingquan, Cui, He, Chen, Yimin, van Engelen, Arna, de Bruijne, Marleen, Azarpazhooh, M Reza, Sohrevardi, Seyed Mojtaba, Chow, Tommy W S, Spence, J David, Chiu, Bernard, Chen, Xueli, Lin, Mingquan, Cui, He, Chen, Yimin, van Engelen, Arna, de Bruijne, Marleen, Azarpazhooh, M Reza, Sohrevardi, Seyed Mojtaba, Chow, Tommy W S, Spence, J David, and Chiu, Bernard

Abstract

BACKGROUND AND OBJECTIVE: Dietary supplements are expected to confer a smaller beneficial effect than medical treatments. Therefore, there is a need to develop cost-effective biomarkers that can demonstrate the efficacy of such supplements for carotid atherosclerosis. The aim of this study is to develop such a biomarker based on the changes of 376 plaque textural features measured from 3D ultrasound images.METHODS: Since the number of features (376) was greater than the number of subjects (171) in this study, principal component analysis (PCA) was applied to reduce the dimensionality of feature vectors. To generate a scalar biomarker for each subject, elements in the reduced feature vectors produced by PCA were weighted using locality preserving projections (LPP) to capture essential patterns exhibited locally in the feature space. 96 subjects treated by pomegranate juice and tablets, and 75 subjects receiving placebo-matching juice and tablets were evaluated in this study. The discriminative power of the proposed biomarker was evaluated and compared with existing biomarkers using t-tests. As the cost of a clinical trial is directly related to the number of subjects enrolled, the cost-effectiveness of the proposed biomarker was evaluated by sample size estimation.RESULTS: The proposed biomarker was more able to discriminate plaque changes exhibited by the pomegranate and placebo groups than total plaque volume (TPV) according to the result of t-tests (TPV: p=0.34, Proposed biomarker: p=1.5×10-5). The sample size required by the new biomarker to detect a significant effect was 20 times smaller than that required by TPV.CONCLUSION: With the increase in cost-effectiveness afforded by the proposed biomarker, more proof-of-principle studies for novel treatment options could be performed.

Published
2020

41. Global, regional, and national disability-adjusted life-years (DALYs) for 333 diseases and injuries and healthy life expectancy (HALE) for 195 countries and territories, 1990-2016: A systematic analysis for the Global Burden of Disease Study 2016

Author

Abajobir, A, Abate, K, Abbafati, C, Abbas, K, Abd-Allah, F, Abdulkader, R, Abdulle, A, Abebo, T, Abera, S, Aboyans, V, Abu-Raddad, L, Ackerman, I, Adedeji, I, Adetokunboh, O, Afshin, A, Aggarwal, R, Agrawal, S, Agrawal, A, Ahmed, M, Aichour, M, Aichour, A, Aichour, I, Aiyar, S, Akinyemiju, T, Akseer, N, Al Lami, F, Alahdab, F, Al-Aly, Z, Alam, K, Alam, N, Alam, T, Alasfoor, D, Alene, K, Ali, R, Alizadeh-Navaei, R, Alkaabi, J, Alkerwi, A, Alla, F, Allebeck, P, Allen, C, Al-Maskari, F, Almazroa, M, Al-Raddadi, R, Alsharif, U, Alsowaidi, S, Althouse, B, Altirkawi, K, Alvis-Guzman, N, Amare, A, Amini, E, Ammar, W, Amoako, Y, Ansha, M, Antonio, C, Anwari, P, Ärnlöv, J, Arora, M, Artaman, A, Aryal, K, Asgedom, S, Atey, T, Atnafu, N, Avila-Burgos, L, Avokpaho, E, Awasthi, A, Awasthi, S, Azarpazhooh, M, Azzopardi, P, Babalola, T, Bacha, U, Badawi, A, Balakrishnan, K, Bannick, M, Barac, A, Barker-Collo, S, Bärnighausen, T, Barquera, S, Barrero, L, Basu, S, Battista, R, Battle, K, Baune, B, Bazargan-Hejazi, S, Beardsley, J, Bedi, N, Béjot, Y, Bekele, B, Bell, M, Bennett, D, Bennett, J, Bensenor, I, Benson, J, Berhane, A, Berhe, D, Bernabé, E, Betsu, B, Beuran, M, Beyene, A, Bhansali, A, Bhatt, S, Bhutta, Z, Biadgilign, S, Bicer, B, Bienhoff, K, Bikbov, B, Birungi, C, Biryukov, S, Bisanzio, D, Bizuayehu, H, Blyth, F, Boneya, D, Bose, D, Bou-Orm, I, Bourne, R, Brainin, M, Brayne, C, Brazinova, A, Breitborde, N, Briant, P, Britton, G, Brugha, T, Buchbinder, R, Bulto, L, Bumgarner, B, Butt, Z, Cahuana-Hurtado, L, Cameron, E, Campos-Nonato, I, Carabin, H, Cárdenas, R, Carpenter, D, Carrero, J, Carter, A, Carvalho, F, Casey, D, Castañeda-Orjuela, C, Castle, C, Catalá-López, F, Chang, J, Charlson, F, Chaturvedi, P, Chen, H, Chibalabala, M, Chibueze, C, Chisumpa, V, Chitheer, A, Chowdhury, R, Christopher, D, Ciobanu, L, Cirillo, M, Colombara, D, Cooper, L, Cooper, C, Cortesi, P, Cortinovis, M, Criqui, M, Cromwell, E, Cross, M, Crump, J, Dadi, A, Dalal, K, Damasceno, A, Dandona, L, Dandona, R, das Neves, J, Davitoiu, D, Davletov, K, de Courten, B, De Leo, D, De Steur, H, Defo, B, Degenhardt, L, Deiparine, S, Dellavalle, R, Deribe, K, Deribew, A, Des Jarlais, D, Dey, S, Dharmaratne, S, Dhillon, P, Dicker, D, Djalainia, S, Do, H, Dokova, K, Doku, D, Dorsey, E, dos Santos, K, Driscoll, T, Dubey, M, Duncan, B, Ebel, B, Echko, M, El-Khatib, Z, Enayati, A, Endries, A, Ermakov, S, Erskine, H, Eshetie, S, Eshrati, B, Esteghamati, A, Estep, K, Fanuel, F, Farag, T, Farinha, C, Faro, A, Farzadfar, F, Fazeli, M, Feigin, V, Feigl, A, Fereshtehnejad, S, Fernandes, J, Ferrari, A, Feyissa, T, Filip, I, Fischer, F, Fitzmaurice, C, Flaxman, A, Foigt, N, Foreman, K, Franklin, R, Frostad, J, Fullman, N, Fürst, T, Furtado, J, Futran, N, Gakidou, E, Garcia-Basteiro, A, Gebre, T, Gebregergs, G, Gebrehiwot, T, Geleijnse, J, Geleto, A, Gemechu, B, Gesesew, H, Gething, P, Ghajar, A, Gibney, K, Gillum, R, Ginawi, I, Gishu, M, Giussani, G, Godwin, W, Goel, K, Goenka, S, Goldberg, E, 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Abstract

Background: Measurement of changes in health across locations is useful to compare and contrast changing epidemiological patterns against health system performance and identify specific needs for resource allocation in research, policy development, and programme decision making. Using the Global Burden of Diseases, Injuries, and Risk Factors Study 2016, we drew from two widely used summary measures to monitor such changes in population health: disability-adjusted life-years (DALYs) and healthy life expectancy (HALE). We used these measures to track trends and benchmark progress compared with expected trends on the basis of the Socio-demographic Index (SDI). Methods: We used results from the Global Burden of Diseases, Injuries, and Risk Factors Study 2016 for all-cause mortality, cause-specific mortality, and non-fatal disease burden to derive HALE and DALYs by sex for 195 countries and territories from 1990 to 2016. We calculated DALYs by summing years of life lost and years of life lived with disability for each location, age group, sex, and year. We estimated HALE using age-specific death rates and years of life lived with disability per capita. We explored how DALYs and HALE difered from expected trends when compared with the SDI: the geometric mean of income per person, educational attainment in the population older than age 15 years, and total fertility rate. Findings: The highest globally observed HALE at birth for both women and men was in Singapore, at 75·2 years (95% uncertainty interval 71·9-78·6) for females and 72·0 years (68·8-75·1) for males. The lowest for females was in the Central African Republic (45·6 years [42·0-49·5]) and for males was in Lesotho (41·5 years [39·0-44·0]). From 1990 to 2016, global HALE increased by an average of 6·24 years (5·97-6·48) for both sexes combined. Global HALE increased by 6·04 years (5·74-6·27) for males and 6·49 years (6·08-6·77) for females, whereas HALE at age 65 years increased by 1·78 years (1·61-1·93) for males

Published
2017

42. Global, regional, and national disability-adjusted life-years (DALYs) for 333 diseases and injuries and healthy life expectancy (HALE) for 195 countries and territories, 1990-2016: A systematic analysis for the Global Burden of Disease Study 2016

Author

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Abstract

Background: Measurement of changes in health across locations is useful to compare and contrast changing epidemiological patterns against health system performance and identify specific needs for resource allocation in research, policy development, and programme decision making. Using the Global Burden of Diseases, Injuries, and Risk Factors Study 2016, we drew from two widely used summary measures to monitor such changes in population health: disability-adjusted life-years (DALYs) and healthy life expectancy (HALE). We used these measures to track trends and benchmark progress compared with expected trends on the basis of the Socio-demographic Index (SDI). Methods: We used results from the Global Burden of Diseases, Injuries, and Risk Factors Study 2016 for all-cause mortality, cause-specific mortality, and non-fatal disease burden to derive HALE and DALYs by sex for 195 countries and territories from 1990 to 2016. We calculated DALYs by summing years of life lost and years of life lived with disability for each location, age group, sex, and year. We estimated HALE using age-specific death rates and years of life lived with disability per capita. We explored how DALYs and HALE difered from expected trends when compared with the SDI: the geometric mean of income per person, educational attainment in the population older than age 15 years, and total fertility rate. Findings: The highest globally observed HALE at birth for both women and men was in Singapore, at 75·2 years (95% uncertainty interval 71·9-78·6) for females and 72·0 years (68·8-75·1) for males. The lowest for females was in the Central African Republic (45·6 years [42·0-49·5]) and for males was in Lesotho (41·5 years [39·0-44·0]). From 1990 to 2016, global HALE increased by an average of 6·24 years (5·97-6·48) for both sexes combined. Global HALE increased by 6·04 years (5·74-6·27) for males and 6·49 years (6·08-6·77) for females, whereas HALE at age 65 years increased by 1·78 years (1·61-1·93) for males

Published
2017

43. Age, sex, and setting in the etiology of stroke study (ASSESS): Study design and protocol.

Author

Swartz R.H., Amiri A., Kapral M.K., Yassi N., Bahit C., Kaul S., Alladi S., Nilanont Y., Coppola M., Nucera A., Silver B., Werring D., Simister R., Owolabi M.O., Hachinski V., Ovbiagele B., Azarpazhooh M.R., Mandzia J.L., Thrift A.G., Sposato L.A., Morovatdar N., Swartz R.H., Amiri A., Kapral M.K., Yassi N., Bahit C., Kaul S., Alladi S., Nilanont Y., Coppola M., Nucera A., Silver B., Werring D., Simister R., Owolabi M.O., Hachinski V., Ovbiagele B., Azarpazhooh M.R., Mandzia J.L., Thrift A.G., Sposato L.A., and Morovatdar N.

Abstract

Rationale: Stroke etiology and risk factors vary by age, sex, setting (hospital or community-based) and by region. Identifying these differences would improve our understanding of stroke etiology, diagnosis, and treatment. Aim(s): The Age, Sex and Setting in the Etiology of Stroke Study (ASSESS) is a multicenter cohort study to assess differences in stroke etiology. Methods and design: Data from all centers will be categorized according to age, sex, setting, stroke subtypes. Centers with extensive hospital- or community-based data regarding stroke from Argentina, Australia, Canada, India, Iran, Italy, Ghana, Nigeria, Thailand, the United Kingdom and the United States have agreed to participate so far. Study outcomes: The primary outcome includes differences in stroke etiology in study centers. The secondary outcomes include stroke incidence, risk factors, preventive strategies, and short- and long-term outcomes. Conclusion(s): ASSESS will enable comparisons of data from different regions to determine the age and sex distribution of the most common causes of stroke in each setting. This will help clinicians to tailor the assessment and treatment of stroke patients on the basis of their specific local characteristics. It will also empower stroke epidemiologists to design preventive measures by targeting the specific characteristics of each population.Copyright © 2019

Published
2019

44. Long-term disability after stroke in Iran: Evidence from the Mashhad Stroke Incidence Study.

Author

Mokhber N., Amiri A., Kapral M.K., Behrouz R., Juibary A.G., Azarpazhooh M.R., Farzadfard M.T., Sheikh Andalibi M.S., Thrift A.G., Morovatdar N., Stranges S., Mokhber N., Amiri A., Kapral M.K., Behrouz R., Juibary A.G., Azarpazhooh M.R., Farzadfard M.T., Sheikh Andalibi M.S., Thrift A.G., Morovatdar N., and Stranges S.

Abstract

Background: Accurate information about disability rate after stroke remains largely unclear in many countries. Population-based studies are necessary to estimate the rate and determinants of disability after stroke. Method(s): Patients were recruited from the Mashhad Stroke Incidence Study and followed for five years after their index event. Disability was measured using the modified Rankin scale and functional dependency was measured using the Barthel index. Result(s): Among 684 patients registered in this study, 624 were first-ever strokes. In total, 69.0% (n = 409) of patients either died or remained disabled at five-year follow-up. Among the first-ever stroke survivors, 18.5% (n = 69) at one year and 15.9% (n = 31) at five years required major assistance in their daily activities. Patients with a history of stroke (before the study period) compared with first-ever strokes were more likely to be disabled at one year (modified Rankin scale>2 in 40.0% vs. 19.1%; P < 0.001). Advanced age, severity of stroke at the time of admission, diabetes mellitus, and educational level (<12 years) were independently associated with greater disability and functional dependency. Conclusion(s): We found that significant disability and functional dependency after stroke in Northeast Iran were largely attributable to the effects of stroke severity and prior dependency.Copyright © 2018 World Stroke Organization.

Published
2019

45. Socioeconomic Status and Long-Term Stroke Mortality, Recurrence and Disability in Iran: The Mashhad Stroke Incidence Study.

Author

Mokhber N., Amiri A., Heshmati A., Ghahremani A., Farzadfard M.T., Azarpazhooh M.R., Morovatdar N., Thrift A.G., Stranges S., Kapral M., Behrouz R., Mokhber N., Amiri A., Heshmati A., Ghahremani A., Farzadfard M.T., Azarpazhooh M.R., Morovatdar N., Thrift A.G., Stranges S., Kapral M., and Behrouz R.

Abstract

Background: Little is known about the association between socioeconomic status and long-term stroke outcomes, particularly in low- and middle-income countries. Method(s): Patients were recruited from the Mashhad Stroke Incidence Study in Iran. We identified different socioeconomic variables including the level of education, occupation, household size, and family income. Residential location according to patient's neighbourhood was classified into less privileged area (LPA), middle privileged area and high privileged area (HPA). Using Cox regression, competing risk analysis and logistic regression models, we determined the association between socioeconomic status and 1- and 5-year stroke outcomes. Generalized linear model was used for adjusting associated variables for stroke severity. Result(s): Six hundred twenty-four patients with first-ever stroke were recruited in this study. Unemployment prior to stroke was associated with an increased risk of 1- and 5-year post-stroke mortality (1 year: adjusted hazard ratio [aHR] 3.3; 95% CI 1.6-7.06: p = 0.001; 5 years: aHR 2.1; 95% CI 1.2-3.6: p = 0.007). The 5-year mortality rate was higher in less educated patients (<12 years) as compared to those with at least 12 years of schooling (aHR 1.84; 95% CI 1.05-3.23: p = 0.03). Patients living in LPA compared to those living in HPAs experienced a more severe stroke at admission (aB 3.84; 95% CI 0.97-6.71, p = 0.009) and disabling stroke at 1 year follow-up (OR 6.1; 95% CI 1.3-28.4; p = 0.02). Conclusion(s): A comprehensive stroke strategy should also address socioeconomic disadvantages.Copyright © 2019 S. Karger AG, Basel. All rights reserved.

Published
2019

46. Age, sex, and setting in the etiology of stroke study (ASSESS): Study design and protocol.

Author

Swartz R.H., Amiri A., Kapral M.K., Yassi N., Bahit C., Kaul S., Alladi S., Nilanont Y., Coppola M., Nucera A., Silver B., Werring D., Simister R., Owolabi M.O., Hachinski V., Ovbiagele B., Azarpazhooh M.R., Mandzia J.L., Thrift A.G., Sposato L.A., Morovatdar N., Swartz R.H., Amiri A., Kapral M.K., Yassi N., Bahit C., Kaul S., Alladi S., Nilanont Y., Coppola M., Nucera A., Silver B., Werring D., Simister R., Owolabi M.O., Hachinski V., Ovbiagele B., Azarpazhooh M.R., Mandzia J.L., Thrift A.G., Sposato L.A., and Morovatdar N.

Abstract

Rationale: Stroke etiology and risk factors vary by age, sex, setting (hospital or community-based) and by region. Identifying these differences would improve our understanding of stroke etiology, diagnosis, and treatment. Aim(s): The Age, Sex and Setting in the Etiology of Stroke Study (ASSESS) is a multicenter cohort study to assess differences in stroke etiology. Methods and design: Data from all centers will be categorized according to age, sex, setting, stroke subtypes. Centers with extensive hospital- or community-based data regarding stroke from Argentina, Australia, Canada, India, Iran, Italy, Ghana, Nigeria, Thailand, the United Kingdom and the United States have agreed to participate so far. Study outcomes: The primary outcome includes differences in stroke etiology in study centers. The secondary outcomes include stroke incidence, risk factors, preventive strategies, and short- and long-term outcomes. Conclusion(s): ASSESS will enable comparisons of data from different regions to determine the age and sex distribution of the most common causes of stroke in each setting. This will help clinicians to tailor the assessment and treatment of stroke patients on the basis of their specific local characteristics. It will also empower stroke epidemiologists to design preventive measures by targeting the specific characteristics of each population.Copyright © 2019

Published
2019

47. Long-term disability after stroke in Iran: Evidence from the Mashhad Stroke Incidence Study.

Author

Mokhber N., Amiri A., Kapral M.K., Behrouz R., Juibary A.G., Azarpazhooh M.R., Farzadfard M.T., Sheikh Andalibi M.S., Thrift A.G., Morovatdar N., Stranges S., Mokhber N., Amiri A., Kapral M.K., Behrouz R., Juibary A.G., Azarpazhooh M.R., Farzadfard M.T., Sheikh Andalibi M.S., Thrift A.G., Morovatdar N., and Stranges S.

Abstract

Background: Accurate information about disability rate after stroke remains largely unclear in many countries. Population-based studies are necessary to estimate the rate and determinants of disability after stroke. Method(s): Patients were recruited from the Mashhad Stroke Incidence Study and followed for five years after their index event. Disability was measured using the modified Rankin scale and functional dependency was measured using the Barthel index. Result(s): Among 684 patients registered in this study, 624 were first-ever strokes. In total, 69.0% (n = 409) of patients either died or remained disabled at five-year follow-up. Among the first-ever stroke survivors, 18.5% (n = 69) at one year and 15.9% (n = 31) at five years required major assistance in their daily activities. Patients with a history of stroke (before the study period) compared with first-ever strokes were more likely to be disabled at one year (modified Rankin scale>2 in 40.0% vs. 19.1%; P < 0.001). Advanced age, severity of stroke at the time of admission, diabetes mellitus, and educational level (<12 years) were independently associated with greater disability and functional dependency. Conclusion(s): We found that significant disability and functional dependency after stroke in Northeast Iran were largely attributable to the effects of stroke severity and prior dependency.Copyright © 2018 World Stroke Organization.

Published
2019

48. Socioeconomic Status and Long-Term Stroke Mortality, Recurrence and Disability in Iran: The Mashhad Stroke Incidence Study.

Author

Mokhber N., Amiri A., Heshmati A., Ghahremani A., Farzadfard M.T., Azarpazhooh M.R., Morovatdar N., Thrift A.G., Stranges S., Kapral M., Behrouz R., Mokhber N., Amiri A., Heshmati A., Ghahremani A., Farzadfard M.T., Azarpazhooh M.R., Morovatdar N., Thrift A.G., Stranges S., Kapral M., and Behrouz R.

Abstract

Background: Little is known about the association between socioeconomic status and long-term stroke outcomes, particularly in low- and middle-income countries. Method(s): Patients were recruited from the Mashhad Stroke Incidence Study in Iran. We identified different socioeconomic variables including the level of education, occupation, household size, and family income. Residential location according to patient's neighbourhood was classified into less privileged area (LPA), middle privileged area and high privileged area (HPA). Using Cox regression, competing risk analysis and logistic regression models, we determined the association between socioeconomic status and 1- and 5-year stroke outcomes. Generalized linear model was used for adjusting associated variables for stroke severity. Result(s): Six hundred twenty-four patients with first-ever stroke were recruited in this study. Unemployment prior to stroke was associated with an increased risk of 1- and 5-year post-stroke mortality (1 year: adjusted hazard ratio [aHR] 3.3; 95% CI 1.6-7.06: p = 0.001; 5 years: aHR 2.1; 95% CI 1.2-3.6: p = 0.007). The 5-year mortality rate was higher in less educated patients (<12 years) as compared to those with at least 12 years of schooling (aHR 1.84; 95% CI 1.05-3.23: p = 0.03). Patients living in LPA compared to those living in HPAs experienced a more severe stroke at admission (aB 3.84; 95% CI 0.97-6.71, p = 0.009) and disabling stroke at 1 year follow-up (OR 6.1; 95% CI 1.3-28.4; p = 0.02). Conclusion(s): A comprehensive stroke strategy should also address socioeconomic disadvantages.Copyright © 2019 S. Karger AG, Basel. All rights reserved.

Published
2019

49. Measuring progress from 1990 to 2017 and projecting attainment to 2030 of the health-related Sustainable Development Goals for 195 countries and territories: a systematic analysis for the Global Burden of Disease Study 2017

Author

Lozano, R. Fullman, N. Abate, D. Abay, S.M. Abbafati, C. Abbasi, N. Abbastabar, H. Abd-Allah, F. Abdela, J. Abdelalim, A. Abdel-Rahman, O. Abdi, A. Abdollahpour, I. Abdulkader, R.S. Abebe, N.D. Abebe, Z. Abejie, A.N. Abera, S.F. Abil, O.Z. Aboyans, V. Abraha, H.N. Abrham, A.R. Abu-Raddad, L.J. Abu-Rmeileh, N.M. Abyu, G.Y. Accrombessi, M.M.K. Acharya, D. Acharya, P. Adamu, A.A. Adebayo, O.M. Adedeji, I.A. Adedoyin, R.A. Adekanmbi, V. Adetokunboh, O.O. Adhena, B.M. Adhikari, T.B. Adib, M.G. Adou, A.K. Adsuar, J.C. Afarideh, M. Afshari, M. Afshin, A. Agarwal, G. Aghayan, S.A. Agius, D. Agrawal, A. Agrawal, S. Ahmadi, A. Ahmadi, M. Ahmadieh, H. Ahmed, M.B. Ahmed, S. Akalu, T.Y. Akanda, A.S. Akbari, M.E. Akibu, M. Akinyemi, R.O. Akinyemiju, T. Akseer, N. Alahdab, F. Al-Aly, Z. Alam, K. Alam, T. Albujeer, A. Alebel, A. Alene, K.A. Al-Eyadhy, A. Alhabib, S. Ali, R. Alijanzadeh, M. Alizadeh-Navaei, R. Aljunid, S.M. Alkerwi, A. Alla, F. Allebeck, P. Allen, C.A. Almasi, A. Al-Maskari, F. Al-Mekhlafi, H.M. Alonso, J. Al-Raddadi, R.M. Alsharif, U. Altirkawi, K. Alvis-Guzman, N. Amare, A.T. Amenu, K. Amini, E. Ammar, W. Anber, N.H. Anderson, J.A. Andrei, C.L. Androudi, S. Animut, M.D. Anjomshoa, M. Ansari, H. Ansariadi, A. Ansha, M.G. Antonio, C.A.T. Anwari, P. Appiah, L.T. Aremu, O. Areri, H.A. Ärnlöv, J. Arora, M. Aryal, K.K. Asayesh, H. Asfaw, E.T. Asgedom, S.W. Asghar, R.J. Assadi, R. Ataro, Z. Atique, S. Atre, S.R. Atteraya, M.S. Ausloos, M. Avila-Burgos, L. Avokpaho, E.F.G.A. Awasthi, A. Quintanilla, B.P.A. Ayele, H.T. Ayele, Y. Ayer, R. Azarpazhooh, M.R. Azzopardi, P.S. Azzopardi-Muscat, N. Babalola, T.K. Babazadeh, A. Badali, H. Badawi, A. Balakrishnan, K. Bali, A.G. Banach, M. Banerjee, A. Banoub, J.A.M. Banstola, A. Barac, A. Barboza, M.A. Barker-Collo, S.L. Bärnighausen, T.W. Barrero, L.H. Barthelemy, C.M. Bassat, Q. Basu, A. Basu, S. Battista, R.J. Baune, B.T. Baynes, H.W. Bazargan-Hejazi, S. Bedi, N. Beghi, E. Behzadifar, M. Behzadifar, M. Béjot, Y. Bekele, B.B. Bel and Lozano, R. Fullman, N. Abate, D. Abay, S.M. Abbafati, C. Abbasi, N. Abbastabar, H. Abd-Allah, F. Abdela, J. Abdelalim, A. Abdel-Rahman, O. Abdi, A. Abdollahpour, I. Abdulkader, R.S. Abebe, N.D. Abebe, Z. Abejie, A.N. Abera, S.F. Abil, O.Z. Aboyans, V. Abraha, H.N. Abrham, A.R. Abu-Raddad, L.J. Abu-Rmeileh, N.M. Abyu, G.Y. Accrombessi, M.M.K. Acharya, D. Acharya, P. Adamu, A.A. Adebayo, O.M. Adedeji, I.A. Adedoyin, R.A. Adekanmbi, V. Adetokunboh, O.O. Adhena, B.M. Adhikari, T.B. Adib, M.G. Adou, A.K. Adsuar, J.C. Afarideh, M. Afshari, M. Afshin, A. Agarwal, G. Aghayan, S.A. Agius, D. Agrawal, A. Agrawal, S. Ahmadi, A. Ahmadi, M. Ahmadieh, H. Ahmed, M.B. Ahmed, S. Akalu, T.Y. Akanda, A.S. Akbari, M.E. Akibu, M. Akinyemi, R.O. Akinyemiju, T. Akseer, N. Alahdab, F. Al-Aly, Z. Alam, K. Alam, T. Albujeer, A. Alebel, A. Alene, K.A. Al-Eyadhy, A. Alhabib, S. Ali, R. Alijanzadeh, M. Alizadeh-Navaei, R. Aljunid, S.M. Alkerwi, A. Alla, F. Allebeck, P. Allen, C.A. Almasi, A. Al-Maskari, F. Al-Mekhlafi, H.M. Alonso, J. Al-Raddadi, R.M. Alsharif, U. Altirkawi, K. Alvis-Guzman, N. Amare, A.T. Amenu, K. Amini, E. Ammar, W. Anber, N.H. Anderson, J.A. Andrei, C.L. Androudi, S. Animut, M.D. Anjomshoa, M. Ansari, H. Ansariadi, A. Ansha, M.G. Antonio, C.A.T. Anwari, P. Appiah, L.T. Aremu, O. Areri, H.A. Ärnlöv, J. Arora, M. Aryal, K.K. Asayesh, H. Asfaw, E.T. Asgedom, S.W. Asghar, R.J. Assadi, R. Ataro, Z. Atique, S. Atre, S.R. Atteraya, M.S. Ausloos, M. Avila-Burgos, L. Avokpaho, E.F.G.A. Awasthi, A. Quintanilla, B.P.A. Ayele, H.T. Ayele, Y. Ayer, R. Azarpazhooh, M.R. Azzopardi, P.S. Azzopardi-Muscat, N. Babalola, T.K. Babazadeh, A. Badali, H. Badawi, A. Balakrishnan, K. Bali, A.G. Banach, M. Banerjee, A. Banoub, J.A.M. Banstola, A. Barac, A. Barboza, M.A. Barker-Collo, S.L. Bärnighausen, T.W. Barrero, L.H. Barthelemy, C.M. Bassat, Q. Basu, A. Basu, S. Battista, R.J. Baune, B.T. Baynes, H.W. Bazargan-Hejazi, S. Bedi, N. Beghi, E. Behzadifar, M. Behzadifar, M. Béjot, Y. Bekele, B.B. Bel

Abstract

Background: Efforts to establish the 2015 baseline and monitor early implementation of the UN Sustainable Development Goals (SDGs) highlight both great potential for and threats to improving health by 2030. To fully deliver on the SDG aim of “leaving no one behind”, it is increasingly important to examine the health-related SDGs beyond national-level estimates. As part of the Global Burden of Diseases, Injuries, and Risk Factors Study 2017 (GBD 2017), we measured progress on 41 of 52 health-related SDG indicators and estimated the health-related SDG index for 195 countries and territories for the period 1990–2017, projected indicators to 2030, and analysed global attainment. Methods: We measured progress on 41 health-related SDG indicators from 1990 to 2017, an increase of four indicators since GBD 2016 (new indicators were health worker density, sexual violence by non-intimate partners, population census status, and prevalence of physical and sexual violence [reported separately]). We also improved the measurement of several previously reported indicators. We constructed national-level estimates and, for a subset of health-related SDGs, examined indicator-level differences by sex and Socio-demographic Index (SDI) quintile. We also did subnational assessments of performance for selected countries. To construct the health-related SDG index, we transformed the value for each indicator on a scale of 0–100, with 0 as the 2·5th percentile and 100 as the 97·5th percentile of 1000 draws calculated from 1990 to 2030, and took the geometric mean of the scaled indicators by target. To generate projections through 2030, we used a forecasting framework that drew estimates from the broader GBD study and used weighted averages of indicator-specific and country-specific annualised rates of change from 1990 to 2017 to inform future estimates. We assessed attainment of indicators with defined targets in two ways: first, using mean values projected for 2030, and then using the probab

Published
2018

50. Xylitol for the prevention of acute otitis media episodes in children aged 2-4 years: protocol for a pragmatic randomised controlled trial.

Author

Persaud, Nav, Persaud, Nav, Laupacis, Andreas, Azarpazhooh, Amir, Birken, Catherine, Hoch, Jeffrey S, Isaranuwatchai, Wanrudee, Maguire, Jonathan L, Mamdani, Muhammad M, Thorpe, Kevin, Allen, Christopher, Mason, Dalah, Kowal, Christine, Bazeghi, Farnaz, Parkin, Patricia, TARGet Kids! Collaboration, Persaud, Nav, Persaud, Nav, Laupacis, Andreas, Azarpazhooh, Amir, Birken, Catherine, Hoch, Jeffrey S, Isaranuwatchai, Wanrudee, Maguire, Jonathan L, Mamdani, Muhammad M, Thorpe, Kevin, Allen, Christopher, Mason, Dalah, Kowal, Christine, Bazeghi, Farnaz, Parkin, Patricia, and TARGet Kids! Collaboration

Abstract

IntroductionXylitol (or 'birch sugar') is a naturally occurring sugar with antibacterial properties that has been used as a natural non-sugar sweetener in chewing gums, confectionery, toothpaste and medicines. In this preventative randomised trial, xylitol will be tested for the prevention of acute otitis media (AOM), a common and costly condition in young children. The primary outcome will be the incidence of AOM. Secondary outcomes will include upper respiratory tract infections (URTIs) and dental caries.Methods and analysisThis study will be a pragmatic, blinded (participant and parents, practitioners and analyst), two-armed superiority, placebo-controlled randomised trial with 1:1 allocation, stratified by clinical site. The trial will be conducted in the 11 primary care group practices participating in the TARGet Kids! research network in Canada. Eligible participants between the ages of 2-4 years will be randomly assigned to the intervention arm of regular xylitol syrup use or the control arm of regular sorbitol use for 6 months. We expect to recruit 236 participants, per treatment arm, to detect a 20% relative risk reduction in AOM episodes. AOM will be identified through chart review. The secondary outcomes of URTIs and dental caries will be identified through monthly phone calls with specified questions.Ethics and disseminationEthics approval from the Research Ethics Boards at the Hospital for Sick Children and St. Michael's Hospital has been obtained for this study and also for the TARGet Kids! research network. Results will be submitted for publication to a peer-reviewed journal and will be discussed with decision makers.Trial registration numberNCT03055091; Pre-results.

Published
2018

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