Ischemic stroke in Morocco: Prehospital delay and associated factors

ObjectivesThis study aimed to estimate prehospital delay and to identify the factors associated with the late arrival of patients with ischemic stroke at the Souss Massa Regional Hospital Center in Morocco.Patients and methodsAn observational, prospective, cross-sectional study was conducted from March 2019 to September 2019 in the Souss Massa regional hospital center, which is a public hospital structure. A questionnaire was administered to patients with ischemic stroke and to bystanders (family or others), while clinical and paraclinical data were collected from medical records. Univariate and multivariate logistic regression analyses were used to identify the factors associated with delayed arrival at emergency department.ResultsA total of 197 patients and 197 bystanders who fulfilled the criteria for the study were included. The median time from symptom onset to hospital arrival was 6 hours (IQR, 4–16). Multiple regression analysis showed that illiteracy (OR 38.58; CI_95%: 3.40–437.27), waiting for symptoms to disappear (patient behavior) (OR 11.24; CI_95%: 1.57–80.45), deciding to go directly to the hospital (patient behavior) (OR 0.07; CI_95%: 0.01–0.57), bystander's knowledge that stroke is a disease requiring urgent care within a limited therapeutic window (OR 0.005; CI_95%: 0.00–0.36), and direct admission without reference (OR 0.005; CI_95%: 0.00–0.07), were independently associated with late arrival (> 4.5 hours) of patients with acute ischemic stroke. In addition, illiteracy (OR 24.62; CI_95%: 4.37–138.69), vertigo and disturbance of balance or coordination (OR 0.14; CI_95%: 0.03–0.73), the relative's knowledge that stroke is a disease requiring urgent care and within a limited therapeutic window (OR 0.03; CI_95%: 0.00–0.22), calling for an ambulance (relative's behavior) (OR 0.16; CI_95%: 0.03–0.80), distance between 50 and 100 km (OR 10.16; CI_95%: 1.16–89.33), and direct admission without reference (OR 0.03; CI_95%: 0.00–0.14), were independently associated with late arrival (> 6 hours) of patients with acute ischemic stroke.ConclusionPatient behavior, bystander knowledge and direct admission to the competent hospital for stroke care are modifiable factors potentially useful for reducing onset-to-door time, and thereby increasing the implementation rates of acute stroke therapies.     

Three endpoints of in vivo tumour radiobiology and their statistical estimation

Purpose:?To review the existing endpoints of tumour growth delay assays in experimental radiobiology with an emphasis on their efficient estimation for statistically significant identification of the treatment effect. To mathematically define doubling time (DT), tumour-growth delay (TGD) and cancer-cell surviving fraction (SF) in?vivo using exponential growth and regrowth models with tumour volume measurements obtained from animal experiments.

Materials and methods:?A statistical model-based approach is used to define and efficiently estimate the three endpoints of tumour therapy in experimental cancer research.

Results:?The log scale is advocated for plotting the tumour volume data and the respective analysis. Therefore, the geometric mean should be used to display the mean tumour volume data, and the group comparison should be a t-test for the log volume to comply with the Gaussian-distribution assumption. The relationship between cancer-cell SF, TGD and rate of growth is rigorously established. The widespread formula for cell kill is corrected; it has been rigorously shown that TGD is the difference between DTs. The software for the tumour growth delay analysis based on the mixed modeling approach with a complete set of instructions and example can be found on the author's webpage.

Conclusions:?The existing practice for TGD data analysis from animal experiments suffers from imprecision and large standard errors that yield low power and statistically insignificant treatment effect. This practice should be replaced with a model-based statistical analysis on the log scale.     

Is neonatal jaundice associated with autism spectrum disorder,attention deficit hyperactivity disorder,and other psychological development? A nationwide prospective study

Neonatal jaundice may cause the lifelong sequelae of central nerve system developmental disorders. However, the results are inconsistent. 2016 newborns with neonatal jaundice and 8064 age-/gender-matched (1:4) controls were enrolled during 1999–2000. Participants of autistic spectrum disorder (ASD), attention-deficit hyperactivity disorder (ADHD), and other developmental disorders that occurred during the follow-up were identified. Newborns with neonatal jaundice had increased risks of developing ASD (hazard ratio [HR]: 1.75, 95% confidence interval [CI]: 1.05–2.90), any developmental delay (HR: 1.27, 95% CI: 1.02–1.58), and developmental speech or language disorder (HR: 1.41, 95% CI: 1.11–1.79). Newborn exposure to hyperbilirubinemia was related to the increased risk of developing ASD, any developmental delay, and developmental speech or language disorder in later life.     

Leptospirosis in a Japanese urban area: A case report and literature review

Leptospirosis is not a major disease in urban areas of Japan. We describe a 49-year-old man with leptospirosis, who lived in an urban area and had no history of living in endemic area of leptospirosis. As he worked at a fish market infested with rats, he was suspected of having contracted leptospirosis and received antimicrobial agent treatment. Serum and urinary tests confirmed the diagnosis of leptospirosis. Although it took six days from the onset until treatment initiation, the patient improved in response to receiving ceftriaxone for seven days.Analyzing past reports of Japanese patients with leptospirosis who had no history of overseas travel, we identified 90 patients with courses similar to that of our patient, and the period from onset to treatment initiation was about six days on average (described in 46 cases). Health care providers as well as patients need to recognize that even people with no history of being in an endemic area of leptospirosis may still be at risk of developing this disease depending on occupations and activities.     

Coronary sinus lead delay index for optimization of coronary sinus lead placement

Aim

Optimization of coronary sinus (CS) lead position to the latest activated left ventricular (LV) area is important to increase cardiac resynchronization therapy (CRT) response. We aimed to detect the relationship between coronary sinus lead delay index (CSDI) and echocardiographic, electrocardiographic response to CRT treatment.

Methods

We prospectively included 137 consecutive patients with heart failure (HF) diagnosis, QRS ≥ 120 ms, left bundle branch block (LBBB), New York Heart Association score (NYHA) II–IV, LV ejection fraction (LVEF) <35% and scheduled for CRT (84 male, 53 female; mean age 65.1 ± 10.1 years). Echocardiographic CRT response was defined as ≥15% reduction in LV end‐systolic volume (LVESV). CS lead sensing delay was calculated as the time interval from the onset of surface QRS wave to the onset of depolarization wave recorded from the CS lead by using the CS pacing lead as a bipolar electrode. CSDI was calculated by dividing the CS lead sensing delay by the QRS duration.

Results

LVESV reduction was associated with baseline QRS width (r = .257, p = .002), QRS narrowing (r = .396, p < .001), CSDI (r = .357, p < .001), and NT‐proBNP (r = ?0.213, p = .022) in bivariate analysis. In logistic regression analysis, CSDI was found to be only independent parameter for predicting significant LVESV reduction (Beta = 0.318, p < .001). CSDI was also found to be significantly associated with LVEF increase (r = .244, p = .004) and QRS narrowing (r = .178, p = .046).

Conclusion

CSDI may be used as a marker to predict the favorable response to CRT. It may be useful to integrate CSDI to CRT implantation procedure in order to minimize nonresponders.

     

Structure theorems and the dynamics of nitrogen catabolite repression in yeast

By using current biological understanding, a conceptually simple, but mathematically complex, model is proposed for the dynamics of the gene circuit responsible for regulating nitrogen catabolite repression (NCR) in yeast. A variety of mathematical "structure" theorems are described that allow one to determine the asymptotic dynamics of complicated systems under very weak hypotheses. It is shown that these theorems apply to several subcircuits of the full NCR circuit, most importantly to the URE2-GLN3 subcircuit that is independent of the other constituents but governs the switching behavior of the full NCR circuit under changes in nitrogen source. Under hypotheses that are fully consistent with biological data, it is proven that the dynamics of this subcircuit is simple periodic behavior in synchrony with the cell cycle. Although the current mathematical structure theorems do not apply to the full NCR circuit, extensive simulations suggest that the dynamics is constrained in much the same way as that of the URE2-GLN3 subcircuit. This finding leads to the proposal that mathematicians study genetic circuits to find new geometries for which structure theorems may exist.