Browsing by Subject "stroke"

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    Cerebral Arterial Asymmetries in the Neonate: Insight into the Pathogenesis of Stroke
    (Multidisciplinary Digital Publishing Institute, 2022-02-24) van Vuuren, Anica Jansen; Saling, Michael; Rogerson, Sheryle; Anderson, Peter; Cheong, Jeanie; Solms, Mark
    Neonatal and adult strokes are more common in the left than in the right cerebral hemisphere in the middle cerebral arterial territory, and adult extracranial and intracranial vessels are systematically left-dominant. The aim of the research reported here was to determine whether the asymmetric vascular ground plan found in adults was present in healthy term neonates (n = 97). A new transcranial Doppler ultrasonography dual-view scanning protocol, with concurrent B-flow and pulsed wave imaging, acquired multivariate data on the neonatal middle cerebral arterial structure and function. This study documents for the first-time systematic asymmetries in the middle cerebral artery origin and distal trunk of healthy term neonates and identifies commensurately asymmetric hemodynamic vulnerabilities. A systematic leftward arterial dominance was found in the arterial caliber and cortically directed blood flow. The endothelial wall shear stress was also asymmetric across the midline and varied according to vessels’ geometry. We conclude that the arterial structure and blood supply in the brain are laterally asymmetric in newborns. Unfavorable shearing forces, which are a by-product of the arterial asymmetries described here, might contribute to a greater risk of cerebrovascular pathology in the left hemisphere.
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    Clinical Outcomes Associated with Speech, Language and Swallowing Difficulties Post-Stroke – A Prospective Cohort Study
    (2022) Kaylor, Stephanie Anne; Singh, Shajila
    Background: Due to a lack of prospective research in South Africa's Speech-Language Therapy (SLT) private healthcare sector, this prospective cohort study investigated associations between speech, language, and swallowing conditions (i.e. dysarthria, apraxia of speech, aphasia, dysphagia), risk factors, and outcomes post-stroke (i.e. length of hospital stay, degree of physical disability according to the Modified Rankin Scale [mRS], functional level of oral intake according to the Functional Oral Intake Scale [FOIS], dehydration, weight loss, aspiration pneumonia, mortality). Methods: Adults with a new incident of stroke without pre-existing speech, language or swallowing difficulties (N=68) were recruited. Convenience sampling was used to select participants. A prospective design was used to determine the incidence of speech, language, and swallowing conditions poststroke and association with outcomes from admission to discharge. Results: Co-occurring speech, language, and swallowing conditions frequently occurred post-stroke (88%). Participants who were referred to SLT greater than 24 hours post-admission (52.94%) stayed in hospital for a median of three days longer than those who were referred within 24 hours (p=.042). Dysphagia was significantly associated with moderate to severe physical disability. Dysphagia with aspiration was significantly associated with poor functional level of oral intake (i.e. altered consistency diets and enteral nutrition), at admission and at discharge (p<. 01). Dysphagia had a higher likelihood of mortality (OR=2.86) (p=.319). At discharge, aspiration pneumonia was significantly associated with severe physical disability (p< .01, r=0.70). Risk factors; poor oral hygiene (p=1.00), low level of consciousness (p=1.00), dependent for oral intake (p=.040), and enteral nutrition (p=.257); were not associated with aspiration pneumonia. Conclusion: In South Africa's private sector, cooccurring speech, language, and swallowing conditions commonly occurred post-stroke, and dysphagia was strongly associated with physical disability and poor functional level of oral intake. Length of hospital stay was increased by delayed SLT referrals.
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    Evaluating the performance of the GRACE and TIMI risk scores in acute coronary syndromes: a South African cohort
    (2024) Khiroya, Mitesh Satish; Ntsekhe, Mpiko; Lukhna, Kishal
    Introduction: The GRACE and TIMI scores are validated risk stratification tools that accurately predict risk of in-hospital, 30-day, and one-year major adverse cardiac events (MACE) in patients with Acute Coronary Syndromes (ACS). The performance of GRACE and TIMI scores in a setting where most ST-elevation myocardial infarction (STEMI) patients receive thrombolytic reperfusion therapy after 6 hours and a considerable proportion of non-ST elevation myocardial infarction (NTSEMI) patients receive delayed angiography and revascularisation after 48 hours, is unknown. Objective: To evaluate the accuracy of GRACE and TIMI risk scores in predicting in-hospital and 30-day mortality in a population characterised by a significant prevalence of delayed ACS presentation, limited access to primary percutaneous coronary intervention (PPCI) and delayed revascularisation. Methods: We conducted a retrospective review of all patients admitted to the coronary care unit (CCU) at Groote Schuur Hospital, Cape Town, with either STEMI or NSTEMI, between January 1 st to December 31st, 2019. For each participant, both GRACE and TIMI risk scores were calculated and recorded electronically. Performance of each score was determined and compared using receiver operating characteristic curve (ROC) analysis. Results: Of 329 participants with ACS, 58.6% presented with STEMI and 41.4% with NSTEMI. Mean age was 61.3 (SD±11.9) years, and 59.6% were male. Mean time from symptom onset to hospital admission was 18.3 (SD ± 37.4) hours, with only 4 participants (2.1%) receiving PPCI. STEMI in-hospital and 30-day mortality was 4.1% and 4.2%, respectively, whereas in-hospital mortality for NSTEMI was 1.5%. In the STEMI cohort, both GRACE and TIMI risk scores were comparable, showed excellent discrimination for in-hospital mortality (AUC=0.927, 95% CI: 0.83- 1.00 versus AUC=0.923, 95% CI: 0.87-0.98; p 0.91), and demonstrated modest accuracy for predicting 30-day mortality (GRACE AUC=0.587, 95% CI: 0.29-0.88; TIMI AUC=0.530, 95% CI: 0.12-0.94; p 0.44). In the NSTEMI cohort, GRACE performed significantly better than TIMI (AUC=0.905, 95% CI: 0.85-0.96 versus AUC=0.278, 95% CI: 0.00-0.68; p 0.001) for predicting in-hospital mortality. Conclusion: Both GRACE and TIMI scores demonstrated high accuracy in predicting in-hospital mortality and their predictive accuracy was modest when predicting 30-day mortality for STEMI patients. In addition, GRACE outperformed the TIMI score in assessing NSTEMI in-hospital mortality. Further research in low-and middle-income countries in SSA is needed to evaluate the potential impact of these scores on treatment strategies and cardiovascular outcomes.