medRxiv : serveur de preprint pour les sciences médicales

Introduction: Early after the start of the COVID-19 pandemic, a major drop in the number of influenza B/Yamagata detections was observed globally. Given the potential public health implications, particularly with regards to influenza vaccination, we conducted a systematic review of influenza B/Yamagata virus circulation data from multiple complementary sources of information. Methods: We searched articles published until 20th March 2023 in PubMed and EMBASE; examined epidemiological and virological influenza data for 2020-2023 contained in the publicly available WHO-FluNet and GISAID (Global Initiative on Sharing All Influenza Data) global databases, or collected by the multi-national Global Influenza Hospital Surveillance Network (GIHSN) study; and looked for influenza data in the webpages of respiratory viruses surveillance systems from countries worldwide. Results: Highly consistent findings were found across all sources of information, with a progressive decline of influenza B/Yamagata detections from 2020 onwards across all world regions, both in absolute terms (total number of cases), the positivity rate, and as a fraction of influenza B detections. Isolated influenza B/Yamagata cases continue to be sporadically reported, and these are typically vaccine-derived, mistaken data entries or under investigation. Discussion: While it is still too early to conclude that B/Yamagata is (or will soon become) extinct, the current epidemiological and virological data call for a rapid response in terms of influenza prevention practices, particularly regarding the formulation of influenza vaccines. The current epidemiological situation is unprecedented in recent decades, underlying the importance of continuously and carefully monitoring the circulation of influenza viruses (as well as SARS-CoV-2 and the other respiratory viruses) in the coming years.

Background: Phosphodiesterases (PDEs) are regarded as important therapeutic targets for multiple diseases, and the cardiovascular benefits of several PDE inhibitors have received extensive interests. Objectives: To explore the relationship between genetically-predicted PDEs and ischemia heart disease via drug target Mendelian Randomization (MR) approach. Methods: The expression of genes encoding PDEs was used to proxy the level of PDEs, and available quantitative trait loci of gene expression and DNA methylation (eQTLs and mQTLs) for each target gene were identified as the genetic instruments. Coronary heart disease (CHD) and myocardial infarction (MI) were the outcomes. Summary-data-based MR method was used to generate the estimates and two-step MR analysis was applied to investigate the mediation of metabolic traits. Results: MR analyses identified two types of PDEs, PDE5 and PDE8, genetically-predicted expression in blood of the encoded genes was significantly associated with the risk of CHD (ORPDE5A=1.22,95% CI=1.06-1.40; ORPDE8A=1.26,95% CI=1.07-1.49) and MI (ORPDE5A=1.27,95% CI=1.09-1.48; ORPDE8A=1.24,95% CI=1.04-1.48). Especially, the highest expression of PDE5A was observed in artery aorta, which was also positively related to CHD (OR=1.17,95% CI=1.05-1.32) and MI (OR=1.15,95% CI=1.02-1.30). Besides, the methylation level of 12 CpG sites showed a relation with CHD or MI via affecting PDE5A expression. The observed association between PDE5A expression and outcomes were partly mediated by blood pressure and LDL cholesterol, and the association with MI were mostly mediated by CHD (Proportion-mediated: 78.84%). Conclusions: This study provided genetic evidence about the protective role of PDE5 inhibition against ischemic heart disease, especially in preventing patients with CHD from developing MI.

Background Dyslipidemia is a well-known risk factor for cardiovascular disease, which has been the leading cause of mortality worldwide. Although habitual intake of fish oil has been implicated in offering cardioprotective effects through triglyceride reduction, the interactions of fish oil with the genetic predisposition to dysregulated lipids remain elusive. Objectives We examined whether fish oil supplementation can modify the genetic potential for the circulating levels of four lipids, including total cholesterol, low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C), and triglycerides. Methods A total of 441,985 participants with complete genetic and phenotypic data from the UK Biobank were included in our study. Polygenic scores (PGS) were calculated in participants of diverse ancestries. Multivariable linear regression models were used to assess associations with adjustment for relevant risk factors. Results Fish oil supplementation mitigated genetic susceptibility to elevated levels of total cholesterol, LDL-C, and triglycerides, while amplifying genetic potential for increased HDL-C among 424,090 participants of European ancestry (Pinteraction < 0.05). Consistent significant findings were obtained using PGS calculated based on multiple genome-wide association studies or alternative PGS methods. We also showed that fish oil significantly attenuated genetic predisposition to high triglycerides in African-ancestry participants. Conclusions Fish oil supplementation attenuated the genetic susceptibility to elevated blood levels of total cholesterol, LDL-C, and triglycerides, while accentuating genetic potential for higher HDL-C. These results suggest that fish oil may have a beneficial impact on modifying genome-wide genetic effects on elevated lipid levels in the general population.

Background: The treatment of pain in the emergency department (ED) has historically relied on pharmacological analgesia. However, little is known about the concurrent use of non-pharmacological analgesia. Aims/Objectives: This research explores the self-reported use and outcomes of non-pharmacological analgesia in adult ED patients with moderate to severe pain. Methods: This is a cross-sectional study in an adult ED of self-reported use of non-pharmacological pain management via a patient-reported outcome measure. The results are presented with descriptive statistics and multivariable modelling. Results: 45.8% (n=296) of all respondents used non-pharmacological interventions. The most used non-pharmacological interventions are hot packs (34.9%, n=103), distraction (22.3%, n=66), and cold packs (12.9%, n=38). In multivariate modelling, females, patients who did not receive pre-hospital analgesia, and daily average access block time all affected the use of non-pharmacological analgesia. Within a multivariable model, non-pharmacological analgesia increased the amount of pain relief achieved. Conclusion: Non-pharmacological analgesia use is affected by gender, treatment before the ED and ED workload. Nevertheless, clear benefits to the use of non-pharmacological analgesia were seen. Further work must be undertaken to encourage providers' use of this modality and capture any additional benefits to the patient.

To broaden our understanding of bradyarrhythmias and diseases of the cardiac conduction system, we performed cross-sectional multi-ancestry genome-wide association study meta-analyses in up to 1.3 million individuals for sinus node dysfunction (SND), distal conduction disease (DCD), and pacemaker implantation (PM). We evaluated the biological relevance of bradyarrhythmia loci by analyses of transcriptomes, pleiotropy, and partitioned heritability based on cardiac single cell RNA sequencing data. Finally, we performed rare variant burden testing in 460,000 whole exome sequenced individuals from two biobanks. We identified 13, 28, and 21 common variant loci for SND, DCD, and PM, respectively. Four well-known common variant arrhythmia loci (SCN5A/SCN10A, CCDC141, TBX20, and CAMK2D) were shared for SND and DCD, while other loci were more specific for SND or DCD. Cardiomyocyte-expressed genes were strongly enriched for contributions to DCD heritability, while SND and PM were more heterogeneous. Rare variant analyses implicated LMNA for all bradyarrhythmia subtypes; SMAD6 and SCN5A for DCD; and TTN, MYBPC3, and SCN5A for PM. The genetic architectures of SND and DCD are both overlapping and distinct. Multiple genetic mechanisms involving ion channels, sarcomeric components, cellular homeostasis, and cardiac development may influence the development of bradyarrhythmias.

Our understanding of the quality of cellular and humoral immunity conferred by COVID-19 vaccination alone versus vaccination plus SARS-CoV-2 breakthrough (BT) infection remains incomplete. While the current (2023) SARS-CoV-2 immune landscape of Canadians is complex, in late 2021 most Canadians had either just received a third dose of COVID-19 vaccine, or had received their two dose primary series and then experienced an Omicron BT. Herein we took advantage of this coincident timing to contrast cellular and humoral immunity conferred by three doses of vaccine versus two doses plus BT. Our results show that mild BT infection induces cell-mediated immune responses to variants comparable to an intramuscular vaccine booster dose. In contrast, BT subjects had higher salivary IgG and IgA levels against the Omicron Spike and enhanced reactivity to the ancestral Spike for the IgA isotype, which also reacted with SARS-CoV-1. Serum neutralizing antibody levels against the ancestral strain and the variants were also higher after BT infection. Our results support the need for mucosal vaccines to emulate the enhanced mucosal and humoral immunity induced by Omicron without exposing individuals to the risks associated with SARS-CoV-2 infection.

Paediatric immunisation had been relevant in reducing the widespread of Hepatitis B virus, as an outcome of the induction of hepatitis B surface antigen specific-IgG antibodies (anti-HBs). Studies revealed alteration effects of memory B cells during antiretroviral therapy (ART). We aimed at assessing anti-HBs response profile with respect to the most prominently used ART regimens in children. A cross-sectional study was conducted in 116 participants made up of 72 HIV-exposed and infected children, subdivided into 20 antiretroviral-naive on one hand and on another hand 52 ARV treated children made up of regimen subgroups, including 8 ABC-3TC-EFV/NVP (ART-R1), 19 ABC-3TC-LPV/r (ART-R2), 21 AZT-3TC-NVP (ART-R3) and 4 AZT-3TC-LPV/r (ART-R4), and 44 HIV-uninfected and unexposed (HUx or control group) children. Participants included in this study were regularly vaccinated children aged between 4 months and 5 years old, born to HIV-infected mothers. An optimized and adapted home-made ELISA and BioELISA Biohit kit were used to measure specific IgM, IgG and IgG subclasses to HBs in children. As a result, this study showed that the rates of vaccine protective response in children treated with ART under regimens R1, R2, R3 and R4 were 25%, 38%, 51% and 75%, respectively. These protective response rates were significantly lower (p<0.0001) in children under R1, R2 and R3 than the control group (92%). When comparing anti-HBs specific IgM and IgG response medians; IgM response levels were similar in both control and ARV treated children, whereas R1 (p=0.0045), R2 (p=0.0016), and R4 (p<0.0001) showed a significantly lower IgG level compared to the control group. Anti-HBs IgG subclass profile pattern in the control was IgG3{approx}IgG1{approx}IgG4>IgG2. However, IgG3{approx}IgG1{approx}IgG4>IgG4 profile pattern was estimated for children submitted to R1, R2 and R4, and the profile pattern of IgG3>IgG1{approx}IgG4{approx}IgG2 in those treated with R3 which also showed the most prominent anti-HBs IgG response mean rank level.

In the past few decades, several emerging/re-emerging mosquito-borne flaviviruses have resulted in disease outbreaks of public health concern in the tropics and subtropics. Due to cross-reactivities of antibodies recognizing the envelope protein of different flaviviruses, serosurveillance remains a challenge. Previously we reported that anti-premembrane (prM) antibody can discriminate between three flavivirus infections by Western blot analysis. In this study, we aimed to develop a serological assay that can discriminate infection or exposure with flaviviruses from four serocomplexes, including dengue (DENV), Zika (ZIKV), West Nile (WNV) and yellow fever (YFV) viruses, and explore its application for serosurveillance in flavivirus-endemic countries. We employed Western blot analysis including antigens of six flaviviruses (DENV1, 2 and 4, WNV, ZIKV and YFV) from four serocomplexes. We tested serum samples from YF-17D vaccinees, and from DENV, ZIKV and WNV panels that had been confirmed by RT-PCR or by neutralization assays. The overall sensitivity/specificity of anti-prM antibodies for DENV, ZIKV, WNV, and YFV infections/exposure were 91.7%/96.4%, 91.7%/99.2%, 88.9%/98.3%, and 91.3%/92.5%, respectively. When testing 48 samples from Brazil, we identified multiple flavivirus infections/exposure including DENV and ZIKV, DENV and YFV, and DENV, ZIKV and YFV. When testing 50 samples from the Philippines, we detected DENV, ZIKV, and DENV and ZIKV infections with a ZIKV seroprevalence rate of 10%, which was consistent with reports of low-level circulation of ZIKV in Asia. Together, these findings suggest that anti-prM antibody is a flavivirus serocomplex-specific marker and can be employed to delineate four flavivirus infections/exposure in regions where multiple flaviviruses co-circulate.

Development of coating technologies for electrochemical sensors that consistently exhibit antifouling activities when exposed to diverse and complex biological environments over extended time is vital for development more effective medical devices and diagnostics. Here, we describe a micrometer-thick, porous nanocomposite coating with both exceptional antifouling and electroconducting properties that greatly enhance the sensitivity of electrochemical sensors. Nozzle-assisted printing of oil-in-water emulsion is used to create a 1 micrometer thick coating composed of cross-linked albumin with interconnected pores, which also contains electroconducting gold nanowires. Using this approach, the antifouling conductive coating can be deposited only on the surface of the working electrode, and not on the reference and counter electrodes, which greatly facilitates the fabrication and functionality of multiplexed electrochemical sensors. The layer effectively resists biofouling and maintains rapid electron transfer kinetics for over one month when exposed directly to complex biological fluids, including serum and nasopharyngeal secretions. Compared to previously described thinner (nanometer thick) antifouling electroconductive coating made with drop casting or a spin coating of the same thickness, the nozzle-printed sensors coated with this thick porous nanocomposite exhibited sensitivities that were enhanced by 3.75- to 17-fold when three different target biomolecules were tested. As a result, emulsion-coated, multiplexed electrochemical sensors coated were able to carry out simultaneous detection of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) nucleic acid, antigen, and host antibody in clinical specimens with high sensitivity and specificity. This thick porous emulsion coating technology may provide a way to address hurdles currently restricting the application of electrochemical sensors for point-of-care (POC) diagnostic applications, as well as their use in implantable devices and other healthcare monitoring systems.

Objectives: This study will identify blood donor characteristics in Jordan. The study aims to investigate the extent of awareness and knowledge regarding blood donation among blood donors and to explore their attitudes towards blood donation in general. It also highlights various motivational factors and obstacles, which influence the decision to donate blood among Jordanian donors. Background: Recruitment of low risk blood donors can be challenging. Efforts should be made to increase the level of awareness and positive attitude toward blood donation. An essential step to achieve this is obtaining comprehensive data about the current situation of awareness, knowledge, and attitudes of the population towards blood donation. Methods/Materials: The present study was conducted at two blood donation centers in Amman, Jordan, during 2021. A total of 535 whole blood donors were included. Data regarding their demographic characteristics, blood donation history as well as their knowledge and attitudes regarding blood donation was collected by a questionnaire. Results: Four hundred ninety participants (91.6%) were males while 45 only (8.4%) were females. One hundred forty subjects (19.4%) were first time donors while 431 subjects (80.6%) had previous donations. The participants' median score in the knowledge section was 19.0 points (range 5-25 points). There was no significant correlation between participants' overall attitude score and their corresponding demographic characteristics or their overall knowledge score. Conclusion: Measures to improve knowledge and attitude toward blood donation should be implemented in order to meet the increasing demand for blood and blood components. Targeted campaigns, correction of some misconceptions, and using different motivations are suggested.

Background Assessment of thyroid nodules histopathology using AI is crucial for an accurate diagnosis. This systematic review aims to analyze recent works employing deep learning approaches for classifying thyroid nodules based on histopathology images, evaluate their performance, and identify limitations. Methods Eligibility criteria focused on peer-reviewed English papers published in the last 5 years, applying deep learning to categorize thyroid histopathology images. The PubMed database was searched using relevant keywords combination. Descriptive analysis of extracted data on approaches, accuracy, and limitations. Results Out of 103 articles, 11 studies met inclusion criteria. They used convolutional neural networks (CNNs) to classify thyroid nodules. Accuracy ranged from 77% to 100%, with most over 90%. Discussion The findings from our analysis reveal the effectiveness of deep learning to identify discriminative morphological patterns from histopathology images thus leading to enhancing the accuracy of thyroid nodule histopathological classification. Key limitations were small sample sizes, subjective annotation, and limited dataset diversity. Further research with larger diverse datasets, model optimization, and real-world validation is essential to translate these tools into clinical practice.

India has seen Menstrual Hygiene Scheme for 15-19 aged adolescents as a mass movement in 2011 with Intervention, Education, Communication (IEC) interventions and subsidized menstrual product. While the phenomenal increase in hygienic menstrual usage during 2010-20 is celebrated, it leaves us to question if this is the MHS in play or a gradual transition due to overall developmental drive. As the age-cohorts move out of the beneficiary net over time, sustainability of the program can only be reflected if there is a behavioral change which is captured through difference in choice patterns over duration of program exposure. Using triple difference-in-difference methodology on unit level data from NFHS 4, the results find that overall the program fails to mark any significant effect on choice of hygienic product in India. However, the low rung of the cohorts in terms of education and media exposure reap the benefit of the scheme, leaving the better-off counterparts unaffected. This concludes that the issues targeted through the scheme is holistic to reach the lowest strata of the society, but a proper choice of target cohort can considerably reduce the project cost, free it of supply side inefficiencies and enhance targeting of IEC techniques, thereby making the scheme more effective.

Aims: Type 2 diabetes (T2D) is a major risk factor for heart failure (HF) across demographic groups. On the other hand, metabolic impairment, including elevated T2D incidence is a hallmark of HF pathophysiology. We investigated the bidirectional relationship between T2D and HF, and identified genetic associations with diabetes-related HF after correction for potential collider bias. Methods: We performed a genome-wide association study (GWAS) of HF to identify genetic instrumental variables (GIVs) for HF, and to enable bidirectional Mendelian Randomization (MR) analysis between T2D and HF. Since genetics and HF can independently influence T2D, collider bias may occur when T2D (i.e., collider) is controlled for by design or analysis. Thus, we conducted GWAS of diabetes-related HF with correction for collider bias. Results: We first identified 61 genomic loci, including 24 novel loci, significantly associated with all-cause HF in 114,275 HF cases and over 1.5 million controls of European ancestry. Combined with the summary statistics of a T2D GWAS, we obtained 59 and 82 GIVs for HF and T2D, respectively. Using a two-sample bidirectional MR approach, we estimated that T2D increased HF risk (OR 1.07, 95% CI 1.04-1.10), while HF also increased T2D risk (OR 1.60, 95% CI 1.36-1.88). Then we performed a GWAS of diabetes-related HF corrected for collider bias due to prevalent HF affecting incidence of T2D. After removing the spurious association of TCF7L2 locus due to collider bias, we identified two genome-wide significant loci close to PITX2 (chromosome 4) and CDKN2B-AS1 (chromosome 9) associated with diabetes-related HF in the Million Veteran Program, and replicated the associations in the UK Biobank study. Conclusion: We identified novel HF-associated loci to enable bidirectional MR study of T2D and HF. Our MR findings support T2D as a HF risk factor and provide strong evidence that HF increases T2D risk. As a result, collider bias leads to spurious genetic associations of diabetes-related HF, which can be effectively corrected to identify true positive loci. Evaluation of collider bias should be a critical component when conducting GWAS of complex disease phenotypes such as diabetes-related cardiovascular complications.

Background and Purpose: Hypertension is a leading risk factor for cardiovascular disease (CVD) and is modulated by genetic variants. This study aimed to assess the effect of gene and environmental interaction focusing on adiposity genetic liability and physical activity on hypertension among European and African ancestry individuals within the UK Biobank (UKB). Methods: Participants were 230,115 individuals of European ancestry and 3,239 individuals of African ancestry from UKB. Genetic liability for adiposity were estimated using previously published data including the list of genetic variants and effect sizes for body mass index (BMI), waist-hip ratio (WHR) and waist circumference (WC) using Plink software. The outcome was defined as stage 2 hypertension (systolic blood pressure ? 140 mmHg, diastolic blood pressure ? 90 mmHg, or the use of anti-hypertensive medications). The association between adiposity genetic liability and the outcome was assessed across categories of self-reported physical activity using logistic regression. Results: Among European ancestry participants, there was up to a 20% hypertension risk difference between participants with a combination of high genetic liability and low physical activity compared with participants with a combination of low genetic liability and high physical activity (P <0.001). There was an interaction effect of physical activity on the association between BMI genetic liability and hypertension (P interaction=0.04). There was no evidence of an association between adiposity genetic liability and hypertension in individuals of African ancestry (P > 0.05). Conclusion: This study suggests that engaging in physical activity may reduce the risk of stage 2 hypertension among European ancestry individuals who carry high genetic liability for adiposity. This cannot be inferred for individuals of African ancestry, possibly due to the low African ancestry sample size within the UKB.

Background: Previous studies showed that remnant cholesterol(RC) partially explained the residual risk of cardiovascular disease. We tried to test the hypothesis that remnant cholesterol is a risk factor for all-cause mortality in oldest-old(>80 years old) patients with acute coronary syndrome(ACS). Methods: 662 oldest-old patients with acute coronary syndrome and undergoing coronary angiography were finally included in our study. Remnant cholesterol(RC) was calculated by fasting total cholesterol(TC) minus low-density lipoprotein cholesterol(LDL-C) and high-density lipoprotein cholesterol(HDL-C).Multivariable Cox regression analysis was used to identify the association between RC and all-cause mortality. Receiver operating characteristic(ROC) curve was used to compare the discrimination capacity of RC, TC, HDL-C and LDL-C to predict all-cause mortality. Results: Among the 662 oldest-old patients enrolled, 92.90% accepted statin therapy. The average age was 81.87 {+/-} 2.14 years old. In the fully-adjusted Cox regression model, the Hazard ratio(HR) [95% confidence interval (CI)] of all-cause mortality was 1.17 (1.01, 1.36) for each standard deviation(SD) increase in RC. Compared to tertile 1, tertile 3 was associated with a 130% increased risk of all-cause mortality (HR:2.30;95%CI:1.45, 3.63). The increased risk of death from tertile 1 to tertile 3 was statistically significant (P for trend<0.001). The subgroup analysis confirmed the significant association between RC and all-cause mortality. ROC curve showed that RC had a better discrimination capacity at predicting all-cause mortality and improved the prognostic value of the Gensini score combined with left ventricular ejection fraction(LVEF). Conclusion: Remnant cholesterol was associated with all-cause mortality in oldest-old patients with ACS in a long-term follow-up.

Breast cancer remains a significant concern worldwide, with a rising incidence in Indonesia. This study aims to evaluate the applicability of risk-based screening approaches in the Indonesian demographic through a case-control study involving 305 women. We developed a personalized breast cancer risk assessment workflow that integrates multiple risk factors, including clinical (Gail) and polygenic (Mavaddat) risk predictions, into a consolidated risk category. By evaluating the area under the receiver operating characteristic curve (AUC) of each single-factor risk model, we demonstrate that they retain their predictive accuracy in the Indonesian context (AUC for clinical risk: 0.6744; AUC for genetic risk: 0.6742). Notably, our combined risk approach enhanced the AUC to 0.7015, highlighting the advantages of a multifaceted model. Our findings demonstrate for the first time the applicability of the Mavaddat and Gail models to Indonesian populations, and show that within this demographic, combined risk models provide a superior predictive framework compared to single-factor approaches.

Background Delayed cord clamping is a proven intervention to improve both maternal and neonatal health and nutrition. World Health Organization recommends not clamping the umbilical cord before 1 minute of delivery. However, little is known about the timing of umbilical cord clamping, and associated factors in Ethiopia. Objective To assess the timing of umbilical cord clamping and associated factors among women who gave birth at public health institutions in Debremarkos town, 2022/23. Methods A facility-based cross-sectional study was conducted from December 01, 2022, to January 30, 2023, among women selected using systematic random sampling. Data was collected through observation and review of medical records using a checklist. The data was entered to Epi-data version 4.6.0.4 and analyzed by STATA 14. Descriptive statistics, bivariable and multivariable logistic regression models were fitted. Result A study of 388(91.73% response rate) women-newborn pairs found that 206(53.09%) newborns received delayed umbilical cord clamping, with mean and median clamping times of 67.87 {+/-} 39.86 SD and 60s, respectively. In the multivariable analysis, giving birth at the hospital (AOR = 2.47, 95% CI: 1.21-5.03), attended by medical interns (AOR = 2.47, 95% CI: 1.29-5.41), receiving uterotonic for AMTSL at or after 60 seconds of giving birth (AOR = 10.36, 95% CI: 6.02-17.84), Rh-negative mothers (AOR = 3.91, 95% CI: 1.40-10.95), and multiparity (AOR = 0.54, 95% CI: 0.32-0.93) were significantly associated with delayed umbilical cord clamp. Conclusion In this study, half of the newborns had delayed umbilical cord clamping. However, the result is still unsatisfactory, as the recommendations for delayed cord clamping extend to all newborns who do not require intensive care. Therefore, considering the proven benefit of delayed umbilical cord clamping, obstetric care providers should adhere to clinical guidelines for this proven intervention.

Background and rationale Evaluating scales to detect large vessel occlusion (LVO) could aid in considering early referrals to a thrombectomy-capable center in the prehospital stroke code setting. Nevertheless, they entail a significant number of false positives, corresponding to intracranial hemorrhages (ICH), which could result in a delay in medical attention and potential harm. Our study aims to identify easily collectible variables for the development of a scale to differentiate patients with ICH from LVO in a prehospital context. Methods We conducted a prospective cohort study of stroke code patients between May 2021 and January 2023. Patients were evaluated with CT/CT-Angiography at arrival. We compared clinical variables and vascular risk factors between ICH and LVO patients to design a prehospital ICH screening scale (PreICH). Results Out of 989 stroke code patients, we included 190 (66.7%) LVO cases and 95 (33.3) ICH cases. In the multivariate analysis, headache (odds ratio [OR] 3.56; 1.50-8.43), GCS<8 (OR 8.19; 3.17-21.13), SBP>160mmHg (OR 6.43; 3.37-12.26) and male sex (OR 2.07; 1.13- 3.80) were associated with ICH, while previous hypercholesterolemia (HCL) (OR 0.35; 0.19-0.65) with LVO. The scale design was conducted, assigning a score to each significant variable based on its specific weight: +2 points for SBP > 160, +1 points for headache, +1 points for male sex, +2 points for GCS<8, and -1 points for HCL. The area under the curve (AUC) was 0.82 (0.77-0.87). A score ?4 exhibited a sensitivity of 0.10, a specificity of 0.99, a positive predictive value of 0.21, and a negative predictive value of 0.98 . Conclusion We present the development of a prehospital scale to discriminate between ICH and LVO patients, utilizing easily detectable variables in the prehospital setting.

Background: Accumulating evidence suggest that cardiac complications after stroke are an important yet understudied manifestation of brain-heart interactions. Our aim was to investigate and compare cardiac findings after different cerebrovascular events (acute ischemic stroke, transient ischemic attack, and hemorrhagic stroke). Methods: 7113 patients treated between December 2013 and December 2020 at the University Hospital Zurich for ischemic stroke, transient ischemic attack, and hemorrhagic stroke were screened. 721 patients without evidence of previous cardiac disease or presumed cardioembolic origin of their cerebrovascular disease and with at least one cardiac check-up were included. Clinical reports from the year following disease onset were screened for new cardiac findings, which were categorized as arrhythmia/electrocardiographic (ECG) changes, myocardial alterations, valvular abnormalities, coronary perfusion insufficiency, and hypotensive/hypertensive blood pressure abnormalities. Differences in proportions of findings between groups were analyzed using Pearson?s Chi-Square Test or Fisher?s exact Test. Results: ECG changes were observed in 81.7% of patients with ischemic stroke, 71.4% with transient ischemic attack, and 55.8% with hemorrhagic stroke (p<0.001). Myocardial alterations occurred often in all three groups (60.9% ischemic stroke, 59.2% transient ischemic attack, 44.2% hemorrhage, p=0.1). Hypotensive/hypertensive blood pressure abnormalities were most frequent (48.8%) in hemorrhagic stroke patients (p<0.001). Conclusions: Cardiac complications are frequent in patients with cerebrovascular disease, even without prior cardiac problems or suspected cardiac etiology. While findings were different in the three event types, our data suggest that all patients with acute cerebrovascular events should receive thorough workup searching for cardiac complications.

Background: Unlike systolic blood pressure (SBP), the prognostic value of diastolic blood pressure (DBP) in kidney function has not been established. We hypothesized that pulse pressure (PP), which is associated with arteriosclerosis, would affect the prognostic value of DBP. Methods: This longitudinal study used data from the Japan Specific Health Checkups Study conducted between 2008 and 2014. The participants were stratified into 3 PP subgroups (low-PP [≤]39, normal-PP 40-59, and high-PP [≥]60 mmHg). The exposures of interest were SBP and DBP, and the association between SBP/DBP and kidney outcomes (30% decline in the estimated glomerular filtration rate from baseline) was examined in each PP subgroup using a Cox proportional hazards model. Results: Among 725,022 participants, 20,414 (2.8%) developed kidney outcomes during a median follow-up period of 34.6 months. Higher SBP was consistently associated with a higher incidence of kidney outcome in all PP subgroups. Although DBP had a positive linear association with the incidence of kidney outcome in low- and normal-PP subgroups, both lower ([≤]60 mmHg) and higher ([≥]101 mmHg) DBP were associated with a higher incidence of kidney outcome in high-PP subgroup with U-shaped curve. Hazard ratios (95% confidence intervals) of [≤]60 mmHg (reference: 61-80 mmHg in normal-PP subgroup) and [≥]101 mmHg were 1.26 (1.15-1.38) and 1.86 (1.62-2.14), respectively. Conclusion: In this large population-based cohort, DBP was differently associated with kidney outcome by PP levels; lower DBP was significantly associated with a higher incidence of kidney outcome in high-PP subgroup but not in low- and normal-PP subgroups.