Duration of Heightened Risk of Acute Ischemic Stroke After Hospitalization for Acute Systolic Heart Failure.

Background The duration and magnitude of increased stroke risk after a hospitalization for acute systolic heart failure (HF) remains uncertain. Methods and Results The authors performed a retrospective cohort study using claims (2008-2018) from a nationally representative 5% sample of Medicare beneficiaries aged ≥66 years. Cox regression models were fitted separately for the groups with and without acute systolic HF to examine its association with the incidence of ischemic stroke after adjustment for demographics, stroke risk factors, and Charlson comorbidities. Corresponding survival probabilities were used to compute the hazard ratio (HR) in each 30-day interval after discharge. The authors stratified patients by the presence of atrial fibrillation (AF) before or during the hospitalization for acute systolic HF. Among 2 077 501 eligible beneficiaries, 94 641 were hospitalized with acute systolic HF. After adjusting for demographics, stroke risk factors, and Charlson comorbidities, the risk of ischemic stroke was highest in the first 30 days after discharge from an acute systolic HF hospitalization for patients with AF (HR, 2.4 [95% CI, 2.1-2.7]) and without AF (HR, 4.6 [95% CI, 4.0-5.3]). The risk of stroke remained elevated for 60 days in patients with AF (HR, 1.4 [95% CI, 1.2-1.6]) and was not significantly elevated afterward. The risk of stroke remained significantly elevated through 330 days in patients without AF (HR, 2.1 [95% CI, 1.7-2.7]) and was no longer significantly elevated afterward. Conclusions A hospitalization for acute systolic HF is associated with an increased risk of ischemic stroke up to 330 days in patients without concomitant AF.

The association of parental involvement with adolescents' well-being in Oman: evidence from the 2015 Global School Health Survey.

BACKGROUND: The parent-adolescent relationship plays a key role in adolescent development, including behaviour, physical health, and mental health outcomes. Studies on the parental factors that contribute to an adolescent's dietary habits, exercise, mental health, physical harm and substance use are limited in the Middle East and North Africa region, with none in Oman. This study aims to investigate the association between parental involvement and adolescent well-being in Oman. METHODS: Cross-sectional data from the 2015 Global School Health Survey for Oman was analysed. The dataset consisted of 3468 adolescents. Adolescents reported on their parental involvement (checking to see if they did their homework, understanding their problems, knowing what they are doing in their free time and not going through their things without permission). Parental involvement was scored on a 20-point scale. Associations with the following dependent variables: nutrition, exercise, hygiene, physical harm, bullying, substance use, tobacco use and mental health well-being were done using Spearman's correlations, linear and logistic regressions. RESULTS: The surveyed population was 48% male, 65% aged 15 to 17 years old and 5% reported that they "most of the time or always" went hungry. Parental involvement was positively correlated with each of the dependent variables. Adolescents with higher parental involvement had significantly higher odds of good nutrition (1.391), hygiene (1.823) and exercise (1.531) and lower odds of physical harm (0.648), being bullied (0.628), poor mental health (0.415), tobacco use (0.496) and substance use (0.229). CONCLUSIONS: Parental involvement plays a positive role in all aspects of adolescents' well-being in Oman. Awareness campaigns and interventions aimed to help improve the well-being of adolescents should incorporate such positive role in their designs.

Real-world experience of ocrelizumab in multiple sclerosis in an Arab population.

OBJECTIVE: Pivotal clinical trials revealed good clinical efficiency of ocrelizumab while having a good safety profile in the management of multiple sclerosis (MS). However, real-world data of ocrelizumab in daily clinical practice remain scarce. The aim of this study was to evaluate the preliminary safety profile and effectiveness of ocrelizumab treatment for MS in an Arab population in a real-world clinical setting. METHODS: In this retrospective single-center observational study in Qatar, we reviewed the medical records and analyzed the clinical and MRI data of all patients with relapsing-remitting MS (RRMS) and active secondary progressive MS (aSPMS)-between October 2017 through December 2020-who had received at least one infusion of ocrelizumab (Q-OCRE). RESULTS: A total of 60 MS patients were included (57 with RRMS, three SPMS). The Median follow-up period was 19 months (range, 1-32). The most common reason for switching to ocrelizumab was increased disease activity and three-quarters of the patients were on a previous disease-modifying drug (DMD). No evidence of disease activity (NEDA) status at year 1 was achieved in 73% of the cohort. Mild infusion-related reactions (IRR) and infections were reported (mainly upper respiratory tract infections followed by urinary tract infection) with a declining percentage over the follow-up applications. No severe side effects were observed. CONCLUSION: Our real-world experience confirms good efficacy, tolerability, and safety of ocrelizumab in our Arab population.

Racial Differences in Atrial Cardiopathy Phenotypes in Ischemic Stroke Patients.

OBJECTIVE: To test the hypothesis that thrombogenic atrial cardiopathy may be relevant to stroke-related racial disparities, we compared atrial cardiopathy phenotypes between Black versus White ischemic stroke patients. METHODS: We assessed markers of atrial cardiopathy in the Greater Cincinnati/Northern Kentucky Stroke Study, a study of stroke incidence in a population of 1.3 million. We obtained ECGs and reports of echocardiograms performed during evaluation of stroke during the 2010/2015 study periods. Patients with atrial fibrillation (AF) or flutter (AFL) were excluded. Investigators blinded to patients' characteristics measured P-wave terminal force in ECG lead V1 (PTFV1), a marker of left atrial fibrosis and impaired inter-atrial conduction, and abstracted left atrial diameter from echocardiogram reports. Linear regression was used to examine the association between race and atrial cardiopathy markers after adjustment for demographics, body mass index, and vascular comorbidities. RESULTS: Among 3,426 ischemic stroke cases in Black or White patients without AF/AFL, 2,391 had a left atrial diameter measurement (mean, 3.65 ±0.70 cm). Black race was associated with smaller left atrial diameter in unadjusted (ß coefficient, -0.11; 95% CI, -0.17 to -0.05) and adjusted (ß, -0.15; 95% CI, -0.21 to -0.09) models. PTFV1 measurements were available in 3,209 patients (mean, 3,434 ±2,525 µV*ms). Black race was associated with greater PTFV1 in unadjusted (ß, 1.59; 95% CI, 1.21 to 1.97) and adjusted (ß, 1.45; 95% CI, 1.00 to 1.80) models. CONCLUSIONS: We found systematic Black-White racial differences in left atrial structure and pathophysiology in a population-based sample of ischemic stroke patients. CLASSIFICATION OF EVIDENCE: This study provides class II evidence that the rate of atrial cardiopathy is greater among Black people with acute stroke compared to White people.

Acute sensorineural hearing loss as atypical presentation of typhoid fever in adult patient.

Salmonella Typhi is the main cause of an acute febrile, sometimes fatal, multisystemic illness called typhoid fever. The diverse presentations of this disease make it a diagnostic challenge in some patients. Involvement of the neurological system, including cochleovestibular system, is very rare with less than a handful of reported cases. This case report describes the condition of a previously healthy 23-year-old Pakistani man with acute onset of hearing loss associated with fever, headache, and disorientation. The most likely differential diagnoses were bacterial or viral meningoencephalitis, and other bacterial infections, such as Rickettsial and spirochetal diseases. Salmonella Typhi grew on blood culture; thus, treatment with intravenous antibiotics and systemic steroids was provided with excellent response. Hearing loss gradually improved and almost completely resolved within 3 to 4 weeks.