Adherence to Antithrombotic Treatment and Ischemic Stroke Recurrence in Egypt and Germany: A Comparative Analysis.

BACKGROUND: The burden of stroke weighs heavily in developing countries where recurrence rates clearly exceed that of developed countries. The impact of nonadherence to antithrombotic treatment within this context has been poorly investigated. OBJECTIVE: The objective of this study was to evaluate patients with recurrent ischemic stroke in Egypt and Germany with focus on stroke subtype distribution and adherence to antithrombotic therapy. METHODS: We conducted a comparative cross-sectional retrospective cohort study enrolling consecutive patients hospitalized for recurrent ischemic stroke in 2017 in 2 academic centers. Data were collected on demographics, risk factors, stroke subtypes, and medication adherence. Nonadherence to antithrombotic agents was analyzed at the time point of index stroke (recurrent stroke). Predictors of nonadherence were analyzed using logistic regression. RESULTS: A total of 373 Egyptian and 468 German patients with ischemic stroke were included. The proportion of recurrent ischemic stroke among all patients was higher in the Egyptian cohort compared to the German cohort (33 vs. 10%, p < 0.05). Small-vessel occlusion stroke was the most frequent subtype in Egyptians, with a significantly greater proportion than in Germans (45 vs. 26%, p < 0.05). Nonadherence to antiplatelets at the time point of the recurrent stroke was higher in Egyptians than in Germans (82 vs. 19%, p < 0.001). Low educational attainment among Egyptians (OR 0.14, 95% CI [0.00-0.19], p < 0.01) and high comorbidity scores among Germans (OR 2.45, 95% CI [1.06-5.66], p < 0.05) were found to be predictors of nonadherence to antithrombotic treatment. CONCLUSIONS: The large stroke recurrence burden in Egypt may be partly explained by differing adherence to secondary preventative antithrombotic pharmacotherapy. Predictors of medication nonadherence have to be addressed to reduce stroke recurrence disparities.

Pilomyxoid astrocytoma presenting as diencephalic syndrome.

We report the case of a child who presented with diencephalic syndrome. During diagnostic work- up, he was found to have a supra-sellar hypothalamic tumour. Histopathological examination of the tumour revealed it to be pilomyxoid astrocytoma, which is a WHO grade-II tumour, previously considered to be part of the spectrum of WHO grade-I pilocytic astrocytomas. However, because of its characteristic histopathology and behaviour, it was later segregated from pilocytic astrocytomas. In this case report, we discuss the cytological and histopathological features of this tumor with the aim of increasing awareness of this tumour amongst general histopathologists, to highlight the importance of its differentiation from pilocytic astrocytomas in view of its different behaviour, treatment and prognosis and that it should be included in the differential diagnosis of diencephalic syndrome.

Clinical and neurophysiological risk factors of learning disabilities in different types of idiopathic focal epilepsy.

Objectives: Academic difficulties are common in epileptic children. A learning disability (LD) is a reduction in the learning capacity of children or the intellectual ability of adults, which is different from mental retardation or dementia. Materials & Methods: The participants were 56 patients, of whom 35 were males (62.5%), and 21 were females (37.5%). The participants attended the Neurology Outpatient Clinic, the Sohag University Hospital, between December 2016 and May 2017. Children with chronological age between 7 and 16 years with idiopathic focal and normal mental and motor developmental history were enrolled in this cross-sectional study. The Revised Quick Neurological Screening Test was used to assess different types of LD. Results: LDs were present in 67.9% of our participants with a statistically significant association between LDs in one arm and younger age, earlier age of onset of epilepsy, frequent seizures, and seizure semiology, particularly of temporal lobe origin, in the other arm. In addition, left epileptic focus on EEG, prolonged treatment duration with antiepileptic drugs (AED), and polytherapy were significantly correlated with LDs. Conclusion: Many factors are significantly correlated with LDs in children with idiopathic focal epilepsy, like age of the patient, age of epilepsy onset, seizure semiology, prolonged AED treatment, and polytherapy.

Dual ionic liquid-based crosslinked chitosan for fine-tuning of antifouling, water throughput, and denitrification performance of polysulfone membrane.

This study aimed to design a facile and efficient protocol for upgrading the performance indices of polysulfone (PS) membrane (porosity, hydrophilicity, pure water flux (PWF), surface charge, and fouling-resistance) by blending with newly synthesized poly(ionic) crosslinked chitosan Schiff bases (PICCSBs). The PS-PICCSBs mixed-matrix membranes (MMMs) have successfully fabricated and characterized based on spectral and microscopic analyses, porosity, zeta potential, water contact angle, and water uptake (wettability) measurements. The PWF, fouling-resistance against bovine serum albumin (BSA), as well as ion exchange capacity (IEC) against nitrate anion were studied. The wettability, hydrophilicity and overall porosity of new MMMs have greatly increased, in comparison to a pristine PS membrane (M0). In addition, blending of PS with PICCSBs resulted in switching its surface from negatively- to positively-charged. The PWF of MMMs has increased to reach a maximum value of 238.6 L/m2 h for MMM1 (9.3-fold higher than M0). Meanwhile, BSA rejection has declined from 96.62% for M0 to 41.9% for MMM1. The fouling parameters results of MMMs indicated their low fouling propensity. The IEC of nitrate anions revealed that the nitrate uptake by MMM1 is higher than that for M0 and MMM2 by 34% and 14%, respectively.

Pleuropulmonary blastoma: a case report and review of the literature.

The case of 38-month-old boy is being reported who was brought to the pediatrics clinic with fever, cough, hemoptysis, and breathing difficulty. Imaging studies revealed a right lower chest mass. Lobectomy and histopathological examination revealed it to be predominantly solid pleuropulmonary blastoma type II. It is a rare pediatric pleuropulmonary tumor with aggressive behavior and tendency to spread to the brain. The case is being presented to make the general histopathologist aware of this rare entity and to highlight to the pediatric physicians/surgeons, radiologists, and histopathologists the fact that lung cysts in infants and young children should be evaluated seriously and sampled thoroughly to diagnose cases of type I pleuropulmonary blastoma which will progress over time to type II or type III tumors. Also the siblings and first degree relatives of the patient should be screened for associated pulmonary and extrapulmonary benign and malignant conditions.