Stroke Care Trends During COVID-19 Pandemic in Zanjan Province, Iran. From the CASCADE Initiative: Statistical Analysis Plan and Preliminary Results

BACKGROUND: The emergence of the COVID-19 pandemic has significantly impacted global healthcare systems and this may affect stroke care and outcomes. This study examines the changes in stroke epidemiology and care during the COVID-19 pandemic in Zanjan Province, Iran. METHODS: This study is part of the CASCADE international initiative. From February 18, 2019, to July 18, 2020, we followed ischemic and hemorrhagic stroke hospitalization rates and outcomes in Valiasr Hospital, Zanjan, Iran. We used a Bayesian hierarchical model and an interrupted time series analysis (ITS) to identify changes in stroke hospitalization rate, baseline stroke severity [measured by the National Institutes of Health Stroke Scale (NIHSS)], disability [measured by the modified Rankin Scale (mRS)], presentation time (last seen normal to hospital presentation), thrombolytic therapy rate, median door-to-needle time, length of hospital stay, and in-hospital mortality. We compared in-hospital mortality between study periods using Cox-regression model. RESULTS: During the study period, 1,026 stroke patients were hospitalized. Stroke hospitalization rates per 100,000 population decreased from 68.09 before the pandemic to 44.50 during the pandemic, with a significant decline in both Bayesian [Beta: -1.034; Standard Error (SE): 0.22, 95% CrI: -1.48, -0.59] and ITS analysis (estimate: -1.03, SE = 0.24, p < 0.0001). Furthermore, we observed lower admission rates for patients with mild (NIHSS < 5) ischemic stroke (p < 0.0001). Although, the presentation time and door-to-needle time did not change during the pandemic, a lower proportion of patients received thrombolysis (-10.1%; p = 0.004). We did not see significant changes in admission rate to the stroke unit and in-hospital mortality rate; however, disability at discharge increased (p < 0.0001). CONCLUSION: In Zanjan, Iran, the COVID-19 pandemic has significantly impacted stroke outcomes and altered the delivery of stroke care. Observed lower admission rates for milder stroke may possibly be due to fear of exposure related to COVID-19. The decrease in patients treated with thrombolysis and the increased disability at discharge may indicate changes in the delivery of stroke care and increased pressure on existing stroke acute and subacute services. The results of this research will contribute to a similar analysis of the larger CASCADE dataset in order to confirm findings at a global scale and improve measures to ensure the best quality of care for stroke patients during the COVID-19 pandemic

Stimuli of Sensory-Motor Nerves Terminate Arterial Contractile Effects of Endothelin-1 by CGRP and Dissociation of ET-1/ETA-Receptor Complexes

Endothelin-1 (ET-1), a long-acting paracrine mediator, is implicated in cardiovascular diseases but clinical trials with ET-receptor antagonists were not successful in some areas. We tested whether the quasi-irreversible receptor-binding of ET-1 (i) limits reversing effects of the antagonists and (ii) can be selectively dissociated by an endogenous counterbalancing mechanism.-receptor complexes.-receptors by ET-1 (i) occur at an antagonist-insensitive site of the receptor and (ii) are selectively terminated by endogenously released CGRP. Hence, natural stimuli of sensory-motor nerves that stimulate release of endogenous CGRP can be considered for therapy of diseases involving ET-1

Call to Action: SARS-CoV-2 and CerebrovAscular DisordErs (CASCADE)

Background and purpose: The novel severe acute respiratory syndrome coronavirus 2 (SARS-Cov-2), now named coronavirus disease 2019 (COVID-19), may change the risk of stroke through an enhanced systemic inflammatory response, hypercoagulable state, and endothelial damage in the cerebrovascular system. Moreover, due to the current pandemic, some countries have prioritized health resources towards COVID-19 management, making it more challenging to appropriately care for other potentially disabling and fatal diseases such as stroke. The aim of this study is to identify and describe changes in stroke epidemiological trends before, during, and after the COVID-19 pandemic. Methods: This is an international, multicenter, hospital-based study on stroke incidence and outcomes during the COVID-19 pandemic. We will describe patterns in stroke management, stroke hospitalization rate, and stroke severity, subtype (ischemic/hemorrhagic), and outcomes (including in-hospital mortality) in 2020 during COVID-19 pandemic, comparing them with the corresponding data from 2018 and 2019, and subsequently 2021. We will also use an interrupted time series (ITS) analysis to assess the change in stroke hospitalization rates before, during, and after COVID-19, in each participating center. Conclusion: The proposed study will potentially enable us to better understand the changes in stroke care protocols, differential hospitalization rate, and severity of stroke, as it pertains to the COVID-19 pandemic. Ultimately, this will help guide clinical-based policies surrounding COVID-19 and other similar global pandemics to ensure that management of cerebrovascular comorbidity is appropriately prioritized during the global crisis. It will also guide public health guidelines for at-risk populations to reduce risks of complications from such comorbidities. © 202

Quercetin Loaded Silica and Gold - Coated Silica Nanoparticles: Characterization, Evaluation and Comparison of Their in vitro Characteristics

Herein, silica nanoparticles (NPs) and gold-silica NPs were loaded with the anti-cancer agent quercetin (QC) to produce silica NPs-QC and gold coated silica NPs-QC, respectively. The nanosystems were characterized using transmission electron microscopy (TEM), dynamic light scattering (DLS) and Fourier transform infrared (FTIR). Drug encapsulation efficiency (EE), loading capacity (LC) and release rate were measured using UV spectrophotometer. The drug was encapsulated in silica NPs in a high percentage (71%) and reduced by about 16% after gold coating. The mean particle size increased after coating and QC loading with a polydispersity index (PDI) between (∼ 0.2 - 0.6) and negative zeta potential (-13 to - 15 mV). The intensity of FTIR peaks of silica NPs has been significantly decreased upon gold coating indicating a successful attachment of the gold thin layer. The drug release was slightly faster from coated compared to uncoated NPs but both slower than free QC. The percentages of their cell toxicity were almost the same but lower than free QC and generally were higher against HeLa cells compared to fibroblast cells. Both nanosystems could be considered as promising nanocarriers with reasonable EE, slower release rate and lower toxicity compared to the free drug

Chitosan and Starch-Based Hydrogels Via Graft Copolymerization

Graft copolymerization is an attractive method for surface functionalization of natural polymers and can be initiated by chemical methods, radiation technique, and other systems. Polymer grafting onto polysaccharides is an effective method for the synthesis of superabsorbents. Depending upon the type of monomers and the conditions employed the properties of graft copolymers vary to a large extent. Chitosan is a nontoxic, biocompatible polysaccharide, and starch is a natural hydrophilic biopolymer. Both these are most abundant natural organic materials which are extensively investigated in the development of biodegradable and environment-friendly materials. Their hydrogels are of utmost importance for wide use in many fields including structural transplants, target drug delivery, tissue engineering, biosensors, adsorbents, etc. In this chapter, the various techniques used for the synthesis of chitosan/starch graft copolymers, their properties and possible applications are discussed in detail

STANDARIZED ECONOMICAL STUDY OF EGYPTIAN OILS AND FATS DEMAND FACTORS

Recent data shows a declining performance in Egyptian foreign trade of agricultural sector especially by increased the Egyptian agricultural import, which leads to increase the deficit of agricultural trade balance. Agricultural processed proucts is consider one of main source of agricultural trade balance deficit. As a result, it is necessary to study the main factors affecting the Egyptian demand of foreign agricultura processed products to determine the most important factors and determine the possible solution in future. It is clear through the research resealt of the factors affecting the quantity of the Egyptian fats and oil imports, that their main factors are determined by the total production of the Egyptian fats and oil, the imports price and the consumption of oils and fats and in the total exports of USA from oil and fats. Moreover, it is obvious from the factors affecting the demand in Egyptian market that the price of the USA fats and oil is considered the main factor in most of these markets. Moreover the effect of free trade agreement and European Egyptian agreement were significant positive for increase the Egyptian demand of foreign oils and fats. So it is important to use some possible solution for decreasing these positive impact of these fators on Egyptian demand for foreign oils and fats for developing countries without being against the activation of these agreements. It is important to control the national consumption and increase the total production of oil and fats

Ondansetron Use During Pregnancy: Birth Defects and Obstetric Outcomes

Ondansetron is a widely administered medication for nausea and vomiting of pregnancy. Further examination of its teratogenic capacity is necessary. This study examines the association between ondansetron treatment during pregnancy and birth defects and adverse obstetric outcomes. Patient data were extracted from Clalit Health Services, Israel. A propensity-score analysis was performed matching those exposed to ondansetron with those who were not. Findings identified 774 women exposed to ondansetron, matched 1:1 with unexposed control patients. No significant differences were found between the groups for: cleft palate, cardiovascular congenital abnormalities, spina bifida occulta, preterm delivery, or small for gestational age. Ondansetron may be a useful and safe alternative as treatment for women who suffer from hyperemesis gravidarum and do not respond to other antiemetic drugs. Notwithstanding, additional prospectively designed research is needed to establish the safety of ondansetron treatment during pregnancy. </jats:p