Publications by authors named "Sarraj A"
Background: Several social and biological factors are shown to differentially affect stroke outcomes between men and women. We evaluated whether clinical outcomes and endovascular thrombectomy (EVT) treatment effects differed between the sexes in patients presenting with large ischemic stroke.
Methods: The SELECT2 trial (A Randomized Controlled Trial to Optimize Patient's Selection for Endovascular Treatment in Acute Ischemic Stroke) was a randomized controlled trial assessing the efficacy and safety of EVT in patients with large strokes across the United States, Canada, Europe, Australia, and New Zealand between October 2019 and September 2022.
Background: Stroke is a leading cause of global mortality and disability, with a disproportionately high burden in low- and middle-income countries. Access to intravenous thrombolysis (IVT) and endovascular treatment (EVT) remains extremely limited.
Aims: We evaluated the spatial distribution and geographic accessibility of stroke centers in India.
Background: Previous studies have reported higher circulating bile acid levels in patients with HCC compared to healthy controls. However, the association between prediagnostic bile acid levels and HCC risk among patients with cirrhosis is unclear.
Methods: We measured total BA (TBA) concentration in serum samples collected from a prospective cohort of patients with cirrhosis who were followed until the development of HCC, death, or last study date.
Article Synopsis
- This study analyzed decisions regarding decompressive hemicraniectomy (DHC) and early withdrawal of life-sustaining therapy (WLST) in patients with large vessel occlusion (LVO) and large ischemic strokes from the SELECT2 trial.* -
- Among 352 patients, DHC was utilized in 55 patients, and WLST was chosen for 81, showing no significant differences in usage between those receiving endovascular thrombectomy (EVT) and those treated medically.* -
- About 21% of DHC patients were able to walk independently after one year, indicating that DHC did not negatively impact the benefits of thrombectomy, while WLST generally resulted in poor outcomes.*
Introduction And Importance: Transomental hernia (TOH) is an extremely rare clinical condition that represents 1-4% of all internal hernias. Spontaneous TOH occurs in patients with no history of surgery or previous abdominal trauma. It happens after protrusion of the abdominal viscera, commonly the small bowel loops through a defect on the great omentum.
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- Endovascular thrombectomy (EVT) has proven safe and effective for patients suffering from large core strokes, but the effects of reperfusion quality and procedure details on outcomes are still unclear.
- In the SELECT2 trial, findings indicated that 80% of patients experienced successful reperfusion, which correlates with better clinical outcomes, particularly in those who achieved near-complete reperfusion.
- Longer procedure times negatively impacted patient outcomes, while the method of thrombectomy (aspiration vs stent-retriever) showed no significant differences in reperfusion success or functional recovery.
Article Synopsis
- A study evaluated the safety and efficacy of endovascular thrombectomy in patients with acute large-vessel occlusion and tandem lesions, focusing on those with low (0-5) and high (6-10) Alberta Stroke Program Early Computed Tomography Scores (ASPECTS).
- The analysis included 691 patients, revealing that those with low ASPECTS had significantly lower odds of achieving a favorable functional outcome (mRS 0-2) and higher odds of suffering symptomatic intracranial hemorrhage compared to those with high ASPECTS.
- The researchers concluded that endovascular thrombectomy may lead to poorer functional recovery in patients with tandem lesions and low ASPECTS, particularly in the
Article Synopsis
- Endovascular thrombectomy (EVT) is shown to be cost-effective for patients with extensive ischemic injury, providing better health outcomes and lower societal costs compared to standard care among various populations, including those in the US, Australia, and Spain.
- The analysis utilized a Markov model to assess outcomes based on quality-adjusted life years (QALYs) and found significant cost savings, with reductions of $23,409 in the US, $10,691 in Australia, and $30,036 in Spain.
- EVT remains cost-effective across different age groups and severity levels of strokes, indicating a need to adapt healthcare systems to increase thrombectomy access for patients with larger strokes.
Article Synopsis
- The European Stroke Organisation recommends using tenecteplase (TNK) as an alternative to alteplase (TPA) for treating acute ischemic stroke within 4.5 hours, based on previous studies establishing its noninferiority.
- An updated systematic review and meta-analysis assessed the efficacy and safety of TNK compared to TPA, using data from 11 randomized controlled trials involving nearly 7,600 patients.
- Results showed that TNK was linked to better chances of achieving excellent functional outcomes and reduced disability at 3 months, while maintaining similar safety profiles for symptomatic intracranial hemorrhage when compared to TPA.
Article Synopsis
- A study evaluated the safety and efficacy of IV thrombolysis (IVT) for acute ischemic stroke (AIS) in patients who received dabigatran reversal with idarucizumab, as limited data exist on this topic.
- Thirteen cohorts and one case series involving 553 patients were analyzed, revealing low rates of symptomatic intracranial hemorrhage (4%), any intracranial hemorrhage (10%), and 3-month mortality (18%).
- Functional outcomes were promising, with 56% achieving excellent outcomes and 70% good outcomes at 3 months, with no significant differences observed between patients treated with idarucizumab and those without.
Purpose: The purpose of this study was to compare the clinical efficacy of a virtual reality rehabilitation-based training (VRT) with balance-specific training (BST) and conventional training (CT) on the balance and gross motor functions (GMF) of children with cerebral palsy (CwCP).
Methods: This study was a double blinded, randomized controlled trial. Participants were recruited from different CP rehabilitation centers and clinics and were then randomly allocated using the block randomization method into three groups: (1) group 1 (VRT using a set of Xbox 360 games that triggered balance), (2) group 2 (BST applying a protocol of 13 exercises to enhance balance in different conditions), and (3) control group 3 (CT using traditional physiotherapy techniques).
Article Synopsis
- Home dialysis therapies like peritoneal dialysis (PD) and home hemodialysis (HHD) enhance patient quality of life but have low prevalence due to short technique survival times.
- A retrospective study analyzed data from over 17,000 patients in France to compare the risk of transferring to facility-based hemodialysis among those using autonomous PD, nurse-assisted PD, and HHD.
- The findings indicated no significant differences in transfer risks among the three modalities, suggesting that assisted PD may benefit a wider range of patients than previously thought, especially in France.
Endovascular thrombectomy (EVT) safety and efficacy in patients with large core infarcts receiving oral anticoagulants (OAC) are unknown. In the SELECT2 trial (NCT03876457), 29 of 180 (16%; vitamin K antagonists 15, direct OACs 14) EVT, and 18 of 172 (10%; vitamin K antagonists 3, direct OACs 15) medical management (MM) patients reported OAC use at baseline. EVT was not associated with better clinical outcomes in the OAC group (EVT 6 [4-6] vs MM 5 [4-6], adjusted generalized odds ratio 0.
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- - Stroke is a major concern for patients with sudden neurological symptoms in the emergency room, and imaging techniques like CT and MRI are essential for diagnosis and treatment decisions
- - Non-contrast CT or MRI helps distinguish between ischemic strokes and bleeding in the brain, which is critical for timely treatment, including thrombolytics
- - Advanced imaging can identify blockages in blood vessels and assess brain tissue health, guiding more complex treatments like endovascular thrombectomy and informing future developments in stroke imaging protocols
Article Synopsis
- Researchers looked at how bleeding in the brain (intracerebral hemorrhage or ICH) affects people who had a specific treatment for severe strokes called endovascular thrombectomy (EVT).
- Out of the 351 patients studied, many experienced bleeding, especially those who had EVT, but serious types of bleeding were rare.
- In the end, having some bleeding didn’t make the patients’ health outcomes worse, and there may be new treatments that could help those with bleeding issues in similar cases.
Article Synopsis
- Patients with large ischemic core strokes often have poor outcomes and are rarely transferred for endovascular thrombectomy (EVT), leading to a need for better understanding of treatment effects in different patient groups.
- The study analyzed data from the SELECT2 trial, focusing on adults with acute ischemic strokes due to specific artery occlusions, comparing those who were directly treated at EVT centers with those who were transferred.
- Results indicated that EVT improved functional outcomes in both transfer and non-transfer patients, suggesting that EVT can benefit patients regardless of transfer delays, although the median ASPECTS score showed a decline during transfers.
Background: Multiple randomised trials have shown efficacy and safety of endovascular thrombectomy in patients with large ischaemic stroke. The aim of this study was to evaluate long-term (ie, at 1 year) evidence of benefit of thrombectomy for these patients.
Methods: SELECT2 was a phase 3, open-label, international, randomised controlled trial with blinded endpoint assessment, conducted at 31 hospitals in the USA, Canada, Spain, Switzerland, Australia, and New Zealand.
Cardioembolic stroke is a major cause of morbidity, with a high risk of recurrence, and anticoagulation represents the mainstay of secondary stroke prevention in most patients. The implementation of endovascular treatment in routine clinical practice complicates the decision to initiate anticoagulation, especially in patients with early hemorrhagic transformation who are considered at higher risk of hematoma expansion. Late hemorrhagic transformation in the days and weeks following stroke remains a potentially serious complication for which we still do not have any established clinical or radiological prediction tools.
View Article and Find Full Text PDFImportance: Whether endovascular thrombectomy (EVT) efficacy for patients with acute ischemic stroke and large cores varies depending on the extent of ischemic injury is uncertain.
Objective: To describe the relationship between imaging estimates of irreversibly injured brain (core) and at-risk regions (mismatch) and clinical outcomes and EVT treatment effect.
Design, Setting, And Participants: An exploratory analysis of the SELECT2 trial, which randomized 352 adults (18-85 years) with acute ischemic stroke due to occlusion of the internal carotid or middle cerebral artery (M1 segment) and large ischemic core to EVT vs medical management (MM), across 31 global centers between October 2019 and September 2022.
Background: Data on systolic blood pressure (SBP) trajectories in the first 24 hours after endovascular thrombectomy (EVT) in acute ischemic stroke are limited. We sought to identify these trajectories and their relationship to outcomes.
Methods: We combined individual-level data from 5 studies of patients with acute ischemic stroke who underwent EVT and had individual blood pressure values after the end of the procedure.
Is thrombectomy indicated in all ischemic stroke with large vessel occlusion?
Curr Opin Neurol
February 2024
Purpose Of Review: Purpose of this topical review is to examine the current randomized and nonrandomized evidence evaluating endovascular thrombectomy (EVT) in selected patient populations with acute ischemic stroke due to large vessel occlusions.
Recent Findings: After establishing EVT as the first-line treatment in patients with large vessel occlusions and limited ischemic changes on neuroimaging, recent trials successfully demonstrated efficacy and safety in patients with large core strokes and those with basilar occlusions up to 24 h of last known well. Nonrandomized evidence in patients with mild stroke severity, baseline disability, medium and distal vessel occlusions and time from last known well >24 h also suggested potential benefit of EVT in selected patients.
Introduction: Data on the association between blood pressure variability (BPV) after endovascular thrombectomy (EVT) for acute ischemic stroke (AIS) and outcomes are limited. We sought to identify whether BPV within the first 24 hours post EVT was associated with key stroke outcomes.
Methods: We combined individual patient-data from five studies among AIS-patients who underwent EVT, that provided individual BP measurements after the end of the procedure.
Background And Purpose: Isolated posterior cerebral artery occlusions (iPCAO) were underrepresented in pivotal randomized clinical trial (RCTs) of endovascular thrombectomy (EVT) in ischemic stroke, and the benefit of EVT in this population is still indeterminate. We performed a systematic review and a meta-analysis to compare the safety and efficacy of EVT compared to best medical management (BMM) in patients with iPCAO.
Methods: We searched Medline/PubMed, Embase, Web of Science, and the Cochrane databases up to May 2023 for eligible studies reporting outcomes of patients with iPCAO treated with EVT or BMM.
Diabetes Insipidus due to Metastases of Undiagnosed Lung Cancer: A Case Report from Syria.
Case Rep Endocrinol
September 2023
Pituitary metastases (PM) are extremely uncommon, accounting for less than 1% of all intracranial metastases. PM of an undiagnosed malignancy can commonly present with symptoms of hormonal deficiencies, central diabetes insipidus, and/or visual symptoms. Lung and breast malignancies are the most common cancers associated with PM.
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