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Circulation. Heart failure, Jan 7, 2015

New England Journal of Medicine, 2012

JAMA

ImportanceUse of oral vitamin K antagonists (VKAs) may place patients undergoing endovascular thr... more ImportanceUse of oral vitamin K antagonists (VKAs) may place patients undergoing endovascular thrombectomy (EVT) for acute ischemic stroke caused by large vessel occlusion at increased risk of complications.ObjectiveTo determine the association between recent use of a VKA and outcomes among patients selected to undergo EVT in clinical practice.Design, Setting, and ParticipantsRetrospective, observational cohort study based on the American Heart Association’s Get With the Guidelines–Stroke Program between October 2015 and March 2020. From 594 participating hospitals in the US, 32 715 patients with acute ischemic stroke selected to undergo EVT within 6 hours of time last known to be well were included.ExposureVKA use within the 7 days prior to hospital arrival.Main Outcome and MeasuresThe primary end point was symptomatic intracranial hemorrhage (sICH). Secondary end points included life-threatening systemic hemorrhage, another serious complication, any complications of reperfusion th...

Circulation, Jan 27, 2017

Background -Patients with minor acute ischemic stroke (AIS) or transient ischemic attack (TIA) ar... more Background -Patients with minor acute ischemic stroke (AIS) or transient ischemic attack (TIA) are at high risk for subsequent stroke, and more potent antiplatelet therapy in the acute setting is needed. However, the potential benefit of more intense antiplatelet therapy must be assessed in relation to the risk for major bleeding. The SOCRATES trial was the first trial with ticagrelor in patients with AIS or TIA, in which the efficacy and safety of ticagrelor were compared with aspirin. The main safety objective was assessment of PLATO-defined major bleeds on treatment, with special focus on intracranial hemorrhage (ICrH). Methods -An independent adjudication committee, blinded to study treatment, classified bleeds according to the PLATO, TIMI and GUSTO definitions. The definitions of ICrH and major bleeding excluded cerebral micro-bleeds and asymptomatic hemorrhagic transformations of cerebral infarctions so that the definitions better discriminated important events in the acute st...

Neurocritical Care, 2019

Background Neurocritical care is devoted to the care of critically ill patients with acute neurol... more Background Neurocritical care is devoted to the care of critically ill patients with acute neurological or neurosurgical emergencies. There is limited information regarding epidemiological data, disease characteristics, variability of clinical care, and in-hospital mortality of neurocritically ill patients worldwide. We addressed these issues in the Point PRevalence In Neurocritical CarE (PRINCE) study, a prospective, cross-sectional, observational study. Methods We recruited patients from various intensive care units (ICUs) admitted on a pre-specified date, and the investigators recorded specific clinical care activities they performed on the subjects during their first 7 days of admission or discharge (whichever came first) from their ICUs and at hospital discharge. In this manuscript, we analyzed the final data set of the study that included patient admission characteristics, disease type and severity, ICU resources, ICU and hospital length of stay, and inhospital mortality. We present descriptive statistics to summarize data from the case report form. We tested differences between geographically grouped data using parametric and nonparametric testing as appropriate. We used a multivariable logistic regression model to evaluate factors associated with in-hospital mortality. Results We analyzed data from 1545 patients admitted to 147 participating sites from 31 countries of which most were from North America (69%, N = 1063). Globally, there was variability in patient characteristics, admission diagnosis, ICU treatment team and resource allocation, and in-hospital mortality. Seventy-three percent of the participating centers were academic, and the most common admitting diagnosis was subarachnoid hemorrhage (13%). The majority of patients were male (59%), a half of whom had at least two comorbidities, and median Glasgow Coma Scale (GCS) of 13. Factors associated with in-hospital mortality included age (OR 1.

Vascular and endovascular surgery, 2013

Although intraarterial shunting during carotid endarterectomy is a well-defined practice, its use... more Although intraarterial shunting during carotid endarterectomy is a well-defined practice, its use remains controversial. Complication rates associated with shunt placement remain low, but may be underreported. When complications secondary to routine intraarterial shunting occur, they can cause significant morbidity or even mortality, emphasizing the importance of meticulous technique to prevent adverse outcomes. We report a case of internal carotid artery dissection and pseuedoaneurysm due to the technical failure of a safety device of an intraarterial shunt used during carotid endarterectomy.

Southern Medical Journal, 2003

Archives of Internal Medicine, 2001

We describe a patient who developed pancerebellar syndrome as a result of hyperthermia that devel... more We describe a patient who developed pancerebellar syndrome as a result of hyperthermia that developed after cocaine use. The patient had long-standing schizophrenia and had been taking risperidone for 2 years, without evidence of abnormal movements. A literature review revealed a marked similarity between cocaine and neuroleptics in their ability to cause hyperthermia. Based on our observations and the compatible evidence from the literature, we suggest that cocaine use may cause hyperthermia and result in chronic pancerebellar dysfunction.

Clinical Neuropharmacology, 2004

Charcot-Marie-Tooth (CMT) identifies a rare group of inherited disorders of the peripheral nervou... more Charcot-Marie-Tooth (CMT) identifies a rare group of inherited disorders of the peripheral nervous system that share clinical features of sensory and motor defects, but rarely affect cardiac function. The few references that relate CMT to cardiac pathology of any sort are so rare that their finding was considered either fortuitous or suggestive of an erroneous diagnosis. The 5-HT1B/1D agonists or triptan drug class was introduced to the clinical practice arena in the early 1990s, and since then several cardiac adverse events have been associated with its use. The authors report the case of a 41-year-old white woman with CMT who had been recently prescribed sumatriptan and who presented with sudden loss of consciousness associated with ventricular fibrillation. These findings have been reported in the literature, but the association of triptan-induced arrhythmias and degenerative neuropathies remains to be established. The authors propose, through this case report and review, that the relative rarity of CMT coupled with the lack of further investigation of their association with conduction abnormalities might have set the stage for underestimation of the potentially synergistic effect with triptans in their capacity to generate life-threatening arrhythmias.

SUMMARY-Adenocarcinomas of the pancreas were experi-mentally induced in rats after the implantati... more SUMMARY-Adenocarcinomas of the pancreas were experi-mentally induced in rats after the implantation of 7,12-dimethylbenz[a]anthracene (DMBA). Rats were anesthetized with Nembutal, the pancreas was exposed, and a 2- to 3-mm incision was made in the "head " of the pancreas approxi-mately 1 cm from the duodenum. Crystalline DMBA (2-3 mg) was implanted and the incision was closed with silk suture. Eight % of animals developed tumors in the pancreas from 119 to 363 days after implantation (mean, 194 days). Ten an-imals developed tumors in less than 180 days. The adenocar-cinomas were invasive, metastasized, and had pronounced ductal cell characteristics. The light-microscopic morphology of these pancreatic tumors was presented.-J Natl Cancer Inst 55: 857-864, 1975. Epidemiologic surveys indicate an increase during

Neurocritical Care, 2019

Background Neurocritical care is devoted to the care of critically ill patients with acute neurol... more Background Neurocritical care is devoted to the care of critically ill patients with acute neurological or neurosurgical emergencies. There is limited information regarding epidemiological data, disease characteristics, variability of clinical care, and in-hospital mortality of neurocritically ill patients worldwide. We addressed these issues in the P oint P R evalence I n N eurocritical C ar E (PRINCE) study, a prospective, cross-sectional, observational study. Methods We recruited patients from various intensive care units (ICUs) admitted on a pre-specified date, and the investigators recorded specific clinical care activities they performed on the subjects during their first 7 days of admission or discharge (whichever came first) from their ICUs and at hospital discharge. In this manuscript, we analyzed the final data set of the study that included patient admission characteristics, disease type and severity, ICU resources, ICU and hospital length of stay, and in-hospital mortali...

Translational stroke research, Apr 5, 2017

The occurrence of a stroke while on antiplatelet agents presents a therapeutic dilemma. One of th... more The occurrence of a stroke while on antiplatelet agents presents a therapeutic dilemma. One of the main causes for recurrent strokes is antiplatelet resistance more commonly known as high on treatment platelet reactivity (HTPR). Prior studies have established that proteinuria is associated with HTPR following myocardial infarction. Here, we investigated whether dipstick proteinuria correlates with HTPR in patients presenting with stroke. We performed a retrospective cohort analysis of 102 patients admitted for a recurrent ischemic stroke that had either a VerifyNow aspirin or VerifyNow clopidogrel laboratory test performed to assess platelet reactivity. Dipstick proteinuria was defined as > 30 mg/dl (2+ or more). HTPR was defined as an aspirin resistance unit > 550 for aspirin and a P2Y12 reactivity unit > 208 for clopidogrel. Patients with proteinuria on dipstick were significantly more likely to have HTPR to either aspirin (p value 0.017) or clopidogrel (p value 0.017). A...

Neurology, 2016

Go to Neurology.org for full disclosures. Funding information and disclosures deemed relevant by ... more Go to Neurology.org for full disclosures. Funding information and disclosures deemed relevant by the authors, if any, are provided at the end of the article.

Circulation. Heart failure, Jan 7, 2015

New England Journal of Medicine, 2012

JAMA

ImportanceUse of oral vitamin K antagonists (VKAs) may place patients undergoing endovascular thr... more ImportanceUse of oral vitamin K antagonists (VKAs) may place patients undergoing endovascular thrombectomy (EVT) for acute ischemic stroke caused by large vessel occlusion at increased risk of complications.ObjectiveTo determine the association between recent use of a VKA and outcomes among patients selected to undergo EVT in clinical practice.Design, Setting, and ParticipantsRetrospective, observational cohort study based on the American Heart Association’s Get With the Guidelines–Stroke Program between October 2015 and March 2020. From 594 participating hospitals in the US, 32 715 patients with acute ischemic stroke selected to undergo EVT within 6 hours of time last known to be well were included.ExposureVKA use within the 7 days prior to hospital arrival.Main Outcome and MeasuresThe primary end point was symptomatic intracranial hemorrhage (sICH). Secondary end points included life-threatening systemic hemorrhage, another serious complication, any complications of reperfusion th...

Circulation, Jan 27, 2017

Background -Patients with minor acute ischemic stroke (AIS) or transient ischemic attack (TIA) ar... more Background -Patients with minor acute ischemic stroke (AIS) or transient ischemic attack (TIA) are at high risk for subsequent stroke, and more potent antiplatelet therapy in the acute setting is needed. However, the potential benefit of more intense antiplatelet therapy must be assessed in relation to the risk for major bleeding. The SOCRATES trial was the first trial with ticagrelor in patients with AIS or TIA, in which the efficacy and safety of ticagrelor were compared with aspirin. The main safety objective was assessment of PLATO-defined major bleeds on treatment, with special focus on intracranial hemorrhage (ICrH). Methods -An independent adjudication committee, blinded to study treatment, classified bleeds according to the PLATO, TIMI and GUSTO definitions. The definitions of ICrH and major bleeding excluded cerebral micro-bleeds and asymptomatic hemorrhagic transformations of cerebral infarctions so that the definitions better discriminated important events in the acute st...

Neurocritical Care, 2019

Background Neurocritical care is devoted to the care of critically ill patients with acute neurol... more Background Neurocritical care is devoted to the care of critically ill patients with acute neurological or neurosurgical emergencies. There is limited information regarding epidemiological data, disease characteristics, variability of clinical care, and in-hospital mortality of neurocritically ill patients worldwide. We addressed these issues in the Point PRevalence In Neurocritical CarE (PRINCE) study, a prospective, cross-sectional, observational study. Methods We recruited patients from various intensive care units (ICUs) admitted on a pre-specified date, and the investigators recorded specific clinical care activities they performed on the subjects during their first 7 days of admission or discharge (whichever came first) from their ICUs and at hospital discharge. In this manuscript, we analyzed the final data set of the study that included patient admission characteristics, disease type and severity, ICU resources, ICU and hospital length of stay, and inhospital mortality. We present descriptive statistics to summarize data from the case report form. We tested differences between geographically grouped data using parametric and nonparametric testing as appropriate. We used a multivariable logistic regression model to evaluate factors associated with in-hospital mortality. Results We analyzed data from 1545 patients admitted to 147 participating sites from 31 countries of which most were from North America (69%, N = 1063). Globally, there was variability in patient characteristics, admission diagnosis, ICU treatment team and resource allocation, and in-hospital mortality. Seventy-three percent of the participating centers were academic, and the most common admitting diagnosis was subarachnoid hemorrhage (13%). The majority of patients were male (59%), a half of whom had at least two comorbidities, and median Glasgow Coma Scale (GCS) of 13. Factors associated with in-hospital mortality included age (OR 1.

Vascular and endovascular surgery, 2013

Although intraarterial shunting during carotid endarterectomy is a well-defined practice, its use... more Although intraarterial shunting during carotid endarterectomy is a well-defined practice, its use remains controversial. Complication rates associated with shunt placement remain low, but may be underreported. When complications secondary to routine intraarterial shunting occur, they can cause significant morbidity or even mortality, emphasizing the importance of meticulous technique to prevent adverse outcomes. We report a case of internal carotid artery dissection and pseuedoaneurysm due to the technical failure of a safety device of an intraarterial shunt used during carotid endarterectomy.

Southern Medical Journal, 2003

Archives of Internal Medicine, 2001

We describe a patient who developed pancerebellar syndrome as a result of hyperthermia that devel... more We describe a patient who developed pancerebellar syndrome as a result of hyperthermia that developed after cocaine use. The patient had long-standing schizophrenia and had been taking risperidone for 2 years, without evidence of abnormal movements. A literature review revealed a marked similarity between cocaine and neuroleptics in their ability to cause hyperthermia. Based on our observations and the compatible evidence from the literature, we suggest that cocaine use may cause hyperthermia and result in chronic pancerebellar dysfunction.

Clinical Neuropharmacology, 2004

Charcot-Marie-Tooth (CMT) identifies a rare group of inherited disorders of the peripheral nervou... more Charcot-Marie-Tooth (CMT) identifies a rare group of inherited disorders of the peripheral nervous system that share clinical features of sensory and motor defects, but rarely affect cardiac function. The few references that relate CMT to cardiac pathology of any sort are so rare that their finding was considered either fortuitous or suggestive of an erroneous diagnosis. The 5-HT1B/1D agonists or triptan drug class was introduced to the clinical practice arena in the early 1990s, and since then several cardiac adverse events have been associated with its use. The authors report the case of a 41-year-old white woman with CMT who had been recently prescribed sumatriptan and who presented with sudden loss of consciousness associated with ventricular fibrillation. These findings have been reported in the literature, but the association of triptan-induced arrhythmias and degenerative neuropathies remains to be established. The authors propose, through this case report and review, that the relative rarity of CMT coupled with the lack of further investigation of their association with conduction abnormalities might have set the stage for underestimation of the potentially synergistic effect with triptans in their capacity to generate life-threatening arrhythmias.

SUMMARY-Adenocarcinomas of the pancreas were experi-mentally induced in rats after the implantati... more SUMMARY-Adenocarcinomas of the pancreas were experi-mentally induced in rats after the implantation of 7,12-dimethylbenz[a]anthracene (DMBA). Rats were anesthetized with Nembutal, the pancreas was exposed, and a 2- to 3-mm incision was made in the "head " of the pancreas approxi-mately 1 cm from the duodenum. Crystalline DMBA (2-3 mg) was implanted and the incision was closed with silk suture. Eight % of animals developed tumors in the pancreas from 119 to 363 days after implantation (mean, 194 days). Ten an-imals developed tumors in less than 180 days. The adenocar-cinomas were invasive, metastasized, and had pronounced ductal cell characteristics. The light-microscopic morphology of these pancreatic tumors was presented.-J Natl Cancer Inst 55: 857-864, 1975. Epidemiologic surveys indicate an increase during

Neurocritical Care, 2019

Background Neurocritical care is devoted to the care of critically ill patients with acute neurol... more Background Neurocritical care is devoted to the care of critically ill patients with acute neurological or neurosurgical emergencies. There is limited information regarding epidemiological data, disease characteristics, variability of clinical care, and in-hospital mortality of neurocritically ill patients worldwide. We addressed these issues in the P oint P R evalence I n N eurocritical C ar E (PRINCE) study, a prospective, cross-sectional, observational study. Methods We recruited patients from various intensive care units (ICUs) admitted on a pre-specified date, and the investigators recorded specific clinical care activities they performed on the subjects during their first 7 days of admission or discharge (whichever came first) from their ICUs and at hospital discharge. In this manuscript, we analyzed the final data set of the study that included patient admission characteristics, disease type and severity, ICU resources, ICU and hospital length of stay, and in-hospital mortali...

Translational stroke research, Apr 5, 2017

The occurrence of a stroke while on antiplatelet agents presents a therapeutic dilemma. One of th... more The occurrence of a stroke while on antiplatelet agents presents a therapeutic dilemma. One of the main causes for recurrent strokes is antiplatelet resistance more commonly known as high on treatment platelet reactivity (HTPR). Prior studies have established that proteinuria is associated with HTPR following myocardial infarction. Here, we investigated whether dipstick proteinuria correlates with HTPR in patients presenting with stroke. We performed a retrospective cohort analysis of 102 patients admitted for a recurrent ischemic stroke that had either a VerifyNow aspirin or VerifyNow clopidogrel laboratory test performed to assess platelet reactivity. Dipstick proteinuria was defined as > 30 mg/dl (2+ or more). HTPR was defined as an aspirin resistance unit > 550 for aspirin and a P2Y12 reactivity unit > 208 for clopidogrel. Patients with proteinuria on dipstick were significantly more likely to have HTPR to either aspirin (p value 0.017) or clopidogrel (p value 0.017). A...

Neurology, 2016

Go to Neurology.org for full disclosures. Funding information and disclosures deemed relevant by ... more Go to Neurology.org for full disclosures. Funding information and disclosures deemed relevant by the authors, if any, are provided at the end of the article.