Neurocritical care
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Meta Analysis
Safety and Efficacy of Vinpocetine as a Neuroprotective Agent in Acute Ischemic Stroke: A Systematic Review and Meta-Analysis.
Vinpocetine as a neuroprotective agent is effective in acute ischemic stroke in some randomized controlled trials (RCTs). Since the last systematic review has been published in 2008, which didn't find conclusive evidence favoring its use, two more RCTs have also been completed. ⋯ Vinpocetine has some promising efficacy in patients with ischemic stroke when used in the acute stage in reducing the disability, but presently there is not enough evidence to suggest that it also reduces case fatality. More double-blind, placebo-controlled RCTs of adequate sample size are needed before making recommendations for the routine administration of vinpocetine for all patients with acute ischemic stroke.
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Twitter journal clubs are a modern way of highlighting articles published in a scientific journal. The Neurocritical Care journal (NCC) initiated a bimonthly, Twitter-based, online journal club in 2015 to increase the outreach of its published articles. We hypothesize that articles included in the Neurocritical Care Society Twitter Journal Club (NCSTJC) had greater engagement than other articles published during the same time period. We also investigated the relationship between number of citations and Altmetric score to assess whether the enhanced online activity resulted in higher citations. ⋯ Scientific journals are evolving their social media strategies in attempt to increase the outreach of their articles to the medical community. Platforms such as Twitter journal clubs can enhance such engagement. The long-term influence of such strategies on the impact factor of a medical journal and traditional engagement metrics, such as citations, calls for further research.
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Multicenter Study
Neurological Prognostication After Hypoglycemic Coma: Role of Clinical and EEG Findings.
Hypoglycemic coma (HC) is an uncommon but severe clinical condition associated with poor neurological outcome. There is a dearth of robust neurological prognostic factors after HC. On the other hand, there is an increasing body of literature on reliable prognostic markers in the postanoxic coma, a similar-albeit not identical-situation. The objective of this study was thus to investigate the use and predictive value of these markers in HC. ⋯ This preliminary study suggests that highly malignant EEG patterns might be reliable prognostic markers of unfavorable outcome after HC. Other EEG findings, including lack of EEG reactivity and seizures and clinical findings appear less accurate. These findings should be replicated in a larger multicenter prospective study.
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Big data (BD) and artificial intelligence (AI) have increasingly been used in neurocritical care. "BD" can be operationally defined as extremely large datasets that are so large and complex that they cannot be analyzed by using traditional statistical modeling. "AI" means the ability of machines to perform tasks similar to those performed by human intelligence. We present a brief overview of the most commonly applied AI techniques to perform BD analytics and discuss some of the recent promising examples in the field of neurocritical care. The latter include the following: cognitive motor dissociation in disorders of consciousness, hypoxic-ischemic injury following cardiac arrest, delayed cerebral ischemia and vasospasm after subarachnoid hemorrhage, and monitoring of intracranial pressure. ⋯ These collaborations will allow us to share data, combine predictive algorithms, and analyze multiple and cumulative sources of data retrospectively and prospectively. Once AI algorithms are validated at multiple centers, they should be tested in randomized controlled trials investigating their impact on clinical outcome. The neurocritical care community must work to ensure that AI incorporates standards to ensure fairness and health equity rather than reflect our biases present in our collective conscience.
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Hyperventilation resulting in hypocapnic alkalosis (HA) is frequently encountered in spontaneously breathing patients with acute cerebrovascular conditions. The underlying mechanisms of this respiratory response have not been fully elucidated. The present study describes, applying the physical-chemical approach, the acid-base characteristics of cerebrospinal fluid (CSF) and arterial plasma of spontaneously breathing patients with aneurismal subarachnoid hemorrhage (SAH) and compares these results with those of control patients. Moreover, it investigates the pathophysiologic mechanisms leading to HA in SAH. ⋯ Patients with SAH have a reduction of CSF SID due to an increased lactate concentration. The resulting localized acidifying effect is compensated by CSF hypocapnia, yielding normal CSF pH values and resulting in a higher incidence of arterial HA.