"Scientists have recently determined that it takes approximately 400 repetitions to create a new synapse in the brain—unless it is done with play, in which case, it takes between 10 and 20 repetitions!"—Dr. Karyn Purvis

The twitter thread trying to track down the research supporting the statement is here:

https://twitter.com/heartsatplay/status/998737978133438465

Or maybe you would rather have your doctor try these instead?

MIT research laid groundwork for promising Alzheimer's-fighting drink November 2017

With this statement in it:The mixture increases production of new synapses and restores connectivity between brain regions, improving memory and other cognitive functions.

Or this one?

Recovery after stroke improved with new treatment that creates nerve synapses in the brain, a key factor for learning: Study January 2017

Which delivers C3a peptide thru nasal drops in mice. So your stroke hospital needs to followup with human research, they've only had 3+ years to get that accomplished.

 

 The unknown research here:

 "Scientists have recently determined that it takes approximately 400 repetitions to create a new synapse in the brain—unless it is done with play, in which case, it takes between 10 and 20 repetitions!"—Dr. Karyn Purvis 

 

Code Blue for COVID-19 Patients: No Survivors

This is precisely why you need to get anticoagulation immediately, to prevent COVID-19 from getting to this point.  I'm seeing a doctor as soon as I get symptoms and demanding heparin. Don't tough it out at home.

 Heparin binds to cells at a site adjacent to ACE2, the portal for SARS-CoV-2 infection, and "potently" blocks the virus, which could open up therapy options.

Anticoagulation Again Shown to Improve Survival in COVID-19 Patients;-Mortality risk about 50% lower

I'm not medically trained so I know nothing, don't listen to me.

The latest here:

 

Code Blue for COVID-19 Patients: No Survivors

One group reports 100% mortality from IHCA during the pandemic

by Nicole Lou, Staff Writer, MedPage Today September 28, 2020

Survival chances were bleak among COVID-19 patients who sustained in-hospital cardiac arrest (IHCA), U.S. data showed.

After a median 8 minutes of CPR on 54 such patients, 53.7% had return of spontaneous circulation, according to Corey Mayer, DO, MBA, of William Beaumont Hospital in Royal Oak, Michigan, and colleagues reporting online in JAMA Internal Medicine.

Roughly half of those patients had their code status changed to "do not resuscitate"; the other half were re-coded but died nonetheless after additional CPR.

Ultimately, none of the 54 COVID-19 patients survived to discharge after IHCA.

"The high mortality following CPR is likely multifactorial," according to Mayer's group.

The initial rhythm was nonshockable in 96.3%, with 81.5% showing pulseless electrical activity and 14.8% in asystole. Two patients had pulseless ventricular tachycardia.

"Given that most of the patients in this study developed a nonshockable rhythm, the outcome was likely to be poor. Additionally, at the time of cardiac arrest, many patients were either receiving mechanical ventilation, kidney replacement therapy, or vasopressor support, all factors previously shown to be associated with a poor outcome following IHCA," the authors said.

Their findings echoed a previous report from Wuhan, China, that found 30-day survival of IHCA in COVID-19 to be only 2.9% in a cohort that also largely had nonshockable rhythms.

In contrast, an estimated one-quarter of IHCA patients survived to discharge before the pandemic, and the initial rhythm was nonshockable in 81% of cases, Mayer's team noted.

More research is needed to understand the risks and benefits of performing prolonged CPR in COVID-19 patients in hospital given the aerosol-generating nature of the resuscitation process and the limited supply of PPE across the country, the group urged.

"Improving our understanding of the likelihood of successful outcomes after CPR is crucial to informing goals-of-care discussions, determining the appropriateness of resuscitative efforts, and guiding policy," agreed J. Randall Curtis, MD, MPH, and colleagues of Harborview Medical Center and University of Washington in Seattle, in an invited commentary.

In March, the American Heart Association issued interim guidance on protective measures for hospital and EMS workers resuscitating people in cardiac arrest.

The investigators identified 1,309 adults diagnosed with COVID-19 who were admitted to Mayer's institution in the early phase of the pandemic from March 15 to April 3, 2020.

Of those patients, 60 received CPR for IHCA and 54 had adequate documentation for the present analysis (median age 61.5 years, 61.1% men).

Most patients had comorbidities, including hypertension (77.8%), diabetes (55.6%), or hyperlipidemia (50.0%). Median BMI was 33.

Median time from hospital admission to cardiac arrest was 8 days. At the time of cardiac arrest, 79% were on mechanical ventilation, 33% kidney replacement therapy, and 46.3% vasopressor support.

The Chinese and U.S. case series "must be interpreted with caution, as only one or two additional survivors would make important differences in the observed estimates," cautioned Curtis and colleagues.

"Outcomes in the setting of COVID-19 may not actually differ from pre-COVID-19 outcomes of IHCA for patients with nonshockable rhythms, for whom hospital survival is often less than 15%," according to the editorialists.

In any case, it will be "challenging" to improve outcomes for severely ill people with COVID-19 and IHCA, since few of the likely drivers of poor outcomes are modifiable, they wrote.

"While these early results should not warrant universal do-not-attempt-resuscitation orders for patients with COVID-19, they highlight the importance of conducting goals-of-care discussions early during the course of COVID-19 and revisiting those discussions with changes in clinical status," Curtis' group emphasized.

It was notable that two-thirds of cohort were African American, a group that tends to request CPR despite poor prognosis, to have less advance care planning documentation, and to report poorer quality communication during serious illness and greater mistrust in the health system, they commented.

"Although there are important limitations on current data regarding outcomes of IHCA for patients with COVID-19, we have enough data to conclude that it is important to implement programs to promote conversations about values and goals in the community and early goals-of-care discussions for patients hospitalized with COVID-19," according to the editorialists.

Established programs to start these discussions include The Conversation Project and PREPARE For Your Care.

• 

  Nicole Lou is a reporter for MedPage Today, where she covers cardiology news and other developments in medicine. Follow

Disclosures

Mayer's group had no disclosures.

Curtis reported grants from the NIH, Cambia Health Foundation, and National Palliative Care Research Center.

Primary Source

JAMA Internal Medicine

Source Reference: Thapa SB, et al "Clinical outcomes of in-hospital cardiac arrest in COVID-19" JAMA Intern Med 2020; DOI: 10.1001/jamainternmed.2020.4796.

Secondary Source

JAMA Internal Medicine

Source Reference: Modes ME, et al "Outcomes of cardiopulmonary resuscitation in patients with COVID-19 -- limited data, but further reason for action" JAMA Intern Med 2020; DOI: 10.1001/jamainternmed.2020.4779.

 

Stroke occurs frequently in COVID-19, leads to ‘devastating consequences’ for patients

This is precisely why you need to get anticoagulation immediately, to prevent COVID-19 from getting to a stroke.  I'm seeing a doctor as soon as I get symptoms and demanding heparin. Don't tough it out at home.

 Heparin binds to cells at a site adjacent to ACE2, the portal for SARS-CoV-2 infection, and "potently" blocks the virus, which could open up therapy options.

Anticoagulation Again Shown to Improve Survival in COVID-19 Patients;-Mortality risk about 50% lower

I'm not medically trained so I know nothing, don't listen to me.

The latest here:

Stroke occurs frequently in COVID-19, leads to ‘devastating consequences’ for patients

 

Respiratory symptom severity served as the most significant indicator of in-hospital mortality among patients with COVID-19 who had a stroke, according to a systematic review published in Neurology.

Older age and a greater number of cardiovascular comorbidities also correlated with in-hospital mortality in this patient population, study findings demonstrated.

“To date, relatively little is known about the frequency, clinical characteristics and outcomes of acute cerebrovascular events in patients with COVID-19,” the researchers wrote. “We hypothesized that stroke is a frequent complication among COVID-19 patients, that in-hospital mortality is higher in patients with stroke and COVID-19 compared to historical non-COVID-19 cohorts, and that young patients would show a higher mortality due to a higher incidence of large vessel occlusion (LVO).”

The researchers added that the burden on the health care system and other factors related to the pandemic have led the frequency of stroke events to be underestimated.

Sebastian Fridman, MD, MPH, of the department of clinical neurological sciences at Schulich School of Medicine and Dentistry, Western University, in Ontario, and colleagues’ systematic review analyzed studies published between November 1, 2019, and May 29, 2020, with a random-effects meta-analysis. The review included studies that addressed the proportion of patients with COVID-19 who experience a stroke event, the type of cerebrovascular event and the mortality rate.

The intended outcomes of the review were to estimate the proportion of COVID-19 patients who experience stroke; analyze their comorbidities, clinical characteristics and outcomes; determine clinical phenotypes; and compare in-hospital mortality between those clinical phenotypes.

Fridman and colleagues analyzed data from 10 published studies that were pooled with one unpublished series from Canada. They applied random-effects meta-analyses to determine the number of strokes that occurred among patients with COVID-19. They also conducted an additional systematic search for case series of strokes in patients with COVID-19 (n = 125) and pooled that data with 35 unpublished studies from Canada, the United States and Iran.

The researchers assessed in-hospital mortality rates for patients who experienced a stroke between 14 days before and 60 days after a COVID-19 diagnosis and compared results between patients under age 50, those aged 51-70 and those over age 70. They applied cluster analyses to determine different clinical phenotypes and their relationships with mortality.

Fridman and colleagues found that 1.8% of patients with COVID-19 experienced a stroke (95% CI, 0.9%-3.7%), including 1.5% who had an ischemic stroke (95% CI, 0.8%-2.8%). They also reported an in-hospital mortality rate of 34.4% (95% CI, 27.2%-42.2%). Both the rates of stroke and in-hospital mortality were “exceedingly high,” according to the researchers.

Patients aged less than 50 years experienced a mortality rate that was 67% lower relative to those aged more than 70 years (OR = 0.33; 95% CI, 0.12-0.94). Large vessel occlusion occurred at twice the frequency reported in previous studies (46.9%) and was high across all age groups, “even in the absence of risk factors or comorbidities.” Fridman and colleagues found that a clinical phenotype characterized by older age, increased comorbidity burden and severe COVID-19-related respiratory symptoms correlated with the highest rates of in-hospital mortality (58.6%) and a risk for death three times greater than the rest of the cohort (OR = 3.52; 95% CI, 1.53-8.09).

“Interestingly, 50% of patients <50 years old experienced their strokes before the onset of COVID-19 respiratory symptoms, and this was significantly more frequent than in other age groups,” the researchers wrote. “This finding may imply that, in the COVID-19 era, younger patients presenting to the [ED] with acute stroke would need to be tested for SARS-COV-2 even in the absence of specific symptoms or regardless of having passed a COVID-19 screen.”

The researchers found that stroke is “relatively frequent” among patients with COVID-19, with “devastating consequences” for patients of all ages.

“Our findings should serve as information for guiding prognostication, resource allocation, and counseling of patients and their families,” Fridman and colleagues wrote.

Greater Occipital Nerve Stimulation Boosts Associative Memory in Older Individuals: A Randomized Trial

Just maybe you want this post stroke. Ask your doctor for this. No knowledge, the board of directors needs to be fired, the buck stops at the board of directors, they are responsible for not setting correct goals for the stroke department.

Greater Occipital Nerve Stimulation Boosts Associative Memory in Older Individuals: A Randomized Trial

Show all authors

Alison M. Luckey, MSc, S. Lauren McLeod, MSc, Ian H. Robertson, MSc, PhD, ...

First Published September 23, 2020 Research Article 

https://doi.org/10.1177/1545968320943573

Article information

 

Abstract

Transcutaneous electrical stimulation (tES) is a new approach that aims to stimulate the brain. Recently, we have developed tES approaches to enhance plasticity that modulate cortical activity via the greater occipital nerve (ON) in a “bottom-up” way. Thirty subjects between the ages of 55 and 70 years were enrolled and tested using a double-blind, sham-controlled, and randomized design. Half of the participants received active stimulation, while the other half received sham stimulation. Our results demonstrate that ON-tES can enhance memory in older individuals after one session, with effects persisting up to 28 days after stimulation. The hypothesized mechanism by which ON-tES enhances memory is activation of the locus coeruleus–noradrenaline (LC-NA) pathway. It is likely that this pathway was activated after ON-tES, as supported by observed changes in α-amylase concentrations, a biomarker for noradrenaline. There were no significant or long-lasting side effects observed during stimulation. Clinicaltrial.gov (NCT03467698).

Keywords occipital nerve stimulation, associative memory

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A HERO for Stroke Patients: a new hand exoskeleton 3D printed on textiles for rehabilitation

This sounds great. Where is the protocol for building it AND the protocol for recovery of your hand? Your hospital should have it available in one month. If not, have the board of directors fired.

A HERO for Stroke Patients: a new handexoskeleton 3D printed on textiles for rehabilitation

Rommel Soares de Araujo*
, Camille Reategui Silva, Severino Peixoto Nunes Netto, Edgard Morya and
Fabricio Lima Brasil

Abstract

Background: 

Stroke survivors can be affected by motor deficits in the hand.
Robotic equipment associated with brain-machine interfaces (BMI) may aid the
motor rehabilitation of these patients. BMIs involving orthotic control by motor
imagery practices have been successful in restoring stroke patients’ movements.
However, there is still little acceptance of the robotic devices available, either by
patients and clinicians, mainly because of the high costs involved. Motivated by
this context, the present work aims to design and construct the Hand
Exoskeleton for Rehabilitation Objectives (HERO) to recover extension and
flexion movements of the fingers.
Methods: 

A 3D printing technique in association with textiles was used to
produce a lightweight and wearable device. 3D-printed actuators have also been
designed to reduce equipment costs. The actuator transforms the torque of DC
motors into linear force transmitted by Bowden cables to move the fingers
passively. The exoskeleton was controlled by neuroelectric signal —
electroencephalography (EEG). Concept tests were performed to evaluate control
performance. A healthy volunteer was submitted to a training block with the
exoskeleton, according to the Graz-BCI protocol. Ergonomy was evaluated with a
2D tracking software.
Results: 

The outcome of the applied manufacturing technique was aesthetically
pleasing. HERO’s glove can be compared to ordinary clothing. The weight over
the hand was around 102 g. The volunteer(Was this a stroke survivor?) was able to control the exoskeleton
with 91.5% accuracy.
Conclusions: 

HERO’s project resulted in a lightweight, simple, portable,
ergonomic, and low-cost device. Its use is not restricted to a clinical setting.
Thus, users will be able to execute motor training with the HERO at hospitals,
rehabilitation clinics, and home, increasing the rehabilitation intervention time.
This may favor motor rehabilitation and improve the life quality of stroke
survivors.
 

Advances in the treatment of stroke

 

Somehow forgot to mention all these problems in stroke. Nothing that will get you to 100% recovery.

EVERYTHING IS A FAILURE IN STROKE!

The current state of stroke is a complete failure. None of the following have cures. 

1. 30% get spasticity NOTHING THAT WILL CURE IT.

2. At least half of all stroke survivors experience fatigue Or is it 70%?

Or is it 40%?

NOTHING THAT WILL CURE IT.

3. Over half of stroke patients have attention problems.

NOTHING THAT WILL CURE IT.

NO PROTOCOLS THAT WILL CURE IT.

4.  The incidence of constipation was 48%.

NO PROTOCOLS THAT WILL CURE IT.

5. No EXACT stroke protocols that address any of your muscle limitations.

6. Poststroke depression(33% chance)

NO PROTOCOLS THAT WILL ADDRESS IT. 

7.  Poststroke anxiety(20% chance) NO PROTOCOLS THAT WILL ADDRESS IT. 

8. Posttraumatic stress disorder(23% chance)  NO PROTOCOLS THAT WILL ADDRESS IT.

  9.  12% tPA efficacy for full recovery NO ONE IS WORKING ON SOMETHING BETTER.

10.  10% seizures post stroke NO PROTOCOLS THAT WILL ADDRESS IT. 

11. 21% of patients had developed cachexia NO PROTOCOLS THAT WILL ADDRESS IT. 

 

12. You lost 5 cognitive years from your stroke  NO PROTOCOLS THAT WILL ADDRESS IT.

13.  33% dementia chance post-stroke from an Australian study?

       Or is it 17-66%?

       Or is it 20% chance in this research?

NO PROTOCOLS THAT WILL ADDRESS THIS

But the whitewashing is below:

 

Advances in the treatment of stroke

• By Andrew Ellsworth, M.D.
• Sep 28, 2020 Updated 1 hr ago

Andrew Ellsworth, MD

Weakness on one side of the body, slurred speech, facial drooping, inability to find or understand words; these are symptoms of a stroke which are typically sudden in onset. The symptoms can be subtle, or they can be severe. Regardless, rapid diagnosis and treatment is the key to recovery.(But we don't know how to get you recovered. NO STOKE REHAB PROTOCOLS EXIST!)

Not long ago, not much could have been done for someone as they were having a stroke. Often, we could only wait and see how the patient recovered with rehabilitation. For years, prevention was the only tool we had to combat initial and recurring strokes. Preventative measures such as blood pressure control, aspirin or other blood thinners, cholesterol control, and of course, a healthy diet and exercise remain especially important today. Thankfully, we now have a few more options.

Clot-busting medications have been a great advancement in the treatment of strokes since the mid-1990s. If administered soon enough, sometimes these clot-busting medications can work to break up a clot that is blocking blood flow in an area of the brain thus restoring circulation. This can help to preserve or at least minimize the area of the brain that would be permanently damaged.

There are risks to these meds, such as bleeding, but the chance of improving the outcome usually justifies their use. To minimize risks, the clot-busting medication must be initiated within three to four- and one-half hours following the onset of symptoms. Physicians also consider other criteria before treating with clot-busting meds, including the patient’s medical history, blood test results, and they must rule out a hemorrhagic stroke using CT imaging of the brain. A hemorrhagic stroke is when damage is done by a ruptured blood vessel rather than from blockage.

More recently, technological developments have changed the emergent care offered for very severe strokes. It is now possible to manually restore blood flow to the brain using minimally invasive surgery. A surgeon inserts a system of catheters and wires into an artery in the arm or groin, advances this system up through the neck and into the brain. Then, at the location of the blood vessel blockage, the blood clot is removed and the circulation to the affected area is restored.

Highly specialized, this new procedure seems almost miraculous. It has been referred to as the “Lazarus” procedure as it literally brings people back to life and sometimes immediate improvement is noted as soon as during the procedure.

The keys are recognition and time. Know the signs and get help quickly. Think of the acronym FAST: Face drooping? Arm weakness? Speech difficulty? Time to call 9-1-1.

Andrew Ellsworth, M.D. is part of The Prairie Doc® team of physicians and currently practices family medicine in Brookings, South Dakota. For free and easy access to the entire Prairie Doc® library, visit www.prairiedoc.org and follow Prairie Doc® on Facebook featuring On Call with the Prairie Doc® a medical Q&A show streamed most Thursdays at 7 p.m. central.

Resuming sexual activity shortly after MI could improve survival

 But what about after stroke? What does you doctor say about all the following research?

Does your doctor even know about the need for sex post stroke?

All this is why you need to be doing lots of sex, why the hell can't your doctor get you fucking again?

Sexual Frequency Predicts Greater Well-Being, But More is Not Always Better

 

Sex after stroke

 

Sex linked to better brain power in older age

Sex: The Ultimate Full Body Workout

 

Better Memory From This Extremely Pleasurable Activity - Sex

 

WHY SEX IS BETTER FOR YOUR BRAIN THAN SUDOKU 

 

Sex linked to better brain power in older age

 

Good News About Sex- It Doesn't Cause a Stroke

 

Sex Does Not Increase Heart Attack Risk - What about stroke?

 

Frequent orgasms may protect against heart attacks

 

An orgasm a day keeps the doctor away!

In case you don't have a partner she could prescribe this.

Electrosex

And the benefits of marijuana for sex here:

Sex, Marijuana and Baby Booms

The latest here:

Resuming sexual activity shortly after MI could improve survival

ADD TOPIC TO EMAIL ALERTS

Patients who resumed sexual activity a few months after MI may have an improved long-term survival compared with those who abstained or decreased sexual activity, researchers found.

Yariv Gerber

“We found that maintaining or increasing the frequency of sexual activity within the first months after an MI was associated with better survival,” Yariv Gerber, PhD, professor of epidemiology and head of the School of Public Health at Tel Aviv University, told Healio. “The reduction in risk for mortality was approximately 35%. The benefit was mostly attributable to reduced non-cardiovascular disease mortality.”

Source: Adobe Stock.

Gerber added that despite use of advanced statistical methods, it is difficult to conclude whether this association is causal. “Indeed, numerous physical and psychosocial health parameters are required for maintaining regular sexual activity. In light of this, the ‘net benefit’ of sexual activity per se is still a matter of debate. We believe that resumption of sexual activity soon after an MI may be a part of one’s self-perception as a healthy, functioning, young and energetic person. This may lead to a healthier lifestyle in a broad sense.”

Young patients with acute MI

In the study published in the European Journal of Preventive Cardiology, Gali Cohen, MSc, PhD student in the department of epidemiology and preventive medicine at Tel Aviv University School of Public Health, and colleagues analyzed data from 495 patients (median age, 53 years) aged 65 years and younger hospitalized for acute MI from 1992 to 1993.

All patients were sexually active before the MI, as reported during an interview within 1 week after the index MI. Patients attended follow-up interviews between 3 and 6 months after MI to report on whether they resumed sexual activity and to what frequency. Patients were then categorized my sexual activity frequency after MI: abstained/decreased (n = 232; mean age, 54 years; 13% women) or maintained/increased (n = 263; mean age, 52 years; 8% women).

Patients were followed up for a median of 22 years for all-cause and cause-specific mortality.

At index MI, 73% of patients reported they were sexually active at least once per week, which decreased to 60% at the follow-up interview. Sexual activity resumed in 88% of patients after MI, of whom 53% maintained or increased frequency from before their MI. The remaining patients (n = 232) either decreased (n = 171) or entirely abstained (n = 61) from sexual activity after MI compared with before MI.

Patients who maintained or increased their frequency were more likely to be slightly younger, had lower depression scores, more likely to perceive their health as good and had higher socioeconomic status compared with those who abstained or decreased frequency.

During follow-up, 43% of patients died after MI. Maintaining or increasing the frequency of sexual activity was inversely linked to all-cause mortality compared with abstaining or reducing frequency (HR = 0.65; 95% CI, 0.48-0.88). This association was stronger for non-CVD mortality (HR = 0.56; 95% CI, 0.36-0.85) than for CVD mortality (HR = 0.9; 95% CI, 0.53-1.51).

“Sexuality and sexual activity are markers of well-being,” Gerber said in an interview. “Resumption of sexual activity after an MI is likely an important part of a wider perception of one’s self and general quality of life. General better perception of oneself may lead to a healthier lifestyle. These data should serve to reduce unnecessary patients’ concerns and support a recommendation to maintain a level of sexual activity soon after MI.”

Studies to assess gender differences

Further research is needed in this area, Gerber told Healio.

“Larger and more contemporary follow-up studies are required that include a larger number of women participants and can thus assess gender differences in the sexual activity-survival association,” he said. “Also, combining other sources of information regarding sexual activity habits (eg, spouse/partner reports) — beyond patients’ self-reports — can reduce misclassification and recall biases.”

For more information:

Yariv Gerber, PhD, can be reached at yarivg@tauex.tau.ac.il.

 

You're invited to the National Stroke Quality Improvement Virtual Workshop 2020

Notice ABSOLUTELY NOTHING ON GETTING SURVIVORS 100% RECOVERED. NO PROTOCOLS; NOTHING FOR SURVIVORS!

You're invited to the National Stroke Quality Improvement Virtual Workshop 2020

The Florey Institute of Neuroscience and Mental Health, The Stroke Foundation, and Monash University are proud to present the 8th annual National Stroke Quality Improvement Workshop. This year’s workshop will be held as a Virtual meeting across three days Wednesday 21st, Wednesday 28th and Thursday 29th of October 2020. 

This is a FREE online event that will feature presentations from a range of stroke clinicians, academics, and government representatives from across Australia.

In 2020, the program will include sessions on:

• National health care improvement initiatives;
• Innovations in prehospital, emergency and acute care: monitoring the effectiveness of innovative models of acute stroke care;(When will you realize survivors don't care about 'care'? They want recovery results you blithering idiots!)
  
• The National Stroke Data Linkage Interest Group;
• Telerehabilitation

The 2020 Workshop Agenda Overview can be viewed here.
Please note: The presenters and time slots depicted in the Agenda Overview are provisional and may be subject to change.
 

---

 

Registration is now open!
Spots are limited so get in quick to secure your spot.

CLICK HERE TO REGISTER

First RCT in COVID Anticoagulation Says Go Full Dose

 So no one wants to stick their neck out and make a full recommendation. I'm requesting heparin.

First RCT in COVID Anticoagulation Says Go Full Dose

Respiratory outcomes better, but 20-person trial far from conclusive

by Crystal Phend, Senior Editor, MedPage Today September 25, 2020

Therapeutic-level dosing of enoxaparin (Lovenox) improved respiratory outcomes in severe COVID-19, a pilot randomized trial showed.

Gas exchange measured by the PaO₂/FiO₂ ratio improved significantly over time in the 10-patient therapeutic group (from 163 at baseline to 209 at 7 days and 261 at 14 days, P=0.0004) but not in the 10-patient control group receiving lower prophylactic-level doses in the open-label study (184, 168, and 195, respectively, P=0.487).

Compared with prophylactic dosing of the drug, therapeutic dosing also led to four-fold more patients being weaned off of mechanical ventilation (P=0.031) and more ventilator-free days (15 vs 0 days, P=0.028), Carlos Henrique Miranda, MD, PhD, of São Paulo University in Brazil, and colleagues reported in Thrombosis Research.

Three patients died within 28 days with therapeutic anticoagulation (two secondary to healthcare-associated infections) versus one with prophylactic dosing, but the difference wasn't statistically significant. The study wasn't powered for clinical outcomes, the researchers noted.

There were no major bleeding events, but numerically more minor bleeding with the higher dose anticoagulation.

"It's a remarkable step forward in the sense that now for the first time we are having randomized trial data related to antithrombotic therapy for COVID-19," commented Behnood Bikdeli, MD, of Brigham and Women's Hospital and Harvard in Boston.

While the study couldn't address the mechanism, "hypothetically, it's reducing the risk and/or severity of macrothrombi and microthrombi in the lung," he told MedPage Today.

However, "this study is far, far, far from being conclusive," Bikdeli cautioned. "As enthusiastic as I am to see the results, we have to be honest with respect to their research design and limitations."

"It's such a heated debate," he said. Proponents cite mechanistic reasons for why low molecular weight heparin like enoxaparin should help in COVID-19 (one recent study showed it blocks SARS-CoV-2 from binding with cells) and observational studies that have suggested better mortality outcomes with it. Opponents cite retrospective data like that from a small study suggesting higher mortality with preemptive therapeutic dose anticoagulation.

Miranda and colleagues' single-center study randomly assigned 20 patients with severe COVID-19 and elevated D-dimer (>1,000 μg/L) who required mechanical ventilation to receive standard prophylactic anticoagulation versus therapeutic anticoagulation, both utilizing subcutaneous unfractionated enoxaparin.

Enoxaparin doses in the therapeutic-level group were set according to age and estimated creatinine clearance, generally ranging from 0.75 mg/kg once daily to 1 mg/kg twice daily, up to a maximum of 140 mg twice daily. The control group received 40 mg of enoxaparin once or twice daily or 5,000-7,500 IU of unfractionated heparin three times daily -- for both, the higher dose was for patients weighing more than 120 kg.

A third arm with therapeutic IV unfractionated heparin "was abandoned due to difficulties in adjusting the activated partial thromboplastin time (aPTT) during the pandemic," the researchers noted.

The small size and open-label design make the choice of a "softer" surrogate measure (gas exchange vs mortality as a hard endpoint) as the primary endpoint more challenging, Bikdeli noted. And the endpoint of liberation from mechanical ventilation is to some extent discretionary, he added.

Still, the question of how to dose and which agent to use for thromboprophylaxis are going to be more definitively answered soon, noted Bikdeli, whose INSPIRATION trial protocol for intermediate versus prophylactic dose anticoagulation was published alongside the Brazilian study in Thrombosis Research.

"As of now there are more than 20 ongoing or registered randomized studies to address the questions of optimal anticoagulation in various subgroups of patients with COVID-19 -- from outpatients to inpatients or critically-ill patients," he said.

 

COVID-19 Disease and Hypercoagulability Leading to Acute Ischemic Stroke

This is precisely why you need to get anticoagulation immediately, to prevent COVID-19 from getting to a stroke.  I'm seeing a doctor as soon as I get symptoms and demanding heparin. Don't tough it out at home.

 Heparin binds to cells at a site adjacent to ACE2, the portal for SARS-CoV-2 infection, and "potently" blocks the virus, which could open up therapy options.

Anticoagulation Again Shown to Improve Survival in COVID-19 Patients;-Mortality risk about 50% lower

I'm not medically trained so I know nothing, don't listen to me.

The latest here:

 

COVID-19 Disease and Hypercoagulability Leading to Acute Ischemic Stroke

Show all authors

Naresh Mullaguri, MD, Madihah Hepburn, MD, James Matthew Gebel, Jr, MD, ...

First Published September 23, 2020 Brief Report 

https://doi.org/10.1177/1941874420960324

Article information

Abstract

Introduction:

SARS-Coronavirus-2 infection leading to COVID-19 disease presents most often with respiratory failure. The systemic inflammatory response of SARS-CoV-2 along with the hypercoagulable state that the infection elicits can lead to acute thrombotic complications including ischemic stroke. We present 3 cases of patients with COVID-19 disease who presented with varying degrees of vascular thrombosis.

Cases:

Cases 1 and 2 presented as cerebral ischemic strokes without respiratory failure. Given their exposure risks, they were both tested for COVID-19 disease. Case 2 ultimately developed respiratory failure and pulmonary embolism. Cases 2 and 3 were found to have simultaneous arterial and venous thromboembolism (ischemic stroke and pulmonary embolism) as well as positive antiphospholipid antibodies.

Conclusion:

Our case series highlight the presence of hypercoagulability as an important mechanism in patients with COVID-19 disease with and without respiratory failure. Despite arterial and venous thromboembolic events, antiphospholipid and hypercoagulable panels in the acute phase can be difficult to interpret in the context of acute phase response and utilization of thrombolytics. SARS-CoV-2 testing in patients presenting with stroke symptoms may be useful in communities with a high case burden or patients with a history of exposure.

Keywords COVID-19, ischemic stroke, respiratory failure, hypercoagulability

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UC Health(Cincinnati, OH) Launches Region’s First Mobile Stroke Unit

I personally think mobile stroke units are way too slow as currently setup. You have to get the neurologist out of the picture, because of all the diagnosis failures.

• diagnosis failure (27)

 

Maybe one of these much faster possibilities?

Hats off to Helmet of Hope - stroke diagnosis in 30 seconds   February 2017

 

Microwave Imaging for Brain Stroke Detection and Monitoring using High Performance Computing in 94 seconds March 2017

 

New Device Quickly Assesses Brain Bleeding in Head Injuries - 5-10 minutes April 2017

The latest here:

 

UC Health(Cincinnati, OH)h Launches Region’s First Mobile Stroke Unit

Unit brings advanced stroke care directly to those who need it most

CINCINNATI (Monday, Aug. 10, 2020) — UC Health, Greater Cincinnati’s academic healthcare system, has launched the region’s first Mobile Stroke Unit, bringing UC Health’s advanced stroke care directly to those who need it most. The unit’s first day of operation is Tuesday, Aug. 11.

A Mobile Stroke Unit is an ambulance specially designed to evaluate and treat patients with a possible stroke. The unit combines an emergency department (ED) and an ambulance to provide hospital-level care at the scene of the emergency.

“Our goal is to shorten the time(NOT GOOD ENOUGH!) between the onset of stroke-like symptoms and the delivery of clot-busting medication(But you don't know how fast you have to deliver tPA to get 100% recovery , do you? Shooting in the dark, aren't you?). Millions of brain cells die every minute that stroke treatment is delayed, and research shows that mobile stroke units can provide treatment 20 to 30 minutes faster than in an emergency department,” said Joseph Broderick, MD, director of the UC Gardner Neuroscience Institute and Professor of Neurology and Rehabilitation Medicine at the UC College of Medicine.

When a possible stroke is reported to 911, the UC Health Mobile Stroke Unit can be dispatched right alongside the local EMS department. A highly-trained team of four – a UC Health Air Care & Mobile Care paramedic, EMT and a critical care registered nurse, and a UC Health CT technician – staff the unit, and a Greater Cincinnati/Northern Kentucky Stroke Team physician will respond via telemedicine.

This team can quickly assess the patient and provide treatment if necessary. The UC Health Mobile Stroke Unit is equipped with advanced diagnostic technology, including a mobile CT scanner and the clot-busting medication tPA (tissue plasminogen activator). tPA is the only FDA-approved medical treatment for ischemic or thrombotic stroke, and it was developed by the experts at UC Health’s Comprehensive Stroke Center, part of the UC Gardner Neuroscience Institute.

“The UC Health Mobile Stroke Unit is the latest example of how UC Health continues to innovate in the delivery of stroke care and emergency medicine, with the goal of saving and improving lives,” Broderick said.
Currently, the average stroke patient in Greater Cincinnati does not receive clot-busting medication until about 45 or 60 minutes after arriving at a hospital, where a CT scan and other pre-treatment assessments are first performed. By bringing the advanced skills of the emergency department and the stroke team directly to the patient, the experts at UC Health hope to reduce that time significantly and improve patients’ chances for a full recovery.

“The UC Health Mobile Stroke Unit is the first of its kind in Southwest Ohio and is a tremendous resource for our community. We are able to bring the emergency department to the curbside in order to diagnose and treat stroke as quickly and safely as possible,” said Christopher T. Richards, MD, medical director of the mobile stroke unit and Assistant Professor of Emergency Medicine at the UC College of Medicine. “We look forward to working side-by-side with our fifteen partner fire departments to provide excellent acute stroke care.”

The UC Health Mobile Stroke Unit is a partnership between the Department of Emergency Medicine, UC Health Air Care & Mobile Care, and the UC Comprehensive Stroke Center. The center pioneered tPA as well as the F.A.S.T. method for diagnosing stroke, and it serve as the national coordinating center for the National Institutes of Health “StrokeNet” program to advance stroke research.

The UC Health Mobile Stroke Unit is based at the Springfield Township Fire Department located at 9150 Winton Road and will respond in an area of approximately 15 minutes from the fire station. The Hamilton County Communications Center will co-dispatch the mobile stroke unit at the time of the 9-1-1 call as part of the EMS response for any patient with a possible stroke in the service area. The unit will be available between 7 a.m. and 7 p.m. daily, including holidays.

While the Mobile Stroke Unit is provided by UC Health, patients will be transported to the most appropriate hospital, which may or may not be a UC Health hospital.

UC Health is the 21st healthcare system in the U.S. to provide a Mobile Stroke Unit, and its apparatus is the 23rd such unit in the nation. It is the only Mobile Stroke Unit in Greater Cincinnati.

 

Shorter dream-stage sleep may be related to earlier death

Useless. Describes a problem, OFFERS NO EXACT SOLUTION.

Absolutely nothing here is going to help with 30% of survivors having sleep problems. Damn it all, solve stroke problems, don't just do quote useless guidelines.

Is your doctor suggesting either of these? Never mind, way too soon for your doctor to read, understand and implement these interventions. Maybe 50 years from now.

Effects of saffron on sleep quality in healthy adults with self-reported poor sleep: A randomized, double-blind, placebo-controlled trial June 2020

Pink Noise Machines Improve Sleep & Fight Dementia  June 2020

 The latest here:

 

Shorter dream-stage sleep may be related to earlier death

Time and time again, adequate sleep has been shown to be critical to daily functioning and long-term health. Sleep serves numerous roles: recovering energy for the brain, clearing waste products, and forming memories. Prior studies have clearly linked shortened sleep times to heart disease, obesity, reduced cognitive performance, worsened mood, and even a shorter life. There is now new research that suggests that lack of a certain type of sleep (the dream stage of sleep) may be related to an earlier death in middle-aged and older people.

What is REM sleep?

Normal sleep is broken down into two sleep types: rapid eye movement (REM) and non-rapid eye movement (NREM). NREM is further classified by depth of sleep; N1 and N2 are lighter sleep stages, and N3 is deep sleep, which is most restorative. (REM is the stage where vivid dreaming occurs.) Brainwave activity during this time appears similar to the brain’s activity while awake. REM periods generally occur every 90 minutes, and are longest during the second half of the night. REM sleep normally makes up 20% to 25% of sleep time.

How does sleep change with age?

Sleep time and sleep stages naturally change as we age. Total sleep time decreases by 10 minutes every decade until age 60, when it stops decreasing. Time in N3 sleep, the deepest sleep stage, also shortens with age; time in N1 and N2 tends to increase. As a result, people wake more easily from sleep as they age. The percentage of REM sleep also naturally decreases; thus, reduced time spent in REM may be a marker of aging.

The circadian rhythm is a 24-hour internal clock that governs numerous body functions including body temperature, release of hormones, and sleep time. The internal clock “advances” with age, so older adults tend to fall asleep earlier and wake earlier. Adapting to jet lag and shift work becomes more difficult. Daytime napping also increases as the strength of the circadian rhythm and the drive to sleep at night decrease.

Studies have also shown that older adults who are healthy may not perceive problems with sleep when it is actually impaired, or may assume that certain disruptions are part of aging when they have treatable conditions.

Why would less sleep increase my risk of death?

In the short term, sleep deprivation increases cortisol levels, causes increased blood pressure, decreases glucose tolerance, and increases the activity of the body’s fight-or-flight system, all of which are linked to increased risk of diabetes, heart attacks, and strokes. Daytime cognitive performance is also reduced, resulting in more accidents. Twenty-four hours of sustained wakefulness impairs driving ability to the same degree as a blood alcohol concentration of 0.10%, which is above the legal limit.

In the long term, both short and long sleep (less than five hours or more than nine hours) have been associated with earlier death. People who sleep less than four hours dramatically increase their risk of dying early, possibly through heart disease, diabetes, high blood pressure, chronic stress, lower immunity, and overall more rapid aging.

Less dream-stage sleep makes a difference

We know that short sleep is associated with increased mortality, but until now it has been unclear if shorter sleep in a particular sleep stage makes a difference in the health risks associated with sleep deprivation. A new study published in JAMA Neurology looked at the relationship between REM sleep and earlier death in two large study groups, one consisting of 2,675 older men and the other of 1,386 middle-aged men and women. They followed both groups over time and looked at the relationship between sleep stages and causes of death.

Both groups showed increased mortality rates related to a decrease in REM sleep, with a 13% higher mortality rate for every 5% reduction in REM sleep. REM sleep was the most important sleep stage for predicting survival.

Putting new research into context: What does this mean for me?

This study showed an association between reduced REM and increased mortality, but it did not demonstrate the cause of the association. REM deprivation could independently contribute to the development of numerous other diseases. The results apply more clearly to older adults, given that the age groups studied averaged in the 50s and 70s. Short REM may also be a marker of a sick or aging brain; less REM sleep has already been tied to a greater risk of dementia. Overall, ensuring adequate REM sleep is important to protecting your long-term health.

Getting better sleep in middle age and beyond

Maintaining good sleep should remain a priority throughout your life. Everyone can make healthy choices to maximize restorative sleep. Dr. Suzanne Bertisch has written previously about recommendations(NOT PROTOCOLS) for improving sleep hygiene, and even more suggestions(NOT PROTOCOLS) are available in the Harvard Health Publishing Special Health Report Improving Sleep: Getting a Good Night’s Rest.

Some fundamental steps to improve your sleep and health include:

• Get at least seven hours of sleep each night. If you still feel tired, sleep a little more; some people need eight or nine hours of sleep to feel rested.
• Keep a consistent bedtime and wake time. This will make falling asleep easier, and will keep your circadian rhythm aligned with your sleep and wake time.
• Try to sleep when your body naturally wants to fall asleep and wake up. This can differ from sleep and wake times required for work schedules, which also has negative consequences. A sleep doctor can help you realign your circadian clock with your schedule.
• Depression or other mood disorders can cause disrupted sleep. Talk to your doctor if you are feeling low, no longer enjoy your hobbies, or are struggling with anxiety or sadness.
• If you can’t fall asleep, stay asleep, or feel sleepy all the time, you may need evaluation from a doctor for a sleep disorder such as sleep apnea or insomnia. Treating these disorders can make a major difference in overall sleep quality and health.

Related Information: Improving Sleep: A guide to a good night’s rest

Just One Serving of This Fruit Can Give You an Instant Brain Boost, Study Says

Notice the adjective 'wild'.  I have only found them a couple of times in the wild while camping, they are very small and took a long time to pick one cup.

Just One Serving of This Fruit Can Give You an Instant Brain Boost, Study Says

Over the years, scientific research has shown that while a balanced diet is key to staying healthy, there are certain foods that just knock it out of the park in terms of overall benefits for your body. But what about your mind? It turns out, there might be at least one easy option: According to a recent study, eating wild blueberries could be one of the easiest ways to give your brain an instant boost.

A recent randomized, double-blind, cross-over study examined 35 middle-aged individuals between 40 and 65 years old that were fed either one cup of wild blueberries or a placebo equivalent for breakfast. They were then asked to complete a series of cognitive tasks over the course of the day that tested brain function and memory. (Related: 21 Best Healthy Cooking Hacks of All Time.)

The results were clear: Those who had eaten wild blueberries (aka WBB) were able to maintain a sustained level of concentration and performance during the day in both sets of tasks, while those who had been given a placebo saw a decrease in performance as the day went on. Researchers also noticed that those in the wild blueberry group were faster in their correct responses than the placebo group.

"This study indicated acute cognitive benefits of [wild blueberry] WBB intake in cognitively healthy middle-aged individuals, particularly in the context of demanding tasks and cognitive fatigue," the study authors wrote.

This is far from the first study to find that wild blueberries provide bountiful brain benefits. A 2011 study published in The Journal of Agricultural and Food Chemistry significantly improved the memory performance of older adults who were at risk for Alzheimer's disease. And a study from 2007 found that regularly consuming wild blueberries could help alleviate cognitive decline in aging adults—most likely thanks to their anti-inflammatory properties.

Whether you're putting them in your morning oatmeal or simply taking them down by the handful as you run out the door, it sounds like there's plenty of science behind blueberries as a fantastic and healthy snack.

 

Association between serum matrix metalloproteinase-9 and poor prognosis in acute ischemic stroke patients: The role of dyslipidemia

Well what the fuck are you going to do with this information to get survivors recovered? Prognosis is totally fucking useless to survivors.

Association between serum matrix metalloproteinase-9 and poor prognosis in acute ischemic stroke patients: The role of dyslipidemia

Zheng X, Zhong C, Zhu Z, et al

Nutrition, Metabolism & Cardiovascular Diseases|September 17, 2020

This is the first study investigating the prognostic impact of matrix metalloproteinase-9 (MMP-9) among ischemic stroke patients stratified by dyslipidemia status. MMP-9 levels were assessed for 2,977 patients with acute ischemic stroke from 26 participating hospitals across China, and clinical outcome results were collected within one year of the ischemic stroke. According to results, increased MMP-9 has been correlated with poor prognosis only in patients with dyslipidemia within one-year after stroke, indicating that the prognostic importance of MMP-9 is modified by dyslipidemia status of patients with ischaemic stroke.