A5009957062- Acute Ischemic Stroke Management
- Stroke Rehabilitation and Recovery
- Cerebrovascular and Carotid Artery Diseases
- Traumatic Brain Injury and Neurovascular Disturbances
- Venous Thromboembolism Diagnosis and Management
- Healthcare Systems and Practices
- Intracerebral and Subarachnoid Hemorrhage Research
- Anesthesia and Sedative Agents
- Anesthesia and Pain Management
- Healthcare Policy and Management
- Trauma and Emergency Care Studies
- Airway Management and Intubation Techniques
- Advanced Causal Inference Techniques
- Emergency and Acute Care Studies
- Foreign Body Medical Cases
- Cardiac Valve Diseases and Treatments
- Medical Imaging and Analysis
- Peripheral Artery Disease Management
- Vector-Borne Animal Diseases
- Health Systems, Economic Evaluations, Quality of Life
- Trauma Management and Diagnosis
- Cardiac, Anesthesia and Surgical Outcomes
- Congenital Anomalies and Fetal Surgery
- MRI in cancer diagnosis
- Nanoparticles: synthesis and applications
University of Texas Health Science Center at Dallas
2023
The University of Texas Health Science Center at Houston
2019-2023
Smt. Kashibai Navale Medical College and General hospital
2021
Cancer Research And Biostatistics
2019
Mobile stroke units (MSUs) are ambulances with staff and a computed tomographic scanner that may enable faster treatment tissue plasminogen activator (t-PA) than standard management by emergency medical services (EMS). Whether how much MSUs alter outcomes has not been extensively studied.In an observational, prospective, multicenter, alternating-week trial, we assessed from MSU or EMS within 4.5 hours after onset of acute symptoms. The primary outcome was the score on utility-weighted...
A double blind trial of practolol in coronary heart disease has been conducted for 2 years. In 298 patients with acute myocardial infarction there was no reduction overall mortality. a group initial rate over 100 per minute mortality significantly lowered up to 1 year. Of 484 treatment years did not produce significant or sudden death. Beta-adrenergic blocking drugs have shown reduce left ventricular work and an antiarrhythmic action. On these grounds they would seem theoretically place the...
Treatment of patients with acute ischemic stroke on mobile units (MSUs) improves outcomes compared management by standard emergency medical services ambulances and is associated more treated intravenous tPA (tissue-type plasminogen activator) in the first golden hour after last known normal. We explored predictors first-hour treatment (FHT) later an alternating-week cluster-controlled trial MSUs.
Background and Purpose- Endovascular thrombectomy (ET) door-to-puncture time (DTPT) is a modifiable metric. One of the most important, yet time-consuming steps, documentation large vessel occlusion by computed tomography angiography (CTA). We hypothesized that obtaining CTA on board Mobile Stroke Unit direct alert ET team shortens DTPT over 30 minutes. Methods- compared between patients having onboard then subsequent from September 2018 to November 2019 in August 2014 2018, when was not...
Noncontrast head CT and perfusion (CTP) are both used to screen for endovascular stroke therapy (EST), but the impact of imaging strategy on likelihood EST is undetermined. Here, we examine influence CTP utilization in patients with large vessel occlusion (LVO).We identified acute ischemic at 4 comprehensive centers. All hospitals had 24/7 capability were covered by a single physician group (Neurology, NeuroIntervention, NeuroICU). centers performed noncontrast angiography initial...
Hematoma enlargement (HE) after intracerebral hemorrhage (ICH) is a therapeutic target for improving outcomes. Hemostatic therapies to prevent HE may be more effective the earlier they are attempted. An understanding of in first 1 2 hours specifically prehospital setting would help guide future treatment interventions this time frame and setting.Patients with spontaneous ICH within 4 symptom onset were prospectively evaluated between May 2014 April 2020 as prespecified substudy multicenter...
Background and Purpose- The impact of a mobile stroke unit (MSU) on access to intraarterial thrombectomy (IAT) is prespecified BEST-MSU substudy (Benefits Stroke Treatment Delivered Using Mobile Unit Compared Standard Management by Emergency Medical Services). On the MSU, IAT decision-making steps, such as computed tomography, neurological exam, tPA (tissue-type plasminogen activator) treatment are completed before emergency department arrival. We hypothesized that pre-ED assessment...
The 90-day modified Rankin Scale is a widely used outcome after stroke but sometimes hard to ascertain due loss follow-up. Missing outcomes can result in biased and/or inefficient estimates clinical trials. aim of this study assess the validity acquiring at later point time when patient has been lost 90 days impute missing value.Participants who had prospectively completed questionnaire on their own Benefits Stroke Treatment Using Mobile Unit were randomly interviewed recall 6, 9, or 12...
Background: Prehospital automated large vessel occlusion (LVO) detection in Mobile Stroke Units (MSUs) could accelerate identification and treatment of patients with LVO acute ischemic stroke. Here, we evaluate the performance a machine learning (ML) model on CT angiograms (CTAs) obtained from 2 MSUs to detect LVO. Methods: Patients evaluated Houston Los Angeles out-of-hospital CTAs were identified. Anterior circulation was defined as an intracranial internal carotid artery, middle cerebral...
Few data exist on acute stroke treatment in patients with pre-existing disability (PD) since they are usually excluded from clinical trials. A recent trial of mobile units (MSUs) demonstrated faster and improved outcomes, included PD patients.To determine outcomes tissue plasminogen activator (tPA), benefit MSU versus management by emergency medical services (EMS), for patients.Primary were utility-weighted modified Rankin Scale (uw-mRS). Linear logistic regression models compared without...
Background Recanalization of cerebral large‐vessel occlusions (LVOs) by intravenous thrombolysis is infrequent but has been relatively unexplored with ultraearly treatment. We evaluated prehospital treatment tissue plasminogen activator (tPA) in a mobile stroke unit to explore the recanalization rate patients LVOs and its effect on early clinical improvement long‐term disability. Methods Prospectively collected data were analyzed from Houston who treated tPA had identified either hyperdense...
Studies face challenges with missing 5-level EQ-5D (EQ-5D-5L) data, often because of the need for longitudinal EQ-5D-5L data collection. There is a dearth validated methodologies dealing in literature. This study, first time, examined possibility using retrospectively collected as proxies data.Participants who had prospectively completed 3rd month postdischarge instrument (in-the-moment collection) were randomly interviewed to respond 2nd "retrospective collection" their at 6th, 9th, or 12th...
Machine learning methods played a major role in improving the accuracy of predictions and classification DNA (Deoxyribonucleic Acid) protein sequences. In eukaryotes, Splice-site identification prediction is though not straightforward job because numerous false positives. To solve this problem, here, paper, we represent bidirectional Long Short Term Memory (LSTM) Recurrent Neural Network (RNN) based deep model that has been developed to identify predict splice-sites for exons from eukaryotic...
This study was undertaken to examine averted stroke in optimized systems.
Central neuraxial blocks are contraindicated in patient with aortic stenosis. We report one severe stenosis posted for lower limb surgery. Combined sciatic and femoral nerve block was used as a sole anesthetic technique. Patient hemodynamically stable intraoperative well postoperative period. had good analgesia 12 hrs. Postoperatively the referred to cardiologist further management.
Background: Laryngoscopy and endotracheal intubation form the basis of controlling patient's airway during general anaesthesia or artificial ventilation which may have deleterious respiratory, neurological, cardiovascular effects associated with hemodynamic changes. These transient responses are usually well tolerated by normotensive patients cause no consequences in them. Patients hypertension known to exhibit exaggerated pressor response complications like cardiac failure, myocardial...
Background: Few data exists on acute stroke treatment in patients with pre-existing disability (PD) since they are usually excluded from clinical trials. Methods: A pre-specified subgroup analysis of tPA-eligible PD enrolled a prospective multicenter trial Mobile Stroke Units (MSUs) vs standard management by emergency medical services (EMS). All had baseline mRS scores. Co-primary outcomes were mean utility-weighted modified Rankin Scale score (uw-mRS) and return to at 90 days. Linear...
Introduction: While the goal of IV tissue plasminogen activator (TPA) is to prevent infarction, few data exist on averted stroke. Methods: Secondary analysis a multicenter trial from 2014-2020 comparing outcomes between patients treated for stroke by mobile unit (MSU) vs standard care (SC). The analytical cohort were with suspected TPA. primary outcome was time-defined diagnosis, defined as final diagnosis resolution presenting symptoms/signs 24 hours. secondary tissue-defined hours and no...
<h3>Objective:</h3> Evaluate the impact of a direct-to-angiosuite (DTAS) workflow on Mobile Stroke Units (MSU) in stroke patients with large vessel occlusions (LVO) needing mechanical thrombectomy (MT). <h3>Background:</h3> MSUs are equipped CT/CT angiography (CTA), thrombolytics and personnel that can deliver emergency care to reduce time-to-thrombolytic administration improve clinical outcomes. Although there is no benefit alert-to-puncture times, reduction time was seen when CTA obtained...
Background The impact of mobile stroke units (MSUs) on outcomes in patients with large vessel occlusions eligible for endovascular thrombectomy (EVT) has yet to be characterized. Methods We completed a prespecified substudy EVT‐eligible anterior and posterior circulation computed tomography and/or angiography who were enrolled BEST‐MSU (Benefits Stroke Treatment using Mobile Unit). Primary outcome was 90‐day utility‐weighted modified Rankin scale. Groups compared chi‐square or Fisher's exact...
Introduction: The impact of a Mobile stroke unit (MSU) on access to Endovascular Thrombectomy (ET) is pre-specified BEST-MSU sub-study. On the MSU, ET decision-making steps such as CT, neurologic exam, and tPA treatment are completed prior Emergency Room (ER) arrival. We hypothesized that pre-ER assessment potential patients MSU improves metrics. Methods: prospective comparative effectiveness study vs Standard Management by Medical Services (SM). compared ER door-to-puncture-time (mins,...