Background: and Purpose In patients with ischemic stroke and isolated cervical internal carotid artery occlusion (c-ICA-O), endovascular therapy (EVT) can improve cerebral perfusion. To maintain vessel patency, EVT is frequently combined with carotid artery stenting (CAS). We assessed the efficacy and safety of emergent CAS during EVT for isolated c-ICA-O. Methods: This retrospective multinational cohort study (42 centers) included consecutive patients who underwent EVT for isolated c-ICA-O within 24 hours from the time last seen well. Patients who underwent emergent CAS were compared with those who did not. Co-primary outcomes were c-ICA vessel patency and symptomatic intracerebral hemorrhage (sICH) 24 hours post-EVT. Secondary outcomes included any intracerebral hemorrhage (ICH) at 24 hours and disability at 3 months (modified Rankin Scale [mRS] shift). Outcomes were adjusted using inverse probability of treatment weighting. Results: Of 317 patients (mean age, 68.6 years [standard deviation, 12.9]; median National Institutes of Health Stroke Scale 11 [interquartile range, 6–17]; 26.8% female), 219 (69.1%) underwent CAS, whereas 98 (30.9%) did not. At 24 hours, vessel patency was more common after CAS (83.5% vs. 40.7%; adjusted odds ratio [aOR], 9.45; 95% confidence interval [CI], 4.91–18.17); sICH rates did not differ (2.3% vs. 3.1%; aOR, 0.92; 95% CI, 0.18–4.73). Any ICH was more common after CAS (19.3% vs. 9.3%; aOR, 2.50; 95% CI, 1.12–5.60). CAS was not associated with mRS at 3 months (adjusted common odds ratio, 0.98; 95% CI, 0.62–1.56). Conclusions In patients undergoing EVT for isolated c-ICA-O, emergent CAS was technically effective and reasonably safe. More frequent vessel patency in patients who underwent CAS did not translate into improved functional outcome at 3 months.

BACKGROUND: Patients aged 85 years or older admitted for heart failure (HF) have increased enormously due to improved survival in this disease. However, few studies assess the characteristics, treatments, and prognosis of very elderly patients admitted for acute HF. METHODS: This study is a retrospective analysis of the EPICTER registry, that included patients admitted for acute HF in 74 Spanish hospitals. For this analysis, a total of 1887 patients were included and divided into 2 groups: 85 years or older (very elderly, 680 patients) and those under 85 years. RESULTS: Compared to patients < 85 years, very elderly patients were more frequently women, had more hypertension and disease cerebrovascular disease, and less presence of chronic obstructive pulmonary disease (COPD), diabetes, and acute myocardial infarction. There were no differences in symptoms, except for delirium, significantly more common in very elderly patients. Management of these patients was more conservative and died more than the younger ones (41% vs. 25%, P < 0.001). The predictor variables of mortality in very elderly patients were the presence of COPD and peripheral arterial disease, delirium, and estimated survival of less than 6 months assessed by the physician in charge of the patient care. CONCLUSION Very elderly patients admitted for HF differ from younger ones in comorbidities, management, and symptoms, and have higher mortality. The presence of delirium, peripheral arterial disease, and COPD worsen the prognosis in these patients and can help to adapt the therapeutic effort and place emphasis on adequate symptom control.

Background: Nasopharyngeal swab/oropharyngeal swab (NPS/OPS) qRT-PCR is the gold standard for detecting SARS-CoV-2. However, it has its own limitations including cost and invasiveness. As an alternative, individual qRT-PCR testing of saliva samples was validated and shown to be comparable in sensitivity and specificity with NP-OP qRT-PCR. To further maximize its utility, the researchers wish to explore antigen and pooled testing methods. Objective: The study aimed to evaluate the diagnostic accuracy of detecting SARS-CoV-2 infection using saliva-based pooled qRT-PCR and rapid antigen test compared with individual saliva qRT-PCR. Methodology: In this retrospective cross-sectional study, saliva specimen from individuals aged 18 years old and above from the outpatient specimen collection station at the Philippine Children’s Medical Center were tested individually using qRT-PCR (Mag-bind RNA Extraction Kit/MACURA, Allsheng Extraction Machine, Sansure PCR kit, and MA-600 Sansure Biotech). Non-probability convenience sampling was utilized. Based on the individual results, pools of five (5) individual specimens, which includes one (1) positive sample were tested with qRT-PCR for sensitivity. DNK-2150-1S Dynamiker SARS-CoV-2 Ag Rapid Test (Dynamiker Biotechnology Co., Ltd., Tianjin, China) was also used to test individual saliva specimens. . Out of 196 individual saliva specimens, 73 were detected to have SARS-COV-2 by qRT-PCR, while the remaining 123 were negative. Compared with the individual saliva qRT-PCR, rapid antigen tests done showed sensitivity of 46.58% (95% CI 35.13%, 58.02%), specificity of 86.18% (95% CI 80.08%, 92.28%), positive and negative predictive value of 66.67% (95% CI 53.71%, 79.60%) and 73.10% (95% CI 65.89%, 80.32%) respectively. Based on the results of individual saliva-based qRT-PCR, 62 pools were tested and showed sensitivity of 98.39% (95% CI 91.34%, 99.96%). Conclusion and Recommendation Pooled saliva-based testing for SARS-CoV-2 is comparable with individual saliva-based rapid antigen testing. The use of rapid antigen testing is less sensitive and less specific compared with qRT-PCR consistent with prior reports. Additional studies are recommended to determine optimal conditions for testing.
SARS-CoV-2 ; COVID-19