Computed-tomography scanning (CT-scan) is as a gold standard for diagnosing stroke and deciding for subsequent stroke management inspite had several difficulty to evaluate early ischemic changes. CT-scan assessment with ASPECTS has a similarity in interpretation among neurologists, radiologist and neuroradiologist. We hypothesize that there were good inter-rater reliability of ASPECT score between stroke neurologist and neuroradiologist. This study was an analytic-descriptive crosssectional on first-time ischemic stroke patient in Neurology Department of Dr. Hasan Sadikin Central General Hospital from October 2017 – February 2018. Classification were done using the Trial of Org 10172 in Acute Stroke Treatment (TOAST) criteria. ASPECTS was calculated from CT-scan of patients by stroke neurologist and neuroradiologist. Cohen’s kappa test were used to analyze inter-rater agreement from two experts. A total of the 46 subjects were enrolled, with 13 cases of cardioembolic stroke, 10 cases of large arteries (LAA) stroke, 22 cases of lacunar stroke, and 1 other stroke cause. Mean onset of stroke was 13.6±7.1 hours with 10 (21.7%) cases was hyperacute stroke and 36 (78.3%) was acute stroke. Mean score of ASPECTS was 7.54±2.11 and there was very good agreement between 2 experts assessment of ASPECT score (Cohen kappa=86.95%). There was a very good inter-rater reliability between stroke neurologist and neuroradiologist in assessing ASPECT score on acute ischemic stroke patients.
Down syndrome (DS) is the most common genetic cause of learning difficulties and intellectual disabilities. DS patients often present with several congenital defects and chronic diseases, including immunity disorders. Elevated levels of pro-inflammatory cytokines such as interleukin (IL)-6 and tumor necrosis factor alpha (TNF-α) have been seen, which appear to vary with age. At birth, patients present with combined immunodeficiency, with frequent infections that decrease with age. Furthermore, high levels of IL-4 and IL-10 with anti-inflammatory properties and low levels of IL-6 and TNF-α are described in children. The immune system is believed to play an essential role in SARS-CoV-2 pathogenesis, and it has been associated with elevated levels of pro-inflammatory cytokines and an exaggerated cytokine release syndrome (CRS) that may eventually trigger a severe situation called cytokine storm. On the other hand, genetic features seem to be involved in the predisposition to illness and its severity. Overexpression of DSCR1 and ZAKI-4 inhibits the translocation of activated T lymphocyte nuclear factor (NF-AT) to the nucleus, a main step in the inflammatory responsiveness. We discuss here the possible role of immunology and genetic features of DS in the infection and prognosis in COVID-19.
We recently examined the efficacy of low-level laser therapy (LLLT) to treat autistic children and adolescents up to 12 months after finishing LLLT therapy. In this paper, we present the follow up assessment up to 12 months after completion of LLLT procedure, demonstrating that improvement in symptoms continued in the patients initially randomized to the active (test) group, with no change at all for placebo subjects. After finishing the above-mentioned protocol, we decided to treat the initial placebo group (now, placebo cross-over group) and clinically follow up the cases up to 12-months, as we had done with the active (test) group. Hence, in this paper we compare the clinical evaluation providing progressive results for up to 12-months follow-up evaluation (relative to treatment end) for the subject groups enrolled in our protocol.
