Risultati per: Colite ulcerosa negli adulti: review

Stroke, Volume 54, Issue Suppl_1, Page ATP52-ATP52, February 1, 2023. Background:Post-acute transition of care (TOC) in stroke patients is a multifactorial process. Different TOC interventions have been tested, with inconsistent benefits.Objective:Our aim is to evaluate the effect of post-acute TOC interventions on various stroke patients’ outcomes.Methods:All published interventional studies evaluating the impacts of TOC models for stroke survivors, during their post-acute care disposition, were included. We excluded studies tackling only patients with intracerebral hemorrhage (ICH) or transient ischemic attacks, those with purely rehabilitative interventions, case reports and case studies, as well as systematic reviews and meta-analyses. We searched MEDLINE, EMBASE, the Cochrane Central Register of Controlled Trials (CENTRAL) and the Cumulative Index to Nursing and Allied Health Literature (CINAHL) through July 2022.Results:We included 38 studies involving 82,416 patients. TOC services were heterogeneous, commonly including scheduled home visits, telephone calls and office visits, in the setting of a multidisciplinary approach. Outcome measurement time varied between 1 month and 5 years. Activities of daily living (ADLs)-related outcomes, functionality, quality of life (QOL)-related outcomes, readmission rates, mental health-related outcomes, and mortality were reported in 20, 11, 10, 10, 7, and 6 studies, respectively. Only 4 studies looked at rates of medication adherence and 2 studies at control of vascular risk factors. In 6 out of 10 studies, improvements in QOL measurements and patient-reported health surveys were reported, whereas no study reported improvement in mortality rates. Three studies showed improvement for each of the following outcomes: ADLs, functionality, and readmission rates. Only 2 studies noted decrease in mental health problems with the intervention, and 2 noted better control of vascular risk factors. Both studies with medication adherence outcomes showed that the intervention increases rates of compliance to prescribed drugs.Conclusion:Post-acute TOC interventions seem to have a positive effect on stroke survivors’ quality of life and self-perceived health, as well as on rates of medication adherence, but bear no effect on mortality.

Stroke, Volume 54, Issue Suppl_1, Page ATP34-ATP34, February 1, 2023. Background and Purpose:Descriptive study to review 200 patients presenting with Covid-19 and neurology consultation.Methods:Retrospective review of 200 patients with Covid-19 requiring neurologic consultation from April 2020 to February 2021. Characteristics reviewed included age, sex, BMI, past medical history, presenting symptoms, labs, imaging, symptomatic vs asymptomatic Covid-19, acute stroke, stroke intervention, and death status. Labs reviewed were on the day of neurologic consultation.Results:All 200 patients were laboratory confirmed Covid-19 positive. Consultation indication included stroke symptoms (36%), encephalopathy (32%), abnormal movements / seizure (9.5%), myopathy (5.5%), headache (4.5%), and other (11.5%). The mean age of the patient was 67.2 ± 16.6, and 85 (47.5%) were female. 88 (44%) of the patients were obese, 123 (61.5%) were diabetic, and 118 (59%) had dyslipidemia, while 40% reported history of neuropathy. CRP was elevated in 47.9%, d-dimer elevated in 41.9%. 29.5% of patients complained of dizziness and 34% headache. 65% had acute upper respiratory symptoms, 68% acute encephalopathy, and 53% impaired consciousness. 29% (59) had finding of acute ischemic stroke on imaging. 46% (27) of the acute stroke patients were deceased. 17% of the acute strokes that met criteria underwent acute intervention with IV-tPA (8.6%) and thrombectomy (8.6%).Conclusions:In conclusion, there is a high mortality rate with acute stroke in the setting of Covid-19 and neurology consultation. Additionally, increased rates of co-morbidities such as obesity, diabetes, and dyslipidemia are noted, interesting 40% had a history of neuropathy. Further review of these characteristics in comparison to death status in patients with Covid-19 and neurology consultation is recommended and will follow.

Stroke, Volume 54, Issue Suppl_1, Page AWP150-AWP150, February 1, 2023. Introduction:Asymptomatic intracerebral hemorrhage (aICH) occurs in ~40% of acute ischemic stroke patients after endovascular thrombectomy (EVT). Unlike symptomatic ICH, which is undoubtedly associated with worse outcomes, studies evaluating the association of aICH on long-term outcomes have been inconclusive. We performed a systematic review and meta-analysis to evaluate the long-term effects of post-EVT aICH.Methods:The meta-analysis protocol was submitted to PROSPERO a priori. PubMed, SCOPUS and Web of Science were searched from inception through April 2022 using database-specific searches with combination of keywords and controlled vocabulary. After deduplication, two authors independently reviewed all abstracts. Included studies contained adult AIS patients undergoing EVT with follow-up imaging assessment of ICH reporting comparative outcomes according to aICH vs no ICH . Meta-analysis was performed using Cochrane Review Manager v5.4. Summary effects were estimated by a fixed-effects model to estimate summary odds ratio (OR) of the effect of aICH vs no ICH on primary outcomes of 90-day modified Rankin score 3-6 and mortality.Results:Systematic review yielded 278 studies; 52 abstracts were fully reviewed ; 8 studies fulfilled inclusion criteria (n=4701 patients total; 1562 with aICH). aICH was associated with 90-day mRS 3-6 (OR 2.11 [95% CI 1.85-2.40]; Figure 1A) and higher mortality (OR 1.66 [95% CI 1.41-1.96]; Figure 1B) compared to no ICH. There was insufficient evidence of difference in 90-day mRS 3-6 when studies were grouped according to Heidelberg (n=2 studies; OR 2.37 [95% CI 0.92, 6.12]) vs ECASS (n=5 studies; OR 2.07 [95%CI 1.62, 2.64]) criteria for ICH. Meta-regression analysis adjusting for covariates will be presentedConclusion:aICH is associated with worse 90-day functional outcomes and higher mortality. Further studies to evaluate the factors predicting aICH and treatments aimed at reducing its occurrence are warranted.

Stroke, Volume 54, Issue Suppl_1, Page ATP229-ATP229, February 1, 2023. Introduction:Stroke and traumatic brain injury (TBI) accounts for 70% of secondary epilepsy in the adult population. The genetic architecture of epilepsy secondary to TBI or stroke is poorly understood.Objective:We undertook a systematic review to test the association of single nucleotide polymorphisms (SNPs) with the risk of posttraumatic epilepsy (PTE) and post-stroke epilepsy (PSE).Methods:We conducted a comprehensive literature search until 5 July 2022 in PubMed, Embase, PsycINFO, Web of Science, and Google Scholar. We preregistered the protocol of this systematic review on PROSPERO (CRD42022325617). We collated the association statistics from the articles to assess the association of SNPs with the risk of epilepsy amongst TBI or stroke patients. We assessed the study quality using the Quality of Genetic Association (Q-Genie) tool. We report Odds Ratio (OR) and Hazard Ratio (HR) with a 95% confidence interval (CI), including combined OR where a meta-analysis was possible.Results:The literature search yielded 420 articles, of which 16 were included in our systematic review. Q-Genie-based assessment of the literature found that 58% of the included studies were of poor quality. We examined published data on 127 SNPs from 32 genes identified in PTE and PSE patients. Twelve studies reported that 718 TBI patients (21%) suffered from PTE. Four studies reported PSE in 1192 stroke patients (50%). Eleven SNPs were associated with an increased risk of PTE. Three SNPs,TRMP6rs2274924,ALDH2rs671,CD40-1C/T, were significantly associated with an increased risk of PSE, while two SNPs,AT1Rrs12721273 and rs55707609, were significantly associated with reduced risk. Only two studies tested the association ofAPOEE4with PTE; no other studies validated previously reported genetic association data. Hence, the limited data precluded meta-analysis of all but one SNP, i.e., theAPOEE4allele. The meta-analysis for the association of theAPOEE4allele with PTE was non-significant (OR 1.8, CI 0.6-5.6).Conclusions:The current evidence on the association of genetic polymorphisms in epilepsy secondary to TBI or stroke is of low quality and lacks validation. A collaborative effort to pool genetic data linked to epileptogenesis in stroke and TBI patients is warranted.

Stroke, Volume 54, Issue Suppl_1, Page AWMP1-AWMP1, February 1, 2023. Introduction:Prior systematic reviews have focused on a comparison of efficacy endpoints between tenecteplase (TNK) and alteplase. The objectives of this study are to determine whether the rate of treatment complications differs between patients treated with the two agents.Methods:This systematic review (CRD42022303835) was performed according to PRISMA guidelines. We included prospective, interventional studies and prospective and retrospective observational studies. We searched MEDLINE, the Cochrane Central Register of Controlled Trials, Embase, Web of Science and the ClinicalTrials.gov registry from inception through June 3rd2022. The primary endpoint was symptomatic intracranial hemorrhage (sICH) and secondary endpoints included any ICH, mortality, angioedema, gastrointestinal hemorrhage and other extracranial hemorrhage. We performed separate random effects meta analyses for each endpoint. Evidence was synthesized as relative risks, comparing subjects exposed to TNK versus alteplase as well as absolute risks in those treated with TNK.Results:Of 2,226 records identified, 26 were eligible for inclusion including 7,921 patients. Seventeen studies included alteplase as a comparator group and 10 were non-comparative. The relative risk of sICH in patients treated with TNK compared with alteplase was 0.93 (95% CI: 0.68-1.28). Across those treated with low, medium and high doses of TNK, the relative risks were 0.78 (95% CI: 0.22-2.82), 0.84 (95% CI: 0.58-1.20) and 2.31 (0.69-7.75) respectively. The unadjusted rate of sICH, including comparative and non-comparative studies, was 1%, 2% and 4% within the low, medium and high dose groups.Discussion:To-date, this is the most comprehensive systematic review examining relative complications of TNK and alteplase. The rate of treatment harms is broadly comparable between those treated with the two agents. We present evidence that the rate of sICH may be increased in those treated with higher doses of TNK.

Stroke, Volume 54, Issue Suppl_1, Page A50-A50, February 1, 2023. Introduction:When mechanical thrombectomy (MT) fails to achieve successful recanalization, rescue stenting (RS) has proven to be a feasible rescue therapy. However, the available evidence remains underpowered to assess its safety and efficacy.Objective:To compare the safety and efficacy of RS versus routine medical treatment in patients who failed MT using an aggregated metanalysis.Methods:A systematic review was performed in Scopus, Embase, Medline, and Web of Science from inception to July 2022 for all studies that tested the safety and efficacy of RS after failed MT. Outcomes of interest included an mRS score of 0-2 at 90 days, successful recanalization (mTICI 2b-3) after RS, symptomatic intracranial hemorrhage (sICH), and all-cause mortality at 90 days. A random-effects meta-analysis was performed between the RS and medical treatment arm to calculate pooled odds ratios (OR) for each outcome. Statistical heterogeneity across studies was assessed with I2statistics.Results:In total 12 studies involved 1855 participants, 729 in the RS arm and 1126 in the medical treatment arm. The pooled results indicated that RS was associated with a higher proportion of patients with an mRS score of 0-2 at 90 days (RS: 41% vs. 21%; OR = 3.27; 95% CI 2.08 – 5.16; I2= 64%) and a decreased risk of mortality at 90 days (RS: 22.5% vs. 33.8%; OR = 0.47; 95% CI 0.32 – 0.69; I2= 45%), compared with medical treatment after failed MT. The pooled rate of successful recanalization after RS was 87% (95% CI 82 – 91; I2= 57%). The rate of sICH did not differ between groups (RS: 8.5% vs. 11.7%; OR = 0.85; 95% CI 0.59 – 1.20; I2= 7%)Conclusion:RS represents a promising strategy that for maximizing recovery in acute stroke patients after first line MT fails to achieve meaningful reperfusion. However, a randomized trial using a standardized approach/technique and independently adjudicated outcomes is needed to confirm this observation.

Stroke, Volume 54, Issue Suppl_1, Page AWMP48-AWMP48, February 1, 2023. Background:Subgroup analyses are widely used to evaluate heterogeneity of treatment effects in randomized clinical trials. However, there is a limited investigation of the quality of prespecified and reported subgroup analyses in stroke trials. This study evaluated the credibility of subgroup analyses in stroke trials.Methods and Analysis:We searched Medline/PubMed, Embase, the Cochrane Central Register of Controlled Trials, and the Web of Science from inception to March 24th, 2021. Three reviewers screened, extracted, and analyzed the data from the publications. Primary publications of stroke trials that reported at least one subgroup effect and had published corresponding study protocols were included. The Instrument for Assessing the Credibility of Effect Modification Analyses (ICEMAN) was used to examine the quality of the subgroup effects reported. The risk of bias was assessed using the Cochrane Risk-of-Bias tool for randomized trials version 2.Results:Seventy-four articles met the inclusion criteria and altogether reported 647 subgroup effects. The median sample size was 1264 (interquartile range (IQR): 380 – 3876) while the median number of subgroups prespecified in the protocol was 6 (IQR:2 – 10), and 61 studies (82.4%) used the univariate test of interaction. One hundred and thirty-nine subgroup effects (43.6%) in acute stroke treatment and 131 subgroup effects (35.03%) in studies published in 2015 or later had moderate credibility. Overall, 458 subgroup effects (70.8%) had low credibility, while 189 subgroup effects (29.2%) had moderate credibility.Conclusion:Subgroup analysis reporting quality in stroke trials remains poor. Trialists and medical journal publishers must ensure that reporting guidelines, such as ICEMAN, are adopted to improve the credibility of reported subgroup analyses in stroke trials.

Stroke, Volume 54, Issue Suppl_1, Page AWP46-AWP46, February 1, 2023. Introduction:There has been a shift in prehospital systems of care to prioritize transporting acute ischemic stroke (AIS) patients with suspected emergent large vessel occlusion (ELVO) stroke to thrombectomy capable stroke centers (TSCs), as opposed to primary stroke centers (PSCs) which may be closer and offer intravenous thrombolysis faster. Large scale data on clinical outcomes in direct triage are lacking.Methods:We conducted a systematic review and meta-analysis using PRISMA guidelines with the Nested Knowledge AutoLit platform to search PubMed for relevant terms from 01/2015 to 05/2022. Our primary endpoint was proportion of patients with a good clinical outcome [modified Rankin Score (mRS) 0-2] at 90 days.Results:We identified 390 studies, 16 of which compared direct triage to various models and were included. Amongst these, Mobile Stroke Unit (MSU; n=1), Mothership only (n=1), Drip-and-Ship only (n=3), and Mothership + Drip-and-Ship (n=11) were compared to Direct Triage. Among the eleven that reported 90-day functional status outcomes, there were no discernible trends. Four studies that compared 90-day functional outcomes amongst patients who received EVT and compared Direct Triage to Drip-and-Ship + Mothership models were analyzed. Baseline age, sex, and presenting NIHSS were similar. Patients who underwent Direct Triage were more likely to have a good outcome (mRS 0-2) at 90-days (OR 1.35, 95% CI 1.03-1.76).Conclusions:Amongst patients who received EVT, patients who underwent Direct Triage were more likely to have better functional outcomes at 90 days. Direct Triage of AIS patients is a promising strategy to improve clinical outcomes in patients who undergo EVT. More research is needed in patients who do not receive EVT.

Stroke, Volume 54, Issue Suppl_1, Page AWP169-AWP169, February 1, 2023. Background:Studies suggest divergent temporal trends in stroke incidence in high income countries, with increasing rates in younger people, particularly women. No age- and sex-specific stroke incidence data are available for Latin American and Caribbean (LAC) regions, despite large populations undergoing rapid structural changes.Aim:To determine temporal trends in age and sex stroke incidence in LAC populations.Methods:A systematic review in accordance with MOOSE and PRISMA guidelines was undertaken with a modified Cochrane Stroke Group search strategy of MEDLINE, WOS, and LILACS databases, to identify relevant references for prospective observational studies with sex-disaggregated data on stroke incidence in LAC populations from January 1997 to December 2021. Two independent reviewers screened titles/abstracts, and reviewed selected full text articles. Random-effects meta-analysis was conducted to estimate the pooled overall crude stroke incidence and relative temporal rate ratio (RTTR) by age-groups in all and sex-disaggregated data. The Joanna Briggs Institute’s risk of bias assessment was applied.Results:Of 9242 identified records, 6 LAC studies (9 periods) were selected. Overall crude stroke incidence was higher in men than women (incidence [men:women] rate ratio [IRR] = 1.12, 95% confidence interval [CI] 1.04-1.21 [I2=38.3%]). When analyzed for temporal trend, relative ratio of stroke incidence was greater in younger than older age-groups (

Stroke, Volume 54, Issue Suppl_1, Page AWMP73-AWMP73, February 1, 2023. Introduction:Stroke secondary to intracranial atherosclerosis (ICAD) results in three distinct infarct patterns: (a) border zone infarcts (BZI) due to impaired distal perfusion (b) territorial infarcts due to distal plaque/thrombus embolization, and (c) perforator infarcts due to plaque progression. Previous studies indicate higher stroke recurrence in ICAD patients with BZI.Methods:This registered systematic review (CRD42021265230) comprised Medline and Web of Science search from inception to March 2022 for keywords (Intracranial Atherosclerosis OR Intracranial Stenosis) AND (Border zone OR Infarct Pattern) to identify papers and conference abstracts reporting initial infarct patterns and recurrence rates in patients with symptomatic ICAD. Sensitivity analyses were performed for studies including any BZI vs isolated BZI and those excluding posterior circulation strokes. The study outcome included neurological deterioration and/or stroke recurrence. For all outcome events, corresponding risk ratios (RR) and 95% confidence intervals (CI) were calculated. Risk of bias assessments will be presented.Results:Literature search yielded 4478 studies,11 met inclusion criteria (n=1315 patients, 354 with BZI, weighted proportions summarized in figure). The meta-analysis of these studies with moderate heterogeneity (I2=38.7%) demonstrated that RR of outcomes in BZI group compared to non-BZI group was 2.10 (95% CI 1.52-2.90). Limiting analysis to studies including any BZI, RR (and 95% CI) was 2.32 (1.58-3.40), and 3.25 (2.09-5.07) for studies only including anterior circulation strokes with low heterogeneity for both (I2=0%). A non-significantly high outcome rate was seen with isolated BZI (RR 2.29, 95% CI 0.94-5.62) but with moderate heterogeneity across studies (I2=70.25%).Conclusion:We demonstrate the presence of BZI secondary to symptomatic ICAD can be imaging biomarker to predict neurological deterioration and/or stroke recurrence.

Stroke, Volume 54, Issue Suppl_1, Page ATMP101-ATMP101, February 1, 2023. Post-stroke cognitive impairment (PSCI) occurs in 20-40% of patients 3-6 months after stroke. However, the question regarding risks of recurrent stroke and death in patients with PSCI remains controversial. The goal of this study was to conduct meta-analysis of published literature to estimate the risks of stroke recurrence and death associated with PSCI, as well as to assess the quality of these studies, and to identify sources of variation. Electronic databases (PubMed, EMbase, Google Scholar, Cochrane Library, and Scopus) were screened for eligible studies published from 1992 to 2019. Study quality was assessed using the Newcastle Ottawa Scale. Risk of bias in non-randomized and randomized studies was assessed using ROBINS-E and RoB 2 tools, respectively. Funnel plots and selection models were used for evaluating publication bias. Heterogeneity was assessed using a combination of statistics:I2,Q-statistic, and Kendallτ2.Estimates were obtained using a random effects model and restricted maximum likelihood estimation. Pooled estimates for the two outcomes of interest were calculated as hazard ratios (HR) with 95% confidence intervals (CIs). We included eight studies examining the effect of PSCI on risk of stroke recurrence. We found no evidence of potential publication bias among the included studies in stroke recurrence (χ2=3.440, p=0.487) and mortality (χ2=3.797, p=0.150). Pooled data from the eight studies involving n=1,840 PSCI and n=5,824 non-PSCI showed that the hazard of recurrent stroke risk was significantly higher in individuals with PSCI compared to non-PSCI participants (HR = 1.71; 95% CI: 1.45 – 2.01;I2= 0%). Seventeen studies were included examining the impact of PSCI on mortality risk. The pooled data from these studies comprised n=7,591 PSCI and n=22,328 non-PSCI study participants. The pooled hazard of mortality was significantly higher in the PSCI group relative to the non-PSCI group (HR = 1.98; 95% CI: 1.64 – 2.40;I2= 82.95%). This meta-analysis shows an increased risk of mortality and recurrent stroke in patients with PSCI. Post-stroke cognitive testing may identify patients at a higher risk of stroke recurrence and death who may require more aggressive interventions for secondary prevention.

Stroke, Volume 54, Issue Suppl_1, Page AWP1-AWP1, February 1, 2023. Introduction:Patients with large vessel occlusion stroke (LVO) benefit from thrombolysis before thrombectomy. Previous meta-analysis suggested superiority of tenecteplase over alteplase in achieving good clinical outcome at 3 months.Aim:We aimed to compare clinical outcomes after tenecteplase 0.25 mg/kg versus alteplase in patients with LVO.Methods:An experienced librarian searched PubMed and Scopus databases through July 13, 2022 for randomized controlled trials comparing tenecteplase with alteplase in patients with LVO. We included trials using 0.25 mg/kg tenecteplase dose, reporting blindly assessed pre-specified clinical outcomes at 3-4 months among patients with LVO. Two authors independently reviewed eligibility and extracted the data. We used RevMan 5.4 and random effect models with inverse variance weights to calculate odds ratios (OR) and 95% confidence intervals (CI). This systematic review is registered (CRD42022349414).Results:From 585 retrieved abstracts, 3 trials and 1 pooled secondary analysis involving 704 unique patients met the inclusion criteria. Among patients with LVO, tenecteplase 0.25mg/kg is not superior to alteplase in achieving good clinical outcome (defined as modified Rankin Scale [mRS] 0-2, OR 1.82 (95% CI 0.91-3.65, panel A); nor all-cause mortality, OR 0.75 (95% CI 0.49-1.13, panel B); while tenecteplase increases the odds of excellent outcome (mRS 0-1), OR 1.52 (95% CI 1.11-2.09, panel C), and odds of functional improvement (defined as a shift on the ordinal mRS), OR 1.54 (95% CI 1.07-2.20, panel D). High heterogeneity was present (I2 =70%) for the good clinical outcome.Conclusion:Tenecteplase is not superior over alteplase in achieving good clinical outcome. Tenecteplase, as compared to alteplase, increases the odds of functional improvement and excellent outcome. These findings support bridging tenecteplase in patients with LVO.

Stroke, Volume 54, Issue Suppl_1, Page AWMP88-AWMP88, February 1, 2023. Introduction:Chronic occlusion of the ICA (COICA) is an important cause of ischemic strokes. Evidence has showed that medical management (MM) alone is not sufficient for prevention of ischemic events. Carotid occlusion endovascular revascularization & stenting (COERS) is a promising technique, yet its safety and superiority to MM remain unclear.Objective:To pool and compare rates of safety and efficacy outcomes of COERS versus MM of COICA.Methods:We conducted a systematic search in Embase, Medline, and Web of Science for studies reporting short and long-term outcomes of symptomatic COICA patients who received MM and/or COERS. Main efficacy outcomes were successful recanalization and long-term recurrence of ischemic events. Safety outcomes for COERS were periprocedural (<30 days) events. We performed a meta-analysis of proportions for MM and COERS groups, using GLMM transformation and a random-effects model.Results:11 studies contained data of COICA patients undergoing COERS, 3 studies of patients who received only MM, and 2 studies compared both arms; they provided data for 513 and 313 patients in the COERS and MM groups, respectively. The pooled recanalization rate after treatment with COERS was 75% (95% CI 0.67-0.82, PI 0.49-0.94, I264%). Recurrence rates of ischemic events at long-term follow-up were 19% (95% CI 0.15-0.25, PI 0.11-0.32, I225%) with MM, and 11% (95% CI 0.07-0.19, PI 0.02-0.42, I22%) after COERS; comparison meta-analysis showed a similar non-significant trend (MM:24% vs. COERS:13%, OR 0.52, 95% CI 0.17-1.59, I20%). The rate of periprocedural events in the COERS group were 2.3% (95% CI 0.012-0.045, I20%) for stroke/TIA, and 2.1% (95% CI 0.011-0.038, I20%) for any ICH.Conclusion:COERS is a feasible technique and a safe strategy for maximizing secondary stroke prevention for the treatment of symptomatic COICA. Still, further prospective trials to better define safety and efficacy boundaries are needed before starting a RCT.

Stroke, Volume 54, Issue Suppl_1, Page AWP30-AWP30, February 1, 2023. Background and Purpose:Identify characteristics contributing to death in patients with Covid-19 and neurology consultationHypothesis:We suspected many characteristics contributed to death in those with Covid-19 requiring neurologic consultation based on our clinical experience and prior descriptive study.Methods:A retrospective review of the characteristics of 200 patients with Covid-19 requiring neurology consultation from April 2020 to February 2021 were analyzed. Continuous variables were summarized by mean ± standard deviation and compared using the Student’s T-test of Wilcoxon rank-sum test. Categorical variables were summarized by frequency and percent and compared using Chi-squared or Fisher’s exact tests. Analyses were preformed with the use of SAS software (version 9.4). P-value < 0.01 was considered statistically significant.Results:The patients who were deceased tended to be older compared to the patients who were alive (73.1 ± 12.4 vs. 64.7 ± 17.6, P-value = 0.001). Patients who were deceased had lower RBC (3.9 ± 1.0 vs 4.5 ± 1.7, P-value=0.006) and higher creatinine (2.3 ± 2.5 vs 1.4 ± 1.3, P-value = 0.003). Patients who were deceased were more likely to have impaired consciousness, coma, acute stroke, and encephalopathy compared to patients who were alive (83.1% vs 41.3%, 56.9% vs 16.9%, 48.3% vs 22.7%, and 86.2% vs. 62.3%). Among 58 with acute stroke, there was no statistically significant difference in type of stroke (38.5% vs 53.6%, P-value = 0.265) or intervention on stroke (15.4% vs 20.7%, P-value = 0.732) by death status. The patients with stroke who were deceased had lower platelets (180.4 ± 98.5 vs 276.6 ± 145.5, P-value = 0.004). Stroke patients who were deceased were more likely to have impaired consciousness and coma (78.6% vs 43.4%, and 53.6% vs 17.2%, respectively).Conclusion:Patients requiring neurologic consultation with Covid-19 have a higher likelihood of death in the setting of acute stroke, coma, encephalopathy, low RBC count, and elevated creatinine; and those with stroke had higher mortality with low platelet count. Further studies with early intervention to improve these factors may play a role in reducing morality.

Introduction
Observational studies in health-related research often aim to answer causal questions. Missing data are common in these studies and often occur in multiple variables, such as the exposure, outcome and/or variables used to control for confounding. The standard classification of missing data as missing completely at random, missing at random (MAR) or missing not at random does not allow for a clear assessment of missingness assumptions when missingness arises in more than one variable. This presents challenges for selecting an analytic approach and determining when a sensitivity analysis under plausible alternative missing data assumptions is required. This is particularly pertinent with multiple imputation (MI), which is often justified by assuming data are MAR. The objective of this scoping review is to examine the use of MI in observational studies that address causal questions, with a focus on if and how (a) missingness assumptions are expressed and assessed, (b) missingness assumptions are used to justify the choice of a complete case analysis and/or MI for handling missing data and (c) sensitivity analyses under alternative plausible assumptions about the missingness mechanism are conducted.

Methods and analysis
We will review observational studies that aim to answer causal questions and use MI, published between January 2019 and December 2021 in five top general epidemiology journals. Studies will be identified using a full text search for the term ‘multiple imputation’ and then assessed for eligibility. Information extracted will include details about the study characteristics, missing data, missingness assumptions and MI implementation. Data will be summarised using descriptive statistics.

Ethics and dissemination
Ethics approval is not required for this review because data will be collected only from published studies. The results will be disseminated through a peer reviewed publication and conference presentations.

Trial registration number
This protocol is registered on figshare (https://doi.org/10.6084/m9.figshare.20010497.v1).

Objectives
Whether KMT2A-PTD has a prognostic impact on patients with acute myeloid leukaemia (AML) is controversial. Therefore, we conducted a meta-analysis to assess the prognostic value of KMT2A-PTD in patients with AML.

Methods
Eligibility criteria: we included studies concerning the prognostic value of KMT2A-PTD in patients with AML.
Information sources: Eligible studies were identified from PubMed, Embase, Medline, Web of Science, Cochrane Library and Chinese Biomedical Database. The systematic search date was 19 December 2020.
Risk of bias: Sensitivity analysis was used to evaluate the stability and reliability of the combined results. Begg’s and Egger’s tests were used to assess the publication biases of studies.
Synthesis of results: We calculated the pooled HRs and their 95% CIs for overall survival (OS) and event-free survival (EFS) by Stata V.12 software.

Results
Included studies: 18 studies covering 6499 patients were included.
Synthesis of results: KMT2A-PTD conferred shorter OS in total population (HR=1.30, 95% CI 1.09 to 1.51). In the subgroup analysis, KMT2A-PTD also resulted in shorter OS in karyotypically normal AML patients (HR=2.72, 95% CI 1.83 to 3.61) and old AML patients (HR=1.93, 95% CI 1.44 to 2.42). KMT2A-PTD indicated no prognostic impact on EFS in total population (HR=1.26, 95% CI 0.86 to 1.66). However, in the sensitivity analysis, KMT2A-PTD resulted in poor EFS (HR=1.34, 95% CI 1.04 to 1.64) when deleting the study with a relatively obvious effect on the combined HR. In the subgroup analysis, KMT2A-PTD was associated with poor EFS in old AML patients (HR=1.64, 95% CI 1.25 to 2.03).

Conclusion
The findings indicated that KMT2A-PTD had an adverse impact on the prognosis of patients with AML in the total population, and the conclusion can also be applied to some subgroups including karyotypically normal AML and old AML patients. KMT2A-PTD may be a promising genetic biomarker in patients with AML in the future.

Trial registration number
CRD42021227185.