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Stroke is the second main cause of mortality and the third leading cause of mortality and permanent disability combined. Many potential biomarkers have been described to contribute to the diagnosis, prognosis of outcomes, and risk stratification after stroke. Copeptin is an inactive peptide that is produced in an equimolar ratio to arginine vasopressin (AVP) in response to the activation of the endogenous stress system.The present study isa systematic review and meta-analysis to assess plasma copeptin concentrations, diagnostic and prognostic values for risk stratification after acute ischemic stroke and transient ischemic attack.Mean copeptin level in stroke vs. non-stroke groups varied and amounted to 19.8 ± 17.4 vs. 9.7 ± 6.6 pmol/L, respectively (mean differences [MD]: 12.75; 95% confidence interval [CI]: 5.00 to 20.49; p0.001), in good vs. poor outcome 12.0 ± 3.6 vs. 29.4 ± 14.5 (MD: -8.13; 95% CI: -8.37 to -7.88; p0.001) and in survive vs. non-survive stroke patients: 13.4 ± 3.2 vs. 33.0 ± 12.3, respectively (MD: -13.43; 95% CI: -17.82 to -9.05; p0.001).The above systematic review and meta-analysis suggests that monitoring the copeptin levels may help predict the long-term prognosis of ischemic stroke efficiently. Determining the copeptin level may help individualize the management of ischemic stroke patients, keep stroke risk lower, reduce post-stroke complications, including patient death, and minimize healthcare costs.

BACKGROUND: Stroke is a leading cause of disability and death in both developed and developing countries. While hemorrhagic stroke often necessitates immediate neurosurgical intervention, ischemic stroke is treated with reperfusion therapies such as thrombolysis with intravenous recombinant tissue plasminogen activator (IV rtPA) and early endovascular thrombectomy for broad vessel occlusions. OBJECTIVES: Early diagnoses, accurate emergency medical services (EMS) dispatch, rapid EMS transfer, and stroke team activation have helped reduce door-to-IV tPA time and continue to be critical in saving time for stroke patients’ treatment. MATERIAL AND METHODS: One reason for prehospital delays may be incorrect qualification by emergency team members due to incomplete medical records and incorrect evaluation of symptoms by dispatchers or paramedics. The dispatcher’s precise identification of the report helps them decide on the patient’s priority disposal of the ambulance. In comparison, a correct initial diagnosis by paramedics allows the patient to be transported immediately to the destination hospital, i.e., the unit with a stroke unit. Extending the time it takes for the patient to enter the stroke facility due to the patient being moved through stages reduces the probability of successful treatment being introduced significantly. RESULTS: We hypothesized that paramedics’ knowledge of prehospital stroke management protocols would be linked to their clinical experience as well as their stroke preparation. CONCLUSION: A secondary goal of this study was to evaluate and compare the theoretical knowledge on stroke management among paramedics and identify factors associated with high knowledge. 468 EMS providers agreed to complete a questionnaire that included demographic questions, practical experience questions, and 14 theoretical information questions. Our research found that paramedics in Poland have significant awareness gaps in existing stroke treatment guidelines.

Coronary artery disease (CAD) is the leading cause of death worldwide. Patients with pre-existing CAD were shown to have a more severe course of COVID-19, but this association has not been clarified. We performed a meta-analysis to determine the association between CAD and COVID-19 outcomes. We searched Scopus, Medline (PubMed), Web of Science, Embase, and Cochrane databases up to 2 November 2021. There were 62 studies with a total population of 49,286 patients included in the meta-analysis. CAD occurrence in survivor vs. non-survivor groups varied and amounted to 9.2% vs. 22.9%, respectively (OR = 0.33; 95%CI: 0.29 to 0.39; I2 = 70%; p < 0.001). CAD was also associated with increased severity of COVID-19 disease and was (10.8% vs. 5.6%, respectively, for severe vs. non-severe groups (OR = 2.28; 95%CI: 1.59 to 3.27; I2 = 72%; p < 0.001). The role of history of CAD in mortality and severe condition in COVID-19 presents itself as prominent—although a risk of bias in retrospective trials needs to be assessed, in case of our meta-analysis the statistically significant results when it comes to higher mortality among patients with CAD compared to non-CAD patients, a more severe condition observed in patients with CAD, and a visibly more frequent admission to intensive care unit in patients with CAD, it seems that an incidence of cardiovascular events plays a role in COVID-19 prognosis.

BACKGROUND: Traumatic brain injury (TBI) is a leading cause of death and disability. In many cases of TBI-related intracranial hemorrhage (ICH) is associated with a high risk of coagulopathy and may lead to an increased risk of hemorrhage growth. Therefore, tranexamic acid (TXA), which is known as an antifibrinolytic agent that reduces bleeding by inhibiting the breakdown of blood clots, might limit ICH expansion. MATERIAL AND METHODS: We aimed to quantify the effects of TXA in brain injury and thus performed a literature search using PubMed, Web of Science, Scopus, EMBASE, and Cochrane Center Register of Controlled Trials (CENTRAL) for studies that were published between the respective database inception, and April 10, 2021. RESULTS: A total of nine studies were identified; these included 5845 patients treated with, and 5380 treated without TXA. The 28-day or in-hospital mortality was 17.8% for the TXA group, compared with 19.3% for the no-TXA group (OR = 0.92; 95% CI: 0.83, 1.01; p = 0.08). At 6-months follow-up, mortality was 18.3% vs 19.9% (OR = 0.91; 95% CI: 0.63–1.31; p = 0.60), with and without TXA, respectively. A Glasgow Outcome Scale less than 4 points at 28-days follow-up was reported in 3 studies and was 29.8% vs 34.8% (OR = 0.91; 95% CI: 0.45, 1.82; p = 0.78), with and without TXA, respectively. No differences were found in adverse events between TXA and non-TXA groups. CONCLUSION: Our analysis found showed no statistical significance between TXA and non-TXA treatment of TBI patients, however, in the TXA group a trend to decrease 28-day mortality compared to non-TXA treatment was observed. More high-quality studies are needed to show the significant benefit of using TXA, especially in moderate and severe TBI patient groups.