BackgroundNumerous stroke severity scales have been published, but few have been studied with emergency medical services (EMS) in the prehospital setting. We studied the Vision, Aphasia, Neglect (VAN) stroke assessment scale in the prehospital setting for its simplicity to both teach and perform. This prospective prehospital cohort study was designed to validate the use and efficacy of VAN within our stroke systems of care, which includes multiple comprehensive stroke centers (CSCs) and EMS agencies.MethodsThe performances of VAN and the National Institutes of Health Stroke Scale (NIHSS) ≥6 for the presence of both emergent large vessel occlusion (ELVO) alone and ELVO or any intracranial hemorrhage (ICH) combined were reported with positive predictive value, sensitivity, negative predictive value, specificity, and overall accuracy. For subjects with intraparenchymal hemorrhage, volume was calculated based on the ABC/2 formula and the presence of intraventricular hemorrhage was recorded.ResultsBoth VAN and NIHSS ≥6 were significantly associated with ELVO alone and with ELVO or any ICH combined using χ2 analysis. Overall, hospital NIHSS ≥6 performed better than prehospital VAN based on statistical measures. Of the 34 cases of intraparenchymal hemorrhage, mean±SD hemorrhage volumes were 2.5±4.0 mL for the five VAN-negative cases and 17.5±14.2 mL for the 29 VAN-positive cases.ConclusionsOur VAN study adds to the published evidence that prehospital EMS scales can be effectively taught and implemented in stroke systems with multiple EMS agencies and CSCs. In addition to ELVO, prehospital scales such as VAN may also serve as an effective ICH bypass tool.

Objective: Schizophrenia, a neuropsychiatric disorder, is known to be neurodevelopmentally progressive. Due to the extensive interindividual variability found in the responses of patients, management of schizophrenia has proven to be challenging. This interindividual variability to treatment could be justified by the variation of the enzymes in charge of metabolizing medications, especially those associated with cytochrome P450. Since genetic factors influence the phenotypic responses to drugs, researchers are involved in identifying schizophrenic genetic factors, which could impact responses and severe effects for commonly known neuroleptic drugs known as pharmacogenetics. In order to predict drug response at the personal level, genetic variants that determine drug effects need to be identified. Methods:We have chosen to investigate gene targets for risperidone and clozapine, two commonly administered drugs for the treatment of schizophrenia. The aim of this review is to contribute in the understanding of genetic influences on drug responses of risperidone and clozapine in schizophrenia. We reviewed original primary research articles, meta-analysis, and review publications on drug and gene interaction on the treatment of schizophrenia. Our main findings focused on schizophrenia, pharmacogenetics and cytochrome P450. Results and conclusion:After filtering our results to human species and English language, a total of 45 scientific articles were used for this review. A promising direction for future research in schizophrenia treatment lies behind the identification of the specific genetic contributors that affect drug response.

Hypothesis: Hospital presentation for acute stroke may have been delayed during COVID-19. We hypothesize that stroke patients with mild symptoms (NIHSS <= 5) were more likely to present in a delayed fashion during the early days of the pandemic. Methods: Get with The Guidelines Stroke registry was used to identify stroke patients that presented between January 1 and August 31, 2020 to the University Hospital in San Antonio, Texas. The cohort was stratified by date of presentation (before COVID: Jan 1 - Mar 15; during COVID: Mar 16 - Aug 31) and presenting NIHSS (<=5 versus >5). We then analyzed by the thrombolytic exclusion criteria delay to arrival and the time interval of stroke symptoms discovery to hospital presentation. Subgroup analysis included age, sex, and ethnicity; race was excluded due to 90% Caucasian cohort. Results: A total of 294 subjects were included of which 115 were before and 179 were during COVID. There were no significant differences in the demographics for these two time periods, although a trend for greater male presentation was seen during COVID (Table 1). After both groups were dichotomized by NIHSS <=5, stroke symptoms discovery to hospital arrival and delay to arrival (Table 2) were not significantly different across subgroups. Conclusions: Regardless of NIHSS, a significant time delay in acute stroke presentation to our hospital was not seen when comparing before and during COVID. Although our study included a large Hispanic population, the cohort was primarily Caucasian; and therefore, the results have limited application. Whether men were more likely than women to present with stroke during COVID is unclear but warrants further study with a larger sample size.