LAVADOS GERMAIN, PABLO MANUEL
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LAVADOS GERMAIN, PABLO MANUEL
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p.lavados@udd.cl
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57188955599

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Regional variation in acute stroke care organisation

2016 , MUÑOZ VENTURELLI, PAULA ANDREA , Thompson Robinson , LAVADOS GERMAIN, PABLO MANUEL , OLAVARRIA IANISZEWSKY, VERONICA VIVIANA , Hisatomi Arima , Laurent Billot , Maree L. Hackett , Joyce Y. Lim , Sandy Middleton , Octavio Pontes-Neto , Bin Peng , Liying Cui , Lily Song , Gillian Mead , Caroline Watkins , Ruey-Tay Lin , Tsong-Hai Lee , Jeyaraj Pandian , H. Asita de Silva , Craig S. Anderson

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Cluster-Randomized, Crossover Trial of Head Positioning in Acute Stroke

2017 , Craig S. Anderson , Hisatomi Arima , LAVADOS GERMAIN, PABLO MANUEL , Laurent Billot , Maree L. Hackett , OLAVARRIA IANISZEWSKY, VERONICA VIVIANA , MUÑOZ VENTURELLI, PAULA ANDREA , BRUNSER RABOVICH, ALEJANDRO MICHEL , Bin Peng , Liying Cui , Lily Song , Kris Rogers , Sandy Middleton , Joyce Y. Lim , Denise Forshaw , C. Elizabeth Lightbody , Mark Woodward , Octavio Pontes-Neto , H. Asita De Silva , Ruey-Tay Lin , Tsong-Hai Lee , Jeyaraj D. Pandian , Gillian E. Mead , Thompson Robinson , Caroline Watkins

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Disparities in Stroke Incidence Over Time by Sex and Age in Latin America and the Caribbean Region 1997 to 2021: A Systematic Review and Meta‐Analysis

2023 , Marilaura Nuñez , Carlos Delfino , Claudia Asenjo‐Lobos , SCHILLING REDLICH, ANDREA INGRID , LAVADOS GERMAIN, PABLO MANUEL , Craig S. Anderson , MUÑOZ VENTURELLI, PAULA ANDREA

Background High‐income country studies show unfavorable trends in stroke incidence (SI) in younger populations. We aimed to estimate temporal change in SI disaggregated by age and sex in Latin America and the Caribbean region. Methods and Results A search strategy was used in MEDLINE, WOS, and LILACS databases from 1997 to 2021, including prospective population‐based observational studies with first‐ever stroke incidence in Latin America. Reports without data broken down by age and sex were excluded. Risk of bias was assessed with The Joanna Briggs Institute's guide. The main outcomes were incidence rate ratio and relative temporal trend ratio of SI, comparing time periods before 2010 with after 2010. Pooled relative temporal trend ratios considering only studies with 2 periods in the same population were calculated by random‐effects meta‐analysis. Meta‐regression analysis was used to evaluate incidence rate determinants. From 9242 records identified, 6 studies were selected including 4483 first‐ever stroke in 4 101 084 individuals. Crude incidence rate ratio in younger subjects (<55 years) comparing before 2010:after 2010 periods showed an increase in SI in the past decade (incidence rate ratio, 1.37 [95% CI, 1.23–1.50]), in contrast to a decrease in older people during the same period (incidence rate ratio, 0.83 [95% CI, 0.76–0.89]). Overall relative temporal trend ratio (<55:≥55 years) was 1.65 (95 CI%, 1.50–1.80), with higher increase in young women (pooled relative temporal trend ratio, 3.08 [95% CI, 1.18–4.97]; P for heterogeneity <0.001). Conclusions An unfavorable change in SI in young people, especially in women, was detected in population‐based studies in the past decade in Latin America and the Caribbean. Further investigation of the explanatory variables is required to ameliorate stroke prevention and inform local decision‐makers. Registration URL: https://www.crd.york.ac.uk/prospero/ Identifier: CRD42022332563.

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Frequency, determinants, and effects of early seizures after thrombolysis for acute ischemic stroke: The ENCHANTED trial

2017 , Ying Xu , Maree L. Hackett , John Chalmers , Richard I. Lindley , Xia Wang , Qiang Li , Thompson Robinson , Hisatomi Arima , LAVADOS GERMAIN, PABLO MANUEL , Craig S. Anderson

AbstractBackground:Seizures after ischemic stroke have not been well-studied. We aim to determine the frequency, determinants, and significance of early seizures after thrombolysis for acute ischemic stroke.Methods:Data are from the Enhanced Control of Hypertension and Thrombolysis Stroke Study (ENCHANTED), an international, multicenter, randomized controlled trial where patients with acute ischemic stroke were randomized to low-dose (0.6 mg/kg) or standard-dose (0.9 mg/kg) IV alteplase. The protocol prespecified prospective data collection on in-hospital seizures over 7 days postrandomization. Logistic regression models were used to determine variables associated with seizures and their significance on poor outcomes of death or disability (modified Rankin scale scores 3–6), symptomatic intracerebral hemorrhage (sICH), and European Quality of Life 5-Dimensions questionnaire [EQ-5D] over 90 days.Results:Data were available for 3,139 acute ischemic stroke participants, of whom 42 (1.3%) had seizures at a median 22.7 hours after the onset of symptoms. Baseline variables associated with seizures were male sex (odds ratio [OR] 2.19, 95% confidence interval [CI] 1.07–4.50), severe neurologic impairment (NIH Stroke Scale score ≥10; OR 2.16, 95% CI 1.06–4.40), and fever (OR 4.55, 95% CI 2.37–8.71). Seizures independently predicted poor recovery: death or major disability (OR 2.88, 95% CI 1.28–6.47), unfavorable ordinal shift of mRS scores (OR 1.94, 95% CI 1.10–3.39), and lower than median EQ-5D health utility index score (OR 3.50, 95% CI 1.37–8.91). There was no association of seizures with sICH in adjusted analysis.Conclusions:In thrombolysis-treated patients with acute ischemic stroke, seizures are uncommon, occur early, and predict poor recovery.Clinicaltrials.gov identifier:NCT01422616.

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Significance of Hematoma Shape and Density in Intracerebral Hemorrhage The Intensive Blood Pressure Reduction in Acute Intracerebral Hemorrhage Trial Study

2016 , Candice Delcourt , Shihong Zhang , Hisatomi Arima , Shoichiro Sato , Rustam Al-Shahi Salman , Xia Wang , Leo Davies , Christian Stapf , Thompson Robinson , LAVADOS GERMAIN, PABLO MANUEL , John Chalmers , Emma Heeley , Ming Liu , Richard I. Lindley , Craig S. Anderson

Background and Purpose— In patients with acute intracerebral hemorrhage (ICH), the shape and density of the hematoma are associated with its subsequent growth, but the impact of these parameters on clinical outcome is uncertain. Methods— Baseline computed tomographic scans and clinical data were obtained in the Intensive Blood Pressure Reduction in Acute Intracerebral Hemorrhage Trial (INTERACT2). Three independent neurologists blind to clinical data assessed ICH for shape and density using a previously described scale. Shape was defined as irregular when the ICH had ≥2 extra lesions added to the ellipsoid-shaped ICH. Density was heterogeneous when there were ≥3 low-density lesions within the ICH. Outcome measures were death and major disability (modified Rankin scale score of 3–5), combined and separate at 90-day postrandomization. Multivariable logistic regression models were used to determine the significance of hematoma characteristics on outcome. Results— There were 2066 patient computed tomographic scans included in the analysis, with 46% and 38% having irregular and heterogeneous ICH, respectively. Irregular shape was independently associated with death/major disability (adjusted odds ratio, 1.60; 95% confidence interval [CI], 1.29–1.98) and major disability alone (adjusted odds ratio, 1.60; 95% CI, 1.31–1.95), but not with death alone (adjusted odds ratio, 0.97; 95% CI, 0.68–1.39). Heterogeneous density was not associated with clinical outcomes (adjusted odds ratio, 1.06; 95% CI, 0.85–1.33), 1.04 (95% CI, 0.73–1.48), and 1.14 (95% CI, 0.93–1.39), respectively, for death/major disability, death alone, and disability alone). Conclusions— Irregular shape, but not heterogeneous density, is independently associated with poor outcome after ICH. Clinical Trial Registration— URL: http://www.clinicaltrials.gov . Unique identifier: NCT00716079.

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Positive impact of the participation in the ENCHANTED trial in reducing Door-to-Needle Time

2017 , Jie Yang , Xia Wang , Jian ping Yu , Jing Hang , LAVADOS GERMAIN, PABLO MANUEL , Thompson Robinson , Hisatomi Arima , Richard I. Lindley , Craig S. Anderson , John Chalmers

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Clinical Prediction Algorithm (BRAIN) to Determine Risk of Hematoma Growth in Acute Intracerebral Hemorrhage

2015 , Xia Wang , Hisatomi Arima , Rustam Al-Shahi Salman , Mark Woodward , Emma Heeley , Christian Stapf , LAVADOS GERMAIN, PABLO MANUEL , Thompson Robinson , Yining Huang , Jiguang Wang , Candice Delcourt , Craig S. Anderson

Background and Purpose— We developed and validated a simple algorithm to predict the risk of hematoma growth in acute spontaneous intracerebral hemorrhage (ICH) to better inform clinicians and researchers in their efforts to improve outcomes for patients. Methods— We analyzed data from the computed tomography substudies of the pilot and main phases of the Intensive Blood Pressure Reduction in Acute Cerebral Hemorrhage Trials (INTERACT1 and 2, respectively). The study group was divided into a derivation cohort (INTERACT2, n=964) and a validation cohort (INTERACT1, n=346). Multivariable logistic regression was used to identify factors associated with clinically significant (≥6 mL) increase in hematoma volume at 24 hours after symptom onset. A parsimonious risk score was developed on the basis of regression coefficients derived from the logistic model. Results— A 24-point BRAIN score was derived from INTERACT2 (C-statistic, 0.73) based on baseline ICH volume (mL per score, ≤10=0, 10–20=5, >20=7), recurrent ICH (yes=4), anticoagulation with warfarin at symptom onset (yes=6), intraventricular extension (yes=2), and number of hours to baseline computed tomography from symptom onset (≤1=5, 1–2=4, 2–3=3, 3–4=2, 4–5=1, >5=0) predicted the probability of ICH growth (ranging from 3.4% for 0 point to 85.8% for 24 points) with good discrimination (C-statistic, 0.73) and calibration (Hosmer–Lemeshow P =0.82) in INTERACT1. Conclusions— The simple BRAIN score predicts the probability of hematoma growth in ICH. This could be used to improve risk stratification for research and clinical practice. Clinical Trial Registration— URL: http://www.clinicaltrials.gov . Unique identifier: NCT00226096 and NCT00716079.

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Low Ambient Temperature and Intracerebral Hemorrhage: The INTERACT2 Study

2016 , Danni Zheng , Hisatomi Arima , Shoichiro Sato , Antonio Gasparrini , Emma Heeley , Candice Delcourt , Serigne Lo , Yining Huang , Jiguang Wang , Christian Stapf , Thompson Robinson , Pablo Lavados , John Chalmers , Craig S. Anderson , Xiaoying Wang

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Low blood pressure and adverse outcomes in acute stroke: HeadPoST study explanations

2020 , Menglu Ouyang , MUÑOZ VENTURELLI, PAULA ANDREA , Laurent Billot , Xia Wang , Lili Song , Hisatomi Arima , LAVADOS GERMAIN, PABLO MANUEL , Maree L. Hackett , OLAVARRIA IANISZEWSKY, VERONICA VIVIANA , BRUNSER, ALEJANDRO , Sandy Middleton , Octavio M. Pontes-Neto , Tsong-Hai Lee , Caroline L. Watkins , Thompson Robinson , Craig S. Anderson

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Intensive Care Unit Admission for Patients in the INTERACT2 ICH Blood Pressure Treatment Trial: Characteristics, Predictors, and Outcomes

2017 , Katja E. Wartenberg , Xia Wang , MUÑOZ VENTURELLI, PAULA ANDREA , Alejandro A. Rabinstein , LAVADOS GERMAIN, PABLO MANUEL , Craig S. Anderson , Thompson Robinson

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