Vahed Maroufy’s research while affiliated with The University of Texas Health Science Center at Houston and other places

Objective: To investigate the post-ICH association between the hematoma coagulation and an increase in surrounding perihematomal edema (PHE) volume using serial non-invasive MRI in patients with acute hemorrhagic stroke. Introduction: PHE is excessive fluid accumulation encompassing brain swelling, elevated intracranial pressure (ICP), tissue herniation, and midline shift. Typical treatment strategies include decompressive hemicraniectomy and hyperosmolar therapy. Post-ICH release of lysed blood products and other neurotoxins has been associated with PHE growth. However, very little is known about the role of hematoma coagulation in PHE growth. Here, using a recently developed imaging marker of cerebral coagulation, we investigated the relation between the clotted blood volume within hematoma and PHE development. Methods: In this retrospective serial MRI image analysis, twenty-four patients with acute spontaneous ICH were imaged 3 times within 12-24 (V1), 36-48 (V2), and 60-72(V3) hours of last seen well (LSW) on a 3T MRI system. 3D anatomical (FLAIR, T1W), multi gradient echo (mGRE), and diffusion tensor (DTI) images were acquired. Using FLAIR images, hematoma and PHE volumes (HV, EV) were segmented and applied as a region of interest (ROI). Quantitative Susceptibility Maps (QSM) and Mean Diffusivity (MD) maps were created using mGRE and DTI images. The HV voxel with susceptibility less and greater than 0.5ppm were categorized as liquid and clotted blood voxel respectively. The clotted blood volume (CBV) was associated with HV, EV, NIHSS, and MD. A non-linear regression model was used for statistical analysis. Results: We enrolled 14M/10F, with an average age of 65.8±12y diagnosed with mild spontaneous ICH. Temporally, between the V1 and V3 imaging, the EV (22.9±12.3 to 31.4±19 mL; P<0.05) and CBV (3.36±3.3 to 5.58±4.8 mL; P< 0.05) significantly increased. A significant increase (R=0.42, P = 0.08 to R = 0.80, P < 0.05) positive correlation between EV and CBV was recorded. A positive (P < 0.05) association was also observed between EV and HV whereas no association among MD, NIHSS, and CBV was recorded at any time. These results are summarized in Figure 1. Conclusion: Here, we showed hematoma coagulopathy plays a significant role in perihematomal growth in patients with acute ICH. We speculate that the presence of non-coagulated and coagulated blood within the hematoma increases the risk of hematoma and PHE expansion respectively.

Aims: This study sought to examine how perceived social support changes over time for U.S. veterans and how social support relates to their mental health longitudinally. Methods: Data from a nationally representative sample of 783 low-income U.S. veterans in 2021-2023 were analyzed to examine changes and correlates of four different types of social support (Emotional/Informational Support, Tangible Support, Affectionate Support and Positive Social Interaction) over 1 year. Weighted logistic mixed models were conducted. Results: The majority of veterans reported no change in their level of perceived social support, but about 18%-26% reported either an increase or decrease (about evenly split about increase/decrease) in their perceived level of one of the four types of social support. High levels of the four types of social support were associated with being married and a lower likelihood of screening positive for depression. Other differential associations were found between sociodemographic characteristics and some types of social support. Conclusion: These findings confirm the value of assessing perceived social support among veterans with low socioeconomic status who may have mental health issues.

To provide a comprehensive examination of different types of social support and associations with mental health among U.S. military veterans, a group vulnerable to psychosocial dysfunction. Using a nationally representative sample of 1,004 low-income U.S. veterans, this study examined the prevalence and mental health correlates of emotional, informational/tangible, positive social interaction, and affectionate social support. In the sample, 49–60% of participants perceived the four types of social support “most of the time” with the lowest prevalence being positive social interaction and the highest being affectionate support. Multivariable analyses found higher levels of all four types of social support were significantly associated with being married and greater mental health functioning. Some types of social support were uniquely associated with income level and positive screens for specific psychiatric disorders. Low social support is common among low-income U.S. veterans, and there is a need for community health interventions that target different types of social support to improve mental health and community integration.

Background The impact of rheumatic diseases (RDs) on the Quality of Life (QoL) of antenatal women remains underexplored. This study aimed to investigate health-related QoL among pregnant and breastfeeding women with RDs in comparison to their healthy counterparts, utilizing data from the COVAD-2 e-survey database. Objectives To assess health-related QoL using Patient-Reported Outcome Measurement Information System (PROMIS) instruments, focusing on Global Physical Health (GPH) and Global Mental Health (GMH) scores. Comparative analyses were conducted among four groups: 1) Non-pregnant/breastfeeding healthy, 2) Non-pregnant/breastfeeding RDs, 3) Pregnant/breastfeeding healthy, and 4) Pregnant/breastfeeding RDs. The study sought to identify factors influencing GPH and GMH scores within each group. Methods Demographic information, diagnosis of RDs, comorbidities, disease activity, and treatments were analyzed using data from the COVAD-2-e-survey database. GPH, and GMH scores were compared among the four groups, and multivariable regression analysis was employed to identify the factors affecting GPH and GMH scores within each group. Results After excluding missing values, our analysis encompassed 2931 cases across four groups: 1) Non-pregnant/breastfeeding healthy (1337 cases), 2) Non-pregnant/breastfeeding RDs (1459 cases), 3) Pregnant/breastfeeding healthy (77 cases), and 4) Pregnant/breastfeeding RDs (58 cases).The General Physical Health (GPH) median score peaked in the pregnant/breastfeeding healthy group (17 [10-20]), contrasting with the lowest score observed in Non-pregnant/breastfeeding RDs (14 [4-20]) (Figure 1). Among RD patients, pregnant/breastfeeding groups exhibited significantly higher GPH scores compared to non-pregnant/breastfeeding groups (p=0.01), an observation absent in healthy controls. Influencing factors in RDs included ethnicity, with Caucasians showing better scores than Asians (p=0.017), pregnant/breastfeeding status (p=0.002), concomitant comorbidities (p=0.041), and mental disorders (p=0.001). Similarly, the General Mental Health (GMH) median score was highest in the pregnant/breastfeeding healthy group (17 [4-20]) and lowest in Non-pregnant/breastfeeding RDs (15 [4-20]) (Figure 1). Pregnant/breastfeeding RDs groups exhibited significantly higher GMH scores than their non-pregnant/breastfeeding counterparts (p=0.003), a distinction not observed in healthy controls. Influencing factors in RDs included ethnicity, with Caucasians showing better scores than African Americans (p=0.000) or Asians (p=0.025), pregnant/breastfeeding status (p=0.001), and concomitant mental disorders (p=0.000). Conclusion Women with RDs exhibit better mental and physical QoL during the antenatal period than their non-pregnant/breastfeeding counterparts—a distinction not observed in healthy controls, possibly as disease is planned in safe periods or goes into remission during antenatal period and this is reassuring. Ethnicity, comorbidities, and mental disorders have a substantial impact on QoL in this demographic, calling for targeted healthcare interventions that acknowledge the unique features of women of childbearing age with RDs. Further, these observations call for long term prospective international studies to comprehensively address the aspects of QoL in this specific demographic, enabling the development of more informed and personalized healthcare strategies.REFERENCES: NIL. • Download figure • Open in new tab • Download powerpoint Figure 1. Comparison of Global Physical Health (GPH) scores and Global Mental Health (GMH) scores within four groups: 1) Non-pregnant/breastfeeding healthy, 2) Non-pregnant/breastfeeding RDs, 3) Pregnant/breastfeeding healthy, and 4) Pregnant/breastfeeding RDs. Acknowledgements NIL Disclosure of Interests None declared

Objectives To investigate health-related quality of life in patients with idiopathic inflammatory myopathies (IIMs) compared with those with non-IIM autoimmune rheumatic diseases (AIRDs), non-rheumatic autoimmune diseases (nrAIDs), and without autoimmune diseases (controls), using Patient-Reported Outcome Measurement Information System (PROMIS) instrument data obtained from the second COVID-19 vaccination in autoimmune disease (COVAD-2) e-survey database. Methods Demographics, diagnosis, comorbidities, disease activity, treatments, and PROMIS instrument data were analysed. Primary outcomes were PROMIS Global Physical Health (GPH) and Global Mental Health (GMH) scores. Factors affecting GPH and GMH scores in IIMs were identified using multivariable regression analysis. Results We analysed responses from 1582 IIMs, 4700 non-IIM AIRDs, 545 nrAIDs, and 3675 controls gathered until May 23, 2022. GPH median (IQR) scores were the lowest in IIMs and non-IIM AIRDs (13 [10–15] IIMs vs.s 13 [11–15] non-IIM AIRDs vs.s 15 [13–17] nrAIDs vs.s 17 [15–18] controls, p < 0.001). GMH median (IQR) scores in IIMs were also significantly lower compared with those without autoimmune diseases (13 [10–15] IIMs vs.s 15 [13–17] controls, p < 0.001). Inclusion body myositis, comorbidities, active disease, and glucocorticoid use were the determinants of lower GPH scores, whereas overlap myositis, interstitial lung disease, depression, active disease, lower PROMIS Physical Function-10a, and higher PROMIS Fatigue-4a scores were associated with lower GMH scores in IIMs. Conclusion Both physical and mental health are significantly impaired in IIMs, particularly in those with comorbidities and increased fatigue, emphasizing the importance of patient-reported experiences and optimized multidisciplinary care to enhance well-being in people with IIMs.

Deep intracerebral hemorrhage (ICH) exerts a direct force on corticospinal tracts (CST) causing shape deformation. Using serial MRI, Generalized Procrustes Analysis (GPA), and Principal Components Analysis (PCA), we temporally evaluated the change in CST shape. Thirty-five deep ICH patients with ipsilesional-CST deformation were serially imaged on a 3T-MRI with a median imaging time of day-2 and 84 of onset. Anatomical and diffusion tensor images (DTI) were acquired. Using DTI color-coded maps, 15 landmarks were drawn on each CST and the centroids were computed in 3 dimensions. The contralesional-CST landmarks were used as a reference. The GPA outlined the shape coordinates and we superimposed the ipsilesional-CST shape at the two-time points. A multivariate PCA was applied to identify eigenvectors associated with the highest percentile of change. The first three principal components representing CST deformation along the left-right (PC1), anterior-posterior (PC2), and superior-inferior (PC3) respectively were responsible for 57.9% of shape variance. The PC1 (36.1%, p < 0.0001) and PC3 (9.58%, p < 0.01) showed a significant deformation between the two-time points. Compared to the contralesional-CST, the ipsilesional PC scores were significantly (p < 0.0001) different only at the first-timepoint. A significant positive association between the ipsilesional-CST deformation and hematoma volume was observed. We present a novel method to quantify CST deformation caused by ICH. Deformation most often occurs in left-right axis (PC1) and superior-inferior (PC3) directions. As compared to the reference, the significant temporal difference at the first time point suggests CST restoration over time.

Background Comprehensive and large-scale assessment of health-related quality of life in patients with idiopathic inflammatory myopathies (IIMs) worldwide is lacking. The second COVID-19 vaccination in autoimmune disease (COVAD-2) study [1] is an international, multicentre, self-reported e-survey assessing several aspects of COVID-19 infection and vaccination as well as validated patient-reported outcome measures (PROMs) to outline patient experience in various autoimmune diseases (AIDs), with a particular focus on IIMs. Objectives To investigate physical and mental health in a global cohort of IIM patients compared to those with non-IIM autoimmune inflammatory rheumatic diseases (AIRDs), non-rheumatic AIDs (NRAIDs), and those without AIDs (controls), using Patient-Reported Outcome Measurement Information System (PROMIS) global health data obtained from the COVAD-2 survey. Methods Demographics, AID diagnoses, comorbidities, disease activity, treatments, and PROMs were extracted from the COVAD-2 database. The primary outcomes were PROMIS Global Physical Health (GPH) and Global Mental Health (GMH) scores. Secondary outcomes included PROMIS physical function short form-10a (PROMIS PF-10a), pain visual analogue scale (VAS), and PROMIS Fatigue-4a scores. Each outcome was compared between IIMs, non-IIM AIRDs, NRAIDs, and controls. Factors affecting GPH and GMH scores in IIMs were identified using multivariable regression analysis. Results A total of 10,502 complete responses from 1582 IIMs, 4700 non-IIM AIRDs, 545 NRAIDs, and 3675 controls, which accrued as of May 2022, were analysed. Patients with IIMs were older [59±14 (IIMs) vs. 48±14 (non-IIM AIRDs) vs. 45±14 (NRAIDs) vs. 40±14 (controls) years, p<0.001] and more likely to be Caucasian [82.7% (IIMs) vs. 53.2% (non-IIM AIRDs) vs. 62.4% (NRAIDs) vs. 34.5% (controls), p<0.001]. Among IIMs, dermatomyositis (DM) and juvenile DM were the most common (31.4%), followed by inclusion body myositis (IBM) (24.9%). Patients with IIMs were more likely to have comorbidities [68.1% (IIMs) vs. 45.7% (non-IIM AIRDs) vs. 45.1% (NRAIDs) vs. 26.3% (controls), p<0.001] including mental disorders [33.4% (IIMs) vs. 28.2% (non-IIM AIRDs) vs. 28.4% (NRAIDs) vs. 17.9% (controls), p<0.001]. GPH median scores were lower in IIMs compared to NRAIDs or controls [13 (interquartile range 10–15) IIMs vs. 13 (11–15) non-IIM AIRDs vs. 15 (13–17) NRAIDs vs. 17 (15–18) controls, p<0.001] and PROMIS PF-10a median scores were the lowest in IIMs [34 (25–43) IIMs vs. 40 (34–46) non-IIM AIRDs vs. 47 (40–50) NRAIDs vs. 49 (45–50) controls, p<0.001]. GMH median scores were lower in AIDs including IIMs compared to controls [13 (10–15) IIMs vs. 13 (10–15) non-IIM AIRDs vs. 13 (11–16) NRAIDs vs. 15 (13–17) controls, p<0.001]. Pain VAS median scores were higher in AIDs compared to controls [3 (1–5) IIMs vs. 4 (2–6) non-IIM AIRDs vs. 2 (0–4) NRAIDs vs. 0 (0–2) controls, p<0.001]. Of note, PROMIS Fatigue-4a median scores were the highest in IIMs [11 (8–14) IIMs vs. 8 (10–14) non-IIM AIRDs vs. 9 (7–13) NRAIDs vs. 7 (4–10) controls, p<0.001]. Multivariable regression analysis in IIMs identified older age, male sex, IBM, comorbidities including hypertension and diabetes, active disease, glucocorticoid use, increased pain and fatigue as the independent factors for lower GPH scores, whereas coexistence of interstitial lung disease, mental disorders including anxiety disorder and depression, active disease, increased pain and fatigue were the independent factors for lower GMH scores. Conclusion Both physical and mental health are significantly impaired in patients with IIMs compared to those with non-IIM AIDs or those without AIDs. Our results call for greater attention to patient-reported experience and comorbidities including mental disorders to provide targeted approaches and optimise global well-being in patients with IIMs. Reference [1]Fazal ZZ, Sen P, Joshi M, et al. COVAD survey 2 long-term outcomes: unmet need and protocol. Rheumatol Int. 2022;42:2151–58.