1. Clarify novel systemic and local inflammatory mechanisms underlying the cross talk between brain and heart ischemic states, 2. Investigate the new aspects of NAC beyond traditional therapy, in cerebral and myocardial ischemic conditions, both in animal models and clinical cases.
The study was conducted on 121 adult acute ischemic stroke patients admitted to stroke unit; either intermediate care or intensive care, of Kasr El Ainy Medical Hospital, Cairo University. Five patients were excluded as they didn't meet our eligibility criteria. Oral form of NAC was given. Patients were divided into 4 groups: * Group I (AIS-IHD): critically ill AIS patients who had past history and / or current evidence of IHD (30 patients), Without administration of NAC (as a control group). * Group II (AIS-IHD-NAC): critically ill AIS patients who had past history and / or current evidence of ischemic heart disease (IHD) (30 patients), With nasogastric or oral administration of NAC. * Group III (AIS-NON-IHD): critically ill AIS patients who had Neither past history Nor current evidence of IHD (27 patients), Without administration of NAC (as a control group). * Group IV (AIS-NON-IHD-NAC): critically ill AIS patients who had Neither past history Nor current evidence of IHD (29 patients), With nasogastric or oral administration of NAC.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
DOUBLE
Enrollment
121
* NAC was administered in a dose of 600 mg, every 8 hours, for 3 consecutive days, either through direct oral route, or indirectly through Ryle tube (in Ryle-feeding patients). * NAC was started shortly after hospital admission, following baseline assessment of patient. * NAC sachet form was used, so it was administrated as liquid oral solution, which was prepared from pure NAC powder, dissolved in water. * This recommended dose is within the approved therapeutic range (World Health Organization, 2021).
50 ml normal saline was administered either through direct oral route or through nasogastric tube in Ryle feeding patients.
Stroke Unit, Neurology Department, Kasr Al Ainy, Cairo University Hospital
Cairo, Egypt
Detect the effect of oral administration of NAC in critically ill acute ischemic stroke patients on the functional outcome.
This outcome was assessed by evaluation of Glasgow Coma Score, the minimum and the worst = 3, and the maximum and the best = 15. It depends on assessment of Eye opening, Verbal response, Motor response. Also, evaluation of Modified Rankin Scale, for measuring the degree of disability following stroke, the maximum and the worst = 6, the minimum and the best = 0. Furthermore, evaluation of National Institutes of Health Stroke Scale (NIHSS), the most widely used functional assessment score for stroke, the maximum and the worst = 42, and the minimum and the best = 0. It depends on assessment of various clinical aspects, e.g., consciousness, orientation, vision, gaze, fascial palsy, speech, motor power, coordination, and sensation.
Time frame: At admission (on day 1), after 3 days (on day 4), and at discharge from hospital (up to day 30).
Detect the effect of oral administration of NAC in critically ill acute ischemic stroke patients on the inflammatory storm and autophagy markers.
Inflammatory storm and autophagy markers were evaluated by measuring serum levels of C-Reactive Protein, Total Leucocytic Count, and LC3B, BECN1, respectively.
Time frame: At admission (on day 1) and after 3 days (on day 4).
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