Objective Altered consciousness during focal seizures adversely affects patients’ quality of life, yet patients’ memory of ictal events remains underexplored. Methods We prospectively assessed 114 focal seizures from 48 patients undergoing video-EEG monitoring between 2018 and 2024. Consciousness and ictal memory were evaluated using the Consciousness Seizure Scale, Ictal Consciousness Inventory, and Seizure Perception Survey. Clinical and electrographic variables, including epileptogenic zone, lateralization, and sleep-wake state, were analyzed. Results Ictal memory was preserved in 52.5% of seizures, with 70% of these occurring despite impaired consciousness. Aura recall strongly correlated with preserved ictal memory (p = 0.0001). Seizures originating from the left frontal lobe and during wakefulness were associated with memory preservation, whereas seizures in temporal lobe epilepsy (TLE) and sleep-related seizures were linked to ictal amnesia. Conclusions Assessment of ictal memory provides valuable clinical insights beyond responsiveness measures and may improve patient confidence and seizure characterization in focal epilepsy.
No evidences have been reported on the clinical benefits of prolonged infusion (PI) of β-lactams in febrile neutropenic patients (FNP) with Enterobacterales bacteremia (EB). A prospective observational multicenter study was conducted in 9 referral academic centers in Argentina between February 2019 and December 2024. The first episodes of EB in high-risk FNP who received appropriate empirical treatment (AET) with piperacillin-tazobactam (PT), cefepime (C), or meropenem (M) were included. Clinical, epidemiological, and outcome variables were compared in patients receiving either standard infusion (SI) or PI AET. A propensity score (PS) to balance baseline covariates was used. Adjusted conditional multivariate logistic regression analysis to PS was used to identify independent risk factors for 30-day mortality. 201 patients were included (116 SI and 85 PI). Median age was 49 years (IQR: 35-63), and the most common underlying diseases were acute leukemia (61.69%) and lymphoma (18.91%). The microorganisms most frequently observed in both groups were E. coli (58.71%) and Klebsiella spp. (32.84%). Bacteremia presented with a clinical source in 58.82% of PI cases vs. 55.17% of SI cases, p = 0.60. Hypotension and shock were present in PI vs. SI in 28.4% vs. 25%, p=0.60, and 17.65% vs. 14.66%, p=0.56, respectively. Intensive care unit admission and multiorgan failure occurred in PI vs. SI: 18.82% vs. 12.07%, p = 0.56, and 16.47% vs. 11.21%, p = 0.28, respectively. Seven-day clinical response between IP and IB was 90.59% vs. 93.10%, p = 0.51. Thirty-day overall mortality and EB-related mortality were 14.12% vs. 10.34% (p = 0.41) and 8.24% vs. 3.45% (p = 0.20) for PI and SI, respectively. Septic shock was the risk factor associated with 30-day mortality (OR: 11.65, 95% CI, 3.66-36.91, p < 0.001), while 7-day clinical response was a protective factor for survival (OR: 0.06, 95% CI, 0.01-0.24, p < 0.001). PI did not correlate with impact on mortality (OR: 1.78, 95% CI: 0.54-5.79, p = 0.34). In our high-risk FNP cohort with EB, AET with PI did not improve outcomes. However, randomized trials are needed to confirm the study findings. Alberto Carena, n/a, Roche Diagnostics: Medical affairs lead
Post-traumatic aortic pseudoaneurysm is a rare but potentially life-threatening condition that may present years after the initial injury. Management can be particularly challenging when the lesion is located adjacent to major visceral arterial branches. We report the case of a late-presenting abdominal aortic pseudoaneurysm secondary to a gunshot wound, successfully treated using a percutaneous endovascular approach. This case highlights the role of multimodality cardiovascular imaging in the diagnosis, procedural planning, and treatment of complex vascular lesions.
INTRODUCTION:Patients discharged with a diagnosis of acute coronary syndrome (ACS) are at increased risk for recurrent cardiovascular events. Improved adherence to treatment has been associated with better outcomes. The objective of this study was to evaluate the effect of an educational intervention on medication adherence in patients following ACS. MATERIALS AND METHODS:A single-center, randomized, open-label, controlled clinical trial with parallel groups and a six-month follow-up. RESULTS:Sixty-three patients were randomized to the mixed educational intervention group and sixty-nine to the control group. Baseline characteristics were similar between groups: 82.6% were male, with a median age of 56 years (IQR 51-61), 73.5% had completed primary education. Mean ejection fraction (EF) was 47.7% (SD 12.33). Most patients were discharged with more than four medications, with a median of seven (IQR 6.0-8.0) tablets per day. At one month, adherence was 80.0% in the intervention group and 66.2% in the control group (RR 1.21; 95% CI 0.97-1.50; p = 0.12). At three months, adherence was 79.7% vs. 77.4% (RR 1.03; 95% CI 0.85-1.24; p = 0.94), and at six months -the primary endpoint- 73.3% vs. 71.9% (RR 1.02; 95% CI 0.82-1.27; p = 1.00). No significant differences were observed between groups in the occurrence of clinical events. CONCLUSION:The educational intervention was well accepted and feasible to implement, but it did not result in improved medication adherence or a reduction in clinical events over the medium term.
Tyrosine kinase inhibitors (TKIs) have transformed chronic myeloid leukemia (CML) into a manageable disease, and discontinuation has become a feasible goal for many patients. However, molecular relapse after TKI cessation remains a challenge. This study investigated factors influencing molecular relapse-free survival (MRFS) in a real-world cohort of CML patients undergoing TKI discontinuation, focusing on clinical, molecular, and immune-related variables. Traditional prognostic tools, such as the Sokal score, showed limited capacity to predict relapse risk in this context. Instead, total treatment duration and depth of molecular response emerged as critical predictors, with longer therapy and deeper remission associated with improved outcomes. A key novel finding was the prognostic relevance of cytokine profiles, particularly interleukin-6 (IL-6) and monocyte chemoattractant protein-1 (MCP-1). These cytokines were strong predictors of relapse in a decision tree model that achieved high specificity and positive predictive value in an independent validation cohort. Notably, lower IL-6 and MCP-1 levels were associated with increased relapse risk, suggesting reduced immune surveillance may contribute to recurrence. Integrating cytokine signatures with molecular markers improved prognostic accuracy, supporting immune biomarkers as complements to established clinical parameters. These findings underscore the complexity of relapse mechanisms and the need for individualized risk assessment when considering TKI discontinuation.
