BACKGROUND AND OBJECTIVES:Previous antiplatelet therapy (APT) may influence outcomes in patients undergoing direct endovascular therapy (EVT) for anterior circulation large vessel occlusion (LVO) stroke, but evidence on clinical benefits and safety is limited and inconsistent. We aimed to evaluate the effects of previous APT on the outcomes of direct EVT. METHODS:We conducted a retrospective analysis of consecutive patients treated at 20 high-volume stroke centers across 9 European countries and Israel (EVA-TRISP registry, 2015-2023). We included adults with anterior circulation LVO strokes, without previous use of IV thrombolysis (IVT) or anticoagulants. We compared outcomes of direct EVT patients stratified by previous APT regimen, using propensity score matching based on medical history and multilevel models to address confounders. The primary outcome was the 90-day modified Rankin Scale (mRS) score. The secondary efficacy outcomes were 90-day independence and the rate of successful reperfusion. The secondary safety outcomes were the rate of symptomatic intracranial hemorrhage (sICH) and mortality. RESULTS:Among 12,950 patients, 2,611 met the criteria and 1,308 were matched: 480 without previous APT and 828 with any previous APT, among whom 764 were on single APT and 64 on dual APT. The overall mean age was 75.8 ± 11.4 years, and 49.4% were female; the mean NIH Stroke Scale score was 13.1 ± 7.2 points, the successful reperfusion rate was 74.7%, and the median mRS score was 3 (interquartile range 2-4), with 38.8% of patients independent at 90 days. When compared with no previous APT, any previous APT was associated with a shift toward lower mRS scores at 90 days (odds ratio [OR] 1.30, CI 1.04-1.61, p = 0.018). Independence at 90 days was associated with any previous APT (OR 1.62, CI 1.22-2.16, p = 0.001). Any previous APT was not associated with successful reperfusion (OR 0.96, CI 0.69-1.35, p = 0.821), sICH (OR 1.06, CI 0.47-2.39, p = 0.880), or mortality (OR 0.89, CI 0.66-1.21, p = 0.821). There was no significant interaction between any previous APT and proximal/distal occlusion location (p = 0.213) or time-to-groin earlier/later than 6 hours (p = 0.743). DISCUSSION:In patients with anterior circulation LVO stroke treated with direct EVT and no previous anticoagulation, pretreatment with any APT was independently linked to better 90-day functional outcomes and higher independence, without increasing sICH risk. CLASSIFICATION OF EVIDENCE:This study provides Class III evidence that, in patients with anterior circulation LVO stroke treated with direct EVT, previous APT is associated with better 90-day functional outcomes compared with no previous APT.
Abstract Introduction Primary aldosteronism (PA) is the most frequent secondary hypertension wich can lead to increased occurrence of cardiovascular, renal and central nervous system complications. Subjects with PA due to aldosterone-producing adenoma (APA) are diagnosed mostly due to clinical picture of hypokalaemia and hypertension. Materials and Methods The study group of PA included 40 patients (25 females, 15 males). The study groups (CS n = 20; A+HT n = 40) did not differ by age and sex. Standardized endocrinological testing for the diagnosis confirmation was done. The aim of this study was analyze clinical characteristics of the PA due to adenoma (PA) and to compare the frequency of many cardiovascular, renal and cerebrovascular events with those found in adrenal Cushing syndrome (CS) and adrenal tumour associated with essential hypertension (A+HT). Results There was no significant difference between groups related to the age, nor sex distribution, although a higher number of women in all groups was recorded (P = .099). Systolic and diastolic blood pressures were significantly higher in PA group (P = .005 and P = .002 respectivaly), with the lowest levels in NFA+HT group. The significanteley higher mean arterial pressure (MAP) was also found in PA group (P = .001). The longest hypertension duration was recorded in the PA group, and was significantly longer (P = .001) than in CS+SCS group. PA patients had also the longest hypertension history (P = .01) and all had hypokalaemia. The smallest mean tumour diameter was found in PA group (P < .001). Atrial fibrillation is found to be twelve times more frequent in PA than in essential hypertension (EHT), but only patients older than 50 years have myocardial infarction 6.5 times and cerebrovascular infarction (CVI) 4.2 times independent of blood pressure and PA subtypes. Chronic renal failure was found in 20% of patients. Chronic renal failure was quite common in all three groups of hypertensive patients Conclusions It revealed that patients with aldosterone-producing adenoma have significantly higher systolic, diastolic and mean blood pressures compared to patients with nonfunctioning adrenal adenoma with hypertension. All patients with PA also had hypokalaemia, which aggravated organ damage or hypertensive emergencies.
Introduction. The aims of the study were to find out sex differences among patients starting regular hemodialysis (HD) in 2014 and to check whether these differences change over a five-year period. Methods. The retrospective five-year study included 35 patients (24 men; 11 women) starting HD in HD centers in Leskovac and Pirot in 2014. Demographic data, clinical data, laboratory findings, and medication used for examined patients were taken from medical records. Results. A comparison of patients of different sexes at the beginning of the study showed that women were significantly older (70.55 ± 13.27 vs. 58.88 ± 15.27 years), but diabetes and hypertension were more frequent causes of chronic kidney disease in men. Women had significantly lower body mass index and serum creatinine level than men in the first year of the study. During all five years, the HD adequacy index spKt/V was higher in women than in men, but the difference reached statistical significance only in the third year (1.4 ± 0.2 vs. 1.2 ± 0.2). Serum iPTH level was higher in women than in men in almost the entire study period. There was no significant sex difference in blood pressure, type of vascular access, number of HD hours per week, in the percentage of patients who used erythropoiesis-stimulating agents or phosphate binders. During the study period 10 (42.7%) men and five (45.5%) women died and the most frequent causes of death were cerebrovascular and cardiovascular diseases. Conclusion. The study revealed several differences between men and women on regular HD, but no treatment inequality was found.
Leberjeva hereditarna optična nevropatija (LHON) je redka dedna mitohondrijska bolezen, ki povzroča slepoto najpogosteje pri mladih odraslih. Navadno se izrazi kot subakutna, neboleča izguba vida na eno oko, ki ji sledi poslabšanje vida drugega očesa v nekaj tednih do mesecih. Bolezen večinoma pušča trajne posledice, le pri nekaterih bolnikih lahko v redkih primerih pride do delnega spontanega izboljšanja vida. Razmerje med moškimi in ženskimi bolniki se ocenjuje na 3 : 1. V zadnjih letih je z razvojem zdravilne učinkovine idebenone možno podporno farmakološko zdravljenje, ki lahko prispeva k delnemu izboljšanju vidne funkcije. Bolezen zaradi svoje redkosti velikokrat ostane ne- ali napačno diagnosticirana. V članku predstavljamo štiri klinične primere bolnikov, pri katerih se je po obsežnem in dolgotrajnem diagnosticiranju izkazalo, da imajo LHON. Od leta 1996 se v Sloveniji vodi baza bolnikov z redkimi dednimi očesnimi boleznimi. Na tej podlagi je ocenjena prevalenca LHON 1/72.000. Ob sumu na bolezen so ključni družinska anamneza slabovidnosti po materini strani, genetsko testiranje in napotitev na obravnavo ter zdravljenje v terciarno ustanovo.
Traumatic brain injury (TBI) is considered to be a "silent global epidemic" and is the leading cause of death in young males in developed countries, major cause of disability, morbidity, and mortality worldwide. The classification of TBI severity was performed using the Glasgow coma scale (GCS) into mild (GCS = 15-13), moderate (GCS = 12-9), and severe (GCS = 8-3). Despite developments in modern intensive care, improvements in resuscitation and vital organ support, the management of critically ill patients with traumatic brain injury presents a challenge to all members of the critical care team. Since severe head injury is often associated with poor functional outcomes due to secondary brain insults, the benefits of intensive treatment and care may not become apparent until months or years later during rehabilitation after injury. Due to the complexity and specificity of TBI, implementation of an easy-to-remember mnemonic can significantly help anesthesiologists and clinicians in conducting intensive therapy. Mnemonic GOST CAP was implementing to help with treatment of patients with primary craniocerebral trauma and prevention of secondary brain injury. GOST CAP acronym emphasizes the significance of glycemic control in neurotrauma, maintaining haemoglobin levels, oxygen support, sodium concentration, temperature maintenance, pain and agitation control, arterial blood pressure control in maintaining cerebral perfusion pressure, and partial pressure of CO2 control. The aim of this paper is to display acronyms that address the most important steps in treating patients with TBI.
