Pulsus Group is a publisher of scientific, technical, and medical literature. It was formed in 1984, primarily to publish peer-reviewed medical journals. As of 2016, Pulsus published 49 hybrid and full open-access journals, 15 of which had been adopted as the official publications of the related medical societies. Pulsus Group also conducts conferences in association with scientific societies.OMICS Publishing Group, an open access publisher widely regarded as predatory, purchased Pulsus in 2016, causing controversy and putting the future of the journals into question. The company has been placed on Jeffrey Beall's list of "Potential, possible, or probable" predatory open-access publishers.
BACKGROUND:The use of balloon guide catheter (BGC) has been associated with better reperfusion and clinical outcomes in mechanical thrombectomy (MT) for large vessel occlusion stroke. However, the impact of BGC on angiographic and clinical outcomes in patients with distal medium vessel occlusion (DMVO) strokes undergoing MT has not been extensively investigated. METHODS:This is a retrospective analysis of a prospectively collected database from 14 comprehensive stroke centers in the United States and Europe. Patients with anterior circulation DMVO due to middle cerebral artery (MCA) M3/M4 or anterior cerebral artery (ACA) A1/A2-3 were included. The cohort was divided into BGC and non-BGC groups. Multivariable logistic regression and inverse probability of treatment weighting (IPTW) were used for comparison. The primary outcome was first pass effect (FPE) defined as modified treatment in cerebral infarction (mTICI) grade 2C/3 after single device pass. RESULTS:Among 199 patients who were eligible for analysis, 81 (40.7%) were female. The median age was 69 (60-81) years, and National Institutes of Health Stroke Scale score was 13 (7-18). The BGC group (n=73) had higher rates of FPE (53.4% vs 13.7%; IPTW aOR 5.63, 95%CI (2.43 to 13.10), P<0.001) compared with the non-BGC group (n=126). The BGC group had higher rates of modified Rankin Scale (mRS) 0-1 (42.9% vs 27.1%; IPTW aOR 2.78, 95% CI (1.10 to 7.07), P=0.031), mRS 0-2 (60.3% vs 41.5%; IPTW aOR 4.31, 95% CI (1.66 to 11.19), P=0.003), and lower rates of mortality at 90-days (12.7% vs 25.4%; IPTW aOR 0.32, 95% CI (0.11 to 0.98), P=0.047) compared with the non-BGC group. The rates of successful reperfusion at the end of the procedure and symptomatic intracerebral hemorrhage were comparable between both groups. CONCLUSION:The present study suggests that the use of BGC in DMVO undergoing MT may be associated with improved angiographic and clinical outcomes with no safety concerns. Prospective studies are warranted.
BACKGROUND:Craniotomy for subdural hematoma (SDH) in elderly patients with comorbidities can be challenging. The Subdural Evacuating Port System (SEPS; Medtronic, Minneapolis, MN) offers a less invasive alternative, while middle meningeal artery embolization (MMAE) has shown effectiveness in preventing SDH recurrence. We evaluated the combined effectiveness of SEPS+MMAE for chronic SDH (cSDH) treatment. METHODS:Retrospective database reviews were conducted. Demographic, comorbidity, procedural, and outcomes data were analyzed. cSDH resolution was tracked by measuring hematoma volumes on noncontrast computed tomograms pre-SEPS+MMAE, 24-48 hours post-SEPS+MMAE, and 6-8 weeks afterward (follow-up-SEPS+MMAE). RESULTS:Our study included 114 patients (median age: 77 years (interquartile range (IQR): 69-83 years); men: women=74:40) with 134 cSDHs treated with SEPS+MMAE were included. Median pre-SEPS+MMAE cSDH volume was 122.9 mL (88-152.4 mL) with midline shift of 6 mm (3.4-9.5 mm). Most MMAE procedures were performed under general anesthesia (68.7%), utilizing the femoral approach (61.9%) and particle embolic agents (55.2%). In-hospital rescue craniotomy was required after 10 (7.5%) procedures. Median post-SEPS+MMAE and follow-up-SEPS+MMAE cSDH volume reductions were 71.1 mL (54.1-94.8 mL) and 23.4 mL (2-56.3 mL), respectively, resulting in 38.1% (22.1-52.9%) and 79.9% (51-97.8%) reductions, respectively. Of 109 patients with follow-up, 10 (9.2%) were readmitted for cSDH residual/recurrence within 90 days, eight (7.3%) required retreatment: five (4.6%) with craniotomy, three (2.8%) with SEPS. Hyperlipidemia (P=0.002), anticoagulant use (P=0.036), and larger pre-SEPS+MMAE cSDH volume (P<0.001) predicted greater SEPS-mediated clearance. Older age (P=0.03), coronary artery disease (P=0.004), membranes within cSDH (P=0.039), acute/subacute components in cSDH (P=0.047), and unilateral cSDH (P=0.017) predicted less SEPS-mediated clearance. Older age (P=0.006), acute/subacute components in cSDH (P=0.016), and longer follow-up (P=0.013) predicted higher MMAE effectiveness. Higher pre-SEPS+MMAE cSDH volume (P=0.047) and unilateral MMAE for bilateral cSDH (P=0.036) predicted lower MMAE effectiveness. CONCLUSION:SEPS+MMAE was an effective, safe treatment for cSDH.
Purpose/aim of the study: There is limited real-world evidence regarding the effectiveness and safety of dupilumab in Gulf countries. The study aimed to evaluate atopic dermatitis (AD) disease control in adult and adolescent patients (>= 12 years) treated with dupilumab in Gulf countries. Materials and methods: This observational study included patients with moderate-to-severe AD who initiated dupilumab within 30 days. Disease control, itching/pruritus, and patient satisfaction were assessed using Scoring Atopic Dermatitis (SCORAD), AD Control Tool (ADCT), and Patient Global Assessment of Treatment Effect (PGATE) scores at weeks 4, 12, and 24. Results: The study included 187 participants with a mean age of 33.6 years. After 24 weeks, 75.1% of patients achieved disease control (ADCT score <7) compared to 4.3% at baseline (p < 0.001). Both ADCT and SCORAD scores significantly decreased from baseline scores (from 16.5 to 4.1 and 57.5 to 13.4, respectively, p < 0.001). Also, patient satisfaction improved significantly, with 65.3% reporting "Very Good" or "Excellent" PGATE scores in the 24th week compared to 20.3% at the baseline (p < 0.001). The limitations are the small number of included patients and the lack of long-term safety data. Conclusion: In conclusion, Dupilumab therapy is effective in controlling symptoms of moderate-to-severe AD patients in the Gulf countries. Most patients achieved high disease control and satisfaction levels.
BackgroundThe elderly population (≥80 years) were underrepresented in recent trials of endovascular thrombectomy (EVT) for anterior circulation large vessel occlusion acute ischemic stroke (LVO-AIS) with low Alberta Stroke Program Early CT Score (ASPECTS) (≤5).MethodsThis study analyzed data from a prospectively maintained database of 37 thrombectomy centers. The primary cohort of the study comprised patients with LVO-AIS aged ≥80 who underwent EVT with ASPECTS≤5 from 2013 to 2023. The primary outcome was favorable modified Rankin Scale (mRS) score of 0–3. Propensity score matching (PSM) and multivariate regression were applied.ResultsIn a study of 14 233 patients undergoing EVT, 1741 patients were 80 or older, with 122 presenting with low ASPECTS. While successful recanalization rates were similar between age groups, patients aged ≥80 had significantly lower favorable 90-day mRS scores and higher mortality before propensity score matching (PSM). After PSM, differences in mortality and symptomatic intracranial hemorrhage (sICH) were no longer significant. Among all elderly patients, higher ASPECTS was an independent predictor of a 90-day favorable outcome but was not associated with 90-day mortality. For patients aged ≥80 years with low ASPECTS, favorable outcomes were associated only with lower rates of atrial fibrillation, baseline functioning (mRS 0–1), fewer thrombectomy passes, and higher likelihood of first-pass reperfusion within 30 min of puncture.ConclusionWhile age ≥80 increases mortality and disability in patients with AIS and low ASPECTS, select elderly patients may still benefit from EVT when clinical factors are considered, supporting individualized treatment and better patient selection for future trials.
Rationale: Omalizumab, the first biologic therapy approved for children with moderate-to-severe asthma, carries a warning for anaphylaxis. Prescribing information recommends monitoring after the injection with epinephrine commonly prescribed. Four newer biologics with pediatric indications have no clear recommendations on post-injection observation nor consensus on the need for access to epinephrine. We sought to understand current clinical practices of epinephrine prescriptions and post-injection monitoring for biologics in pediatric subspecialty asthma clinics. Methods: The Severe Pediatric Asthma Consortium (SPAC) is composed of pediatric allergists and pulmonologists from tertiary academic centers across the US with multi-disciplinary severe asthma programs. Eleven centers completed a survey inquiring about: 1) the number of biologics being prescribed in 2022; 2) if anaphylactic reactions occurred in patients receiving biologic treatment; 3) if epinephrine prescriptions were required for biologic administration in clinic or at home (if applicable); and 4) any monitoring parameters for the medications post injection. Results: In 2022, 533 youth with moderate-to-severe asthma at these eleven centers were prescribed biologics FDA-approved for children/adolescents (omalizumab, mepolizumab, benralizumab, tezepelumab, dupilumab). Dupilumab was the most common biologic prescribed (56%) and most often prescribed for home administration (70%). Among the 533 patients, no cases of anaphylaxis were reported to any biologic administered in-office or at-home. All centers required epinephrine availability for omalizumab administered in the office and all but one required epinephrine for at-home administration. Eight centers required a 2-hour wait time after the first three omalizumab injections followed by 30-minute observations for subsequent injections in the office. Centers reported a wide range of observation periods after non-omalizumab biologic administration (0-120 minutes). Two centers required epinephrine availability for all biologics administered in-office and at-home; one center required epinephrine availability for administration of omalizumab, mepolizumab and benralizumab in-office but not for at-home administration of mepolizumab or benralizumab. Conclusions: There were no reports of anaphylaxis in 533 patients receiving biologic injections. These observations suggest an overall favorable safety profile in pediatric patients with moderate-to-severe asthma. However, there is variability in observation periods and access to epinephrine among the included programs. We recognize there are post marketing reports of anaphylaxis with biologic therapies other than omalizumab, and that the decision for access to epinephrine and monitoring ultimately is made between patient and provider. We propose access to epinephrine and post-injection monitoring with omalizumab but not with other biologic medications.
