Objectives: Thrombolytic therapy with Alteplase is the standard treatment for eligible patients with acute ischemic stroke, but clinical response and hemorrhagic complications vary considerably among patients. This study aimed to investigate whether selected polymorphisms within the MMP-8 and MMP-9 genes are associated with baseline stroke severity, functional recovery, and hemorrhagic complications after thrombolytic therapy. Materials and Methods: Over a 24-month period, 166 Caucasian patients with acute ischemic stroke treated with intravenous Alteplase were prospectively enrolled. Genotyping was performed for MMP-9 rs3918241 and rs3918249, and MMP-8 rs1940475 and rs11225395 polymorphisms. Associations with neurological severity, functional outcome, and postthrombolytic hemorrhagic complications were analyzed. Haplotype analysis was performed for the investigated MMP-8 and MMP-9 variants. Results: No significant associations were observed between the investigated MMP-9 polymorphisms and functional recovery or hemorrhagic complications after Alteplase treatment. However, carriers of the MMP-9 rs3918249 T allele had lower National Institutes of Health Stroke Scale scores at admission, suggesting a less severe initial clinical presentation. For MMP-8 , patients who developed symptomatic intracerebral hemorrhage were significantly more likely to carry the rs1940475 TT genotype ( P = 0.032; odds ratio = 5.10; 95% CI: 1.27-20.56). Haplotype analysis showed strong linkage disequilibrium between rs1940475 and rs11225395, and the TG haplotype was significantly more frequent in patients without hemorrhagic transformation than in those with hemorrhagic transformation. Conclusions: The investigated MMP-9 polymorphisms were not associated with postthrombolytic recovery or hemorrhagic complications. In contrast, MMP-8 rs1940475 and MMP-8 haplotypes may be related to hemorrhagic risk after Alteplase therapy.
Background/Objectives: Traumatic brain injury (TBI) is a major cause of morbidity and mortality. The initial insult can lead to tissue and cellular damage that results in an excessive catecholamine release, which may be mitigated with beta-blockers (BB). However, guidelines recommend their use only under specific conditions. This study compared the use of BB to no BB use in patients with TBI at an urban trauma center. Methods: This was a retrospective chart review of all adult patients with TBI admitted to the intensive care unit (ICU). Patients who received at least 2 consecutive doses of any scheduled BB were compared with those who did not receive any BB. The primary outcome was in-hospital mortality. Secondary outcomes were the rate of 28-day mortality, in-hospital length of stay, ICU length of stay, and discharge disposition. Safety outcomes were bradycardia, hypotension, and use of vasopressors following BB administration. Subgroup analyses of propranolol, mild/moderate, and severe TBI populations were also evaluated. Results: A total of 1197 patients were included in the study, of whom 375 received BB and 822 did not. The majority of patients were male (71.1%) and had a mean age of 53.5 years. Propranolol (42.1%) was the most commonly ordered initial BB. There was no difference in the rate of in-hospital mortality between the BB and no-BB groups (13.1% vs. 11.9%; P =0.570); however, in the adjusted analysis, BB use was associated with reduced in-hospital mortality (odds ratio: 0.589; 95% CI: 0.381-0.909; P =0.017). Regression analysis based on severity showed that the use of BB was associated with reduced mortality in severe TBI (odds ratio: 0.298; 95% CI: 0.173-0.513; P <0.001), but not mild or moderate TBI (odds ratio: 1.948; 95% CI: 0.970-3.914; P =0.061). Conclusions: The use of BB in patients with severe TBI was associated with lower in-hospital mortality.
Background/Objectives: Acute psychotic episodes in schizophrenia represent a critical stage in clinical management, often characterized by significant ideobehavioral disorganization, poor therapeutic adherence, and increased suicide risk. Currently, a broad consensus of clinicians and experts consider long-acting injectables (LAIs) a valuable and indispensable tool in clinical practice, also used as a first-line treatment in the acute phases of the illness. Risperidone ISM (in situ microparticles), reaches effective therapeutic concentrations within the first 24 hours of administration, without any oral supplementation, thus representing a potentially useful option, particularly during the hospitalization phase. Methods: A prospective, single-center observational study was conducted at the Psychiatric Diagnosis and Treatment Service (SPDC) of the AST of Ascoli Piceno (Marche Region; Italy), between November 2024 and November 2025. Patients with a diagnosis of acute psychosis who were administered risperidone ISM (75 to 100 mg) during their hospitalization were included. Anamnestic data and psychometric assessments were collected at the first administration of risperidone ISM (T0), one week after administration (T1), and 30 days after the first administration (T2). Results: A total of 53 patients were selected (mean age 37.8; 60% male). PANSS score decreased by 29% between T0 and T2; the subscales showed reductions of 31.5% (positive symptoms), 25.2% (negative symptoms), and 30.4% (general symptoms). Perceived clinical severity (CGI-S) decreased by 40%. SAS decreased by 33%, with a decrease in high-risk patients from 28% to 4%. Conclusions: Risperidone ISM produced rapid and significant clinical stabilization in patients with acute psychosis admitted to SPDC, with a measurable reduction in psychopathology and suicidality.
Background: Fingolimod is a sphingosine-1-phosphate receptor modulator widely used in the treatment of relapsing-remitting multiple sclerosis (RRMS). Clinically significant weight loss during fingolimod therapy has rarely been characterized in detail, particularly regarding body composition findings and the relative contribution of adipose tissue loss. Case Presentation: We report a 54-year-old man with RRMS who developed progressive, unintentional weight loss during fingolimod therapy. Over ∼2 years, body weight decreased from 100 to 78 kg without appetite loss, dietary restriction, increased physical activity, or major lifestyle changes. Extensive multidisciplinary evaluation did not identify malignancy, chronic infection, gastrointestinal disease, endocrine abnormalities, or systemic inflammatory disorders. Multifrequency bioelectrical impedance analysis demonstrated low adipose tissue parameters with relative preservation of skeletal muscle mass and hydration status, suggesting that adipose tissue reduction represented a major component of the observed weight loss pattern. Body weight subsequently remained stable during additional clinical follow-up. Conclusion: This case describes progressive unintentional weight loss during fingolimod therapy in a patient with RRMS, with body composition findings suggesting predominant adipose tissue involvement. Although causality cannot be established from a single observation, the temporal association and exclusion of major alternative etiologies suggest a possible association that may merit further investigation. This report also highlights the potential value of body composition assessment in patients presenting with unexplained weight loss during fingolimod therapy.
