Introduction: Preclinical studies have demonstrated that dexmedetomidine (DEX), a sedative widely used in intensive care units (ICU), exerts neuroprotective effects. However, its potential protective role and underlying mechanisms in ischemic stroke patients with atrial fibrillation (IS-AF) remain unclear. The studyʼs objective was to assess the connection between the early administration of DEX and short-term mortality from all causes in patients with IS-AF. Methods: From the MIMIC-IV database, patients with IS-AF were identified, including those who were administered DEX and those who were not. The primary endpoint was 7-day all-cause mortality, and the secondary endpoint was 90-day all-cause mortality. Propensity score matching (PSM) was utilized to ensure baseline covariates were balanced. Cox proportional hazards models and Kaplan-Meier survival curves and were utilized to evaluate the association between DEX use and mortality, with subgroup analyses conducted to ensure the findingsʼ robustness. Results: In total, 1,355 patients with IS-AF participated, with 253 (18.7%) receiving DEX. After PSM, 208 pairs were matched. In the fully adjusted model, DEX administration was significantly associated with lower all-cause mortality compared with the control group at both 7 days (before PSM, HR = 0.36, 95% CI: 0.19–0.68, p = 0.002; after PSM, HR = 0.26, 95% CI: 0.12–0.54, p < 0.001) and 90 days (before PSM, HR = 0.84, 95% CI: 0.66–1.07, p = 0.162; after PSM, HR = 0.72, 95% CI: 0.53–0.97, p = 0.031). The subgroup analyses revealed that DEXʼs protective effect was stronger in patients aged 70 and above, females, those with hypertension, and those without heart failure or chronic kidney disease. Kaplan-Meier survival curves consistently illustrated that DEX users had greater survival probabilities both before and after matching. Conclusion: In patients with IS-AF, DEX administration is connected to decreased all-cause mortality mortality, underlining the possible importance of DEX in ICU settings.
Votive offerings (ex voto) are material objects deposited in sacred spaces as expressions of gratitude, petitions for divine assistance, or as part of consecration rituals. In Eastern Orthodox Christianity, particularly in Greece and the Balkan region, these offerings frequently take the form of tamata; these are small metal votive plaques depicting body parts or organs often rendered with a high degree of realism. Here we report previously unreported tama depicting a child/young adolescent with features suggestive of Parry-Romberg syndrome, also known as progressive hemifacial atrophy. The 18th-19th century collection of votive offerings from the Orthodox Monastery of Floreşti (Romania) was examined. Among the seven identified objects, one tama portrays a child/adolescent, approximately 10–15 years of age, in the shape of an angel, with evident pathological features. The artifact was carefully examined by a multidisciplinary team following the International Guidelines for Iconodiagnosis in order to establish a consensus diagnosis and to determine the level of iconodiagnostic evidence. The votive plaque displays right-sided hemifacial atrophy, ipsilateral enophthalmos, and atrophy of the right upper and lower limbs. A deliberate reduction in the size of the right wing compared to the contralateral side is also evident. Correlation of these morphological features with clinical data from the medical literature supports the iconodiagnostic hypothesis of Parry-Romberg syndrome with possible ipsilateral extension to both the upper and lower limbs (level II iconodiagnostic evidence). This tama may represent an early Orthodox votive depiction of Parry-Romberg syndrome. This finding highlights the value of votive collections as interdisciplinary sources for the historical documentation of rare diseases and for the application of iconodiagnosis within a religious context.
Introduction: Amyotrophic lateral sclerosis (ALS) is a neurodegenerative disease requiring complex multidisciplinary care. As disability advances, patients’ and caregivers’ needs may diverge. Methods: The objectives of the study were to assess needs, priorities and satisfaction with care among people with ALS (pALS) and their caregivers; to examine the association between satisfaction and quality of life (QoL); to explore differences according to clinical characteristics; to understand the Italian ALS community's willingness to engage in research. In this cross-sectional multicenter study, 154 pALS and 211 caregivers were recruited (July 2021–November 2022). Structured interviews explored information received, care priorities, research expectations and satisfaction. Answers to the interview were compared between patients and caregivers and between different patients’ subgroups with the chi-square or Fisher’s exact test. The scores of QoL questionnaires were compared between satisfied and unsatisfied patients (ALSAQ-40) and caregivers (SF-36) with the Wilcoxon-Mann-Whitney test. Results: Patients prioritized finding a cure (95%) and overcoming disease-related limitations (72%) over safe and tolerable drugs (55%), similarly to caregivers. Research on psychological and emotional support was rated more important by caregivers (70%) than patients (49%). QoL was higher among satisfied patients, with better ALSAQ-40 scores in mobility, daily activities, communication and emotional domains. Caregivers needing urgent psychological support were fewer among the satisfied (35%) than the not satisfied (50%), and SF-36 mental health scores were also higher in satisfied caregivers. Conclusion: Incorporating both pALS and caregiver perspectives into clinical practice and research planning may enhance patient- and family-centered care, improve QoL, and better align healthcare research and resources with societal needs.
Introduction: Continuous electroencephalogram (cEEG) is increasingly utilized in the intensive care unit for consciousness-impaired patients with various conditions. It is, however, costly in terms of technical and human resources, and its impact on prognosis compared with routine EEG (rEEG) remains debated. We aimed to characterize the effect of cEEG vs rEEG on clinical management modifications, and to determine if these correlated with a better outcome. Methods: This is an ancillary analysis using data of CERTA (NCT03129438), a randomized trial comparing cEEG versus repeated rEEG in critically ill adults with altered consciousness. Clinical management modifications due to the EEG intervention, pre-defined as performed within 60 hours of EEG start, were prospectively recorded (anti-seizure medication -ASM, sedation, new radiological examination, new surgical intervention, withdrawal of life sustaining therapy). Correlation with the EEG type were analyzed by 2x2 tables; Mantel-Haenszel tests explored the impact on mortality and functional outcome at 6 months. Results: The trial included 364 patients completing follow-up (182 each in the cEEG and rEEG groups). While 58.2% of cEEG and 45.6% of rEEG patients had any management change (p= 0.018), ASM were modified in 22.0% (cEEG) and 12.1% (rEEG) (p = 0.012)); other clinical interventions were comparable across EEG groups. Adjusting for ASM modifications, mortality (p=0.845) and functional outcome (p=0.619) remained similar between the EEG groups. Conclusion: In critically ill adults, cEEG is associated with more clinical management modifications compared to repeated rEEG, particularly regarding ASM, but this does not seem to translate into improved patients’ outcomes.
Background: Idiopathic intracranial hypertension (IIH) is a chronic disorder characterized by elevated intracranial pressure (ICP) without an identifiable intracranial mass lesion or abnormal cerebrospinal fluid (CSF) composition. Traditionally viewed as a disorder of impaired CSF absorption or venous outflow obstruction, IIH predominantly affects women of reproductive age with obesity and remains a major cause of preventable visual loss. Emerging evidence, however, suggests that IIH is driven by a broader biologic framework involving dysregulated CSF secretion, metabolic and endocrine dysfunction, immune activation, and genetic susceptibility. Summary: This narrative review synthesizes recent advances in the molecular and cellular pathophysiology of IIH and examines emerging mechanism-based therapeutic strategies. Particular emphasis is placed on choroid plexus biology and hormonally regulated CSF hypersecretion mediated through glucocorticoid metabolism via 11β-hydroxysteroid dehydrogenase type 1 (11β-HSD1) and androgen signaling pathways that modulate Na⁺/K⁺-ATPase activity. Distinct metabolic features of IIH, including visceral adiposity, insulin resistance, and adipose tissue inflammation, are integrated with evidence of systemic and central immune dysregulation. Recent genetic and biobank-based studies further support IIH-specific biological risk extending beyond obesity alone and implicate pathways involved in steroid metabolism, ion transport, vascular biology, and glymphatic regulation. We additionally review translational and clinical evidence supporting targeted therapies, including glucagon-like peptide-1 (GLP-1) receptor agonists and 11β-HSD1 inhibitors, which demonstrate ICP-lowering effects that may occur partially independent of weight loss. Key Messages: Accumulating mechanistic evidence supports a paradigm shift in IIH from a diagnosis of exclusion toward a biologically defined neuroendocrine disorder characterized by dysregulated CSF secretion, endocrine and metabolic dysfunction, inflammation, and impaired glymphatic regulation. Advances in molecular biology and translational therapeutics are enabling the development of targeted, disease-modifying therapies and may facilitate future precision medicine approaches for IIH management.
