Relevance of admission hyperglycaemia and diabetes mellitus to efficacy and safety of mechanical thrombectomy in stroke patients

Introduction. The relevance of diabetes mellitus (DM) to the efficacy of mechanical thrombectomy (MT) has been the subject of few studies and with only inconclusive results. Objectives. This study aimed to evaluate the effect of DM and admission hyperglycaemia on the efficacy and safety of MT in stroke patients. Material and methods. This retrospective study analysis focused on the relevance of admission hyperglyacemia and DM to the functional status of patients treated with MT at the Upper Silesian Medical Centre of the Silesian Medical University in Katowice, Poland. Results. 417 stroke patients (median age 70 years) were qualified for the study. There were 103 patients (24.70%) with DM. Admission hyperglycaemia ≥ 140 mg% was found in 91 patients (21.82%), of whom 69 were diagnosed with DM before or during hospitalisation. The parameters with the strongest effect on the functional status on days 7, 90 and 365 were: age, and neurological status according to the National Institutes of Health Stroke Scale (NIHSS) on the first day of ischaemic stroke before MT. The angiographic effect indirect after MT and patient functional status on days 7, 90 and 365 were comparable between the groups, regardless of the DM burden. The frequency of symptomatic intracranial bleeding 24 hours after MT was comparable between patients with and patients without DM (p = 0.092). Model based on parameters were age, NIHSS on the first day of ischaemic stroke, an when score in Thrombolysis In Cerebral Infarct (TICI) showed good predictive attributes for the functional status of patients in the acute period (day 7). Age, a lack of admission hyperglycaemia, and the neurological state on day 1 of ischaemic stroke (before MT) were the key parameters for a favourable outcome (≤ 2 points on the modified Rankin Scale, mRS) on day 90. Admission hyperglycaemia ≥ 140 mg/dL, regardless of the presence or absence of DM, had a negative effect on achieving a good functional status one week after stroke onset. Conclusions. Diabetes mellitus has a neutral effect on the angiographic and clinical outcomes of mechanical thrombectomy in stroke patients. It does not increase the risk of intracranial haemorrhage after instrumental therapy. It is admission hyperglycaemia, rather than diabetes mellitus, that is a predictor of poor functional status in patients treated with thrombectomy. According to our results, the patient’s neurological status, age, and the outcome of thrombectomy are relevant to the functional status in the acute ischaemic stroke period

Recanalisation of cerebral artery aneurysms treated endovascularly — a midterm follow-up

Endovascular methods of aneurysm treatment, as an alternative to neurosurgical clipping, have proved a welcome opportunity to treat patients with unruptured aneurysms or those disqualified from neurosurgical intervention. This paper presents our own experience of endovascular treatment of cerebral aneurysms in 107 patients. It includes clinical and technical data from the perioperative period and a 12-month radiological follow-up of 78 patients. Method. Our retrospective evaluation covered patients with intracranial aneurysms treated endovascularly. The following were analysed: age, sex, neurological symptoms, and familial burden of intracranial aneurysm. Multivariate analysis was performed to determine independent factors of recanalisation of the cerebral aneurysm 12 months after embolisation. Results. The data of 107 patients at a mean age of 61 years [57.09 ± 14.27] treated with embolisation was analysed. The indication for intervention in 16 patients was subarachnoid haemorrhage; in the remaining 91 cases, aneurysms were revealed during diagnostic procedures for different symptoms or during imaging examinations. The intracranial segment of the internal carotid artery and the anterior communicating artery were the most common locations for aneurysms. After embolisation, subarachnoid haemorrhage occurred in one patient, ischaemic stroke in two patients, and one patient died because of acute circulatory insufficiency. The functional status of 94 patients on the day of discharge from the department (on days 4-21) was very good. 78 patients completed a 12-month follow-up period. In 11 of those, a follow-up MR angiography revealed recanalisation 12 months after the intervention. Except for one patient reporting vertigo, aneurysm recanalisation procedures were asymptomatic. The only independent risk factor for recanalisation was the size of aneurysm > 10 mm; OR 3.0; CI [1.15–7.83] p = 0.0255. Conclusions. Embolisation of cerebral aneurysms is a safe method with few perioperative complications, and most of these are mild and transient.The size of the aneurysm during qualification for embolisation is a risk factor for recanalisation in the subsequent 12 months. Recanalisation of embolised cerebral aneurysms concerns less than 20% of patients in a one-year follow-up and is most often asymptomatic

Lifestyle of students of Medical University of Silesia, Katowice, Poland, in years 2005 and 2020

WSTĘP: Styl życia jest szerokim pojęciem i ma duży wpływ na zdrowie. Zmienia się na przestrzeni czasu pod wpływem doniesień naukowych, trendów społecznych i indywidualnych uwarunkowań. Celem pracy było międzypokoleniowe porównanie stylu życia studentów Śląskiego Uniwersytetu Medycznego w Katowicach (SUM). MATERIAŁ I METODY: Badanie przekrojowe przeprowadzono z wykorzystaniem autorskiego kwestionariusza. W badaniu uczestniczyły dwie grupy liczące po 221 osób, studenci kierunków medycznych w latach 2003–2005 i w roku 2020. Do oceny stylu życia użyto rekomendacji Światowej Organizacji Zdrowia, a zmienne zaklasyfikowano jako ,,zdrowy nawyk” lub ,,niezdrowy nawyk”. WYNIKI: Studenci w roku 2020 wykazywali ,,zdrowsze” zachowania w porównaniu ze studentami z lat 2003–2005, jeśli chodzi o regularność spożywania posiłków (p = 0,02), rzadsze spożycie posiłków z dużą zawartością soli kuchennej (p = 0,03), częstsze spożycie warzyw i owoców (p < 0,01) oraz dłuższy sen (p < 0,01); zwiększyły się natomiast używanie kofeiny (p = 0,02), częstość spożywania napojów alkoholowych (p = 0,04) oraz liczba osób odczuwających stres (p < 0,01), który dla większości był destabilizujący (p < 0,01). WNIOSKI: Styl życia studentów kierunków medycznych na przestrzeni 15 lat poprawił się w zakresie nawyków żywieniowych. Zmiany niekorzystne dotyczą spożycia alkoholu i odczuwania stresu.INTRODUCTION: Lifestyle is a broad concept with a large impact on health. It changes over time under the influence of scientific reports, social trends and individual conditions. The aim of this study was to make an intergenerational comparison of the lifestyle of students of the Medical University of Silesia, Katowice, Poland. MATERIAL AND METHODS: A cross-sectional study was conducted using the author’s own questionnaire. Two groups of 221 subjects each, medical students in 2003–2005 and 2020, participated in the study. Recommendations of the World Health Organization were used to assess lifestyle and the variables were classified as “healthy” or “unhealthy”. RESULTS: The students in 2020 exhibited “healthier” behaviors compared to the students in 2003–2005 in terms of the regularity of meals (p = 0.02), less frequent consumption of meals with a high salt content (p = 0.03), more frequent consumption of fruits and vegetables (p < 0.01) and longer sleep periods (p < 0.01). In contrast, caffeine use (p = 0.02), the frequency of alcoholic beverage consumption (p = 0.04) and the number of people experiencing stress (p < 0.01), which was destabilizing for most (p < 0.01), increased. CONCLUSIONS: The lifestyle of medical students improved over 15 years in terms of eating habits. Unfavorable changes are related to alcohol consumption and perceived stress

Do physicians lead healthier lifestyles than when they were students?

WSTĘP: Styl życia jest głównym determinantem zdrowia, może jednak zmieniać się z biegiem lat. Studentów cechują zwykle „gorsze” zachowania zdrowotne niż te u osób dorosłych. To ciekawe zjawisko nie było badane w środowisku lekarskim. Celem pracy była ocena stylu życia lekarzy w porównaniu z ich zachowaniami z lat studenckich. MATERIAŁ I METODY: Badanie przekrojowe przeprowadzono w 2020 r. z wykorzystaniem autorskiego kwestionariusza oceniającego różne elementy stylu życia, które klasyfikowano jako „zdrowe” lub „niezdrowe” na podstawie rekomendacji Światowej Organizacji Zdrowia. W badaniu uczestniczyło 112 lekarzy (64,3% mężczyzn i 35,7% kobiet); mediana wieku wynosiła 37 lat (IQR 36–38). Wyniki porównano z danymi otrzymanymi w tej grupie na podstawie tego samego kwestionariusza dystrybuowanego w latach 2003–2005, tj. gdy badani byli studentami medycyny. WYNIKI: Zaobserwowano istotne, korzystne zmiany dotyczące rzadszego spożycia posiłków z dużą zawartością soli kuchennej (p &amp;lt; 0,01) oraz częstszego spożycia warzyw i owoców (p &amp;lt; 0,01). Zaobserwowano zwiększenie częstości picia kawy (p &amp;lt; 0,01). W pozostałym zakresie nawyki żywieniowe i stosowanie używek pozostawały niezmienne. Nie stwierdzono różnic dotyczących aktywności fizycznej, występowania stresu oraz jego charakteru (mobilizujący/destabilizujący). WNIOSKI: Styl życia lekarzy nie zmienia się znacząco w porównaniu z latami studenckimi, co można wiązać z przyzwyczajeniami z lat młodości.INTRODUCTION: Lifestyle is a major determinant of health, but this can change over time. Students tend to have worse health behaviors than adults. This interesting phenomenon has not been verified in relation to the medical community. The aim of this study was to evaluate the lifestyle of physicians and compare it with their habits from their student years. MATERIAL AND METHODS: A cross-sectional study was conducted in 2020 using an original questionnaire assessing various lifestyle elements that were classified as “healthy” or “unhealthy” based on World Health Organization recommendations. 112 physicians (64.3% male and 35.7% female) with a median age of 37 years (IQR 36–38) participated in the study. The results were compared with data obtained in this group from the same questionnaire distributed between 2003 and 2005, i.e. when the subjects were medical students. RESULTS: Significant favorable changes were observed regarding less frequent consumption of meals with a high content of table salt (p &amp;lt; 0.01) and increased consumption of fruits and vegetables (p &amp;lt; 0.01). An increased frequency of coffee drinking was observed (p &amp;lt; 0.01). Their dietary habits and stimulant use remained unchanged. There were no differences in physical activity, the occurrence of stress or its nature (mobilizing or destabilizing). CONCLUSIONS: The lifestyles of physicians do not change significantly compared to their student years, which may be related to the habits from their youth

Clinical and Non-Clinical Determinants of the Effect of Mechanical Thrombectomy and Post-Stroke Functional Status of Patients in Short and Long-Term Follow-Up

To date, inconsistent results evaluating the effect of parameters on mechanical thrombectomy (MT) outcomes in stroke-patients have been published. This study aimed to identify the key parameters for functional status after MT in stroke-patients in short and long-term follow-up. Method: The study analysis focused on the relevance of selected clinical and non-clinical parameters to the functional status of the patients after MT. Results: 417 stroke-patients (mean age 67.8 ± 13.2 years) were qualified. Atrial fibrillation, and leukocytosis were significant for the neurological status on the first day of stroke (p = 0.036, and p = 0.0004, respectively). The parameters with the strongest effect on the functional status on day 10 were: age (p = 0.009), NIHSS (p = 0.002), hyperglycemia (p = 0.009), the result in TICI (p = 0.046), and first pass effect (p = 0.043). The parameters with the strongest effect on the functional status on day 365 were: age and NIHSS on the first day of stroke (p = 0.0002 and 0.002, respectively). Leukocytosis and the neurological status at baseline were key parameters associated with ICB after MT (p = 0.007 and p = 0.003, respectively). Conclusions: Age and neurological status in the ultra-acute phase of stroke are crucial for the functional status in short and long-term observations of patients treated with mechanical thrombectomy. Atrial fibrillation, hyperglycemia, and inflammatory state are relevant to the short-term post-stroke functional status. First pass effect and the degree of post-interventional reperfusion are important technical parameters to the short-term functional status. Neurological status and white blood count during the acute phase are associated with a high rate of post-procedural intracranial bleeding