The Relationship of Stroke and Sleep-A Review

Ischemic stroke appears the third leading cause of mortality and the first cause of disability in developing countries. The relationship between sleep disorders and cerebrovascular risk factors is well defined and there are different mechanisms in pathophysiology. Ischemic stroke affects many pathways, such as hypoxia, increased wakefulness reactions, decreased sleep quality, increased free oxygen radicals, inflammatory mechanisms activation, endothelial dysfunction, atherosclerosis, hypertension, and insulin resistance. Sleep disturbances contribute to stroke pathology through multiple direct or indirect mechanisms. Due to the fact that sleep disorders are among the changeable cerebrovascular risk factors, it is very important to raise awareness about the diagnosis, management and prevention of sleep disorders

Frequency, Treatment and Outcome of Immune-Related Toxicities in Patients with Immune-Checkpoint Inhibitors for Advanced Melanoma: Results from an Institutional Database Analysis

Immune checkpoint inhibitors (ICIs) can induce immune-related adverse events (irAEs), which may result in treatment discontinuation. We sought to describe the onset, frequency, and kinetics of irAEs in melanoma patients in a real-life setting and to further investigate the prognostic role of irAEs in treatment outcomes. In this retrospective single-center cohort study, we included 249 melanoma patients. Onset, grade, and resolution of irAEs and their treatment were analyzed. A total of 191 (74.6%) patients in the non-adjuvant and 65 (25.3%) in the adjuvant treatment setting were identified. In the non-adjuvant setting, 29 patients (59.2%) with anti-CTLA4, 43 (58.1%) with anti-PD1, and 54 (79.4%) with anti-PD1/anti-CTLA4 experienced some grade of irAE and these had an improved outcome. In the adjuvant setting, the frequency of irAEs was 84.6% in anti-CTLA4 and 63.5% in anti-PD1, but no correlation with disease relapse was observed. Patients with underlying autoimmune conditions have a risk of disease exacerbation. Immunomodulatory agents had no impact on treatment efficacy. IrAEs are correlated with increased treatment efficacy in the non-adjuvant setting. Application of steroids and immunomodulatory agents, such as anti-TNF-alpha or anti-IL6, did not affect ICI efficacy. These data support irAEs as possible prognostic markers for ICI treatment

Pain in IBD Patients: Very Frequent and Frequently Insufficiently Taken into Account.

Pain is a common symptom related to inflammatory bowel disease (IBD). In addition to abdominal pain, pain can also be an extraintestinal manifestation of IBD. Pain treatment is challenging and a substantial part of IBD patients are treated with opioids. Therefore, a better knowledge on pain symptoms is crucial for a better therapeutic approach to this clinical problem. Patients of the Swiss IBD Cohort Study (SIBDCS) (n = 2152) received a questionnaire regarding pain intensity, pain localization and impact of pain on daily life and social activities. Furthermore, the questionnaire investigated the use of pain-specific medication. A vast majority of patients (71%) experienced pain during the disease course. For a substantial part of patients (49% in UC and 55% in CD) pain is a longstanding problem (>5 years). Pain in UC was of shorter duration compared to CD (p < 0.01). Abdominal pain (59.5%) and back pain (38.3%) were the main pain localizations. 67% of patients took pain medication; 24% received no pain treatment. The general quality of life was significantly lower in patients suffering of pain compared to those without pain (38 vs. 77; (-100 very bad; 100 very good) p<0.0001). Prevalence of pain is high in patients of the SIBDCS. It is a longstanding problem for the majority of the patients affected. Pain was found to be undertreated in the SIBDCS and was significantly associated with health-related quality of life. Thus, an increased awareness is mandatory to address this frequent complication in the course of IBD

Airplane headache: An atypical case with autonomic symptoms and long duration

WOS:000616431700026Airplane Headache (AH) which is classified under headache attributed to disorder of homeostasis in International Classification of Headache Disorders (ICHD)-3 is a severe, unilateral, orbitofrontal headache that occurs during and caused by airplane travel. It remits after landing. AH cases with autonomic symptoms had rarely been reported. We present a 35-year-old male complained of five attacks of right-sided, unilateral, orbitofrontal headache accompanied with lacrimation, conjunctival injection and eye redness ipsilaterally, starting 20-30 minutes prior to landing. The headache duration varied between 30-90 minutes. AH diagnosis was made in the light of anamnesis and neurological examination. The secondary causes and primary headaches with autonomic symptoms were ruled out. As far as we know this is the first reported longer duration AH case with autonomic symptoms in the literature. AH is an underdiagnosed headache. We report this atypical AH case to call attention to this rare but treatable headache