The prevalence of maternal medication ingestion in the antenatal period

The prevalence of ingestion of medication by pregnant women was recorded in 236 patients attending the antenatal clinics at New Somerset and Peninsula Maternity Hospitals. Patients were interviewed over two periods, 23 - 26 July and 2 - 12 December 1991. Of these women, 168 (71,2%) took a total of 283 drugs from 18 different categories. One hundred and forty women (59%) took prescribed and 68 (28,8%) non-prescribed medications. The most commonly used medicines were analgesics, cough and cold medicines, antibiotics, laxatives and antacids. Analgesics that contain aspirin constituted 13,8% of self-administered medicines and 2% of prescribed medicines. The most common sources of non-prescribed medication were pharmacies (60%), followed by supermarkets (32,5%). One hundred and sixty-two women (68,6%) received no advice on medication during their pregnancy. Of those who received advice, formal sources (doctor/nurse/ pharmacist/midwife) accounted for 56,8% and informal sources (family/friends /magazines) for 43,3% of advice; 59,7% of women did not know that certain medicines are unsafe during pregnancy.Our data indicate that pregnant women in Cape Town take a large number of medicines, - often without being aware of the potential adverse effects. This study shows the need for education in this regard, especially at antenatal clinics, pharmacies and supermarkets

Intravenous thrombolysis may not improve clinical outcome of acute ischemic stroke patients without a baseline vessel occlusion

Background and Purpose: The benefit of thrombolysis in ischemic stroke patients without a visible vessel occlusion still requires investigation. This study tested the hypothesis that non-lacunar stroke patients with no visible vessel occlusion on baseline imaging would have a favorable outcome regardless of treatment with alteplase. Methods: We utilized a prospectively collected registry of ischemic stroke patients [the International Stroke Perfusion Imaging Registry (INSPIRE)] who had baseline computed tomographic perfusion and computed tomographic angiography. The rates of patients achieving modified Rankin Scale (mRS) 0-1 were compared between alteplase treated and untreated patients using logistic regression to generate odds ratios. Results: Of 1569 patients in the INSPIRE registry, 1,277 were eligible for inclusion. Of these, 306 (24%) had no identifiable occlusion and were eligible for alteplase, with 141 (46%) of these patients receiving thrombolysis. The treated and untreated groups had significantly different median baseline National Institutes of Health Stroke Scale (NIHSS) [alteplase 8, interquartile range (IQR) 5-10, untreated 6, IQR 4-8, P < 0.001] and median volume of baseline perfusion lesion [alteplase 5.6 mL, IQR 1.3-17.7 mL, untreated 2.6 mL, IQR 0-6.7 mL, P < 0.001]. After propensity analysis, alteplase treated patients without a vessel occlusion were less likely to have an excellent outcome (mRS 0-1; 56%) than untreated (78.8%, OR, 0.42, 95% confidence interval, 0.24-0.75, P = 0.003). Conclusions: In this non-randomized comparison, alteplase treatment in patients without an identifiable vessel occlusion did not result in higher rates of favorable outcome compared to untreated. However, treated patients displayed less favorable baseline prognostic factors than the untreated group. Further studies may be required to confirm this data.Huiqiao Tian, Mark W. Parsons, Christopher R. Levi, Xin Cheng, Richard I. Aviv, Neil J. Spratt, Timothy J. Kleinig, Billy O'Brien, Kenneth S. Butcher, Longting Lin, Jingfen Zhang, Qiang Dong, Chushuang Chen and Andrew Bivar

Association of Endovascular Thrombectomy With Functional Outcome in Patients With Acute Stroke With a Large Ischemic Core

First published July 8, 2022Background and Objectives: Endovascular thrombectomy (EVT) is effective for patients with large vessel occlusion (LVO) stroke with smaller volumes of CT perfusion (CTP)-defined ischemic core. However, the benefit of EVT is unclear in those with a core volume >70 mL. We aimed to compare outcomes of EVT and non-EVT patients with an ischemic core volume ≥70 mL, hypothesizing that there would be a benefit from EVT for fair outcome (3-month modified Rankin scale [mRS] 0–3) after stroke. Methods: A retrospective analysis of patients enrolled into a multicenter (Australia, China, and Canada) registry (2012–2020) who underwent CTP within 24 hours of stroke onset and had a baseline ischemic core volume ≥70 mL was performed. The primary outcome was the estimation of the association of EVT in patients with core volume ≥70 mL and within 70–100 and ≥100 mL subgroups with fair outcome. Results: Of the 3,283 patients in the registry, 299 had CTP core volume ≥70 mL and 269 complete data (135 had core volume between 70 and 100 mL and 134 had core volume ≥100 mL). EVT was performed in 121 (45%) patients. EVT-treated patients were younger (median 69 vs 75 years; p = 0.011), had lower prestroke mRS, and smaller median core volumes (92 [79–116.5] mL vs 105.5 [85.75–138] mL, p = 0.004). EVT-treated patients had higher odds of achieving fair outcome in adjusted analysis (30% vs 13.9% in the non-EVT group; adjusted odds ratio [aOR] 2.1, 95% CI 1–4.2, p = 0.038). The benefit was seen predominantly in those with 70–100 mL core volume (71/135 [52.6%] EVT-treated), with 54.3% in the EVT-treated vs 21% in the non-EVT group achieving a fair outcome (aOR 2.5, 95% CI 1–6.2, p = 0.005). Of those with a core volume ≥100 mL, 50 of the 134 (37.3%) underwent EVT. Proportions of fair outcome were very low in both groups (8.1% vs 8.7%; p = 0.908). Discussion: We found a positive association of EVT with the 3-month outcome after stroke in patients with a baseline CTP ischemic core volume 70–100 mL but not in those with core volume ≥100 mL. Randomized data to confirm these findings are required. Classification of Evidence: This study provides Class III evidence that EVT is associated with better motor outcomes 3 months after CTP-defined ischemic stroke with a core volume of 70–100 mL.Carlos Garcia-Esperon, Andrew Bivard, Hannah Johns, Chushuang Chen, Leonid Churilov, Longting Lin, Kenneth Butcher, Timothy J. Kleinig, Philip M.C. Choi, Xin Cheng, Qiang Dong, Richard I. Aviv, Ferdinand Miteff, Neil J. Spratt, Christopher R. Levi, Mark W. Parsons, on behalf of the INSPIRE Study grou

Tranexamic acid in patients with intracerebral haemorrhage (STOP-AUST): a multicentre, randomised, placebo-controlled, phase 2 trial

Background: Despite intracerebral haemorrhage causing 5% of deaths worldwide, few evidence-based therapeutic strategies other than stroke unit care exist. Tranexamic acid decreases haemorrhage in conditions such as acute trauma and menorrhoea. We aimed to assess whether tranexamic acid reduces intracerebral haemorrhage growth in patients with acute intracerebral haemorrhage. Methods: We did a prospective, double-blind, randomised, placebo-controlled, investigator-led, phase 2 trial at 13 stroke centres in Australia, Finland, and Taiwan. Patients were eligible if they were aged 18 years or older, had an acute intracerebral haemorrhage fulfilling clinical criteria (eg, Glasgow Coma Scale score of >7, intracerebral haemorrhage volume 33% relative or >6 mL absolute) at 24 h. The primary and safety analyses were done in the intention-to-treat population. The trial is registered at ClinicalTrials.gov (NCT01702636). Findings: Between March 1, 2013, and Aug 13, 2019, we enrolled and randomly assigned 100 participants to the tranexamic acid group (n=50) or the placebo group (n=50). Median age was 71 years (IQR 57–79) and median intracerebral haemorrhage volume was 14·6 mL (7·9–32·7) at baseline. The primary outcome was not different between the two groups: 26 (52%) patients in the placebo group and 22 (44%) in the tranexamic acid group had intracerebral haemorrhage growth (odds ratio [OR] 0·72 [95% CI 0·32–1·59], p=0·41). There was no evidence of a difference in the proportions of patients who died or had thromboembolic complications between the groups: eight (16%) in the placebo group vs 13 (26%) in the tranexamic acid group died and two (4%) vs one (2%) had thromboembolic complications. None of the deaths was considered related to study medication. Interpretation: Our study does not provide evidence that tranexamic acid prevents intracerebral haemorrhage growth, although the treatment was safe with no increase in thromboembolic complications. Larger trials of tranexamic acid, with simpler recruitment methods and an earlier treatment window, are justified.Atte Meretoja, Nawaf Yassi, Teddy Y Wu, Leonid Churilov, Gerli Sibolt, Jiann-Shing Jeng, Timothy Kleinig, Neil J Spratt, Vincent Thijs, Tissa Wijeratne, Der-Yang Cho, Darshan Shah, Geoffrey C Cloud, Thanh Phan, Christopher Bladin, Andrew Moey, Richard I Aviv, Christen D Barras, Gagan Sharma, Chung Y Hsu, Henry Ma, Bruce C V Campbell, Peter Mitchell, Bernard Yan, Mark W Parsons, Marjaana Tiainen, Sami Curtze, Daniel Strbian, Sung-Chun Tang, Jackson Harvey, Christopher Levi, Geoffrey A Donnan, Stephen M Davi

Acute Stroke Imaging Research Roadmap II.

The Stroke Imaging Research (STIR) Group, the American Society of Neuroradiology, and the Foundation of the American Society of Neuroradiology sponsored a series of working group meetings >12 months, with the final meeting occurring during the Stroke Treatment Academy Industry Roundtable (STAIR) on March 9 to 10, 2013, in Washington, DC. This process brought together vascular neurologists, neuroradiologists, neuroimaging research scientists, members of the National Institute of Neurological Disorders and Stroke, industry representatives, and members of the US Food and Drug Administration to discuss stroke imaging research priorities, especially in the light of the recent negative results of acute stroke clinical trials that tested the concept of penumbral imaging selection. The goal of this process was to propose a research roadmap for the next 5 years. STIR recommendations include (1) the use of standard terminology, aligned with the National Institute of Neurological Disorders and Stroke Common Data Elements. ; (2) a standardized imaging assessment of revascularization in acute ischemic stroke trials, including a modified Treatment In Cerebral Ischemia (mTICI) score. ; (3) a standardized process to assess whether ischemic core and penumbral imaging methods meet the requirements to be considered as an acceptable selection tool in acute ischemic stroke trials. ; (4) the characteristics of a clinical and imaging data repository to facilitate the development and testing process described in recommendation no. 3. ; (5) the optimal study design for a clinical trial to evaluate whether advanced imaging adds value in selecting acute ischemic stroke patients for revascularization therapy. ; (6) the structure of a stroke neuroimaging network to implement and coordinate the recommendations listed above. All of these recommendations pertain to research, not to clinical care

Surgical indications and techniques for failed coiled aneurysms.

For two decades, endovascular coiling has revolutionized the treatment of intracranial aneurysms. However, as with all techniques, it has limitations and endovascular radiologists and neurosurgeons are regularly confronted by what we call "failed" coiled aneurysms. Failed coiled aneurysms can occur in different situations: a) presence of a significant remnant at the end of an endovascular procedure; b) recanalization of an initially satisfactory occlusion; and c) coil extrusion deemed too thrombogenic or threatening the blood flow in the parent vessel. We and other teams around the world have developed strategies to manage these difficult cases. Here, we compare our own experience with other reports in the literature