Platelet transfusion versus standard care after acute stroke due to spontaneous cerebral haemorrhage associated with antiplatelet therapy (PATCH): a randomised, open-label, phase 3 trial

Item does not contain fulltextBACKGROUND: Platelet transfusion after acute spontaneous primary intracerebral haemorrhage in people taking antiplatelet therapy might reduce death or dependence by reducing the extent of the haemorrhage. We aimed to investigate whether platelet transfusion with standard care, compared with standard care alone, reduced death or dependence after intracerebral haemorrhage associated with antiplatelet therapy use. METHODS: We did this multicentre, open-label, masked-endpoint, randomised trial at 60 hospitals in the Netherlands, UK, and France. We enrolled adults within 6 h of supratentorial intracerebral haemorrhage symptom onset if they had used antiplatelet therapy for at least 7 days beforehand and had a Glasgow Coma Scale score of at least 8. With use of a secure web-based system that concealed allocation and used biased coin randomisation, study collaborators randomly assigned participants (1:1; stratified by hospital and type of antiplatelet therapy) to receive either standard care or standard care with platelet transfusion within 90 min of diagnostic brain imaging. Participants and local investigators giving interventions were not masked to treatment allocation, but allocation was concealed from outcome assessors and investigators analysing data. The primary outcome was shift towards death or dependence rated on the modified Rankin Scale (mRS) at 3 months, and analysed by ordinal logistic regression, adjusted for stratification variables and the Intracerebral Haemorrhage Score. The primary analysis was done in the intention-to-treat population and safety analyses were done in the intention-to-treat and as-treated populations. This trial is registered with the Netherlands Trial Register, number NTR1303, and is now closed. FINDINGS: Between Feb 4, 2009, and Oct 8, 2015, 41 sites enrolled 190 participants. 97 participants were randomly assigned to platelet transfusion and 93 to standard care. The odds of death or dependence at 3 months were higher in the platelet transfusion group than in the standard care group (adjusted common odds ratio 2.05, 95% CI 1.18-3.56; p=0.0114). 40 (42%) participants who received platelet transfusion had a serious adverse event during their hospital stay, as did 28 (29%) who received standard care. 23 (24%) participants assigned to platelet transfusion and 16 (17%) assigned to standard care died during hospital stay. INTERPRETATION: Platelet transfusion seems inferior to standard care for people taking antiplatelet therapy before intracerebral haemorrhage. Platelet transfusion cannot be recommended for this indication in clinical practice. FUNDING: The Netherlands Organisation for Health Research and Development, Sanquin Blood Supply, Chest Heart and Stroke Scotland, French Ministry of Health

Serodiagnostiek van kinkhoest: interpretatie van hoge IgG/IgA concentraties in acute fase serum: (Her)evaluatie van eenpuntsserologie

Voor aangifte van kinkhoest geldt sinds 1988 dat serodiagnostiek alleen positief genoemd mag worden indien een significante titerstijging in gepaarde sera is aangetoond. Vaak blijft het serologisch onderzoek echter inconclusief ; doordat geen tweede serummonster was ingestuurd of de patienten al verhoogde titers in het eerste serummonster hadden die niet verder meer stegen. De casus-definitie voor aangifte heeft hierdoor een hoge specificiteit, maar lage gevoeligheid. Om de diagnostiek van kinkhoest te verbeteren werd in dit onderzoek de diagnostische waarde van eenpuntsserologie bestudeerd. Hiertoe werden IgA-antistof concentraties tegen sonicaat van Bordetella pertussis bacterien en IgG-antistofconcentraties tegen gezuiverd pertussistoxine gemeten: 1. bij 799 personen uit de algemene bevolking ; 2. bij 503 kinderen op de leeftijden van +-3 maanden, +-6 maanden, +-11 maanden en +-13 maanden d.w.z. resp. voor vaccinatie, 2-6 weken na de primaire serie van drie entingen tegen DKTP-Hib, voor de vierde (re)vaccinatie en 2-6 weken na de revaccinatie en 3. in het tweede serummonster van patienten bij wie een significante titerstijging in gepaarde sera is aangetoond (n=1590). Geconcludeerd wordt dat meting van bepaalde leeftijdspecifieke IgA/IgG-antistofconcentraties in een eerste serum van een patient met hoestklachten de diagnose 'infectie met B. pertussis' of 'kinkhoest' in sterke mate ondersteunen. Door acceptatie van eenpuntsserologie is het voor een groter deel van de kinkhoest patienten en in een vroeger stadium van ziekte mogelijk de diagnose te stellen en tijdig preventieve maatregelen voor bescherming van kwetsbaren te nemen. Echter, de incidentie gebaseerd op aangiften zal dan veranderen en daarmee de interpretatie van trends in incidentie. Verdere validatie van de gevonden cut-off waarden in een voor de algemene bevolking representatieve steekproef is noodzakelijk. Tevens zal in de nabije toekomst geanalyseerd worden of cut-off waarden voor positiviteit van eenpuntsserologie separaat geformuleerd kunnen worden voor de IgA-titer en de IgG-titer.<br

Data from: Long‐term follow‐up, quality of life and survival of Lambert‐Eaton myasthenic syndrome patients

Objective To study survival and characterize long-term functional impairments as well as health-related quality of life (HRQOL) of Lambert-Eaton myasthenic syndrome (LEMS) patients. Methods In this observational study, survival of LEMS patients, separately for non-tumor (NT) and small-cell lung cancer (SCLC), was compared to the Dutch general population and to patients with SCLC. Disease course in LEMS patients was recorded retrospectively. Several scales for functional impairments and health-related quality of life were assessed. Results We included 150 LEMS patients. Survival was similar to the general population in 65 NT-LEMS patients. Tumor survival was significantly longer in 81 SCLC-LEMS patients compared to non-LEMS SCLC patients (overall median survival 17 vs. 7.0 months,

Data from: Long‐term follow‐up, quality of life and survival of Lambert‐Eaton myasthenic syndrome patients

Objective To study survival and characterize long-term functional impairments as well as health-related quality of life (HRQOL) of Lambert-Eaton myasthenic syndrome (LEMS) patients. Methods In this observational study, survival of LEMS patients, separately for non-tumor (NT) and small-cell lung cancer (SCLC), was compared to the Dutch general population and to patients with SCLC. Disease course in LEMS patients was recorded retrospectively. Several scales for functional impairments and health-related quality of life were assessed. Results We included 150 LEMS patients. Survival was similar to the general population in 65 NT-LEMS patients. Tumor survival was significantly longer in 81 SCLC-LEMS patients compared to non-LEMS SCLC patients (overall median survival 17 vs. 7.0 months, p&lt;0.0001). At diagnosis, 39 patients (62%) of 63 patients with complete follow-up data were independent for ADL activities, improving to 85% at 1-year follow-up. Physical HRQOL composite score (55.9) was significantly lower than in the general population (76.3, p&lt;0.0001) and comparable to myasthenia gravis (60.5) Mental HRQOL composite score was 71.8 in LEMS patients, comparable to the general population (77.9, p=0.19) and myasthenia gravis (70.3). Conclusions This study shows NT-LEMS patients have normal survival. SCLC-LEMS patients have an improved tumor survival, even after correcting for tumor stage. A majority of LEMS patients report a stable disease course and remain or become independent for self-care after treatment

Effectiveness of combined oral contraceptives for depressive symptoms in women with premenstrual syndrome or premenstrual disphoric disorder: network meta-analysis of randomized trials

Dataset and script used for article: Effectiveness of combined oral contraceptives for depressive symptoms in women with premenstrual syndrome or premenstrual disphoric disorder: network meta-analysis of randomized trial