44 research outputs found
Ponovljena intravenska tromboliza kod bolesnika s recidivom ishemijskog moĆŸdanog udara â prikaz sluÄaja i prikaz iz literature
Background
Recurrent strokes occur in 25% of the cases during the first 5 years after the initial event. Each recur- rent stroke increases the risk for severe disability and mortality. Intravenous thrombolysis (IVT) with recombinant tissue plasminogen activator (rtPA) is one of the therapeutic options when secondary prevention is not efficient and recurrent stroke occurs.
Aim
Aim of this paper is to present the first ever case of repeated IVT with rtPA in a female patient with recurrent stroke, hospitalized at the Department for Urgent Neurology, University Clinic of Neurology in Skopje, North Macedonia with a review from the literature.
Case presentation
A 59 years old female patient was admitted due to acute onset of motor and sensory dysphasia and right-sided hemiplegia. The symptoms occurred 1,5 hours before admission. Urgent computed tomography (CT) of the brain showed chronic cerebral infarction in the left and parietal regions, which causing traction of the left lateral ventricle. The patient experienced her first ischemic stroke 2,5 years ago and she was treated with IVT at the time. At the second hospital admission, the patient was conscious, with vital signs and urgent laboratory parameters within normal range. NIHSS score was 13 and a decision for IVT treatment was made. During the application of rtPA, her vital parameters were stable and no side effects were observed. Neurological status of the patient also improved, with NIHSS of 7 at the end of the IVT treatment. Control CT scan performed 24 hours after was without any new lesions. The patient was discharged in a stable condition, with a NIHSS of 4 and mRS of 3.
Conclusion
Repeated IVT in recurrent stroke is feasible and safe in carefully selected patients. Assessment of risk factors and neuroimaging are crucial when deciding on repeated IVT.Uvod
Recidivi moĆŸdanih udara javljaju se u 25% sluÄajeva tijekom prvih 5 godina nakon inicijalnog dogaÄaja. Svaki ponovljeni moĆŸdani udar poveÄava rizik za teĆŸu onesposobljenost i smrtnost. Intravenska tromboliza (IVT) s rekombinantnim tkivnim aktivatorom plazminogena (rtPA) jedna je od terapijskih moguÄnosti u sluÄajevima kada sekundarna prevencija moĆŸdanog udara nije uÄinkovita te nastupi recidiv moĆŸdanog udara.
Prikaz sluÄaja
Predstavljamo prvi sluÄaj na naĆĄoj klinici s recidivom moĆŸdanim udarom lijeÄenim ponovljenim IVT. 59-godiĆĄnja pacijentica primljena je zbog akutne pojave senzomotore disfazije i desne hemiplegije. Simptomi su se javili 1,5 sata prije prijema u bolnicu. Hitna kompjuterizirana tomografija (CT) mozga nije pokazala nove lezije, dok su se prikazale malacijske lezije u lijevoj frontalnoj i parijetalnoj regiji uzrokujuÄi retraktilne promjene na lijevu lateralnu moĆŸdanu klijetku. Pacijentica je prvi ishemijski moĆŸdani udar doĆŸivjela prije 2,5 godine i tada je lijeÄena IVT-om. Pri ovom prijemu u bolnicu, paci- jentica je bila pri svijesti, s vitalnim znakovima i hitnim laboratorijskim parametrima unutar normal- nih granica. NIHSS rezultat je bio 13 i donesena je odluka o IVT lijeÄenju. Tijekom primjene rtPA, vitalni su joj parametri bili stabilni i nisu primijeÄene nuspojave. NeuroloĆĄki status pacijenta takoÄer se poboljĆĄao na NIHSS od 7 na kraju IVT-a. Kontrolno CT snimnanje mozga nakon 24 sata nije poka- zalo novih lezija. Pacijentica je otpuĆĄten u stabilnom stanju, s NIHSS 4 i mRS 3.
ZakljuÄak
Ponovljeni IVT kod ponovljenog moĆŸdanog udara izvediv je i siguran kod paĆŸljivo odabranih bole- snika. Procjena Äimbenika rizika i nalaz neuoslikovnih metoda prikaza mozga presudni su pri odluci o ponovljenoj primjeni IVT-a
Head-to-head randomized trials are mostly industry sponsored and almost always favor the industry sponsor.
HMGB1: A Common Biomarker and Potential Target for TBI, Neuroinflammation, Epilepsy, and Cognitive Dysfunction
High mobility group box protein 1 (HMGB1) is a ubiquitous nuclear protein released by glia and neurons upon inflammasome activation and activates receptor for advanced glycation end products (RAGE) and toll-like receptor (TLR) 4 on the target cells. HMGB1/TLR4 axis is a key initiator of neuroinflammation. In recent days, more attention has been paid to HMGB1 due to its contribution in traumatic brain injury (TBI), neuroinflammatory conditions, epileptogenesis, and cognitive impairments and has emerged as a novel target for those conditions. Nevertheless, HMGB1 has not been portrayed as a common prognostic biomarker for these HMGB1 mediated pathologies. The current review discusses the contribution of HMGB1/TLR4/RAGE signaling in several brain injury, neuroinflammation mediated disorders, epileptogenesis and cognitive dysfunctions and in the light of available evidence, argued the possibilities of HMGB1 as a common viable biomarker of the above mentioned neurological dysfunctions. Furthermore, the review also addresses the result of preclinical studies focused on HMGB1 targeted therapy by the HMGB1 antagonist in several ranges of HMGB1 mediated conditions and noted an encouraging result. These findings suggest HMGB1 as a potential candidate to be a common biomarker of TBI, neuroinflammation, epileptogenesis, and cognitive dysfunctions which can be used for early prediction and progression of those neurological diseases. Future study should explore toward the translational implication of HMGB1 which can open the windows of opportunities for the development of innovative therapeutics that could prevent several associated HMGB1 mediated pathologies discussed herein
EAN Guideline on Palliative Care of People with Severe, Progressive Multiple Sclerosis
Background and Purpose: Patients with severe, progressive multiple sclerosis (MS) have complex physical and psychosocial needs, typically over several years. Few treatment options are available to prevent or delay further clinical worsening in this population. The objective was to develop an evidence-based clinical practice guideline for the palliative care of patients with severe, progressive MS. Methods: This guideline was developed using the Grading of Recommendations Assessment, Development and Evaluation methodology. Formulation of the clinical questions was performed in the PatientsâInterventionâ ComparatorâOutcome format, involving patients, carers and healthcare professionals (HPs). No uniform deïŹnition of severe MS exists: in this guideline, constant bilateral support required to walk 20m without resting (Expanded Disability Status Scale score >6.0) or higher disability is referred to. When evidence was lacking for this population, recommendations were formulated using indirect evidence or good practice statements were devised. Results: Ten clinical questions were formulated. They encompassed general and specialist palliative care, advance care planning, discussing with HPs the patientâs wish to hasten death, symptom management, multidisciplinary rehabilitation, interventions for caregivers and interventions for HPs. A total of 34 recommendations (33 weak, 1 strong) and seven good practice statements were devised. Conclusions: The provision of home-based palliative care (either general or specialist) is recommended with weak strength for patients with severe, progressive MS. Further research on the integration of palliative care and MS care is needed. Areas that currently lack evidence of efïŹcacy in this population include advance care planning, the management of symptoms such as fatigue and mood problems, and interventions for caregivers and HPs
A life course examination of the physical environmental determinants of physical activity behaviour: A âDeterminants of Diet and Physical Activityâ (DEDIPAC) umbrella systematic literature review
Background: Participation in regular physical activity is associated with a multitude of health benefits across the life course. However, many people fail to meet PA recommendations. Despite a plethora of studies, the evidence regarding the environmental (physical) determinants of physical activity remains inconclusive. Objective: To identify the physical environmental determinants that influence PA across the life course. Methods: An online systematic literature search was conducted using MEDLINE, ISI Web of Science, Scopus and SPORTDiscus. The search was limited to studies published in English (January 2004 to April 2016). Only systematic literature reviews (SLRs) and meta-analyses (MAs) of observational studies, that investigated the association between physical determinants and physical activity outcomes, were eligible for inclusion. The extracted data were assessed on the importance of determinants, strength of evidence and methodological quality. Results: The literature search identified 28 SLRs and 3 MAs on 67 physical environmental characteristics potentially related to physical activity that were eligible for inclusion. Among preschool children, a positive association was reported between availability of backyard space and outdoor toys/equipment in the home and overall physical activity. The availability of physical activity programs and equipment within schools, and neighbourhood features such as pedestrian and cyclist safety structure were positively associated with physical activity in children and adolescents. Negative street characteristics, for example, lack of sidewalks and streetlights, were negatively associated with physical activity in adults. Inconsistent associations were reported for the majority of reviewed determinants in adults. Conclusion: This umbrella SLR provided a comprehensive overview of the physical environment determinants of physical activity across the life course and has highlighted, particularly amongst youth, a number of key determinants that may be associated with overall physical activity. Given the limited evidence drawn mostly from cross-sectional studies, longitudinal studies are needed to further explore these associations. Registration: PROSPERO CRD42015010616
Socio-cultural determinants of physical activity across the life course: A \u27Determinants of Diet and Physical Activity\u27 (DEDIPAC) umbrella systematic literature review
Objective: Regular physical activity (PA) reduces the risk of disease and premature death. Knowing factors associated with PA might help reducing the disease and economic burden caused by low activity. Studies suggest that socio-cultural factors may affect PA, but systematic overviews of findings across the life course are scarce. This umbrella systematic literature review (SLR) summarizes and evaluates available evidence on socio-cultural determinants of PA in children, adolescents, and adults. Methods: This manuscript was drafted following the recommendations of the \u27Preferred Reporting Items for Systematic reviews and Meta-Analyses\u27 (PRISMA) checklist. The MEDLINE, Web of Science, Scopus, and SPORTDiscus databases were searched for SLRs and meta-analyses (MAs) on observational studies published in English that assessed PA determinants between January 2004 and April 2016. The methodological quality was assessed and relevant information on socio-cultural determinants and any associations with PA was extracted. The available evidence was evaluated based on the importance of potential determinants and the strength of the evidence. Results: Twenty SLRs and three MAs encompassing 657 eligible primary studies investigated potential socio-cultural PA determinants, with predominantly moderate methodological quality. Twenty-nine potential PA determinants were identified that were primarily assessed in children and adolescents and investigated the micro-environmental home/household level. We found probable evidence that receiving encouragement from significant others and having a companion for PA were associated with higher PA in children and adolescents, and that parental marital status (living with partner) and experiencing parental modeling were not associated with PA in children. Evidence for the other potential determinants was limited, suggestive, or non-conclusive. In adults, quantitative and conclusive data were scarce. Conclusions: A substantial number of SLRs and MAs investigating potential socio-cultural determinants of PA were identified. Our data suggest that receiving social support from significant others may increase PA levels in children and adolescents, whereas parental marital status is not a determinant in children. Evidence for other potential determinants was limited. This was mainly due to inconsistencies in results on potential socio-cultural determinants of PA across reviews and studies. Trial registrations: This umbrella SLR was recorded on PROSPERO (Record ID: CRD42015010616)
Increased incidence trend of low-grade and high-grade neuroendocrine neoplasms
Purpose: The incidence of neuroendocrine neoplasms is increasing. This work aimed at: (i) establishing worldwide incidence trend of low-grade neuroendocrine neoplasms; (ii) defining the incidence and temporal trend of high-grade neuroendocrine neoplasms in USA utilizing the Surveillance Epidemiology and End Results database; (iii) comparing trends for low-grade vs. high-grade neuroendocrine neoplasms. Methods: We conducted a literature search on MEDLINE and Scopus databases and incidence trends were plotted for 1973-2012. The Surveillance Epidemiology and End Results database was used to identify incidence rates in USA for 1973-2012. Incidence rates were stratified according to histological grade, gender and ethnicity. Trends were summarized as annual percent change and corresponding 95% confidence interval. Results: 11 studies were identified involving 72,048 cases; neuroendocrine neoplasm incidence rates increased over time in all countries for all sites, except for appendix. In Surveillance Epidemiology and End Results low-grade neuroendocrine neoplasm incidence rate increased from 1.09 in 1973 to 3.51 per 100,000 in 2012. During this interval, high-grade neuroendocrine neoplasm incidence rate increased from 2.54 to 10.52 per 100,000. African Americans had the highest rates of digestive neuroendocrine neoplasms with male prevalence in high-grade. Conclusions: Our data indicate an increase in the incidence of neuroendocrine neoplasms as a worldwide phenomenon, affecting most anatomical sites and involving both low-grade and high-grade neoplasms. © 2017, The Author(s)
Behavioural determinants of physical activity across the life course: a "Determinants of Diet and Physical Activity" (DEDIPAC) umbrella literature review
Background
Low levels of physical activity (PA) are a global concern and increasing PA engagement is becoming a priority in current public health policies. Despite the large number of studies and reviews available, the evidence regarding the behavioral determinants of PA is still inconclusive. Thus, the aim of this umbrella systematic literature review (SLR) was to summarize the evidence on the behavioral determinants of PA across the life course.
Methods
A systematic online search was conducted on MEDLINE, ISI Web of Science, Scopus, and SPORTDiscus databases. The search was limited to studies published in English from January, 2004 to April, 2016. SLRs and meta-analyses (MAs) of observational studies that investigated the behavioral determinants of PA were considered eligible. The extracted data were assessed based on the importance of the determinants, the strength of evidence, and the methodological quality. The full protocol is available from PROSPERO (PROSPERO 2014:CRD42015010616).
Results
Seventeen reviews on 35 behavioral determinants of PA were eligible for this umbrella SLR. Regardless of age, the most investigated determinants were those related with âscreen useâ and âsmokingâ. For youth, probable positive evidence emerged for âprevious PAâ and âindependent mobility and active transportâ among children and adolescents. For the adult population, âtransition to universityâ and âpregnancy/having a childâ showed probable negative associations.
Conclusions
Although the majority of the evidence was limited and most of the determinants were not associated with PA, this umbrella SLR provided a comprehensive overview of the associations between behavioral determinants and PA. Youth should be physically active in the early years and increase active transportation to/from school, independent mobility, and âfree-range activitiesâ without adult supervision, whilst adult PA behaviors are mostly influenced by the life events. Finally, more research is needed that incorporates prospective study designs, standardized definitions of PA, objective measurement methods of PA assessment, and the use of interactionist and mediational approaches for the evaluation of different behavioral determinants influencing PA behaviors
Socio-cultural determinants of physical activity across the life course: a 'Determinants of Diet and Physical Activity' (DEDIPAC) umbrella systematic literature review
Objective
Regular physical activity (PA) reduces the risk of disease and premature death. Knowing factors associated with PA might help reducing the disease and economic burden caused by low activity. Studies suggest that socio-cultural factors may affect PA, but systematic overviews of findings across the life course are scarce. This umbrella systematic literature review (SLR) summarizes and evaluates available evidence on socio-cultural determinants of PA in children, adolescents, and adults.
Methods
This manuscript was drafted following the recommendations of the âPreferred Reporting Items for Systematic reviews and Meta-Analysesâ (PRISMA) checklist. The MEDLINE, Web of Science, Scopus, and SPORTDiscus databases were searched for SLRs and meta-analyses (MAs) on observational studies published in English that assessed PA determinants between January 2004 and April 2016. The methodological quality was assessed and relevant information on socio-cultural determinants and any associations with PA was extracted. The available evidence was evaluated based on the importance of potential determinants and the strength of the evidence.
Results
Twenty SLRs and three MAs encompassing 657 eligible primary studies investigated potential socio-cultural PA determinants, with predominantly moderate methodological quality. Twenty-nine potential PA determinants were identified that were primarily assessed in children and adolescents and investigated the micro-environmental home/household level. We found probable evidence that receiving encouragement from significant others and having a companion for PA were associated with higher PA in children and adolescents, and that parental marital status (living with partner) and experiencing parental modeling were not associated with PA in children. Evidence for the other potential determinants was limited, suggestive, or non-conclusive. In adults, quantitative and conclusive data were scarce.
Conclusions
A substantial number of SLRs and MAs investigating potential socio-cultural determinants of PA were identified. Our data suggest that receiving social support from significant others may increase PA levels in children and adolescents, whereas parental marital status is not a determinant in children. Evidence for other potential determinants was limited. This was mainly due to inconsistencies in results on potential socio-cultural determinants of PA across reviews and studies
A life course examination of the physical environmental determinants of physical activity behaviour: A âDeterminants of Diet and Physical Activityâ (DEDIPAC) umbrella systematic literature review.
Background: Participation in regular physical activity is associated with a multitude of health benefits across the life course. However, many people fail to meet PA recommendations. Despite a plethora of studies, the evidence regarding the environmental (physical) determinants of physical activity remains inconclusive.
Objective: To identify the physical environmental determinants that influence PA across the life course.
Methods: An online systematic literature search was conducted using MEDLINE, ISI Web of Science, Scopus and SPORTDiscus. The search was limited to studies published in English (January 2004 to April 2016). Only systematic literature reviews (SLRs) and meta-analyses (MAs) of observational studies, that investigated the association between physical determinants and physical activity outcomes, were eligible for inclusion. The extracted data were assessed on the importance of determinants, strength of evidence and methodological quality.
Results: The literature search identified 28 SLRs and 3 MAs on 67 physical environmental characteristics potentially related to physical activity that were eligible for inclusion. Among preschool children, a positive association was reported between availability of backyard space and outdoor toys/equipment in the home and overall physical activity. The availability of physical activity programs and equipment within schools, and neighbourhood features such as pedestrian and cyclist safety structure were positively associated with physical activity in children and adolescents. Negative street characteristics, for example, lack of sidewalks and streetlights, were negatively associated with physical activity in adults. Inconsistent associations were reported for the majority of reviewed determinants in adults.
Conclusion: This umbrella SLR provided a comprehensive overview of the physical environment determinants of physical activity across the life course and has highlighted, particularly amongst youth, a number of key determinants that may be associated with overall physical activity. Given the limited evidence drawn mostly from cross-sectional studies, longitudinal studies are needed to further explore these associations