External Validation of the PREMISE Score in the Athens Stroke Registry

Background: A simple score was proposed recently for Predicting Early Mortality from Ischemic Stroke (PREMISE) derived from the Austrian Stroke Unit Registry. This score could be useful in clinical practice and research. However, its generalizability is uncertain, as it was validated internally only. Aims: We aimed to validate the PREMISE score externally. Methods: The analysis was performed in the Athens Stroke Registry. The PREMISE score was calculated as described in the original publication. The outcome was death within 7 days after stroke. Logistic regression analysis was used to estimate the relative death risk in different strata of the PREMISE score using the lowest values of the score (ie, 0-4) as the reference category. We assessed the score's calibration by the Hosmer-Lemeshow goodness-of-fit test and its discriminatory power by calculating the area under the receiver operating characteristics curve (AUC). Results: In 2608 consecutive patients (median age 71 years, 38.8% women) with acute ischemic stroke treated in the stroke unit, mortality increased with increasing PREMISE score from .1% (95% confidence intervals [95% CI]: 0%-.2%) in patients with a score of 0-4 to 28.2% (95% CI: 14.1%-42.3%) in patients with a score of ≥10. The risk for death was more than 6 times higher in patients with a PREMISE score of ≥10 compared to patients with 0-4 points (odds ratio [OR]:6.21, 95% CI:4.13-8.29). Τhe PREMISE score showed excellent calibration (Hosmer-Lemeshow χ2: .01, P= .99) and good discriminatory power (AUC .873, 95% CI: .844-.901). Conclusions: The present study confirms the prognostic accuracy of the PREMISE score in an independent cohort of patients with acute ischemic stroke treated in the stroke unit. © 2019 Elsevier Inc

Interoceptive awareness in essential hypertension

Objective: Clinical practice and research provide evidence indicating the involvement of psychological factors in essential hypertension. Little is known about interoception (i.e. the ability of perceiving bodily signals) in essential hypertension. The present study focused on the assessment of interoceptive awareness in newly diagnosed-untreated hypertensives by means of ambulatory blood pressure monitoring (ABPM), a useful tool in the detection and evaluation of hypertension. Methods: The study population consisted of 50 untreated newly diagnosed hypertensives (48.3 ± 9.7. years) and 31 normotensives (49.5 ± 14.2. years) matched regarding sex, BMI and prevalence of smoking. All participants underwent 24-hour ABPM (Spacelabs 90207). Cardiac interoceptive awareness was assessed by means of a heartbeat detection task. Results: Hypertensives exhibited higher office blood pressure (BP) and heart rate (HR) levels (clinic systolic BP: 152 ± 20 vs 140 ± 17; p= 0.01, clinic diastolic BP: 95 ± 10 vs 89 ± 11; p= 0.008, clinic HR: 82 ± 13 vs 74 ± 11; p= 0.04) as well as ambulatory measurements (systolic BP24: 137 ± 11 vs 119 ± 7; p< 0.001, diastolic BP24: 87 ± 7 vs 73 ± 5; p< 0.001, HR24: 79 ± 9 vs 71 ± 10; p< 0.01) compared to normotensives. Moreover, the analysis revealed an increased interoceptive awareness in hypertensives as compared to normotensives. A comparison within the hypertensive group between subjects with and without interoceptive awareness revealed that subjects with increased interoceptive awareness had higher office systolic and diastolic blood pressure values, as well as mean ambulatory HR. Conclusion: These findings give credence to the idea that interoceptive awareness may represent an enhanced cardiovascular reactivity involved in essential hypertension, even in its early stages. The cross-sectional nature of this study precludes causal inference, but provides valuable directions for future prospective investigations. © 2010 Elsevier B.V

Diagnosis and management of hypertension in advanced renal cell carcinoma: Prospective evaluation of an algorithm in patients treated with sunitinib

Hypertension may complicate treatment with antiangiogenic agents, leading to dose reductions and treatment delays. To prospectively evaluate the frequency and management of hypertension in 10 patients with advanced kidney cancer receiving sunitinib, we used 24-h blood pressure monitoring (BPM) and home BPM and homogenously treated hypertension according to guidelines of the European Society of Hypertension. Normal BP was ensured prior to sunitinib initiation with the successive use of hydrochlorothiazide + irbesartan, nebivolol, amlodipine. During treatment, additional antihypertensive therapy was introduced, if necessary. Sunitinib dose was modified only if BP was not controlled with four anti-hypertensive agents. Four patients had baseline hypertension, while 5 of 6 normotensive patients required antihypertensive treatment during sunitinib administration. One patient permanently discontinued sunitinib due to hypertensive crisis but 9 patients received full dose. Sunitinib-associated hypertension is more frequent than previously reported. Aggressive BP monitoring and treatment of hypertension may achieve uninterrupted, full-dose therapy in most patients treated with sunitinib. The application of such protocols instead of commonly used toxicity criteria should be further validated. © E.S.I.F.T. srl

Convexity Subarachnoid Hemorrhage Due to Cardioembolic Stroke in a Woman with Thyrotoxicosis: Α Case Report

Background Non-traumatic convexity subarachnoid hemorrhage (cSAH) is a rarely reported condition with a wide spectrum of etiologies. Cerebral ischemia secondary to extracranial or intracranial atherosclerotic disease has been identified as a relatively uncommon cause of cSAH. Case report We report a case of cSAH caused by cardioembolic stroke. A 69-year old female patient developed suddenly left-sided face and body weakness and numbness and visual neglect on the left. She was newly detected with paroxysmal atrial fibrillation on the ground of thyrotoxicosis. Brain magnetic resonance imaging revealed ischemia of embolic pattern with cSAH. Further evaluation excluded other cause of hemorrhage. Dilation of leptomeningeal collateral vessels and rupture of pial vessels in distal cortical arteries may caused cSAH. Full anticoagulation was initiated. After one month, her condition improved significantly (NIHSS from 6 to 2). Conclusions cSAH may be a rare complication of cardioembolic stroke. © 2017 National Stroke Associatio

Diagnosis and management of hypertension in advanced renal cell carcinoma: prospective evaluation of an algorithm in patients treated with sunitinib

Hypertension may complicate treatment with antiangiogenic agents, leading to dose reductions and treatment delays. To prospectively evaluate the frequency and management of hypertension in 10 patients with advanced kidney cancer receiving sunitinib, we used 24-h blood pressure monitoring (BPM) and home BPM and homogenously treated hypertension according to guidelines of the European Society of Hypertension. Normal BP was ensured prior to sunitinib initiation with the successive use of hydrochlorothiazide + irbesartan, nebivolol, amlodipine. During treatment, additional antihypertensive therapy was introduced, if necessary. Sunitinib dose was modified only if BP was not controlled with four anti-hypertensive agents. Four patients had baseline hypertension, while 5 of 6 normotensive patients required antihypertensive treatment during sunitinib administration. One patient permanently discontinued sunitinib due to hypertensive crisis but 9 patients received full dose. Sunitinib-associated hypertension is more frequent than previously reported. Aggressive BP monitoring and treatment of hypertension may achieve uninterrupted, full-dose therapy in most patients treated with sunitinib. The application of such protocols instead of commonly used toxicity criteria should be further validated. © E.S.I.F.T. srl