Dynamic Hyperglycemic Patterns Predict Adverse Outcomes in Patients with Acute Ischemic Stroke Undergoing Mechanical Thrombectomy

Admission hyperglycemia impairs outcome in acute ischemic stroke (AIS) patients undergoing mechanical thrombectomy (MT). Since hyperglycemia in AIS represents a dynamic condition, we tested whether the dynamic patterns of hyperglycemia, defined as blood glucose levels > 140 mg/dl, affect outcomes in these patients

Modulation of ongoing cognitive processes by emotionally intense words

Abstract Contrary to what occurs with negative pictures, negative words are, in general, not capable of interfering with performance in ongoing cognitive tasks in normal subjects. A probable explanation is the limited arousing power of linguistic material. Especially intense words (insults and compliments), neutral personal adjectives, and pseudowords were presented to 28 participants while they executed a lexical decision task. Insults were associated with the poorest performance in the task and compliments with the best. Amplitude of the late positive component of the event-related potentials, originating at parietal areas, was maximal in response to compliments and insults, but latencies were delayed in response to the latter. Results suggest that intense emotional words modulate ongoing cognitive processes through both bottom-up (attentional capture by insults) and top-down (facilitation of cognitive processing by arousing words) mechanisms

The use of alteplase, although safe, does not offer clear clinical advantages when mild stroke is non-disabling

IntroductionIt is unknown whether alteplase is effective and safe in patients with mild acute ischemic stroke (AIS). Determining whether symptoms are “disabling” or not is a crucial factor in the management of these patients. This study aimed to investigate the efficacy and safety of alteplase in patients with mild, non-disabling AIS.MethodsWe included all consecutive patients admitted for AIS at our institution from January 2015 to May 2022 who presented a baseline NIHSS score of 0–5 and fit the criteria to receive intravenous thrombolysis. In order to select only subjects with non-disabling AIS, we excluded patients who scored more than 1 point in the following NIHSS single items: vision, language, neglect, and single limb. Patients who scored at least 1 point in the NIHSS consciousness item were excluded as well. This study is a retrospective analysis of a prospectively collected database.ResultsAfter the application of the exclusion criteria, we included 319 patients, stratified into patients receiving and not receiving alteplase based on non-disabling symptoms. The two groups were comparable regarding demographic and clinical data. Rates of a 3-month favorable outcome, defined as a 3-month mRS score of 0–1, were similar, being 82.3% and 86.1% in the treated and untreated patients, respectively. Hemorrhagic complications and mortality occurred infrequently and were not affected by alteplase treatment.DiscussionThis observational study suggests that the use of alteplase, although safe, is not associated with a better outcome in highly selected patients with non-disabling AIS

Pattern of Relapse and Treatment Response in WNT- Activated Medulloblastoma

Over the past decade, wingless-activated (WNT) medulloblastoma has been identified as a candidate for therapy de-escalation based on excellent survival; however, a paucity of relapses has precluded additional analyses of markers of relapse. To address this gap in knowledge, an international cohort of 93 molecularly confirmed WNT MB was assembled, where 5-year progression-free survival is 0.84 (95%, 0.763-0.925) with 15 relapsed individuals identified. Maintenance chemotherapy is identified as a strong predictor of relapse, with individuals receiving high doses of cyclophosphamide or ifosphamide having only one very late molecularly confirmed relapse (p = 0.032). The anatomical location of recurrence is metastatic in 12 of 15 relapses, with 8 of 12 metastatic relapses in the lateral ventricles. Maintenance chemotherapy, specifically cumulative cyclophosphamide doses, is a significant predictor of relapse across WNT MB. Future efforts to de-escalate therapy need to carefully consider not only the radiation dose but also the chemotherapy regimen and the propensity for metastatic relapses

Disease Activity and Progression in Multiple Sclerosis: New Evidences and Future Perspectives

Multiple sclerosis (MS) is a chronic, debilitating, autoimmune-mediated, inflammatory disease of the central nervous system (CNS), in which a combination of inflammation, demyelination and axonal degeneration takes place with extreme highly interpersonal variability [...

Factores de Riesgo Psicosocial y Burnout en Poblaci�n Econ�micamente Activa de Lima, Per�

El estudio de los factores de riesgo psicosocial recobra mayor relevancia ante las din�micas impuestas por las econom�as globalizadas que generan entornos competitivos, aumentando las exigencias f�sicas, psicol�gicas y sociales de los trabajadores, quienes manifiestan diversas respuestas como el estr�s laboral cr�nico tambi�n conocido como burnout o S�ndrome de Quemarse por el Trabajo (SQT). El presente estudio tuvo como objetivo determinar la prevalencia del burnout y su relaci�n con la presencia de factores de riesgo psicosocial laborales, percibidos como negativos en trabajadores de la Poblaci�n Econ�micamente Activa (PEA) de Lima, Per�. Se encuestaron 339 trabajadores con la aplicaci�n del Inventory General Survey (MBI-GS)�, instrumento en su nueva versi�n, y la escala de Factores Psicosociales en el Trabajo�, encontr�ndose prevalencia de burnout muy alto en la dimensi�n desgaste emocional o agotamiento (6,22%), asociado con 4 diferentes factores de riesgo psicosocial. El mayor factor de riesgo lo representan las exigencias laborales (p<0,004) y (OR= 6,979) con la dimensi�n cinismo de burnout; lo anterior deja de manifiesto que ante las exigencias laborales, los trabajadores expresan actitudes c�nicas como mecanismo de defensa, por lo que se concluye que la prevalencia del burnout se relaciona significativamente con los factores de riesgo psicosocial, de ah� que las organizaciones deben prestar especial atenci�n en estos factores

Erenumab Impact on Sleep Assessed With Questionnaires and Home-Polysomnography in Patients With Migraine: The ERESON Study

Introduction: Migraine and sleep share a complex and unclear relationship. Poor sleep may trigger migraine attacks; migraine, in turn, is frequently associated with sleep disorders. Few previous studies used questionnaires to assess sleep changes in patients who were treated with migraine-preventive medications (MPMs). More extensive polysomnography (PSG)-based studies for this purpose were not available. Objective: To investigate possible sleep changes in patients with migraine treated with erenumab, using validated sleep questionnaires and home-PSG. Methods: This observational, prospective, open-label pilot study was conducted at the Clinical Neurology Unit Headache Center of Udine University Hospital from 2020 to 2021. Patients were treated with erenumab as monotherapy or add-on treatment for migraine prevention. Sleep changes were evaluated with questionnaires and polysomnographic recordings at baseline, after 3 and 12 months of treatment. Erenumab efficacy and safety in migraine prophylaxis were also investigated. Results: Twenty-nine patients completed 3 months of follow-up, whereas 15 patients completed 12 months. We found a weak trend of improvement in daytime somnolence after 3 months of treatment, with stronger results after 12 months (median Epworth Sleepiness Scale (ESS) score from 6.0 to 4.0, p = 0.015); a significant improvement in subjective sleep quality (median Pittsburgh Sleep Quality Index (PSQI) total score from 7 to 5; p = 0.001) was also observed. Home-PSG showed a significant increase in objective sleep efficiency (SE), both after 3 (from 88.1 to 91.0, p = 0.006) and 12 months (from 87.1 to 91.0, p = 0.006) of treatment. In addition, our data confirmed erenumab effectiveness and safety in migraine prevention. Conclusion: Our study demonstrated an improvement in both subjective and objective sleep quality in patients treated with a migraine-preventive therapy. Erenumab, in particular, does not cross the blood-brain barrier (BBB), thus a direct effect on sleep is unlikely. Future studies are needed to better understand the mutual influence between migraine and sleep disorders

Restless legs syndrome in internal medicine

Restless legs syndrome/Willis-Ekbom Disease (RLS/WED) is a common but still underdiagnosed neurological disorder. RLS/WED might impair nocturnal rest causing decreased alertness, depression, reduced job performance and poor quality of life. RLS/WED can occur as an isolated disease, mostly at a young age, or can be associated with comorbidities such as cardiovascular disease, diabetes, renal failure, arterial hypertension and peripheral neuropathy. The literature also offers some evidence of an association with gastrointestinal, rheumatological, pneumological, and neoplastic disorders. It is important to be aware of these associations in order to promptly recognize RLS/WED and also to think about an underlying medical condition when a patient reports symptoms of RLS/WED

Efectos del pago por servicios ambientales y la certificaci?n forestal en el desempe?o ambiental y socioecon?mico del manejo de bosques naturales en Costa Rica

7 ilus. 7 tab. 46 ref