Everything you always wanted to know about sex and Neurology: neurological disability and sexuality

ABSTRACT Chronic neurological disorders generate disabilities affecting multiple aspects of life, including sexuality. Objective To describe the presence of sexual dysfunction and comorbidities in a population with chronic neurological disorders. To analyze the relationship between disability and sexual dysfunction. Methods A cross-sectional case-control study was carried out. Patients with amyotrophic lateral sclerosis (ALS), multiple sclerosis (MS), Parkinson’s disease (PD), and stroke of at least one year since the onset of symptoms were included, and compared with controls with no neurological disease, matched by age and sex. Results We included 71 participants: 29 controls, with a mean age of 49.4 years, and 42 patients with a mean age of 53.8 years. Sexual dysfunction was present in 22.5% of the controls and 77.5% of the patients. A statistically significant relationship between sexual dysfunction and disability was found in the logistic regression analysis (OR = 20.38, 95%CI: 2.5 –165.86). Conclusions Disability proved to be the main variable related to the presence of sexual dysfunction. Patients with ALS had the worst rates of sexual dysfunction. Patients with MS were similar to the control group. As for the PD group, no patient had normal sexuality. Finally, in stroke patients, the presence of comorbidities and their treatment may have negatively influenced sexuality. These findings showed that patients with chronic neurological diseases have sexual dysfunction and underscore the need for neurologists to know and address this problem

RACCOMANDAZIONI PER L\u2019ASSISTENZA ALLA DONNA VITTIMA DI VIOLENZA SESSUALE

Di fronte ad una vittima di violenza sessuale la priorit\ue0 assistenziale dovr\ue0 essere la tutela della sua salute e del suo benessere. \uc8 importante restituire alla donna il suo valore di persona in ogni fase del percorso clinico. Trattare la donna con rispetto ed empatia pu\uf2 essere di aiuto nella successiva elaborazione del trauma. \u2022 L\u2019esame fisico e la raccolta delle prove dovrebbero avvenire nello stesso tempo per evitare visite ripetute e lo stress a queste correlato. La completezza dell\u2019esame comporta un inevitabile impegno di tempo e di risorse da parte del personale sanitario. \u2022 Sar\ue0 importante riservare una stanza predisposta per accogliere la vittima per tutto il tempo che rimane nella struttura (in caso di Ospedale la stanza dovr\ue0 essere preferibilmente nel punto di ac\u2011 cesso e cio\ue8 il Pronto Soccorso). Il personale dovr\ue0 rivolgersi alla vittima con voce calma, senza esprimere sorpresa o incredulit\ue0, con parole e atteggiamento assolutamente non giudicante. \u2022 Per aiutare il sanitario ad applicare correttamente le procedure diagnostiche e terapeutiche validate, \ue8 suggerito l\u2019impiego di una SCHEDA CLINICA GUIDATA che si applica alle ragazze di et\ue0 superiore ai 13 anni e alle donne adulte. \u2022 La scheda costituisce documentazione clinica da archiviare e da consegnare eventualmente alla donna in copia per gli usi che ritiene opportuni (per es. la denuncia) oltre al verbale di Pronto Soc\u2011 corso che viene abitualmente compilato. \uc8 inoltre uno strumento che favorisce la raccolta di dati epidemiologici per lo studio del fenomeno. \u2022 Si dovr\ue0 ottenere il consenso per tutta la procedura e per la comunicazione delle informazioni a terzi. Le domande e le scelte della donna saranno assecondate in ogni fase. Nel caso in cui il personale sanitario debba procedere con la denuncia d\u2019ufficio all\u2019Autorit\ue0 Giudiziaria, la donna deve esserne informata ma non \ue8 richiesto consenso. \u2022 La scheda clinica guidata dovr\ue0 inserirsi in una PROCEDURA di accoglienza pi\uf9 ampia sviluppata in modo MULTIDISCIPLINARE che preveda un iter specifico fin dal momento in cui la donna incontra la struttura (generalmente il pronto soccorso) per la risposta standardizzata a ogni problematica presente in caso di violenza sessuale. In particolare si dovr\ue0 definire un protocollo per il metodo di raccolta e conservazione delle prove forensi, un protocollo per la profilassi dell\u2019HIV, un protocollo per i test tossi\u2011 cologici dato che spesso la violenza \ue8 facilitata dall\u2019uso di sostanze, infine un protocollo per la presa in carico successiva della vittima che non pu\uf2 essere abbandonata dopo la prima valutazione. \u2022 La costituzione di una RETE multidisciplinare composta dalle varie competenze e risorse presenti nello specifico ambito territoriale garantir\ue0 la coerenza della presa in carico in fase iniziale e di quella nei tempi successivi, per una tutela della vittima non solo sanitaria ma anche psicologica e sociale nonch\ue9 legale. La legge prevede la denuncia a querela di parte entro dodici mesi, quando non sono presenti le condizioni per denuncia d\u2019ufficio

Risk for Major Bleeding in Patients Receiving Ticagrelor Compared With Aspirin After Transient Ischemic Attack or Acute Ischemic Stroke in the SOCRATES Study (Acute Stroke or Transient Ischemic Attack Treated With Aspirin or Ticagrelor and Patient Outcomes)

International audienc

Risk for Major Bleeding in Patients Receiving Ticagrelor Compared With Aspirin After Transient Ischemic Attack or Acute Ischemic Stroke in the SOCRATES Study (Acute Stroke or Transient Ischemic Attack Treated With Aspirin or Ticagrelor and Patient Outcomes)

Abstract: Background: Patients with minor acute ischemic stroke or transient ischemic attack are at high risk for subsequent stroke, and more potent antiplatelet therapy in the acute setting is needed. However, the potential benefit of more intense antiplatelet therapy must be assessed in relation to the risk for major bleeding. The SOCRATES trial (Acute Stroke or Transient Ischemic Attack Treated With Aspirin or Ticagrelor and Patient Outcomes) was the first trial with ticagrelor in patients with acute ischemic stroke or transient ischemic attack in which the efficacy and safety of ticagrelor were compared with those of aspirin. The main safety objective was assessment of PLATO (Platelet Inhibition and Patient Outcomes)\u2013defined major bleeds on treatment, with special focus on intracranial hemorrhage (ICrH). Methods: An independent adjudication committee blinded to study treatment classified bleeds according to the PLATO, TIMI (Thrombolysis in Myocardial Infarction), and GUSTO (Global Use of Strategies to Open Occluded Coronary Arteries) definitions. The definitions of ICrH and major bleeding excluded cerebral microbleeds and asymptomatic hemorrhagic transformations of cerebral infarctions so that the definitions better discriminated important events in the acute stroke population. Results: A total of 13 130 of 13 199 randomized patients received at least 1 dose of study drug and were included in the safety analysis set. PLATO major bleeds occurred in 31 patients (0.5%) on ticagrelor and 38 patients (0.6%) on aspirin (hazard ratio, 0.83; 95% confidence interval, 0.52\u20131.34). The most common locations of major bleeds were intracranial and gastrointestinal. ICrH was reported in 12 patients (0.2%) on ticagrelor and 18 patients (0.3%) on aspirin. Thirteen of all 30 ICrHs (4 on ticagrelor and 9 on aspirin) were hemorrhagic strokes, and 4 (2 in each group) were symptomatic hemorrhagic transformations of brain infarctions. The ICrHs were spontaneous in 6 and 13, traumatic in 3 and 3, and procedural in 3 and 2 patients on ticagrelor and aspirin, respectively. In total, 9 fatal bleeds occurred on ticagrelor and 4 on aspirin. The composite of ICrH or fatal bleeding included 15 patients on ticagrelor and 18 on aspirin. Independently of bleeding classification, PLATO, TIMI, or GUSTO, the relative difference between treatments for major/severe bleeds was similar. Nonmajor bleeds were more common on ticagrelor. Conclusions: Antiplatelet therapy with ticagrelor in patients with acute ischemic stroke or transient ischemic attack showed a bleeding profile similar to that of aspirin for major bleeds. There were few ICrHs. Clinical Trial Registration: URL: http://www.clinicaltrials.gov. Unique identifier: NCT01994720.Abstract: BACKGROUND: Patients with minor acute ischemic stroke or transient ischemic attack are at high risk for subsequent stroke, and more potent antiplatelet therapy in the acute setting is needed. However, the potential benefit of more intense antiplatelet therapy must be assessed in relation to the risk for major bleeding. The SOCRATES trial (Acute Stroke or Transient Ischemic Attack Treated With Aspirin or Ticagrelor and Patient Outcomes) was the first trial with ticagrelor in patients with acute ischemic stroke or transient ischemic attack in which the efficacy and safety of ticagrelor were compared with those of aspirin. The main safety objective was assessment of PLATO (Platelet Inhibition and Patient Outcomes)-defined major bleeds on treatment, with special focus on intracranial hemorrhage (ICrH). METHODS: An independent adjudication committee blinded to study treatment classified bleeds according to the PLATO, TIMI (Thrombolysis in Myocardial Infarction), and GUSTO (Global Use of Strategies to Open Occluded Coronary Arteries) definitions. The definitions of ICrH and major bleeding excluded cerebral microbleeds and asymptomatic hemorrhagic transformations of cerebral infarctions so that the definitions better discriminated important events in the acute stroke population. RESULTS: A total of 13 130 of 13 199 randomized patients received at least 1 dose of study drug and were included in the safety analysis set. PLATO major bleeds occurred in 31 patients (0.5%) on ticagrelor and 38 patients (0.6%) on aspirin (hazard ratio, 0.83; 95% confidence interval, 0.52-1.34). The most common locations of major bleeds were intracranial and gastrointestinal. ICrH was reported in 12 patients (0.2%) on ticagrelor and 18 patients (0.3%) on aspirin. Thirteen of all 30 ICrHs (4 on ticagrelor and 9 on aspirin) were hemorrhagic strokes, and 4 (2 in each group) were symptomatic hemorrhagic transformations of brain infarctions. The ICrHs were spontaneous in 6 and 13, traumatic in 3 and 3, and procedural in 3 and 2 patients on ticagrelor and aspirin, respectively. In total, 9 fatal bleeds occurred on ticagrelor and 4 on aspirin. The composite of ICrH or fatal bleeding included 15 patients on ticagrelor and 18 on aspirin. Independently of bleeding classification, PLATO, TIMI, or GUSTO, the relative difference between treatments for major/severe bleeds was similar. Nonmajor bleeds were more common on ticagrelor. CONCLUSIONS: Antiplatelet therapy with ticagrelor in patients with acute ischemic stroke or transient ischemic attack showed a bleeding profile similar to that of aspirin for major bleeds. There were few ICrHs