Gender Differences in Acute Ischemic Stroke Treatment

Introduction: In order to personalize stroke treatment, it is important to know if there are differences between genders in clinical features, acute phase treatment and outcomes. Material and Methods: Longitudinal retrospective study that included patients with ischemic stroke, admitted in a stroke unit during a 30 months period and treated with throm bectomy with or without thrombolysis. The objective was to assess gender differences. Results: Of 594 patients included, 50% were women. At admission, women had higher median age (78 vs 73 years), higher modified Rankin Score (mRS) and higher median Na tional Institutes of Health Stroke Scale (NIHSS). No gender differences were found in treatment type, median time be tween symptoms onset and computed tomography, between computed tomography and thrombolysis and with respect to revascularization success. Disability expressed by mRS and mortality at 3 months were similar between genders. More women had atrial fibrillation (AF) (51% vs 35%), nevertheless, less women with known AF were receiving anticoagulant ther apy before the event, compared to men (38% vs 52%). Discussion: Even if women were older and had worse pre morbid functional status, no gender differences were evident with regard to acute phase treatment efficacy and medium term outcomes. Conclusion: In women, age should not limit acute phase treatment of stroke and decisions should be individualizedIntrodução: Na abordagem personalizada do acidente vascular cerebral (AVC) é importante definir se existem diferenças de género relativamente às caraterísticas clínicas, tratamento de fase aguda e resultados. Material e Métodos: Estudo longitudinal retrospetivo que incluiu doentes com AVC isquémico admitidos na Unidade Cerebro Vascular, durante 30 meses, tratados com trombectomia com ou sem trombólise prévia, com o objetivo de avaliar diferenças de género. Resultados: De 594 doentes, 50% eram mulheres apresentando, à admissão, idade mediana maior (78 vs 73 anos), maior pontuação na escala modificada de Rankin (mRS) e na National Institutes of Health Stroke Scale (NIHSS). Não houve diferenças no tipo de tratamento, no tempo mediano entre o início dos sintomas e tomografia computadorizada (TC), entre o tempo TC-trombólise ou na eficácia da revascularização. A disabilidade expressa pelo valor de mRS e a mortalidade aos 3 meses foram sobreponíveis entre géneros. Mais mulheres sofriam de fibrilhação auricular (FA) (51% vs 35%), no entanto menos mulheres com FA conhecida recebiam terapêutica anticoagulante antes do evento, comparativamente aos homens (38% vs 52%). Discussão: Apesar das mulheres apresentarem idade mais elevada e maior grau de dependência, não existiram diferenças de género na eficácia do tratamento de fase aguda nem nos resultados a médio prazo. Conclusão: No género feminino, a idade não deve constituir uma limitação à realização de terapêutica de fase aguda do AVC.info:eu-repo/semantics/publishedVersio

Fatal CTLA-4 Heterozygosity With Autoimmunity and Recurrent Infections: a De Novo Mutation

Primary immunodeficiency disorders are rarely diagnosed in adults but must be considered in the differential diagnosis of combined recurrent infections and autoimmune disease. We describe a patient with CTLA-4 haploinsufficiency and an abnormal regulatory T-cell phenotype. Unusually, infections were more severe than autoimmunity, illustrating therapeutic challenges in disease course.info:eu-repo/semantics/publishedVersio

Mandibular Resorption and Vocal Cord Paralysis: a Catastrophic Form of Systemic Sclerosis

Sudden respiratory distress in association with severe weight loss are unusual features of systemic sclerosis (SSc). We report the case of a 56-year-old Caucasian woman with a 9-year history of a diffuse form of SSc who presented with acute stridor due to vocal cord paralysis and required an emergency tracheostomy. She had sought medical attention only after 4 years of disease onset, presenting with a mask-like face, diffuse skin thickening, acro-osteolysis and severe interstitial lung disease. Even though skin tightness improved after immunosuppressive treatment, several spontaneous facial fractures and episodes of dysphagia and choking occurred in the years that followed. At the time of stridor, she was severely malnourished and a percutaneous endoscopic gastrostomy was required for feeding. Permanent vocal cord damage in combination with severe loco-regional bone resorption resulted in severe disability and impaired nutrition. We hereby highlight the features of SSc for which therapy remains challenging.info:eu-repo/semantics/publishedVersio

Fatal CTLA-4 Heterozygosity With Autoimmunity and Recurrent Infections: a De Novo Mutation

Primary immunodeficiency disorders are rarely diagnosed in adults but must be considered in the differential diagnosis of combined recurrent infections and autoimmune disease. We describe a patient with CTLA-4 haploinsufficiency and an abnormal regulatory T-cell phenotype. Unusually, infections were more severe than autoimmunity, illustrating therapeutic challenges in disease course.info:eu-repo/semantics/publishedVersio

The impact of COVID-19 on rare and complex connective tissue diseases: the experience of ERN ReCONNET

During the COVID-19 pandemic, the need to provide high-level care for a large number of patients with COVID-19 has affected resourcing for, and limited the routine care of, all other conditions. The impact of this health emergency is particularly relevant in the rare connective tissue diseases (rCTDs) communities, as discussed in this Perspective article by the multi-stakeholder European Reference Network on Rare and Complex Connective Tissue and Musculoskeletal Diseases (ERN ReCONNET). The clinical, organizational and health economic challenges faced by health-care providers, institutions, patients and their families during the SARS-CoV-2 outbreak have demonstrated the importance of ensuring continuity of care in the management of rCTDs, including adequate diagnostics and monitoring protocols, and highlighted the need for a structured emergency strategy. The vulnerability of patients with rCTDs needs to be taken into account when planning future health policies, in preparation for not only the post-COVID era, but also any possible new health emergencies

The impact of COVID-19 on rare and complex connective tissue diseases: the experience of ERN ReCONNET

none57During the COVID-19 pandemic, the need to provide high-level care for a large number of patients with COVID-19 has affected resourcing for, and limited the routine care of, all other conditions. The impact of this health emergency is particularly relevant in the rare connective tissue diseases (rCTDs) communities, as discussed in this Perspective article by the multi-stakeholder European Reference Network on Rare and Complex Connective Tissue and Musculoskeletal Diseases (ERN ReCONNET). The clinical, organizational and health economic challenges faced by health-care providers, institutions, patients and their families during the SARS-CoV-2 outbreak have demonstrated the importance of ensuring continuity of care in the management of rCTDs, including adequate diagnostics and monitoring protocols, and highlighted the need for a structured emergency strategy. The vulnerability of patients with rCTDs needs to be taken into account when planning future health policies, in preparation for not only the post-COVID era, but also any possible new health emergencies.noneTalarico R.; Aguilera S.; Alexander T.; Amoura Z.; Antunes A.M.; Arnaud L.; Avcin T.; Beretta L.; Bombardieri S.; Burmester G.R.; Cannizzo S.; Cavagna L.; Chaigne B.; Cornet A.; Costedoat-Chalumeau N.; Doria A.; Ferraris A.; Fischer-Betz R.; Fonseca J.E.; Frank C.; Gaglioti A.; Galetti I.; Grunert J.; Guimaraes V.; Hachulla E.; Houssiau F.; Iaccarino L.; Krieg T.; Limper M.; Malfait F.; Mariette X.; Marinello D.; Martin T.; Matthews L.; Matucci-Cerinic M.; Meyer A.; Montecucco C.; Mouthon L.; Muller-Ladner U.; Rednic S.; Romao V.C.; Schneider M.; Smith V.; Sulli A.; Tamirou F.; Taruscio D.; Taulaigo A.V.; Terol E.; Tincani A.; Ticciati S.; Turchetti G.; van Hagen P.M.; van Laar J.M.; Vieira A.; de Vries-Bouwstra J.K.; Cutolo M.; Mosca M.Talarico, R.; Aguilera, S.; Alexander, T.; Amoura, Z.; Antunes, A. M.; Arnaud, L.; Avcin, T.; Beretta, L.; Bombardieri, S.; Burmester, G. R.; Cannizzo, S.; Cavagna, L.; Chaigne, B.; Cornet, A.; Costedoat-Chalumeau, N.; Doria, A.; Ferraris, A.; Fischer-Betz, R.; Fonseca, J. E.; Frank, C.; Gaglioti, A.; Galetti, I.; Grunert, J.; Guimaraes, V.; Hachulla, E.; Houssiau, F.; Iaccarino, L.; Krieg, T.; Limper, M.; Malfait, F.; Mariette, X.; Marinello, D.; Martin, T.; Matthews, L.; Matucci-Cerinic, M.; Meyer, A.; Montecucco, C.; Mouthon, L.; Muller-Ladner, U.; Rednic, S.; Romao, V. C.; Schneider, M.; Smith, V.; Sulli, A.; Tamirou, F.; Taruscio, D.; Taulaigo, A. V.; Terol, E.; Tincani, A.; Ticciati, S.; Turchetti, G.; van Hagen, P. M.; van Laar, J. M.; Vieira, A.; de Vries-Bouwstra, J. K.; Cutolo, M.; Mosca, M

The impact of COVID-19 on rare and complex connective tissue diseases: the experience of ERN ReCONNET

During the COVID-19 pandemic, the need to provide high-level care for a large number of patients with COVID-19 has affected resourcing for, and limited the routine care of, all other conditions. The impact of this health emergency is particularly relevant in the rare connective tissue diseases (rCTDs) communities, as discussed in this Perspective article by the multi-stakeholder European Reference Network on Rare and Complex Connective Tissue and Musculoskeletal Diseases (ERN ReCONNET). The clinical, organizational and health economic challenges faced by health-care providers, institutions, patients and their families during the SARS-CoV-2 outbreak have demonstrated the importance of ensuring continuity of care in the management of rCTDs, including adequate diagnostics and monitoring protocols, and highlighted the need for a structured emergency strategy. The vulnerability of patients with rCTDs needs to be taken into account when planning future health policies, in preparation for not only the post-COVID era, but also any possible new health emergencies