The use of swallowing test for prevention of pneumonia in patients with stroke

State University of Medicine and Pharmacy “Nicolae Testemiţanu”, Department of Neurology no.1, Congresul consacrat aniversării a 75-a de la fondarea Universității de Stat de Medicină și Farmacie „Nicolae Testemițanu” din Republica Moldova, Ziua internațională a științei pentru pace și dezvoltareIntroduction According to the WHO, 15 million people suffer stroke worldwide each year. Of these, 5 million die and another 5 million are permanently disabled. In the Republic of Moldova, the share of stroke in the structure of cerebrovascular diseases, on average, is 25.0%, and the average mortality is 201.2 cases per 100,000 inhabitants. Up to 95% of patients have at least one complication in the first 3 months after a stroke and about a third of them die during hospitalization due to it. The most common are infectious complications, including pneumonia, which occur in 30% of post-stroke patients. The frequency of pneumonia associated with stroke is between 5 and 22%, half of which occur in the first 48 hours after the onset of stroke. The main factor causing pneumonia is dysphagia detected in approximately 55% of patients with acute stroke. Dysphagic patients are 3 times more likely to develop pneumonia, and those with confirmed aspiration eleven times more likely. Materials & Methods It is presented a retrospective research of 94 patients hospitalized in the Neuro Emergency Department of the Institute of Neurology and Neurosurgery, during September (44 patients) and December (50 patients) 2019, with the diagnosis of acute stroke. Of these, 50 patients were participants in the QASC (Quality in Acute Stroke Care) program, undergoing the FeSS (Fever, Sugar, Swallow) protocol. The material was selected according to a questionnaire that included clinical and paraclinical examination, evaluation scales (NIHSS, mRS, GCS) and methods applied to prevent pneumonia. Results By analyzing the graph.1, it has been determined that there was no essential difference in number of patients (50% of each lot) who received antibiotic prophylaxis during hospitalization. As well, only subjects of December were tested for swallowing problems- 50 patients (100%), with an important statistical difference (p <0,05). On this line, in graph.2, it was observed that the incidence of pneumonia in September is higher- 27 patients (61.4%), in comparison with December- 22 patients (44%). Conclusions The use of swallowing test (p < 0,05), has contributed to the decrease of frequency of pneumonia by 17,4% cases, being far superior to antibiotic prophylaxis that proved no efficiency in preventing stroke associated pneumonia

Clinical features of cerebral venous thrombosis based on a series of 50 cases

Background: Cerebral venous thrombosis (CVT) is responsible for approximately 1% of all strokes. Diagnosis is often delayed due to nonspecific clinical features and the subacute course of the disease. We aimed to analyze the clinical pattern of patients with CVTs in a tertiary neurological hospital. Material and methods: The study included patients with CVTs, admitted to the Institute of Neurology and Neurosurgery between 2008 and 2021. The diagnosis was confirmed by MRI and/or CT-angiography images. Results: Totally 50 patients with CVTs were included, with a median age of 45.3 years, 27 females. The venous infarct was noticed in 13, subarachnoid hemorrhage – in 7, and no cerebral parenchymal lesion was seen in 25 cases. The thrombus occluded superior sagittal sinus (23), transvers sinus (18), cavernous sinus (16), cerebral veins (3). In 16 patients there were multiple venous sinus involvement. Risk factors were present in 34 cases: infections (22), prothrombotic states (6), puerperium (4), cancer (4), oral contraceptives (3), head injury (3), autoimmune disease (1). In 7 cases multiple risk factors were noticed. The most common clinical features were: the abrupt onset (34), intracranial hypertension (33), headache (29), focal deficit (18), visual loss (13), epileptic seizures (8). 5 patients (10%) died. 27 patients were prescribed anticoagulants and 5 patients received modified Rankin score 0 at discharge. Conclusions: Young adults with new onset headache, visual loss or other focal lesions should be evaluated for CVT in order to avoid severe consequences and long-term disability

Involvement of TSP1 and MMP9/NGAL in Angiogenesis during Orthodontic Periodontal Remodeling

In the present study the aim was to measure the levels of Thrombospondin-1 (TSP1) and Lipocalin-2/matrix metalloproteinase 9 (MMP9/NGAL) complex in gingival crevicular fluid (GCF) at different time points of orthodontic treatment, to determine the relationship between these values and those of total-matrix metalloproteinase 9 (MMP9) and theirs implication in angiogenesis balance, in the situation of a good control of the bacterial plaque, emphasizing the role of TSP1 and MMP9/NGAL complex. GCF samples were collected from 16 young orthodontic patients requiring upper canine distalization (test tooth) with first premolar extraction. The contralateral canine (control tooth) was free from orthodontic force. For the orthodontic appliance, brackets Roth 0.018 inch with 0.012 inch NiTi archwire and a laceback were used. TSP1, MMP9/NGAL, and MMP9 increased from 1 hour before activation of orthodontic appliance to a maximum at 8 hours for MMP9 and 72 hours for MMP9/NGAL and TSP1. The results show a change in time of TSP1, MMP9/NGAL, and MMP9 levels in GCF of patients with this method of orthodontic treatment. The powerful correlation of MMP9/NGAL with TSP1 suggests their stronger involvement in angiogenesis processes in PDL during orthodontic periodontal remodeling, in the situation of a healthy periodontium and a good control of the bacterial plaque

The Relationship of Cytokines IL-13 and IL-17 with Autoantibodies Profile in Early Rheumatoid Arthritis

Aims. In the present study, we aimed to assess the concentrations of IL-13 and IL-17 in serum of patients with early rheumatoid arthritis (eRA), the investigation of correlation between the concentrations of these cytokines and disease activity score, and the concentration of some autoantibodies and the evaluation of the utility of IL-13 and -17 concentration measurements as markers of disease activity. Materials and Methods. Serum samples were collected from 30 patients and from 28 controls and analysed parameters. Results. The serum concentrations of IL-13, IL-17, anti-CCP, and IgM-RF were statistically significantly higher in patients with eRA, compared to the controls. IL-13 concentrations in the severe and moderate groups with eRA were statistically higher than in the mild and control groups. Also, in the case of IL-17, serum concentrations increased proportionally with the disease activity of eRA. We observe that concentrations of IL-13 and -17 did not correlate with autoantibodies. IL-17 concentration significantly positively correlated with CRP, while IL-13 concentration significantly negatively correlated with CRP. Disease activity score, DAS28, was strongly positively correlated with levels of ESR and weakly positively correlated with concentrations of anti-RA33 autoantibodies. IL-13 has a higher diagnostic utility than IL-17, CRP, ESR, IgM-RF, and anti-CCP as markers of disease activity. Conclusions. The presence of higher IL-13 and IL-17 serum levels in patients, compared with those of controls, confirms that these markers, found with high specificity, might be involved in the pathogenesis of eRA. IL-13 and IL-17 might be of better usefulness in the prediction of eRA activity status than IgM-RF and anti-CCP

THE SPECTRUM OF IGG4-RELATED DISEASES

IgG4-related disease (IgG4-RD) is now recognized as a worldwide disease. It is a rare systemic fibroinflammatory disorder. The evaluation for IgG4-RD should include a comprehensive clinical history, physical examination, and selected laboratory investigation, along with appropriate radiologic studies. A wide variety of organs can be involved in IgG4-RD. Confirmation of the diagnosis by biopsy is important for the exclusion of malignancy and other disorders that may mimic IgG4-RD. Consequently, diagnostic criteria for IgG4-RD have been proposed recently. The hallmarks of IgG4-RD are lymphoplasmacytic tissue infiltration of mainly IgG4-positive plasma cells and small lymphocytes, which may be accompanied by fibrosis, obliterative phlebitis, and, in the majority of patients, elevated serum levels of IgG4. The serum IgG4 level is elevated above the upper limit of normal (>135 mg/dL). The serum IgG4 concentration tends to increase with the number of organs involved and usually decreases after treatment with glucocorticoids. Among several autoantibodies identified so far, autoantibodies against lactoferrin and carbonic anhydrase II are most frequently detected in serum of IgG4-disease patients. Glucocorticoids, azathioprine, micophenolate mofetil, methotrexate and rituximab are therapeutical options

COULD BE CONSIDERED SERUM ANTI-S-100 AUTOANTIBODIES A BIOMARKER IN PATIENTS WITH ACUTE NON-CARDIOEMBOLIC ISCHEMIC STROKE?

In ischemic stroke patients there were found autoantibodies against brain epitopes. The presence of anti-S-100 autoantibodies may reflect alteration and dysfunction of the blood-brain barrier. The aim of the study was to assess the prevalence of serum anti-S-100 autoantibodies in the early stage of ischemic non-cardioembolic stroke and their correlation with clinical outcome. The study included 78 patients with acute non-cardioembolic ischemic stroke, 46 females and 32 males, ranges from 46 to 81 years, mean age 74.3±6.8 years. Blood samples for anti-S-100 autoantibodies measurement were taken within 24 hours after the onset of ischemic stroke. Seventy-two patients served as matched controls 43 females and 29 males, ranges from 42 to 79 years, mean age 71.3±6.4 years. Serum anti-S-100 autoantibodies were measured by means of ELISA. Significance difference between groups was calculated by the Wilcoxon signed rank method. A value of p<0.05 was considered significant. Anti-S-100 autoantibodies were detected in 25 patients (32%). Patients with acute ischemic stroke had significantly higher levels of anti-S-100 autoantibodies (87.3±9.23 IU/ml) as compared to healthy controls (23.1±1.17 IU/ml) (p<0.01). In 24 patients the cerebral CT scan was negative in the first 24 hours, out of them in 6 patients anti-S-100 autoantibodies were positive. The higher titers correlated significantly with worse clinical outcome (132.0±12.4 IU/ml; p<0.001). The negative predictive value of anti-S-100 autoantibodies was 87%, and positive predictive value of anti-S-100 autoantibodies was 71%. Measurement of anti-S-100 autoantibodies may be used to select patients with early negative cerebral CT scanning as presenting ischemic stroke