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https://www.readbyqxmd.com/read/28742644/update-on-sglt2-inhibitors-new-data-released-at-the-american-diabetes-association
#1
Sara Lee
Sodium-glucose cotransporter 2 (SGLT2) inhibitors are one of the newer classes of antiglycemic agents approved for the management of patients with type 2 diabetes mellitus. Due to their unique mechanism of action, SGLT2 inhibitors have shown to be beneficial beyond glucose control. The improvement in cardiovascular (CV) outcomes was first observed in the landmark EMPA-REG OUTCOMES study. Following these results, numerous CV outcome trials were designed to identify whether the beneficial CV and renal effects observed with empagliflozin are unique or a drug class effect...
September 2017: Critical Pathways in Cardiology
https://www.readbyqxmd.com/read/28741278/italian-intersociety-consensus-on-prevention-diagnosis-and-treatment-of-delirium-in-hospitalized-older-persons
#2
Giuseppe Bellelli, Alessandro Morandi, Marco Trabucchi, Guido Caironi, Daniele Coen, Carlo Fraticelli, Ciro Paolillo, Carolina Prevaldi, Angela Riccardi, Gianfranco Cervellin, Corrado Carabellese, Salvatore Putignano, Stefania Maggi, Antonio Cherubini, Paola Gnerre, Andrea Fontanella, Nicola Latronico, Concezione Tommasino, Antonio Corcione, Giovanni Ricevuti, Nicola Ferrara, Francesco De Filippi, Alberto Ferrari, Mario Guarino, Maria Pia Ruggieri, Pietro Amedeo Modesti, Carlo Locatelli, Patrizia Hrelia, Marco Otto Toscano, Emi Bondi, Antonio Tarasconi, Luca Ansaloni, Francesco Perticone
Delirium is a severe neuropsychiatric syndrome characterized by inattention and global cognitive dysfunction in the setting of an acute medical illness, medical complication, drug intoxication, or drug withdrawal. The most important risk factors are advanced age and dementia, whereas pain, dehydration, infections, stroke, metabolic disturbances, and surgery are the most common triggering factors. Although delirium is a common clinical syndrome in different settings of care (acute care hospitals, inpatient rehabilitation facilities, nursing homes, and hospices), it often remains under-recognized, poorly understood, and inadequately managed...
July 24, 2017: Internal and Emergency Medicine
https://www.readbyqxmd.com/read/28740997/guidelines-for-bystander-first-aid-2016
#3
Jen Heng Pek
Cardiac life support is a form of first aid for cardiac emergencies. However, research and evidence in this field is lacking compared with other forms of first aid. Having identified the common emergencies that are encountered in the hospital, based on the available evidence, we have put together what could be an evidence-based approach to the first aid management of some of these common emergencies, viz. breathlessness, chest pain, allergies, stroke, heat injury, poisoning, unconsciousness, seizures, and trauma situations such as bleeding, wounds, contusions, head injury, burns and fractures...
July 2017: Singapore Medical Journal
https://www.readbyqxmd.com/read/28738808/carotid-plaque-rather-than-intima-media-thickness-as-a-predictor-of-recurrent-vascular-events-in-patients-with-acute-ischemic-stroke
#4
Hyun Ju Yoon, Kye Hun Kim, Hyukjin Park, Jae Yeong Cho, Young Joon Hong, Hyung Wook Park, Ju Han Kim, Youngkeun Ahn, Myung Ho Jeong, Jeong Gwan Cho, Jong Chun Park
BACKGROUND: To investigate the impacts of carotid plaque and intima-media thickness (IMT) on future vascular events (VEs) in the patients with acute ischemic stroke. METHODS: A total of 479 consecutive Korean patients with acute ischemic stroke were divided into 2 groups according to development of VEs; VE group (65.4 ± 10.9 years) vs no VE group (62.8 ± 13.2 years). VEs were defined as the development of recurrent stroke, coronary events, peripheral arterial disease, and death...
July 24, 2017: Cardiovascular Ultrasound
https://www.readbyqxmd.com/read/28737064/the-effects-of-delirium-prevention-guidelines-on-elderly-stroke-patients
#5
Jihye Song, Minkyung Lee, Dukyoo Jung
This study aimed to evaluate the effectiveness of the delirium prevention interventions recommended by the Delirium Prevention Guidelines for Elderly Stroke Patients (DPGESP). The DPGESP comprises nine dimensions with 28 interventions, including risk factor assessment, orientation disorder prevention, sleeping pattern maintenance, sensory interventions, constipation, dehydration, hypoxia and infection prevention, pain management, and appropriate nutrition maintenance. This quasi-experimental study used a nonequivalent control group and a pretest-posttest design...
July 1, 2017: Clinical Nursing Research
https://www.readbyqxmd.com/read/28736561/recent-advances-in-stroke-prevention-in-patients-with-atrial-fibrillation-and-end-stage-renal-disease
#6
REVIEW
Federico Ronco, Patrizio Mazzone, Leila Hosseinian, Simonetta Genovesi
BACKGROUND: Chronic kidney disease (CKD) is associated with a high prevalence of atrial fibrillation (AF), but in this population the risk/benefit ratio of anticoagulant therapy with vitamin K antagonists (VKA) for thromboprophylaxis is uncertain. SUMMARY: In end-stage renal disease (ESRD) patients undergoing hemodialysis, VKA seem less effective in stroke prevention than in the general population, with an increased risk of major bleeding. Recently, novel oral anticoagulant agents (NOACs) have proven to be effective for stroke prevention in AF and have demonstrated an improved safety profile compared to VKA...
June 2017: Cardiorenal Medicine
https://www.readbyqxmd.com/read/28736507/national-mortality-burden-due-to-communicable-non-communicable-and-other-diseases-in-ethiopia-1990-2015-findings-from-the-global-burden-of-disease-study-2015
#7
Awoke Misganaw, Tilahun N Haregu, Kebede Deribe, Gizachew Assefa Tessema, Amare Deribew, Yohannes Adama Melaku, Azmeraw T Amare, Semaw Ferede Abera, Molla Gedefaw, Muluken Dessalegn, Yihunie Lakew, Tolesa Bekele, Mesoud Mohammed, Biruck Desalegn Yirsaw, Solomon Abrha Damtew, Kristopher J Krohn, Tom Achoki, Jed Blore, Yibeltal Assefa, Mohsen Naghavi
BACKGROUND: Ethiopia lacks a complete vital registration system that would assist in measuring disease burden and risk factors. We used the Global Burden of Diseases, Injuries, and Risk Factors Study 2015 (GBD 2015) estimates to describe the mortality burden from communicable, non-communicable, and other diseases in Ethiopia over the last 25 years. METHODS: GBD 2015 mainly used cause of death ensemble modeling to measure causes of death by age, sex, and year for 195 countries...
2017: Population Health Metrics
https://www.readbyqxmd.com/read/28735353/non-vitamin-k-oral-anticoagulants-noacs-and-their-reversal
#8
REVIEW
Sujan T Reddy, T C Cossey, Sean I Savitz, James C Grotta
PURPOSE OF REVIEW: An 80-year-old man presents with an acute right hemiparesis and National Institutes of Health Stroke Scale (NIHSS) of 25, 14 h after taking dabigatran. Activated partial thromboplastin time (aPTT) is 42.8 s. Arteriogram demonstrates left internal carotid artery thrombosis. What is the appropriate management of this patient with acute ischemic stroke while on a NOAC? RECENT FINDINGS: Idarucizumab is a reversal agent approved for dabigatran, and two more reversal agents, andexanet alfa and aripazine, are currently in development for NOACs...
September 2017: Current Neurology and Neuroscience Reports
https://www.readbyqxmd.com/read/28735014/initial-clinical-experience-with-testosterone-undecanoate-therapy-aveed-%C3%A2-in-testosterone-deficient-men-in-the-united-states
#9
Abraham Morgentaler, Yonah Krakowsky, William Conners, Emily Davidson, Alex Rawji
OBJECTIVE: To report our initial experiences with TU 750mg in testosterone-deficient men. METHODS: All patients receiving TU 750mg at our center between July 1 2014 to August 1 2016 were identified. Clinical response was assessed via structured interviews and laboratory evaluations. Adverse events were documented, including increases in prostate specific antigen (PSA), hematocrit (Hct), and the development of post-injection cough. RESULTS: More than two injections were received by 147 men, with mean age 63...
July 19, 2017: Urology
https://www.readbyqxmd.com/read/28734880/dual-versus-single-antiplatelet-regimen-with-or-without-anticoagulation-in-transcatheter-aortic-valve-replacement-indirect-comparison-and-meta-analysis
#10
Monica Verdoia, Lucia Barbieri, Matteo Nardin, Harry Suryapranata, Giuseppe De Luca
INTRODUCTION AND OBJECTIVES: There is uncertainty on the correct management of antithrombotic therapies after transcatheter aortic valve replacement (TAVR), with dual antiplatelet therapy (DAPT) being currently recommended on an empirical basis. The aim of the present meta-analysis was to assess the safety and effectiveness of DAPT in patients undergoing TAVR. METHODS: Studies comparing different antithrombotic regimens after TAVR were included. The primary endpoint was 30-day overall mortality...
July 19, 2017: Revista Española de Cardiología
https://www.readbyqxmd.com/read/28733057/clinical-validation-of-non-invasive-cardiac-output-monitoring-in-healthy-pregnant-women
#11
Kelsey McLaughlin, Stephen P Wright, John C P Kingdom, John D Parker
OBJECTIVE: Non-invasive hemodynamic monitoring has the potential to be a valuable clinical tool for the screening and management of hypertensive disorders of pregnancy. The objective of this study was to validate the clinical utility of the non-invasive cardiac output monitoring (NICOM) system in pregnant women. METHODS: Twenty healthy pregnant women with a singleton pregnancy at 22 to 26 weeks' gestation were enrolled in this study. Measures of heart rate, stroke volume, and cardiac output were obtained through NICOM and compared with Doppler echocardiography...
July 18, 2017: Journal of Obstetrics and Gynaecology Canada: JOGC, Journal D'obstétrique et Gynécologie du Canada: JOGC
https://www.readbyqxmd.com/read/28732536/national-mortality-burden-due-to-communicable-non-communicable-and-other-diseases-in-ethiopia-1990-2015-findings-from-the-global-burden-of-disease-study-2015
#12
Awoke Misganaw, Tilahun N Haregu, Kebede Deribe, Gizachew Assefa Tessema, Amare Deribew, Yohannes Adama Melaku, Azmeraw T Amare, Semaw Ferede Abera, Molla Gedefaw, Muluken Dessalegn, Yihunie Lakew, Tolesa Bekele, Mesoud Mohammed, Biruck Desalegn Yirsaw, Solomon Abrha Damtew, Kristopher J Krohn, Tom Achoki, Jed Blore, Yibeltal Assefa, Mohsen Naghavi
BACKGROUND: Ethiopia lacks a complete vital registration system that would assist in measuring disease burden and risk factors. We used the Global Burden of Diseases, Injuries, and Risk Factors Study 2015 (GBD 2015) estimates to describe the mortality burden from communicable, non-communicable, and other diseases in Ethiopia over the last 25 years. METHODS: GBD 2015 mainly used cause of death ensemble modeling to measure causes of death by age, sex, and year for 195 countries...
July 21, 2017: Population Health Metrics
https://www.readbyqxmd.com/read/28730950/statistical-analysis-plan-for-the-head-position-in-stroke-trial-headpost-an-international-cluster-cross-over-randomized-trial
#13
Laurent Billot, Mark Woodward, Hisatomi Arima, Maree L Hackett, Paula Muñoz Venturelli, Pablo M Lavados, Alejandro Brunser, Bin Peng, Liying Cui, Lily Song, Stephane Heritier, Stephen Jan, Sandy Middleton, Verónica V Olavarría, Joyce Lim, Thompson Robinson, Octavio Pontes-Neto, Caroline Watkins, Craig S Anderson
Background There is evidence to indicate that the lying flat head position increases cerebral blood flow and oxygenation in patients with acute ischemic stroke, but how these physiological effects translate into clinical outcomes is uncertain. The Head Position in Stroke Trial aims to determine the comparative effectiveness of lying flat (0°) compared to sitting up (≥30°) head positioning, initiated within 24 h of hospital admission for patients with acute stroke. Design An international, pragmatic, cluster-randomized, crossover, open, blinded outcome assessed clinical trial...
August 2017: International Journal of Stroke: Official Journal of the International Stroke Society
https://www.readbyqxmd.com/read/28730068/stroke-survivors-levels-of-community-reintegration-quality-of-life-satisfaction-with-the-physiotherapy-services-and-the-level-of-caregiver-strain-at-community-health-centres-within-the-johannesburg-area
#14
Adrian Kusambiza-Kiingi, Douglas Maleka, Veronica Ntsiea
BACKGROUND: Stroke survivors are discharged home before they are functionally independent and return home with activity limitations that would not be manageable without a caregiver. AIM: To determine stroke survivors' levels of community reintegration, quality of life (QOL), satisfaction with the physiotherapy services and the level of caregiver strain at community health centres within the Johannesburg area. METHOD: This was a cross-sectional study using the following outcome measures: Maleka Stroke Community Reintegration Measure, Stroke-specific quality of life scale, Caregiver strain index and Physical therapy patient satisfaction questionnaire...
2017: Afr J Disabil
https://www.readbyqxmd.com/read/28729311/a-review-of-rate-control-in-atrial-fibrillation-and-the-rationale-and-protocol-for-the-rate-af-trial
#15
Dipak Kotecha, Melanie Calvert, Jonathan J Deeks, Michael Griffith, Paulus Kirchhof, Gregory Yh Lip, Samir Mehta, Gemma Slinn, Mary Stanbury, Richard P Steeds, Jonathan N Townend
BACKGROUND AND OBJECTIVE: Atrial fibrillation (AF) is common and causes impaired quality of life, an increased risk of stroke and death as well as frequent hospital admissions. The majority of patients with AF require control of heart rate. In this article , we summarise the limited evidence from clinical trials that guides prescription, and present the rationale and protocol for a new randomised trial. As rate control has not yet been shown to reduce mortality, there is a clear need to compare the impact of therapy on quality of life, cardiac function and exercise capacity...
July 20, 2017: BMJ Open
https://www.readbyqxmd.com/read/28728489/idarucizumab-for-the-treatment-of-hemorrhage-and-dabigatran-reversal-in-patients-requiring-urgent-surgery-or-procedures
#16
Ovidiu Vornicu, Anne-Sophie Larock, Anne-Sophie Dincq, Jonathan Douxfils, Jean-Michel Dogné, François Mullier, Sarah Lessire
Idarucizumab is a specific antagonist for dabigatran etexilate (DE). The recent market authorization of idarucizumab in Europe and the USA may reassure prescribers of DE, as it can increase the safety of the emergency management of patients taking this anticoagulant. However, idarucizumab use should be limited to specific indications to avoid unnecessary risks to patients and costs to healthcare systems. Areas covered: The authors provide an overview of idarucizumab development and its pharmacokinetic and pharmacodynamic properties...
July 20, 2017: Expert Opinion on Biological Therapy
https://www.readbyqxmd.com/read/28727356/-management-of-carotid-artery-stenosis
#17
Francesco Puccinelli, Marco Roffi, Nicolas Murith, Roman Sztajzel
Carotid artery atherosclerosis remains one of the major causes of stroke. The efficacy of carotid artery recanalization has already been established and is considered significant for symptomatic stenosis >70% and moderate for stenosis between 50-69 %. Regarding asymptomatic stenosis, carotid artery recanalization should be reserved for carefully selected patients with a stenosis between 70-90 % and an estimated procedural risk at less than 3 %. Two therapeutic options are currently available : angioplasty with stent placement and endarterectomy...
April 26, 2017: Revue Médicale Suisse
https://www.readbyqxmd.com/read/28727192/current-evidence-for-endovascular-therapy-in-stroke-and-remaining-uncertainties-r1
#18
REVIEW
Ronan Motyer, Hamed Asadi, John Thornton, Patrick Nicholson, Hong Kuan Kok
Class 1 level A evidence now supports endovascular thrombectomy as best practice in the management of large vessel occlusion acute ischemic stroke. However, significant questions pertaining to initial imaging, radiological assessment, patient selection and therapeutic limits remain unanswered. A specific cohort of patients who benefit from endovascular thrombectomy has been established, although current uncertainties regarding selection of those not meeting top-tier evidence criteria may potentially deny certain patients the benefit of intervention...
July 20, 2017: Journal of Internal Medicine
https://www.readbyqxmd.com/read/28726795/a-retrospective-analysis-of-hypertension-screening-at-a-mass-gathering-in-india-implications-for-non-communicable-disease-control-strategies
#19
S Balsari, P Vemulapalli, M Gofine, K Oswal, R Merchant, S Saunik, G Greenough, T Khanna
Cardiovascular disease is the leading case of mortality from non-communicable diseases (NCD) in India. The government's National Programme for Prevention and Control of Cancer, Diabetes, Cardiovascular Diseases and Stroke seeks to increase capacity building, screening, referral and management of NCDs across India, and includes community-based outreach and screening programmes. The government in India routinely provides basic care at religious mass gatherings. However, in 2015, at the Kumbh Mela in Nashik and Trimbakeshwar, the state government extended its services to include a hypertension screening programme...
July 20, 2017: Journal of Human Hypertension
https://www.readbyqxmd.com/read/28726651/factors-associated-with-post-stroke-fatigue-within-the-first-3-month-after-stroke
#20
I Delva, N Lytvynenko, M Delva
Aim - identify socio-demographic, personal and psychological factors associated with certain post-stroke fatigue (PSF) domains within first 3 months after stroke. There were examined patients consequently in definite time points after ischemic or hemorrhagic strokes: at hospital stay (234 patients), in 1 month (203 patients) and in 3 months (176 patients). Global PSF and certain PSF domains were measured by multidimensional fatigue inventory-20 (MFI-20) scale. In multivariate logistic regression analysis the majority of variables (gender, marital status, education level, smoking status, level of alcohol consumption, apathetic impairments, arterial hypertension, atrial fibrillation, ischemic heart disease, diabetes mellitus, body mass index, waist circumference) were not significantly associated with any PSF domain risk at any time point after stroke...
June 2017: Georgian Medical News
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