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https://www.readbyqxmd.com/read/27913538/sickle-cell-disease-when-and-how-to-transfuse
#1
Jo Howard
Blood transfusion remains an important therapeutic intervention in patients with sickle cell disease (SCD), aiming to both increase the oxygen carrying capacity of blood and to reduce the complications of vaso-occlusion. Simple, manual exchange and automated exchange can be effective in reducing the acute and chronic complications of SCD, and the advantages and disadvantages of each methodology mean they all have a role in different situations. Evidence for the role of emergency transfusion in the management of the acute complications of SCD, including acute pain and acute chest syndrome, comes from observational data...
December 2, 2016: Hematology—the Education Program of the American Society of Hematology
https://www.readbyqxmd.com/read/27913201/early-mortality-and-associated-factors-among-patients-with-stroke-admitted-to-a-large-teaching-hospital-in-tanzania
#2
Kigocha Okeng'o, Pilly Chillo, William K Gray, Richard W Walker, William Matuja
BACKGROUND: Stroke is a major cause of death worldwide and 85.5% of stroke deaths occur in low- and middle-income countries due to stroke. The aim of this study was to investigate correlates and predictors of 30-day mortality in stroke patients in urban Tanzania. METHODS: A prospective 30-day follow-up study was conducted at the Muhimbili National Hospital, Dar es Salaam, Tanzania. We recruited all patients with stroke seen at the Emergency Medicine Department and medical wards...
November 29, 2016: Journal of Stroke and Cerebrovascular Diseases: the Official Journal of National Stroke Association
https://www.readbyqxmd.com/read/27911120/new-frontiers-in-anticoagulation-non-vitamin-k-oral-anticoagulants-in-stroke-prevention
#3
Valentina Arnao, Marianna Riolo, Antonino Tuttolomondo, Antonio Pinto, Brigida Fierro, Paolo Aridon
Non vitamin-K oral anticoagulants (NOACs) are direct and specific inhibitors of the coagulation factors IIa (dabigatran) and Xa (apixaban, rivaroxaban, edoxaban) which share many pharmacokinetic properties. However, indications are lacking regarding the use of NOACs during thrombolysis, surgery and bleeding events. Areas covered: In this paper, the authors retrospectively analyzed the relevant literature on the NOACs using the PubMed and Google Scholar databases. Expert Commentary: Although warfarin is effective in cardioembolic stroke prevention, easier handling and more favorable risk-benefit profile often render NOACs a more preferable therapy choice for neurologists...
December 2, 2016: Expert Review of Neurotherapeutics
https://www.readbyqxmd.com/read/27911071/severe-brain-injury-in-massachusetts-assessing-the-continuum-of-care
#4
Laura Lorenz, Gabrielle Katz
Acquired brain injury (ABI) is a major public health problem in Massachusetts (Hackman et al, 2014) and includes traumatic brain injury (TBI), stroke, ABI-related infectious diseases, metabolic disorders affecting the central nervous system (brain and spinal cord), and brain tumor. Advances in emergency medical care and neurosurgery mean that more people are surviving severe traumatic brain injury (Trexler et al, 2014). Yet many patients with severe TBI in particular, are not receiving inpatient services after initial treatment (Hackman et al, 2014; CDC, 2014) or later that are known to be effective (Malec & Kean, 2015; Lewis & Horn, 2015; BI Commission, 2011; Kolakowsky-Hayner et al, 2000; Interviews)...
December 10, 2015: Issue Brief
https://www.readbyqxmd.com/read/27909516/the-role-of-noacs-in-atrial-fibrillation-management-a-qualitative-study
#5
Katherine Kirley Md Ms, Goutham Rao Md, Victoria Bauer Bs, Christopher Masi Md PhD
Patients with atrial fibrillation (AF) benefit from anticoagulation to reduce stroke risk. However, 30-60% of patients with AF are not anticoagulated. This study explored physicians' reasons for under-treatment of AF, focusing on the role of the novel oral anticoagulants (NOACs). We interviewed primary care physicians and cardiologists involved in AF management in a variety of practice settings. We conducted interviews using a semi-structured format and analyzed the data using the Framework Method. Four themes emerged...
June 2016: Journal of Atrial Fibrillation
https://www.readbyqxmd.com/read/27909476/atrial-fibrillation-and-risk-of-dementia-cognitive-decline
#6
REVIEW
Anand D Shah Md, Faisal M Merchant Md, David B Delurgio Md
Emerging evidence suggests a link between atrial fibrillation and subsequent development of dementia. While a majority of risk can be attributed to cardioembolic stroke secondary to atrial fibrillation, additional risk is apparent, and may be driven by vascular inflammation and changes in cerebral perfusion. Medical therapies including anticoagulation, statin therapy, and angiotensin-renin-aldosterone axis antagonists may reduce dementia risk. Procedural therapies such as atrial fibrillation catheter ablation and left atrial appendage closure may also prove to be important mediators of acute and long-term risk...
February 2016: Journal of Atrial Fibrillation
https://www.readbyqxmd.com/read/27909000/distinct-contributions-of-dorsal-and-ventral-streams-to-imitation-of-tool-use-and-communicative-gestures
#7
Andrea Dressing, Kai Nitschke, Dorothee Kümmerer, Tobias Bormann, Lena Beume, Charlotte S M Schmidt, Vera M Ludwig, Irina Mader, Klaus Willmes, Michel Rijntjes, Christoph P Kaller, Cornelius Weiller, Markus Martin
Imitation of tool-use gestures (transitive; e.g., hammering) and communicative emblems (intransitive; e.g., waving goodbye) is frequently impaired after left-hemispheric lesions. We aimed 1) to identify lesions related to deficient transitive or intransitive gestures, 2) to delineate regions associated with distinct error types (e.g., hand configuration, kinematics), and 3) to compare imitation to previous data on pantomimed and actual tool use. Of note, 156 patients (64.3 ± 14.6 years; 56 female) with first-ever left-hemispheric ischemic stroke were prospectively examined 4...
November 30, 2016: Cerebral Cortex
https://www.readbyqxmd.com/read/27908782/adaptive-responses-of-neuronal-mitochondria-to-bioenergetic-challenges-roles-in-neuroplasticity-and-disease-resistance
#8
REVIEW
Sophia M Raefsky, Mark P Mattson
An important concept in neurobiology is "neurons that fire together, wire together" which means that the formation and maintenance of synapses is promoted by activation of those synapses. Very similar to the effects of the stress of exercise on muscle cells, emerging findings suggest that neurons respond to activity by activating signaling pathways (e.g., Ca(2+), CREB, PGC-1α, NF-κB) that stimulate mitochondrial biogenesis and cellular stress resistance. These pathways are also activated by aerobic exercise and food deprivation, two bioenergetic challenges of fundamental importance in the evolution of the brains of all mammals, including humans...
November 28, 2016: Free Radical Biology & Medicine
https://www.readbyqxmd.com/read/27907969/neuroprotection-in-critical-care-neurology
#9
Menno R Germans, Hieronymus D Boogaarts, R Loch Macdonald
Ischemic stroke, intracerebral hemorrhage, subarachnoid hemorrhage, and traumatic brain injury-all have in common early brain injury due to brain tissue destruction, reduced cerebral blood flow and oxygen delivery, and overall substantial morbidity and mortality. The pathophysiology of brain tissue damage likely includes common cellular mechanisms. Neuroprotection has seldom, if ever, been shown to reduce early brain injury. Secondary brain injury develops after these conditions due to macroscopic events such as increased intracranial pressure and reduced cerebral blood flow, as well as cellular processes including vascular damage, inflammation, and apoptotic/necrotic cell death...
December 2016: Seminars in Neurology
https://www.readbyqxmd.com/read/27907893/factors-impacting-complication-rates-for-catheter-ablation-of-atrial-fibrillation-from-2003-to-2015
#10
Eunice Yang, Esra Gucuk Ipek, Muhammad Balouch, Yuliya Mints, Jonathan Chrispin, Joseph E Marine, Ronald D Berger, Hiroshi Ashikaga, Jack Rickard, Hugh Calkins, Saman Nazarian, David D Spragg
AIMS: Complications from catheter ablation for atrial fibrillation (AF) are well described. Changing aspects of AF ablation including patient populations referred, institutional experience, and emerging catheter and pharmacological options may impact complication rates. We assessed procedural complication trends in AF ablation patients from 2003-2015 to identify what factors affect adverse event rates. METHODS AND RESULTS: We evaluated consecutively enrolled patients undergoing initial AF ablation from 2003 through 2015...
October 6, 2016: Europace: European Pacing, Arrhythmias, and Cardiac Electrophysiology
https://www.readbyqxmd.com/read/27906602/meta-analysis-of-pre-clinical-trials-of-therapeutic-hypothermia-for-intracerebral-hemorrhage
#11
Kara R Melmed, Patrick D Lyden
Therapeutic hypothermia (TH) is a potent neuroprotectant for experimental ischemic stroke, but studies of TH for intracerebral hemorrhage (ICH) are emerging. We systematically reviewed the experimental literature to assess TH efficacy for ICH. We found 18 suitable papers; quality scores were moderately good. Compared with normothermia, TH reduced measures of edema (mean effect size (95% CI) -1.6873 (-2.3640, -1.0106), p < 0.0001) or blood-brain barrier leakage (p < 0.0001) and improved behavioral outcomes (p < 0...
December 1, 2016: Therapeutic Hypothermia and Temperature Management
https://www.readbyqxmd.com/read/27902596/portable-disposable-ultrathin-endoscopy-tested-through-percutaneous-endoscopic-gastrostomy
#12
Myong Ki Baeg, Chul-Hyun Lim, Jin Su Kim, Yu Kyung Cho, Jae Myung Park, Bo-In Lee, In-Seok Lee, Myung-Gyu Choi
BACKGROUND: A portable disposable ultrathin endoscope (DUE) with high visual quality and maneuverability would reduce the need for expensive facilities and emergency endoscopy could be available anywhere. It would increase patient satisfaction, prevent unnecessary sedation, and reduce infection. Our aim was to evaluate the usefulness of portable DUE in performing percutaneous endoscopic gastrostomy (PEG). METHODS: We prospectively enrolled patients who underwent PEG under DUE guidance and compared them with historical controls who underwent PEG under conventional ultrathin endoscopy (CUE) guidance...
November 2016: Medicine (Baltimore)
https://www.readbyqxmd.com/read/27901250/perception-of-stroke-symptoms-and-utilization-of-emergency-medical-services
#13
Maximiliano A Hawkes, Mauricio F Farez, Ismael L Calandri, Sebastián F Ameriso
Methods: Review of hospital records and structured telephone interviews of 100 consecutive stroke patients. Forward stepwise logistic regression was used for the statistical analysis. Results: Seventy patients (75%) arrived at the hospital 4.5 hours after stroke symptoms onset. The use of EMS did not improve arrival times. Most patients who recognized their symptoms did not use EMS (p < 0.02). Nineteen patients (20%) were initially misdiagnosed. Eighteen of them were first assessed by non-neurologist physicians (p < 0...
November 2016: Arquivos de Neuro-psiquiatria
https://www.readbyqxmd.com/read/27899799/population-health-based-approaches-to-utilizing-digital-technology-a-strategy-for-equity
#14
Garth N Graham, MaryLynn Ostrowski, Alyse B Sabina
Health care disparities and high chronic disease rates burden many communities and disproportionally impact racial/ethnic populations in the United States. These disparities vary geographically, increase health care expenses, and result in shortened lifespans. Digital technologies may be one tool for addressing health disparities and improving population health by increasing individuals' access to health information-especially as most low-income U.S. residents gain access to smartphones. The Aetna Foundation partners with organizations to use digital technologies, including mobile applications, data collection, and related platforms, for learning and sharing...
November 2016: Journal of Public Health Policy
https://www.readbyqxmd.com/read/27899742/acute-endovascular-treatment-delivery-to-ischemic-stroke-patients-transferred-within-a-telestroke-network-a-retrospective-observational-study
#15
Jessica Barlinn, Johannes Gerber, Kristian Barlinn, Lars-Peder Pallesen, Timo Siepmann, Charlotte Zerna, Claudia Wojciechowski, Volker Puetz, Rüdiger von Kummer, Heinz Reichmann, Jennifer Linn, Ulf Bodechtel
BACKGROUND: Five randomized controlled trials recently demonstrated efficacy of endovascular treatment in acute ischemic stroke. Telestroke networks can improve stroke care in rural areas but their role in patients undergoing endovascular treatment is unknown. AIM: We compared clinical outcomes of endovascular treatment between anterior circulation stroke patients transferred after teleconsultation and those directly admitted to a tertiary stroke center. METHODS: Data derived from consecutive patients with intracranial large vessel occlusion who underwent endovascular treatment from January 2010 to December 2014 at our tertiary stroke center...
November 29, 2016: International Journal of Stroke: Official Journal of the International Stroke Society
https://www.readbyqxmd.com/read/27896324/the-relationship-between-anemia-and-recurrence-of-ischemic-stroke-in-patients-with-trousseau-s-syndrome-a-retrospective-cross-sectional-study
#16
Mehmet Yigit, Ozgur Sogut, Eda Yigit, Kenan Ahmet Turkdogan, Onur Kaplan, Ali Dur, Ertan Sonmez, Bulut Demirel
OBJECTIVES: The relationship between cancer and thrombosis was first recognized by the French internist Armand Trousseau in 1865. Trousseau's syndrome is a spectrum of symptoms that result from recurrent thromboembolism associated with cancer or malignancy-related hypercoagulability. In this study, we investigated whether demographics, clinical features, or laboratory findings were able to predict recurrent stroke episodes in patients with Trousseau's syndrome. METHODS: In total, 178 adult patients were enrolled in this retrospective cross-sectional study...
June 2016: Turkish Journal of Emergency Medicine
https://www.readbyqxmd.com/read/27895093/stroke-paradox-with-sglt-2-inhibitors-a-play-of-chance-or-a-viscosity-mediated-reality
#17
REVIEW
Konstantinos P Imprialos, Chrysoula Boutari, Konstantinos Stavropoulos, Michael Doumas, Asterios I Karagiannis
Diabetes mellitus is a major risk factor for cardiovascular morbidity and mortality. Current therapeutic strategies have not provided constant beneficial cardiovascular-related results. Sodium-glucose co-transporters 2 (SGLT-2) inhibitors have emerged as a novel antidiabetic class of drugs that exert favourable results in a variety of other cardiovascular risk factors too, such as increased blood pressure and body weight. The Empagliflozin, Cardiovascular Outcomes, and Mortality in Type 2 Diabetes (EMPA-REG OUTCOME) study was the first trial that evaluated cardiovascular outcomes in patients with diabetes with the use of empagliflozin, a member of this new class of drugs...
November 28, 2016: Journal of Neurology, Neurosurgery, and Psychiatry
https://www.readbyqxmd.com/read/27895035/microrna-210-enhances-fibrous-cap-stability-in-advanced-atherosclerotic-lesions
#18
Suzanne M Eken, Hong Jin, Ekaterina Chernogubova, Yuhuang Li, Nancy Simon, Changyan Sun, Greg Korzunowicz, Albert Busch, Alexandra Bäcklund, Cecilia Österholm, Anton Razuvaev, Thomas Renné, Hans-Henning Eckstein, Jaroslav Pelisek, Per Eriksson, Maria Gonzalez Diez, Ljubica P Matic Perisic, Isabel N Schellinger, Uwe Raaz, Nicholas J Leeper, Göran K Hansson, Gabrielle Paulsson-Berne, Ulf Hedin, Lars Maegdefessel
RATIONALE: In the search for markers and modulators of vascular disease, miRNAs have emerged as potent therapeutic targets. OBJECTIVE: To investigate miRNAs of clinical interest in patients with unstable carotid stenosis at risk of stroke. METHODS AND RESULTS: Utilizing patient material from the Biobank of Karolinska Endarterectomies (BiKE), we profiled miRNA expression in patients with stable vs unstable carotid plaque. A PCR-based miRNA array of plasma, sampled at the carotid lesion site, identified eight deregulated miRNAs (miR-15b, -29c, -30c/d, -150, -191, -210 and -500)...
November 28, 2016: Circulation Research
https://www.readbyqxmd.com/read/27894558/helicopter-scene-response-for-stroke-patients-a-5-year-experience
#19
Andrew Hawk, Catherine Marco, Matt Huang, Bonnie Chow
OBJECTIVE: The purpose of this study was to examine the usefulness of an emergency medical service (EMS)-requested air medical helicopter response directly to the scene for a patient with clinical evidence of an ischemic cerebrovascular accident (CVA) and transport to a regional comprehensive CVA center. METHODS: CareFlight, an air medical critical care transportation service, is based in Dayton, OH. The 3 CareFlight helicopters are geographically located and provided transport to all CVA scene patients in this study...
November 2016: Air Medical Journal
https://www.readbyqxmd.com/read/27894313/identifying-the-barriers-and-enablers-for-a-triage-treatment-and-transfer-clinical-intervention-to-manage-acute-stroke-patients-in-the-emergency-department-a-systematic-review-using-the-theoretical-domains-framework-tdf
#20
REVIEW
Louise E Craig, Elizabeth McInnes, Natalie Taylor, Rohan Grimley, Dominique A Cadilhac, Julie Considine, Sandy Middleton
BACKGROUND: Clinical guidelines recommend that assessment and management of patients with stroke commences early including in emergency departments (ED). To inform the development of an implementation intervention targeted in ED, we conducted a systematic review of qualitative and quantitative studies to identify relevant barriers and enablers to six key clinical behaviours in acute stroke care: appropriate triage, thrombolysis administration, monitoring and management of temperature, blood glucose levels, and of swallowing difficulties and transfer of stroke patients in ED...
November 28, 2016: Implementation Science: IS
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