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Bradley Kjer posted an update 6 months, 2 weeks ago
Ventriculoatrial (VA) shunts are life-saving in circumstances where ventriculoperitoneal shunts (VP) have failed. They are at risk for different complications, and more specific of them are cardiopulmonary complications. Currently, there are no standard recommendations concerning screening for risk factors, prophylaxis, or anticoagulation treatment in patients after VA shunt placement. Our study aims to prospectively study the possible role and efficacy of the use of aspirin to increase the survival of shunts in children with VA shunt and avoid secondary morbidity. In this article, the authors describe the interim results of an ongoing prospective study which supports the use of aspirin for VA shunt.
The study design is prospective. The duration of the study is 2011 onwards and is ongoing. Cabozantinib Hospital ethics board clearance and consent from the family were taken before inclusion in the study. All patients who had VA shunt were given a once-a-day low-antiplatelet dose of aspirin 5mg/kg, from the first postoperative day onwards. Primary endpoints of the study are as follows (1) major distal end malfunction documented on echocardiography or (2) any cardiac complications associated with the VA shunt catheter.
We have 6 patient since march 2011, who are being followed up. None of the shunts had malfunctioned until the reporting. None of the patients had any cardiac issues reported. The patients are to be followed continually. The present follow-up ranges from 2.5 to 10years. The patient follow-up is being continued.
Aspirin is a drug with well-accepted safety profile, and its use and our preliminary observation and outcome of the use of aspirin in VA shunt are promising.
Aspirin is a drug with well-accepted safety profile, and its use and our preliminary observation and outcome of the use of aspirin in VA shunt are promising.
Fingolimod (FNG) is associated with the development of symptomatic macular edema (ME) in a small subset of multiple sclerosis (MS) patients. By using spectral domain optical coherence tomography (SD-OCT), an increase in the total macular volume (TMV) was rarely detected during the first months of treatment.
The objective of this study is to assess whether FNG treatment leads to long-term macular changes in a real-life setting.
Sixty RRMS patients starting FNG, according to therapeutic indication, were enrolled at three Italian MS centers and followed for 2years.
The mean TMV did not change between baseline and the follow-up. No patients experienced visual acuity drop during the follow-up.
Initiation of FNG in MS is associated with a modest, not significant, increase in macular volume followed by no further significant changes over 2years, highlighting the good safety profile of such treatment in MS.
Initiation of FNG in MS is associated with a modest, not significant, increase in macular volume followed by no further significant changes over 2 years, highlighting the good safety profile of such treatment in MS.
To assess risk factors of transient global amnesia (TGA) recurrence.
Retrospective study of a case series of patients with the diagnosis of TGA in our neurology center in the last 8years, identified through an anonymized database search. TGA was identified by applying Hodges and Warlow criteria.
Seventy patients (70% female, average age 64.8 ± 7.8years) were enrolled; mean follow-up was 16.5months. More frequent co-morbidities were hypertension (50%), depression (25.7%), diabetes mellitus (17.1%), migraine (15.7%), and cerebrovascular disease (8.6%). Average TGA episode duration was 4h. Forty-one percent had an identifiable trigger-emotional stress (25.7%), physical effort (8.6%), and sexual intercourse (4.3%). Five patients (7.1%) had hippocampus restriction on diffusion weighted MRI. Nineteen patients (27.1%) had TGA recurrence. Patients with recurrent TGA were more likely to be female and have history of depression, shorter duration episode, and hippocampus hyperintensity on brain MRI. None of the other clinical characteristics and complementary studies were predictors of recurrence. In the multivariate analysis, history of depression was the only factor found to predict which patients had a higher risk of recurrence.
We present a cohort of TGA patients with a considerable recurrent rate (27%), alerting for the possibility of recurrence of this clinical entity. TGA recurrence was associated with the following factors female sex, depression, shorter episode duration, and hippocampal hyperintensity on brain MRI. History of depression was found to be the most important recurrence predictor in our study.
We present a cohort of TGA patients with a considerable recurrent rate (27%), alerting for the possibility of recurrence of this clinical entity. TGA recurrence was associated with the following factors female sex, depression, shorter episode duration, and hippocampal hyperintensity on brain MRI. History of depression was found to be the most important recurrence predictor in our study.
Changes in the levels of circulating markers of inflammation, oxidative stress, and neurotrophic factors might be a good candidate for the prediction of cognitive impairment in multiple sclerosis (MS). Here, the correlation between the mentioned circulating markers with the Cambridge neuropsychological test automated battery (CANTAB) task outcomes was determined in MS patients.
The CANTAB (paired-associate learning (PAL), reaction time (RTI), rapid visual information processing (RVP), and spatial working memory tasks (SWM)) was completed by the patients. Accordingly, the serum levels of interferon-γ (INF-γ), C-reactive protein (CRP), ciliary neurotrophic factor (CNTF), glial cell line-derived neurotrophic factor (GDNF), and brain-derived neurotrophic factor (BDNF), malondialdehyde (MDA), total antioxidant capacity (TAC), and the acetylcholine esterase (AChE) activity were measured. Cognitive impairment status and the correlation between the circulating factors with the CANTAB outcomes were determined.
The cognitively impaired (CI) patients appropriately differentiated from not cognitively impaired (NCI) ones using the CANTAB tasks. The serum levels of MDA, TAC, CRP, INF-γ, and GDNF correlated with the cognitive scores in MS patients (p < 0.05). After adjusting for age, sex, disease duration, and disability levels (covariates in a regression model), the MDA, INF-γ, and GDNF factors levels were statistically different between CI and NCI groups (p < 0.05).
The mentioned markers might predict the cognitive impairment progress and be used as an index of its detection, in addition to neuropsychological assessments, in MS patients.
The mentioned markers might predict the cognitive impairment progress and be used as an index of its detection, in addition to neuropsychological assessments, in MS patients.