Search Results for: CA-antagonisti (Nifedipina)

Objectives
To evaluate the association between left atrial appendage volume (LAAV) and atrial fibrillation (AF) recurrence after catheter ablation (CA) and explore the potential mechanism.

Design
Systematic review and meta-analysis.

Data sources
PubMed, EMBASE, Web of Science and Cochrane Library databases were searched systematically from inception through 28 September 2024 to identify relevant studies.

Eligibility criteria
Observational studies that estimated the association between LAAV and AF recurrence.

Data extraction and synthesis
Two independent investigators screened studies for inclusion and extracted data. Statistical heterogeneity was assessed using the Cochrane Q-test and I², with p 50% indicating significant heterogeneity. This study used a random-effects model to account for potential heterogeneity. The quality of the included studies was assessed using the Newcastle–Ottawa Scale (NOS), Risk of Bias in Non-randomized Studies of Interventions (ROBINS-I tool) and the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. Publication bias was examined through funnel plots and Egger’s test.

Result
Seventeen studies (3078 patients) were included. Meta-analysis of 11 studies suggested that LAAV was significantly associated with the risk of AF recurrence in both univariate (HR 1.06, 95%CI 1.04 to 1.08, p

Introduction
Differentiated thyroid cancer (DTC) is the most common endocrine malignancy, with a high 5-year survival rate of approximately 98%. Despite advances in diagnosis and treatment, up to 20% of patients experience recurrence, adversely affecting their quality of life. Predictive models have been developed to assess recurrence risk and guide clinical decision-making, but these models often face limitations such as retrospective design, lack of diversity in study populations and absence of external validation. The primary aim is to externally validate existing predictive models for DTC recurrence using prospective data from a diverse Latin American cohort. The secondary aim is to explore opportunities for model recalibration to improve their performance in our population.

Methods and analysis
The CaTaLiNA study is a multicentre prospective observational study conducted across 10 hospitals in five Latin American countries, including Ecuador, Peru, Uruguay and Mexico. Patients aged 18 years or older receiving treatment for DTC, such as the first thyroid surgery, active surveillance or radiofrequency ablation will be included. Recruitment will occur from November 2023 to June 2025, with follow-up extending until June 2028. Data collection will include baseline clinical, surgical and histological characteristics, treatment details and follow-up outcomes. Statistical analysis will follow the Transparent Reporting of a multivariable prediction model for Individual Prognosis or Diagnosis guidelines, using imputation strategies for missing data and evaluating calibration and discrimination of the prediction models. Calibration measures include the ratio of expected and observed events, calibration slope and calibration plot, while discrimination will be assessed using the C-index and area under the receiver operating characteristic curve.

Ethics and dissemination
This study protocol was approved by Comité de Ética de Investigación en Seres Humanos de la Universidad San Francisco de Quito USFQ ‘CEISH-USFQ’ APO-010–2023-CEIHS-USFQ Oficio No. 161-2023-CA-23030M-CEISH-USFQ. Results will be disseminated via peer-reviewed publications.

Stroke, Ahead of Print. BACKGROUND:For patients with acute ischemic stroke due to a large vessel occlusion admitted in primary stroke centers, helicopter transfer to comprehensive stroke centers is often used to expedite access to mechanical thrombectomy. Some studies have suggested that vibrations generated during helicopter transport might enhance intravenous thrombolysis (IVT) efficacy. We aimed to evaluate the impact of helicopter transfer, compared with ground transportation, on interhospital recanalization and functional outcomes.METHODS:We conducted a retrospective analysis of 2 prospectively collected cohorts of anterior circulation acute ischemic stroke due to a large vessel occlusion patients transferred to 2 comprehensive stroke centers (Stanford, CA, November 2019 to January 2023, and Montpellier, France, January 2015 to January 2017) for mechanical thrombectomy consideration with arterial imaging both at the primary stroke center and on comprehensive stroke center arrival. The primary outcome was interhospital recanalization, determined by comparison of the baseline and posttransfer arterial imaging and defined as revised arterial occlusive lesion scores of 2b to 3. The association between transportation mode (helicopter versus ground) and interhospital recanalization was studied in logistic regression analysis, adjusting for pretransfer IVT use, occlusion site, and transfer duration.RESULTS:Among 520 included patients, 315 (61%) were transferred by helicopter and 259 (50%) received IVT before transfer. Interhospital recanalization rates were similar between helicopter and ground transfers in both the overall cohort (23% versus 19%;P=0.30) and the IVT subgroup (36% versus 33%;P=0.61). Adjusted analyses confirmed no association between helicopter transport and interhospital recanalization (adjusted odds ratio, 1.23 [95% CI, 0.72–2.11];P=0.44). Favorable 3-month functional outcome (modified Rankin Scale score, 0–2) rates were also similar between helicopter and ground transfers in both unadjusted (35% versus 40%;P=0.29) and adjusted analyses (adjusted odds ratio, 1.12 [95% CI, 0.67–1.88];P=0.67).CONCLUSIONS:In this multicenter observational cohort study, helicopter transfer was not associated with improved interhospital recanalization or favorable functional outcomes compared with ground transport. These findings do not support the hypothesis that vibrations during helicopter transport enhance IVT efficacy.

Stroke, Ahead of Print. BACKGROUND:Evidence about the impact of multiple metal exposure on brain neuroimaging metrics remains limited. We aim to investigate the effects of single and mixed metal exposure on white matter hyperintensities (WMHs).METHODS:This cross-sectional study included 1183 subjects without stroke history from the META-KLS (Multi-modality Medical Imaging Study Based on Kailuan Study), which is an existing prospective cohort in Tangshan, China. Plasma metal levels, including Mg, Ca, V, Mn, Co, Ni, Cu, Zn, As, Se, Rb, Cs, Tl, Pb, and Cd, were measured using an inductively coupled plasma mass spectrometer. Ordinal and binary logistic regression models were used to examine the effects of metal exposure on the WMH burden, deep white matter hyperintensity, and periventricular white matter hyperintensity. All metal concentrations were naturally log-transformed to reduce skewness and were analyzed as both continuous and tertile forms. Weighted quantile sum regression, quantile-based g-computation model, and Bayesian Kernel Machine Regression were used in the metal mixture analysis.RESULTS:Compared with the first tertile, the adjusted odds ratios and 95% CIs for the WMH burden in the third tertile were 1.57 (1.05–2.34) for As, 2.01 (1.28–3.18) for Cu, 1.68 (1.14–2.50) for V, 1.61 (1.07–2.44) for Cs, and 1.56 (1.04–2.34) for Tl (allPfor trend

Introduction
Falls can lead to serious health-related consequences in the older population. If an emergency occurs within the home environment of an older person living alone, the initiation of emergency care can be delayed, leading to even worse outcomes for this population. Smart home emergency call systems (HECSs) can detect falls and automatically trigger an emergency alarm, potentially reducing time to emergency care and improving outcomes. The INES (Intelligentes NotfallErkennungsSystem—smart emergency detection system) study is a prospective randomised controlled trial conducted in three German federal states that aims to investigate the effectiveness and cost-effectiveness of a smart HECS.

Methods and analysis
Following a telephone interview, individuals aged 70 years or older, living alone, at risk of falling and willing to participate are included in the study. Participants are assigned to one of two groups depending on their previous use of a HECS. Based on the sample size calculation, the study aims to recruit n=498 participants already using a standard HECS (group A) and n=1378 participants who have not used a HECS before (group B). Within both groups, participants are randomised into the intervention arm (IA) and control arm (CA). The IA receives a smart HECS during the 21-month follow-up period. In addition to a standard HECS with a base station and a wearable radio transmitter, the smart HECS includes sensors that can detect falls and automatically trigger an alarm. The primary outcome assessed will be the days spent in the hospital after an emergency admission. Secondary outcomes include the utilisation of healthcare services and their total costs, progression of care dependency, fear of falling (Falls Efficacy Scale—International), health-related quality of life (EQ-5D-5L) and well-being (ICEpop CAPability measure for Older people).

Ethics and dissemination
The design and conceptualisation of the INES study were approved by the ethics committee of the Hamburg Medical Association on 26 June 2023 (2023-101032-BO-ff). Results of the INES study will be published in peer-reviewed articles.

Trial registration number
Deutsches Register Klinischer Studien, German Clinical Trials Register DRKS00031408. Registered on 28 June 2023.

Objectives
Congenital anomalies (CAs) are significant contributors to perinatal mortality and morbidity. The epidemiology of CAs in the Gulf Cooperation Council (GCC) countries remains insufficiently explored. This scoping review aims to provide a comprehensive overview of the existing literature on the epidemiology of perinatally diagnosed CAs in the GCC countries.

Design
Scoping review.

Data sources
We searched MEDLINE, Embase, Scopus and Web of Science for articles published between 1 January 2000 and 1 February 2024.

Eligibility criteria
This review included (a) original observational studies such as cross-sectional, cohort or nested case–control studies, which were sourced from general populations, hospital records or registries; (b) published in English between 2000 and 2024; (c) conducted in any of the six GCC countries; and (d) reporting the prevalence or incidence of CAs.

Data extraction and synthesis
Two reviewers independently screened titles, abstracts and full texts for inclusion and extracted data using Covidence software.

Results
In total, 51 studies reporting the epidemiology of CAs in the GCC countries were eligible and thus summarised. Saudi Arabia dominated with nearly two-thirds of the studies, while Bahrain contributed the least. All studies were hospital based and primarily retrospective. The most researched CAs were cleft lip and cleft palate as well as nervous and circulatory system anomalies, whereas the least researched CAs were chromosomal abnormalities, digestive anomalies and urinary system anomalies. The review reported discrepancies in CA rates across the region, ranging from 2.5 to 68.7 per 1000 live births for multiple anomalies. Few studies explored the association between CAs and risk factors; the main factors reported were advanced maternal age, maternal diabetes and consanguinity.

Conclusions
This review summarises the heightened prevalence of CAs in the GCC countries, discrepancies in estimates and gaps in research on specific anomalies. Future research is warranted to explore the association between CAs and various risk factors, thereby enabling the development of targeted preventive strategies.

Objectives
This study aimed to understand the experiences and perceptions of medical students and medical educators regarding barriers and facilitators for pursuing clinical academic pathways.

Design
A qualitative study using semistructured interviews and focus groups was conducted. A reflexive thematic analysis was used for data analysis. Theoretical and snowball sampling approaches were applied for participant recruitment.

Setting
University of Manchester and NHS Trusts in the Greater Manchester region.

Participants
The sample of this study was composed of 43 participants, including medical and dental students, clinical academics, clinicians and stakeholders.

Results
Three themes were identified: Theme 1: Knowledge of the CA pathway; Theme 2: The costs linked to pursuing a clinical academic pathway; Theme 3: Exposure to and time for research.

Conclusions
While institutions offer opportunities for research experience, there is a need for extended and more tailored opportunities and information, and the overall cost of training for students reduces the attractiveness of the clinical academic pathway.

Objective
Targeted temperature management (TTM), through its physiological effects on intracranial pressure, may impede the progression to brain death (BD) in severe anoxic brain injury post-cardiac arrest (CA). We examined the potential association between the use of TTM and the occurrence of BD after CA.

Design
Monocentric, retrospective study.

Setting
Intensive care unit, Versailles Hospital, France.

Participants
Comatose survivors of CA who died from BD or postanoxic encephalopathy (PAE) after 24 hours.

Main outcome measures
PAE deaths corresponded to withdrawal of life-sustaining therapy (WLST) due to irreversible postanoxic coma or vegetative state according to prognostication guidelines. BD corresponded to the cessation of cerebral vascularisation secondary to intracranial hypertension. The diagnosis of BD was definite by clinical diagnosis of deep coma according to the Glasgow Coma Scale 3, loss of all brainstem reflexes and the demonstration of apnoea during a hypercapnia test. A cerebral omputed tomography (CT) scan or two isoelectric and unreactive electroencephalograms were used to confirm BD. To identify the independent association between TTM and BD, we conducted a multivariable logistic regression analysis.

Results
Out of 256 patients included between 2005 and 2021, 54.3% received TTM for at least 24 hours, and 56 patients (21.9%) died from BD. In the multivariable analysis, TTM for 24 hours or more was not associated with a decrease in BD (Odds Ratio 1.08, 95% CI 0.51 to 2.32). Factors associated with BD included a total duration of no-flow plus low-flow exceeding 30 min, CA due to neurological causes or hanging and a high arterial partial pressure of carbon dioxide between days 1 and 2 after admission.

Conclusions
This exploratory analysis of post-CA patients with severe anoxic brain injury did not find an association between TTM ≥24 hours and a reduction in BD. Further studies are needed to identify specific subgroups of post-CA patients for whom TTM may be especially futile or even harmful.

Moscone (Ca’ Foscari), relazione fino ad ora poco esplorata

Objective
This study aimed to investigate the trends and factors associated with congenital anomalies (CAs) among newborns in Eastern Ethiopia from 2015 to 2022.

Design
Open cohort study.

Setting
The Kersa Health and Demographic Surveillance System (KHDSS), which is located in the Kersa district of the Oromia region in Eastern Ethiopia, covering 24 kebeles.

Population
Newborns registered at birth in the database of the KHDSS site in Eastern Ethiopia.

Methods
The KHDSS tracks demographic and health changes in the community. Newborn data were extracted using a checklist. Trends in CAs over time (in years) were analysed and the associated factors were identified through logistic regression analysis.

Outcome measure
Newborn CAs, which are structural or functional abnormalities present at birth, were assessed through thorough physical examinations and detailed interviews conducted by trained data collectors using a standardised questionnaire.

Results
Between 2015 and 2022, a total of 27 350 newborns were recorded in the KHDSS, 104 of whom had CAs. The overall rate of CAs was 3.83 per 1000 live births (95% CI 3.19, 4.61). There was a significant increase in the trend of CAs over the study period, with a Mantel-Haenszel 2 of 82.76 (p=0.001). Factors associated with CA included maternal age over 35 years (adjusted OR (AOR)=1.68, 95% CI 1.07, 2.62), place of birth (AOR=2.04, 95% CI 1.04, 4.02) and normal birth weight (AOR=0.14, 95% CI 0.04, 0.47).

Conclusion
The data from the KHDSS revealed a rising trend in CAs. CA was associated with factors such as the mother’s age, place of birth and the baby’s birth weight. It is crucial for healthcare providers and stakeholders to consider these factors in efforts to reduce the prevalence of CAs.

Stroke, Volume 56, Issue Suppl_1, Page AWP184-AWP184, February 1, 2025. Objective:High calcium (Ca), low phosphate(P), and Ca-P product (CPP) levels are associated with cardiovascular disease and coronary artery atherosclerosis in patients with chronic kidney disease. However, whether this relationship persists in individuals with carotid artery atherosclerosis of acute ischemic stroke is unknown. We investigated the association of serum Ca, P, and CPP to carotid artery atherosclerotic plaque assessed by high-resolution MR vessel wall imaging in acute ischemic stroke patients.Methods:A total of 251 ischemic stroke participants with carotid artery atherosclerosis (mean age 68 years old, male 80.1%) were consecutively included in a comprehensive stroke center. Serum Ca, and P were obtained from blood tests after admission, and carotid artery plaque characteristics including plaque burden and vulnerability were evaluated using high-resolution MR vessel wall imaging, then the association between serum Ca, P, CPP, and atherosclerosis plaque characteristics was analyzed in multi-variate linear or logistic regression analysis； Finally, the consistency was also explored in different subgroups.Results:The mean±SD of serum Ca and P in this population is 2.26±0.11 and 1.16±0.19 individually. Serum P and CPP were associated with carotid artery plaque burden, presented as maximum wall thickness (max WT), wall area, and lipid-rich necrotic core (LRNC), in univariate analysis, with β=-0.205，95% CI (-0.348,-0.061), β=-0.258，95% CI (-0.405,-0.113), OR=0.182, 95% CI (0.034,0.975) for P, and β=-0.203，95% (-0.346,-0.059), β=-0.221，95% CI (-0.366,-0.074), OR=0.466, 95% CI (0.237,0.915) for CPP, respectively. In multivariate regression analysis, after further correction of age, sex in model 1 and cardiovascular risk factors in model 2, P level is associated with wall area independently, β=-0.211, 95% CI (-0.367, -0.052), while CPP is associated with wall area marginally, with β=-0.147, 95%CI (-0.300, 0.008) in model 1, and β=-0.157, 95%(-0.314, 0.004) in model 2. In subgroup analysis, the independent relationship between P and wall area can still be consistent in age＞65 years (β=-0.222, 95%CI [-0.400, -0.011]), male (β=-0.219， 95%CI [-0.446,-0.045], and hypertension (β=-0.314， 95%CI [-0.513, -0.130] subgroups.Conclusion:Lower serum P was associated with increased carotid artery plaque burden presented with wall area, and this relationship could differ in different age, sex, and hypertension subgroups.

Stroke, Volume 56, Issue Suppl_1, Page ATMP45-ATMP45, February 1, 2025. Background:Prior studies reported only half of stroke patients arrived at emergency departments (ED) via emergency medical services (EMS). Some studies found EMS arrival to be associated with more rapid evaluation and treatment which have been shown to be associated with better outcomes. We sought to explore ED modes of arrival for potential acute stroke patients in two large racial-ethnically diverse regional cohorts in California.Methods:Kaiser Permanente Northern California (KPNC) consists of 21 certified stroke centers, and Kaiser Permanente Southern California (KPSC) have 15 certified centers. Both regions have standardized Telestroke programs for all stroke centers to include video evaluation by a teleneurologist. From 1/1/2016 to 12/31/2022, the KPNC study cohort included all non-cancelled stroke alerts who were potential candidates for further workup for acute ischemic stroke treatment. Non-cancelled group was approximately 45% of the total stroke alert volume in the KPNC region. During the same period, KPSC study cohort included all stroke alerts who were evaluated by Telestroke for possible acute stroke. KPSC did not use a cancel-versus-non-cancel system. Assessment included demographics, ED mode of arrival, and neighborhood deprivation index (NDI).Results:During the study period, there were 17,437 patients from KPNC and 41,466 patients from KPSC yielding a combined total of 58,903 adults evaluated by Telestroke neurologists for possible acute stroke at 36 stroke centers in California. Overall, 31,533 (53.5%) arrived via walk-in rather than EMS. However, in Southern CA, patients were more likely on average, to arrive as walk-in (67.7%) compared to Northern CA (19.8%). Range of walk-in for KPNC facilities was 11% to 38.5%, and 34% to 86.1% for KPSC centers [Figure]. Patients who presented as walk-in tended to be younger and more Hispanic. Those from more impoverished communities presented via EMS more often than via walk-in [Table].Conclusions:In our combined cohort, there were several differences between walk-in patients and those who arrived via EMS. There was notable variation in ED arrival mode by facility and stark contrast between the two regions in California. Further research is needed to understand these differences and whether they are associated with outcomes, and to identify potential targets for future interventions to improve acute stroke care delivery for walk-in patients.