The risk stratification based on the CHA2DS2-VASc may predict the response to intravenous thrombolysis after stroke

CHA₂DS₂-VASc score influences the outcome in stroke patients with or without atrial fibrillation (AF). We assessed whether the risk stratification based on the prestroke CHA₂DS₂-VASc score may predict the response to intravenous (IV) thrombolysis in stroke patients. We conducted an analysis on prospectively collected data of 516 consecutive AF and non-AF patients treated with IV thrombolysis. Outcome measures were major improvement (NIH Stroke Scale [NIHSS] ≤8 points from baseline or NIHSS score 0) and deterioration (death or NIHSS ≥1 points from baseline) or no improvement (NIHSS score equivalent to baseline) at 24 h; excellent (modified Rankin Scale [mRS] score ≤1) and unfavorable outcome (mRS score >2) at 3 months. Multivariate analysis showed that ORs for major improvement and excellent outcome were lower in patients with intermediate risk (CHA₂DS₂-VASc = 1) (OR 0.39, 95 % CI 0.16–0.92, p = 0.032; OR 0.10, 95 % CI 0.02–0.56, p = 0.009), moderately high risk (CHA₂DS₂-VASc = 2) (OR 0.43, 95 % CI 0.19–0.96, p = 0.040; OR 0.16, 95 % CI 0.03–0.76, p = 0.022), and very high risk (CHA₂DS₂-VASc > 3) (OR 0.31, 95 % CI 0.15–0.65, p = 0.002; OR 0.17, 95 % CI 0.04–0.81, p = 0.026), whereas ORs for deterioration or no improvement and unfavorable outcome were higher only in patients with very high risk (OR 4.26, 95 % CI 1.24–14.65, p = 0.021; OR 9.26, 95 % CI 1.15–74.65, p = 0.037), compared with low risk (CHA₂DS₂-VASc = 0). Low-risk level based on the prestroke CHA₂DS₂-VASc score was predictor of effective response to IV thrombolysis. Very high-risk level was predictor of failed response, compared with low-risk level.     

Quantitative electroencephalogram analysis confirms the presence of frontal lobe deficit among attention deficit disorder with hyperactivity children

BACKGROUND: [corrected] The Attention Deficit Disorder with Hyperactivity (ADDH) Barkley model predicts concomitant deficits in working memory and in the development of a sense of time as a consequence of poor behavioral inhibition. Objective: To evaluate electrophysiologically Barkley's theory (1997). SUBJECTS AND METHODS: We studied the electroencephalogram (EEG) of fifteen right-handed, normal limit IQ ADDH children (inattentive subtype), aged 7-11 years, and a control group. Subjects were studied at rest, with the eyes open (RO) while performing a time estimation task (ET). Forty-two data matrices were analyzed in three conditions: RO, ET and ET-RO, to assess broad-band spectral parameters; the anteriority, temporal-referenced and laterality quotients (Aq, Aqt and Lq, respectively); and the theta/alpha and theta/beta ratios. RESULTS: Analyses of variance revealed significant differences for ES-RA, in absolute (Aq &Aqt) and relative powers (Aq). Discriminant function analysis was able to predict group membership with an accuracy over 80%, but it decreased slightly when the leave-one-out method was applied Linear discrimination based on right hemisphere Aqt values showed the highest discrimination accuracy. CONCLUSIONS: These results support Barkley's theory, suggesting further evaluation of the temporal-referenced anteriority quotient as a promising electrophysiological tool for the diagnosis and follow up of ADDH children.     

Radiation‐induced nausea and vomiting in head and neck cancer: Is it something worth considering in the intensity modulated radiotherapy era? “A narrative review”

Radiation therapy is one of the cornerstones in the treatment of head and neck squamous cell carcinomas (HNSCC), alone or in combination with chemotherapy or surgery. Technological advances which occurred over the last few decades have increased the efficacy of radiotherapy (RT), particularly, intensity‐modulated RT (IMRT). IMRT can deliver treatments on complex tumoral targets with dose escalation while sparing organs at risk; anyway IMRT deposits dose in unpredictable patterns outside of the target volume with the purpose of improving conformality. Radiation‐induced nausea and vomiting (RINV) is a frequent albeit neglected side effect of RT that can lead to delays in treatment with serious consequences on cure rates. According to several guidelines (MASCC 2016, NCCN 2018), RT for HNSCC has traditionally been regarded as a low emetic risk treatment. Nevertheless, several works suggest that IMRT could increase RINV. Further studies are needed to define the exact incidence and the detailed pathophysiology of RINV in patients with HNSCC treated with state of art IMRT techniques, with and without concurrent chemotherapy.     

High Heterogeneity of Echoviruses in Brazilian Children with Acute Gastroenteritis

Echoviruses (E) are a diverse group of viruses responsible for various pathological conditions in humans including aseptic meningitis, myocarditis, and acute flaccid paralysis. The detection and identification of echovirus genotypes in clinical samples is challenging due to its high genetic diversity. Here, we report the complete genome sequences of nine echoviruses, obtained by next-generation sequencing of 238 fecal samples from individuals with gastroenteritis in regions of Brazil. Detected viruses were classified into six genotypes: Three E1 sequences (BRA/TO-028, BRA/TO-069 and BRA/TO-236), one E3 (BRA/TO-018), one E11 (BRA/TO-086), one E20 (BRA/TO-016), two E29 (BRA/TO-030 and BRA/TO-193), and one E30 sequence (BRA/TO-032). Phylogenetic analysis indicated that the echoviruses E1 and E29 circulating in Brazil are divergent from strains circulating worldwide. The genotype diversity identified in our study may under-represent the total echovirus diversity in Brazil because of the small sample size and the restricted geographical distribution covered by the survey.     

Gastric emptying before and after cholecystectomy in patients with cholecystolithiasis

BACKGROUND/AIMS: The objective of the present study was to measure gastric emptying time of solids and semisolids in dyspeptic individuals with cholecystolithiasis before and 6 months after cholecystectomy in order to determine whether cholecystectomy interferes with gastric emptying. METHODOLOGY: A prospective, self-pairing study was conducted on 29 patients selected according to appropriate inclusion and exclusion criteria. Gastric emptying time of solids and semisolids was determined before and six months after laparoscopic cholecystectomy by the 13C-octanoic acid and 13C-acetate breath tests, respectively. The samples were analyzed by infrared spectrometry. The gastric retention time (lag phase) and gastric emptying half-time of solid and semisolid were determined and the results obtained before and after surgery were compared in the same patient. In addition, the effects of surgery on dyspeptic symptoms were assessed. RESULTS: No significant differences (p>0.05) in gastric retention time and gastric emptying half-time of solid and semisolid test meals were observed before and after cholecystectomy. Dyspeptic symptoms (pain, upper abdominal gases, early satiety, nausea and vomiting) improved after surgery. CONCLUSIONS: Laparoscopic cholecystectomy does not interfere with the gastric emptying time of solids or semisolids in dyspeptic individuals with cholecystolithiasis.