scholarly journals B.2 Neurologic outcome trajectory following neonatal arterial ischemic stroke (NAIS): A longitudinal observational study

2021 ◽  
Vol 48 (s3) ◽  
pp. S16-S16
Author(s):  
M Slim ◽  
E Pullenayegum ◽  
A Aziz ◽  
N Dlamini ◽  
D MacGregor ◽  
...  
Keyword(s):  
Cognitive Deficits ◽  
Classification Scheme ◽  
Close Monitoring ◽  
Arterial Ischemic Stroke ◽  
Cognitive Domains ◽  
Neurologic Outcomes ◽  
Longitudinal Observational Study ◽  
Long Term Follow Up

Background: Studies evaluating long-term neurologic outcomes following NAIS are scanty. We aimed to study the emergence pattern of neurologic deficits following NAIS. Methods: Neonates diagnosed with AIS were prospectively enrolled and outcomes were evaluated using the validated Pediatric Stroke Outcome Measure-Severity Classification Scheme. Neurologic outcomes were classified as normal/mild, moderate or severe. Trend analysis was conducted using Cochran-Armitage test. Results: A total of 126 neonates (59% males) were followed for a median of 5.2 years (IQR:3.4-6.4 years). The proportion of children classified as normal/mild declined from 94% to 76% >5 years post-stroke (p<0.01). Moderate and severe outcomes increased from 5% to 15% and 1% to 8% (p=0.01), respectively. Sensorimotor, language and cognitive deficits emerged in 16%, 14%, and 17% of enrolled neonates, respectively. Of those who had normal/mild outcomes at baseline, 83 remained stable throughout the study. Improvement in neurologic outcomes was seen in 8 children. Thirty-five neonates had emerging deficits at one point during follow-up. Congenital heart disease predicted the emergence of deficits (odds ratio=3.3, 95% confidence interval:1.01-10.5). Conclusions: Emerging deficits following NAIS are not uncommon and can equally manifest in sensorimotor, language or cognitive domains. Thus, long-term follow-up and close monitoring of outcomes following NAIS is crucial.

scholarly journals Computerized Working-Memory Training for Children Following Arterial Ischemic Stroke: A Pilot Study With Long-Term Follow-Up

2016 ◽  
Vol 5 (4) ◽  
pp. 273-282 ◽  
Author(s):  
Megan Eve ◽  
Fiadhnait O'Keeffe ◽  
Simren Jhuty ◽  
Vijeya Ganesan ◽  
Gary Brown ◽  
...  
Keyword(s):  
Working Memory ◽  
Ischemic Stroke ◽  
Pilot Study ◽  
Working Memory Training ◽  
Memory Training ◽  
Arterial Ischemic Stroke ◽  
Long Term Follow Up

scholarly journals Usefulness of desmopressin testing to predict relapse during long-term follow-up in patients in remission from Cushing’s disease

2017 ◽  
Vol 6 (8) ◽  
pp. 791-799 ◽  
Author(s):  
Alberto Giacinto Ambrogio ◽  
Massimiliano Andrioli ◽  
Martina De Martin ◽  
Francesco Cavagnini ◽  
Francesca Pecori Giraldi
Keyword(s):  
Cushing’S Disease ◽  
Transsphenoidal Surgery ◽  
Response Pattern ◽  
Disease Recurrence ◽  
Cushing's Disease ◽  
Close Monitoring ◽  
Long Term Follow Up ◽  
Over Time

Recurrence of Cushing’s disease after successful transsphenoidal surgery occurs in some 30% of the patients and the response to desmopressin shortly after surgery has been proposed as a marker for disease recurrence. The aim of the present study was to evaluate the response to desmopressin over time after surgery. We tested 56 patients with Cushing’s disease in remission after transsphenoidal surgery with desmopressin for up to 20 years after surgery. The ACTH and cortisol response to desmopressin over time was evaluated in patients on long-term remission or undergoing relapse; an increase by at least 27 pg/mL in ACTH levels identified responders. The vast majority of patients who underwent successful adenomectomy failed to respond to desmopressin after surgery and this response pattern was maintained over time in patients on long-term remission. Conversely, a response to desmopressin reappeared in patients who subsequently developed a recurrence of Cushing’s disease, even years prior to frank hypercortisolism. It appears therefore that a change in the response pattern to desmopressin proves predictive of recurrence of Cushing’s disease and may indicate which patients require close monitoring.

Progression of Albuminuria Among Patients with Type 1 Diabetes Mellitus: A Long Term Observational Follow-up Study

2019 ◽  
Author(s):  
Theodora Stratigou ◽  
Natalia Vallianou ◽  
Stavroula Koutroumpi ◽  
Barbara Vlassopoulou ◽  
Theofanis Apostolou ◽  
...  
Keyword(s):  
Glycosylated Hemoglobin ◽  
Close Monitoring ◽  
Appropriate Use ◽  
Urine Albumin Excretion ◽  
Follow Up Study ◽  
Urine Albumin ◽  
Long Term Follow Up

Abstract Background The purpose of the present study was to determine whether patients with DM1 have shown improvement, stabilization or deterioration of their urine albumin excretion levels during a close follow-up. Patients and Methods A cohort of 84 patients, 18–76 years of age, a median duration of diabetes of 24 years (1–50 years) and a median follow-up duration of 12 years (1–37 years) were included in the study. Results Among the 84 patients for whom we had UAE levels at the beginning and by the end of the study, mean glycosylated hemoglobin was statistically significantly decreased during the follow-up period, from 8.02±2.04–7.06±1.05% (p=0.036). Normoalbuminuria was present in 66 patients and remained so in 56 patients while 9 patients progressed to microalbuminuria and one patient to macroalbuminuria by the end of the study. Microalbuminuria was present in 15 patients: regression was observed in 8 patients, and progression in one patient. Regression of macroalbuminuria to microalbuminuria was noted in one patient and to normoalbuminuria was noted in one participant, too. Conclusions Improvement of glycemic control with close monitoring of DM1 patients together with the appropriate use ACE or AT2 inhibitors and statins, seems to exert nephron-protective potential and to delay or even reverse the presence of micro/macroalbuminuria. This long term follow-up study has demonstrated a statistically significant increase in serum HDLcholesterol levels. The study also revealed that intensively treated diabetes patients may show reductions in serum ALP levels. Whether this finding is related to diabetic nephropathy, NAFLD, or diabetic hepatosclerosis remains to be assessed in future trials.

Safety of anticoagulants in children with arterial ischemic stroke

Blood ◽  
2012 ◽  
Vol 119 (4) ◽  
pp. 949-956 ◽  
Author(s):  
Tal Schechter ◽  
Adam Kirton ◽  
Suzanne Laughlin ◽  
Ann-Marie Pontigon ◽  
Yaron Finkelstein ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Safety Data ◽  
Hemorrhagic Complication ◽  
Complication Rates ◽  
Arterial Ischemic Stroke ◽  
Neurologic Outcomes ◽  
Stroke Study ◽  
Limited Applicability

Abstract Pediatric arterial ischemic stroke (AIS) is increasingly diagnosed and carries significant risks of recurrence, morbidity, and mortality. Anticoagulant therapy (ACT) is commonly prescribed in childhood AIS. Hemorrhagic complication rates in pediatric stroke are unknown, and adult safety data are of limited applicability. We analyzed a prospectively enrolled cohort of children (aged 1 month-18 years) with acute AIS selected using standardized criteria for protocol-based ACT over14-year period. We assessed ACT-associated intracranial hemorrhage (ICH), including frequency, clinical and radiologic characteristics, predictors, and outcome. Among 215 children with AIS, 123 received ACT within 7 days after diagnosis. During anticoagulation, 14 (11%) children developed new or increased ICH, all within 26 days from diagnosis. ICH was symptomatic in 5 (4%), asymptomatic in 9 (7%), and mild (European Cooperative Acute Stroke Study grades HI1 or HI2) in all but 1 child (ECASS PH-2). Long-term neurologic outcomes after ACT-associated ICH in survivors were abnormal in 73% (8/11). Comparably, 12 of 75 (16%) children treated without anticoagulation developed new or increased ICH on follow-up imaging (P = .3507). We conclude that ACT is relatively safe in children with AIS, with a 4% risk of symptomatic ICH. Based on the safety of ACT in our study, clinical trials of ACT in childhood AIS are warranted.

Therapy and prevention for mental health: What if mental diseases are mostly not brain disorders?

2019 ◽  
Vol 42 ◽  
Author(s):  
John P. A. Ioannidis
Keyword(s):  
Mental Health ◽  
Mental Disease ◽  
Brain Disorders ◽  
Social Stressors ◽  
Labor Education ◽  
Mental Diseases ◽  
Long Term Follow Up ◽  
Political Decisions

AbstractNeurobiology-based interventions for mental diseases and searches for useful biomarkers of treatment response have largely failed. Clinical trials should assess interventions related to environmental and social stressors, with long-term follow-up; social rather than biological endpoints; personalized outcomes; and suitable cluster, adaptive, and n-of-1 designs. Labor, education, financial, and other social/political decisions should be evaluated for their impacts on mental disease.

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