The perinatal consequences of SARS-CoV-2 infection are still largely unknown. This study aimed to describe the features and outcomes of pregnant women with or without SARS-CoV-2 infection after the ...universal screening was established in a large tertiary care center admitting only obstetric related conditions without severe COVID-19 in Mexico City. This retrospective case-control study integrates data between April 22 and May 25, 2020, during active community transmission in Mexico, with one of the highest COVID-19 test positivity percentages worldwide. Only pregnant women and neonates with a SARS-CoV-2 result by quantitative RT-PCR were included in this study. Among 240 pregnant women, the prevalence of COVID-19 was 29% (95% CI, 24% to 35%); 86% of the patients were asymptomatic (95% CI, 76%-92%), nine women presented mild symptoms, and one patient moderate disease. No pregnancy baseline features or risk factors associated with severity of infection, including maternal age > 35 years, Body Mass Index >30 kg/m2, and pre-existing diseases, differed between positive and negative women. The median gestational age at admission for both groups was 38 weeks. All women were discharged at home without complications, and no maternal death was reported. The proportion of preeclampsia was higher in positive women than negative women (18%, 95% CI, 10%-29% vs. 9%, 95% CI, 5%-14%, P<0.05). No differences were found for other perinatal outcomes. SARS-CoV-2 test result was positive for nine infants of positive mothers detected within 24h of birth. An increased number of infected neonates were admitted to the NICU, compared to negative neonates (44% vs. 22%, P<0.05) and had a longer length of hospitalization (2 2-18 days vs. 2 2-3 days, P<0.001); these are potential proxies for illness severity. This report highlights the importance of COVID-19 detection at delivery in pregnant women living in high transmission areas.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
Objective
This study was undertaken to evaluate functional and safety outcomes for endovascular thrombectomy (EVT) versus medical management (MM) in patients with large vessel occlusion (LVO) and ...mild neurological deficits, stratified by perfusion imaging mismatch.
Methods
The pooled cohort consisted of patients with National Institutes of Health Stroke Scale (NIHSS) < 6 and internal carotid artery (ICA), M1, or M2 occlusions from the Extending the Time for Thrombolysis in Emergecy Neurological Deficits ‐ Intra‐Arterial (EXTEND‐IA) Trial, Tenecteplase vs Alteplase before Endovascular Thrombectomy in Ischemic Stroke (EXTEND‐IA TNK) trials Part I/II and prospective data from 15 EVT centers from October 2010 to April 2020. RAPID software estimated ischemic core and mismatch. Patients receiving primary EVT (EVTpri) were compared to those who received primary MM (MMpri), including those who deteriorated and received rescue EVT, in overall and propensity score (PS)‐matched cohorts. Patients were stratified by target mismatch (mismatch ratio ≥ 1.8 and mismatch volume ≥ 15ml). Primary outcome was functional independence (90‐day modified Rankin Scale = 0–2). Secondary outcomes included safety (symptomatic intracerebral hemorrhage sICH, neurological worsening, and mortality).
Results
Of 540 patients, 286 (53%) received EVTpri and demonstrated larger critically hypoperfused tissue (Tmax > 6 seconds) volumes (median IQR: 64 26–96 ml vs MMpri: 40 14–76 ml, p < 0.001) and higher presentation NIHSS (median IQR: 4 2–5 vs MMpri: 3 2–4, p < 0.001). Functional independence was similar (EVTpri: 77.4% vs MMpri: 75.6%, adjusted odds ratio aOR = 1.29, 95% confidence interval CI = 0.82–2.03, p = 0.27). EVT had worse safety regarding sICH (EVTpri: 16.3% vs MMpri: 1.3%, p < 0.001) and neurological worsening (EVTpri: 19.6% vs MMpri: 6.7%, p < 0.001). In 414 subjects (76.7%) with target mismatch, EVT was associated with improved functional independence (EVTpri: 77.4% vs MMpri: 72.7%, aOR = 1.68, 95% CI = 1.01–2.81, p = 0.048), whereas there was a trend toward less favorable outcomes with primary EVT (EVTpri: 77.4% vs MMpri: 83.3%, aOR = 0.39, 95% CI = 0.12–1.34, p = 0.13) without target mismatch (pinteraction = 0.06). Similar findings were observed in a propensity score‐matched subpopulation.
Interpretation
Overall, EVT was not associated with improved clinical outcomes in mild strokes due to LVO, and sICH was increased. However, in patients with target mismatch profile, EVT was associated with increased functional independence. Perfusion imaging may be helpful to select mild stroke patients for EVT. ANN NEUROL 2022;92:364–378
La hidratación es un proceso de consumo de agua que aporta grandes beneficios y mantiene la homeostasis hídrica de un organismo. Las fuentes de hidratación en el mundo se han diversificado en razón ...de la amplia disponibilidad de productos hídricos para el consumo humano. La calidad de los mismos es igualmente variable y van desde los que aportan solo agua hasta aquellos que contienen vitaminas, minerales, electrolitos, azúcares, edulcorantes no calóricos, colorantes, entre otros constituyentes.
To evaluate functional and safety outcomes for endovascular thrombectomy (EVT) versus medical management (MM) in patients with large vessel occlusion (LVO) and mild neurological deficits, stratified ...by perfusion imaging mismatch.
Pooled cohort of patients with NIHSS<6 and ICA, M1, M2 occlusions from EXTEND-IA, EXTEND-IA-TNK I/II RCTs and prospective data from 15 EVT centers from 10/2010 to 4/2020. RAPID software estimated ischemic core and mismatch. Patients receiving primary endovascular thrombectomy (EVT
) were compared to those who received primary MM (MM
), including those who deteriorated and received rescue EVT, in overall and PS matched cohorts. Patients were stratified by target mismatch (mismatch-ratio≥1.8 and mismatch-volume≥15cc). Primary outcome was functional independence (90-day mRS:0-2); Secondary outcomes included safety (sICH, neurological worsening, and mortality).
Of 540 patients, 286/540(53%) received EVT
and demonstrated larger critically hypoperfused tissue (Tmax>6s) volumes of (6426-96mL vs MM
:4014-76mL, p<0·001) and higher presentation NIHSS (4(2-5) vs MM
:3(2-4), p<0·001). Functional independence was similar (EVT
:77·4% vs MM
:75.6%, aOR:1.29,95%CI:0.82-2.03,p=0.27). EVT had worse safety: sICH (EVT
:8.8% vs MM
:1.3%, p<0.001) and neurological worsening (EVT
:19.6% vs MM
:6.7%, p<0.001). In 414(76.7%) with target mismatch, EVT was associated with improved functional independence (EVT
:77·4% vs MM
:72.7%, aOR:1.68, 95%CI:1.01-2.81,p=0.048), whereas, there was a trend toward less favorable outcomes with primary EVT (EVT
:77·4% vs MM
:83.3%, aOR:0.39,95%CI:0.12-1.34,p=0.13) without target mismatch, (p
=0.06). Similar findings were observed in a PS matched subpopulation.
Overall, EVT was not associated with improved clinical outcomes in mild strokes due to LVO, and sICH was increased. However, in patients with target mismatch profile, EVT was associated with increased functional independence. Perfusion imaging may be helpful to select mild stroke patients for EVT. This article is protected by copyright. All rights reserved.
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