INTRODUCTIONEvidence from experimental and clinical studies is accumulating about the possible cerebral protective properties of antithypertensive drugs, mainly angiotensin receptor blockers (ARB) or ...angiotensin-converting enzyme inhibitors (ACEI). Our aim was to analyse the impact of prestroke use of antihypertensive drugs on stroke severity and outcome.
METHODSWe analysed 1968 consecutive patients with first-ever acute cerebral infarction admitted to an acute stroke unit. Stroke severity was evaluated using the Canadian Neurological Scale and the modified Rankin Score (mRS) was used to evaluate the outcome at discharge.
RESULTSPrevious diagnosis of arterial hypertension was reported in 1212 patients and 73% were on antihypertensive treatment. No significant differences in stroke severity were found between patients with or without previous arterial hypertension, either in patients with or without antihypertensive treatment. Patients taking antihypertensive drugs at stroke onset had lower rates of poor outcome than those not on antihypertensive treatment (47 vs. 53%; P = 0.047) and those taking ARB had better outcomes than those without ARB (mRS ≤ 275 vs. 65.8%; P = 0.029), with no differences in the analysis of other antihypertensive drugs. The multivariable logistic regression analysis showed that previous treatment with ARB was independently associated with reduced stroke severity (OR0.40; 95%CI 0.24–0.65; P < 0.001) and against poor outcome (OR0.41; 95%CI 0.23–0.78; P = 0.003).
CONCLUSIONOur study suggests that prestroke treatment with ARB may be associated with reduced stroke severity and also with better outcome. This finding agrees with experimental data that suggest a cerebral protective effect.
Carotid plaques undergo histologic changes early after an ischemic stroke. However, the evolution of carotid plaques echolucency after a recent brain ischemia is not well known. A prospective ...observational study that included consecutive stroke patients and asymptomatic individuals with plaques showing ≥50% stenosis on duplex ultrasound was conducted. Plaque echogenicity was measured with the standardized gray-scale median (GSM) and compared with respect to symptoms presence and time from stroke onset. One hundred twenty-six carotid plaques in 124 patients were studied and four groups of plaques were analyzed: (1) plaques seen within 24 h of stroke onset (32); (2) between 1-7 days (50); (3) more than 7 days after stroke onset (22) and; (4) plaques without associated symptoms (22). Plaques of group 1 had less echogenicity than those of groups 2-4: median GSM (interquartile range) 14 (16), 19.5 (19), 22.5 (21), 26.5 (16) respectively (p = 0.001). In conclusion, carotid plaque echogenicity is increased with time from stroke onset and could be an early marker of plaque remodeling.
Ultrasound (US) techniques increase the ability of neurologists specializing in stroke to rapidly evaluate stroke patients, determine likely mechanisms of brain ischemia, determine arterial patency, ...quantify stenosis severity, and determine the most appropriate clinical management. Furthermore, the development of new US techniques based on the detection of US contrast agents may permit the evaluation of cerebral microcirculation and the identification of regions of angiogenesis, inflammation and thrombus during brain ischemia.
Neuromyelitis optica, or Devic's disease, is an inflammatory, demyelinating disease of the central nervous system that selectively affects the optic nerves and the spinal cord, with a high rate of ...relapses. Anti-aquaporin-4 (AQP4) antibodies are a highly specific marker for this condition.
A 66-year-old female with longitudinally extensive dorsal transverse myelitis with complete remission following steroidal treatment and later acute relapse, with palsy in one limb. The differential diagnoses considered included a spinal tumour and arteriovenous malformation of the spinal cord. Being positive for AQP4 was the decisive factor in the final diagnosis.
Early detection of anti-AQP4 antibodies together with appropriate immunotherapy can be the key to a better prognosis. An early diagnosis is essential to be able to start treatment at an early stage and thus prevent relapses and severe sequelae.
Polycythaemia vera (PV) is an haematological neoplasm that frequently presents neurological symptoms. However, chorea is a rare complication of this disease, occurring in less than 5% of the ...patients. Cognitive impairment related to PV unbalanced is also a rare complication, and it can improve with proper treatment. We present a 96-year-old-man with acute-onset hemichorea and frontal lobe syndrome with no vascular pathology in the basal ganglia or frontal region. A clear relationship was observed between the onset of involuntary movements and the cognitive impairment and worsening of haematological parameters in the patient. After causal and symptomatic treatment, the patient’s clinical status improved. In the elderly, PV must be considered as a cause of acute chorea and sudden cognitive impairment, as early diagnosis leads to effective treatment and prevention of complications.
Food addiction is characterized by a loss of behavioral control over food intake and is associated with obesity and other eating disorders. The mechanisms underlying this behavioral disorder are ...largely unknown. We aimed to investigate the changes in miRNA expression promoted by food addiction in animals and humans and their involvement in the mechanisms underlying the behavioral hallmarks of this disorder. We found sharp similitudes between miRNA signatures in the medial prefrontal cortex (mPFC) of our animal cohort and circulating miRNA levels in our human cohort, which allowed us to identify several miRNAs of potential interest in the development of this disorder. Tough decoy (TuD) inhibition of miRNA-29c-3p in the mouse mPFC promoted persistence of the response and enhanced vulnerability to developing food addiction, whereas miRNA-665-3p inhibition promoted compulsion-like behavior and also enhanced food addiction vulnerability. In contrast, we found that miRNA-137-3p inhibition in the mPFC did not lead to the development of food addiction. Therefore, miRNA-29c-3p and miRNA-665-3p could be acting as protective factors with regard to food addiction. We believe the elucidation of these epigenetic mechanisms will lead to advances toward identifying innovative biomarkers and possible future interventions for food addiction and related disorders based on the strategies now available to modify miRNA activity and expression.
The aim of this study was to assess the immunogenicity of severe acute respiratory syndrome coronavirus 2 (SARS‑CoV‑2) vaccines among people living with HIV (PLWH) with severe immunosuppression, ...after a booster dose. The design was a case–control study nested in a prospective cohort of PLWH. All patients with CD4 cell count <200 cells/mm3 who had received additional dose of messenger RNA (mRNA) COVID‐19 vaccine, after a standard immunization scheme were included. Control group: patients age‐ and sex‐matched, with CD4 ≥ 200 cells/mm3, in the ratio of 2:1. Antibody response to a booster dose (anti‐S levels 33.8 ≥ BAU/mL) and neutralizing activity against SARS‐CoV‐2 B.1, B.1.617.2, and Omicron BA.1, BA.2, and BA.5 strains were assessed after the booster shot. Fifty‐four PLWH were included, 18 with CD4 counts < 200 cells/mm3. Fifty‐one (94%) showed response to a booster dose. Response was less frequent in PLWH with CD4 < 200 cells/mm3 than in those with CD4 counts ≥ 200 cells/mm3 (15 83% vs. 36 100%, p = 0.033). In the multivariate analysis, CD4 counts ≥ 200 cells/mm3 incidence rate ratio (IRR) = 18.1 (95% confidence interval CI: 16.8–19.5), p < 0.001 was associated with a higher probability of showing antibody response. Neutralization activity against SARS‐CoV‐2 B.1, B.1.617, BA.1, and BA.2 strains was significantly inferior among individuals with CD4 counts < 200 cells/mm3. In conclusion, among PLWH with CD4 counts < 200 cells/mm3, the immune response elicited by mRNA additional vaccine dose is reduced.
Anatolia was home to some of the earliest farming communities. It has been long debated whether a migration of farming groups introduced agriculture to central Anatolia. Here, we report the first ...genome-wide data from a 15,000-year-old Anatolian hunter-gatherer and from seven Anatolian and Levantine early farmers. We find high genetic continuity (~80-90%) between the hunter-gatherers and early farmers of Anatolia and detect two distinct incoming ancestries: an early Iranian/Caucasus related one and a later one linked to the ancient Levant. Finally, we observe a genetic link between southern Europe and the Near East predating 15,000 years ago. Our results suggest a limited role of human migration in the emergence of agriculture in central Anatolia.
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