Viral infections during pregnancy are a considerable cause of adverse outcomes and birth defects, and the underlying mechanisms are poorly understood. Among those, cytomegalovirus (CMV) infection ...stands out as the most common intrauterine infection in humans, putatively causing early pregnancy loss. We employed murine CMV as a model to study the consequences of viral infection on pregnancy outcome and fertility maintenance. Even though pregnant mice successfully controlled CMV infection, we observed highly selective, strong infection of corpus luteum (CL) cells in their ovaries. High infection densities indicated complete failure of immune control in CL cells, resulting in progesterone insufficiency and pregnancy loss. An abundance of gap junctions, absence of vasculature, strong type I interferon (IFN) responses, and interaction of innate immune cells fully protected the ovarian follicles from viral infection. Our work provides fundamental insights into the effect of CMV infection on pregnancy loss and mechanisms protecting fertility.
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•Cytomegalovirus strongly infects all ovarian cells except follicular cells•Infection of corpus luteum compromises progesterone production and pregnancy•Blood follicle barrier and innate immune responses protect the follicles•IFNβ signaling is the main factor of follicular cell resistance
Although viral infections are known risk factors during pregnancy, little is known about their effect on reproductive organs and fertility. Tomac et al. demonstrate how human cytomegalovirus infection of the ovaries could result in abortion and identifies immunological barriers protecting future fertility.
Our aim was to determine the frequency and characteristics of neurological post-COVID-19 syndrome and the diagnostic and therapeutic measures that were used for the treatment of these patients. Data ...were collected for 243 patients examined during the period of 11 May 2021 to 22 June 2022. The inclusion criteria were COVID-19 illness and neurological symptoms associated with COVID-19. The exclusion criteria were non-neurological symptoms, patients who did not suffer from COVID-19, and symptoms that occurred after vaccination against the SARS-CoV-2 virus. Data for 227 patients with neurological post-COVID-19 symptoms were analyzed. Most patients presented with multiple symptoms, most often headache, cognitive impairment, loss of smell, paresthesia, fatigue, dizziness, and insomnia. Patients were most often referred for consultative examinations, neuroradiological imaging, and EEG. The therapy was mostly symptomatic. Most patients had no change in their symptoms on follow-up visits (53.21%), while positive outcome was found in 44.95% of patients. This study found that neurological post-COVID-19 syndrome appears to be more common in women, and generally, the most common symptoms are headache and cognitive impairment. The gender distribution of symptoms was clearly visible and should be further investigated. There is a need for longitudinal follow-up studies to better understand the disease dynamic.
Background and purpose: Inevitable lockdown scenario during the first wave of COVID-19 pandemic led to different approaches of medical care system worldwide. During this period, health care services ...faced theproblem of time, place and human resources management. However, in spite of redirecting health forces to fight this new and unknown virus in all countries, the need of routine treatment of all the other emergencies according to the guidelines remained present. The aim of our study was to analyse the acute stroke care in Croatia during first wave of Covid pandemic.Materials and methods: In order to achieve the rate of stroke patients admitted to hospital care in dedicated hospital stroke units and centers, we have gathered the data from four Croatian University Hospitals. We analyzed the number of hospitalized stroke patients from 1th of February to 1th of May 2020 and the proportions of patients treated with recanalization therapy.Results: Our results showed a slight decrease of number of all neurological patients who arrived to the Emergency Unit. In 2019 recanalization therapy was given to 158 patients (19%) vs 177 (26%) in 2020. Thrombolysis alone was given to 72 (9%) of patients in 2019 and to 68 (10%) of patients in 2020, while thrombectomy (with or without thrombolysis) has been performed to 86 (10%) vs 109 (16%) patients in 2019 and 2020 respectively.Conclusion: In conclusion, we did not notice less severe stroke patients or lower level of stroke care in University Hospitals.
Traumatic brain injury (TBI) is the leading cause of death and disability worldwide. Calpains, a family of cysteine proteases have been implicated in cells death following TBI. Using ...immunohistochemistry calpain expression was analyzed in post mortem brain tissue obtained from patients who died after TBI, and findings were compared with the brain tissue from patients who died from sudden cardiac arrest. In the injured cortex an increase in calpain expression was observed in all resident brain cells: neurons, glial and endothelial cells in comparison to the control group (all p < 0.001). Calpain expression was analyzed in different post-traumatic intervals, from day 0 until 10 days post-injury, in order to establish a time course of expression in the brain cortex after TBI. Expression was detected in the cortex 5 hours after the accident, peaked at 72 hours, and substantially reduced by 10 days after TBI. Calpain expression in the cortex significantly changed during the time from TBI to death (p < 0.001), and the most prominent expression was detected in the cortex 3 days after TBI. Our results indicate that prolonged calpain expression in resident brain cells (neurons, glial and endothelial cells) plays an important role in neuronal degeneration following TBI.
Disposal of the body by setting in concrete or sealing with bricks represents relatively rare form of corpse hiding after crime. We report a unique case of juvenile offender who killed his father and ...subsequently concealed the body. The victim had been reported missing by members of his family but the body was not found until 12 months later. Hidden in concrete body was well preserved allowing not only identification of the victim but also determination of the cause of death.
Background
Acute ischemic stroke (AIS) has a high risk of recurrence, particularly in the early stage. Recurrent ischemic stroke (RIS) is associated with adverse neurological outcomes but the ...phenomenon of early RIS in the endovascular thrombectomy era has not been frequently discussed. We report a case addressing this issue.
Case presentation
We present a patient who was successfully treated by mechanical thrombectomy (MT) for middle cerebral artery occlusion. Due to an early stroke recurrence, within 72 h after the first MT, he received systemic thrombolysis and repeated MT was performed with excellent clinical outcome.
Discussion
We discuss the aspects of reperfusion therapy for patients experiencing early stroke recurrence. Consideration was given to stroke etiology and off-label use of thrombolytic therapy. Also, effectiveness of repeated MT for early re-occlusion of initially reanalyzed vessel was evaluated in order to allow more patients with RIS to benefit from reperfusion therapy.
Intravenous (i.v.) thrombolysis with recombinant tissue plasminogen activator (rt-PA) is the only available pharmacological therapy to improve the outcome of acute ischemic stroke. We compared 71 ...patients presenting with ischaemic stroke and given intravenous rt-PA (0.9 mg/kg total dose) within 3 h with 71 patients who present to the hospital more than 3 hours after stroke symptom onset. The primary endpoint was the modified Rankin scale (mRS) at 90 days, dichotomised for favourable and unfavourable (score 2-6). Outcome measures were symptomatic intracerebral haemorrhage within 36 h (haemorrhage associated with National Institutes of Health Stroke Scale NIHSS > or = 4 points deterioration), and mortality at 3 months. More patients had favourable outcome with the rt-PA-treated group than with the control group (64.79% vs. 22.54%; p = 0.0001). The greater proportion of patients left with minimal or no deficit 90 days after rt-PA treatment, as compared with the control group. In the treated group symptomatic intracranial hemorrhage occurred in 1 patient who recovered to a level of functional independence, and asymptomatic intracranial hemorrhage was observed in 2 patients. Our experience of an acute stroke thrombolysis service shows that we are able to provide this treatment safely and in accordance with established treatment guidelines. We recommend thrombolytic treatment in acute ischemic stroke for selected population.
Subarachnoid haemorrhage (SAH) is the only type of stroke with female predominance. We conducted a retrospective analysis of SAH patients throughout a decade and tried to establish any reason for ...such remarkable sex difference. We conducted a retrospective analysis of subarachnoid haemorrhages treated in Istria County between 2010 and 2021. Some of those patients were referred to a comprehensive stroke centre and we collected those data too. We also collected data regarding the outcome recorded at follow up exams of patients treated for SAH in that period. A total of 193 patients with subarachnoid haemorrhage were found in observed period. We found a lower incidence regarding general population but with a tendency to increase, compared with data from other studies. Among all SAH, 113 were female, which makes a Risk Ratio (RR) of 1.44. The highest RR in females was in aneurysmal subarachnoid haemorrhages, 2.06. We obtained a similar high RR of 2.03 in the case of female ruptured multiple intracranial aneurysms (IA), clearly with a worse outcome. Conversely, the RR in non-aneurysmal subarachnoid haemorrhages and perimesencephalic subarachnoid haemorrhages was lower in the case of female sex and amounted 0.67. We noticed similar sex inequality as shown in other studies, so we can also state that women are at higher risk of IA rupture than men. The reason has to be multifactorial. As found in this study, women have different predilection sites of IA rupture compared with men so we strongly believe that certain hemodynamic forces may lead to aneurysm growth and rupture. As we also confirmed IA rupture is age dependent more in women than in men. As shown in other studies, oestrogen level might be the reason for that. Future studies should further establish and prove these risk factors for IA aneurysm rupture and improve preventive measures.
U zadnjem desetljeću paradigma liječenja akutnog ishemijskog moždanog udara značajno je promijenjena. Za razliku od nekadašnjeg pasivnog pristupa koji je podrazumijevao medikamentoznu terapiju i ...medicinsko praćenje, danas se primjenjuje aktivno liječenje koje uključuje intravensku trombolizu i mehaničku trombektomiju. Mehanička trombektomija počela se provoditi početkom ovog stoljeća, no značajan procvat metode započeo je objavom nekoliko multicentričnih randomiziranih studija (MR CLEAN, ESCAPE, SWIFT PRIME, REVASCAT, THRACE, PISTE) koje su 2015. godine potvrdile dobrobit ove metode liječenja. Danas je dokazano da je mehanička trombektomija povoljna i poželjna metoda liječenja bolesnika s akutnim ishemijskim moždanim udarom. Razvoj novih dijagnostičkih uređaja i standardizacija protokola snimanja omogućila je objektivniju procjenu stupnja oštećenja parenhima mozga, što je izravno utjecalo na odluku o daljnjem liječenju. Danas je postupak mehaničke trombektomije moguće provesti unutar 24 sata od nastupa simptoma, što su potvrdile i multicentrične randomizirane studije, DAWN i DEFUSE 3. Svakodnevni napredak mehaničke trombektomije doveo je do liječenja i distalnijih okluzija, poput M2 i M3 segmenta srednje moždane arterije i proksimalnih okluzija anteriorne i posteriorne moždane cirkulacije. Istovremeno je neurointervencijski tim postao veoma važna karika u lancu liječenja bolesnika s moždanim udarom. Nedavnom implementacijom mehaničke trombektomije u standardan protokol liječenja bolesnika s akutnim ishemijskim moždanim udarom u sve kliničke bolničke centre u Republici Hrvatskoj, bolesnicima koji borave u Republici Hrvatskoj omogućeno je liječenje najsuvremenijom metodom, sukladno najnovijim smjernicama.
The paradigm of acute ischemic stroke treatment has changed significantly in the last decade. Clinicians switched from the former passive approach to active treatment that includes intravenous thrombolysis and mechanical thrombectomy. Epiphany of mechanical thrombectomy as a preferable treatment method for acute ischemic stroke started with publication of several multicentred randomized studies (MR CLEAN, ESCAPE, SWIFT PRIME, REVASCAT, THRACE, PISTE), which confirmed the benefits of this method in the year 2015. Today, mechanical thrombectomy is proven to be a favorable and desirable method of treatment for patients with acute ischemic stroke. Further development of new diagnostic devices and standardization of imaging protocols enabled objective estimation of brain damage, which resulted with extension of the time frame in which invasive treatment has potential benefit. Consequently, it is now advised to perform mechanical thrombectomy even 24 hours from symptom onset, which was confirmed by DAWN and DEFUSE 3 studies. The development of new endovascular materials, techniques and trained medical staff resulted with treating more distally located vascular structures, such as occlusions of M2 and M3 segments of the middle cerebral artery and proximal occlusions of anterior and posterior cerebral circulation. Meanwhile, neurointerventional team becamethe crucial link in acute ischemic stroke treatment. With recent implementation of mechanical thrombectomy in every Clinical Hospital Center in Croatia, a modern and up to date treatment of acute ischemic stroke became available to every patient in our country.
Multiple sclerosis (MS) is demyelization disease of central nervous system of unidentified causes. Analytic epidemiological research of 19 patients, clinically approved cases of MS and 25 controls, ...autochthonic inhabitants of town of Cabar, Croatia, the high-risk zone for the disease, was made. The research plan included case-control investigation--the "door to door" questionnaire--about nutrition habits. An odds ratio (OR) was calculated for all the factors which were more frequently found in the patients than in the controls, and vice versa. The variables that were connected with significant risk for MS in the town of Cabar included: alcohol consumption (p = 0.05), animal fats/dried meat products consumption (p = 0.007), nitrate salting (p = 0.03), strong spices (p = 0.007), mixed bread (p = 0.002), oat and oat products consumption (p = 0.0075). No connection was found with regular consumption of vegetables and fruit (p = 0.009), blue fresh fish (p = 0.028), other fresh fish (p = 0.03), freshwater fish (p = 0.002), canned fish (p = 0.004), dormouse meat (p = 0.007), air-dried meat products (p = 0.004) and using the water from water supply (p = 0.011). In the town of Cabar nutritional customs, primarily food rich in animal fats, alcohol-abuse, and oat consumption could have an influence on MS pathogenesis in genetically inclined individuals.
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