Neurology
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Iron Therapy for Acute Heart Failure
Giving intravenous ferric carboxymaltose to stabilized post-acute heart failure patients with iron deficiency improved quality of life vs. placebo-treated patients within four weeks, which persisted during subsequent therapy for up to 24 weeks.
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Proton-Pump Inhibitors and Community-Associated Clostridioides difficile Infection
A nationwide cohort study of adults in Denmark found that proton-pump inhibitor (PPI) use was associated with a moderately increased risk of community-associated Clostridioides difficile infection, and the risk remained elevated up to one year after PPI treatment had ended.
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Clostridioides difficile Infection: Guideline Update
Fidaxomicin is preferred over vancomycin for initial and recurrent cases. Bezlotoxumab is recommended in many cases of recurrent infection and initial infection in patients at high risk of recurrence.
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Can Antibiotics Lead to Colon Cancer?
Swedish researchers saw an association between frequent antibiotic use and proximal colorectal cancer.
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In Young Adults, Marijuana Use Is Not Associated with Increased Risk of Early Onset Ischemic Stroke
Marijuana use, both recreational and medical, is increasing among young adults, and many states are legalizing its use. A variety of cardiovascular effects have been described, which could increase the risk of cardiovascular complications, including stroke, and some observational studies have suggested an increased stroke risk from marijuana use. But there are few epidemiological studies that have evaluated this association.
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Clinical and Perfusion Mismatch Criteria Both Are Reliable in Identifying Patients Who Will Benefit from Endovascular Therapy
Since 2015, when multiple clinical trials were published showing the efficacy of endovascular thrombectomy (EVT) for large vessel occlusion within six hours of stroke onset, additional criteria have been developed to identify those patients who will benefit from EVT beyond six hours. The AURORA investigators collected patient data from six large clinical trials and performed a meta-analysis to determine if a clinical mismatch or an imaging mismatch protocol was better at predicting good outcomes in patients treated between six hours and 24 hours after the onset of clinical stroke symptoms.
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Basilar Artery Occlusion: Endovascular Thrombectomy and Medical Therapy Have Similar Outcomes
Basilar artery occlusion is a rare form of ischemic stroke and accounts for about 10% of large vessel occlusions reported in the literature. These investigators conducted a randomized trial, enrolling patients from 2011 through 2019, even though multiple studies published in 2015 demonstrated benefit of endovascular therapy in anterior circulation large vessel occlusions. Efficacy and safety were compared with medical therapy in patients who underwent endovascular therapy within six hours after the estimated time of onset of symptoms.
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Telestroke Consultation Increases Rate of Thrombolysis and Reduces Mortality
Real-time video conferencing between the patient, a remotely located stroke specialist, and the bedside healthcare provider in a hospital emergency department is referred to as “telestroke.” However, there are little data comparing its benefit with in-person evaluation and treatment for hospitals that do not have in-hospital stroke specialists 24 hours per day, seven days per week.
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Intensive Lowering of Blood Pressure Does Not Affect the Progression of Small Vessel Disease
Small vessel disease of the brain accounts for 20% to 25% of all ischemic strokes and is a common cause of vascular cognitive impairments. The major risk factor for small vessel disease is hypertension. Targeting a systolic blood pressure of 120 mmHg to 125 mmHg has been recommended, but this has not been confirmed as effective in preventing stroke or long-term cognitive impairment in these patients.
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Pregnancy-Associated Stroke Is Increasing in Frequency
Stroke during pregnancy or the puerperium is a rare event but accounts for a considerable part of maternal morbidity and mortality. The incidence has been increasing in all countries, particularly in wealthy industrialized countries, where pregnancy is being delayed considerably and other cardiovascular risk factors have taken on greater importance.