The comparison of mechanical thrombectomy and symptomatic therapy on early outcome of acute ischemic stroke in patients older than 80 years: A retrospective cohort study.

OBJECTIVE: Multiple randomized trials have confirmed that endovascular thrombectomy (ET) is an effective treatment method for patients with acute ischemic stroke (AIS) caused by large vessel occlusion (LVO). However, patients older than eighty years of age show worse functional outcomes and higher mortality rates after ET. Our retrospective study aimed to confirm the efficacy of ET in older patients and identify characteristics or variables that can be associated with a better or worse outcome of ET. METHODS: The data of 102 patients with AIS aged 80 years or older were retrospectively collected from January 2019 to September 2020 from the Clinical University Hospital of Split (Department of Neurology). All patients had the AIS caused by occlusion of the M1 segment of the middle cerebral artery (MCA), 51 of them were treated with ET, and 51 of them received general supportive measures (symptomatic therapy - ST group). Detailed demographic information about age, gender, previous diseases (stroke risk factors), baseline National Institute of Health Stroke Scale (NIHSS), and modified Rankin Scale (mRS), as well as NIHSS and mRS at discharge, were collected. In addition, concomitant use of recombinant tissue-type plasminogen activator, symptom onset to hospital admission time, time from admission to groin puncture, thrombectomy duration, and thrombolysis in cerebral infarction scale (TICI) recanalization grading scores were collected. RESULTS: Rates of functional independence (mRS score 0-2) were significantly higher among elderly patients treated with ET than with ST (14 vs. 8% respectively, Z = 1.98, p < 0.05). Mortality in the ET group was 33%, while in the ST group was 41%, and no statistically significant difference was found. TICI 2b and 3 negatively correlate with thrombectomy duration (r = -0.39; p < 0.05). Patients with a good outcome had significantly better TICI scores (86% of patients had TICI 2b and 3) and lower NIHSS at admission (12.6 ± 5.4 vs. 16.4 ± 3.6 in the group with poor outcome, p < 0.01). Hypertension (HTN) showed to be an independent predictor of poor clinical outcome (OR 4, p = 0.03, CI 1.11-14.35). CONCLUSIONS: Outcomes of ET among older adults are better than among the older adults treated with ST. The lower NIHSS at the admission, shorter duration of ET, and better TICI could be the predictors of good ET outcome, while HTN could be a predictor of poor outcome. Better patient selection and more studies of ET in the elderly are needed.

Validation of the fatigue severity scale in Croatian population of patients with multiple sclerosis disease: Factor structure, internal consistency, and correlates.

BACKGROUND: Fatigue is a common symptom in people with multiple sclerosis (MS) and is evaluated and monitored with self-report questionnaires. The objective of this study was to determine the psychometric properties of the Croatian version of the Fatigue Severity Scale (FSS) in people with MS. MATERIAL AND METHODS: This is a retrospective cohort study conducted as an online survey from December 16, 2020, until January 13, 2021. A total of 179 people with MS and 999 control subjects completed FSS and self-administered questionnaires capturing information of demographic, education level, disease-related variables (duration of the disease, MS type, the expanded disability status scale (EDSS), and Multiple Sclerosis Impact Scale-29 (MSIS-29). Psychometric properties were examined by estimating the validity, reliability, and factor structure of the FSS scale in people with MS. RESULTS: The Croatian version of the FSS had excellent internal consistency (Cronbach's α value 0.93). Factor analysis demonstrated a unidimensional structure. The concurrent validity of the FSS appeared to be satisfactory due to the significant differences between people with MS and control subjects (p < .05). The correlations between FSS and MSIS-29 physical (r = 0.60) and psychological (r = 0.50) subscale results confirmed the convergent validity of the FSS scale. Results also indicated that the best cut-off score is between 4 and 5 with a relatively high sensitivity and specificity. CONCLUSIONS: The Croatian version of FSS was shown to have excellent psychometric properties in people with MS and can be used in the research and clinical settings evaluating fatigue in people with MS in Croatia.

Spontaneous Heterotopic Pregnancy as an Uncommon Clinical Problem.

BACKGROUND: Heterotopic pregnancy refers to the simultaneous coexistence of an intrauterine and extrauterine pregnancy. In natural conception it is very rare, with a rising incidence in patients undergoing assisted reproduction technologies. It presents a serious diagnostic problem which is often misdiagnosed. Currently, there are no standard protocols for the treatment and diagnosis of heterotopic pregnancy. METHODS: Two rare cases of spontaneous heterotopic pregnancy are presented. RESULT: The first patient had a complete abortion upon which an extrauterine pregnancy was detected. The second patient, after an extrauterine pregnancy removal, progressed with an intrauterine pregnancy until full term and it ended with the delivery of a healthy infant. CONCLUSION: Two demonstrated cases underscore that whenever abnormal adnexal findings are presented and the beta-hCG blood test is positive, the possibility of a heterotopic pregnancy should be suspected.