Posterior Circulation Stroke: Coma (More Than Time) is Brain.

BACKGROUND AND PURPOSE: Contrary to anterior circulation, the legitimacy of endovascular treatment in posterior circulation stroke is still being questioned. Finding reliable prognostic factors and determining how patient selection should be done has become top priority. METHODS: Observational and retrospective study from two Portuguese hospitals, including all consecutive patients with posterior circulation occlusions who underwent thrombectomy between January 1st 2015 and December 31st 2019. RESULTS: Out of a total of 126 patients, the median age was 74 (IQR 61-80) and 39.7% were female. A good clinical outcome (mRS ≤2) was associated with a lower incidence of coma (24,2% vs 66,7%, p < 0,001) and of sudden onset coma (3% vs 18%,=0,04), a lower NIHSS at admission (14 vs 19, p < 0,001), a higher pc-ASPECTS at admission (10 vs 9, p < 0,001) and at 24 h (8 vs 6, p < 0,001) and a higher BATMAN score (7 vs 6, p = 0,017). Differences in the times of symptom-onset-to-recanalization (496 vs 536, p = 0,19) and symptom-onset-to-coma (130 vs 195, p = 0,52) were not remarkable. When excluding NIHSS and pc-ASPECTS at 24 h, coma (p = 0,003; OR=0,22; 95% CI: 0,08-0,59) and the pc-ASPECTS at admission (p = 0,037; OR=1,63; 95% CI: 1,03-2,57) become independent predictors of good outcome. CONCLUSIONS: In strokes from the posterior circulation, coma, more than time, appears to be an important prognostic factor. The BATMAN and the pc-ASPECTS scores were also associated with clinical outcome and coma.

Acute Ischemic Stroke in a Child Successfully Treated with Thrombolytic Therapy and Mechanical Thrombectomy.

Acute ischemic stroke in the pediatric population is rare but carries lasting and often lifelong morbidity. Thrombolysis and mechanical thrombectomy are mainstays of care in adults, yet there is very little evidence for these treatments in children. We present the case of a 4-year-old boy with complex congenital heart disease, admitted 30 min after sudden onset of an aphasia and right hemiplegia, scoring 14 on the Pediatric National Institutes of Health Stroke Scale (PedNIHSS). Non-contrast brain computed tomography (CT) showed no evidence of acute ischemia. CT angiogram demonstrated a thrombus in the M1 segment of the left middle cerebral artery. Intravenous recombinant tissue plasminogen activator (rTPA) was infused 3.5 h after onset of symptoms. An improvement was observed in the hour after rTPA, with a PedNIHSS score of 7. Digital subtraction angiography was performed approximately 9 h from the onset of symptoms, showing a complete left M1 occlusion. The patient underwent successful mechanical thrombectomy and was discharged with a PedNIHSS score of 2. This case emphasizes the importance of early recognition to direct children towards rapid diagnosis and hyperacute treatment.

Mechanical thrombectomy in patients with acute basilar occlusion using stent retrievers.

BACKGROUND: Early arterial recanalisation with stent retrievers (SR) has been recently demonstrated to improve clinical outcome of patients with large-vessel occlusion of the anterior circulation. However, the benefit of SR thrombectomy in the setting of acute basilar artery occlusion (BAO) has not been proven yet. This study evaluated a series of consecutive patients with BAO treated with SR, focusing on the efficacy, safety and clinical results. METHODS: We analysed 24 consecutive patients with acute BAO who were treated with SR mechanical thrombectomy. Good clinical outcome at three months was defined as mRS ≤ 2. Data from patients with good outcome were compared to that from patients with poor outcome. RESULTS: Sufficient recanalisation (TICI 2 b or 3) was achieved in 63% (15/24) of patients. At three months, 33% (8/24) of patients had died; good clinical outcome was obtained in 21% (5/24). Age (46 vs. 60 years old, p = 0.05) and time from symptoms onset to recanalisation (370 vs. 521 minutes, p = 0.048) was significantly lower in patients with good outcome as compared to patients with poor outcome. There were three cases (12.5%) of periprocedural complications, all of them related to arterial wall dissection/perforation. CONCLUSIONS: SR thrombectomy might be an efficient and safe treatment for patients with acute BAO occlusion and might help improve outcome.

The prolonged use of niclosamide as a molluscicide for the control of Schistosoma mansoni

Applications of niclosamide at three-monthly intervals were undertaken for 14 years in foci of Biomphalaria glabrata in the water sources of Peri-Peri (Capim Branco, MG). All the residents of the area were submitted to an annual fecal examination (Kato/Katz) and those individuals eliminating Schistosoma mansoni eggs were treated with oxamniquine. A malacological survey was undertaken at three-monthly intervals by means of ten scoops with a perforated ladle each ten metres along the two banks of the ditches and streams of the region. Where snails were found, molluscicide was applied by means of dripping or aspersion using a 3 ppm aqueous suspension of niclosamide. Initially, a mean of 14.3% of snails in the region were found to be eliminating cercariae. Following the first four applications of molluscicide, this was reduced to 0.0% and maintained at about 1.5% throughout the program. Thus, there was a continued possibility of schistosomiasis transmission in the area and it was observed that the population of snails reestablished itself within three months of molluscicide application. The results obtained in this study do not encourage the continual use of niclosamide as the only method of control of schistosomiasis

Atividade moluscicida e cercaricida de diferentes espécies de eucalyptus / Molluscacide and Cercariacide activity of different species of eucalyptus

Os hidrolatos e óleos essenciais de diferentes espécies de Eucalyptus foram testados sobre caramujos adultos e desovas de Biomphalaria glabrata e cercárias de Schistosoma mansoni. Esses produtos foram obtidos por arraste de vapor. Dos 21 hidrolatos ensaiados, oito foram ativos sobre caramujos, nove demonstraram açäo sobre desovas e três apresentaram atividade sobre cercárias a partir da diluiçäo de 1:4 (V/V). Dos óleos estudados, 11 tiveram atividade para planorbídeos e desovas nas concentraçöes de 20ppm (p/V). O hidrolato do Eucalyptus deanei foi ativo sobre caramujos, desovas e cercárias a partir da diluiçäo de 1:4 e o óleo na concentraçäo de 20 ppm

Atividade moluscicida da mistura de ácidos 6-n-alquil salicílicos (ácido anacárdico) e dos seus complexos com cobre (II) e chumbo (II) / Molluscacide activity of a mixture of 6-n-alkyl salicylic acids (anardic acid) and 2 of its complexes with copper (II) and lead (II)

Foi comparada, em laboratório, a atividade moluscicida do extrato hexânico da casca da castanha do caju - Anacardium occidentale L. (EHCCC), do complexo de cobre (II), do complexo de chumbo (II) e do ácido anacárdico com objetivo de encontrar entre eles um produto que apresentasse maior estabilidade que o ácido anacárdico. Este foi preparado tratando o EHCCC com hidróxido de chumbo (II) ou com o sulfato de cobre mais hidróxido de sódio ou com hidróxido de cobre (II). Em seguida, o complexo de chumbo (II) ou os complexos de cobre(II) preprarados foram tratados com uma soluçäo de ácido sulfúrico diluída. As misturas dos dez produtos obtidos foram testadas sobre caramujos adultos de Biomphalaria galabrata nas concentraçöes de 1 a 10 ppm. Os mais ativos foram o compleso de cobre (II), obtido com sulfato de cobre mais hidróxido de sódio, e o ácido anacárdico (hidróxido de chumbo) que apresentaram atividade a partir da concentraçäo de 4ppm. O teor de chumbo do ácido anacárdico (hidróxido de chumbo) foi acima das normas recomendadas pelos Padröes de Saúde Pública dos Estados Unidos

Atividade moluscicida de alguns produtos naturais sobre Biomphalaria glabrata / Molluscicide activity of some natural products on Biomphalaria glabrata

Foi avaliada, em laboratório, a açäo moluscicida de extratos aquosos (macerado e fervido), hexânico e etanólico de Aristolochia brasiliensis, Caesalpinia peltophoroides, Caesalpinia pulcherrima, Delonix regia, Spathodea campanulata e Tibouchina scrobiculata. As soluçöes dos extratos obtidos foram testadas sobre caramujos adultos e desovas de Biomphalaria glabrata, criados em laboratório, nas concentraçöes de 1, 10, 20, 200 e 1000ppm. Dos extratos testado o mais ativo foi o etanólico das flores da D. regia (flamboyant) que apresentou atividade moluscicida sobre caramujos adultos na concentraçäo de 20ppm