208 results match your criteria: "University Hospital Bern and University of Bern[Affiliation]"

Background: The rising prevalence of acute ischemic stroke (AIS) in young adults, particularly with undetermined pathogenesis, is a growing concern. This study assessed risk factors, treatments, and outcomes between young AIS patients with undetermined and determined pathogeneses.

Methods And Results: This was a retrospective cohort study including AIS patients aged 18 to 55 years in Switzerland, treated between 2014 and 2022.

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Background: We aimed to investigate the effect of daily supplemental vitamin D, omega-3s, and a thrice-weekly home exercise program, alone or in combination, on change of appendicular lean muscle mass index (ALMI) and incident sarcopenia in older adults.

Methods: This is a secondary endpoint analysis of a 3-year randomized, double-blind, placebo-controlled trial with a 2 × 2 × 2 factorial design among 2157 community-dwelling, healthy adults aged 70 + years, from 2012 to 2018 (DO-HEALTH). Participants were randomized to 2000 IU/d vitamin D and/or 1 g/d marine omega-3s and/or exercise.

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Rising Prevalence of Multiple Sclerosis in Switzerland: Results from the Swiss Multiple Sclerosis Registry.

Neuroepidemiology

November 2024

Department of Epidemiology, Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland.

Introduction: Understanding the prevalence of multiple sclerosis (MS) provides information for healthcare planning and helps identify trends and patterns of disease occurrence. For Switzerland, the number of persons with MS (pwMS) was last estimated at approximately 15,000 in 2016. The study's objectives were to update estimates of MS prevalence and characterise the change in MS prevalence in Switzerland between 2016 and 2021, the last year with complete administrative data.

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Intracerebral haemorrhage - mechanisms, diagnosis and prospects for treatment and prevention.

Nat Rev Neurol

December 2024

Stroke Research Centre, Department of Brain Repair and Rehabilitation, UCL Queen Square Institute of Neurology, University College London, London, UK.

Intracerebral haemorrhage (ICH) is a devastating condition associated with high mortality and substantial residual disability among survivors. Effective treatments for the acute stages of ICH are limited. However, promising findings from randomized trials of therapeutic strategies, including acute care bundles that target anticoagulation therapies, blood pressure control and other physiological parameters, and trials of minimally invasive neurosurgical procedures have led to renewed optimism that patient outcomes can be improved.

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Article Synopsis
  • CPPD disease is a significant cause of arthritis that can resemble other rheumatic conditions, making accurate diagnosis crucial.
  • A deep-learning algorithm was developed and tested to automatically detect CPPD features in hand radiographs, focusing specifically on certain joint areas.
  • The combined model for detecting CPPD showed strong performance metrics, with a mean AUROC of 0.86 and good sensitivity and specificity, while separate models for different joint areas had varying success rates.
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  • The study aims to assess how common intracranial vessel occlusion is among patients with atrial fibrillation (AF) who have ischemic strokes, as well as its impact on their functional recovery after 90 days.
  • It analyzed data from over 10,000 patients who underwent CT or MR angiography between 2014 and 2022, finding that over half displayed vessel occlusion, particularly in the anterior circulation.
  • Results showed that those with vessel occlusion had a significantly higher rate of poor functional outcomes, indicating that this condition worsens recovery prospects regardless of anticoagulant use.
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Background: Levodopa-carbidopa intestinal gel (LCIG) is a continuously delivered Parkinson's disease therapy intended to stabilize plasma levodopa levels. Patients receiving LCIG require education and follow-up. Some LCIG support programs use video-assisted telenursing.

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Introduction: The risk of ischemic stroke and intracerebral hemorrhage (ICH) with intensive lipid control by statins among patients with atrial fibrillation (AF) who require direct oral anticoagulants (DOAC) is unclear. We aimed to determine the risks of ischemic stroke and ICH in AF patients treated with DOAC and statins.

Patients And Methods: In a population-based retrospective cohort study, we identified AF patients concurrently on DOAC and statins from 2015 to 2021 in Hong Kong.

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  • - Cardiovascular imaging is becoming increasingly important for diagnosing and managing cardiovascular disease, highlighting the need for standardized practices.
  • - The European Society of Cardiovascular Radiology (ESCR) aims to enhance the credibility and quality of their scientific documents through a rigorous consensus development methodology.
  • - By establishing clear guidelines for producing ESCR documents, the society seeks to improve the overall impact on patient management and health outcomes in cardiovascular care.
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  • Physicians can use nystagmus fixation suppression to help diagnose acute vestibular syndrome, but the accuracy of detecting this suppression using simulations by doctors is limited.
  • In a study with 20 doctors, their ability to identify changes in nystagmus was tested under different conditions, revealing that both beginners and experienced physicians struggled similarly.
  • The results showed that small changes in nystagmus velocity were difficult to detect, especially when the baseline nystagmus was strong, indicating that clinical tests for this condition may benefit from additional technology, like video-oculography.
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Projections of Endovascular Therapy-Eligible Patients With Stroke for the US Population.

Stroke

August 2024

Department of Neurology and Rehabilitation Medicine (E.A.M., B.M.K., K.S.A., S.F., S.L.D., M.H., D.W., Y.N.A., P.K.), University of Cincinnati, OH.

Background: As stroke endovascular thrombectomy (EVT) treatment indications expand, understanding population-based EVT eligibility becomes critical for resource planning. We aimed to project current and future population-based EVT eligibility in the United States.

Methods: We conducted a post hoc analysis of the physician-adjudicated GCNKSS (Greater Cincinnati Northern Kentucky Stroke Study; 2015 epoch), a population-based, cross sectional, observational study of stroke incidence, treatment, and outcomes across a 5-county region.

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Background: Anti-inflammatory therapy with long-term colchicine prevented vascular recurrence in coronary disease. Unlike coronary disease, which is typically caused by atherosclerosis, ischaemic stroke is caused by diverse mechanisms including atherosclerosis and small vessel disease or is frequently due to an unknown cause. We aimed to investigate the hypothesis that long-term colchicine would reduce recurrent events after ischaemic stroke.

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Objective: Technology and advances in clinical care have changed the management of abdominal aortic aneurysms (AAAs) but the clinical effectiveness of continuing advances needs to be assessed. To facilitate rapid synthesis of new evidence and improve stakeholder representation, including patients, the concept of core outcome sets (COS) has been developed. COS, reflecting the needs of all stakeholders, have been established across several surgical specialties.

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Background: Lipoprotein (a) [Lp(a)] serum levels are highly genetically determined and promote atherogenesis. High Lp(a) levels are associated with increased cardiovascular morbidity. Serum Lp(a) levels have recently been associated with large artery atherosclerosis (LAA) stroke.

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Atrial fibrillation is one of the most common cardiac arrhythmias and is a major cause of ischaemic stroke. Recent findings indicate the importance of atrial fibrillation burden (device-detected, subclinical, or paroxysmal and persistent or permanent) and whether atrial fibrillation was known before stroke onset or diagnosed after stroke for the risk of recurrence. Secondary prevention in patients with atrial fibrillation and stroke aims to reduce the risk of recurrent ischaemic stroke.

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D-dimer levels significantly increase with declining renal function and hence, renal function-adjusted D-dimer cutoffs to rule out pulmonary embolism were suggested. Aim of this study was to "post hoc" validate previously defined renal function-adjusted D-dimer levels to safely rule out pulmonary embolism in patients presenting to the emergency department. In this retrospective, observational analysis, all patients with low to intermediate pre-test probability receiving D-dimer measurement and computed tomography angiography (CTA) to rule out pulmonary embolism between January 2017 and December 2020 were included.

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Prothrombin Complex Concentrate vs Conservative Management in ICH Associated With Direct Oral Anticoagulants.

JAMA Netw Open

February 2024

Department of Medicine and Therapeutics, Faculty of Medicine, The Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong SAR.

Importance: Intracerebral hemorrhage (ICH) associated with direct oral anticoagulant (DOAC) use carries extremely high morbidity and mortality. The clinical effectiveness of hemostatic therapy is unclear.

Objective: To compare the clinical and radiological outcomes of DOAC-associated ICH treated with prothrombin complex concentrate (PCC) vs conservative management.

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Background And Aims: Low density lipoprotein (LDL-C) and other atherogenic lipoproteins are coated by apolipoprotein B100 (apoB). The correlation between LDL-C and apoB is usually thight, but in some cases LDL-C underestimates apoB levels and residual cardiovascular risk. We aimed to assess if a discordance of LDL-C-levels with apoB levels is associated with LAA stroke.

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Article Synopsis
  • The study looked at how well a drug called andexanet alfa works compared to other treatments for older people who had brain bleeding because of certain blood thinners.
  • They analyzed data from two different studies with 243 patients, focusing on whether their brain bleeding got worse and if they had any serious complications after treatment.
  • The results showed that patients treated with andexanet alfa had a lower chance of their bleeding getting worse compared to those who got other treatments.
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  • This study focused on how emergency departments manage hyperacute treatments for patients with non-traumatic intracerebral hemorrhage, revealing significant gaps in knowledge.
  • A total of 332 ICH patients were analyzed, showing varied modes of referral and treatment delays, with only 44% of those with high blood pressure achieving control during their stay.
  • The results indicate that patients referred through stroke codes had lower mortality rates, emphasizing the importance of prompt and appropriate care in improving outcomes.
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  • * Caplacizumab, a new treatment that targets von Willebrand factor, isn't approved for use in pregnant or breastfeeding women but shows promise.
  • * A case report demonstrates successful off-label use of caplacizumab during a patient's pregnancy, leading to positive outcomes without major complications.
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  • The study aimed to evaluate the effectiveness of the video Head Impulse Test (vHIT) in diagnosing vestibular strokes in patients presenting with acute vestibular syndrome in the emergency department.
  • Out of 76 patients tested, 24 were confirmed to have vestibular strokes, with the vHIT showing an accuracy of 86.8% based on vestibulo-ocular reflex gain compared to lower accuracy from saccade metrics.
  • While the vestibulo-ocular reflex gain proved to be the most accurate, saccade metrics still offered valuable diagnostic insights, though automated detection methods need improvement to match expert analysis.
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  • * The study discovered that deep incisional and organ/space infections were the most common types of SSIs, with Escherichia coli and Enterococcus spp. being the most frequently identified bacteria.
  • * Key risk factors for developing SSIs included a BMI of 25 or higher and delayed graft function, both of which were linked to increased chances of graft loss post-transplant.
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The acute vestibular syndrome: prevalence of new hearing loss and its diagnostic value.

Eur Arch Otorhinolaryngol

April 2024

Department of Otorhinolaryngology, Head and Neck Surgery, Inselspital, University Hospital Bern and University of Bern, 3010, Bern, Switzerland.

Objectives: To assess the prevalence of new hearing losses in patients with acute vestibular syndrome (AVS) and to start to evaluate its diagnostic value for the differentiation between peripheral and central causes.

Design: We performed a cross-sectional prospective study in AVS patients presenting to our Emergency Department (ED) from February 2015 to November 2020. All patients received an MRI, Head-impulse test, Nystagmus test and Test of skew ('HINTS'), caloric testing and a pure-tone audiometry.

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Article Synopsis
  • Vestibular symptoms in emergency department patients can signal serious conditions like stroke, and accurate identification is critical for effective treatment.
  • A study from 2015 to 2019 examined 1647 ED patients with these symptoms, leading to a focus on 122 confirmed stroke cases through MRI scans.
  • Findings revealed that 13% of dizzy patients had strokes, predominantly in the posterior circulation, with nystagmus present in half of the stroke cases, yet many stroke patients lacked this symptom, making diagnosis challenging.
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