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Organ-specific bleeding patterns of anticoagulant therapy: lessons from clinical trials.
Abstract Anticoagulants are effective at preventing and treating thrombosis, but can cause bleeding. For decades, vitamin K antagonists (VKAs) have been the only available oral anticoagulants. The development of non-VKA oral anticoagulants (NOACs), which inhibit either factor Xa or thrombin stoichiometrically, has provided alternatives to VKAs for several indications. The results of recent large-scale randomised controlled trials comparing NOACs with VKAs for the prevention of stroke in patients with non-valvular atrial fibrillation (AF) have produced some unexpected results. As a group, NOACs showed similar effic...
Source: Thrombosis and Haemostasis - September 4, 2014 Category: Hematology Authors: Vanassche T, Hirsh J, Eikelboom JW, Ginsberg JS Tags: Thromb Haemost Source Type: research

WATCHMAN device-related thrombus successfully treated with apixaban: A case report
Rationale: Among atrial fibrillation patients with high risk of bleeding, left atrial appendage occlusion has emerged as an alternative to long-term oral anticoagulation therapy for stroke prevention. Device-related thrombus remains a major concern because it may result in recurrent embolic events. To date, there is no consensus on the optimal method of treating device-related-thrombus. Patient concerns: A 78-year-old man with atrial fibrillation had an episode of intracranial hemorrhage while taking warfarin. He subsequently underwent percutaneous placement of a 30-mm Watchman device to the left atrial appendage. He ...
Source: Medicine - November 1, 2017 Category: Internal Medicine Tags: Research Article: Clinical Case Report Source Type: research

Recovery of an injured medial lemniscus with concurrent recovery of pusher syndrome in a stroke patient: a case report
Rationale: A 67-year-old, right-handed male patient underwent craniotomy and drainage for hematoma removal related to an intracerebral hemorrhage (ICH) in the right thalamus and basal ganglia at the neurosurgery department of a university hospital. Patient concerns: He presented with severe motor weakness of left extremities, impairment of proprioception, and severe pusher syndrome at the start of rehabilitation. Diagnoses: He was diagnosed as ICH in the right thalamus and basal ganglia. Interventions: The patient received comprehensive rehabilitative therapy, movement therapy, and somatosensory stimulation. Ou...
Source: Medicine - June 1, 2018 Category: Internal Medicine Tags: Research Article: Clinical Case Report Source Type: research

A case report on middle cerebral artery aneurysm treated by rapid ventricular pacing: A CARE compliant case report
Rationale: Cerebral aneurysm is a common cause of intracranial hemorrhage, stroke, and death. It is treated with vascular surgeries, such as coil embolism and artery clipping. However, surgery itself is a risk factor that may cause rupture of aneurysm, and leads to irreversible brain damage, and even death. Rapid ventricular pacing (RVP) is a procedure that temporarily lowers blood pressure by increasing heart rate and reducing ventricular filling time. RVP has been widely used to reduce blood vessel tension in many cardiovascular surgeries. Patient concerns: A 46-year-old man came to our hospital with intermittent ri...
Source: Medicine - November 1, 2018 Category: Internal Medicine Tags: Research Article: Clinical Case Report Source Type: research

Cerebral venous sinus thrombosis presenting with multifocal intracerebral hemorrhage and subarachnoid hemorrhage: A case report
Rationale: Multifocal cerebral hemorrhage refers to the cerebral hemorrhage in 2 or more lesions at the same time or 48 h in the brain caused by various causes, which has an acute onset, high mortality rate, and poor clinical treatment effect. Subarachnoid hemorrhage (SAH) is caused by the direct flow of blood into the subarachnoid cavity due to the rupture of the diseased vessels at the base or surface of the brain. Cerebral venous sinus thrombosis (CVST) affects approximately 5 people per million and accounts for approximately 1% of all stroke events. CVST with both SAH and multifocal intracerebral hemorrhage (ICH) a...
Source: Medicine - December 1, 2018 Category: Internal Medicine Tags: Research Article: Clinical Case Report Source Type: research

Staged reconstruction of large skull defects with soft tissue infection after craniectomy using free flap and cranioplasty with a custom-made titanium mesh constructed by 3D-CT-guided 3D printing technology: Two case reports
Rationale: A craniectomy, which results in a large skull defect, is performed to decrease the intracranial pressure under conditions such as intracranial hemorrhage and ischemic stroke. When the patient's condition is stabilized, autologous cranioplasty using the bone flap previously removed in the craniectomy is performed. Bone flap infection after the autologous cranioplasty is not uncommon and is difficult to treat. After the infection is controlled, cranioplasty is needed to improve the head deformity and neurologic function. Cranioplasty with a titanium mesh can result in aesthetic improvement and a low infection ra...
Source: Medicine - February 1, 2019 Category: Internal Medicine Tags: Research Article: Clinical Case Report Source Type: research

Psychosis Polyrisk Score (PPS) for the Detection of Individuals At-Risk and the Prediction of Their Outcomes
Conclusions The combination of risk/protective factors encompassing genetic (PRS) and non-genetic information (PPS) holds promise for overcoming the epidemiological weakness of the CHR-P paradigm. The PPS conceptually and empirically developed here will facilitate future research in this field and hopefully advance our ability to detect individuals at-risk for psychosis and forecast their clinical outcomes. Ethics Statement This study was supported by the King's College London Confidence in Concept award from the Medical Research Council (MRC) (MC_PC_16048) to PF-P. This study also represents independent researc...
Source: Frontiers in Psychiatry - April 16, 2019 Category: Psychiatry Source Type: research

Acute onset bilateral hearing loss in dorsomedial pontine hemorrhage: A Case report
We report herein a rare case of acute onset bilateral hearing loss caused by nontraumatic pontine hemorrhage. Pontine hemorrhage is often associated with disturbance of consciousness; however, care is required as latent communication disorder due to impaired hearing is possible regardless of the state of consciousness.
Source: Medicine - August 1, 2019 Category: Internal Medicine Tags: Research Article: Clinical Case Report Source Type: research

Pathogeny of cerebral venous thrombosis in SARS-Cov-2 infection: Case reports
We describe 2 cases of women admitted during the spring of 2020 for intracranial hypertension signs, in stroke units in Great-east, a French area particularly affected by COVID-19 pandemia. Diagnoses: Cerebral imaging revealed extended CVT in both cases. The first case described was more serious due to right supratentorial venous infarction with hemorrhagic transformation leading to herniation. Both patients presented typical pneumonia due to SARS-Cov-2 infection, confirmed by reverse transcription polymerase chain reaction on a nasopharyngeal swab in only one. Interventions: The first patient had to undergo ...
Source: Medicine - March 12, 2021 Category: Internal Medicine Tags: Research Article: Clinical Case Report Source Type: research

Wrist-hand extension function recovery in spastic hemiplegia patient by botulinum toxin injection plus surface electromyography biofeedback therapy: A case report
We reported a 46-year-old male suffered a spastic hemiplegia with wrist- hand extension deficit. Diagnoses: Computed tomography showed cerebral hemorrhage in the left basal ganglia region. Interventions: Four hundred units of BoNTA were injected into the spasticity flexors, and four-week post injection surface electromyography (sEMG) biofeedback therapy was applied to the patient. Outcomes: The patient exhibited post-intervention improvement in wrist-hand extensors performance (strength, range of motion, sEMG signals), the flexors spasticity, and upper extremity function. Lessons: The present ca...
Source: Medicine - April 9, 2021 Category: Internal Medicine Tags: Research Article: Clinical Case Report Source Type: research

A journey through clinic and research
I started to study Medicine at the University of Genoa, Italy more than 20 years ago and I now realize that I was quite far from understanding what ‘Medicine’ really means. After weeks and weeks spent on books during the first year, I understood that becoming a MD not only requires the willingness to help people with health problems, but also strong motivation and dedication to learn a huge amount of notions. In Italy, as it is the case for several other countries, the University courses last 6 years, during which the MD student is fully engaged by individual study, lessons and seminars, exercises, and internships. Wit...
Source: European Heart Journal - March 29, 2021 Category: Cardiology Source Type: research

Post-Trial Enhanced Deployment and Technical Performance with the MISTIE Procedure per Lessons Learned
We hypothesize that procedure deployment rates and technical performance with minimally invasive surgery and thrombolysis for intracerebral hemorrhage (ICH) evacuation (MISTIE) can be enhanced in post-trial clinical practice, per Phase III trial results and lessons learned.
Source: Journal of Stroke and Cerebrovascular Diseases - July 22, 2021 Category: Neurology Authors: Ali Mansour, Andrea Loggini, Faten El Ammar, Ronald Alvarado-Dyer, Sean Polster, Agnieszka Stadnik, Paramita Das, Peter C. Warnke, Bakhtiar Yamini, Christos Lazaridis, Christopher Kramer, W. Andrew Mould, Meghan Hildreth, Matthew Sharrock, Daniel F Hanley Source Type: research

Neurological monitoring in ECMO patients: current state of practice, challenges and lessons
ConclusionNeurological monitoring in ECMO is an area of interest to many clinicians, however, the literature is limited, heterogenous, and lacks consensus on the best monitoring practices. The evidence for optimal neurological monitoring that could impact clinical decisions and functional outcomes is lacking. Additional studies are needed to identify effective measures of neurological monitoring while on ECMO.
Source: Acta Neurologica Belgica - January 26, 2023 Category: Neurology Source Type: research

What Sub-Saharan African Nations Can Teach the U.S. About Black Maternal Health
While poor maternal outcomes among Black women in the U.S. is not new, improving it is imperative. U.S. policymakers can look to sub-Saharan Africa for guidance on reversing this trend. Credit: Ernest Ankomah/IPSBy Ifeanyi NsoforABUJA, Jun 2 2023 (IPS) New research shows that Black mothers in the United States disproportionately live in counties with higher maternal vulnerability and face greater risk of preterm death for the fetus, greater risk of low birth weight for a baby, and a higher number of maternal deaths. While poor maternal outcomes among Black women in the U.S. is not new, improving it is imperative. U.S. poli...
Source: IPS Inter Press Service - Health - June 2, 2023 Category: International Medicine & Public Health Authors: Ifeanyi Nsofor Tags: Africa Gender Headlines Health Inequality North America Poverty & SDGs Maternal Health Source Type: news

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