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Ischaemic Stroke Following Ergotamine Overdose
The use of ergotamine in the treatment of migraine has become disputed due to its significant side effects, such as arterial vasospasm particularly affecting peripheral arteries[1]. However, there is conflicting evidence about the effect of ergotamine on cerebral blood flow[2 –4]. Currently, ergotamine continues to be utilised, albeit off-licence, for the treatment of refractory migraine in paediatric patients[5]. Yet, there is a lack of evidence supporting ergotamine’s utility and safety in migraine treatment[5].
Source: Pediatric Neurology - August 5, 2019 Category: Neurology Authors: Nadja F. Bednarczuk, Ming Lim, Ata Siddiqui, Karine Lascelles Tags: Clinical Letter Source Type: research

Ischemic Stroke Following Ergotamine Overdose
The use of ergotamine in the treatment of migraine has become disputed because of its significant side effects, such as arterial vasospasm particularly affecting the peripheral arteries.1 However, there is conflicting evidence about the effect of ergotamine on cerebral blood flow.2-4 At present, ergotamine continues to be utilized, albeit off-license, for the treatment of refractory migraine in pediatric patients.5 Yet, there is a lack of evidence supporting ergotamine's utility and safety in migraine treatment.
Source: Pediatric Neurology - August 5, 2019 Category: Neurology Authors: Nadja F. Bednarczuk, Ming Lim, Ata Siddiqui, Karine Lascelles Tags: Clinical Letter Source Type: research

Difficulty of stroke management in the dialysis child
ConclusionCause or consequences of the renal disease, HT must be properly treated in order to reach the recommended targeted blood pressure values. The time required to take charge the hypertensive stroke determines the prognosis. The challenge is to optimize the health care sector to reduce mortality and sequelae.
Source: Archives of Cardiovascular Diseases Supplements - July 24, 2019 Category: Cardiology Source Type: research

Renal Function Estimates and Dosing of Direct Oral Anticoagulants in Stroke Patients with Atrial Fibrillation: An Observational Study.
CONCLUSION: Although substituting eGFR for CrCl carries potential risks of DOAC overdosing in patients with AF, the effect might be offset by clinicians' predilection for lower dosage in this stroke cohort. PMID: 31304571 [PubMed - in process]
Source: Acta Neurologica Taiwanica - July 17, 2019 Category: Neurology Tags: Acta Neurol Taiwan Source Type: research

Choosing the Correct “-ase” in Acute Ischemic Stroke: Alteplase, Tenecteplase, and Reteplase
Alteplase is a tissue plasminogen activator approved for treating acute ischemic stroke (AIS), acute myocardial infarction (AMI), and acute massive pulmonary embolism. Two additional tissue plasminogen activators, tenecteplase and reteplase, are also approved for AMI treatment. However, neither tenecteplase nor reteplase is approved for AIS treatment. The U.S. Food and Drug Administration has received reports of accidental administration of tenecteplase or reteplase instead of alteplase in patients with AIS, which can lead to potential overdose. Primary factors contributing to medication errors include use of the abbreviat...
Source: Advanced Emergency Nursing Journal - July 1, 2019 Category: Emergency Medicine Tags: PROCEDURAL COLUMN Source Type: research

Preventable Cases of Oral Anticoagulant-Induced Bleeding: Data From the Spontaneous Reporting System
Conclusion: Our findings describe the most reported risk factors for preventability of oral anticoagulant-induced bleedings. These factors may be useful for targeting interventions to improve pharmacovigilance activities in our regional territory and to reduce the burden of medication errors and inappropriate prescription. Introduction Oral anticoagulant therapy is widely used for the prevention of stroke and systemic embolism in patients with atrial fibrillation, or for the prevention and treatment of deep vein thrombosis and pulmonary embolism (Raj et al., 1994; Monaco et al., 2017). Oral anticoagulants can be di...
Source: Frontiers in Pharmacology - April 29, 2019 Category: Drugs & Pharmacology Source Type: research

Stroke Dysbiosis Index (SDI) in Gut Microbiome Are Associated With Brain Injury and Prognosis of Stroke
Conclusions: We developed an index to measure gut microbiota dysbiosis in stroke patients; this index was significantly correlated with patients' outcome and was causally related to outcome in a mouse model of stroke. Our model facilitates the potential clinical application of gut microbiota data in stroke and adds quantitative evidence linking the gut microbiota to stroke. Introduction Ischemic stroke imposes a heavy burden on society, with 24.9 million cases worldwide (1). Although intravenous thrombolysis and endovascular treatment greatly improve some patients' prognosis, the prognosis for most pa...
Source: Frontiers in Neurology - April 23, 2019 Category: Neurology Source Type: research

Apixaban for prevention of stroke and systemic embolism in patients with non-valvular atrial fibrillation in France: The PAROS cross-sectional study of routine clinical practice.
CONCLUSIONS: Initiation of apixaban versus NOACs was more common among patients with increased age, higher bleeding risk and decreased renal function, whereas initiation of apixaban versus VKAs was more common among patients with lower bleeding risk and better renal function. PMID: 31014991 [PubMed - as supplied by publisher]
Source: Archives of Cardiovascular Diseases - April 19, 2019 Category: Cardiology Authors: Falissard B, Picard F, Mahe I, Hanon O, Touzé E, Danchin N, Lamy FX, Ricci L, Steg PG Tags: Arch Cardiovasc Dis Source Type: research

Scientists Restore Some Brain Activity in Recently Slaughtered Pigs
(NEW YORK) — Scientists restored some activity within the brains of pigs that had been slaughtered hours before, raising hopes for some medical advances and questions about the definition of death. The brains could not think or sense anything, researchers stressed. By medical standards “this is not a living brain,” said Nenad Sestan of the Yale School of Medicine, one of the researchers reporting the results Wednesday in the journal Nature. But the work revealed a surprising degree of resilience among cells within a brain that has lost its supply of blood and oxygen, he said. “Cell death in the brai...
Source: TIME: Health - April 17, 2019 Category: Consumer Health News Tags: Uncategorized Brain Activity onetime Source Type: news

Inappropriate non-vitamin  K antagonist oral anticoagulants prescriptions: be cautious with dose reductions.
CONCLUSION: An incorrect prescription occurred more often in the reduced-dose NOAC group. Clinical parameters such as renal function are often unknown whilst these are essential to determine the right NOAC and dose. PMID: 30949972 [PubMed - as supplied by publisher]
Source: Netherlands Heart Journal - April 3, 2019 Category: Cardiology Authors: Jacobs MS, van Hulst M, Campmans Z, Tieleman RG Tags: Neth Heart J Source Type: research

Using Benchmark Data as a Launching Point for Quality Improvement in EMS
EMS agencies strive to provide the best possible care and contribute to positive patient outcomes. To ensure a high level of care, many agencies implement quality improvement programs; choosing a place to start for a quality improvement initiative, however, can seem overwhelming, with so many important conditions like cardiac arrest, sepsis, stroke, overdoses, etc. With limited time and resources, it’s necessary to concentrate efforts on measures that matter and are likely to make an impact. A great place to start with quality improvement efforts is where the gold standard is known and the frequency of events isn’t rar...
Source: JEMS Operations - February 20, 2019 Category: Emergency Medicine Authors: Remle Crowe, PhD, NREMT Tags: Exclusive Articles Operations Top Story Source Type: news

Making a case for the right "-ase" in acute ischemic stroke: alteplase, tenecteplase, and reteplase.
Authors: Wyatt Chester K, Corrigan M, Schoeffler JM, Shah M, Toy F, Purdon B, Dillon GM Abstract INTRODUCTION: Alteplase, reteplase, and tenecteplase are tissue plasminogen activators (TPA) approved for the management of acute myocardial infarction. Only alteplase is also approved for the treatment of acute ischemic stroke (AIS). The US Food and Drug Administration has received reports of accidental administration of tenecteplase or reteplase instead of alteplase in patients with AIS, which can result in failure to treat patients with the intended agent and lead to potential overdose. Areas covered: This review com...
Source: Expert Opinion on Drug Safety - February 5, 2019 Category: Drugs & Pharmacology Tags: Expert Opin Drug Saf Source Type: research

Resolution of left ventricular thrombus by edoxaban after failed treatment with warfarin overdose: A case report
Rationale: Although novel oral-anticoagulants are widely used in patients with atrial fibrillation (AF) for stroke prevention, there was only limited evidence for their use in left ventricular (LV) thrombus. Patient concerns: A 41-year-old man who presented with acute onset of right-hand clumsiness and aphasia even under high international normalized ratio (INR: 7.64) from warfarin use. He was previously treated with warfarin for the LV thrombus and non-valvular AF. Brain magnetic resonance imaging (MRI) showed multiple acute infarction in the cortex of the bilateral frontal lobes, left parietal lobe, and bilateral ce...
Source: Medicine - January 1, 2019 Category: Internal Medicine Tags: Research Article: Clinical Case Report Source Type: research

Clinical Performance Measures that Matter —Are You Ready?
Conclusion The future will belong to those who can prove value. The use of a clinical performance dashboard and comparisons to national data will help to ensure that when the payers come knocking on our doors looking for "proof" that what we do enhances patient care and improves patient outcome, we’ll have an answer! This is the first in a yearlong series of articles developed by the Academy of International Mobile Healthcare Integration (AIMHI).The AIMHI article series is developed in partnership with JEMS to help educate EMS agencies on the hallmarks and attributes of high-performance/high-value EMS system de...
Source: JEMS Special Topics - December 11, 2018 Category: Emergency Medicine Authors: Wayne C. Harbour, NRP Tags: Exclusive Articles Operations Administration and Leadership Source Type: news