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  1. Article ; Online: Ischemic stroke risk factors not included in the CHADS-VASC score in patients with non-valvular atrial fibrillation.

    Le Goff, Laurine / Demuth, Stanislas / Fickl, Andreas / Muresan, Lucian

    Arquivos de neuro-psiquiatria

    2023  Volume 81, Issue 8, Page(s) 712–719

    Abstract: Background: In patients with atrial fibrillation, the CHA: Objective: To assess the impact of these factors on ischemic stroke risk in patients with non-valvular atrial fibrillation.: Methods: On a population of 248 patients (124 patients with ... ...

    Title translation Fatores de risco de AVC isquêmico não incluídos no escore CHADS-VASC em pacientes com fibrilação atrial não valvar.
    Abstract Background: In patients with atrial fibrillation, the CHA
    Objective: To assess the impact of these factors on ischemic stroke risk in patients with non-valvular atrial fibrillation.
    Methods: On a population of 248 patients (124 patients with acute ischemic stroke and 124 controls), we performed a logistic regression to assess the impact of multiple non-classic risk factors for the prediction of acute ischemic stroke. Their impact on mortality was assessed by performing a survival analysis.
    Results: A high CHA
    Conclusions: The CHA
    MeSH term(s) Humans ; Atrial Fibrillation/complications ; Ischemic Stroke/complications ; Risk Assessment/methods ; Risk Factors ; Stroke ; Anticoagulants/therapeutic use ; Renal Insufficiency/complications
    Chemical Substances Anticoagulants
    Language English
    Publishing date 2023-08-11
    Publishing country Germany
    Document type Journal Article
    ZDB-ID 418916-4
    ISSN 1678-4227 ; 0004-282X
    ISSN (online) 1678-4227
    ISSN 0004-282X
    DOI 10.1055/s-0043-1771167
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  2. Article: Ischemic stroke risk factors not included in the CHADS-VASC score in patients with non-valvular atrial fibrillation

    Le Goff, Laurine / Demuth, Stanislas / Fickl, Andreas / Muresan, Lucian

    Arquivos de Neuro-Psiquiatria

    2023  Volume 81, Issue 08, Page(s) 712–719

    Abstract: Background: In patients with atrial fibrillation, the CHA 2 DS 2 -VAS C score guides stroke prevention using anticoagulants, but it is an imperfect score. Other potential risk factors such as renal failure, the type of atrial fibrillation, active ... ...

    Abstract Background: In patients with atrial fibrillation, the CHA 2 DS 2 -VAS C score guides stroke prevention using anticoagulants, but it is an imperfect score. Other potential risk factors such as renal failure, the type of atrial fibrillation, active smoking, cancer, sleep apnea or systemic inflammation have less well been investigated.
    Objective: To assess the impact of these factors on ischemic stroke risk in patients with non-valvular atrial fibrillation.
    Methods: On a population of 248 patients (124 patients with acute ischemic stroke and 124 controls), we performed a logistic regression to assess the impact of multiple non-classic risk factors for the prediction of acute ischemic stroke. Their impact on mortality was assessed by performing a survival analysis.
    Results: A high CHA 2 DS 2 -VASc score (OR 1.75; 95% CI 1.13–2.70; p = 0.032), treatment with anticoagulants (OR 0.19; 95% CI 0.07–0.51; p < 0.001) and permanent atrial fibrillation (OR 6.31; 95% CI 2.46–16.19; p < 0.001) were independently associated with acute ischemic stroke. Renal failure and chronic obstructive pulmonary disease predicted a higher mortality. After adjusting for age, sex, the CHA 2 DS 2 -VASc score and the use of anticoagulants, the only risk factor predictive for acute ischemic stroke was the permanent type of AF (OR: 8.0 [95% CI 2.5–25.5], p < 0.001).
    Conclusions: The CHA 2 DS 2 -VASc score, the absence of anticoagulants and the permanent type of atrial fibrillation were the main predictive factors for the occurrence of acute ischemic stroke. Larger studies are necessary for conclusive results about other factors.
    Keywords Atrial Fibrillation ; Stroke ; Risk Factors ; CHA ; DS ; -VASc ; Fibrilação Atrial ; Acidente Vascular Cerebral ; Fatores de Risco ; CHA2DS2-VASc
    Language English
    Publishing date 2023-08-01
    Publisher Thieme Revinter Publicações Ltda.
    Publishing place Stuttgart ; New York
    Document type Article
    ZDB-ID 418916-4
    ISSN 1678-4227 ; 0004-282X
    ISSN (online) 1678-4227
    ISSN 0004-282X
    DOI 10.1055/s-0043-1771167
    Database Thieme publisher's database

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  3. Article ; Online: Early use of high efficacy therapies in pediatric forms of relapsing-remitting multiple sclerosis: A real-life observational study.

    Moreau, Augustin / Kolitsi, Ioanna / Kremer, Laurent / Fleury, Marie / Lanotte, Livia / Sellal, François / Gaultier, Claude / Ahle, Guido / Courtois, Sylvie / Fickl, Andreas / Mostoufizadeh, Sohrab / Dentel, Christel / Collongues, Nicolas / de Seze, Jérôme / Bigaut, Kévin

    Multiple sclerosis and related disorders

    2023  Volume 79, Page(s) 104942

    Abstract: Background: Pediatric forms of multiple sclerosis are more active than those in adults. Yet, the effectiveness of different therapeutic approaches is not well studied in this population. Our objective was to compare the effectiveness of the early use of ...

    Abstract Background: Pediatric forms of multiple sclerosis are more active than those in adults. Yet, the effectiveness of different therapeutic approaches is not well studied in this population. Our objective was to compare the effectiveness of the early use of high efficacy therapies (HETs) with the effectiveness of moderate efficacy therapies (METs) in children with MS.
    Methods: This observational study included patients diagnosed with pediatric MS, at 4 hospital centers in France, during a 10-year period. METs included: interferon β-1a, glatiramer acetate, dimethyl fumarate, teriflunomide; HETs included: fingolimod, natalizumab, ocrelizumab, alemtuzumab. The primary endpoint was the occurrence of a new relapse, the secondary endpoint was EDSS worsening.
    Results: Sixty-four patients were included in the analysis (80% women; mean age 15.5 years, 81% treated with MET) with a median follow-up of 22.5 months. At baseline, 52 patients were on MET (interferon β-1a, glatiramer acetate, dimethyl fumarate, teriflunomide) and 12 patients were on HET (natalizumab, ocrelizumab). The cumulative probability of being relapse-free at 6.5 years was 23.3% on MET, vs 90.9% on HET (p = 0.013). The cumulative probability of no EDSS worsening did not differ between the 2 groups.
    Conclusion: Patients starting with METs had much higher clinical disease activity than those starting early with HETs. Rapid initiation of more aggressive treatment may allow better disease control; however, the data on EDSS worsening are not conclusive.
    MeSH term(s) Adolescent ; Child ; Female ; Humans ; Male ; Dimethyl Fumarate/therapeutic use ; Fingolimod Hydrochloride/therapeutic use ; Glatiramer Acetate/therapeutic use ; Immunosuppressive Agents/therapeutic use ; Interferon beta-1a/therapeutic use ; Multiple Sclerosis/drug therapy ; Multiple Sclerosis, Relapsing-Remitting/drug therapy ; Natalizumab/therapeutic use ; Recurrence
    Chemical Substances Dimethyl Fumarate (FO2303MNI2) ; Fingolimod Hydrochloride (G926EC510T) ; Glatiramer Acetate (5M691HL4BO) ; Immunosuppressive Agents ; Interferon beta-1a (XRO4566Q4R) ; Natalizumab ; teriflunomide (1C058IKG3B)
    Language English
    Publishing date 2023-08-13
    Publishing country Netherlands
    Document type Journal Article ; Multicenter Study ; Observational Study
    ZDB-ID 2645330-7
    ISSN 2211-0356 ; 2211-0348
    ISSN (online) 2211-0356
    ISSN 2211-0348
    DOI 10.1016/j.msard.2023.104942
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  4. Article ; Online: Is the Montreal Cognitive Assessment superior to the Mini-Mental State Examination to detect poststroke cognitive impairment? A study with neuropsychological evaluation.

    Godefroy, Olivier / Fickl, Andreas / Roussel, Martine / Auribault, Caroline / Bugnicourt, Jean Marc / Lamy, Chantal / Canaple, Sandrine / Petitnicolas, Gil

    Stroke

    2011  Volume 42, Issue 6, Page(s) 1712–1716

    Abstract: Background and purpose: A screening test is required to improve the diagnosis of poststroke cognitive impairment. The Montreal Cognitive Assessment (MoCA), a newly designed screening test, has been found to be more sensitive than Mini-Mental State ... ...

    Abstract Background and purpose: A screening test is required to improve the diagnosis of poststroke cognitive impairment. The Montreal Cognitive Assessment (MoCA), a newly designed screening test, has been found to be more sensitive than Mini-Mental State Examination (MMSE), but its clinical value has not been established by means of a comprehensive neuropsychological battery. This study was designed to assess the value of MoCA and MMSE to detect poststroke cognitive impairment determined by a neuropsychological battery.
    Methods: Both screening tests and a neuropsychological battery were administered during the acute phase in 95 patients referred for recent infarct or hemorrhage. Raw MMSE and MoCA scores were used with published cutoffs and new cutoff scores for MMSE and MoCA were also computed after adjustment for age and education.
    Results: Using raw scores, MoCA was more frequently impaired (P=0.0001) than MMSE. MoCA showed good sensitivity (sensitivity, 0.94) but moderate specificity (specificity, 0.42; positive predictive value, 0.77; negative predictive value, 0.76), whereas an inverse profile was observed for MMSE (sensitivity, 0.66; specificity, 0.97; positive predictive value, 0.98; negative predictive value, 0.58). Adjusted scores with new cutoffs (MMSE(adj) ≤24, MoCA(adj) ≤20) provided good sensitivity and very good specificity for both tests (MMSE(adj): sensitivity, 0.7, specificity, 0.97, positive predictive value, 0.98, negative predictive value, 0.61; MoCA(adj): sensitivity, 0.67, specificity, 0.9, positive predictive value, 0.93, negative predictive value, 0.57). On receiver operating characteristic curve analysis, areas under the curve of all scores were >0.88.
    Conclusions: The previously reported high sensitivity of MoCA is associated with low specificity. Both screening tests are moderately sensitive to acute poststroke cognitive impairment. This study provides indications for the diagnosis of poststroke cognitive impairment.
    MeSH term(s) Aged ; Cognition Disorders/diagnosis ; Cognition Disorders/etiology ; Cognition Disorders/physiopathology ; Female ; Humans ; Male ; Mental Status Schedule ; Middle Aged ; Neuropsychological Tests ; ROC Curve ; Reproducibility of Results ; Sensitivity and Specificity ; Stroke/complications
    Language English
    Publishing date 2011-06
    Publishing country United States
    Document type Journal Article ; Research Support, Non-U.S. Gov't
    ZDB-ID 80381-9
    ISSN 1524-4628 ; 0039-2499 ; 0749-7954
    ISSN (online) 1524-4628
    ISSN 0039-2499 ; 0749-7954
    DOI 10.1161/STROKEAHA.110.606277
    Database MEDical Literature Analysis and Retrieval System OnLINE

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