RESUMEN
Objective: This study aims to investigate the therapeutic efficacy of patent foramen ovale (PFO) closure in migraine patients with a massive right-to-left shunt (RLS) and white matter lesions (WMLs). Methods: The research focused on migraine patients with a massive RLS who underwent PFO closure in our hospital from June 2020 to June 2021. The study included 51 patients without WMLs (control group, CG) and 27 patients with WMLs (observation group, OG). A 12-month postoperative follow-up survey was conducted to assess headache episodes (frequency and duration), evaluated using the Headache Impact Test-6 (HIT-6) and the Pain Intensity Visual Analog Scale (VAS). The psychological state was also evaluated using the Hamilton Anxiety and Depression Scale (HAMA, HAMD). Adverse reactions during the follow-up were recorded. Results: No significant differences in perioperative and prognostic adverse reactions were observed between OG and CG (P > .05). Both groups showed a reduction in postoperative headache episodes and pain intensity. However, the OG exhibited higher frequency and duration of headache episodes and elevated HIT-6 and VAS scores, resulting in lower clinical efficacy (P < .05). Postoperatively, both groups demonstrated reductions in HAMA and HAMD, with CG showing lower scores compared to OG (P < .05). Logistic regression analysis identified the course of the disease, HIT-6 score, and the presence of WMLs as independent risk factors for the efficacy of PFO closure (P < .05). Conclusions: PFO closure proves effective and safe in treating migraine patients with RLS. However, for those with WMLs, clinical attention should be directed toward the treatment of WMLs.
RESUMEN
BACKGROUND: Emergence of daptomycin-nonsusceptible (DNS) Staphylococcus aureus is a dreadful problem in the treatment of endocarditis. Few current therapeutic agents are effective for treating infections caused by DNS S. aureus. CASE PRESENTATION: We describe the emergence of DNS S. aureus. in a patient with implantable cardioverter-defibrillator (ICD) device -related endocarditis who was priorily treated with daptomycin. Metastatic dissemination as osteomyelitis further complicated the management of endocarditis. The dilemma was successfully managed by surgical removal of the ICD device and combination antimicrobial therapy with high-dose daptomycin and fosfomycin. CONCLUSIONS: Surgical removal of intracardiac devices remains an important adjunctive measure in the treatment of endocarditis. Our case suggests that combination therapy is more favorable than single-agent therapy for infections caused by DNS S. aureus.