Is off-label thrombolysis safe and effective in a real-life primary stroke center? A retrospective analysis of data from a 5-year prospective database.

BACKGROUND: Intravenous thrombolysis (IVT) use for acute ischemic stroke (AIS) varies among countries, partly due to guidelines and product labeling changes. The study aim was to identify the characteristics of patients with AIS treated with off-label IVT and to determine its safety when performed in a primary stroke center (PSC). METHODS: This observational, single-center study included all consecutive patients admitted to Perpignan PSC for AIS and treated with IVT and patients transferred for EVT, between January 1, 2015 and December 31, 2019. Data of patients treated with IVT according to ("in-label group") or outside ("off-label") the initial guidelines and manufacturer's product specification were compared. Safety was assessed using symptomatic intracerebral hemorrhage (SIH) as the main adverse event. RESULTS: Among the 892 patients in the database (834 screened by MRI, 93.5%), 746 were treated by IVT: 185 (24.8%) "in-label" and 561 (75.2%) "off-label". In the "off-label" group, 316 (42.4% of the cohort) had a single criterion for "off-label" use, 197 (26.4%) had two, and 48 (6.4%) had three or more criteria, without any difference in IVT safety pattern among them. SIH rates were comparable between the "off-label" and "in-label" groups (2.7% vs. 1.1%, P=0.21); early neurological deterioration and systematic adverse event due to IVT treatment were similar in the 2 groups. "Off-label" patients had higher in-hospital (8.7% vs. 3.8%, P=0.05) and 3-month mortality rates (12.1% vs 5.4%, P<0.01), but this is explained by confounding factors as they were older (76 vs 67 years, P<0.0001) and more dependent (median modified Rankin scale score 0.4 vs 0.1, P<0.0001) at admission. CONCLUSIONS: "Off-label" thrombolysis for AIS seems to be safe and effective in the routine setting of a primary stroke center.

[Effect of frontal electrodes location on the electrocardiogram quality of obese subjects: Roots versus limb of extremities]. / Effet de l'emplacement des électrodes frontales sur la qualité de l'électrocardiogramme du sujet obèse : racines versus extrémités des membres.

INTRODUCTION: In obese patients, standard recording of electrocardiogram seems to have specific electrical modifications related to obesity. These modifications could be minimized by the use of alternative recording techniques. The aim of this study is to evaluate the effect of the recording technique (standard versus Lund) on the electrocardiogram quality in healthy obese patients. METHOD: This is an observational and descriptive study carried out in emergency medical services during a two years period. Healthy subjects with an age over 18 years and a body mass index (BMI)≥30kg/m2 were included. Each participant had an electrocardiogram according to Lund's technique immediately followed by a standard recording. Deflections amplitude and their respective axes were compared between the two techniques. The primary endpoint was the frequency of microvoltage. The secondary endpoints were the flat T wave at the inferior and the left axial deviations. RESULTS: Fifty obese patients were included. The average BMI was 36.8±6.6kg/m2. The average age was 45±13 years with a sex ratio of 0.52. The standard technique was associated with a higher incidence of microvoltage (40% versus 20%, P=0.029) and flattening of the T wave (40% versus 18%, P=0.015). Analysis of the variance of the P, QRS and T wave axes did not find any difference between the two techniques. CONCLUSION: The Lund technique reduces the incidence of electrical abnormalities in the electrocardiogram of healthy obese patients.

Working with women in mental health: a feminist perspective.

This article examines the deconstruction of current beliefs concerning women and mental health and considers how such deconstruction could lead to a reconstruction of psychiatric practice which would benefit everyone concerned with the helping services.

A feminist perspective on postnatal depression.

Many women will experience postnatal depression (PND) after the birth of their child and will receive treatment which is generally medically prescribed. The definitions and treatment of PND to a great extent remain in the hands of the medical profession: an area dominated by men, where PND is usually perceived as an individual illness. Christine Jebali explores from the alternative viewpoint of feminist theory PND as a condition exclusive to women.

Working together to support women with postnatal depression.

One in seven mothers is likely to experience postnatal depression. Yet health professionals may still ignore or trivialise this distressing and common disorder, either because they do not understand it or they do not know how to help, writes Christine Jebali. Health visitors and community psychiatric nurses can usefully collaborate to support women experiencing depression after the birth of their child, she believes. Here she describes a special initiative set up in the West Midlands to meet this often unacknowledged need.