Immune thrombotic thrombocytopenic purpura in older patients: Results from the Spanish TTP Registry (REPTT).

Immune thrombotic thrombocytopenic purpura (iTTP) is an ultra-rare disease that seldom occurs in the elderly. Few reports have studied the clinical course of iTTP in older patients. In this study, we have analysed the clinical characteristics at presentation and response to therapy in a series of 44 patients with iTTP ≥60 years at diagnosis from the Spanish TTP Registry and compared them with 209 patients with <60 years at diagnosis from the same Registry. Similar symptoms and laboratory results were described in both groups, except for a higher incidence of renal dysfunction among older patients (23% vs. 43.1%; p = 0.008). Front-line treatment in patients ≥60 years was like that administered in younger patients. Also, no evidence of a difference in clinical response and overall survival was seen in both groups. Of note, 14 and 25 patients ≥60 years received treatment with caplacizumab and rituximab, respectively, showing a favourable safety and efficacy profile, like that observed in patients <60 years.

The beneficial effect of statins treatment by stroke subtype.

BACKGROUND AND PURPOSE: Statins have shown some protective effect after ischaemic stroke in observational studies. However, this effect has never been assessed by etiological subtypes. METHODS: Observational study using data from the Stroke Unit Data Bank from consecutive patients with cerebral infarction. Variables analyzed: demographic data, cardiovascular risk factors, treatment with statins at stroke onset, stroke severity, stroke subtype, in-hospital complications, length of stay, and functional status at discharge (modified Rankin Scale). RESULTS: A total of 2742 patients were included, 1539 were men. Mean age was 69.17 years (SD 12.19). Of these, 281 patients (10.2%) were receiving statins when admitted. The logistic regression analyses showed that previous treatment with statins was an independent predictor for better outcome at discharge among all strokes (OR, 2.08; 95% CI, 1.39 to 3.1) as well as for the atherothrombotic (OR, 2.79; 95% CI, 1.33 to 5.84) and lacunar strokes (OR, 2.28; 95% CI, 1.15 to 4.52) after adjustment for demographic data, risk factors, previous treatments, stroke subtypes, stroke severity, in-hospital complications and length of stay. This benefit was not observed either in cardioembolic or in other etiology strokes. CONCLUSIONS: Previous treatment with statins is an independent factor associated with good outcomes in patients with ischaemic stroke. Atherothrombotic and small vessel strokes show the greatest benefit.

Bone marrow toxicity after yellow phosphorus ingestion.

Suicidal ingestions of fireworks containing yellow phosphorus occur often during holidays. A case is reported of a 17 year old woman who intentionally ingested an estimated amount of 5.5 mg of yellow phosphorus, presenting with upper abdominal pain as the only complaint, a physical examination was normal. Blood tests showed a considerable decrease in the granulocyte count; the bone marrow biopsy revealed a decreased cellular mass with degenerative changes. Spontaneous remission was observed during the next 48 hours, with no further complaints.

[Validation of a screening questionnaire for stroke detection in Spanish-speaking communities]. / Validación de un cuestionario para detección de ictus en poblaciones hispanoparlantes.

OBJECTIVE: To evaluate the accuracy of an screening questionnaire for stroke detection in speaking-speaking communities. PATIENTS AND METHODS: We performed a door-to-door survey in Atahualpa (a rural community in coastal Ecuador) using a modified version of the Spanish translation of the OMS questionnaire for stroke detection. Subjects suspected of having a stroke as well as a 2% sample of negative subjects were evaluated by neurologists to evaluate sensitivity, specificity, and predictive value of the questionnaire and that of each of its questions. RESULTS: We found 18 possible cases among 1,568 individuals around 15 years old. Of these, 10 were confirmed stroke patients and 8 were false-positive (crude stroke prevalence of 6.38 per 1,000). We did not find false-negative cases. Sensitivity of the questionnaire was 100%, specificity was 99.5%, positive predictive value was 0.55 and negative predictive value was 1. The accuracy of each question as well as the number of questions answered as affirmative were different between patients and false-positive cases. CONCLUSIONS: The current questionnaire is highly sensitive but its positive predictive value is poor. This causes problems in large-scale studies, as the detection of many false-positives may compromise its viability. We propose a modification of the questionnaire that will turn it more accurate.

Stroke in rural Ecuador: a three-phase, door-to-door survey.

The authors carried out a three-phase door-to-door survey in Atahualpa, Ecuador to assess epidemiologic and pathogenetic mechanisms of stroke. They found 10 stroke patients among 1,568 individuals aged > or =15 years (crude prevalence, 638 per 100,000). There was only one incident case (incidence, 64 per 100,000). Six of the 10 patients had hypertensive arteriolopathy (five with ischemic and one with hemorrhagic stroke). Additional work is needed to increase knowledge on stroke in developing countries.

Validación de un cuestionario para la detección del ictus en poblaciones hispanoparlantes / Validation of a screening questionnaire for stroke detection in Spanish-speaking communities

Objetivo. Evaluar la fiabilidad de un cuestionario para la detección del ictus en comunidades hispanoparlantes. Pacientes y métodos. Realizamos un estudio puerta a puerta en Atahualpa -población rural del litoral ecuatoriano- empleando una versión modificada de la traducción al español del cuestionario de la OMS para la detección del ictus. Los casos sospechosos, así como el 2 por ciento de los no sospechosos, fueron examinados examinados por neurólogos para valorar la sensibilidad, la especificidad y el valor predictivo del cuestionario y de cada una de sus preguntas. Resultados. Encontramos 18 sospechosos entre 1.568 individuos de más de 15 años de edad. De éstos, 10 se confirmaron -prevalencia realista de ictus de 6,38 por 1.000- y ocho fueron falsos positivos. No se encontraron falsos negativos entre los no sospechosos. La sensibilidad del cuestionario fue del 100 por ciento, su especificidad, del 99,5 por ciento, su valor predictivo positivo fue 0,55 y su valor predictivo negativo, 1.La confiabilidad de cada pregunta, así como el número de preguntas respondidas afirmativamente, fue diferente entre los pacientes y los falsos positivos. Conclusiones. El cuestionario utilizado es altamente sensible, pero su valor predictivo positivo es relativamente bajo. Esto causa problemas en estudios a gran escala, ya que la detección de muchos falsos positivos puede afectar su viabilidad. Sugerimos una modificación, que volverá al cuestionario más confiable (AU)

Objective. To evaluate the accuracy of an screening questionnaire for stroke detection in speaking-speaking communities. Patients and methods. We performed a door-to-door survey in Atahualpa (a rural community in coastal Ecuador) using a modified version of the Spanish translation of the WHO questionnaire for stroke detection. Subjects suspected of having a stroke as well as a 2% sample of negative subjects were evaluated by neurologists to evaluate sensitivity, specificity, and predictive value of the questionnaire and that of each of its questions. Results. We found 18 possible cases among 1,568 individuals ≥ 15 years old. Of these, 10 were confirmed stroke patients and 8 were false-positive (crude stroke prevalence of 6.38 per 1,000). We did not find false-negative cases. Sensitivity of the questionnaire was 100%, specificity was 99.5%, positive predictive value was 0.55 and negative predictive value was 1. The accuracy of each question as well as the number of questions answered as affirmative were different between patients and false-positive cases. Conclusions. The current questionnaire is highly sensitive but its positive predictive value is poor. This causes problems in large-scale studies, as the detection of many false-positives may compromise its viability. We propose a modification of the questionnaire that will turn it more accurate (AU)