Background and Aims: Vitamin D is important for calcium absorption and bone growth. Hypovitaminosis and vitamin D deficiency have been observed in developed and developing countries including several in the Middle East. The prevalence of vitamin D deficiency was investigated in Isfahani male and female high school students in Iran in 2004. Methods: In a cross-sectional study, 318 students (153 boys and 165 girls) aged 14–18 years were selected by multistage random sampling. Data were collected by interview and serum 25-hydroxyvitamin D (25-OHD) and parathyroid hormone (PTH) levels were measured. Vitamin D deficiency was defined as serum 25-OHD <20 and <32 ng/ml in which the mean serum PTH began to increase in our population. Results: The prevalence of vitamin D deficiency according to 25-OHD <20 ng/ml in all subjects was 46.2% (72.1% in females and 18.3% in males). Vitamin D deficiency in female students was about four times more common than in males (OR = 3.9, 95% CI = 1.88–3.91, p < 0.001). According to 25-OHD <32 ng/ml, the prevalence of vitamin D deficiency in all students was 72.2% (95.2% in females and 49% in males). Conclusions: Vitamin D deficiency is common in high school students, especially in girls. Avoidance of sunshine or inadequate dietary intake of vitamin D may be the main causes.
Mechanical ventilation, tube feeding, dysphagia, and tracheostomy are exposures associated with increased risk of the development of pneumonia in patients with sICH. Pneumonia is associated with an increase in morbidity, length of stay, and mortality among patients with sICH.
A reversible cerebral vasoconstriction syndrome may occur in some circumstances after a hysterectomy with bilateral salpingo-oophorectomy. The mechanisms involved in the development of this condition are explained by current research concerning effects on the vasculature of sudden drops in estrogens and progesterones. More studies are required to further establish the pathophysiology, diagnosis and treatment of this condition.
Background: Recent advances in the treatment of ischemic stroke have focused on revascularization and led to better clinical and functional outcomes. A systematic review and pooled analyses of 6 recent multicentered prospective randomized controlled trials (MPRCT) were performed to compare intravenous tissue plasminogen activator (IV tPA) and endovascular therapy (intervention) with IV tPA alone (control) for anterior circulation ischemic stroke (AIS) secondary to large vessel occlusion (LVO). Objectives: Six MPRCTs (MR CLEAN, ESCAPE, EXTEND IA, SWIFT PRIME, REVASCAT and THERAPY) incorporating image-based LVO AIS were selected for assessing the following: (1) prespecified primary clinical outcomes of AIS patients in intervention and control arms: good outcomes were defined by a modified Rankin Scale score of 0-2 at 90 days; (2) secondary clinical outcomes were: (a) revascularization rates [favorable outcomes defined as modified Thrombolysis in Cerebral Infarction scale (mTICI) score of 2b/3]; (b) symptomatic intracranial hemorrhage (sICH) rates and mortality; (c) derivation of number needed to harm (NNH), number needed to treat (NNT), and relative percent difference (RPD) between intervention and control groups, and (d) random effects model to determine overall significance (forest and funnel plots). Results: A total of 1,386 patients were included. Good outcomes at 90 days were seen in 46% of patients in the intervention (p < 0.00001) and in 27% of patients in the control groups (p < 0.00002). An mTICI score of 2b/3 was achieved in 70.2% of patients in the intervention arm. The sICH and mortality in the intervention arm compared with the control arm were 4.7 and 14.3% versus 7.9 and 17.8%, respectively. The NNT and NNH in the intervention and control groups were 5.3 and 9.1, respectively. Patients in the intervention arm had a 50.1% (RPD) better chance of achieving a good 90-day outcome as compared to controls. Conclusions: Endovascular therapy combined with IV tPA (in appropriately selected patients) for LVO-related AIS is superior to IV tPA alone. These results support establishing an endovascular therapy in addition to IV tPA as the standard of care for AIS secondary to LVO.
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