Podcasts about Ictus

Citicoline and Stroke Recovery: What the Major Clinical Trials Actually Found If you’re recovering from a stroke or brain injury, there’s a familiar, exhausting question that shows up once the rehab schedule is set: is there anything else a supplement, a nutrient, something that could genuinely support the brain while it rebuilds itself? Citicoline comes up in that search constantly, across nootropic forums, supplement stores, and even some hospital protocols. It also happens to have one of the largest clinical trial records of any brain-recovery compound available. So rather than trusting a product label, it’s worth going straight to what those trials actually found, including the parts that didn’t work. What Citicoline Is Citicoline (cytidine diphosphate-choline, or CDP-choline) is a compound your body already produces. It’s a building block for phosphatidylcholine, a major structural component of neuronal cell membranes. The theory behind supplementing it is straightforward: give the brain more raw material to repair damaged membranes and support neurotransmitter production after an injury. It’s sold over the counter as a supplement (often branded as “Cognizin”), and in some countries it’s used clinically, including intravenously, in hospital stroke and TBI protocols. What the Major Trials Actually Show This is a case where the size of the evidence base is unusually large, and the results are humbling rather than triumphant. The ICTUS trial, published in The Lancet in 2012 with 2,298 patients, tested citicoline for acute ischemic stroke and found no significant benefit over placebo for global recovery at 90 days; the trial was stopped early for futility (PMID 22691567). The COBRIT trial, published in JAMA the same year with 1,213 traumatic brain injury patients, tested a higher dose of 2,000 mg per day for 90 days and again found no meaningful difference in functional or cognitive outcomes at 90 or 180 days (PMID 23168823). A 2020 Cochrane review pooling ten randomized trials and more than 4,000 stroke patients concluded there was little to no difference between citicoline and placebo in mortality, disability, or neurological recovery, and rated the overall evidence quality as low, noting six of the ten trials were industry-sponsored (PMID 32860632). Here’s where the picture becomes more interesting. A separate trial gave stroke survivors citicoline continuously for twelve months, rather than just during the acute phase, and found real improvements in attention, executive function, and temporal orientation compared to usual care, along with a non-significant trend toward better long-term functional outcome (PMID 23406981). A broader 2020 systematic review across neurological conditions similarly found citicoline useful for slowing dementia progression and enhancing cognition in healthy adults, while describing its effect on TBI specifically as “unclear” (PMID 33053828). A separate meta-analysis of twelve trials found citicoline significantly improved functional outcomes overall, even while showing no significant difference on several other individual outcome measures a genuinely mixed result rather than a clean positive or negative (PMID 28458415). The pattern that emerges: as a short-term rescue treatment for acute stroke or acute TBI, the largest, best-designed trials say no, it doesn’t move the needle. As a longer-term support for post-stroke cognitive function, taken consistently over months, there’s a more modest but real signal. What This Means for Stroke Survivors – The Honest Limits Citicoline is not an acute miracle treatment, and the largest trials in the field say so plainly. If you were hoping for a supplement that meaningfully changes outcomes in the days or weeks after a stroke, the evidence doesn’t support that expectation. The more genuine finding of better attention and executive function with twelve months of continuous use comes from a single open-label trial that wasn’t blinded, so it deserves a more cautious read than the large, definitive negative trials. There’s also a dosing gap worth knowing about before anyone assumes a supplement bottle reflects the research: clinical trials used 500 to 2,000 mg per day, often for months, while most over-the-counter citicoline products are dosed at 250 to 500 mg per day, meaningfully lower than the doses that produced the modest cognitive signal. Practical Takeaways – Questions to Bring to Your Treating Team Ask your neurologist or doctor whether citicoline makes sense for your specific recovery stage. Acute stroke support and long-term cognitive support are different questions with different evidence behind them. If you’re considering a supplement, check the label dose against what was actually studied. A product dosed well below 500 mg per day is not comparable to the trials that showed a cognitive benefit. Search “ICTUS citicoline,” “COBRIT trial,” or “citicoline cognitive stroke” on PubMed yourself, and form your own view. The honest picture here is nuanced enough that it’s worth reading past the marketing copy. The value of citicoline, if it exists for you, isn’t as a substitute for rehab, sleep, movement, and nutrition; it’s a small addition on top of everything else you’re already doing well, chosen because you understand the actual trial record rather than a supplement label. For the broader framework I used to separate genuine evidence from supplement hype throughout my own recovery, see my book: https://recoveryafterstroke.com/book. If breakdowns like this one are useful to you, the Recovery After Stroke Patreon (https://patreon.com/recoveryafterstroke) directly funds more of them. This blog is for informational purposes only and does not constitute medical advice. Please consult your doctor before making any changes to your health or recovery plan. The post Citicoline for Brain Recovery: What the Major Trials Actually Found appeared first on Recovery After Stroke.

Cada minuto cuenta cuando ocurre una enfermedad vascular cerebral.Saber reconocer las primeras señales puede marcar la diferencia entre recuperarse o vivir con una discapacidad permanente.Hoy sábado en Enlace 50 nos acompaña el Dr. Carlos Diéguez, Médico Neurólogo, para enseñarnos la técnica CAMALEÓN, una forma sencilla de reconocer los síntomas de alarma de un derrame cerebral y saber qué hacer desde el primer momento.Hablaremos de prevención, de la importancia de actuar a tiempo y de cómo esas primeras decisiones pueden cambiarlo todo.See omnystudio.com/listener for privacy information.

¿Sabías que reconocer un infarto cerebral durante los primeros minutos puede salvar una vida? En este episodio de Enlace 50, Concha León Portilla conversa con el Dr. Carlos Diéguez, médico neurólogo especializado en enfermedad vascular cerebral, sobre cómo identificar un infarto cerebral, cuáles son sus principales síntomas y por qué recibir atención médica inmediata puede marcar la diferencia entre una recuperación favorable y una discapacidad permanente. Durante la conversación, el Dr. Diéguez explica de forma sencilla la diferencia entre un infarto cerebral (embolia cerebral) y un derrame cerebral (hemorragia cerebral), así como la importancia de actuar dentro de la ventana de tratamiento y conocer la estrategia Camaleón, diseñada para que cualquier persona pueda reconocer una emergencia neurológica. En este episodio descubrirás: • Qué es un infarto cerebral. • Cuál es la diferencia entre un infarto cerebral y un derrame cerebral. • Cuáles son los síntomas que nunca debes ignorar. • Qué significa la estrategia Camaleón. • Por qué las primeras 4.5 horas pueden salvar neuronas y reducir secuelas. • Cuáles son los principales factores de riesgo. • Cómo prevenir un infarto cerebral. • Qué tratamientos existen actualmente. • La importancia de la rehabilitación después de un evento vascular cerebral. See omnystudio.com/listener for privacy information.

Jaume Segalés y los expertos de Mundo Natural hablan sobre el ictus cerebral.

Isabel González comenta toda la actualidad del corazón con Emilia Landaluce, Beatriz Cortázar y Tico Chao.

La prevención de enfermedades neurológicas, incluyendo el ictus y demencias como el Alzheimer, depende fundamentalmente del control de factores de riesgo vascular que son completamente modificables. Según la doctora Obdulia Lozano, vocal de la Sociedad Española de Neurología, el 90% de los ictus se deben a estos factores, sin embargo, existe una preocupante falta de hábito preventivo en España: 4 de cada 10 personas nunca controlan su tensión arterial y los jóvenes de 18 a 34 años son quienes más descuidan estas revisiones. Por ello, los expertos recomiendan realizarse analíticas de sangre anuales y controles periódicos de tensión a partir de los 30 o 35 años para detectar "enemigos silenciosos" como la hipertensión o la hipercolesterolemia antes de que den la cara de forma trágica o irreversible. Además del control médico, el autocuidado cerebral implica adoptar un estilo de vida saludable que incluya una dieta equilibrada, evitar tóxicos como el alcohol y el tabaco, y realizar al menos 150 minutos de ejercicio físico aeróbico a la semana.

Isabel González comenta toda la actualidad del corazón con Beatriz Miranda, Carlos Pérez Gimeno y Daniel Carande.

Domenica 19 luglio torna Run Melbourne, gara podistica che attraversa la capitale del Victoria. E tra chi correrà, per almeno 10 km, ci sarà anche Matthew Absalom, docente di italianistica della University of Melbourne. Per lui sarà una corsa speciale, che segna anche il ritorno alla salute dopo un vero e proprio "health scare".Seguici su Facebook e Instagram o abbonati ai nostri podcast cliccando qui. 

All'ospedale di Santorso  il 75% degli ictus ischemici sono trattati entro un'ora. Riconoscimento internazionale per la Stroke Unit: il reparto di Neurologia dell'ULSS 7 Pedemontana ha ricevuto la classificazione “Platinum” degli ESO-Angels Awards per la tempestività nella terapia

Dormire meno di 8 ore non è l'unico problema. Secondo un nuovo studio finlandese anche andare a letto a orari sempre diversi può aumentare — e di molto — i rischi per cuore e cervello. A Obiettivo Salute il commento del prof. Luigi Ferini Strambi, primario del Centro di Medicina del Sonno dell'IRCCS Ospedale San Raffaele di Milano.

In occasione di Aprile Mese della Prevenzione dell’Ictus, A.L.I.Ce. Italia Odv (Associazione per la Lotta all’Ictus Cerebrale) accende i riflettori su obesità e ictus sottolineando come il peso in eccesso sia responsabile fino al 10-15% degli ictus ischemici e che può incidere anche prima dei 50 anni. A Obiettivo Salute il commento del Prof. Danilo Toni, Direttore Unità Trattamento Neurovascolare Policlinico Umberto I di Roma e Presidente del Comitato Tecnico-Scientifico di A.L.I.Ce. Italia Odv

En este episodio de Mantita y Fe, Juan Liquiniano nos comparte un testimonio que atraviesa el dolor, la enfermedad y la muerte… pero también la paz, la fe y la esperanza.Con una cardiopatía congénita extremadamente compleja, Juan ha pasado por múltiples operaciones a corazón abierto, infecciones graves, un mes con el pecho abierto, un marcapasos externo, dos ictus… y la posibilidad real de morir.Y, sin embargo, habla de una paz que no era suya.Habla de una mirada —la de Cristo en la cruz— que lo sostuvo cuando no podía más.Habla de aprender a vivir “a corazón abierto”.Este episodio es para quien está sufriendo.Para quien se pregunta “¿por qué yo?”.Para quien tiene miedo a la muerte.Y para quien quiere aprender a vivir de verdad.✨ “Si hoy estoy aquí es porque tengo algo que dar y algo que recibir.”

El Remate, en La Diez Capital Radio, con una tertulia de actualidad informativa y sin rodeos. Lo hacemos analizando la actualidad pura y dura, sin filtros ni paños calientes. Nos acompañan nuestros colaboradores Antonio Aldana, Moises Pires y Jerónimo González, para poner sobre la mesa los temas que marcan la agenda: política, economía, sociedad y todo aquello que está dando que hablar...

Dopo un ictus, il recupero delle funzioni motorie potrebbe non dipendere solo dall'area colpita, ma anche dall'emisfero cerebrale non lesionato. Uno studio dell'IRCCS Neuromed, in collaborazione con le università di Lund e Washington, evidenzia come il dialogo tra i due emisferi sia fondamentale per la riabilitazione. In questa puntata, il professor Ferdinando Nicoletti, responsabile del laboratorio di Neurofarmacologia del Neuromed, ci guida alla scoperta di questo meccanismo e delle possibili implicazioni per favorire il recupero post-ictus.

Esiste un “grasso invisibile” che può danneggiare le arterie in silenzio, anche quando l'indice di massa corporea (BMI) è “normale”. Una grande ricerca su oltre 33.000 adulti in Canada e Regno Unito, pubblicata su Communications Medicine, rimette in discussione l'uso del BMI come bussola affidabile per stimare il rischio cardiocerebrovascolare. Il grasso viscerale e intraepatico sono metabolicamente attivi, alimentano infiammazione e aterosclerosi e possono ispessire e ostruire le carotidi, i vasi che portano sangue al cervello. Questo si traduce in un rischio maggiore di ictus e infarto—anche in chi porta una “taglia normale”. 

Seminal Belgian new music group Ictus is moving into Anne Teresa De Keersmaeker's  seminal Belgian contemporary dance troupe PARTS' newly expanded building and they are celebrating with an opening festival the first week in February. Ictus Director Tom Pauwels and Ictus Artistic Coordinator Jean-Luc Plouvier spoke with us about the move and celebration.https://www.ictus.be/Photo: Christophe Urbain

En este episodio abordo la farmacología en neurorrehabilitación del adulto desde una perspectiva clínica y realista, pensada especialmente para profesionales no médicos que conviven a diario con informes, pautas y nombres de fármacos sin disponer siempre de un marco claro para interpretarlos. Recorremos los principales medicamentos utilizados en patologías neurológicas frecuentes —ictus, lesión medular, esclerosis múltiple, enfermedad de Parkinson, ELA, distonías y traumatismo craneoencefálico— diferenciando entre tratamientos agudos, terapias modificadoras de la enfermedad y manejo farmacológico de secuelas. A lo largo del episodio explico de forma progresiva los mecanismos de acción, la base neurofisiológica y el estado actual de la evidencia, poniendo especial énfasis en qué fármacos realmente cambian el pronóstico y cuáles cumplen un papel fundamentalmente sintomático. El objetivo no es prescribir, sino entender mejor cómo la farmacología condiciona la recuperación, la participación en terapia y la toma de decisiones en neurorrehabilitación, con una mirada crítica y basada en la evidencia disponible. Referencias del episodio: 1.     Adams, M. M., & Hicks, A. L. (2005). Spasticity after spinal cord injury. Spinal cord, 43(10), 577–586. https://doi.org/10.1038/sj.sc.3101757 (https://pubmed.ncbi.nlm.nih.gov/15838527/). 2.     AFFINITY Trial Collaboration (2020). Safety and efficacy of fluoxetine on functional outcome after acute stroke (AFFINITY): a randomised, double-blind, placebo-controlled trial. The Lancet. Neurology, 19(8), 651–660. https://doi.org/10.1016/S1474-4422(20)30207-6 (https://pubmed.ncbi.nlm.nih.gov/32702334/). 3.     Angeli, C. A., Edgerton, V. R., Gerasimenko, Y. P., & Harkema, S. J. (2014). Altering spinal cord excitability enables voluntary movements after chronic complete paralysis in humans. Brain : a journal of neurology, 137(Pt 5), 1394–1409. https://doi.org/10.1093/brain/awu038 (https://pubmed.ncbi.nlm.nih.gov/24713270/). 4.     Bracken, M. B., Shepard, M. J., Collins, W. F., Holford, T. R., Young, W., Baskin, D. S., Eisenberg, H. M., Flamm, E., Leo-Summers, L., & Maroon, J. (1990). A randomized, controlled trial of methylprednisolone or naloxone in the treatment of acute spinal-cord injury. Results of the Second National Acute Spinal Cord Injury Study. The New England journal of medicine, 322(20), 1405–1411. https://doi.org/10.1056/NEJM199005173222001 (https://pubmed.ncbi.nlm.nih.gov/2278545/). 5.     Bracken, M. B., Shepard, M. J., Holford, T. R., Leo-Summers, L., Aldrich, E. F., Fazl, M., Fehlings, M., Herr, D. L., Hitchon, P. W., Marshall, L. F., Nockels, R. P., Pascale, V., Perot, P. L., Jr, Piepmeier, J., Sonntag, V. K., Wagner, F., Wilberger, J. E., Winn, H. R., & Young, W. (1997). Administration of methylprednisolone for 24 or 48 hours or tirilazad mesylate for 48 hours in the treatment of acute spinal cord injury. Results of the Third National Acute Spinal Cord Injury Randomized Controlled Trial. National Acute Spinal Cord Injury Study. JAMA, 277(20), 1597–1604 (https://pubmed.ncbi.nlm.nih.gov/9168289/). 6.     Cardenas, D. D., Ditunno, J. F., Graziani, V., McLain, A. B., Lammertse, D. P., Potter, P. J., Alexander, M. S., Cohen, R., & Blight, A. R. (2014). Two phase 3, multicenter, randomized, placebo-controlled clinical trials of fampridine-SR for treatment of spasticity in chronic spinal cord injury. Spinal cord, 52(1), 70–76. https://doi.org/10.1038/sc.2013.137 (https://pubmed.ncbi.nlm.nih.gov/24216616/). 7.     Chollet, F., Tardy, J., Albucher, J. F., Thalamas, C., Berard, E., Lamy, C., Bejot, Y., Deltour, S., Jaillard, A., Niclot, P., Guillon, B., Moulin, T., Marque, P., Pariente, J., Arnaud, C., & Loubinoux, I. (2011). Fluoxetine for motor recovery after acute ischaemic stroke (FLAME): a randomised placebo-controlled trial. The Lancet. Neurology, 10(2), 123–130. https://doi.org/10.1016/S1474-4422(10)70314-8 (https://pubmed.ncbi.nlm.nih.gov/21216670/). 8.     Dávalos, A., Alvarez-Sabín, J., Castillo, J., Díez-Tejedor, E., Ferro, J., Martínez-Vila, E., Serena, J., Segura, T., Cruz, V. T., Masjuan, J., Cobo, E., Secades, J. J., & International Citicoline Trial on acUte Stroke (ICTUS) trial investigators (2012). Citicoline in the treatment of acute ischaemic stroke: an international, randomised, multicentre, placebo-controlled study (ICTUS trial). Lancet (London, England), 380(9839), 349–357. https://doi.org/10.1016/S0140-6736(12)60813-7 (https://pubmed.ncbi.nlm.nih.gov/22691567/). 9.     EFFECTS Trial Collaboration (2020). Safety and efficacy of fluoxetine on functional recovery after acute stroke (EFFECTS): a randomised, double-blind, placebo-controlled trial. The Lancet. Neurology, 19(8), 661–669. https://doi.org/10.1016/S1474-4422(20)30219-2 (https://pubmed.ncbi.nlm.nih.gov/32702335/). 10.  Fehlings, M. G., Theodore, N., Harrop, J., Maurais, G., Kuntz, C., Shaffrey, C. I., Kwon, B. K., Chapman, J., Yee, A., Tighe, A., & McKerracher, L. (2011). A phase I/IIa clinical trial of a recombinant Rho protein antagonist in acute spinal cord injury. Journal of neurotrauma, 28(5), 787–796. https://doi.org/10.1089/neu.2011.1765 (https://pubmed.ncbi.nlm.nih.gov/21381984/). 11.  FOCUS Trial Collaboration (2019). Effects of fluoxetine on functional outcomes after acute stroke (FOCUS): a pragmatic, double-blind, randomised, controlled trial. Lancet (London, England), 393(10168), 265–274. https://doi.org/10.1016/S0140-6736(18)32823-X (https://pubmed.ncbi.nlm.nih.gov/30528472/). 12.  Forgione, N., & Fehlings, M. G. (2014). Rho-ROCK inhibition in the treatment of spinal cord injury. World neurosurgery, 82(3-4), e535–e539. https://doi.org/10.1016/j.wneu.2013.01.009 (http://pubmed.ncbi.nlm.nih.gov/23298675/). 13.  Fournier, A. E., Takizawa, B. T., & Strittmatter, S. M. (2003). Rho kinase inhibition enhances axonal regeneration in the injured CNS. The Journal of neuroscience : the official journal of the Society for Neuroscience, 23(4), 1416–1423. https://doi.org/10.1523/JNEUROSCI.23-04-01416.2003 (https://pubmed.ncbi.nlm.nih.gov/12598630/). 14.  Giacino, J. T., Whyte, J., Bagiella, E., Kalmar, K., Childs, N., Khademi, A., Eifert, B., Long, D., Katz, D. I., Cho, S., Yablon, S. A., Luther, M., Hammond, F. M., Nordenbo, A., Novak, P., Mercer, W., Maurer-Karattup, P., & Sherer, M. (2012). Placebo-controlled trial of amantadine for severe traumatic brain injury. The New England journal of medicine, 366(9), 819–826. https://doi.org/10.1056/NEJMoa1102609 (https://pubmed.ncbi.nlm.nih.gov/22375973/). 15.  Goodman, A. D., Brown, T. R., Krupp, L. B., Schapiro, R. T., Schwid, S. R., Cohen, R., Marinucci, L. N., Blight, A. R., & Fampridine MS-F203 Investigators (2009). Sustained-release oral fampridine in multiple sclerosis: a randomised, double-blind, controlled trial. Lancet (London, England), 373(9665), 732–738. https://doi.org/10.1016/S0140-6736(09)60442-6 (https://pubmed.ncbi.nlm.nih.gov/19249634/). 16.  Goodman, A. D., Brown, T. R., Edwards, K. R., Krupp, L. B., Schapiro, R. T., Cohen, R., Marinucci, L. N., Blight, A. R., & MSF204 Investigators (2010). A phase 3 trial of extended release oral dalfampridine in multiple sclerosis. Annals of neurology, 68(4), 494–502. https://doi.org/10.1002/ana.22240 (https://pubmed.ncbi.nlm.nih.gov/20976768/). 17.  Hurlbert, R. J., Hadley, M. N., Walters, B. C., Aarabi, B., Dhall, S. S., Gelb, D. E., Rozzelle, C. J., Ryken, T. C., & Theodore, N. (2013). Pharmacological therapy for acute spinal cord injury. Neurosurgery, 72 Suppl 2, 93–105. https://doi.org/10.1227/NEU.0b013e31827765c6 (https://pubmed.ncbi.nlm.nih.gov/23417182/). 18.  Johnston, S. C., Amarenco, P., Denison, H., Evans, S. R., Himmelmann, A., James, S., Knutsson, M., Ladenvall, P., Molina, C. A., Wang, Y., & THALES Investigators (2020). Ticagrelor and Aspirin or Aspirin Alone in Acute Ischemic Stroke or TIA. The New England journal of medicine, 383(3), 207–217. https://doi.org/10.1056/NEJMoa1916870 (https://pubmed.ncbi.nlm.nih.gov/32668111/). 19.  Kheder, A., & Nair, K. P. (2012). Spasticity: pathophysiology, evaluation and management. Practical neurology, 12(5), 289–298. https://doi.org/10.1136/practneurol-2011-000155 (https://pubmed.ncbi.nlm.nih.gov/22976059/). 20.  Kirkman, M. A., Day, J., Gehring, K., Zienius, K., Grosshans, D., Taphoorn, M., Li, J., & Brown, P. D. (2022). Interventions for preventing and ameliorating cognitive deficits in adults treated with cranial irradiation. The Cochrane database of systematic reviews, 11(11), CD011335. https://doi.org/10.1002/14651858.CD011335.pub3 (https://pubmed.ncbi.nlm.nih.gov/36427235/). 21.  Martinsson L, Hårdemark H, Eksborg S. Amphetamines for improving recovery after stroke. Cochrane Database Syst Rev. 2007 Jan 24;2007(1):CD002090. doi: 10.1002/14651858.CD002090.pub2. PMID: 17253474; PMCID: PMC12278358 (https://pubmed.ncbi.nlm.nih.gov/17253474/). 22.  Miller, T. M., Cudkowicz, M. E., Genge, A., Shaw, P. J., Sobue, G., Bucelli, R. C., Chiò, A., Van Damme, P., Ludolph, A. C., Glass, J. D., Andrews, J. A., Babu, S., Benatar, M., McDermott, C. J., Cochrane, T., Chary, S., Chew, S., Zhu, H., Wu, F., Nestorov, I., … VALOR and OLE Working Group (2022). Trial of Antisense Oligonucleotide Tofersen for SOD1 ALS. The New England journal of medicine, 387(12), 1099–1110. https://doi.org/10.1056/NEJMoa2204705 (https://pubmed.ncbi.nlm.nih.gov/36129998/). 23.  Mueller, B. K., Mack, H., & Teusch, N. (2005). Rho kinase, a promising drug target for neurological disorders. Nature reviews. Drug discovery, 4(5), 387–398. https://doi.org/10.1038/nrd1719 (https://pubmed.ncbi.nlm.nih.gov/15864268/). 24.  Nourbakhsh, B., Revirajan, N., & Waubant, E. (2018). Treatment of fatigue with methylphenidate, modafinil and amantadine in multiple sclerosis (TRIUMPHANT-MS): Study design for a pragmatic, randomized, double-blind, crossover clinical trial. Contemporary clinical trials, 64, 67–76. https://doi.org/10.1016/j.cct.2017.11.005 (https://pubmed.ncbi.nlm.nih.gov/29113955/). 25.  Paganoni, S., Hendrix, S., Dickson, S. P., Knowlton, N., Macklin, E. A., Berry, J. D., Elliott, M. A., Maiser, S., Karam, C., Caress, J. B., Owegi, M. A., Quick, A., Wymer, J., Goutman, S. A., Heitzman, D., Heiman-Patterson, T. D., Jackson, C. E., Quinn, C., Rothstein, J. D., Kasarskis, E. J., … Cudkowicz, M. E. (2021). Long-term survival of participants in the CENTAUR trial of sodium phenylbutyrate-taurursodiol in amyotrophic lateral sclerosis. Muscle & nerve, 63(1), 31–39. https://doi.org/10.1002/mus.27091 (https://pubmed.ncbi.nlm.nih.gov/33063909/). 26.  Schwab M. E. (2004). Nogo and axon regeneration. Current opinion in neurobiology, 14(1), 118–124. https://doi.org/10.1016/j.conb.2004.01.004 (https://pubmed.ncbi.nlm.nih.gov/15018947/). 27.  Shneider, N. A., Harms, M. B., Korobeynikov, V. A., Rifai, O. M., Hoover, B. N., Harrington, E. A., Aziz-Zaman, S., Singleton, J., Jamil, A., Madan, V. R., Lee, I., Andrews, J. A., Smiley, R. M., Alam, M. M., Black, L. E., Shin, M., Watts, J. K., Walk, D., Newman, D., Pascuzzi, R. M., … Bennett, C. F. (2025). Antisense oligonucleotide jacifusen for FUS-ALS: an investigator-initiated, multicentre, open-label case series. Lancet (London, England), 405(10494), 2075–2086. https://doi.org/10.1016/S0140-6736(25)00513-6 (https://pubmed.ncbi.nlm.nih.gov/40414239/). 28.  Stocchi, F., Bravi, D., Emmi, A., & Antonini, A. (2024). Parkinson disease therapy: current strategies and future research priorities. Nature reviews. Neurology, 20(12), 695–707. https://doi.org/10.1038/s41582-024-01034-x (https://pubmed.ncbi.nlm.nih.gov/39496848/).

Miracolo di Natale all'ospedale di Santorso dove un intervento di soli 13 minuti, contro i 32 di media, ha salvato un paziente colpito da ictus. Sempre a Santorso è stato utilizzato per la prima volta in Veneto un nuovo un nuovo farmaco più efficace del 20% che andrà a sostituire quello vecchio.

El consejero de Sanidad de CyL, Alejandro Vázquez, y el presidente de la Junta, Alfonso Fernández Mañueco, han prometido en reiteradas ocasiones las unidades de ictus para todas las provincias para antes de que terminara este 2025

David Diez, investigador del Instituto de Neurociencias en Castilla y León, explica la importancia de las unidades de ictus para su tratamiento precoz

L'ospedale di Santorso è il migliore in Veneto, e tra i migliori in Italia, per la tempestività con cui i pazienti colpiti da ictus ischemico vengono sottoposto alla trombolisi: in media solo 32 minuti. Questo il risultato, che emerge nella più recente rilevazione del programma ESO-Angels Awards, l'agenzia internazionale che monitora l'attività delle stroke unit europee, è valso all'ospedale Alto Vicentino la classificazione “Diamond”, ovvero la massima valutazione possibile da parte della Euroean Stroke Organization.

QFELV (Tramo de 00:00 a 01:00) Javier tiene 30 años y una vida hipotecada por la enfermedad de Tony. La memoria falla, el carácter cambia y la familia desaparece. ¿Hasta dónde llega el deber de cuidar?

En este episodio viajamos desde los orígenes más controvertidos de la Neurociencia moderna —los monos de Silver Spring— hasta la consolidación del protocolo oficial de la Constraint-Induced Therapy (CIMT) de Taub y Morris en la Universidad de Alabama. Repasamos cómo surgió el concepto de learned non-use, cómo se formalizó la terapia, por qué el Paquete de Transferencia fue una revolución conductual, y qué nos dice la evidencia más robusta (incluyendo el EXCITE trial, Premio PEDro al mejor ensayo clínico del año). También exploramos la evolución del protocolo, desde las 6 horas diarias iniciales hasta el formato actual de 3.5h/día, y cómo el equipo brasileño de Sarah Dos Anjos logró expandir la CIMT al miembro inferior con resultados positivos. Cerramos con una revisión profunda del papel del MAL, del protocolo KEYS y de la extended CIMT para manos pléjicas. Un episodio imprescindible para cualquier profesional que trate a personas con ictus o quiera comprender cómo una intervención conductual intensiva puede modificar el uso real del brazo afecto… y el cerebro. Referencias del episodio: 1. Corbetta, D., Sirtori, V., Castellini, G., Moja, L., & Gatti, R. (2015). Constraint-induced movement therapy for upper extremities in people with stroke. The Cochrane database of systematic reviews, 2015(10), CD004433. https://doi.org/10.1002/14651858.CD004433.pub3 (https://pubmed.ncbi.nlm.nih.gov/26446577/). 2. Dos Anjos, S. M., Morris, D. M., & Taub, E. (2020). Constraint-Induced Movement Therapy for Improving Motor Function of the Paretic Lower Extremity After Stroke. American journal of physical medicine & rehabilitation, 99(6), e75–e78. https://doi.org/10.1097/PHM.0000000000001249 (https://pubmed.ncbi.nlm.nih.gov/31246610/). 3. Dos Anjos, S., Morris, D., & Taub, E. (2020). Constraint-Induced Movement Therapy for Lower Extremity Function: Describing the LE-CIMT Protocol. Physical therapy, 100(4), 698–707. https://doi.org/10.1093/ptj/pzz191 (https://pubmed.ncbi.nlm.nih.gov/31899495/). 4. Dos Anjos, S., Bowman, M., & Morris, D. (2025). Effects of a Distributed Form of Constraint-Induced Movement Therapy for Clinical Application: The Keys Treatment Protocol. Brain sciences, 15(1), 87. https://doi.org/10.3390/brainsci15010087 (https://pubmed.ncbi.nlm.nih.gov/39851454/). 5. Gauthier, L. V., Taub, E., Perkins, C., Ortmann, M., Mark, V. W., & Uswatte, G. (2008). Remodeling the brain: plastic structural brain changes produced by different motor therapies after stroke. Stroke, 39(5), 1520–1525. https://doi.org/10.1161/STROKEAHA.107.502229 (https://pmc.ncbi.nlm.nih.gov/articles/PMC2574634/). 6. Hakkennes, S., & Keating, J. L. (2005). Constraint-induced movement therapy following stroke: a systematic review of randomised controlled trials. The Australian journal of physiotherapy, 51(4), 221–231. https://doi.org/10.1016/s0004-9514(05)70003-9 (https://pubmed.ncbi.nlm.nih.gov/16321129/). 7. Morris, D. M., Taub, E., & Mark, V. W. (2006). Constraint-induced movement therapy: characterizing the intervention protocol. Europa medicophysica, 42(3), 257–268 (https://pubmed.ncbi.nlm.nih.gov/17039224/). 8. Richards, L., Gonzalez Rothi, L. J., Davis, S., Wu, S. S., & Nadeau, S. E. (2006). Limited dose response to constraint-induced movement therapy in patients with chronic stroke. Clinical rehabilitation, 20(12), 1066–1074. https://doi.org/10.1177/0269215506071263 (https://pubmed.ncbi.nlm.nih.gov/17148518/). 9. Sterr, A., Elbert, T., Berthold, I., Kölbel, S., Rockstroh, B., & Taub, E. (2002). Longer versus shorter daily constraint-induced movement therapy of chronic hemiparesis: an exploratory study. Archives of physical medicine and rehabilitation, 83(10), 1374–1377. https://doi.org/10.1053/apmr.2002.35108 (https://pubmed.ncbi.nlm.nih.gov/12370871/). 10. Taub, E., Miller, N. E., Novack, T. A., Cook, E. W., 3rd, Fleming, W. C., Nepomuceno, C. S., Connell, J. S., & Crago, J. E. (1993). Technique to improve chronic motor deficit after stroke. Archives of physical medicine and rehabilitation, 74(4), 347–354 (https://pubmed.ncbi.nlm.nih.gov/8466415/). 11. Taub, E., Uswatte, G., & Pidikiti, R. (1999). Constraint-Induced Movement Therapy: a new family of techniques with broad application to physical rehabilitation--a clinical review. Journal of rehabilitation research and development, 36(3), 237–251 (https://pubmed.ncbi.nlm.nih.gov/10659807/). 12. Taub, E., & Morris, D. M. (2001). Constraint-induced movement therapy to enhance recovery after stroke. Current atherosclerosis reports, 3(4), 279–286. https://doi.org/10.1007/s11883-001-0020-0 (https://pubmed.ncbi.nlm.nih.gov/11389792/). 13. Taub, E., Uswatte, G., Mark, V. W., Morris, D. M., Barman, J., Bowman, M. H., Bryson, C., Delgado, A., & Bishop-McKay, S. (2013). Method for enhancing real-world use of a more affected arm in chronic stroke: transfer package of constraint-induced movement therapy. Stroke, 44(5), 1383–1388. https://doi.org/10.1161/STROKEAHA.111.000559 (https://pubmed.ncbi.nlm.nih.gov/23520237/). 14. Uswatte, G., Taub, E., Morris, D., Barman, J., & Crago, J. (2006). Contribution of the shaping and restraint components of Constraint-Induced Movement therapy to treatment outcome. NeuroRehabilitation, 21(2), 147–156 (https://pubmed.ncbi.nlm.nih.gov/16917161/). 15. Uswatte, G., Taub, E., Bowman, M. H., Delgado, A., Bryson, C., Morris, D. M., Mckay, S., Barman, J., & Mark, V. W. (2018). Rehabilitation of stroke patients with plegic hands: Randomized controlled trial of expanded Constraint-Induced Movement therapy. Restorative neurology and neuroscience, 36(2), 225–244. https://doi.org/10.3233/RNN-170792 (https://pubmed.ncbi.nlm.nih.gov/29526860/). 16. Wolf, S. L., Lecraw, D. E., Barton, L. A., & Jann, B. B. (1989). Forced use of hemiplegic upper extremities to reverse the effect of learned nonuse among chronic stroke and head-injured patients. Experimental neurology, 104(2), 125–132. https://doi.org/10.1016/s0014-4886(89)80005-6 (https://pubmed.ncbi.nlm.nih.gov/2707361/). 17. Wolf, S. L., Winstein, C. J., Miller, J. P., Taub, E., Uswatte, G., Morris, D., Giuliani, C., Light, K. E., Nichols-Larsen, D., & EXCITE Investigators (2006). Effect of constraint-induced movement therapy on upper extremity function 3 to 9 months after stroke: the EXCITE randomized clinical trial. JAMA, 296(17), 2095–2104. https://doi.org/10.1001/jama.296.17.2095 (https://pubmed.ncbi.nlm.nih.gov/17077374/).

Como Ana, hay mucha gente en España...Ana tiene 48 años y ha sufrido cuatro ictus, así que va en silla de rudas y depende de que la ayuden los demás. Como Ana, el 85% de los que sobreviven a un accidente cerebrovascular, necesitan soporte. De hecho, el 60% de los familiares de estas personas tienen que abandonar sus trabajos para dedicarse a ellos en cuerpo y alma.Y ahora, prepárense, porque vamos a sacar pecho.Se llama Robopedics, y es una empresa española. 100% española. Ha desarrollado un robot para ayudarles a volver a caminar. Un exoesqueleto que se acopla fácilmente en las piernas, en la cadera, y los levanta. Es un 60% más ligero y un 80% más barato que otras soluciones. Y lo diseñó Iván. Y saben por qué lo ideó. Porque su padre sufrió un ictus.El año que viene podría estar ya en el mercado, pero, de momento, ya lo están usando en algunos hospitales. Y Ana, por ejemplo, podrá entrar en su cocina. Y cortarse las uñas.Y todo eso, por la idea ...

El doctor Javier Marta, jefe de la Unidad de Ictus del Hospital Miguel Servet y coordinador clínico del Plan de Ictus de Aragón, nos acompaña para hablar de salud cerebral. Reconocer los primeros síntomas y actuar con rapidez puede salvar vidas y evitar secuelas graves.

L'Hospital Parc Taulí atén cada any 900 persones per ictus

durée : 00:09:54 - Fausto Romitelli : An Index of Metals - Donatienne Michel-Dansac, Ensemble Ictus - An Index of Metals a pour projet de détourner la forme séculaire de l'opéra vers une expérience de perception totale plongeant le spectateur dans une matière incandescente aussi bien lumineuse que sonore ; un flux magmatique de sons, de formes et de couleurs. Vous aimez ce podcast ? Pour écouter tous les autres épisodes sans limite, rendez-vous sur Radio France.

José Luis Ábalos declara por cuarta vez en el Tribunal Supremo, acogido a su derecho a no declarar, y la Fiscalía no solicita prisión provisional. Se debate la revisión de sus medidas cautelares y la posible afectación a las mayorías parlamentarias. Pedro Sánchez defiende la "decencia" de su gobierno, mientras Núñez Feijóo le acusa de corrupción. La inflación sube al 3% en septiembre, superando la media europea, con aumentos en alimentos y carburantes. Donald Trump critica el gasto en defensa de España y amenaza con aranceles. Israel confirma que un cadáver no corresponde a un rehén. COPE informa de la campaña de vacunación contra la gripe en Madrid. Se celebra el Domund, destacando la labor misionera y el apoyo económico. Legalitas ofrece asesoramiento sobre el IRPF y Senior's colabora con la Asociación Madrileña de Ictus, enfatizando los cuidados domiciliarios tras un ictus.

Ponemos el foco en el ictus, que se presenta en pacientes cada vez más jóvenes, con Javier Marta, jefe de la Unidad de Ictus del Servet y coordinador clínico del Plan de Ictus de Aragón.

Jaume Segalés y los responsables de Mundo Natural hablan de salud y del ictus isquémico.

Quejarse de todo o aprovechar para sentirse dichoso a pesar de las circunstancias. Así se distingue a los seres humanos. Les presento a Muni. Sufrió un ictus hemorrágico hace un año. Ha tenido que aprender a masticar, comer, escribir, pensar cómo poner la lengua para pronunciar algunas letras. Muni tiene 24 años y es Guardia Real. Quizá sea eso lo que marca su carácter. Es capaz de contar sin remilgos su caso, como tratando de entender todo el proceso. Le quitaron una parte del cráneo y estuvo varias semanas con el cerebro abierto. Pero Muni luce ya espléndido. Le ha crecido el pelo y es un bombón de chico. Aunque lo más importante es su cabeza. Ni el derrame que sufrió le ha restado ni un ápice de bondad, generosidad y lucidez. En el fondo se felicita. Podría haber sido peor si le hubiera ocurrido a alguno de los suyos. Eso dice. Muni, ojalá y la vida te devuelva las ganas, los propósitos que mereces pero ojalá y también te conserve ...

En esta edición especial del sábado 24 de mayo de 2025, desde el Hospital Universitario Central de Asturias (HUCA), la tertulia de “Maduritos Interesantes” se adelanta al sábado y reúne a cuatro voces con solera: José Luis Garci, director y guionista de cine; Andrés Aberasturi, periodista y escritor; José Ramón Pardo, divulgador musical; y Sergio Calleja, neurólogo y coordinador de la Unidad de Ictus del HUCA.La conversación arranca con el tema central del entorno: La representación de los hospitales y médicos en la ficción, desde grandes series como Urgencias, Médico de familia o Anatomía de Grey, hasta la reciente Hipócrates o Respira. La tertulia da un giro para rendir homenaje a Mariano Ozores, fallecido esta semana a los 98 años, maestro de la comedia popular con 96 películas a sus espaldas. En la recta final, el recuerdo es para Juanito Valderrama, en el 99 aniversario de su nacimiento. Se repasa su trayectoria, sus inicios con La Niña de la Puebla, su paso por el cine y su legado musical, hoy continuado por su hijo Juan Valderrama. José Ramón Pardo analiza su importancia en la historia de la música española y su papel como figura icónica de la copla.Escuchar audio

Jaume Segalés y los responsables de Mundo Natural hablan de salud y de los ictus Isquémicos.

Este sábado 26 de abril… el mundo entero se despide de Su Santidad el Papa Francisco, quien falleció el pasado lunes a los 88 años a causa de un ictus.See omnystudio.com/listener for privacy information.

El mundo católico, en especial la comunidad hispana, llora la muerte del papa Francisco, uno de los más carismáticos, humildes y cercano a su pueblo. Así lo recordamos.¿Cuál fue su importancia como hombre latinoamericano? ¿Cuál es su legado? En este episodio especial recordamos su vida y obra.

El papa Francisco manifestó en su testamento cómo y dónde quería ser enterrado, rompiendo los protocolos una vez más pues su cuerpo yacerá en la basílica de Santa María la Mayor.El cuerpo del papa Francisco yace en la capilla de la casa de Santa Marta donde se encuentra el apartamento en el que vivió durante su papado y donde murió.Recordamos las últimas 24 horas del papa Francisco en el domingo de resurrección.Argentina, tierra natal del papa, está de luto y te contamos qué está sucediendo allí.En otras noticias: los mercados volvieron a sufrir una fuerte caída por las críticas de Donald Trump a la reserva federal y por la incertidumbre frente a la guerra arancelaria. 

Millones de católicos de todo el mundo recuerdan y despiden al Papa Francisco quien falleció a sus 88 años debido a un accidente cerebral y un colapso cardio circulatorio.¿Qué sucede tras la muerte del Papa? Te explicamos paso a paso lo que está ocurriendo.¿Qué significó que Francisco fuera el primer papa latinoamericano? ¿Cuál es su legado?¿Quién podría ser el próximo Papa? Te contamos quienes son algunos de los candidatos.El testamento de Francisco habla profundamente de su humildad ¿Cómo quiere que sean sus honras fúnebres? 

Hasta la elección del nuevo Papa, la autoridad para la gestión del Vaticano recae en la figura del camarlengo el cardenal estadounidense-irlandés Kevin Farrell La campanas de la Catedral Metropolitana redoblan en memoria del papa FranciscoDestaca Brugada la incansable lucha de Francisco en favor de los pobres y de los pueblosMás información en nuestro podcast

Iñigo Uriarte y Julio Agredano son dos supervivientes de ictus que han querido utilizar su historia de superación para concienciar y divulgar sobre esta condición

Iñigo Uriarte y Julio Agredano son dos supervivientes de ictus que han querido utilizar su historia de superación para concienciar y divulgar sobre esta condición

JAMA Intern Med 2023;183:407-415Background: As we have previously discussed, trials comparing invasive versus conservative management in patients with non-ST elevation myocardial infarction (NSTEMI) have yielded mixed results. The average age of participants in these studies was in the 60s, and multiple comorbidities were relatively uncommon. However, many NSTEMI patients seen in clinical practice are older and have multiple comorbidities. These patients have worse prognosis and have competing risks for mortality. Whether an invasive strategy provides a benefit for this population remains uncertain.Cardiology Trial's Substack is a reader-supported publication. To receive new posts and support our work, consider becoming a free or paid subscriber.The MOSCA-FRAIL trial sought to compare invasive vs conservative strategy in older adults with frailty and NSTEMI.Patients: Eligible patients had to have NSTEMI, be 70 years or older, and have frailty defined by 4 points or greater on the Clinical Frailty Scale.Patients were excluded if they were known to have nonrevascularizable coronary artery disease, significant concomitant non-ischemic heart disease, or life expectancy less than 12 months.Baseline characteristics: The trial randomized 167 patients from 13 hospitals in Spain – 84 randomized to invasive strategy and 83 to conservative strategy.The average age of patients was 86 years and 47% were men. Approximately 92% had hypertension, 56% had diabetes, 77% had hyperlipidemia, 31% had prior myocardial infarction, 27% had history of atrial fibrillation, 18% had prior stroke, 44% had chronic kidney disease, and 3% were current smokers.Procedures: Patients were randomly assigned in a 1:1 ratio to undergo invasive or conservative strategy.In the invasive strategy, patients underwent coronary angiogram within 72 hours of admission, and revascularization was performed as appropriate. In the conservative arm, patients were treated with medical therapy alone. A coronary angiogram was permitted for recurrent ischemia during the index admission.Medical treatment was given according to the guidelines at the time. In both arms, dual antiplatelet was recommended for one year. In patients with high bleeding risk or taking an oral anticoagulant, one antiplatelet could be stopped after the first month.Endpoints: The primary end point was the number of days alive and out of the hospital between discharge from the index hospitalization to 1 year. The coprimary end point was the composite of cardiac death, reinfarction, or post-discharge revascularization.Analysis was performed based on the intention-to-treat principle. The estimated sample size to provide 80% power at 5% alpha was 176 patients. This assumed that the number of days for the primary outcome in the conservative arm was 273 days and that an invasive strategy would increase that by 20%, that is 55 days.Results: Due to the COVID pandemic, the trial was terminated early after randomizing 95% of the planned sample size. During the index admission, 98% of the patients in the invasive arm underwent coronary angiogram and 60% underwent revascularization. Among patients in the conservative arm, 9.6% underwent revascularization due to recurrent ischemia during the index admission.The primary outcome (number of days alive and out of the hospital between discharge from the index hospitalization to 1 year) was numerically lower with the invasive arm but this was not statistically significant (mean difference 28 days, 95% CI: -7 – 62; p= 0.12).There was no difference in the coprimary end point - cardiac death, reinfarction, or post-discharge revascularization – absolute values were not provided. The invasive strategy was associated with significantly more bleeding events requiring hospitalization (8 patients vs 1 patient, incidence rate ratio: 14.9, 95% CI: 1.7 – 129.0; p= 0.02) including 4 deaths related to bleeding.Conclusion: In older, frail patients with NSTEMI, an invasive strategy did not significantly reduce the number of days of being alive and out of the hospital at 1-year. It also did not reduce the coprimary end point which was the composite of cardiac death, reinfarction, or post-discharge revascularization. An invasive strategy was associated with more bleeding requiring hospitalization.The trial is small, and its results should be interpreted with caution. Nonetheless, it is an important study that paves the way for future, larger trials in this population. The primary endpoint is both meaningful and relevant to this population. The average age of participants in this trial is approximately 20 years older than those in TACTICS-TIMI 18, RITA 3, and ICTUS. It is important to recognize that older, frail patients with multiple comorbidities are significantly underrepresented in clinical trials and likely derive less benefit or even harm from interventions.Cardiology Trial's Substack is a reader-supported publication. To receive new posts and support our work, consider becoming a free or paid subscriber. Get full access to Cardiology Trial's Substack at cardiologytrials.substack.com/subscribe

For full review of the trials, please visit https://cardiologytrials.substack.com/ Get full access to Cardiology Trial's Substack at cardiologytrials.substack.com/subscribe

N Engl J Med 2005;353:1095-1104Background: Prior trials on revascularization in patients with acute coronary syndromes without ST-segment elevation have yielded mixed results. While FRISC II and TACTICS-TIMI 18 demonstrated a significant reduction in myocardial infarction, this benefit was not observed in RITA 3. None of these trials showed a significant reduction in mortality. Further research is needed to guide treatment strategies in this population, particularly after the introduction of early use of clopidogrel and intensive lipid-lowering therapy.Cardiology Trial's Substack is a reader-supported publication. To receive new posts and support our work, consider becoming a free or paid subscriber.The Invasive versus Conservative Treatment in Unstable Coronary Syndromes (ICTUS) trial sough to test the hypothesis that an early invasive strategy is superior to selective invasive strategy for patients with non-ST elevation myocardial infarction (NSTEMI).Patients: Eligible patients had to have all of the following: Worsening symptoms of ischemia or symptoms at rest with the last episode being 24 hours before randomization, elevated cardiac troponin T level (≥0.03 μg per liter); and either ischemic EKG changes (defined as ST-segment depression or transient ST-segment elevation exceeding 0.05 mV, or T-wave inversion of ≥0.2 mV in two contiguous leads) or a documented history of coronary artery disease.Patients were excluded if they were older than 80 years, had an indication for primary percutaneous coronary intervention or fibrinolytic therapy, hemodynamic instability or overt congestive heart failure, oral anticoagulant drugs use in the past 7 days, fibrinolytic treatment within the past 96 hours, percutaneous coronary intervention within the past 14 days, elevated bleeding risk, plus others.Baseline characteristics: The trial randomized 1,200 patients from 42 Dutch hospitals – 604 randomized to early invasive strategy and 596 randomized to selective invasive strategy.The average age of patients was 62 years and 74% were men. Approximately 39% had hypertension, 14% had diabetes, 35% had hyperlipidemia, 23% had prior myocardial infarction and 41% were current smokers.Approximately 48% of the patients had ST deviation equal to or greater than 0.1 mV.Procedures: Patients were randomly assigned in a 1:1 ratio to undergo early invasive vs selective invasive strategy.Patients received 300 mg of aspirin at the time of randomization, followed by at least 75 mg daily indefinitely, and enoxaparin (1 mg/kg for a maximum of 80 mg) subcutaneously twice daily for at least 48 hours. The early use of clopidogrel (300 mg immediately, followed by 75 mg daily) in addition to aspirin was recommended to the investigators after the drug was approved for acute coronary syndrome in 2002. Intensive lipid-lowering therapy, preferably atorvastatin 80 mg daily or the equivalent was recommended as soon as possible after randomization. All interventional procedures during the index admission were performed with the use of abciximab.Patients assigned to the early invasive strategy were scheduled to undergo angiography within 24 - 48 hours after randomization. Patients assigned to the selective invasive strategy underwent coronary angiography if they had refractory angina despite optimal medical therapy, hemodynamic or rhythm instability, or significant ischemia on pre-discharge exercise test.In both groups, percutaneous coronary intervention (PCI) was performed when appropriate, without providing more details in the manuscript.The level of creatine kinase MB was measured at 6-hour intervals during the first day, after each new clinical episode of ischemia, and after each percutaneous revascularization procedure.Endpoints: The primary endpoint was a composite of all-cause death, myocardial infarction, or rehospitalization for angina at 1-year.The estimated sample size to provide 80% power to detect 25% relative risk difference between the two treatment groups at 5% alpha was 1,200 patients. This assumed that 21% of the patients in the early invasive arm would experience the primary outcome.Results: During the index admission, 98% of the patients in the early invasive strategy arm underwent coronary angiogram compared to 53% in the selective invasive arm. At 1-year, 79% of the patients in the early invasive strategy arm underwent revascularization compared to 54% in the selective invasive arm.The primary outcome was not significantly different between both treatment groups (22.7% with early invasive vs 21.2% with selective invasive, RR: 1.07; 95% CI: 0.87 - 1.33; p= 0.33). All-cause death was the same in both groups (2.5%). Myocardial infarction was significantly higher with the early invasive strategy (15.0% vs. 10.0%, RR: 1.50, 95% CI: 1.10 – 2.04; p= 0.005), while rehospitalization for angina was lower with early invasive (7.4% vs. 10.9%, RR: 0.68, 95% CI: 0.47 – 0.98; p= 0.04). Most myocardial infarctions were revascularization related and these were significantly more frequent with early invasive (11.3% vs 5.4%). Spontaneous myocardial infarctions were 3.7% with early invasive and 4.6% with selective invasive and this was not statistically significant.Major bleeding, not related CABG, during the index admission was more frequent with the early invasive strategy (3.1% vs 1.7%).There were no significant subgroup interactions for the primary outcome, including based on ST deviation and troponin levels.Conclusion: In patients with NSTEMI, an early invasive strategy was not superior to selective invasive strategy in reducing the composite endpoint of all-cause death, myocardial infarction, or rehospitalization for angina at 1-year. An early invasive strategy was associated with more myocardial infarctions with a number needed to harm of 20 patients, which was secondary to revascularization related myocardial infarction. An early invasive strategy reduced rehospitalization for angina with a number needed to treat of approximately 29 patients.The ICTUS trial showed that revascularization can cause harm and highlighted how counting procedural myocardial infarctions can influence outcome estimates. While there is ongoing debate about the significance of periprocedural myocardial infarctions, evidence indicates an association with increased mortality. Whether periprocedural myocardial infarctions are 'less severe' than spontaneous myocardial infarctions remains controversial, as their impact varies based on infarct size and patient characteristics. This underscores the importance of including all-cause mortality or advanced systolic heart failure as endpoints in trials of revascularization.Patients in ICTUS received better background medical therapy compared to prior trials in this area. While this could be responsible for the divergent results compared to other prior trials. It also highlights the heterogeneity of NSTEMI patients and that an invasive strategy is not appropriate for all.Cardiology Trial's Substack is a reader-supported publication. To receive new posts and support our work, consider becoming a free or paid subscriber. Get full access to Cardiology Trial's Substack at cardiologytrials.substack.com/subscribe

durée : 00:11:28 - La Métamorphose - Je, tu, il : Levinas - Ensemble Ictus - Le choix fait par Michaël Levinas de représenter l'irreprésentable est passionnant car il induit des chemins de traverse, un regard qui est oblique, en quelque sorte.

In der 23. Episode von Irgendwas mit Examen sprechen Marc und Prof. Schmitt-Leonardy über die Irrtumslehre im Strafrecht – ein Thema, das nicht nur höchst examensrelevant ist, sondern auch in der Praxis spannende Fragen aufwirft. Gemeinsam beleuchten sie die verschiedenen Irrtümer, die einem während der Strafrechtsprüfung begegnen können, darunter Tatbestandsirrtümer, Irrtümer zu der rechtlichen (Bewertungs-)Ebene und nicht zuletzt das Angstthema Erlaubnistatbestandsirrtum (ETBI). Was passiert, wenn jemand glaubt, in Notwehr zu handeln, sich aber in der Situation irrt? Wann führt ein Irrtum zum Ausschluss des Vorsatzes und wann bleibt eine Strafbarkeit dennoch bestehen? Und wie unterscheiden sich der ETBI und der Verbotsirrtum in ihren rechtlichen Konsequenzen? Diese und viele weitere Fragen klären Marc und Prof. Schmitt-Leonardy mit praxisnahen Beispielen und klaren Argumentationen. Viel Spaß mit dieser Folge Eures Podcasts zu allen relevanten Examensfragen!

Prevenir es vivir.Un infarto cerebral o un ictus te cambian la vida.¿Reconoces sus señales de alerta, sabes cómo actuar de inmediato y las claves para prevenirlos? See omnystudio.com/listener for privacy information.

Las Unidades del Ictus de Aragón recortan la brecha entre zonas rurales y urbanas en la atención inmediata en caso de sufrir un accidente cerebrovascular. Conocemos dónde están y su funcionamiento.

La actriz Silvia Abascal ("El tiempo de la felicidad", "Al empezar la semana" o "Lobo") ha inaugurado una nueva temporada (la cuarta) de Amigos Alegres en Hoy por Hoy. Allí, además de inscribirse como nueva miembro de este amistoso y afectivo club, nos ha contado cómo llegó al Un, Dos Tres, con Chicho Ibáñez Serrador, "La primera persona que me dio la primera oportunidad con sólo 13 años"; cómo con 16, asaltó las casas de toda España con la serie "Pepa y Pepe", "Donde en la primera semana de rodaje literalmente se hizo pis encima", o cómo es su vida tras sufrir un ictus, "Fue como renacer de nuevo en todos los sentidos". 

Si de pronto se sienten mareados, no pueden hablar bien o sienten la cara entumida, no lo tomen a la ligera, podría ser un Ictus, hoy les damos las señales. La Organización Mundial de la Salud (OMS) dice que las Enfermedades Vasculares Cerebrales, representan la segunda causa de muertes en el mundo. Uno de cada cinco pacientes muere y tres de cada cinco quedan con secuelas. • Según US NEWS en 2021, las tasas más altas se dieron en los Emiratos Árabes Unidos con 208 por cada 100,000 personas; Macedonia con 187 y Jordania con 181. • Las tasas más bajas se dieron en Irlanda con 36; Nepal con 37 y Suiza con 38 derrames o ictus por cada 100.000 habitantes.

Hoy en Martha Debayle por W, "Pada" les enseña música de Quincy Jones, Examen Sorpresa de Historia, el ABC para comprar tu propio depa o casa, el ICTUS y sus señales con el Dr. Erwin Chiquete, Neurólogo, y ¿Por qué elegí a mi pareja?