Antipsychotic drugs are increasingly prescribed in children and adolescents across a wide range of psychiatric conditions. Although cardiovascular adverse effects are generally considered uncommon, concerns about electrocardiographic abnormalities, particularly QTc interval prolongation, have led to ongoing debate regarding appropriate monitoring strategies. Real-world data on the frequency, persistence, and clinical relevance of ECG findings during antipsychotic treatment in youth remain limited.

This was a single-center, observational cohort study including patients younger than 18 years, treated with antipsychotics between January 2020 and December 2024. Inclusion required the availability of at least one 12-lead ECG performed during treatment and accompanied by a cardiology report. ECG parameters were extracted from all available recordings, with QTc calculated using Bazett's formula and interpreted using sex-specific reference thresholds. ECG findings were analyzed primarily at the patient level, defining abnormalities based on their occurrence at any point during follow-up. An exploratory comparison was performed between patients with and without QTc prolongation.

The study included 430 patients (79.1% males; mean age 11.3 ± 3.35 years), of whom 429 had analyzable ECG data. At the patient level, 195 of 429 patients (45.5%) exhibited at least one numeric ECG abnormality during follow-up, most commonly heart rate abnormalities. QTc prolongation above sex-specific thresholds was observed in 24 patients (5.6%) and proved to be persistent in only 5 cases (20.8%), defined as occurrence in at least 2 ECG recordings. No patient exhibited a QTc ≥500 ms, and no clinically significant ventricular arrhythmias, high-grade conduction disturbances, or sudden cardiac events were observed. QTc prolongation was not significantly associated with sex, age, antipsychotic polypharmacy, combined first- and second-generation antipsychotic exposure, or QT-relevant comedications.

In this large naturalistic pediatric cohort, ECG abnormalities during antipsychotic treatment were relatively frequent but predominantly mild, transient, and clinically benign. QTc prolongation occurred in a small minority of patients and was not associated with adverse cardiac outcomes. These findings may support a selective, risk-based approach to ECG monitoring in children and adolescents treated with antipsychotics, rather than routine universal screening.

To evaluate the correlation between creatinine (Cre) level and the risk of three kinds of adverse events in patients after percutaneous coronary intervention (PCI), and to clarify its potential correlation threshold and independent predictive value.

This investigation was designed as a retrospective cohort analysis, encompassing 3, 878 individuals diagnosed with acute myocardial infarction who received PCI between January 2018 and December 2020. The primary outcomes were three types of adverse events that occurred post-procedure. To explore the relationship between Cre levels and the outcome measures, a restricted cubic spline model was employed, while the Cox proportional hazards regression model assessed the independent predictive significance. There were 996 instances (25.7%) of adverse events reported. The evaluation using a restricted cubic spline model revealed a notable J-shaped relationship between creatinine levels and the likelihood of three types of adverse events following PCI (nonlinear P < 0.05), with the inflection point identified at 110 μmol/L. When considering Cre=110 μmol/L as the baseline, patients with Cre levels below this threshold (low value group) exhibited a 15.5% increase in MACE risk (95% CI: 1.006-1.327, P = 0.0416), a 15.6% increase in NACE risk (95% CI: 1.004-1.330, P = 0.0436) and a 16.1% increase in MACCE risk (95% CI: 1.015-1.329, P = 0.0301).

There is a J-shaped correlation between Cre level and the risk of three kinds of adverse events in patients after PCI, and the inflection point of 110 μmol/L can be used as the key threshold for clinical risk stratification and individualized intervention.

Tricuspid regurgitation, associated with poor functional status and reduced survival, is common in patients with rheumatic heart disease after left-sided valve replacement. Although repair is preferred over replacement, surgical repair remains technically challenging. A 60-year-old woman presented with recurrent bilateral leg oedema for 2 years and dizziness with palpitations for 2 months. She had undergone mechanical mitral and aortic valve replacement 18 years earlier for rheumatic heart disease. Echocardiography demonstrated severe central tricuspid regurgitation with preserved prosthetic valve function and atrial arrhythmia. Via median sternotomy and cardiopulmonary bypass, classic rheumatic pathology of the tricuspid valve was identified. Repair consisted of detachment of the anterior and posterior leaflets, augmentation with an annuloplasty-shaped bovine pericardial patch to increase leaflet height and coaptation, and implantation of a partial rigid annuloplasty ring slightly smaller than the patch. Intra-operative echocardiography showed trace residual tricuspid regurgitation. Recovery was uneventful, with early resolution of oedema. Leaflet augmentation combined with partial ring annuloplasty is a simple and reproducible technique that restores early valve competence in complex rheumatic tricuspid regurgitation. Long-term follow-up is required to confirm durability.

This study aimed to assess knowledge, lifestyle behaviours, and sociodemographic associations regarding hypertension control among adults in urban Ghana.

Hypertension is a major contributor to cardiovascular morbidity and mortality in Ghana. However, data on population-level knowledge of its risk factors and related lifestyle behaviours in urban settings remain limited.

A cross-sectional analytical survey was conducted between August 2023 and September 2024 across four urban regions. Using stratified convenience sampling, 7096 adults aged 18-67⁺ years were recruited. Data on sociodemographic, lifestyle behaviours, and hypertension knowledge were collected via a structured questionnaire.

Participants had a mean age of 37.27 (±8.73) years, with a majority being female (63.85%) and married (97.66%). Educational attainment varied. Females constituted most hypertensive cases, particularly for stage 2 hypertension, while males had a notably higher prevalence of pre-hypertension among those aged 27-53 years. Age and body mass index showed significant positive correlations with systolic and diastolic blood pressure (p < 0.01). Men were significantly more likely to smoke and consume alcohol (p < 0.01). Logistic regression indicated that regular exercise reduced the odds of hypertension diagnosis (OR = 0.72, CI: 0.54-0.96), while older age increased the odds. The study underscores the need for targeted public health strategies. Priorities include promoting physical activity and weight management, alongside smoking/alcohol cessation programs tailored for high-risk men. Early intervention for younger adults with pre-hypertension and enhanced educational outreach for less-educated groups are crucial.

Functional stroke-like episodes (FSMs) are an increasingly recognised stroke mimic with demographic and clinical characteristics that differ from acute ischaemic strokes (AISs) but have unclear long-term outcomes.

We report retrospective data on consecutive patients with FSM who underwent acute perfusion-CT (PCT) admitted to Lausanne University Hospital (2003-2017). We compared them to all contemporaneous AISs undergoing PCT from the Acute-STroke-Registry-and-Analysis-of-Lausanne (ASTRAL).

Twenty-five FSMs and 3201 control-AISs were included. FSM patients were significantly younger (median 43 vs. 73 years, adjusted odds ratio (OR_adj) 0.92), had a higher incidence of psychiatric disorders (OR_adj 5.33/17.07), and over half had a prior history of neurological and non-neurological functional disorders. FSM patients more often presented decreased vigilance (OR_adj = 9.28) and sensory deficits (OR_adj = 3.87), and less visual field defects (OR_adj = 0.14) and dysarthria (OR_adj = 0.20). FSM patients showed no significant changes on plain-CT and PCT. Acute revascularisation rates were similar in both groups (48% vs. 43%). Follow-up at 3-months revealed significant handicap in 41% of patients, similar to the control group in propensity-score-matched analysis, and lower mortality (0% vs. 20%, p_adj 0.04). After a median of 9 years follow-up, FSM patients failed to functionally improve further and 55% experienced additional functional neurological events.

In this single-centre cohort of consecutive FSMs undergoing acute PCT, we identified distinctive demographic and clinical features, normal CT-based neuroimaging, but still a high thrombolysis rate. Long-term observation revealed a high rate of recurrent functional events and persistent disability, suggesting the need for more effective treatment and regular follow-up.

Giant cell arteritis is relatively rare in Indian subjects. A retrospective chart review of cases of giant cell arteritis (GCA) in patients with anterior ischemic optic neuropathy (AION) for last five years (2015 to 2020) in a tertiary care Institution was done. GCA cases were diagnosed on the basis of clinical criteria of new onset of headache along with marked sudden visual loss supplemented by raised erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP), and confirmed on temporal artery biopsy. Occult GCA was defined as patients presenting with predominantly ophthalmic symptoms without systemic involvement. All the clinical details of GCA cases have been described in detail. Out of 30 cases of AION, GCA was the diagnosis in 4 cases (13.33%). Among the 4 cases of GCA, 3 cases (75%) were of occult in nature. Three cases underwent superficial temporal artery biopsy which was confirmatory for GCA. GCA was rare in Indian scenario. Earlier age of presentation, male preponderance, and higher number of occult GCA with predominantly ophthalmic involvement were the findings in our study.

Intracranial artery calcification, a common radiological finding in patients with ischemic stroke, manifests in various subtypes, including intimal, medial, and mixed patterns.

This study aimed to investigate the correlation between intracranial artery calcification subtypes and the extent of neurological disability in patients with ischemic stroke.

In this prospective observational study, we have included 135 patients, with a mean age of 67.5 ± 12.3 years and 51% were females. With a standardized method using non-contrast computed tomography (NCCT) scans, we have categorized patients into three groups: a) without calcification, b) mainly intimal calcification, and c) predominant medial calcification. Neurological evaluation was assessed by the National Institutes of Health Stroke Scale (NIHSS) and the modified Rankin Scale (mRS) upon admission and discharge.

Patients with predominant medial calcification were older than those with intimal calcification and no arterial calcification (73.5 ± 9.7 vs. 64.1 ± 11.7 vs. 59 ± 12.6 years), with a statistically significant difference (P < 0.001). However, mainly intimal calcification in the anterior circulation was linked to higher NIHSS scores at discharge compared to patients with mainly medial or no calcification (7.8 ± 4.6 vs. 5.6 ± 3.8 vs. 6.4 ± 4.4), P = 0.03. In a linear regression model adjusting for age, sex, hypertension, diabetes, renal failure, pulse pressure, blood glucose level, dyslipidemia, smoking, and hospital stay days, intimal calcification was associated with a significantly higher NIHSS score at discharge (β = 4.8, 95% confidence interval (CI): 1.70-7.95, P = 0.003).

Patterns of arterial calcification in the intracranial arteries represent a marker of clinical outcomes after ischemic stroke, in patients with mainly intimal calcification of the anterior circulation, having higher disability scales at discharge.

Patients with intracranial aneurysms while undergoing neurosurgical clipping frequently require the use of temporary clip, and this involves the risk of cerebral ischemia. The usual approaches for prevention of such an adverse event include use of pharmacological neuroprotection before temporary clipping of the parent vessel to induce burst suppression of EEG, or detecting ischemia using somatosensory-evoked potential (SSEP) of the relevant arterial territorial distribution and taking corrective measures. We studied the effect of preemptive pharmacological neuroprotection on postoperative neurological deficit and outcome in patients undergoing anterior circulation intracranial aneurysm surgery.

Prospective, randomized, comparative study included adult patients requiring temporary parent vessel occlusion during surgical clipping of ruptured intracranial aneurysm of the anterior circulation. Patients were randomized to Group N (pharmacological neuroprotection) or Group I (non-pharmacological neuroprotection). Anesthesia induction, maintenance of anesthesia, and extubation were standardized in both the groups. Cerebral ischemia monitoring was conducted in both groups using SSEP. Group N (n = 15): received pharmacological neuroprotection using propofol bolus; Group I (n = 15): SSEP monitoring and alerting the surgeon to ischemia, and taking appropriate corrective measures.

The demographic data were comparable between the two groups. There was no statistically significant difference in new onset neurological deficit within 24 hrs between the groups (P = 0.64). There was no significant difference in neurological outcome measured by the extended Glasgow Outcome Scale (GOSE), between the groups at three and six months.

This study shows no difference in short- or long-term neurological outcome with preemptive anesthetic neuroprotection during temporary arterial occlusion in anterior circulation intracranial aneurysm surgery. This pilot study was performed to estimate event rates and feasibility rather than to test efficacy.

In low- and middle-income countries (LMICs) where neurosurgical access is limited, early nonsurgical medical interventions in primary intracerebral hemorrhage (ICH) has potential benefits. This study assesses the efficacy of early intravenous tranexamic acid (TXA), in reducing expansion of hematoma and improving long-term outcomes in ICH patients.

We conducted a phase 2, randomized, double-blind, placebo-controlled trial. Besides controlling blood pressure, patients with primary ICH presenting within 24 hours were randomly assigned to receive either 1g intravenous TXA or a placebo. The primary outcome was hematoma size change at 48 hours. Secondary outcomes included neurological recovery, survival, healthcare utilization, and complications. Data were analyzed on an intention-to-treat basis.

A total of 154 patients were enrolled, with 78 in the TXA group. At 48 hours, the TXA group had a mean reduction in hematoma size of -0.434 ± 2.23 mL, while the placebo group exhibited increase of 0.462 ± 3.02 mL (P = 0.038). Nonprogression of hematoma occurred in 58.1% of the TXA group versus 43.7% in the placebo group (NNT = 7). Mortality at 180 days was significantly lower in the TXA group (25.6%) compared with the placebo group (38.2%, P = 0.047). Surgical intervention rates were also lower in the TXA group (15.4% vs. 26.3%, P = 0.048). No adverse events related to TXA were reported.

Intravenous TXA administered within 24 hours reduced hematoma progression, mortality, and surgical intervention in primary ICH. These findings support its safety and potential benefit, particularly in LMICs, pending confirmation in larger trials.

Basilar artery aneurysms (BAA), though relatively rare, are critical lesions due to their location and potential for catastrophic outcomes if ruptured. The Level 3 pretemporal transcavernous approach has emerged as a valuable surgical technique for the clipping of BAA, especially those that are low-lying. In this video, we present a case of a ruptured low-lying basilar tip aneurysm which was clipped using a Level 3 pretemporal transcavernous approach. A 60-year-old woman presented with modified Hunt and Hess grade IV subarachnoid hemorrhage. Computed tomography angiography showed a low-lying basilar tip aneurysm. The patient underwent a frontotemporal craniotomy, Level 3 pretemporal transcavernous approach, and clipping of the aneurysms. The patient had an uneventful recovery and was independent functionally at 3-month follow-up. Level 3 pretemporal transcavernous approach is a valuable surgical technique for clipping of low-lying basilar tip aneurysms.