Clinica Terapeutica最新文献

{"title":"Use of sodium thiosulfate in prevention of aki in oncologic patient that underwent hipec (Hyperthermic Intraperitoneal Chemotherapy) with Cisplatin: a Case Report.","authors":"V C Sanda, V M Ranieri, M Miccini, D Biacchi, D Crocetti, C Guerra, G Fanello, F Accarpio, G Cavallaro, E Spalice, S Gazzanelli","doi":"10.7417/CT.2026.2019","DOIUrl":"10.7417/CT.2026.2019","url":null,"abstract":"<p><strong>Abstract: </strong>Ovarian cancer is among the most common cancers diagnosed in women. It is the eighth most common cause of cancer death, with five-year survival rates below 45%. It is fundamental to have weapons and strategies to treat this type of cancer. Cisplatin is a well-known anticancer molecule that works by damaging the DNA of cancer cells. It is used in a variety of tumors such as testicular, bladder, lung and mostly in ovarian cancer. We present a case report of a 72-year-old woman diagnosed with ovarian adenocarcinoma. She underwent surgery in another hospital, and the uterus, both ovaries and the left kidney were removed, as it was infiltrated by the cancer. HIPEC is a technique that permits delivery of the anticancer drug directly to its active site. It has been demonstrated that cytoreduction + HIPEC with cisplatin has a better outcome in terms of recurrence-free survival.</p>","PeriodicalId":50686,"journal":{"name":"Clinica Terapeutica","volume":"177 3","pages":"385-387"},"PeriodicalIF":0.0,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147788133","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"International Society on Thrombosis and Hemostasis Bleeding Assessment Tool (ISTH-BAT) and Intrinsic Rotational Thromboelastometry (INTEM-ROTEM) in the Evaluation and Classification of von Willebrand Disease (VWD): An Egyptian Center Cross-Sectional Observational Study.","authors":"Mohammed Ashraf Osman, Aya Omar Mahmoud, Eman Nasreldin, Nabila Mohamed Thabet, Reem Elagooz, Hebatallah Abdellatif, Nessren M Abd El-Rady, Rania Hafez, Fatma M Elsayed, Melody Ehab Sabry Fahim, Mohamed Hanafy Morsy, Nagwan Nabil Mohamed Hossameldin, Ezeldine K Abdalhabib, Eiman Ibrahim, Nagwa Hassanein, Azza Abdelaal","doi":"10.7417/CT.2026.2042","DOIUrl":"10.7417/CT.2026.2042","url":null,"abstract":"<p><strong>Background: </strong>VWD is the most common inherited bleeding disorder, characterized by quantitative or qualitative defects of VWF. Accurate assessment of bleeding severity and disease classification remains clinically challenging. The ISTH-BAT standardizes bleeding history, while viscoelastic assays such as ROTEM may provide additional global hemostatic information.</p><p><strong>Objective: </strong>To evaluate the diagnostic performance of ISTH-BAT in VWD screening and severity assessment, and to investigate the role of INTEM-ROTEM parameters in VWD identification and classification, with correlation to conventional laboratory markers.</p><p><strong>Methods: </strong>This cross-sectional observational study included 69 patients diagnosed with VWD and 68 age- and sex-matched healthy controls. All participants underwent ISTH-BAT evaluation and standard VWD laboratory workup, including VWF antigen (VWF:Ag), VWF activity (VWF:GPIbM), and factor VIII (FVIII). INTEM-ROTEM analysis was performed in 44 patients. Correlation, regression, and receiver operating characteristic (ROC) curve analyses were conducted.</p><p><strong>Results: </strong>Total ISTH-BAT scores differed significantly across VWD types (p=0.047). Clotting time (CT) was the only INTEM-ROTEM parameter showing significant differences between VWD types (p=0.001) and subtypes (p=0.022). CT correlated negatively with VWF:Ag (r=-0.561, p<0.001) and FVIII (r=-0.664, p<0.001), and positively with aPTT (r=0.693, p<0.001). Regression analysis demonstrated that each 1-second increase in CT was associated with a 0.31% decrease in VWF:Ag (p=0.002) and a 0.48% decrease in FVIII (p<0.001). For VWF:Ag <10%, a CT >193 seconds predicted VWD with an AUC of 0.809.</p><p><strong>Conclusion: </strong>ISTH-BAT is a highly sensitive screening tool for VWD and correlates with disease severity. Among INTEM-ROTEM parameters, clotting time shows potential adjunctive value in distinguishing VWD severity, types and subtypes, and correlates significantly with conventional laboratory markers. INTEM-ROTEM CT may provide supportive diagnostic information in clinical settings requiring rapid hemostatic assessment.</p>","PeriodicalId":50686,"journal":{"name":"Clinica Terapeutica","volume":"177 3","pages":"563-571"},"PeriodicalIF":0.0,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147787832","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association between Triglyceride-Glucose Index and In-Hospital Outcomes in Patients with ST-Elevation Myocardial Infarction Undergoing Percutaneous Coronary Intervention.","authors":"Phuong Hai Tran Nguyen, Minh Kha Nguyen, Van Sy Hoang","doi":"10.7417/CT.2026.2048","DOIUrl":"10.7417/CT.2026.2048","url":null,"abstract":"<p><strong>Background: </strong>The triglyceride-glucose (TyG) index is a reliable surrogate biomarker for insulin resistance and has been linked to adverse outcomes in coronary artery disease. However, its association with in-hospital major adverse cardiovascular events (MACE) in ST-elevation myocardial infarction (STEMI).</p><p><strong>Objectives: </strong>To examine the association between the TyG index and in-hospital MACE as the primary outcome in STEMI patients undergoing percutaneous coronary intervention (PCI).</p><p><strong>Methods: </strong>A prospective cross-sectional study enrolled 285 STEMI patients undergoing PCI. Patients were stratified into low TyG (≤ 8.805; n =81) and high TyG (> 8.805; n = 204) groups. In-hospital MACE was defined as a composite of all-cause death, cardiogenic shock, acute heart failure, life-threatening arrhythmia, stroke, and mechanical complications.</p><p><strong>Results: </strong>The high TyG group had significantly higher rates of LVEF ≤ 40% (66.7% vs. 39.5%, p<0.001) and multivessel disease. Of 285 patients, 110 (38.6%) experienced in-hospital MACE. Multivariable logistic regression identified high TyG as an independent prognostic marker of in-hospital MACE (OR = 5.90, 95% CI: 2.29-15.20, p<0.001). The ROC curve yielded an AUC of 0.72 (95% CI: 0.66-0.78, p<0.001), with an optimal cutoff of 9.19 (sensitivity 78.2%; specificity 61.1%).</p><p><strong>Conclusion: </strong>Elevated TyG index is an independent predictor of in-hospital MACE in STEMI patients undergoing PCI, and is significantly associated with reduced LVEF and multivessel coronary disease. As a simple, low-cost index calculable at admission, TyG may serve as a practical adjunct for early risk stratification.</p>","PeriodicalId":50686,"journal":{"name":"Clinica Terapeutica","volume":"177 3","pages":"618-623"},"PeriodicalIF":0.0,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147788095","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Role of Ultrasound-Guided Lipoma Plane Block with or without Adrenaline in Enhancing Anesthetic Precision, Patient Comfort, and Surgical Efficiency: A Prospective Randomized Controlled Trial.","authors":"Atef A Alfeky, Ahmed Gamal Salah Elsawy, Mohamed Alshahat Elsayed Ali, Mohamed Mohamed Hegab, Emad Abd Elhaliem Abd Elsalam Mahmoud, Bahaa G Mohamed, Mahmoud Elsayed Abdelmawla Elsayed, Alaa Abdelraouf Taha Hassan, Ahmed R I Ali, Mahmoud Mohamed Mohamed Abdallah Selim, Osama A M Ramadan, Ahmed Elsayed Sarhan, Mahmoud Mostafa Elabd, Mahmoud Farouk Gadallah, Hala Abdelfatah Ibrahim Ashour, Mohamed Mahmoud Abdelfattah Abdelrahman, Samia Sayed Ahmed, Taiseer Abdulnaser Abofadl Mohamad, Marwa M Abdel-Aziz, Naglaa A Elshehawy, Tamer F Abd Elsalam, Samah Abdelaty Soliman Gaml, Waleed Mohamed Elgendy, Ahmed Shaaban, Mohammed El Sayed Abdel Hameed","doi":"10.7417/CT.2026.2020","DOIUrl":"10.7417/CT.2026.2020","url":null,"abstract":"<p><strong>Background: </strong>Adrenaline is commonly added to local anesthetic solutions to reduce bleeding and prolong analgesia. However, its clinical impact during ultrasound-guided interfascial plane blocks in superficial soft tissue surgery remains insufficiently evaluated. This randomized controlled trial assessed the effect of adding adrenaline (1:200,000) to bupivacaine during ultrasound-guided lipoma plane block.</p><p><strong>Methods: </strong>In this prospective randomized controlled study, 40 adult patients undergoing elective superficial lipoma excision were randomly assigned to two groups (20 patients each). Group A received 0.25% bupivacaine with adrenaline (1:200,000), and Group B received 0.25% bupivacaine alone. Primary outcomes were intraoperative blood loss, operative time, and postoperative pain scores at 2, 6, and 24 hours. Secondary outcomes included need for rescue analgesia, supplemental anesthesia, ease of dissection, capsule integrity, and postoperative complications. Statistical significance was defined as p < 0.05.</p><p><strong>Results: </strong>Baseline characteristics were comparable between groups. Intraoperative blood loss was significantly lower in Group A (6.2 ± 1.5 mL) compared with Group B (12.7 ± 2.8 mL; p < 0.001). Operative time was shorter in the adrenaline group (12.4 ± 3.1 min vs. 17.8 ± 3.9 min; p = 0.002). Postoperative pain scores were significantly lower in Group A at 2 hours (p = 0.004), 6 hours (p = 0.006), and 24 hours (p = 0.009). Rescue analgesia was required less frequently in Group A (15% vs. 40%; p = 0.038). Ease of dissection and capsule integrity preservation were significantly improved with adrenaline. Minor hematoma occurred less frequently in Group A (5% vs. 20%; p = 0.041). No serious adverse events were observed.</p><p><strong>Conclusions: </strong>The addition of adrenaline (1:200,000) to bupivacaine in ultrasound-guided lipoma plane block significantly reduces intraoperative blood loss, shortens operative time, and improves postoperative analgesia. Adrenaline appears to be a safe and effective adjunct in superficial lipoma excision.</p>","PeriodicalId":50686,"journal":{"name":"Clinica Terapeutica","volume":"177 3","pages":"388-394"},"PeriodicalIF":0.0,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147788137","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Chiropractic regulation in Italy: liability profiles in healthcare field.","authors":"Giuseppe Basile, Luca Bianco Prevot, Michela Basile, Vittorio Bolcato, Livio P Tronconi","doi":"10.7417/CT.2026.2053","DOIUrl":"10.7417/CT.2026.2053","url":null,"abstract":"<p><strong>Abstract: </strong>Chiropractic vertebral manipulation is indicated in patients with acute and uncomplicated low back pain. Nowadays, many people seek care for low back pain from manual practitioners. However, within the overall legislative framework regulating in Italy professionals practicing in healthcare, chiropractors remain unevenly regulated. In fact, they are trained abroad and hold internationally recognized degrees that are not regulated under Italian healthcare professionals' legislation. Neither the educational profile, nor a Ministry technical expert committee, nor a national board for ongoing professional evaluation has been established, despite a law in 2007 aimed to regulate the profession and define the national register of doctors in chiropractic. Meanwhile, given their involvement in the healthcare sphere as part of multiprofessional teams, issues of liability arise, made more complex by the fact that chiropractors are not eligible for certain more favourable legal measures for liability assessment granted to healthcare professionals under Italian Law on healthcare safety and liability. Moreover, health-related information for obtaining informed consent cannot be managed independently by these practitioners, again due to their non-healthcare professional status. As a result, prescribing physicians must necessarily be involved in the overall care process. The interaction between healthcare and non-healthcare professionals presents complexities in the patient care and in the proper liability assessment. These aspects are also urgently needed for the definitive recognition and valorisation of the practitioners working in health sphere, which must include State oversight.</p>","PeriodicalId":50686,"journal":{"name":"Clinica Terapeutica","volume":"177 3","pages":"638-641"},"PeriodicalIF":0.0,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147788118","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Serum Neurotensin Levels in Vitiligo Patients: A Comparative Study with Correlation to Disease Activity and Severity. A Case-Control Study.","authors":"Mohamed Elnemr, Mohammad Abd Elhameed Alwaseef, Nora El Saeed Abdelbaset, Esraa Mahmoud Awaad Ahmed Hashem, Azza Samy Mohamed Amer, Fatima G Yehia, Loai Emam, Abdulmabod Omar, Sara M Rashad, Samar Mohamed Solit, Aziza Elsayed Tolba, Eman Elsayed Mohamed, Esam Afifi, Amal Ahmed Ismail, Ola Hamdy Ahmed Elshafey, Ahmed Ayman Azzam, Narmen Hamadelnil Ibrahim Eltrafi, Samantha Georgette Bukas, Mohamed Bashtar, Sara A Tahoun, Rania Mostafa Saleh","doi":"10.7417/CT.2026.2045","DOIUrl":"10.7417/CT.2026.2045","url":null,"abstract":"<p><strong>Background: </strong>Vitiligo is a chronic depigmentary disorder with autoimmune and neurogenic mechanisms. Neurotensin, a neuropeptide with immunomodulatory properties, has been implicated in inflammatory skin conditions, but its role in vitiligo remains unclear.</p><p><strong>Objectives: </strong>To compare serum neurotensin levels in active and stable vitiligo patients versus healthy controls, and to evaluate their correlation with disease activity (VIDA score) and extent (VASI score).</p><p><strong>Methods: </strong>A case-control study was conducted including 40 vitiligo patients (20 active, 20 stable) and 20 age- and sex-matched healthy controls. Serum neurotensin was measured using ELISA. Disease activity and extent were assessed with VIDA and VASI scores, respectively. Statistical analysis included Kruskal-Wallis, Mann-Whitney U, and Spearman rank correlation tests.</p><p><strong>Results: </strong>The median serum neurotensin levels were 20.40 ng/ml (range 7.35-74.00) in active patients, 14.55 ng/ml (range 6.10-30.00) with stable patients and 11.20 ng/ml (range 6.40-18.30) with controls. Kruskal-Wallis test indicated that there was a statistically significant overall difference between the three groups (H=16.506, p<0.001). Serum neurotensin showed a modest but statistically significant positive correlation with VIDA score (rs = 0.333, p = 0.036), but no significant correlation with VASI score (p = 0.190).</p><p><strong>Conclusions: </strong>Serum neurotensin is elevated in vitiligo, particularly in active disease, supporting a potential role for neurogenic mechanisms in melanocyte destruction. Its association with disease activity suggests its potential utility as a biomarker of vitiligo activity.</p>","PeriodicalId":50686,"journal":{"name":"Clinica Terapeutica","volume":"177 3","pages":"591-596"},"PeriodicalIF":0.0,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147788142","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Sociodemographic factors of Environmental Enteropathy among Egyptian infants and children; A Retrospective Case-Control Study.","authors":"May Fouad Nassar, Ehab Khairy Emam, Mohamed Farouk Allam, Ahmed Mohamed Hamdy, Bassma A Abdelhaleem, Nehal Ahmed Radwan, Abeer Mohamed Emam, Haya Essam Ibrahim","doi":"10.7417/CT.2026.2037","DOIUrl":"10.7417/CT.2026.2037","url":null,"abstract":"<p><strong>Background: </strong>There is substantial evidence that nutritional rehabilitation does not effectively resolve growth faltering in low- and middle-income countries, suggesting that environmental enteropathy (EE) may be a key underlying factor. EE is a chronic, subclinical condition associated with poor environmental conditions and limited resources in these regions. It is marked by pathological changes in the small intestine that impair the absorption of both macronutrients and micronutrients, ultimately contributing to growth faltering.</p><p><strong>Objective: </strong>To assess the sociodemographic factors underlying the EE among infants and children with faltering growth (FG) in our community.</p><p><strong>Patients and methods: </strong>This retrospective case control study enrolled 200 cases of primary faltering growth infants and children aged from 6 months to 5 years old after exclusion of secondary cases. Enrolled patients were divided into refractory cases and responsive cases to nutritional rehabilitation programs and sociodemographic factors were assessed among the 2 groups. No routine endoscopy was done nor existing histopathology findings were available.</p><p><strong>Results: </strong>The results of this study revealed that out of the 200 enrolled patients 170 responded to the tailored nutritional program (responsive controls), while 30 patients were considered as refractory cases. On comparing the two groups, there were significantly higher frequencies of housewife mothers, non-skilled manual worker fathers, rural and slum residency, and low socioeconomic status among the refractory cases with p-values of 0.024, 0.002, 0.022, and 0.045 respectively.</p><p><strong>Conclusion: </strong>Malnutrition is a complex condition with multifactorial causes, including socioeconomic factors besides the deficiencies in protein, energy, and essential micronutrients. In developing countries, EE is recognized as a significant contributor to the burden of malnutrition percolating their response to the nutritional rehabilitation program. Non-responders to nutritional rehabilitation program should be referred for endoscopy to confirm the diagnosis of EE.</p>","PeriodicalId":50686,"journal":{"name":"Clinica Terapeutica","volume":"177 3","pages":"525-531"},"PeriodicalIF":0.0,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147788103","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Efficacy of Alexandrite picosecond laser therapy with and without dermal polyrevitalisation (NCTF® 135 HA) in patients with melasma: A Randomised Controlled Trial.","authors":"Yulia Chebotareva, Tatiana Ilina, Iuliia Akulinina, Bela Tonakanyan, Tatiana Kondratieva, Tatiana Khlevchuk","doi":"10.7417/CT.2026.2021","DOIUrl":"10.7417/CT.2026.2021","url":null,"abstract":"<p><strong>Objectives: </strong>This randomised controlled trial aimed to compare the efficacy of Alexandrite picosecond laser therapy combined with dermal polyrevitalisation (NCTF® 135 HA) with laser therapy alone for reducing the severity of melasma. The outcomes were assessed using 3D imaging and the Dermatology Life Quality Index (DLQI). The secondary objectives were to evaluate the safety and tolerability of the combined treatment, and its impact on patients' quality of life.</p><p><strong>Materials and methods: </strong>The study was conducted in a clinical dermatological setting in Moscow, Russia, in 2023. It was designed as a randomised controlled trial comparing two melasma treatment protocols: picosecond Alexandrite laser therapy alone versus the laser combined with the injectable polyrevitalising agent NCTF® 135 HA.</p><p><strong>Results: </strong>A total of 31 patients participated in the study, including 27 women and four men aged between 32 and 61 years. The patients were divided into two groups: 12 patients in Group 1 received laser treatment only, while 19 patients in Group 2 received laser treatment and NCTF® 135 HA. 89.5% of patients in Group 2 reported an improvement in their skin condition compared to 66.7% in Group 1, and the mean reduction in pigmentation was 75% versus 40% respectively (p < 0.01). Erythema severity decreased by 70% in Group 2 and by 35% in Group 1 (p < 0.01). The recurrence rate was 5.3% in Group 2 and 25% in Group 1 (p < 0.05).</p><p><strong>Conclusions: </strong>The application of the combined treatment protocol for melasma over a period of two months resulted in the reduction, fragmentation, and lightening of pigmented lesions. However, further long-term studies with more extensive and diverse populations are needed to confirm these findings due to the small sample size and short follow-up period.</p>","PeriodicalId":50686,"journal":{"name":"Clinica Terapeutica","volume":"177 3","pages":"395-404"},"PeriodicalIF":0.0,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147788091","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cocoa and Cardiac Rhythm: an Arrhythmogenic Trigger in Dietetic Chocolate Abuse?","authors":"Maria Alessandra Gammone, Nicolantonio D'Orazio","doi":"10.7417/CT.2026.2049","DOIUrl":"10.7417/CT.2026.2049","url":null,"abstract":"<p><strong>Abstract: </strong>The link between arrhythmias and lifestyle factors, such as obesity and alcohol consumption, is well-established; while coffee, tea, chocolate, and excessive energy drink consumption appear to be potential harmful in patients with rhythm disorders. However most nutritional recommendations are based on observational studies, still representing a fertile area for further research. This article provides a review of the association between cardiac arrhythmias and cocoa dietary patterns and components, thus discussing potentially related mechanisms.</p>","PeriodicalId":50686,"journal":{"name":"Clinica Terapeutica","volume":"177 3","pages":"624-626"},"PeriodicalIF":0.0,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147788086","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of Diabetes on Collateral Circulation and Thrombectomy Outcomes in Acute Ischemic Stroke: A Prospective Cohort Study.","authors":"Priyanka Cheekatla, Siphora Krupalini Bijjiga, Vidyasagar Akudari, Rishitha Chowdary Vattikonda, Zulkifli Misri, Saraswathy Kannappan, Balachandran Sivaraja Ganesan, Jamuna Rani Ayyalu","doi":"10.7417/CT.2026.2033","DOIUrl":"10.7417/CT.2026.2033","url":null,"abstract":"<p><strong>Background: </strong>In large-vessel occlusion (LVO) stroke, mechanical thrombectomy (MT) restores flow yet outcomes vary. Collateral robustness and the metabolic milieu especially diabetes may shape tissue rescue, but the diabetes-collateral link and its impact on recovery remain uncertain.</p><p><strong>Objective: </strong>To determine whether pre-existing diabetes is independently associated with (1) poorer angiographic collateral status at baseline and (2) higher 90-day functional dependence after mechanical thrombectomy, and to evaluate whether collateral grade modifies the diabetes-outcome relationship after accounting for baseline infarct core volume, stroke territory, and reperfusion success.</p><p><strong>Methods: </strong>Prospective cohort of 41 adults with acute ischemic stroke (AIS) undergoing MT. Collaterals were graded using the American Society of Interventional and Therapeutic Neuroradiology/Society of Interventional Radiology (ASITN/SIR) score for anterior circulation and the Basilar Artery on Computed Tomography Angiography (BATMAN) score for posterior circulation. The primary analysis prespecified anterior strokes (n=33). The primary endpoint was 90-day functional dependence (modified Rankin Scale (mRS) 3-6). Multivariable logistic regression adjusted for clinical, imaging, and procedural covariates; sensitivity analyses included all strokes with a posterior-circulation indicator.</p><p><strong>Results: </strong>Diabetes was present in 59%. In the anterior subgroup, patients with diabetes more often had poor collaterals (45.0% vs 7.7%) and higher functional dependence (60.0% vs 15.4%), with similar reperfusion rates. In adjusted models, baseline diffusion-weighted imaging (DWI) core independently predicted poor outcome (per 10 cc: odds ratio (OR) 2.85; p=0.012), while diabetes showed a large but imprecise association (OR 19.02; p=0.081). The modified Thrombolysis in Cerebral Infarction (mTICI) grade was not independently significant. In the full cohort, posterior location (OR 19.33; p=0.045) and DWI core (OR 3.02; p=0.004) remained associated; diabetes trended similarly (OR 12.25; p=0.064).</p><p><strong>Conclusions: </strong>Diabetes clusters with weaker collaterals, larger cores, and greater disability despite high reperfusion. Tissue burden, not angiographic grade, chiefly drives outcomes. Metabolic phenotyping and pragmatic glycemic stewardship warrant testing.</p>","PeriodicalId":50686,"journal":{"name":"Clinica Terapeutica","volume":"177 3","pages":"490-495"},"PeriodicalIF":0.0,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147787756","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}