Hypertensive Hemorrhage Research Articles

Coil or Plug-Assisted Retrograde transvenous obliteration (CARTO/PARTO) for treating portal hypertensive variceal bleeding: A multi-center, real-world 10-year retrospective study

Background & Aims: CARTO and PARTO are well-accepted treatment for gastric variceal (GV) bleeding. However, long-term (>2 years) clinical outcomes have yet to be studied. In this study, we investigated long-term clinical outcomes, including overall survival (OS) in 10 years Methods: We performed a multi-national, multi-center, retrospective study of CARTO/PARTO in GV treatments between 05/2012 and 07/2024. The primary study outcomes were a long-term OS and prognostic factors of CARTO/PARTO. The secondary outcomes were long-term clinical/technical success, complications, clinical changes including portal hypertensive symptoms. Results: A total of 311 patients (41% female; 69% CARTO) from 13 centers in five countries were included. The cumulative 1-, 3-, 5-, 7-, and 10-year OS rates were 98, 80, 68, 52, and 33%, respectively, with a median OS of 99 months. Prophylactic CARTO/PARTO showed a better OS than CARTO/PARTO for active bleeding (p=0.00035). The independent prognostic factors of OS were having high pre-MELD, concurrent HCC, treating GOV2, history of esophageal variceal bleeding, high pre-TBili, and ammonia levels. Notably, a high pre-MELD score >27 had a significantly higher mortality rate (92.6%) than a lower pre-MELD score (p<0.001). The overall cumulative 1-, 3-, 5-, 7-, and 10-year recurrent GV bleeding rates were 0.9, 3.2, 4.0, 4.5, and 5.4%, respectively. The overall technical and clinical success rates were 96.5% and 95.3%, respectively, with a 4.5% major complication rate over 10 years. Conclusions: CARTO and PARTO have excellent long-term survival and clinical outcomes. However, these are negatively affected by high MELD scores, concomitant HCC, and coexisting esophageal varices.

Non-invasive methods for diagnosing portal hypertension and variceal bleeding due to liver cirrhosis secondary to NAFLD/MASLD: systematic review.

Non-alcoholic fatty liver disease (NAFLD), recently re-termed as metabolic dysfunction-associated steatotic liver disease (MASLD), is a global health concern affecting approximately 25% of adults. Complications such as portal hypertension and variceal bleeding are critical to diagnose but challenging with traditional invasive methods like hepatic venous pressure gradient (HVPG) measurement and esophagogastroduodenoscopy (EGD), which are not always feasible and carry risks. This systematic review aim to evaluate the diagnostic accuracy of non-invasive methods for diagnosing portal hypertension and variceal bleeding in patients with NAFLD/MASLD cirrhosis, comparing these methods to invasive standards. A comprehensive literature search was conducted across PubMed, Cochrane Library, Google Scholar, and ScienceDirect from January 2000 to May 2024. Studies included evaluated non-invasive diagnostic techniques for portal hypertension and variceal bleeding, compared with HVPG and EGD, focusing on adult patients with confirmed NAFLD/MASLD cirrhosis. Data extraction covered study characteristics and diagnostic accuracy metrics. The quality of studies was assessed using the QUADAS-2 tool. Meta-analyses were performed using R and Python. Eleven studies involving 2,707 patients met the inclusion criteria. Liver stiffness measurement (LSM) via transient elastography demonstrated high sensitivity (85%) and specificity (79%) for diagnosing clinically significant portal hypertension (CSPH) at a 20 kPa cutoff. For severe portal hypertension (SPH), LSM had a sensitivity of 81% and specificity of 85% at 25 kPa. Combining LSM with platelet count resulted in a sensitivity of 97% but lower specificity (41%) for CSPH. Spleen stiffness measurement (SSM) also showed good diagnostic performance with a sensitivity of 89% and specificity of 75% for CSPH. Non-invasive tests, particularly LSM and SSM, show promise in diagnosing portal hypertension and variceal bleeding in NAFLD/MASLD cirrhosis. These methods offer high sensitivity, especially in combination, supporting their use in clinical settings to potentially reduce the need for invasive procedures. Future research should aim to standardize protocols and explore additional biomarkers to further enhance diagnostic accuracy. https://www.crd.york.ac.uk/prospero/display_record.php?, identifier CRD42024567024.

First-in-human experience of a portable electrical drill with smart autostop for bedside external ventricular drain placement

BackgroundTimely external ventricular drain (EVD) placement may be a lifesaving neurosurgical procedure. The manual twist drill used for intracranial access represents an opportunity for potential improvement in efficiency, safety, and ease of use. A new generation of portable electrical drills with smart autostop mechanisms, such as the Hubly cranial drill (Hubly Surgical; Lisle, IL), aim to address these opportunities for improvement. ResultsTwo patients received EVDs using the portable electrical autostop drill (PEAD): A 54-year-old woman who suffered a postoperative hemorrhage and a 59-year-old woman who presented with early hydrocephalus secondary to hypertensive subarachnoid hemorrhage (SAH). Between both patients, a total of 9 and 2 access attempts were necessary to breach the inner table and visual dura. Access times in both cases, from skin incision to dural puncture, were less than 5 min. There were no apparent complications with the use of the PEAD in either case, and there was excellent placement of the EVD at the foramen of Monroe in both cases. ConclusionWe demonstrate the first successful use of a portable electrical drill with smart autostop in humans. The PEAD has potential to reduce procedure time and human error. Further development of the smart autostop drill may allow for more consistent and safer EVD placement.

„Bottoms-up“ portal venous recanalization TIPS (PVR-TIPS) utilizing a re-entry catheter

BackgroundThree patients with portal hypertension and gastrointestinal bleeding due to non-cirrhotic portal vein thrombosis were treated with portal venous recanalization transjugular intrahepatic portosystemic shunt (PVR-TIPS) via a trans-splenic access.Main bodyA “bottoms-up” retrograde puncture of the right hepatic vein was performed using a re-entry catheter to gain access to the right hepatic vein. In all patients a successful retrograde puncture of the right hepatic vein was achieved, thereby restoring the splenoportal tract.ConclusionOur cases present an alternative approach to treat chronic portal vein thrombosis expanding the possibilities of the PVR-TIPS procedure.

Increased Plasma β-Secretase 1 Activity Correlates With Neurodegeneration in Cerebral Small Vessel Disease.

β-secretase 1 (BACE1) plays a key role in amyloidogenic pathway and is considered a new mechanism for cerebral small vessel disease (CSVD). We explore the potential role of plasma BACE1 in CSVD and the pathological process it may be involved in. We enrolled 163 participants with CSVD (114 cerebral amyloid angiopathy and 49 hypertensive hemorrhage), and 96 cognitively unimpaired elders and 40 participants with Alzheimer'sdisease as controls. We measured BACE1 activity using a synthetic fluorescence substrate enzyme-linked immunosorbent assay. We used regression models to investigate associations between BACE1 and imaging and blood markers as well as clinical outcomes in CSVD. Plasma BACE1 activity was significantly higher in CSVD (median 862.0 relative fluorescence units [RFU], interquartile range 700.6-1032.9) compared with elder controls (522.5 RFU, 438.3-662.1, P<0.001) but lower than Alzheimer's disease (964.0 RFU, 838.4-1225.0, P=0.032). For CSVD, there was an association between plasma and cerebrospinal fluid BACE1 activity (β=0.50, P=0.030). Plasma BACE1 activity was negatively associated with hippocampal volume (coefficient -2.40, P<0.001), and positively associated with blood neurofilament light chain (coefficient 0.08, P<0.001) and total tau (coefficient 0.15, P=0.006) but not with specific cerebrovascular imaging markers. During 2-year follow-up, BACE1 activity was independently related to dementia conversion (odds ratio, 17.72; P=0.001) but not stroke in CSVD. Plasma BACE1 activity is moderately increased and associated with neurodegeneration and cognitive impairment risk in CSVD. It indicates that BACE1 is a promising biomarker especially for CSVD-related neurodegeneration.

Portal Hypertensive Gastropathy and MELD-Na Score Predict Recurrent Gastrointestinal Bleeding After TIPSS: An ALTA Group Study.

Transjugular intrahepatic portosystemic shunt (TIPSS) is highly effective for treatment of variceal bleeding; however, factors contributing to rebleeding complications remain unclear. In this study, we aim to determine risk factors for recurrent portal hypertensive gastrointestinal bleeding following TIPSS. Utilising the Advancing Liver Therapeutic Approaches multicentre database, we retrospectively identified adult patients who underwent TIPSS for secondary prophylaxis of variceal bleeding and had a gastrointestinal rebleeding event within 1 year. We developed multivariable logistic regression models to identify clinical/procedural characteristics associated with rebleeding. We identified 476 patients, predominately middle-aged (mean age 57), male (62%) and White (65%), with mean MELD-Na 16. 16% (n = 77) had a rebleeding event; these patients were more likely to be male (p = 0.016), with higher serum creatinine (p = 0.005), MELD-Na (p = 0.0002), portal hypertensive gastropathy on pre-TIPSS upper endoscopy (p = 0.000) and with higher incidence of TIPSS revision (p = 0.000). There were no significant differences in type of TIPSS endoprosthesis, concurrent embolotherapy, and post-TIPSS pressure gradients between those who experienced rebleeding and those who did not. After adjusting for TIPSS revision, multivariable analysis revealed MELD-Na and presence of portal hypertensive gastropathy on pre-TIPSS endoscopy were independently associated with rebleeding. In this retrospective analysis of a multicentre, nationally representative database, we found that apart from TIPSS-related factors, high MELD-Na and portal hypertensive gastropathy on pre-TIPSS endoscopy were independent predictors of rebleeding within 1 year following TIPSS. These variables may be used to identify high-risk patients who may require additional monitoring following TIPSS.

Association Between the Fetal-Type Posterior Cerebral Artery and Hypertensive Thalamic Hemorrhage.

This study investigated the association between the fetal-type posterior cerebral artery (FTP) and hypertensive thalamic hemorrhage (HTH). Patients with hypertension who met the admission criteria between January 2020 and August 2022 were retrospectively analyzed and divided into the HTH and non-HTH groups based on the presence or absence of thalamic hemorrhage, respectively. In addition to whether the variable was an FTP, other variables with unbalanced distributions between the two groups were used as matching factors for 1:1 propensity score matching, and other variables that were not used as matching factors were used as covariates for conditional logistic regression. A total of 722 patients were included in the study, with 115 in the HTH group and 607 in the non-HTH group. After propensity score matching, 114 patients were included in both groups. The multivariate logistic regression analysis showed that the FTP (p = 0.003, odds ratio [OR]: 2.712, 95% confidence interval [CI]: 1.407-5.225) and homocysteine levels (p = 0.007; OR: 1.051; 95% CI: 1.014-1.089) were significantly correlated with the occurrence of HTH. The incidence of FTP is not low, and it is an independent risk factor for HTH. Early recognition and appropriate monitoring are warranted for cases of FTP.

The gender difference in cause of death in Japanese atrial fibrillation patients: The Fushimi AF Registry

Abstract Background Previously we reported that incident rate of heart failure (HF) hospitalization was higher in female than male and stroke was comparable between female and male in Japanese atrial fibrillation (AF) patients. We also reported cardiovascular death was mainly related to HF but not stroke. However, the gender difference in cause of death in Japanese AF patients is little known. Method The Fushimi AF Registry is a community-based prospective survey of AF patients in Fushimi-ku, which is a typical urban district of Japan. We started to enroll patients from March 2011, and follow-up data were available for 4,496 patients by the end of February 2022. In the entire cohort, 2,677 were male and 1,819 were female. We compared clinical characteristics and cause and incidence rate of death between two groups. Result Female patients were older (female vs. male; 76.7 years vs. 71.5 years, p&amp;lt;0.01), less in body weight (51.2 kg vs. 65.0 kg, p&amp;lt;0.01), had higher pulse rate (79.4 bpm vs. 77.5 bpm, p&amp;lt;0.01), less often persistent/permanent type (48.2% vs. 52.0%, p=0.04), less likely to have previous stroke/systemic embolism (18.6% vs. 21.1%, p=0.04), diabetes mellitus (19.9% vs. 26.2%, p&amp;lt;0.01), coronary artery disease (12.3% vs. 16.0%, p&amp;lt;0.01) and more likely to have prior HF (32.2% vs. 24.0%, p&amp;lt;0.01), chronic kidney disease (39.3% vs. 33.7%, p&amp;lt;0.01)and had higher CHADS2 score (2.15 vs. 1.96, p&amp;lt;0.01). In prescription data, female patients less often received oral anticoagulant (52.1% vs. 58.2%, p&amp;lt;0.01) and antiplatelet drug (23.8% vs. 29.0%, p&amp;lt;0.01). Systolic blood pressure, hypertension and major bleeding were comparable between two groups. During the median follow-up of 2,093 days, the incidence rate of all cause death was comparable between female group and male group (5.20 vs. 4.86 % per person-year, log rank p=0.32). The incidence rate of cardiac death was significantly higher in female group than male group (0.98 vs. 0.70 % per person-year, log rank p=0.02) and the incidence rate of vascular death was also significantly higher in female group than male group (0.43 vs. 0.26 % per person-year, log rank p=0.03). The incidence rate of death due to HF, which was main cause of cardiac death, was higher in female group but not significant (0.86 vs. 0.66 % per person-year, log rank p=0.08). We analyzed the proportion of cause of death in each gender, cardiac death and stroke were higher and non-cardiovascular death was lower in female than male group. Conclusion The incidence rates of cardiac death and vascular death were significantly higher in female group than male group, and death due to HF was non-significantly higher in female group. Concerning the proportion of cause of death in each gender, cardiac death and stroke were higher in female than male. The impact of cardiovascular events may be stronger and prevention of them may be more important in female.

Pregnancy outcomes among patients with complex congenital heart disease

Patients with complex congenital heart disease (CCHD) may pose a serious threat to the mother-infant safety. This study intends to explore the influencing factors for adverse pregnancy outcomes in the CCHD population. Totally 108 CCHD patients who terminated pregnancy from January 2013 to January 2023 were recruited. We collected clinical data during the pregnancy from electronic medical records. Among them, 45 patients had adverse pregnancy outcomes (41.7%) and no patient died. 5 patients with no newborn. The incidence rate of adverse pregnancy outcomes was significantly higher in patients with brain natriuretic peptide (BNP) > 100 pg/mL (OR: 2.736; 95%CI: 1.001–7.481, p = 0.049) and hypoxemia (OR: 15.46; 95%CI: 1.689–141.512, p = 0.015) and without undergoing cardiac surgical correction (OR: 3.226; 95%CI: 1.121–9.259, p = 0.03). It was confirmed by propensity score matching that no cardiac surgical correction was an independent risk factor. Maternal patients without undergoing cardiac surgical correction had poorer NYHA cardiac function (p = 0.000) and were more prone to heart failure (p = 0.027), hypoxemia (p = 0.042), pulmonary arterial hypertension (p = 0.038) and postpartum hemorrhage (p = 0.016). Moreover, these patients had prolonged Surgical Intensive Care Unit (SICU) stay (p = 0.000) and significantly higher risk of premature delivery (p = 0.005), low birth weight (p = 0.018), infection and asphyxia (p = 0.043). Corrective cardiac surgery in patients with CCHD before pregnancy significantly reduces the incidence of adverse pregnancy outcomes.

Gelfoam Granuloma Mimicking Brain Abscess Following Decompressive Craniotomy

AbstractThe use of adjuvants in brain surgery has increased. Artificial adjuncts are being used in neurosurgery frequently. These foreign materials may result in a foreign body reaction inside the normal brain tissue surrounding the areas of pathology. This material may mimic an abscess or tumor in their presentation and masquerade the magnetic resonance (MR) or computed tomography (CT) image as recurrence, abscess, or granuloma. We present a case of a 42-year-old woman with a history of hypertensive basal ganglia bleeding who was operated on in an emergency. Decompressive craniectomy and clot evacuation were carried out. A thin layer of Gelfoam was applied in the operated area. After 4 weeks, she was planned for cranioplasty where an oval soft to firm yellowish lesion was found at the site of the previous cavity of the evacuated clot, which was sent for biopsy and it was confirmed as a Gelfoam granuloma. Meticulous use of hemostatic agents in the form of small surgical or thin waferlike gelatin sponges should be used intraoperatively. Large-size Gelfoam and artificial agents can lead to foreign body–like granulation tissue formation in normal brain tissue and several complications like hydrocephalous, meningitis, and seizures. Peculiarities in this case include the following: Gelfoam granuloma is a very rare complication following cranial surgery, it was mimicking like an abscess, and the size of Gelfoam used intraoperatively should be a thin wafer coating the raw surface or in the cavity.

Comparison of surgical outcomes between shunt surgery and devascularization in non-cirrhotic portal hypertension

Objective: Non-cirrhotic portal hypertension (NCPH) is the most common cause of portal hypertension and upper gastro-intestinal bleeding in children and adolescents in developing nations. It is characterized by features of portal hypertension with preserved liver function. Proximal splenorenal shunt (PSRS) and esophagogastric devascularization are the two most commonly performed surgeries for its management. The present study is aimed at comparison of surgical outcomes between these two procedures. Material and Methods: Between April 2018 and March 2022, prospectively maintained data of consecutive NCPH cases who underwent surgical intervention was reviewed retrospectively. Cases were categorized into two groups- shunt surgery and devascularization. The pre-operative characteristics, peri-operative morbidity and long-term outcomes were compared between the groups. Results: Of 112 cases who were treated during the study period, 54 cases which underwent surgery were included in the study. Of these, 20 cases underwent PSRS, and splenectomy and devascularization was performed in 34 cases. There was no difference in pre-operative variables between the two groups. Patients undergoing PSRS experienced longer duration of surgery (260 vs. 200 minutes, p&lt; 0.001), and those in the devascularization group had significantly greater operative blood loss (350 vs. 455 ml, p&lt; 0.001). Post-operative morbidity was comparable between the two groups. Hypersplenism was corrected in all cases and no cases reported rebleeding after median follow-up of 30 months. Three cases in each group developed features of portal biliopathy in follow up period. Conclusion: Both PSRS and devascularization procedures have comparable efficacy and safety in the management of NCPH.

Increasing hypertensive thalamic haemorrhage. An 18-year retrospective single-centre study of changes over time in hypertensive intracerebral haemorrhages

Increasing hypertensive thalamic haemorrhage. An 18-year retrospective single-centre study of changes over time in hypertensive intracerebral haemorrhages

Efficacy of therapeutic hypothermia on mild neonatal hypoxic-ischemic encephalopathy: a prospective randomized controlled study

To investigate the efficacy of therapeutic hypothermia on mild neonatal hypoxic-ischemic encephalopathy (HIE). A prospective study was performed on 153 neonates with mild HIE who were born from September 2019 to September 2023. These neonates were randomly divided into two groups: therapeutic hypothermia (n=77) and non-therapeutic hypothermia group (n=76). The short-term clinical efficacy of the two groups were compared. Barkovich scoring system was used to analyze the severity of brain injury shown on magnetic resonance imaging (MRI) between the two groups. There were no significant differences in gestational age, gender, birth weight, mode of birth, and Apgar score between the therapeutic hypothermia and non-therapeutic hypothermia groups (P>0.05). There were no significant differences in the incidence rates of sepsis, arrhythmia, persistent pulmonary hypertension and pulmonary hemorrhage and the duration of mechanical ventilation within the first 72 hours after birth between the two groups. The therapeutic hypothermia group had longer prothrombin time within the first 72 hours after birth and a longer hospital stay (P<0.05). Compared with the non-therapeutic hypothermia group, the therapeutic hypothermia group had lower incidence rates of MRI abnormalities (30% vs 57%), moderate to severe brain injury on MRI (5% vs 28%), and watershed injury (27% vs 51%) (P<0.05), as well as lower medium watershed injury score (0 vs 1) (P<0.05). Therapeutic hypothermia can reduce the incidence rates of MRI abnormalities and watershed injury, without obvious adverse effects, in neonates with mild HIE, suggesting that therapeutic hypothermia may be beneficial in neuroprotection in these neonates.

Bleeding in liver diseases

Bleeding events are feared complications in patients with advanced liver diseases and are associated with morbidity and mortality. In this context, gastrointestinal bleeding, particularly upper gastrointestinal bleeding, has a special clinical importance. In addition to endoscopic measures for hemostasis, reducing portal pressure in particular is akey component of treatment. Although the standard coagulation parameters are often altered in patients with liver diseases, optimizing coagulation plays asecondary role. Typically, abundle of measures are employed in patients with portal hypertensive bleeding, which nowadays in most cases can halt the bleeding and stabilize the situation. The measures include endoscopy, antibiotic treatment, vasopressor treatment and, if necessary, shunt placement (transjugular intrahepatic portosystemic shunt).

Dolichoectasia of Basilar Artery in Hypertensive Putaminal Bleed

Dolichoectasia is a fusiform dilation of vascular structure that can occur anywhere in circulatory system. It is mostly detected and confirmed in the intracranial circulation in angiography. The vertebrobasilar system is the most common location. Putamen bleed has not been reported in association with vertebrobasilar dolichoectasia so far. Here, we report a rare case of detecting dolichoectasia of basilar artery in digital subtraction angiography with left putamen bleed in a middle-age hypertensive gentleman on irregular antihypertensive medication.

Inadvertent iatrogenic splenic vein occlusion resulting in sinistral portal hypertension and massive gastric variceal hemorrhage

Inadvertent iatrogenic splenic vein occlusion resulting in sinistral portal hypertension and massive gastric variceal hemorrhage

Subarachnoid Hemorrhage as the First Manifestation of Pheochromocytoma with Remission of Hypertension and Diabetes Mellitus Postsurgery

Abstract Pheochromocytoma, a rare but life-threatening etiology of secondary hypertension, must be considered in patients with unexplained deterioration of glycemic control and new onset or worsening hypertension. We present the case of a 52-year-old female recently diagnosed with type 2 diabetes mellitus (T2DM) with a history of hypertension and subarachnoid hemorrhage (SAH), who reported intermittent headaches and palpitations at a routine checkup. Further evaluation confirmed elevated levels of urinary and plasma metanephrines, and imaging revealed a mass lesion in the right adrenal gland consistent with pheochromocytoma. The patient underwent laparoscopic right adrenalectomy with successful resolution of hypertension and diabetes. This case underscores considering pheochromocytoma as a differential in cases of hypertensive emergency or resistant hypertension, highlighting the potential for remission of hypertension and T2DM following tumor removal.

Pregnancy Characteristics and Delivery Outcomes of Individual Mother Hospitalized at Jalalabad, Kyrgyzstan

Background: Maternal morbidity is a silent struggle, echoing the untold stories of resilience and strength in the face of adversity. Women of childbearing age are faced with extreme uncertainties; hence the purpose of this study was to analyze fertility trend and maternal complications including the possible high-risk factors connected to maternal morbidity. Maternal morbidity could be prevented through early detection, including the period preceding pregnancy. Methods and methodology: This is a retrospective cross-sectional study using data from hospital database describes trends of fertility and with immediate post-delivery maternal complication. The data was collected just from month January in 2023 from a Regional Maternity Hospital in Jalalabad, Kyrgyzstan. Total of 260 sample were drawn from the data base for the study. Objective: The study intended to find the different pregnancy characteristics and the outcomes of delivery of Individual mother who were Hospitalized at Jalalabad, Kyrgyzstan. We settled for this topic because it is one of the significant causes of death among reproductive age group women around the world. Result: Among 260 delivery cases, majority 56.2% of them were from age group 21 - 25 years. Majority of them have more than one child and 22.7% cases had more than 3 children. Common complications associated during pregnancy were anemia (17.3%) &amp; Pre-eclampsia (16.1%) whereas most common postpartum complication was PPH associated with atony (17.3%). Obesity (10%) and Pre-existing hypertension (9.6%) were the most common comorbidity associated with pregnancy. Conclusion: The research population appears to have high fertility trends. The main causes of obstetric complications were anemia, hypertension, and postpartum hemorrhage. Two prevalent comorbidities linked to pregnancy were obesity and underlying hypertension. To reduce pregnancy-related problems, it is imperative that interventions be implemented that support early ANC attendance, lower obesity, increase access to blood pressure monitoring, and provide family planning information and services.

Influence of Nutrition Management Education on Mothers Knowledge and Attitudes in Fulfilling Nutrition for Obese Pregnant Women

Obesity is a high obstetric risk increasing the risk of maternal and fetal morbidity and death. Complications that can occurred in pregnant women with obesity are an increased risk of hypertension, gestational diabetes, spontaneous abortion, and postpartum hemorrhage. This research aims to determine the effect of nutritional management education on mothers knowledge and attitudes in fulfilling nutritional needs of obese pregnant women. The study used a quasi-experiment with a pre-test and post-test with a control group design. The sample in this study was 60 obese pregnant women who were divided into an intervention group and a control group, each with 30 respondents. The instruments used were observation sheets and nutritional management menu lists. Data analysis used the Mann-Whitney test with a significance level of p ≤ 0.05. The study showed a significant difference between knowledge (p-value=0.015) and mothers' attitudes towards fulfilling nutrition (p-value=0.011) before and after nutrition management education. Nutrition management education is critical to improving nutritional fulfilment for pregnant women.

Spontaneous posterior fossa hemorrhage: profile and functional outcome in patients attending Tanta stroke unit

BackgroundThe most dangerous and least curable type of stroke is spontaneous intracerebral hemorrhage (ICH), and prognosis is highly correlated with location and size in the posterior fossa. The objective of this work was to estimate the frequency of posterior fossa hemorrhage (PFH) in Tanta University Hospitals, as well as identify functional outcomes and mortality in PFH.MethodsThis study was performed on 33 posterior fossa hemorrhagic patients and 119 posterior ischemic stroke patients (PCIS) submitted to the CT brain and the MRI brain, using the following scales: GCS and NIHSS, and the intracerebral hemorrhage scale (ICH score).ResultsPosterior fossa hemorrhage (PFH) represents 16.83% of total hemorrhagic stroke in the ER. Vertigo and DCL are more common in PFH (60.6%, 48.4%) than in PCIS. 82% of PFH patients had hypertension (HTN) hemorrhage. The cerebellum is the most common site for PFH (48%), pontine (24%), thalamic (18%), and midbrain (9%). PFH had unfavorable outcomes in 55% of the studied patients; the MRS mean was 4; and 39% died in the follow-up.ConclusionPosterior fossa hemorrhage is a potentially serious neurovascular emergency associated with complex symptomatology. PFH demonstrates diverse prognoses depending on the location of the intracerebral hemorrhage and the size of the hematoma.