2 Minute Medicine ® - Neonatal/Perinatal Medicine

1. Patients in the thrombectomy plus medical care group reported a significantly lower mRS score at the 1-year follow-up compared to those in the medical care alone group. 2. 1-year mortality in the thrombectomy group was lower than in the medical care alone group. Evidence Rating Level: 1 (Excellent) Study Rundown: Endovascular thrombectomy is known to have good clinical outcomes in patients with ischemic stroke. However, limited data exists regarding its long-term efficacy. This randomized controlled trial aimed to compare the safety and efficacy of endovascular thrombectomy plus medical care versus medical care alone in patients with large-vessel occlusion...

1. Tissue density in the left caudate nucleus was significantly decreased in infants whose mothers had elevated pre-pregnancy body-mass indexes (BMI).  Evidence Rating Level: 2 (Good) Parental obesity, particularly maternal obesity prior to pregnancy, has been identified as a risk factor for offspring obesity by means of both heritable and environmental influences. The mechanisms by which this is thought to take place are complex and varied, but alterations in functioning of neurotransmitter signalling are believed to contribute...

1. In this large population-based study of adults in South Korea, there was an increased risk of developing encephalitis within 28 days of COVID-19 vaccination only for those who received the AstraZeneca (ChAdOx1-S) vaccine, but no increased risk of developing meningitis post-vaccination.  Evidence Rating Level: 2 (Good) Over 5.5 billion people worldwide have received at least one dose of a COVID-19 vaccine. Encephalitis and meningitis have been reported as rare but serious adverse events of special interest (AESIs)...

1. In a cohort of patients with traumatic brain injury, early fixation of extremity fractures within 24 hours of injury was not associated with greater rates of unfavourable functional outcomes at 6 months.  Evidence Rating: 2 (Good)  While extremity fractures are commonly seen in conjunction with traumatic brain injury (TBI), the ideal timing of fixation and definitive treatment of these fractures remain controversial. On one hand, there are those who argue in favour of earlier fixation to promote a shorter recovery course and decreased complication rates...

1. In this case-control study, cerebrospinal fluid (CSF) biomarkers of Alzheimer’s disease increased during the decline of cognitive function. 2. The biomarkers began changing as early as 18 years before the diagnosis. Evidence Rating Level: 2 (Good) Study Rundown: Preclinical Alzheimer’s disease has been identified as the presence of cognitive function with abnormal levels of CSF biomarkers. After the preclinical stage, the disease progresses with mild cognitive decline, which then sometimes develops into clinically apparent dementia...

1. In this retrospective study, in patients with prolonged symptoms of coronavirus disease 2019 (COVID-19), cognitive deficits lasting a year or longer were more likely to be reported. 2. The greatest associations with cognitive deficits were found in individuals affected by COVID-19 near the beginning of the pandemic and those hospitalized. Evidence Rating Level: 2 (Good) Study Rundown: Coronavirus disease has been implicated in having negative long-term effects such as brain fog and poor memory. In the present study, participants were tasked with completing eight cognitive tests on their devices...

1. In this randomized controlled trial, tenecteplase administered at 4.5 to 24 hours after stroke onset to patients with an occluded middle cerebral artery (MCA) or internal carotid artery (ICA) was not superior to placebo. 2. Tenecteplase did not differ from placebo with regards to rates of death and symptomatic intracranial hemorrhage. Evidence Rating Level: 1 (Excellent) Study Rundown: Intravenous thrombolysis with tissue plasminogen activators, such as tenecteplase, is the standard of care for ischemic stroke within 4...

1. In this randomized controlled trial, multiple sclerosis patients who received frexalimab had fewer new gadolinium-enhancing T1 lesions compared to placebo groups. 2. Immune responses that are typically higher in multiple sclerosis patients were reduced in the participants taking frexalimab . Evidence Rating Level: 1 (Excellent)

1. L ifetime exposure to depression in adults was correlated to decreases in global and local neural connectivity on functional magnetic resonance imaging (fMRI).  2. Definitions of depression that were associated with the strongest functional alterations included meeting criteria for diagnosis with the International Statistical Classification of Diseases (ICD-10) and use of antidepressants.  Evidence Rating Level: 2 (Good)           Study Rundown: Major depressive disorder (MDD) is among the most common mental health disorders around the globe, affecting at least ten percent of people over the lifespan worldwide...

1. In a cohort of young patients with a first-ever stroke, the cumulative 6-month and 5-year risk of any recurrent vascular event was 6.7% and 12.2%, respectively. 2. Elevated short-term risk of recurrence was significantly higher for patients with cervical artery dissection (CeAD), atherothrombotic stroke, other rare causes of stroke, and hypertension. 3. Elevated long-term risk of recurrence was significantly higher for patients with cardioembolic stroke, a history of diabetes, and a history of alcohol abuse...

1. In a secondary analysis of a prior study consisting of children and adolescents with concussions, engaging in higher volumes of cumulative moderate-to-vigorous physical activity (cMVPA) within the first 2 weeks of injury was associated with a lower burden of postconcussion symptoms.  2. Patients who returned to physical activity within the first week had a 25% risk of persisting symptoms at four weeks compared to 44% in those who did not.  Evidence Rating Level: 1 (Excellent) Study Rundown:  Concussions not only have a burden on the individual experiencing them but also on the economy and health of the population...

1. Among United States veterans of the Iraq and Afghanistan wars, the experience of a moderate, severe, or penetrating traumatic brain injury was associated with a greater risk of developing brain cancer.  Evidence Rating Level: 2 (Good) Primary brain cancer is uncommon, affecting 7.02 per 100,000 persons in the United States. Little is known about the risk factors for primary brain cancer. In this retrospective cohort study, researchers aimed to determine whether traumatic brain injury (TBI) is associated with the development of primary brain cancer...

1. In this post-hoc analysis of the CHANCE-2 trial, ticagrelor-acetylsalicylic acid was more beneficial compared to clopidogrel-acetylsalicylic acid for preventing recurrent stroke among those with elevated levels of homocysteine and CYP2C19 LOF mutations.  Evidence Rating Level: 2 (Good)  Elevated homocysteine levels are associated with increased hemostasis, progression of atherosclerosis, and greater risk of initial or recurrent stroke. Little is known about whether homocysteine levels impact the effectiveness of dual antiplatelet treatments for preventing stroke...

1. In this randomized controlled trial, N-acetyl-L-leucine (NALL) improved neurologic status in Niemann-Pick Disease type C more effectively than a placebo. 2. Patients showed a significant reduction in neurological symptoms after taking NALL. Evidence Rating Level: 1 (Excellent) Study Rundown: Niemann-Pick Disease Type C is an inherited lysosomal storage disorder following the autosomal recessive pattern leading to premature death. The current treatment method relies on miglustat, a drug used in lysosomal storage disorders, to delay the progression of neurological symptoms typically produced by this disease...

1. This randomized controlled trial showed no evidence that ibuprofen treatment for bronchopulmonary dysplasia reduced premature infant mortality. 2. This study is consistent with other studies examining the role of ibuprofen as a treatment method for patent ductus arteriosus (PDA), showing no effect on mortality rates. Evidence Rating Level: 1 (Excellent) Study Rundown: Neonatal medicine has advanced substantially in recent decades. Yet, the incidence of bronchopulmonary dysplasia has increased in preterm infants with associated mortality...

1. In this randomized controlled trial, apixaban lowered the risk of stroke or systemic embolism significantly more than aspirin in patients with subclinical atrial fibrillation.  2. Apixaban was associated with a higher risk of major bleeding than aspirin.  Evidence Rating Level: 1 (Excellent) Study Rundown: Symptomatic atrial fibrillation is a leading cause of stroke and stroke-related disability and mortality, for which oral anticoagulants are established prophylactic therapies. Conversely, subclinical atrial fibrillation can be asymptomatic or only produce short-lasting symptoms and is only diagnosed by continuous cardiac rhythm monitoring with a pacemaker or defibrillator...

1. Absence of moderate or severe headache 24 hours following administration of treatment drug was significantly greater among patients with migraine attacks that were treated with ubrogepant during the prodrome phase. 2. Adverse events were slightly more frequent in the ubrogepant group versus placebo. Evidence Rating Level: 1 (Excellent) Study Rundown : Ubrogepant, a calcitonin gene-related peptide (cGRP) receptor antagonist, is approved for acute migraine treatment. However, its use during the prodromal phase to reduce the frequency of subsequent migraine headaches is not well understood...

1. In this randomized controlled trial, replacing biomass stoves with those using liquefied petroleum gas (LPG) during pregnancy did not reduce stunting in infants at one year despite reductions in household air pollution.  2. There was no appreciable difference in stunting in infants at six months between the biomass cookstove and liquefied petroleum gas cookstove groups.  Evidence Rating Level: 1 (Excellent) Study Rundown: Household air pollution is a significant environmental risk factor in low- and middle-income countries and arises from incomplete combustion of biomass fuels...

1. This longitudinal prospective cohort study found that older adults with trajectories involving impairments to instrumental activities of daily living, higher comorbidity, and increasing depressive symptoms were particularly at risk for developing cognitive impairment. Evidence Rating Level: 2 (Good) The global population is rapidly aging, and with this comes an increased incidence of morbidity and disease burden. In particular, cognitive impairment – marked by difficulties with memory, learning, concentration, and decision-making – will continue to burden the aging population...

1. In this cohort study, children with low dose prenatal alcohol and tobacco exposure were found to have differences in electroencephalogram activity even at 11 years of age. 2. Males were particularly vulnerable to the effects of prenatal alcohol exposure compared to females.  Evidence Level Rating: 2 (Good) Tobacco and alcohol consumed during pregnancy have teratogenic effects on the fetus, even when consumed in low amounts. In this cohort study, researchers sought to further characterize the effects of PAE and PTE on neurodevelopment in childhood...