A recent study found that in patients experiencing acute mild to moderate ischemic stroke, the combination of clopidogrel and aspirin proved more effective in reducing early neurologic deterioration at 7 days compared to aspirin alone while maintaining a similar safety profile. These results suggest that dual antiplatelet therapy could be a more advantageous treatment option for patients with acute mild to moderate stroke. This study’s results were published in the JAMA Neurology journal.

In this multicenter, randomized, open-label, clinical trial, a total of 3000 patients with acute mild to moderate stroke within 48 hours of symptom onset were included. The patients were randomly assigned to two groups: one group received a combination of clopidogrel and aspirin (n = 1541), while the other group received aspirin alone (n = 1459). The primary endpoint of the trial was early neurologic deterioration at 7 days, which was defined as an increase of 2 or more points in the National Institutes of Health Stroke Scale (NIHSS) score, excluding cases of cerebral hemorrhage, compared to the baseline. Safety end points included bleeding events.

The modified intention-to-treat analysis included a total of 2915 patients. Within the dual antiplatelet therapy group, 72 out of 1502 patients (4.8%) experienced early neurologic deterioration, compared to 95 out of 1413 patients (6.7%) in the aspirin alone group (the risk difference was -1.9%). Additionally, there were no significant differences in bleeding events observed between the two groups.

Thus, it can be concluded that in individuals with acute mild to moderate ischemic stroke, the use of both clopidogrel and aspirin was found to be superior in decreasing early neurologic deterioration at 7 days when compared to aspirin alone, exhibiting a similar safety profile.

According to a recent study, endovascular therapy (EVT) yielded positive results in global analyses of cognitive benefit and across five separate cognitive tests. These findings provide new evidence regarding the influence of EVT on cognition and provide further support for the overall advantages of EVT treatment. This study’s results were published in the Neurology journal.

The ESCAPE randomized trial data were analyzed, which involved 315 patients. Among them, 165 were assigned to EVT and 150 to the control group. Cognitive evaluations were performed 90 days post-stroke using the Sunnybrook Neglect Assessment Procedure (SNAP), Montreal Cognitive Assessment (MoCA), Boston Naming Test (BNT), Trail-making test A (Trails A), and Trail-making test B (Trails B). Logistic regression was used to investigate the connection between EVT and favorable cognitive outcomes on the 5 tests separately, while adjusting for demographic and clinical variables. Generalized estimating equations and ordinal regression were used to determine the likelihood of positive outcomes with EVT on overall cognitive function, incorporating all 5 tests. To examine the connection between final infarct volume (FIV) and cognitive outcome, FIV was incorporated into the models.

There was a greater likelihood of achieving a positive outcome with EVT for MoCA (adjusted odds ratio [aOR] 2.32), BNT (aOR 2.33), SNAP (aOR 3.85), trails A (aOR 3.50), and trails B (aOR 2.56). EVT also showed higher odds of favorable outcome in terms of global binary (aOR 2.57) and ordinal analyses (aOR 2.83) of cognitive function. After incorporating FIV into the models, both EVT and FIV were found to be significantly associated with cognitive outcome. Additionally, there was a significant correlation between global cognitive performance and mRS at day 90 (r = -0.78, p < 0.001), with the most substantial reductions in favorable cognitive outcome observed between mRS scores 4 and 5, as well as between mRS scores 2 and 3.

Thus, it can be concluded that EVT produced favorable outcomes in global analyses of cognitive benefit and in five distinct cognitive assessments.

According to a recent study, tirofiban was found to reduce the likelihood of early neurological deterioration in patients with noncardioembolic stroke who sought medical attention within 24 hours of experiencing symptoms. The use of tirofiban did not result in an increased risk of symptomatic intracerebral hemorrhage or systemic bleeding. This study’s results were published in the journal, JAMA neurology.

In this multicenter, randomized clinical trial, a total of 425 patients were enrolled. Among them, 213 patients received intravenous tirofiban while the remaining 212 patients were given oral aspirin for a duration of 72 hours. All patients then received oral aspirin. The primary efficacy outcome of the study was early neurological deterioration defined as an increase of 4 or more points in the NIHSS score within 72 hours after randomization. Additionally, the primary safety outcome assessed was symptomatic intracerebral hemorrhage occurring within the same 72-hour period after randomization.

9 patients from the tirofiban group and 28 patients from the aspirin group showed early neurological deterioration. Intracerebral hemorrhage was not observed in any of the patients belonging to the tirofiban group.

The above study demonstrated that tirofiban may lower the chances of early neurological deterioration in individuals with noncardioembolic stroke who received medical care within 24 hours of symptom onset. It reduced the risk of early neurological deterioration without raising the risk of symptomatic intracerebral hemorrhage or systemic bleeding.

According to a recent study, a combination of co-trimoxazole and N-acetylcysteine (NAC) is more effective in reducing bacterial adherence on ureteral stent surfaces than either alone. This study was published in the journal, Urolithiasis.

This prospective randomized study included 636 patients, who underwent double J ureteral stent insertion after various urological procedures. Patients were randomized into four groups: no antibiotics or mucolytics during stent indwelling in group A (n = 165); oral NAC (200 mg/day for children aged < 12 years old and 600 mg/day for adults) during stent indwelling in group B (n = 153), oral co-trimoxazole (2 mg TMP/kg/day) during stent indwelling in group C (n = 162), and both oral NAC and co-trimoxazole during stent indwelling in group D (n = 156).

After a duration of two weeks from the insertion of the double J stent (JJ stent), a urinalysis was conducted on all patients and on the day of double J stent removal, a urine culture was carried out for all the patients. 2-weeks postoperatively, the stent was removed, and a stent segment sized 3-5 cm from the bladder segment of the stent was sent for culture. It was found that 63.6%, 43.1%, 37%, and 19.2% patients of groups A, B, C, and D, respectively had positive stent cultures. The most commonly isolated organism from the stent culture in all groups was E. coli.

The above findings suggest that the combination of co-trimoxazole and NAC is more effective in reducing bacterial adherence on ureteral stent surfaces than either alone.