Antonela Bazina

PPARγ and IL-6 - 174G>C gene variants in Croatian patients with ischemic stroke

AIM Etiology of ischemic stroke (IS) is multifactorial and includes interaction of genetic and environmental factors. Different genes, their polymorphisms, host susceptibility, and inflammation processes play a role in IS development. The aim of this study was to evaluate the effect of PPAR-γ and IL-6 gene variants on IS onset. MATERIAL AND METHODS A total of 301 subjects (144 males, 157 females) participated in the study, 114 patients with IS and 187 healthy controls. RESULTS Statistically significant predictors of IS were male gender (OR 7.13, 95% CI 2.92-17.39, p<0.001), hypertension (OR 7.82. 95% CI 2.53-24.19, p<0.001), lowered HDL cholesterol (OR 8.20, 95% CI 2.41-27.94, p=0.001), elevated C-reactive protein (OR 5.26, 95% CI 1.92-14.41) and IL-6 -174 GC (OR 2.44 95% CI 1.01-5.91, p=0.0048) genotype. Males, compared to females, had 7 times higher odds for stroke. IL6 -174G/C genotype increased the odds for IS for 2.4 times. PPARγ was not statistically significantly associated with stroke. CONCLUSION We can point to the IL-6 -174G>C polymorphisms as candidate gene marker and risk factor for the prediction of ischemic stroke.

Prevalence of genetic polymorphisms of CYP2C9 and VKORC1 - implications for warfarin management and outcome in Croatian patients with acute stroke.

BACKGROUND Data on the prevalence of CYP2C9 and VKORC1 genes and their influence on anticoagulant effect and warfarin dose in stroke patients are scarce. The aim of this study was to determine the occurrence and significance of these gene polymorphisms and to establish pharmacogenetic algorithm to estimate the dose of introduction. Also, the goal was to determine tailored safety and intensity of anticoagulation response depending on the allelic variants and their impact on the clinical outcome in acute stroke patients in Croatia. METHODS A total of 106 consented acute stroke patients were tested for CYP2C9 2, 3 and VKORC1 1173C>T gene polymorphisms. We estimated the dose of introduction and monitored anticoagulant effect obtained by INR values, time to reach stable dose, stable maintenance dose, time spent within the therapeutic/supratherapeutic INR range, occurrence of dosage side effects and clinical outcome depending on genotypes. RESULTS We found that 83% of stroke patients in our study were carriers of multiple allelic variants. The predicted initial dose correlated with the stable warfarin maintenance dose (p=0.0311) and we correctly estimated the dose for 81.5% of 61.3% of study patients who required higher/lower doses than average. Warfarin dosage complications were slightly more frequent among the carriers of CYP2C9 2, 3 compared to the carriers of VKORC1 1173T alleles (68. 9% versus 62.5%), but their occurrence did not affect the final clinical outcome. CONCLUSION Our data indicated rapid and safe anticoagulation achieved by using pharmacogenetically-predicted warfarin dose in high-risk acute stroke patients without increasing the risk of warfarin dosage complications in an elderly population.

Endovascular treatment of internal carotid artery pseudo-aneurysm presenting with epistaxis. A case report.

Recurrent epistaxis is a rare presentation of internal carotid artery C4/C5 segment pseudo-aneurysm rupture. We describe a case of a traumatic internal carotid artery pseudo-aneurysm with recurrent epistaxis as a leading symptom that was finally managed with endovascular treatment with stent-assisted coil placement. Clopidogrel and acetylsalicylic acid orally were introduced in the therapy for further stent thrombosis prevention and epistaxis did not recur on six-month follow-up. Endovascular treatment with stent-assisted coil placement seems to be a good method for pseudo-aneurysm treatment while keeping the lumen of the parent artery patent.

BS11. Somatosensory evoked potentials of the median nerve as a potential predictive marker of the clinical outcome in severe hemorrhagic stroke patients

Introduction Previous studies indicated an association between abnormalities of evoked potentials and clinical course in ischemic stroke patients. Our goal was to assess the usefulness of the evoked potentials in the prediction of the clinical outcome in severe hemorrhagic stroke patients. Methods In 40 patients (21 men, mean age 63.50 ± 13.58) with hemorrhagic stroke (30 intracerebral and 10 subarachnoid hemorrhage), within the 48 h after admission to neurointensive care unit (NICU), brainstem auditory evoked potentials (BAEP) and somatosensory evoked potentials (mSSEP) of the median nerve were performed according to previously published guidelines. Among clinical parameters, the Glasgow Coma Score (GCS) and the Full Outline of Unresponsiveness (FOUR) were assessed on the admission date and on the day of discharge. Modified Rankin scale (mRS) was assessed on the day of discharge. Results There was a statistically significant negative correlation between FOUR score at the day of admission and right BAEP latency of V wave (rs = −0.315, p = 0.048). There was also the significant negative correlation between left BAER III-V wave interlatency and FOUR score on the day of discharge (rs = −0.340, p = 0.032) and significant positive correlation of left BAER III-V wave interlatency and mRS on the day of discharge (rs = 0.316, p = 0.047). There were no significant correlations of clinical outcomes with BAEP amplitude. Regarding mSSEP results, significant negative correlation was found between right and left P14-N20 interlatenties and FOUR score on the admission date (rs = −0.359, p = 0.023; and rs = −0.371, p = 0.018; respectively). Significant positive correlation was found between FOUR score on the admission date and right and left mSSEP P15-N20 amplitude (rs = 0.595, p  Significant positive correlation was obtained between right and left mSSEP P15-N20 amplitude and discharge day GCS value (rs = 0.466, p = 0.002; and rs = 0.336, p = 0.034), as well as with FOUR score at the discharge day (rs = 0.340, p = 0.032; and rs = 0.319, p = 0.045). Significant negative correlation was established between right and left mSSEP P15-N20 amplitude and mRS at the day of discharge(rs = −0.497, p = 0.001; and rs = −0.381, p = 0.015). Conclusion Results of evoked potentials, particularly mSSEP, demonstrated significant correlation with clinical outcomes. Results of our study indicate that mSSEP has potential value in prediction of clinical outcome in patients with hemorrhagic stroke.