The authors report eight pregnant women with acute ischemic stroke treated with thrombolysis (rt-PA [recombinant human tissue plasminogen activator] or urokinase). Seven women recovered. Two extracranial and two asymptomatic intracranial hemorrhages complicated treatment; one woman died of arterial dissection complicating angiography. Three patients had therapeutic abortions, two fetuses were miscarried, and two babies were delivered healthy. Although pregnant women may be treated safely with thrombolytics, risks and benefits to mother and fetus must be carefully weighed.
With prospective follow-up by neurologists, the CE complication rate in an academic medical center was significantly higher than the rates reported in controlled clinical trials. The generalizability of data from CE clinical trials is limited and local audits are necessary to better establish the risk/benefit ratio for individual hospitals and surgeons.
Abstract:Introduction: Cardiovascular diseases (CVD) are major causes of mortality among U.S. Hispanic/Latino farmworkers. Since Hispanics/Latinos, in general, are twice as likely as non-Hispanic whites to have elevated alanine aminotransferase (ALT), a biomarker of suspected nonalcoholic fatty liver disease, it is vital to understand the CVD risk factor-ALT relationship in Hispanic/Latino farmworkers. This study investigated the elevated ALT status in Hispanic/Latino farmworkers and the relationships between ALT and CVD risk markers. Methods: In 210 Hispanic/Latino farmworkers (48% female; aged 35.2±9.2 years), fasting blood samples were measured for serum ALT, and elevated ALT was defined by >43 U/L. CVD risk markers were measured with standard methods and defined according to the definitions of metabolic syndrome. Results: The overall prevalence for elevated ALT was 12.4%. Significant linear upward trends across tertiles of serum ALT were observed for body mass index, waist circumference, fasting glucose, and triglycerides after adjusting for age and sex (all P-trend<0.05). Multinomial logistic regression, adjusting for age and sex, revealed that compared to individuals with the lowest ALT levels (tertile1), the adjusted odds ratios for overweight/obesity, prediabetes, elevated triglycerides, and metabolic syndrome were 3.2 (95% CI:1.2-8.6), 3.7 (95% CI:1.6-8.4), 3.0 (95% CI:1.5-6.2), and 2.7 (95% CI:1.3-5.6), respectively, for those in the highest ALT levels (tertile 3). No association was found between serum ALT and blood pressure or HDL-cholesterol. Conclusions: Our findings provide evidence for the high prevalence of elevated ALT levels in Hispanic/Latino farmworkers and suggest that increased serum ALT is associated with multiple markers of CVD risk.
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