East Avenue Medical Center

To evaluate the effect of intraoperative administration of 1g of tranexamic acid (TXA) on perioperative and postoperative outcomes in patients receiving antithrombotic therapy undergoing endoscopic enucleation of the prostate (EEP). This multicenter, prospective, observational study included 932 patients across 30 centers (December 2024-June 2025). Patients were divided into four groups based on TXA use and continuation or discontinuation of blood thinners during EEP. The primary endpoint was bleeding complications within 30 days, defined as a composite of transfusion, clot retention, bleeding requiring restart of continuous bladder washout (CBWO), or surgical reintervention to control hemostasis. Multivariable Logistic regression analysis identified independent predictors of bleeding complications. There were 534 patients in Group 1 (stopped blood thinners, no TXA given), 316 in Group 2 (on blood thinners, no TXA given), 69 in Group 3 (stopped blood thinners, TXA given), and 13 in Group 4 (on blood thinners, TXA given). Median total operative time was longest in Group 2 (88min [IQR 70-127]) and shortest in Group 3 (55min [IQR 39-69]). Hemostasis time was shortest in TXA groups (p < 0.001). Transfusions occurred in 0.6-7.7% and surgical reinterventions in 0.6-7.7% across groups (p < 0.001). At 3 months, urinary symptoms and continence were comparable. On multivariable analysis, TXA reduced the odds of bleeding complications (OR 0.17, p < 0.001), while ongoing anticoagulant therapy (OR 2.93, p = 0.01), dual therapy (OR 4.31, p < 0.001), and longer operative time (OR 1.01, p < 0.001) increased the odds. Intraoperative TXA might mitigate perioperative bleeding and potentially protect patients at higher hemorrhagic risk.

This article provides perspectives on the use of Cerebrolysin as an adjunct treatment to reperfusion therapy in acute ischemic stroke (AIS). In the evolving landscape of AIS reperfusion therapy, we hypothesize that adjunctive cerebroprotective therapy, such as Cerebrolysin, is likely to further improve patient outcomes. Beyond its established neurorecovery benefits, recent data indicate that Cerebrolysin also offers protection to the neurovascular unit and the blood-brain barrier. This paper introduces the CErebrolysin in RECanalization And Perfusion (CERECAP) program, a collaborative initiative of independent academic investigations exploring the favorable trends of Cerebrolysin in reperfusion. The CERECAP program has generated compelling data demonstrating Cerebrolysin's alignment with current AIS reperfusion therapy concepts, particularly its role in early intervention targeting multiple pathways. We review these studies and discuss the critical need to clearly define the patient population that benefit most from adjunctive Cerebrolysin therapy in AIS.

Abstract BACKGROUND Primary solid brain tumors, including glioblastomas, are rare in persons with Down syndrome, who are typically more predisposed to hematologic malignancies than solid tumors. The role of trisomy 21 in neuro-oncologic pathophysiology remains poorly understood. We report a rare case of glioblastoma, IDH-wild type, in a young adult with Down syndrome presenting with new-onset focal seizures. CASE DESCRIPTION A 26-year-old male with Down syndrome and no prior neurologic complaints presented with a one-month progression of right temporal headaches, irritability, and behavioral changes, eventually developing focal motor seizures and left-sided hemiparesis. Cranial MRI revealed a mixed cystic solid mass in the right temporal lobe with calcifications and perilesional edema. Electroencephalography showed focal slowing and epileptiform discharges over the right temporal region. The patient underwent craniotomy and safe maximal resection of the tumor. Histopathologic analysis revealed glioblastoma, IDH-wild type. Immunohistochemistry was positive for ATRX, GFAP, OLIG2, and S100, and negative for IDH1, EMA, and CD99. Despite referral to oncology service, the family opted palliative care. The patient was discharged medically stable with outpatient follow-up. DISCUSSION Glioblastoma is exceedingly rare in patients with Down syndrome, possibly due to overexpression of tumor-suppressor genes on chromosome 21. This case highlights the importance of considering structural intracranial pathology in patients with neurodevelopmental disorders who develop new-onset seizures or behavioral decline. Diagnostic delay may occur due to attribution of symptoms to baseline cognitive impairment. Early neurology consult and imaging is critical in such cases. CONCLUSION This case illustrates a highly unusual occurrence of glioblastoma in Down syndrome, a population typically considered at lower risk for solid brain tumors. The importance of clinical vigilance and prompt neuroimaging in patients who present with atypical neurologic symptoms are highlighted here. This case contributes to the sparse literature and raises important questions about tumor pathogenesis in trisomy 21.

Background: Electromyography and nerve conduction studies (EMG-NCS) often yield nonspecific findings during the early stage of Guillain-Barré syndrome (GBS). Although useful for diagnosis, EMG-NCS are traditionally of little value in predicting a complicated clinical course, which is critical for timely decisions to initiate immunomodulatory treatment. We aimed to identify the early clinical and electrophysiologic predictors of respiratory failure, a prolonged hospital stay, and moderate-to-severe disability at discharge in GBS.Methods: We retrospectively analyzed the clinical and electrophysiologic data of adult GBS patients who were hospitalized during the early course of the disease (&lt;2 weeks from symptom onset).Results: Eighty-one patients aged 47.5 ± 16.1 years were analyzed. The most common clinical variants were Miller-Fisher syndrome (30.9%) and classic sensorimotor GBS (25.9%). The clinical variant was not predictive of a complicated clinical course. Instead, specific clinical features such as dysautonomia (p = 0.006) and marked motor deficits (p = 0.002) were predictive of the primary composite outcome of respiratory failure and/or a prolonged hospital stay, with dysautonomia (p = 0.035) also predictive of moderate-to-severe disability at discharge. The most common abnormalities in EMG-NCS were bilateral absence of the H-reflex (86.4%) and F-wave abnormalities (44.4%). The presence of F-wave abnormalities was predictive of both respiratory failure (p = 0.032) and a prolonged hospital stay (p = 0.001).Conclusions: Early F-wave abnormalities in GBS may serve as an electrophysiologic predictor of a complicated clinical course, suggesting that EMG-NCS can provide prognostic information to guide treatment decisions during the early stage of the disease.