Neuraxial analgesia is not associated with an increased risk of post-partum relapses in MS

Background:

Obstetrical analgesia remains a matter of controversy because of the fear of neurotoxicity of local anesthetics on demyelinated fibers or their potential relationship with subsequent relapses.

Objective:

To assess the impact of neuraxial analgesia on the risk of relapse during the first 3 months post-partum, with a focus on women who experienced relapses during pregnancy.

Methods:

We analyzed data of women followed-up prospectively during their pregnancies and at least 3 months post-partum, collected in the Pregnancy in Multiple Sclerosis (PRIMS) and Prevention of Post-Partum Relapses with Progestin and Estradiol in Multiple Sclerosis (POPARTMUS) studies between 1992–1995 and 2005–2012, respectively. The association of neuraxial analgesia with the occurrence of a post-partum relapse was estimated by logistic regression analysis.

Results:

A total of 389 women were included, 215 from PRIMS and 174 from POPARTMUS. In total, 156 women (40%) had neuraxial analgesia. Overall, 24% experienced a relapse during pregnancy and 25% in the 3 months post-partum. Women with a pregnancy relapse were more likely to have a post-partum relapse (odds ratio (OR) = 1.83, p = 0.02), independently of the use of neuraxial analgesia. There was no association between neuraxial analgesia and post-partum relapse (OR = 1.08, p = 0.78).

Conclusion:

Neuraxial analgesia was not associated with an increased risk of post-partum relapses, whatever multiple sclerosis (MS) activity during pregnancy.

[Hypertension and cardiovascular risk associated with obstructive sleep apnea in adult in Guadeloupe (French West Indies)]

BACKGROUND AND PURPOSE

In Guadeloupe, data on the relationships between arterial hypertension and obstructive sleep apnea are unavailable. The aim of this study was: to assess the frequency of hypertension and non-dipper pattern evaluated by 48-hour ambulatory blood pressure monitoring in an adult population identified obstructive sleep apnea/non-obstructive sleep apnea during overnight polygraphy ; to determine the cardio-metabolic factors associated with obstructive sleep apnea.

DESIGN AND METHOD

A cross-sectional study was realized at Pointe-à-Pitre Hospital. Patients were referred for suspected sleep apnea to sleep specialist and performed a nocturnal polygraphy. Diagnosis was confirmed if the apnea-hypopnea index was ≥ 5. We obtained two groups: sleep apnea/non-sleep apnea. All patients underwent 48-hour ambulatory blood pressure monitoring. The cardio-metabolic factors were identified and assessed (fasten level of hs-CRP and Homa-IR index).

RESULTS

A total of 204 patients were included. Mean age at diagnosis was 54 ± 10 years, 63% were women. OSA was present in 69.6% with a higher frequency in men than in women. Difference was not significant between the two groups for hypertension frequency (84.5% vs 77%; P=0.22), non-dipper pattern (77.5% vs 76%; P=0.79) and hs-CRP. Differences for age, snoring, body max index, mean waist circumference, Homa-IR index, obesity, dyslipidemia, and type 2 diabetes were significant.

CONCLUSIONS

Our data highlight raised frequency of cardiovascular metabolic factors in patients with obstructive sleep apnea and confirm their high cardiovascular risk.

[Ventricular late potentials in myocardial infarction: comparison of thrombolysis, primary angioplasty, and conventional treatment]

OBJECTIVES

The aim of this study was to compare the prevalence of ventricular late potentials (VLP) during the acute phase of myocardial infarction (MI) depending on the treatment used.

METHODS AND RESULTS

This retrospective study was carried out over the period January 1992 to December 1997, and involved 238 patients admitted for primary MI and treated less than six hours after the onset of symptoms by intravenous thrombolysis (rt-PA, n = 83) or primary angioplasty (ATCI, n = 82) and in those cases treated over six hours after the onset of symptoms by standard treatment (heparin, n = 73). Rt-PA perfusion was considered to be effective when the three following criteria were simultaneously present: i) pain sedation; ii) regression of the ST dysfunction > 50%; iii) creatine phosphokinase (CPK) peak before the 16th hour. Treatment success for angioplasty (ATCI+) was confirmed by a TIMI 3 (Thrombolysis in Myocardial Infarction) score for MI arterial perfusion, with residual stenosis of the MI artery of < 50%. Ventricular late potentials (VLP) were investigated between day six and 14, and considered to be present when two of the following criteria were met: total duration of filtered QRS, i.e., QRSd > 114 ms; signal amplitude in the 49 last ms of filtered QRS, i.e., RMS40 < 20 mV, duration of the terminal part of filtered QRS that was below 40 mV, i.e., LAS40 > 38 ms (40 Hz). VLP prevalence was as follows: 25% (rt-PA group), 345 (ATCI group), and 33% (standard treatment) respectively (P = NS). In the thrombolysis with reperfusion subgroup (n = 54/83, 65%), VLP incidence was 18.5% (n = 10/54) versus 35.5% (n = 27/76) in the subgroup ACTI+ (n = 76/82, 93%) (P = 0.03).

CONCLUSIONS

The prevalence of VLP appears to be significantly decreased in the the case of thrombolysis with reperfusion compared to that observed in the ATCI+ group. One of the possible explanations for this abnormally high prevalence in the angioplasty group could be a dysfunction involving reocclusion after initially successful myocardial reperfusion therapy.