Browsing by Author "Covickovic-Sternic, N. (6603691178)"

The aim of this review is to introduce the concept of personalized medicine in secondary stroke prevention with antiplatelet medication. In the last years, many studies have been conducted regarding aspirin resistance and genotyping of clopidogrel metabolism. A review of the currently published data on this issue emphasizes the importance of focusing on the individualizing approach in antiplatelet therapy to achieve maximal therapeutic beneficial effect. However, many authors suggest that, before new information from ongoing trials become available, good clinical practice should dictate the use of low dose of aspirin that was shown to be effective in the prevention of stroke and death in patients with ischemic cerebrovascular disease, because higher doses do not have significantly better efficacy than lower doses in secondary stroke prevention, but lower-dose aspirin is associated with less side effects. On the other hand, many factors are associated with clopidogrel resistance, and recent genetic studies showed that the CYP2C19*2 genotype (loss-of-function allele) is related to poor metabolism of clopidogrel, but larger studies are needed to definitively confirm or rule out the clinical significance of this genetic effect. The aim of personalized approach in secondary stroke prevention is to take the most appropriate medicine in the right dose in accordance with the clinical condition of the patient and associated risk factors. © 2013 John Wiley & Sons A/S.

The aim of this review is to introduce the concept of personalized medicine in secondary stroke prevention with antiplatelet medication. In the last years, many studies have been conducted regarding aspirin resistance and genotyping of clopidogrel metabolism. A review of the currently published data on this issue emphasizes the importance of focusing on the individualizing approach in antiplatelet therapy to achieve maximal therapeutic beneficial effect. However, many authors suggest that, before new information from ongoing trials become available, good clinical practice should dictate the use of low dose of aspirin that was shown to be effective in the prevention of stroke and death in patients with ischemic cerebrovascular disease, because higher doses do not have significantly better efficacy than lower doses in secondary stroke prevention, but lower-dose aspirin is associated with less side effects. On the other hand, many factors are associated with clopidogrel resistance, and recent genetic studies showed that the CYP2C19*2 genotype (loss-of-function allele) is related to poor metabolism of clopidogrel, but larger studies are needed to definitively confirm or rule out the clinical significance of this genetic effect. The aim of personalized approach in secondary stroke prevention is to take the most appropriate medicine in the right dose in accordance with the clinical condition of the patient and associated risk factors. © 2013 John Wiley & Sons A/S.

Aim: The aim of this study was to determine the bilateral distribution of proton metabolites along the long axis of the hippocampus. Materials and methods: Forty-one healthy volunteers were examined using a 1.5 T magnetic resonance imaging system, using proton three-dimensional spectroscopic imaging (3D CSI) of the left and the right hippocampus separately. Three dominant signals were measured: choline (Cho), total creatine (tCr), and n-acetylaspartate (NAA) and expressed as ratios of Cho:tCr, NAA:tCr, NAA:Cho and NAA:(Cho+tCr). We compared the data from three hippocampal regions: head, body and tail. Results: Lower NAA:tCr ratios were found in head compared with the body (p<0.05) and in the head compared with the tail (p<0.05) bilaterally. Lower NAA:Cho and NAA:(Cho+tCr) ratios were found in the head compared with the body (p<0.05), in the body compared with the tail (p<0.05), and in the head compared with the tail (p<0.05) bilaterally. There was no statistically significant difference between the left and the right hippocampus. Conclusion: Ratios of NAA:tCr, NAA:Cho, and NAA:(Cho+tCr) in hippocampal tissue were significantly higher posteriorly than anteriorly. As the differences are present in healthy volunteers, the appearance in patients related to approximate voxel positioning within hippocampi may result in false-positive results. © 2010 The Royal College of Radiologists.