Derhab, Mohamed

Abstract Background The associations between bilateral oophorectomy or hysterectomy with ovarian conservation and the risk of Parkinson's disease (PD) remain inconclusive. Objectives To evaluate the evidence on these two associations. Methods We conducted a systematic search across Embase, PubMed, Scopus, MEDLINE, and Web of Science through May 15, 2024. Data were extracted independently by two reviewers, and random‐effects meta‐analyses were performed. Results Eight studies with a total of 242,275 women were included. For bilateral oophorectomy, the effect size (ES) was greater than 1.0 in 5 of 8 studies. The pooled analysis showed a significant association between premenopausal bilateral oophorectomy and an increased risk of PD in cohort studies (hazard ratio [HR] 1.32; 95% CI 1.12–1.56) but not in case–control studies or combining both cohort and case–control studies. There was a suggestive trend of increasing risk with younger age at bilateral oophorectomy. For hysterectomy with ovarian conservation, the ES was greater than 1.0 in all six studies. The pooled analysis showed a non‐significant association in cohort studies and in case–control studies; however, the association was significant when combining both cohort studies and case–control studies (ES 1.19; 95% CI 1.01–1.41). Conclusions Current studies provided low to moderate evidence for the associations between bilateral oophorectomy and hysterectomy with ovarian conservation and increased risk of PD. However, the evidence was only observational and there was important heterogeneity across the case–control studies. Future studies should focus on surgeries performed at younger ages and on the possible effects of estrogen replacement therapy.

Introduction Mechanical thrombectomy (MT) is a well‐established treatment for acute ischemic stroke (AIS) due to large vessel occlusion (LVO). However, its role in cervical artery dissection‐related (CeAD) LVO remains debated due to anatomical complexities and procedural challenges. This systematic review and meta‐analysis aims to evaluate the safety, efficacy, and clinical outcomes of MT in patients with AIS due to CeAD‐related LVO, compared with other AIS etiologies. Methods PubMed, Embase, and Scopus were systematically searched from inception through March 2025. Comparative observational studies evaluating the use of MT in adult patients with AIS due to LVO were included, specifically those comparing outcomes in those with CeAD versus non‐CeAD etiologies. Most studies were retrospective and multicentric. Eligible interventions included stent retriever thrombectomy, direct aspiration (ADAPT), or combined approaches. Results Nine studies with a total of 4889 patients were included, comprising 446 CeAD‐related and 4443 non‐CeAD LVO cases. MT for CeAD‐related AIS showed no statistically significant difference in successful recanalization compared with non‐CeAD cases (OR:0.81, CI: [0.63,1.04], p=0.10). However, CeAD patients had significantly higher rates of 90‐day functional independence (mRS 0‐2) (OR:2.17, CI: [1.55, 3.05], p < 0.0001) and lower 90‐day mortality (OR:0.34, CI: [0.22, 0.53], p < 0.0001). Rates of distal embolization (OR:1.60, CI: [0.69, 3.70], p = 0.27), symptomatic ICH (OR:0.84, CI: [0.51, 1.38], p=0.49), or iatrogenic dissection (OR:1.58, CI: [0.59, 4.22], p=0.36) did not differ significantly. Conclusions Mechanical thrombectomy in CeAD‐related LVO is safe and associated with clinical outcomes comparable to patients with non‐CeAD acute ischemic causes. They demonstrated a similar patient safety profile, such as functional outcomes and mortality.

Introduction For large vessel occlusion (LVO) ischemic strokes, three major techniques of mechanical thrombectomy have demonstrated efficacy. In this study, we compared stent retrievers (SR),contact aspiration (Asp), and a combined approach to provide an updated comparison of key outcomes for each strategy. Methods We followed PRISMA guidelines to conduct a systematic review and meta‐analysis across PubMed, EMBASE, Scopus, and Web of Science databases up to September 2024. Studies were included if they included outcomes for patients with ischemic stroke who underwent mechanical thrombectomy using a stent retriever, contact aspiration, or a combination of both techniques. Results Twenty‐four studies comprising a total of 12,845 patients were included in the analysis. Compared to the Asp technique alone, the combined mechanical thrombectomy (MT) approach was associated with a higher risk of arterial dissection (RR: 2.00; 95% CI [1.15, 3.44]), longer procedure duration (MD: 13.35 minutes; 95% CI [5.87, 20.83]) and associated with a lower risk of arterial dissection (RR: 0.50; 95% CI [0.29, 0.87]). However, Asp was associated with a lower rate of first‐pass effect (FPE) compared to combined MT (RR: 0.67; 95% CI [0.46, 0.96]). Additionally, stent retriever (SR) use was linked to a higher procedure duration compared to Asp(MD: 13.39 minutes; 95% CI [5.55, 21.22]) and a lower FPE rate (RR: 0.75; 95% CI [0.59,0.96]). No significant differences were observed between groups in terms of successful recanalization, 90‐day functional outcomes, or mortality. Conclusion In our analysis, all three techniques demonstrated similar recanalization rates and functional outcomes. However, aspiration was associated with shorter procedure times and fewer arterialdis section complications, while the combination technique showed a higher first pass effect. Given the comparable overall efficacy, the choice of technique should be guided by the physician's preference, expertise, and confidence, tailored to the individual patient's profile.

Background Mechanical thrombectomy (MT) is a well-established treatment for acute ischemic stroke (AIS) due to large vessel occlusion (LVO). However, its role in cervical artery dissection-related (CeAD) LVO remains debated due to anatomical complexities and procedural challenges. This systematic review and meta-analysis aims to evaluate the safety, efficacy, and clinical outcomes of MT in patients with AIS due to CeAD-related LVO compared with other AIS etiologies. Methods PubMed, Embase, and Scopus were systematically searched from inception to March 2025. Comparative observational studies evaluating the use of MT in adult patients with AIS due to LVO were included, specifically those comparing outcomes in patients with CeAD versus non-CeAD etiologies. Results MT for CeAD-related AIS showed no statistically significant difference in successful recanalization compared with non-CeAD cases (OR 0.81 (95% CI 0.63 to 1.04), P=0.10). However, patients with CeAD-related AIS had significantly higher rates of 90-day functional independence (modified Rankin Scale score 0–2) (OR 2.17 (95% CI 1.55 to 3.05), P<0.01) and lower 90-day mortality (OR 0.34 (95% CI 0.22 to 0.53), P<0.01). Rates of distal embolization (OR 1.60 (95% CI 0.69 to 3.70), P=0.27), symptomatic intracranial hemorrhage (OR 0.84 (95% CI 0.51 to 1.38), P=0.49), or iatrogenic dissection (OR 1.58 (95% CI 0.59 to 4.22), P=0.36) did not differ significantly between patient groups. Conclusions MT in patients with CeAD-related LVO is safe, effective, and associated with improved functional outcomes and lower mortality compared with patients with non-CeAD acute ischemic causes.

Background Early onset Parkinson's disease (EOPD), defined as Parkinson's disease (PD) diagnosed before age 50, often presents unique challenges compared to late-onset PD, particularly with regard to non-motor symptoms. Psychosis in EOPD is associated with increased functional impairment and may lead to a higher mortality risk. Objective Our study is aimed to determine the prevalence of psychosis in EOPD patients and its impact on all-cause mortality, along with examining the effects of antipsychotic medications and Selective Serotonin Reuptake Inhibitors (SSRIs) on mortality in EOPD patients. Methods Our retrospective cohort included EOPD patients diagnosed between 1990 and 2022 at Mayo Clinic, Rochester, Minnesota. Psychosis was defined using the National Institute of Neurological Disorders and Stroke/the National Institute of Mental Health (NINDS/NIMH) Work Group criteria. Cox proportional hazards models were used to analyze the association of psychosis and medications with mortality. Results Of 829 patients with EOPD, 158 (19.1%) developed psychosis at a median of 12.1 years after PD motor symptom onset. Psychosis was significantly associated with increased mortality in unadjusted (HR = 4.31, 95% CI: 2.59–7.18, p < 0.001) and adjusted (HR = 3.55, 95% CI: 2.10–6.01, p < 0.001) models. No significant difference in mortality risk was observed between patients treated with antipsychotics or SSRIs versus those who were not. Conclusions Psychosis is a possible complication in EOPD and is associated with a significant increase in all-cause mortality. The use of antipsychotics and SSRIs did not significantly alter the mortality risk in these patients. Further research is needed to understand the mechanisms driving this association and to develop tailored interventions.