[After a serious brain injury or trauma, there is damaged the functional capacity of the affected persons and their self-image too. Traditional rehabilitation pays little attention to the female patients’ lost femininity. The aim of this study was to present the way of supporting women to realize again their femininity psychologically and physically alike after a brain injury.

In the Brain Injury Rehabilitation Unit of the National Institute for Medical Rehabilitation, the authors completed the female patients’ rehabilitation with special group sessions once a week. The topics were tailored to the needs of participants. There were targeted two specific objectives: achieving to perceive femininity in an autonomous way and regaining the feeling of femininity in the changed life circumstances due to the injury.

Occupational therapist, physiotherapists and nurses provided service to develop functional abilities. A psychologist helped the participants in trauma processing. Since the beginning in January 2022, two therapy cycles have been completed so far, each of which with 10-12 sessions. A total of 31 female patients and 8 supporting team members participated in these two groups so far.

Personalised rehabilitation was adjusted to the involved persons’ life circumstances, individuality, personality, family and social relations. Our experimental female group helped the participants to experience their femininity physically, mentally and psychologically too, according to their feedback.]

[Indication for recanalization therapy of acute ischemic stroke is based on imaging procedures. In order to minimize the time loss passing by recog­nizing the condition and the transfer of images to other facility, we established a stroke imaging network (eStroke network) supported by Artificial Intelligence (AI) in Hungary. Our study aims to present this system. 

Organized by the National Institute of Mental Health, Neurology, and Neurosurgery (NIMNN), we included a total of 28 stroke centers, among them 4 thrombectomy centers. An earlier network of the University of Pécs and the widened network parallel with the NIMNN project cover 10 centers thus the service is now available in 38 stroke centers of this country. Stroke CT scans are automatically transmitted via the central teleradiology server to a central image processing server which analyzes the size of the ischemic area (ASPECT score), detects large vessel occlusion and it’s localization, analyzes the quality of collateral circula­tion and standard CT perfusion parameters using an AI based software (eStroke, Brainomix Ltd.). Results and processed images are sent automatically back to the PACS system of the sending institution and that of the concerning thrombectomy center and become available in anonymous form via cloud by desktop computers or mobile application. 

During the first year of opera­tion, the system has processed 38,060 scans of 16,276 patients. In NIMNN experience by samples of 65 and 152 cases, for drip and ship patients the time from the first alerting of the ambulance service, until arrival at the thrombectomy center was reduced by 38 minutes from 4:18 to 3:40 minutes. 

Building an AI based central stroke imaging network for improving of stroke care’s results is technically feasible. Operation of the eStroke system is capable of reducing patient transportation times, however, further optimization is needed. ]

[Migraine is a headache disorder affecting 14% of general population, being even more prevalent (20%) among women in the 20–64 age group, who are actively working and are mainly at reproductive age. 18–25% of migrainous women have an attack related to menstrual cycle, 7% of them having an attack only at this period. Fluctuation of estrogen level may be responsible for these attacks, we can use NSAIDs, slowly acting triptans or progestin-only treatment as short-term prophylaxis. Hormonal contraception is not contraindicated in migraine. Combined (estrogen+progestin) treatment is proposed only in migraine without aura, but in case of more frequent and/or severe attacks or the appearence of an aura treatment should be stopped. In migraineurs with elevated risk of stroke combined hormonal contraception should be used with caution. In migraine with aura patients progestin-only contraception is possible. During pregnancy in 55–91% of migraineus women attacks disappear or are less severe. In most cases migraine with aura attacks occur during this period. Non-pharmacological treatments should be considered as first in the treatment off attacks, with consideration of risk/benefit ratio paracetamol, metamizol or triptans may be used. With the meno­pause in 2/3 of patients migraine gets better but because of the fluctuation of hormon levels it can be worse than before. Hor­mo­nal replacement therapy is not contraindicated in migrainous women but it can result in worsening of migraine. ]

[Atrial fibrillation (AF) is the most common sustained cardiac arrhythmia that can lead to thromboem­bolic events, including cerebral vascular catastrophe and peripheral embolization. AF treatment while managing directly the arrhythmia aims anticoagulation therapy and prevention of thromboembolic events too.
This study overviews the factors influencing the risk of bleeding while managing AF, and focuses especially on appropriate anticoagulant choice, its tailored use to patient characteristics, management of comorbidities and strategies of reducing risks of bleeding.

This analysis compares the efficacy and safety of specific anticoagulants (VKA, DOAC) while considering the patient characteristics such as renal func­tion and comorbidities in anticoagulation treatment.



The risk of bleeding can be reduced by appropriate anticoagulant choice and its patient-specific administra­tion. Consideration of comorbidities is a key issue to ensure safe and effective treatment. VKA requires maintenance of stable INR values, while DOACs lead to fewer major bleeding events. For planned and emergency interventions, the use of bleeding risk reduction strategies is also important. Consideration of patient characteristics, such as renal function and comorbidities, as well as appropriate anticoagulant choice and use are essential to ensure efficient and safe anticoagulation therapy.

]

[
Chronic thromboembolic pulmonary hy­per­tension (CTEPH) is a vascular disease associated with pulmonary artery thrombosis, which causes changed flow patterns and remodeling of pulmonary blood vessels. CTEPH is a rare long-term complication of pulmonary embolism the cumulative incidence of which ranges between 0.1-9.1 in symptomatic patients. Early sign is the effort dyspnoea, later are dominating the right heart failure symptoms, and rarely the syncope. 
CTEPH should be suspected if there are emerging signs of chronic pulmonary ar­tery thrombosis and echocardiography in­dicates symptoms of pulmonary hypertension. Demonstrating thrombosis V/Q scan, CT angiography or pulmonary angiography can be performed and in case of pulmonary hypertension right heart catheterisation. The modern approach to CTEPH treatment is a multimodality strategy. Pul­mo­na­ry thromboendarterectomy is the first treatment of choice, but if the patient is not suitable for surgery, or he/she has chronic throm­boembolic pulmonary hypertension, balloon pulmonary angioplasty and/or drug therapy should be considered. Treat­ment of chronic thromboembolic pulmonary hypertension patients is recommended in a CTEPH program center.]