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Moawad MHED, Mohamed Shalaby MM, Hamouda E, Mahfouz A, Mouffokes A, Hamouda H, Abbas A, Abdelgawad HAH. Risk of Stroke Among HIV Patients: A Systematic Review and Meta-analysis of Global Studies and Associated Comorbidities. J Acquir Immune Defic Syndr 2024; 95:399-410. [PMID: 38489489 DOI: 10.1097/qai.0000000000003382] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2023] [Accepted: 12/20/2023] [Indexed: 03/17/2024]
Abstract
BACKGROUND Despite advancements in the management of HIV infection, the factors contributing to stroke development among HIV-positive individuals remain unclear. This systematic review and meta-analysis aim to identify and evaluate the relative risk factors associated with stroke susceptibility in the HIV population. METHODS A comprehensive search was conducted in PubMed, Scopus, and Web of Science databases to identify studies investigating the risk of stroke development in HIV patients and assessing the role of different risk factors, including hypertension, diabetes, dyslipidemia, smoking, sex, and race. The quality assessment of case-control studies was conducted using the Newcastle-Ottawa Scale, whereas cohort studies were assessed using the National Institute of Health tool. Meta-analyses were performed using a random-effects model to determine pooled hazard ratios (HRs) or odds ratios (ORs) with 95% confidence intervals (CIs). RESULTS A total of 18 observational studies involving 116,184 HIV-positive and 3,184,245 HIV-negative patients were included. HIV-positive patients exhibited a significantly higher risk of stroke compared with HIV-negative patients [OR (95% CI): 1.31 (1.20 to 1.44)]. Subgroup analyses revealed increased risks for both ischemic stroke [OR (95% CI): 1.32 (1.19 to 1.46)] and hemorrhagic stroke [OR (95% CI): 1.31 (1.09 to 1.56)]. Pooled adjusted HRs showed a significant association between stroke and HIV positivity (HR: 1.37, 95% CI: 1.22 to 1.54). Among HIV-positive patients with stroke, hypertension [OR (95% CI): 3.5 (1.42 to 8.65)], diabetes [OR (95% CI): 5 (2.12 to 11.95)], hyperlipidemia, smoking, male gender, and black race were associated with an increased risk. DISCUSSION Our study revealed a significant increased risk of stroke development among people with HIV. A multitude of factors, encompassing sociodemographic characteristics, racial background, underlying health conditions, and personal behaviors, significantly elevate the risk of stroke in individuals living with HIV. The use of observational studies introduces inherent limitations, and further investigations are necessary to explore the underlying mechanisms of stroke in people with HIV for potential treatment strategies. CONCLUSION HIV patients face a higher risk of stroke development, either ischemic and hemorrhagic strokes. Hypertension, diabetes, hyperlipidemia, smoking, male gender, and black race were identified as significant risk factors. Early identification and management of these risk factors are crucial in reducing stroke incidence among patients living with HIV.
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Affiliation(s)
- Mostafa Hossam El Din Moawad
- Faculty of Pharmacy Clinical Department Alexandria University, Alexandria, Egypt
- Faculty of Medicine Suez Canal University, Ismailia, Egypt
| | | | - Esraa Hamouda
- Faculty of Medicine, Menoufia University, Menoufia, Egypt
| | - Amany Mahfouz
- Faculty of Medicine, Kafrelsheikh University, Kafr El-Sheikh, Egypt
| | - Adel Mouffokes
- Faculty of Medicine, University of Oran 1 Ahmed Ben Bella, Oran, Algeria
| | - Heba Hamouda
- Faculty of Medicine, Menoufia University, Menoufia, Egypt
| | - Abdallah Abbas
- Faculty of Medicine, Al-Azhar University, Damietta, Egypt; and
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Zhao J, Liu S, Xiang X, Zhu X. Versatile strategies for adult neurogenesis: avenues to repair the injured brain. Neural Regen Res 2024; 19:774-780. [PMID: 37843211 PMCID: PMC10664121 DOI: 10.4103/1673-5374.382224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2022] [Revised: 02/22/2023] [Accepted: 07/10/2023] [Indexed: 10/17/2023] Open
Abstract
Brain injuries due to trauma or stroke are major causes of adult death and disability. Unfortunately, few interventions are effective for post-injury repair of brain tissue. After a long debate on whether endogenous neurogenesis actually happens in the adult human brain, there is now substantial evidence to support its occurrence. Although neurogenesis is usually significantly stimulated by injury, the reparative potential of endogenous differentiation from neural stem/progenitor cells is usually insufficient. Alternatively, exogenous stem cell transplantation has shown promising results in animal models, but limitations such as poor long-term survival and inefficient neuronal differentiation make it still challenging for clinical use. Recently, a high focus was placed on glia-to-neuron conversion under single-factor regulation. Despite some inspiring results, the validity of this strategy is still controversial. In this review, we summarize historical findings and recent advances on neurogenesis strategies for neurorepair after brain injury. We also discuss their advantages and drawbacks, as to provide a comprehensive account of their potentials for further studies.
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Affiliation(s)
- Junyi Zhao
- The Brain Cognition and Brain Disease Institute (BCBDI), Shenzhen Institute of Advanced Technology, Chinese Academy of Sciences, Shenzhen, Guangdong Province, China
| | - Siyu Liu
- The Brain Cognition and Brain Disease Institute (BCBDI), Shenzhen Institute of Advanced Technology, Chinese Academy of Sciences, Shenzhen, Guangdong Province, China
| | - Xianyuan Xiang
- The Brain Cognition and Brain Disease Institute (BCBDI), Shenzhen Institute of Advanced Technology, Chinese Academy of Sciences, Shenzhen, Guangdong Province, China
- Faculty of Life and Health Sciences, Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, Shenzhen, Guangdong Province, China
| | - Xinzhou Zhu
- The Brain Cognition and Brain Disease Institute (BCBDI), Shenzhen Institute of Advanced Technology, Chinese Academy of Sciences, Shenzhen, Guangdong Province, China
- Faculty of Life and Health Sciences, Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, Shenzhen, Guangdong Province, China
- Shenzhen-Hong Kong Institute of Brain Science-Shenzhen Fundamental Research Institutions, Shenzhen, Guangdong Province, China
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Stammler R, Guillaume J, Mazighi M, Denier C, Raynouard I, Lapergue B, De Broucker T, Meseguer E, Hosseini H, Leger A, Smadja D, Lamy C, Obadia M, Moulignier A. First-ever acute ischemic strokes in HIV-infected persons: A case-control study from stroke units. Ann Clin Transl Neurol 2024; 11:916-925. [PMID: 38287505 PMCID: PMC11021677 DOI: 10.1002/acn3.52008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Revised: 12/05/2023] [Accepted: 01/09/2024] [Indexed: 01/31/2024] Open
Abstract
OBJECTIVE The stroke risk for persons living with human immunodeficiency virus (PLHIVs) doubled compared to uninfected individuals. Stroke-unit (SU)-access, acute reperfusion therapy-use and outcome data on PLHIVs admitted for acute ischemic stroke (AIS) are scarce. METHODS AIS patients admitted (01 January 2017 to 31 January 2021) to 10 representative Paris-area SUs were screened retrospectively from the National Hospitalization Database. PLHIVs were compared to age-, initial NIHSS- and sex-matched HIV-uninfected controls (HUCs). Outcome was the 90-day modified Rankin Scale score. RESULTS Among 126 PLHIVs with confirmed first-ever AIS, ~80% were admitted outside the thrombolysis-administration window. Despite antiretrovirals, uncontrolled plasma HIV loads exceeded 50 copies/mL (26% of all PLHIVs; 38% of those ≤55 years). PLHIVs' stroke causes by decreasing frequency were large artery atherosclerosis (LAA), undetermined, other cause, cerebral small-vessel disease (CSVD) or cardioembolism. No stroke etiology was associated with HIV duration or detectable HIVemia. MRI revealed previously unknown AIS in one in three PLHIVs, twice the HUC rate (p = 0.006). Neither group had optimally controlled modifiable cardiovascular risk factors (CVRFs): 20%-30% without specific hypertension, diabetes, and/or dyslipidemia treatments. Their stroke outcomes were comparable. Multivariable analyses retained good prognosis associated solely with initial NIHSS or reperfusion therapy. Older age and hypertension were associated with CSVD/LAA for all PLHIVs. Standard neurovascular care and reperfusion therapy were well-tolerated. INTERPRETATION The high uncontrolled HIV-infection rate and suboptimal CVRF treatment support heightened vigilance to counter suboptimal HIV suppression and antiretroviral adherence, and improve CVRF prevention, mainly for younger PLHIVs. Those preventive, routine measures could lower PLHIVs' AIS risk.
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Affiliation(s)
- Romain Stammler
- Department of Neurology and Stroke UnitRothschild Foundation HospitalParisFrance
| | | | - Mikael Mazighi
- APHP, Department of Neurology and Stroke Unit, Lariboisière Hospital, and Department of Interventional NeuroradiologyRothschild Foundation HospitalParisFrance
| | - Christian Denier
- APHP, Department of Neurology and Stroke UnitHôpital Bicêtre, Paris Saclay UniversityLe Kremlin–BicêtreFrance
| | - Igor Raynouard
- Department of Neurology and Stroke UnitRothschild Foundation HospitalParisFrance
| | - Bertrand Lapergue
- Department of Neurology and Stroke Unit, Foch HospitalVersailles Saint‐Quentin‐en‐Yvelines UniversitySuresnesFrance
| | - Thomas De Broucker
- Department of Neurology and Stroke UnitDelafontaine HospitalSaint‐DenisFrance
| | - Elena Meseguer
- APHP, Department of Neurology and Stroke Unit, Bichat–Claude‐Bernard Hospital, INSERM LVTS‐U1148, DHU FIREUniversity of ParisParisFrance
| | - Hassan Hosseini
- APHP, Department of Neurology and Stroke Unit, Henri‐Mondor HospitalUniversity of Paris XIICréteilFrance
| | - Anne Leger
- APHP, Stroke Unit, Pitié–Salpêtrière HospitalSorbonne UniversityParisFrance
| | - Didier Smadja
- Department of Neurology and Stroke Unit, Centre Hospitalier Sud‐FrancilienParis Saclay UniversityCorbeil‐EssonnesFrance
| | - Catherine Lamy
- Neurology Department and Stroke UnitGHU Paris Psychiatrie et Neurosciences, Sainte‐Anne HospitalParisFrance
| | - Michael Obadia
- Department of Neurology and Stroke UnitRothschild Foundation HospitalParisFrance
| | - Antoine Moulignier
- Department of Neurology and Stroke UnitRothschild Foundation HospitalParisFrance
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Mbonde AA, Chang J, Musubire AK, Okello S, Kayanja A, Moses A, Butterfield RJ, Chow FC, Saylor DR, O'Carroll CB, Siedner M. HIV Infection and 90-Day Stroke Outcomes in Uganda: A Prospective Observational Cohort Study. Neurol Clin Pract 2023; 13:e200198. [PMID: 38495078 PMCID: PMC10942001 DOI: 10.1212/cpj.0000000000200198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Accepted: 09/21/2023] [Indexed: 03/19/2024]
Abstract
Background and Objectives Little is known about the impact of HIV infection on the clinical presentation and outcomes after stroke in the modern antiretroviral therapy (ART) era. We aimed to compare stroke characteristics and outcomes between persons with HIV (PWH) and without HIV (PWOH) presenting with stroke in Uganda. Methods We conducted a matched cohort study at Mulago National Referral Hospital and Mbarara Regional Referral Hospital between January 2018 and November 2020. We enrolled consecutive PWH presenting with CT-confirmed acute or subacute stroke (symptom onset ≤14 days) and matched them by sex and stroke type to 2 consecutive available PWOH admitted to the same hospital. We obtained baseline clinical data and followed participants for 90 days from the day of clinical presentation. We compared stroke severity (defined by the NIH stroke scale [NIHSS]) and 90-day all-cause mortality and morbidity (using the modified Rankin Scale [mRS]) by HIV serostatus with and without adjustment for confounders. Results We enrolled 105 PWH and 157 PWOH with stroke. PWH were younger (mean [SD] age 49 [14] vs 59 [16] years, p < 0.001), and nearly 80% (82/105) were on ART for a median of 5 years and a median CD4 count of 214 cells/uL (interquartile range 140, 337). Compared with PWOH, PWH presented with a 3-point lower median NIHSS (16 vs 19, p = 0.011), a 20% lower proportion of all-cause mortality at 90 days (p = 0.001), and had less disability at 90 days (median mRS 4 vs 5, p = 0.004). Age and NIHSS-adjusted odds ratio of 90-day all-cause mortality in PWH compared with PWOH was 0.45 (95% CI 0.22-0.96, p = 0.037). Discussion In the modern ART era, PWH with acute stroke in Uganda present with modest stroke and are significantly less likely to die within 90 days than PWOH. This potentially reflects the protective effects of ART, enhanced health care access, and their younger age at stroke presentation.
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Affiliation(s)
- Amir A Mbonde
- Department of Medicine (AAM, AK, MS), Mbarara University of Science and Technology, Uganda; Harvard Medical School (AAM, MS); Department of Medicine (JC), Boston Medical Center, MA; Department of Medicine (Neurology) (AKM), Makerere University, Kampala, Uganda; Department of Epidemiology (SO), Gillings School of Global Public Health, University of North Carolina at Chapel Hill; Department of Radiology (AM), Mbarara University of Science and Technology, Uganda; Department of Quantitative Health Sciences (RJB), Mayo Clinic Arizona, Phoenix, AZ; Departments of Neurology and Medicine (Infectious Diseases) (FCC), University of California San Francisco; Department of Neurology (DRS), John Hopkins University School of Medicine, Baltimore, MD; Department of Internal Medicine (DRS), University Teaching Hospital, Lusaka, Zambia; Department of Neurology (CBOC), Mayo Clinic Arizona, Scottsdale; and Department of Medicine and Medical Practice Evaluation Center (MS), Massachusetts General Hospital, Boston
| | - Jonathan Chang
- Department of Medicine (AAM, AK, MS), Mbarara University of Science and Technology, Uganda; Harvard Medical School (AAM, MS); Department of Medicine (JC), Boston Medical Center, MA; Department of Medicine (Neurology) (AKM), Makerere University, Kampala, Uganda; Department of Epidemiology (SO), Gillings School of Global Public Health, University of North Carolina at Chapel Hill; Department of Radiology (AM), Mbarara University of Science and Technology, Uganda; Department of Quantitative Health Sciences (RJB), Mayo Clinic Arizona, Phoenix, AZ; Departments of Neurology and Medicine (Infectious Diseases) (FCC), University of California San Francisco; Department of Neurology (DRS), John Hopkins University School of Medicine, Baltimore, MD; Department of Internal Medicine (DRS), University Teaching Hospital, Lusaka, Zambia; Department of Neurology (CBOC), Mayo Clinic Arizona, Scottsdale; and Department of Medicine and Medical Practice Evaluation Center (MS), Massachusetts General Hospital, Boston
| | - Abdu K Musubire
- Department of Medicine (AAM, AK, MS), Mbarara University of Science and Technology, Uganda; Harvard Medical School (AAM, MS); Department of Medicine (JC), Boston Medical Center, MA; Department of Medicine (Neurology) (AKM), Makerere University, Kampala, Uganda; Department of Epidemiology (SO), Gillings School of Global Public Health, University of North Carolina at Chapel Hill; Department of Radiology (AM), Mbarara University of Science and Technology, Uganda; Department of Quantitative Health Sciences (RJB), Mayo Clinic Arizona, Phoenix, AZ; Departments of Neurology and Medicine (Infectious Diseases) (FCC), University of California San Francisco; Department of Neurology (DRS), John Hopkins University School of Medicine, Baltimore, MD; Department of Internal Medicine (DRS), University Teaching Hospital, Lusaka, Zambia; Department of Neurology (CBOC), Mayo Clinic Arizona, Scottsdale; and Department of Medicine and Medical Practice Evaluation Center (MS), Massachusetts General Hospital, Boston
| | - Samson Okello
- Department of Medicine (AAM, AK, MS), Mbarara University of Science and Technology, Uganda; Harvard Medical School (AAM, MS); Department of Medicine (JC), Boston Medical Center, MA; Department of Medicine (Neurology) (AKM), Makerere University, Kampala, Uganda; Department of Epidemiology (SO), Gillings School of Global Public Health, University of North Carolina at Chapel Hill; Department of Radiology (AM), Mbarara University of Science and Technology, Uganda; Department of Quantitative Health Sciences (RJB), Mayo Clinic Arizona, Phoenix, AZ; Departments of Neurology and Medicine (Infectious Diseases) (FCC), University of California San Francisco; Department of Neurology (DRS), John Hopkins University School of Medicine, Baltimore, MD; Department of Internal Medicine (DRS), University Teaching Hospital, Lusaka, Zambia; Department of Neurology (CBOC), Mayo Clinic Arizona, Scottsdale; and Department of Medicine and Medical Practice Evaluation Center (MS), Massachusetts General Hospital, Boston
| | - Adrian Kayanja
- Department of Medicine (AAM, AK, MS), Mbarara University of Science and Technology, Uganda; Harvard Medical School (AAM, MS); Department of Medicine (JC), Boston Medical Center, MA; Department of Medicine (Neurology) (AKM), Makerere University, Kampala, Uganda; Department of Epidemiology (SO), Gillings School of Global Public Health, University of North Carolina at Chapel Hill; Department of Radiology (AM), Mbarara University of Science and Technology, Uganda; Department of Quantitative Health Sciences (RJB), Mayo Clinic Arizona, Phoenix, AZ; Departments of Neurology and Medicine (Infectious Diseases) (FCC), University of California San Francisco; Department of Neurology (DRS), John Hopkins University School of Medicine, Baltimore, MD; Department of Internal Medicine (DRS), University Teaching Hospital, Lusaka, Zambia; Department of Neurology (CBOC), Mayo Clinic Arizona, Scottsdale; and Department of Medicine and Medical Practice Evaluation Center (MS), Massachusetts General Hospital, Boston
| | - Acan Moses
- Department of Medicine (AAM, AK, MS), Mbarara University of Science and Technology, Uganda; Harvard Medical School (AAM, MS); Department of Medicine (JC), Boston Medical Center, MA; Department of Medicine (Neurology) (AKM), Makerere University, Kampala, Uganda; Department of Epidemiology (SO), Gillings School of Global Public Health, University of North Carolina at Chapel Hill; Department of Radiology (AM), Mbarara University of Science and Technology, Uganda; Department of Quantitative Health Sciences (RJB), Mayo Clinic Arizona, Phoenix, AZ; Departments of Neurology and Medicine (Infectious Diseases) (FCC), University of California San Francisco; Department of Neurology (DRS), John Hopkins University School of Medicine, Baltimore, MD; Department of Internal Medicine (DRS), University Teaching Hospital, Lusaka, Zambia; Department of Neurology (CBOC), Mayo Clinic Arizona, Scottsdale; and Department of Medicine and Medical Practice Evaluation Center (MS), Massachusetts General Hospital, Boston
| | - Richard J Butterfield
- Department of Medicine (AAM, AK, MS), Mbarara University of Science and Technology, Uganda; Harvard Medical School (AAM, MS); Department of Medicine (JC), Boston Medical Center, MA; Department of Medicine (Neurology) (AKM), Makerere University, Kampala, Uganda; Department of Epidemiology (SO), Gillings School of Global Public Health, University of North Carolina at Chapel Hill; Department of Radiology (AM), Mbarara University of Science and Technology, Uganda; Department of Quantitative Health Sciences (RJB), Mayo Clinic Arizona, Phoenix, AZ; Departments of Neurology and Medicine (Infectious Diseases) (FCC), University of California San Francisco; Department of Neurology (DRS), John Hopkins University School of Medicine, Baltimore, MD; Department of Internal Medicine (DRS), University Teaching Hospital, Lusaka, Zambia; Department of Neurology (CBOC), Mayo Clinic Arizona, Scottsdale; and Department of Medicine and Medical Practice Evaluation Center (MS), Massachusetts General Hospital, Boston
| | - Felicia C Chow
- Department of Medicine (AAM, AK, MS), Mbarara University of Science and Technology, Uganda; Harvard Medical School (AAM, MS); Department of Medicine (JC), Boston Medical Center, MA; Department of Medicine (Neurology) (AKM), Makerere University, Kampala, Uganda; Department of Epidemiology (SO), Gillings School of Global Public Health, University of North Carolina at Chapel Hill; Department of Radiology (AM), Mbarara University of Science and Technology, Uganda; Department of Quantitative Health Sciences (RJB), Mayo Clinic Arizona, Phoenix, AZ; Departments of Neurology and Medicine (Infectious Diseases) (FCC), University of California San Francisco; Department of Neurology (DRS), John Hopkins University School of Medicine, Baltimore, MD; Department of Internal Medicine (DRS), University Teaching Hospital, Lusaka, Zambia; Department of Neurology (CBOC), Mayo Clinic Arizona, Scottsdale; and Department of Medicine and Medical Practice Evaluation Center (MS), Massachusetts General Hospital, Boston
| | - Deanna R Saylor
- Department of Medicine (AAM, AK, MS), Mbarara University of Science and Technology, Uganda; Harvard Medical School (AAM, MS); Department of Medicine (JC), Boston Medical Center, MA; Department of Medicine (Neurology) (AKM), Makerere University, Kampala, Uganda; Department of Epidemiology (SO), Gillings School of Global Public Health, University of North Carolina at Chapel Hill; Department of Radiology (AM), Mbarara University of Science and Technology, Uganda; Department of Quantitative Health Sciences (RJB), Mayo Clinic Arizona, Phoenix, AZ; Departments of Neurology and Medicine (Infectious Diseases) (FCC), University of California San Francisco; Department of Neurology (DRS), John Hopkins University School of Medicine, Baltimore, MD; Department of Internal Medicine (DRS), University Teaching Hospital, Lusaka, Zambia; Department of Neurology (CBOC), Mayo Clinic Arizona, Scottsdale; and Department of Medicine and Medical Practice Evaluation Center (MS), Massachusetts General Hospital, Boston
| | - Cumara B O'Carroll
- Department of Medicine (AAM, AK, MS), Mbarara University of Science and Technology, Uganda; Harvard Medical School (AAM, MS); Department of Medicine (JC), Boston Medical Center, MA; Department of Medicine (Neurology) (AKM), Makerere University, Kampala, Uganda; Department of Epidemiology (SO), Gillings School of Global Public Health, University of North Carolina at Chapel Hill; Department of Radiology (AM), Mbarara University of Science and Technology, Uganda; Department of Quantitative Health Sciences (RJB), Mayo Clinic Arizona, Phoenix, AZ; Departments of Neurology and Medicine (Infectious Diseases) (FCC), University of California San Francisco; Department of Neurology (DRS), John Hopkins University School of Medicine, Baltimore, MD; Department of Internal Medicine (DRS), University Teaching Hospital, Lusaka, Zambia; Department of Neurology (CBOC), Mayo Clinic Arizona, Scottsdale; and Department of Medicine and Medical Practice Evaluation Center (MS), Massachusetts General Hospital, Boston
| | - Mark Siedner
- Department of Medicine (AAM, AK, MS), Mbarara University of Science and Technology, Uganda; Harvard Medical School (AAM, MS); Department of Medicine (JC), Boston Medical Center, MA; Department of Medicine (Neurology) (AKM), Makerere University, Kampala, Uganda; Department of Epidemiology (SO), Gillings School of Global Public Health, University of North Carolina at Chapel Hill; Department of Radiology (AM), Mbarara University of Science and Technology, Uganda; Department of Quantitative Health Sciences (RJB), Mayo Clinic Arizona, Phoenix, AZ; Departments of Neurology and Medicine (Infectious Diseases) (FCC), University of California San Francisco; Department of Neurology (DRS), John Hopkins University School of Medicine, Baltimore, MD; Department of Internal Medicine (DRS), University Teaching Hospital, Lusaka, Zambia; Department of Neurology (CBOC), Mayo Clinic Arizona, Scottsdale; and Department of Medicine and Medical Practice Evaluation Center (MS), Massachusetts General Hospital, Boston
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Ku HC, Wu YL, Yip HT, Hsieh CY, Li CY, Ou HT, Chen YC, Ko NY. Herpes zoster associated with stroke incidence in people living with human immunodeficiency virus: a nested case-control study. BMC Infect Dis 2023; 23:636. [PMID: 37770849 PMCID: PMC10536781 DOI: 10.1186/s12879-023-08628-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Accepted: 09/19/2023] [Indexed: 09/30/2023] Open
Abstract
BACKGROUND The incidence of stroke is increasing among younger people with human immunodeficiency virus (HIV). The burden of stroke has shifted toward the young people living with HIV, particularly in low- and middle-income countries. People infected with herpes zoster (HZ) were more likely to suffer stroke than the general population. However, the association of HZ infection with the incidence of stroke among patients with HIV remains unclear. METHODS A nested case-control study was conducted with patients with HIV registered in the Taiwan National Health Insurance Research Database in 2000-2017. A total of 509 stroke cases were 1:10 matched to 5090 non-stroke controls on age, sex, and date of first stroke diagnosis. Logistic regression models were used to estimate the odds ratio and 95% confidence intervals (CI) of stroke incidence. RESULTS The odds ratio of stroke was significantly higher in the HIV-infected population with HZ (adjusted odds ratio [AOR]: 1.85, 95% CI: 1.42-2.41). A significantly increased AOR of stroke was associated with hypertension (AOR: 3.53, 95% CI: 2.86-4.34), heart disease (AOR: 2.32, 95% CI: 1.54-3.48), chronic kidney disease (AOR: 1.82, 95% CI: 1.16-2.85), hepatitis C virus infection (AOR: 1.49, 95% CI: 1.22-1.83), hyperlipidemia (OR: 1.41, 95% CI: 1.12-1.78), and treatment with protease inhibitors (AOR: 1.33, 95% CI: 1.05-1.69). CONCLUSIONS Our findings suggest that HZ concurrent with HIV may increase the risk of stroke. The incidence rates of stroke were independent of common risk factors, suggesting strategies for early prevention of HZ infection among people living with HIV.
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Affiliation(s)
- Han-Chang Ku
- Department of Nursing, Chang Gung University of Science and Technology, Chiayi Branch, Chiayi, Taiwan
| | - Yi-Lin Wu
- Department of Nursing, College of Medicine, National Cheng Kung University Hospital, National Cheng Kung University, Tainan, Taiwan
| | - Hei-Tung Yip
- Clinical Trial Research Center (CTC), China Medical University Hospital, Taichung, Taiwan
| | - Cheng-Yang Hsieh
- Institute of Clinical Pharmacy and Pharmaceutical Sciences, College of Medicine, National Cheng Kung University, Tainan, Taiwan
- Department of Neurology, Tainan Sin Lau Hospital, Tainan, Taiwan
| | - Chung-Yi Li
- Department of Public Health, College of Medicine, National Cheng Kung University, Tainan, Taiwan
- Department of Public Health, College of Public Health, China Medical University, Taichung, Taiwan
- Department of Healthcare Administration, College of Medical and Health Science, Asia University, Taichung, Taiwan
| | - Huang-Tz Ou
- Institute of Clinical Pharmacy and Pharmaceutical Sciences, College of Medicine, National Cheng Kung University, Tainan, Taiwan
- Department of Pharmacy, National Cheng Kung University Hospital, Tainan, Taiwan
| | - Yen-Chin Chen
- Department of Nursing, College of Medicine, National Cheng Kung University Hospital, National Cheng Kung University, Tainan, Taiwan
- Department of Nursing, College of Medicine, National Cheng Kung University, 1 University Road, Tainan, 7010, Taiwan
| | - Nai-Ying Ko
- Department of Nursing, College of Medicine, National Cheng Kung University, 1 University Road, Tainan, 7010, Taiwan.
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Tian X, Wang P, Chen S, Zhang Y, Zhang X, Xu Q, Luo Y, Wu S, Wang A. Association of serum uric acid to lymphocyte ratio, a novel inflammatory biomarker, with risk of stroke: A prospective cohort study. CNS Neurosci Ther 2023; 29:1168-1177. [PMID: 36650955 PMCID: PMC10018086 DOI: 10.1111/cns.14094] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Revised: 12/19/2022] [Accepted: 12/29/2022] [Indexed: 01/19/2023] Open
Abstract
MAIN PROBLEM Inflammation plays an important role in the pathological progress associated with stroke. Serum uric acid (SUA) to lymphocyte ratio (ULR), a novel inflammatory biomarker, has been considered as a better risk stratification tool of adverse outcomes than SUA or lymphocyte alone. This study aimed to investigate whether ULR produced more predictive value for stroke and explore the potential mediators of the associations. METHODS This study enrolled 93,023 Chinese participants without stroke and myocardial infarction at baseline. Cox proportional hazard models were used to analyze the associations of ULR with stroke and subtypes. Mediation analyses were conducted to explore potential mediators of the associations. RESULTS During a median follow-up of 13.00 years, 6081 cases of incident stroke occurred, including 5048 cases of ischemic stroke (IS) and 900 cases of hemorrhagic stroke (HS). After adjustment for confounders, the Q4 group was associated with a higher risk of HS (HR, 1.25; 95% CI, 1.03-1.50), but not with total stroke (HR, 1.07; 95% CI, 1.03-1.13) or IS (HR, 1.04; 95% CI, 0.97-1.12). No significant associations were found between SUA or lymphocyte and any stroke. ULR outperformed SUA or lymphocytes alone in predicting stroke. Additionally, the significant association between ULR and HS was partially mediated by systolic blood pressure (20.32%), diastolic blood pressure (11.18%) and estimated glomerular filtration rate (9.19%). CONCLUSIONS ULR was significantly associated with the risk of HS, but not with IS. Systolic blood pressure, diastolic blood pressure and estimated glomerular filtration rate were potential mediators for the association.
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Affiliation(s)
- Xue Tian
- Department of Epidemiology and Health Statistics, School of Public Health, Capital Medical University, Beijing, China.,Beijing Municipal Key Laboratory of Clinical Epidemiology, Beijing, China.,Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Penglian Wang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Shuohua Chen
- Department of Cardiology, Kailuan Hospital, North China University of Science and Technology, Tangshan, China
| | - Yijun Zhang
- Department of Epidemiology and Health Statistics, School of Public Health, Capital Medical University, Beijing, China.,Beijing Municipal Key Laboratory of Clinical Epidemiology, Beijing, China.,Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Xiaoli Zhang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Qin Xu
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Yanxia Luo
- Department of Epidemiology and Health Statistics, School of Public Health, Capital Medical University, Beijing, China.,Beijing Municipal Key Laboratory of Clinical Epidemiology, Beijing, China
| | - Shouling Wu
- Department of Cardiology, Kailuan Hospital, North China University of Science and Technology, Tangshan, China
| | - Anxin Wang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
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Hiransuthikul A, Chutinet A, Sophonphan J, Ubolyam S, Ruxrungtham K, Avihingsanon A. Short Communication: Incidence and Risk Factors of Ischemic Stroke and Transient Ischemic Attack Among People Living with HIV: A Longitudinal Cohort Study. AIDS Res Hum Retroviruses 2022; 38:131-134. [PMID: 34714113 DOI: 10.1089/aid.2021.0046] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
People living with HIV (PLWH) have higher ischemic cerebrovascular disease rates than HIV-negative individuals. We aimed to determine the incidence and risk factors of ischemic stroke (IS) and transient ischemic attack (TIA) among Thai PLWH. Data from adults living with HIV who were enrolled in a prospective HIV-NAT 006 cohort in Bangkok, Thailand, from 1996 to 2020 were included in the analysis. The primary endpoint was first-ever IS or TIA. Among 2020 PLWH included in the analysis, 16 (0.8%) developed first-ever IS/TIA over 23,579 person-years (incidence: 0.7 per 1,000 person-years [95% confidence interval {CI} 0.4-1.1]). Median CD4 cell counts before developing IS/TIA was 480 cells/mL and 87.5% were virologically suppressed. In multivariate models, hypertension was the only factor significantly associated with IS/TIA incidence (adjusted subhazard ratio 4.4; 95% CI 1.2-15.6, p = .02). The incidence of IS/TIA was low among well-suppressed Thai PLWH. Traditional risk factors, particularly hypertension, still play an essential role in developing IS/TIA.
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Affiliation(s)
- Akarin Hiransuthikul
- Department of Preventive and Social Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
- Division of Neurology, Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Aurauma Chutinet
- Division of Neurology, Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
- Chulalongkorn Stroke Center, Chula Neuroscience Center, King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand
| | | | | | - Kiat Ruxrungtham
- HIV-NAT, Thai Red Cross AIDS Research Centre, Bangkok, Thailand
- Tuberculosis Research Unit, Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Anchalee Avihingsanon
- HIV-NAT, Thai Red Cross AIDS Research Centre, Bangkok, Thailand
- Tuberculosis Research Unit, Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
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Wang A, Tian X, Zuo Y, Chen S, Mo D, Zhang L, Wu S, Luo Y, Wang Y. Effect of changes in serum uric acid on the risk of stroke and its subtypes. Nutr Metab Cardiovasc Dis 2022; 32:167-175. [PMID: 34857424 DOI: 10.1016/j.numecd.2021.09.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Revised: 08/31/2021] [Accepted: 09/13/2021] [Indexed: 11/19/2022]
Abstract
BACKGROUND AND AIMS The role of serum uric acid (SUA) in stroke remains controversial and analyses of changes in SUA and stroke are limited. The objective of the study was to investigate the associations of changes in SUA with stroke and its subtypes (ischemic and hemorrhagic stroke). METHODS AND RESULTS A total of 51 441 participants (mean age 52.69 ± 11.71 years) without history of myocardial infarction or stroke were enrolled. Participants were divided into four groups based on SUA level changes during 2006 and 2010: stable low, increasing, decreasing, and stable high. SUA score was quantified on a 3-point scale with 1 point awarded for hyperuricemia at either year 2006, 2008 or 2010. Multivariate Cox proportion models were used to calculated hazard ratios (HRs) and their 95% confidence intervals (CIs). During 7.03-year follow up, 1611 stroke (1410 ischemic stroke, 199 hemorrhagic stroke, and 47 subarachnoid hemorrhage) were identified. Participants with stable high SUA had higher risk of hemorrhagic stroke, the HR was 1.93 (95% CI: 1.06-3.51), compared to those with stable low SUA. Furthermore, cumulative high SUA exposure also increased the risk of hemorrhagic stroke, the HR (95%CI) was 2.99 (1.55-5.74), compared with cumulative low SUA exposure. However, no significant evidence indicated changes in SUA was associated with the risk of total and ischemic stroke, the HRs (95% CIs) were 0.98 (0.74-1.29) and 0.88 (0.65-1.19), respectively. CONCLUSIONS Stable high SUA was positively associated with the risk of hemorrhagic stroke, but not with total and ischemic stroke risk.
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Affiliation(s)
- Anxin Wang
- China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China; Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Xue Tian
- Department of Epidemiology and Health Statistics, School of Public Health, Capital Medical University, Beijing, China; Beijing Municipal Key Laboratory of Clinical Epidemiology, Beijing, China
| | - Yingting Zuo
- Department of Epidemiology and Health Statistics, School of Public Health, Capital Medical University, Beijing, China; Beijing Municipal Key Laboratory of Clinical Epidemiology, Beijing, China
| | - Shuohua Chen
- Department of Cardiology, Kailuan Hospital, North China University of Science and Technology, China
| | - Dapeng Mo
- Department of Neurological Intervention, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Licheng Zhang
- Department of Epidemiology and Health Statistics, School of Public Health, Capital Medical University, Beijing, China; Beijing Municipal Key Laboratory of Clinical Epidemiology, Beijing, China
| | - Shouling Wu
- Department of Cardiology, Kailuan Hospital, North China University of Science and Technology, China.
| | - Yanxia Luo
- Department of Epidemiology and Health Statistics, School of Public Health, Capital Medical University, Beijing, China; Beijing Municipal Key Laboratory of Clinical Epidemiology, Beijing, China.
| | - Yongjun Wang
- China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.
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Harding BN, Avoundjian T, Heckbert SR, Whitney BM, Nance RM, Ruderman SA, Kalani R, Tirschwell DL, Ho EL, Becker KJ, Zunt J, Chow F, Huffer A, Mathews WC, Eron J, Moore RD, Marra CM, Burkholder G, Saag MS, Kitahata MM, Crane HM, Delaney JC. HIV Viremia and Risk of Stroke Among People Living with HIV Who Are Using Antiretroviral Therapy. Epidemiology 2021; 32:457-464. [PMID: 33591056 PMCID: PMC8012252 DOI: 10.1097/ede.0000000000001331] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Rates of stroke are higher in people living with HIV compared with age-matched uninfected individuals. Causes of elevated stroke risk, including the role of viremia, are poorly defined. METHODS Between 1 January 2006 and 31 December 2014, we identified incident strokes among people living with HIV on antiretroviral therapy at five sites across the United States. We considered three parameterizations of viral load (VL) including (1) baseline (most recent VL before study entry), (2) time-updated, and (3) cumulative VL (copy-days/mL of virus). We used Cox proportional hazards models to estimate hazard ratios (HRs) for stroke risk comparing the 75th percentile ("high VL") to the 25th percentile ("low VL") of baseline and time-updated VL. We used marginal structural Cox models, with most models adjusted for traditional stroke risk factors, to estimate HRs for stroke associated with cumulative VL. RESULTS Among 15,974 people living with HIV, 139 experienced a stroke (113 ischemic; 18 hemorrhagic; eight were unknown type) over a median follow-up of 4.2 years. Median baseline VL was 38 copies/mL (interquartile interval: 24, 3,420). High baseline VL was associated with increased risk of both ischemic (HR: 1.3; 95% CI = 0.96-1.7) and hemorrhagic stroke (HR: 3.1; 95% CI = 1.6-5.9). In time-updated models, high VL was also associated with an increased risk of any stroke (HR: 1.8; 95% CI = 1.4-2.3). We observed no association between cumulative VL and stroke risk. CONCLUSIONS Our findings are consistent with the hypothesis that elevated HIV VL may increase stroke risk, regardless of previous VL levels.
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Affiliation(s)
| | | | - Susan R Heckbert
- Department of Epidemiology, University of Washington, Seattle, WA
| | | | - Robin M Nance
- Department of Medicine, University of Washington, Seattle, WA
| | | | - Rizwan Kalani
- Department of Medicine, University of Washington, Seattle, WA
| | | | - Emily L Ho
- Department of Medicine, University of Washington, Seattle, WA
| | - Kyra J Becker
- Department of Medicine, University of Washington, Seattle, WA
| | - Joseph Zunt
- Department of Medicine, University of Washington, Seattle, WA
| | - Felicia Chow
- Department of Medicine, University of California, San Francisco, San Francisco, CA
| | - Andrew Huffer
- Department of Medicine, University of Washington, Seattle, WA
| | | | - Joseph Eron
- Department of Medicine, University of North Carolina, Chapel Hill, NC
| | | | | | - Greer Burkholder
- Department of Medicine, University of Alabama at Birmingham, Birmingham, AL
| | - Michael S Saag
- Department of Medicine, University of Alabama at Birmingham, Birmingham, AL
| | - Mari M Kitahata
- Department of Medicine, University of Washington, Seattle, WA
| | - Heidi M Crane
- Department of Medicine, University of Washington, Seattle, WA
| | - Joseph C Delaney
- College of Pharmacy, University of Manitoba, Winnipeg, Manitoba, Canada
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Crane HM, Nance RM, Avoundjian T, Harding BN, Whitney BM, Chow FC, Becker KJ, Marra CM, Zunt JR, Ho EL, Kalani R, Huffer A, Burkholder GA, Willig AL, Moore RD, Mathews WC, Eron JJ, Napravnik S, Lober WB, Barnes GS, McReynolds J, Feinstein MJ, Heckbert SR, Saag MS, Kitahata MM, Delaney JA, Tirschwell DL. Types of Stroke Among People Living With HIV in the United States. J Acquir Immune Defic Syndr 2021; 86:568-578. [PMID: 33661824 PMCID: PMC9680532 DOI: 10.1097/qai.0000000000002598] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Accepted: 11/17/2020] [Indexed: 11/25/2022]
Abstract
BACKGROUND Most studies of stroke in people living with HIV (PLWH) do not use verified stroke diagnoses, are small, and/or do not differentiate stroke types and subtypes. SETTING CNICS, a U.S. multisite clinical cohort of PLWH in care. METHODS We implemented a centralized adjudication stroke protocol to identify stroke type, subtype, and precipitating conditions identified as direct causes including infection and illicit drug use in a large diverse HIV cohort. RESULTS Among 26,514 PLWH, there were 401 strokes, 75% of which were ischemic. Precipitating factors such as sepsis or same-day cocaine use were identified in 40% of ischemic strokes. Those with precipitating factors were younger, had more severe HIV disease, and fewer traditional stroke risk factors such as diabetes and hypertension. Ischemic stroke subtypes included cardioembolic (20%), large vessel atherosclerosis (13%), and small vessel (24%) ischemic strokes. Individuals with small vessel strokes were older, were more likely to have a higher current CD4 cell count than those with cardioembolic strokes and had the highest mean blood pressure of the ischemic stroke subtypes. CONCLUSION Ischemic stroke, particularly small vessel and cardioembolic subtypes, were the most common strokes among PLWH. Traditional and HIV-related risk factors differed by stroke type/subtype. Precipitating factors including infections and drug use were common. These results suggest that there may be different biological phenomena occurring among PLWH and that understanding HIV-related and traditional risk factors and in particular precipitating factors for each type/subtype may be key to understanding, and therefore preventing, strokes among PLWH.
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Affiliation(s)
| | | | | | | | | | | | | | - Christina M. Marra
- Neurology, University of Washington, Seattle, USA
- Medicine, University of Washington, Seattle, USA
| | - Joseph R. Zunt
- Neurology, University of Washington, Seattle, USA
- Medicine, University of Washington, Seattle, USA
- Epidemiology, University of Washington, Seattle, USA
| | - Emily L. Ho
- Neurology, University of Washington, Seattle, USA
- Swedish Neuroscience Institute, Seattle, USA
| | | | | | | | | | | | | | | | | | - William B. Lober
- Clinical Informatics Research Group, University of Washington, Seattle, USA
| | - Greg S. Barnes
- Clinical Informatics Research Group, University of Washington, Seattle, USA
| | - Justin McReynolds
- Clinical Informatics Research Group, University of Washington, Seattle, USA
| | | | | | | | | | - Joseph A.C. Delaney
- Epidemiology, University of Washington, Seattle, USA
- University of Manitoba, Manitoba, Canada
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11
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Yawoot N, Govitrapong P, Tocharus C, Tocharus J. Ischemic stroke, obesity, and the anti-inflammatory role of melatonin. Biofactors 2021; 47:41-58. [PMID: 33135223 DOI: 10.1002/biof.1690] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Accepted: 10/14/2020] [Indexed: 02/06/2023]
Abstract
Obesity is a predominant risk factor in ischemic stroke and is commonly comorbid with it. Pathologies following these conditions are associated with systemic and local inflammation. Moreover, there is increasing evidence that the susceptibility for ischemic brain damage increases substantially in experimental models of ischemic stroke with concomitant obesity. Herein, we explore the proinflammatory events that occur during ischemic stroke and obesity, and we discuss the influence of obesity on the inflammatory response and cerebral damage outcomes in experimental models of brain ischemia. In addition, because melatonin is a neurohormone widely reported to exhibit protective effects in various diseases, this study also demonstrates the anti-inflammatory role and possible mechanistic actions of melatonin in both epidemic diseases. A summary of research findings suggests that melatonin administration has great potential to exert an anti-inflammatory role and provide protection against obesity and ischemic stroke conditions. However, the efficacy of this hormonal treatment on ischemic stroke with concomitant obesity, when more serious inflammation is generated, is still lacking.
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Affiliation(s)
- Nuttapong Yawoot
- Department of Physiology, Chiang Mai University, Chiang Mai, Thailand
- Graduate School, Chiang Mai University, Chiang Mai, Thailand
| | | | | | - Jiraporn Tocharus
- Department of Physiology, Chiang Mai University, Chiang Mai, Thailand
- Functional Food Research Center for Well-being, Chiang Mai University, Chiang Mai, Thailand
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12
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Augustyn H, de Witt P, Franzsen D. The effect of HIV status on post-stroke outcomes in personal activities of daily living. Br J Occup Ther 2020. [DOI: 10.1177/0308022620902683] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Introduction This study explored the impact of HIV on the functional recovery of personal activities of daily living of stroke survivors. This assisted in identifying possible implications for the rehabilitation of stroke survivors who are also HIV-positive. Method A quantitative, descriptive, longitudinal comparative research design was used to determine the change in personal activities of daily living scores of HIV-negative and HIV-positive stroke survivors from admission to 1 month after discharge. Data were collected at a rehabilitation unit using the South African Database Functional Measure. Results There was no difference in the rate and nature of functional recovery of personal activities of daily living between the two groups between admission and discharge. A difference was noticed during the period from admission to 1 month after discharge, during which the HIV-negative group continued to show improvement, while the HIV-positive group showed little improvement or a decline in personal activities of daily living scores. Conclusions While the rate and nature of functional recovery related to personal activities of daily living for HIV-positive and HIV-negative stroke survivors is similar during inpatient care, discharge planning for the HIV-positive group needs to consider the decline in personal activities of daily living functioning post discharge. Regular follow-ups and the inclusion of the stroke survivors in an outpatient treatment programme is recommended.
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Affiliation(s)
- Hymeri Augustyn
- Department of Occupational Therapy, School of Therapeutic Sciences, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Patricia de Witt
- Department of Occupational Therapy, School of Therapeutic Sciences, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Denise Franzsen
- Department of Occupational Therapy, School of Therapeutic Sciences, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
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13
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Someeh N, Asghari Jafarabadi M, Shamshirgaran SM, Farzipoor F. The outcome in patients with brain stroke: A deep learning neural network modeling. JOURNAL OF RESEARCH IN MEDICAL SCIENCES 2020; 25:78. [PMID: 33088315 PMCID: PMC7554543 DOI: 10.4103/jrms.jrms_268_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/14/2020] [Revised: 04/11/2020] [Accepted: 04/25/2020] [Indexed: 11/19/2022]
Abstract
Background: The artificial intelligence field is obtaining ever-increasing interests for enhancing the accuracy of diagnosis and the quality of patient care. Deep learning neural network (DLNN) approach was considered in patients with brain stroke (BS) to predict and classify the outcome by the risk factors. Materials and Methods: A total of 332 patients with BS (mean age: 77.4 [standard deviation: 10.4] years, 50.6% – male) from Imam Khomeini Hospital, Ardabil, Iran, during 2008–2018 participated in this prospective study. Data were gathered from the available documents of the BS registry. Furthermore, the diagnosis of BS was considered based on computerized tomography scans and magnetic resonance imaging. The DLNN strategy was applied to predict the effects of the main risk factors on mortality. The quality of the model was measured by diagnostic indices. Results: The finding of this study for 81 selected models demonstrated that ranges of accuracy, sensitivity, and specificity are 90.5%–99.7%, 83.8%–100%, and 89.8%–99.5%, respectively. Based on the optimal model (tangent hyperbolic activation function with the minimum–maximum hidden units of 10–20, max epochs of 400, momentum of 0.5, and learning rate of 0.1), the most important predictors for BS mortality were time interval after 10 years (accuracy = 92.2%), age category (75.6%), the history of hyperlipoproteinemia (66.9%), and education level (66.9%). The other independent variables are at moderate importance (66.6%) which include sex, employment status, residential place, smoking habits, history of heart disease, cerebrovascular accident type, blood pressure, diabetes, oral contraceptive pill use, and physical activity. Conclusion: The best means for dropping the BS load is effective BS prevention. DLNN strategy showed a surprising presentation in the prediction of BS mortality based on the main risk factors with an excellent diagnostic accuracy. Moreover, the time interval after 10 years, age, the history of hyperlipoproteinemia, and education level are the most important predictors for BS.
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Affiliation(s)
- Nasrin Someeh
- Department of Statistics and Epidemiology, Faculty of Health, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Mohammad Asghari Jafarabadi
- Department of Statistics and Epidemiology, Faculty of Health, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Seyed Morteza Shamshirgaran
- Department of Statistics and Epidemiology, Faculty of Health Sciences, Neyshabur University of Medical Sciences, Neyshabur, Iran
| | - Farshid Farzipoor
- Department of Statistics and Epidemiology, Faculty of Health, Tabriz University of Medical Sciences, Tabriz, Iran
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14
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Chichetto NE, Polanka BM, So-Armah KA, Sung M, Stewart JC, Koethe JR, Edelman EJ, Tindle HA, Freiberg MS. Contribution of Behavioral Health Factors to Non-AIDS-Related Comorbidities: an Updated Review. Curr HIV/AIDS Rep 2020; 17:354-372. [PMID: 32314325 PMCID: PMC7363585 DOI: 10.1007/s11904-020-00498-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
PURPOSE OF REVIEW We summarize recent literature on the contribution of substance use and depression to non-AIDS-related comorbidities. Discussion of recent randomized clinical trials and implementation research to curtail risk attributed to each behavioral health issue is provided. RECENT FINDINGS Smoking, unhealthy alcohol use, opioid use, and depression are common among PWH and individually contribute to increased risk for non-AIDS-related comorbidities. The concurrence of these conditions is notable, yet understudied, and provides opportunity for linked-screening and potential treatment of more than one behavioral health factor. Current results from randomized clinical trials are inconsistent. Investigating interventions to reduce the impact of these behavioral health conditions with a focus on implementation into clinical care is important. Non-AIDS-defining cancers, cardiovascular disease, liver disease, and diabetes are leading causes of morbidity in people with HIV. Behavioral health factors including substance use and mental health issues, often co-occurring, likely contribute to the excess risk of non-AIDS-related comorbidities.
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Affiliation(s)
- Natalie E Chichetto
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA.
| | - Brittanny M Polanka
- Department of Psychology, Indiana University-Purdue University Indianapolis (IUPUI), Indianapolis, IN, USA
| | - Kaku A So-Armah
- Department of Medicine, Boston University School of Medicine, Boston, MA, USA
| | - Minhee Sung
- Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA
| | - Jesse C Stewart
- Department of Psychology, Indiana University-Purdue University Indianapolis (IUPUI), Indianapolis, IN, USA
| | - John R Koethe
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
- Veterans Affairs Tennessee Valley Healthcare System, Nashville, TN, USA
| | - E Jennifer Edelman
- Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA
| | - Hilary A Tindle
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
- Veterans Affairs Tennessee Valley Healthcare System, Geriatric Research Education and Clinical Centers, Nashville, TN, USA
| | - Matthew S Freiberg
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
- Veterans Affairs Tennessee Valley Healthcare System, Geriatric Research Education and Clinical Centers, Nashville, TN, USA
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Srinivasa S, Grinspoon SK. Every Minute Counts-The Time Is Now to Understand Predictors of Stroke in HIV. EClinicalMedicine 2019; 13:8-9. [PMID: 31517256 PMCID: PMC6734098 DOI: 10.1016/j.eclinm.2019.08.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2019] [Accepted: 08/08/2019] [Indexed: 11/16/2022] Open
Affiliation(s)
| | - Steven K. Grinspoon
- Metabolism Unit, Massachusetts General Hospital and Harvard Medical School, Boston, MA, United States of America
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