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Doskas T, Dardiotis E, Vavougios GD, Ntoskas KT, Sionidou P, Vadikolias K. Stroke risk in multiple sclerosis: a critical appraisal of the literature. Int J Neurosci 2023; 133:1132-1152. [PMID: 35369835 DOI: 10.1080/00207454.2022.2056459] [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: 04/21/2021] [Accepted: 03/14/2022] [Indexed: 10/18/2022]
Abstract
Observational studies suggest that the occurrence of stroke on multiple sclerosis (MS) patients is higher compared to the general population. MS is a heterogeneous disease that involves an interplay of genetic, environmental and immune factors. The occurrence of stroke is subject to a wide range of both modifiable and non-modifiable, short- and long-term risk factors. Both MS and stroke share common risk factors. The immune mechanisms that underlie stroke are similar to neurodegenerative diseases and are attributed to neuroinflammation. The inflammation in autoimmune diseases may, therefore, predispose to an increased risk for stroke or potentiate the effect of conventional stroke risk factors. There are, however, additional determinants that contribute to a higher risk and incidence of stroke in MS. Due to the challenges that are associated with their differential diagnosis, the objective is to present an overview of the factors that may contribute to increased susceptibility or occurrence of stroke in MSpatients by performing a review of the available to date literature. As both MS and stroke can individually detrimentally affect the quality of life of afflicted patients, the identification of factors that contribute to an increased risk for stroke in MS is crucial for the prompt implementation of preventative therapeutic measures to limit the additive burden that stroke imposes.
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Affiliation(s)
- Triantafyllos Doskas
- Department of Neurology, Athens Naval Hospital, Athens, Greece
- Department of Neurology, University Hospital of Alexandroupolis, Alexandroupolis, Greece
| | - Efthimios Dardiotis
- Department of Neurology, Laboratory of Neurogenetics, University Hospital of Larissa, Larissa, Greece
- Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa, Greece
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Chen J, Zhu Q, Yu L, Li Y, Jia S, Zhang J. Stroke Risk Factors of Stroke Patients in China: A Nationwide Community-Based Cross-Sectional Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19084807. [PMID: 35457673 PMCID: PMC9030671 DOI: 10.3390/ijerph19084807] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Revised: 03/31/2022] [Accepted: 04/07/2022] [Indexed: 12/12/2022]
Abstract
Background: Stroke is the leading cause of death in China, and its burdens are rapidly increasing. The prevalence and control of stroke risk factors among stroke patients in China are unknown. Objective: We investigated the stroke risk factors of stroke patients in China. Design: We examined stroke risk factors in 6580 stroke patients aged 18 years or older in the China National Chronic Diseases and Nutrition Surveillance of Adults (2015–2017). With regard to the basic characteristics of the study participants, categorical variables were described as frequency (percent). The chi-square test was used to analyze the difference between men and women. The multivariate logistic regression model was used in the multivariate analysis. Results: Among the 6580 stroke patients, hypertension was the most common stroke risk factor identified in most cases (78.51%), followed by overweight or obesity (61.58%), dyslipidemia (54.38%), smoking (24.04%), diabetes (21.75%), family history of stroke (17.43%), lack of exercise (16.35%), and atrial fibrillation (4.47%). Drinking stroke patients had a lower rate of hypertension, diabetes, and dyslipidemia. Patients with hyperuricemia had a higher rate of hypertension and dyslipidemia than no-hyperuricemia patients. The hypertension awareness, treatment, and control rates among hypertension stroke patients were 73.62%, 70.19%, and 17.79%, respectively. The diabetes awareness, treatment, and control rates among diabetes patients were 69.74%, 65.83%, and 34.59%, respectively. The dyslipidemia awareness, treatment, and control rates among dyslipidemia patients were 42.37%, 29.4%, and 20.07%, respectively. Among treated hypertension patients, the rates of taking medicine as medically advised, controlled diet, increased exercise, and blood pressure monitoring were 91.31%, 58.88%, 45.78%, and 73.99%, respectively. Among treated diabetes patients, the rates of oral antidiabetic medications, insulin injection, diet control, and blood glucose monitoring were 78.24%, 34.71%, 85.77%, and 78.24%, respectively. Among treated dyslipidemic patients, the rate of taking medicine as medical advice, controlled diet, increased exercise, and regular blood lipid monitoring was 80.61%, 77.57%, 56.46%, and 40.3%, respectively. Conclusions: The most common risk factors for community stroke patients in China are hypertension, dyslipidemia, and overweight or obesity. The stroke community patients’ suboptimal awareness and treatment of hypertension, and suboptimal awareness, treatment, and control of diabetes, and dyslipidemia are significant problems in China.
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Affiliation(s)
- Jingyi Chen
- National Institute for Nutrition and Health, Chinese Center for Disease Control and Prevention, Beijing 100050, China; (J.C.); (Q.Z.); (L.Y.); (Y.L.); (S.J.)
| | - Qianrang Zhu
- National Institute for Nutrition and Health, Chinese Center for Disease Control and Prevention, Beijing 100050, China; (J.C.); (Q.Z.); (L.Y.); (Y.L.); (S.J.)
| | - Lianlong Yu
- National Institute for Nutrition and Health, Chinese Center for Disease Control and Prevention, Beijing 100050, China; (J.C.); (Q.Z.); (L.Y.); (Y.L.); (S.J.)
- Shandong Center for Disease Control and Prevention, Ji’nan 250000, China
| | - Yuqian Li
- National Institute for Nutrition and Health, Chinese Center for Disease Control and Prevention, Beijing 100050, China; (J.C.); (Q.Z.); (L.Y.); (Y.L.); (S.J.)
- Key Laboratory of Trace Element Nutrition of National Health Commission (NHC), Beijing 100050, China
| | - Shanshan Jia
- National Institute for Nutrition and Health, Chinese Center for Disease Control and Prevention, Beijing 100050, China; (J.C.); (Q.Z.); (L.Y.); (Y.L.); (S.J.)
- Key Laboratory of Trace Element Nutrition of National Health Commission (NHC), Beijing 100050, China
| | - Jian Zhang
- National Institute for Nutrition and Health, Chinese Center for Disease Control and Prevention, Beijing 100050, China; (J.C.); (Q.Z.); (L.Y.); (Y.L.); (S.J.)
- Correspondence: ; Tel.: +86-010-6623-7147
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A clinical study of 288 patients with anterior cerebral artery infarction. J Neurol 2021; 269:2999-3005. [PMID: 34783885 DOI: 10.1007/s00415-021-10904-z] [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: 10/07/2021] [Revised: 11/05/2021] [Accepted: 11/10/2021] [Indexed: 10/19/2022]
Abstract
OBJECTIVE Acute ischemic stroke in the territory of anterior cerebral artery (ACA) is uncommon. Therefore, large population studies evaluating ACA infarction are scarce. We sought to evaluate epidemiological and etiological characteristics of ACA infarction compared to other territorial infarctions. METHODS We analyzed a prospectively collected stroke registry of all acute ischemic stroke patients for 19 years at two tertiary hospitals. We included patients with acute ischemic stroke caused by large vessel stenosis or occlusion including ACA, middle cerebral artery (MCA), posterior cerebral artery (PCA), and vertebrobasilar artery (VBA). RESULTS A total of 4171 patients were enrolled. Patients with ACA infarction (N = 288) were significantly older with more females than those with MCA, PCA, or VBA infarction. There were more patients with history of prior ischemic stroke in the ACA infarction group than in other groups. The etiology of the ACA infarction was similar to those of the MCA, PCA and also the total population (66.7-71.8% of LAA and 17.9-20.9% of CE). When patients had prior ischemic stroke history, ACA infarction was more likely to be caused by LAA than MCA or PCA infarction (OR = 6.2, 95% CI 2.0-19.2, p = 0.002 and OR = 4.0, 95% CI 1.1-14.6, p = 0.038, respectively). CONCLUSIONS Patients with ACA infarction had significantly more prior ischemic stroke than those with MCA, PCA, or VBA infarction. The etiology of ACA infarction in patients with prior ischemic stroke showed significantly more LAA than that of MCA or PCA infarction.
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Human Milk Oligosaccharide 2'-Fucosyllactose Induces Neuroprotection from Intracerebral Hemorrhage Stroke. Int J Mol Sci 2021; 22:ijms22189881. [PMID: 34576050 PMCID: PMC8467359 DOI: 10.3390/ijms22189881] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Revised: 09/09/2021] [Accepted: 09/10/2021] [Indexed: 11/17/2022] Open
Abstract
Intracerebral hemorrhage (ICH) occurs when brain blood vessels rupture, causing inflammation and cell death. 2-Fucosyllactose (2FL), a human milk oligosaccharide, has potent antiapoptotic and anti-inflammatory effects. The purpose of this study was to examine the protective effect of 2FL in cellular and rodent models of ICH. Hemin was added to a primary rat cortical neuronal and BV2 microglia coculture to simulate ICH in vitro. IBA1 and MAP2 immunoreactivities were used to determine inflammation and neuronal survival. Hemin significantly increased IBA1, while it reduced MAP2 immunoreactivity. 2FL significantly antagonized both responses. The protective effect of 2FL was next examined in a rat ICH model. Intracerebral administration of type VII collagenase reduced open-field locomotor activity. Early post-treatment with 2FL significantly improved locomotor activity. Brain tissues were collected for immunohistochemistry and qRT-PCR analysis. 2FL reduced IBA1 and CD4 immunoreactivity in the lesioned striatum. 2FL downregulated the expression of ER stress markers (PERK and CHOP), while it upregulated M2 macrophage markers (CD206 and TGFβ) in the lesioned brain. Taken together, our data support that 2FL has a neuroprotective effect against ICH through the inhibition of neuroinflammation and ER stress. 2FL may have clinical implications for the treatment of ICH.
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Strinitz M, Pham M, März AG, Feick J, Weidner F, Vogt ML, Essig F, Neugebauer H, Stoll G, Schuhmann MK, Kollikowski AM. Immune Cells Invade the Collateral Circulation during Human Stroke: Prospective Replication and Extension. Int J Mol Sci 2021; 22:9161. [PMID: 34502070 PMCID: PMC8430889 DOI: 10.3390/ijms22179161] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Revised: 08/17/2021] [Accepted: 08/24/2021] [Indexed: 01/09/2023] Open
Abstract
It remains unclear if principal components of the local cerebral stroke immune response can be reliably and reproducibly observed in patients with acute large-vessel-occlusion (LVO) stroke. We prospectively studied a large independent cohort of n = 318 consecutive LVO stroke patients undergoing mechanical thrombectomy during which cerebral blood samples from within the occluded anterior circulation and systemic control samples from the ipsilateral cervical internal carotid artery were obtained. An extensive protocol was applied to homogenize the patient cohort and to standardize the procedural steps of endovascular sample collection, sample processing, and laboratory analyses. N = 58 patients met all inclusion criteria. (1) Mean total leukocyte counts were significantly higher within the occluded ischemic cerebral vasculature (I) vs. intraindividual systemic controls (S): +9.6%, I: 8114/µL ± 529 vs. S: 7406/µL ± 468, p = 0.0125. (2) This increase was driven by neutrophils: +12.1%, I: 7197/µL ± 510 vs. S: 6420/µL ± 438, p = 0.0022. Leukocyte influx was associated with (3) reduced retrograde collateral flow (R2 = 0.09696, p = 0.0373) and (4) greater infarct extent (R2 = 0.08382, p = 0.032). Despite LVO, leukocytes invade the occluded territory via retrograde collateral pathways early during ischemia, likely compromising cerebral hemodynamics and tissue integrity. This inflammatory response can be reliably observed in human stroke by harvesting immune cells from the occluded cerebral vascular compartment.
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Affiliation(s)
- Marc Strinitz
- Department of Neuroradiology, University Hospital of Würzburg, 97080 Würzburg, Germany; (M.S.); (M.P.); (A.G.M.); (J.F.); (F.W.); (M.L.V.)
| | - Mirko Pham
- Department of Neuroradiology, University Hospital of Würzburg, 97080 Würzburg, Germany; (M.S.); (M.P.); (A.G.M.); (J.F.); (F.W.); (M.L.V.)
| | - Alexander G. März
- Department of Neuroradiology, University Hospital of Würzburg, 97080 Würzburg, Germany; (M.S.); (M.P.); (A.G.M.); (J.F.); (F.W.); (M.L.V.)
| | - Jörn Feick
- Department of Neuroradiology, University Hospital of Würzburg, 97080 Würzburg, Germany; (M.S.); (M.P.); (A.G.M.); (J.F.); (F.W.); (M.L.V.)
| | - Franziska Weidner
- Department of Neuroradiology, University Hospital of Würzburg, 97080 Würzburg, Germany; (M.S.); (M.P.); (A.G.M.); (J.F.); (F.W.); (M.L.V.)
| | - Marius L. Vogt
- Department of Neuroradiology, University Hospital of Würzburg, 97080 Würzburg, Germany; (M.S.); (M.P.); (A.G.M.); (J.F.); (F.W.); (M.L.V.)
| | - Fabian Essig
- Department of Neurology, University Hospital of Würzburg, 97080 Würzburg, Germany; (F.E.); (H.N.); (G.S.); (M.K.S.)
| | - Hermann Neugebauer
- Department of Neurology, University Hospital of Würzburg, 97080 Würzburg, Germany; (F.E.); (H.N.); (G.S.); (M.K.S.)
| | - Guido Stoll
- Department of Neurology, University Hospital of Würzburg, 97080 Würzburg, Germany; (F.E.); (H.N.); (G.S.); (M.K.S.)
| | - Michael K. Schuhmann
- Department of Neurology, University Hospital of Würzburg, 97080 Würzburg, Germany; (F.E.); (H.N.); (G.S.); (M.K.S.)
| | - Alexander M. Kollikowski
- Department of Neuroradiology, University Hospital of Würzburg, 97080 Würzburg, Germany; (M.S.); (M.P.); (A.G.M.); (J.F.); (F.W.); (M.L.V.)
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Fu K, Garvan CS, Heaton SC, Nagaraja N, Doré S. Association of Serum Bilirubin with the Severity and Outcomes of Intracerebral Hemorrhages. Antioxidants (Basel) 2021; 10:antiox10091346. [PMID: 34572977 PMCID: PMC8465680 DOI: 10.3390/antiox10091346] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2021] [Revised: 08/19/2021] [Accepted: 08/19/2021] [Indexed: 11/22/2022] Open
Abstract
Intracerebral hemorrhage (ICH) is the second most common subtype of stroke, and it is often associated with a high mortality rate and significant morbidity among survivors. Recent studies have shown that bilirubin, a product of heme metabolism, can exhibit cytoprotective, antioxidant and, anti-inflammatory properties. However, little is known about the role of bilirubin in combating several pathophysiological pathways caused by intracerebral bleeding in patients with ICH. In this study, data were collected retrospectively on 276 patients with ICH who were admitted to a university hospital between 5 January 2014 and 31 December 2017. We assessed the relationship between levels of total, direct, and indirect serum bilirubin and assessments of initial stroke severity and clinical outcomes by using Spearman’s rank correlation and Kruskal-Wallis H tests. A secondary examination of the carrier protein albumin was also undertaken. Our study found that higher levels of direct bilirubin were correlated with worse admission Glasgow Coma Scales (GCS) (rs = −0.17, p = 0.011), worse admission ICH Scores (rs = 0.19, p = 0.008), and worse discharge modified Rankin Scales (mRS) (rs = 0.15, p = 0.045). Direct bilirubin was still significantly correlated with discharge mRS after adjusting for temperature at admission (rs = 0.16, p = 0.047), oxygen saturation at admission (rs = 0.15, p = 0.048), white blood cell count (rs = 0.18, p = 0.023), or Troponin T (rs = 0.25, p = 0.001) using partial Spearman’s correlation. No statistical significance was found between levels of total or indirect bilirubin and assessments of stroke severity and outcomes. In contrast, higher levels of albumin were correlated with better admission GCS (rs = 0.13, p = 0.027), discharge GCS (rs = 0.15, p = 0.013), and discharge mRS (rs = −0.16, p = 0.023). We found that levels of total bilirubin, direct bilirubin, and albumin were all significantly related to discharge outcomes classified by discharge destinations (p = 0.036, p = 0.014, p = 0.016, respectively; Kruskal-Wallis H tests). In conclusion, higher direct bilirubin levels were associated with greater stroke severity at presentation and worse outcomes at discharge among patients with ICH. Higher levels of albumin were associated with lower stroke severity and better clinical outcomes. Future prospective studies on the free bioactive bilirubin are needed to better understand the intricate relationships between bilirubin and ICH.
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Affiliation(s)
- Kai Fu
- Department of Anesthesiology, University of Florida College of Medicine, Gainesville, FL 32610, USA; (K.F.); (C.S.G.)
| | - Cynthia S. Garvan
- Department of Anesthesiology, University of Florida College of Medicine, Gainesville, FL 32610, USA; (K.F.); (C.S.G.)
| | - Shelley C. Heaton
- Department of Clinical & Health Psychology, University of Florida College of Public Health and Health Professions, Gainesville, FL 32610, USA;
| | - Nandakumar Nagaraja
- Department of Neurology, University of Florida College of Medicine, Gainesville, FL 32610, USA;
| | - Sylvain Doré
- Department of Anesthesiology, University of Florida College of Medicine, Gainesville, FL 32610, USA; (K.F.); (C.S.G.)
- Department of Neurology, University of Florida College of Medicine, Gainesville, FL 32610, USA;
- Center for Translational Research in Neurodegenerative Disease, Departments of Psychiatry, Pharmaceutics, and Neuroscience, McKnight Brain Institute, University of Florida College of Medicine, Gainesville, FL 32610, USA
- Correspondence: ; Tel.: +1-352-273-9663
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Dias A, Silva I, Pinto IM, Maia LF. Timely and Blood-Based Multiplex Molecular Profiling of Acute Stroke. Life (Basel) 2021; 11:816. [PMID: 34440560 PMCID: PMC8398526 DOI: 10.3390/life11080816] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Revised: 08/06/2021] [Accepted: 08/07/2021] [Indexed: 12/12/2022] Open
Abstract
Stroke is a leading cause of death and disability in the world. To address such a problem, early diagnosis and tailored acute treatment represent one of the major priorities in acute stroke care. Since the efficacy of reperfusion treatments is highly time-dependent, there is a critical need to optimize procedures for faster and more precise diagnosis. We provide a concise review of the most relevant and well-documented blood-protein biomarkers that exhibit greater potential for translational to clinical practice in stroke differential diagnosis and to differentiate ischemic stroke from hemorrhagic stroke, followed by an overview of the most recent point-of-care technological approaches to address this problem. The integration of fluid-based biomarker profiling, using point-of-care biosensors with demographic, clinical, and neuroimaging parameters in multi-dimensional clinical decision-making algorithms, will be the next step in personalized stroke care.
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Affiliation(s)
- Alexandre Dias
- Department of Neurology, Centro Hospitalar Universitário do Porto (CHUPorto), 4099-001 Porto, Portugal; (A.D.); (I.S.)
- Portugal and Ipatimup—Institute of Molecular Pathology and Immunology, University of Porto, 4200-135 Porto, Portugal
| | - Isabel Silva
- Department of Neurology, Centro Hospitalar Universitário do Porto (CHUPorto), 4099-001 Porto, Portugal; (A.D.); (I.S.)
- Portugal and Molecular Neurobiology, IBMC—Instituto de Biologia Molecular e Celular, University of Porto, 4200-135 Porto, Portugal
| | - Inês Mendes Pinto
- International Iberian Nanotechnology Laboratory, 4715-330 Braga, Portugal
| | - Luís F. Maia
- Department of Neurology, Centro Hospitalar Universitário do Porto (CHUPorto), 4099-001 Porto, Portugal; (A.D.); (I.S.)
- Portugal and Molecular Neurobiology, IBMC—Instituto de Biologia Molecular e Celular, University of Porto, 4200-135 Porto, Portugal
- Instituto de Ciências Biomédicas Abel Salazar, University of Porto (ICBAS-UP), 4050-313 Porto, Portugal
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Korchagin V, Mironov K, Platonov A, Dribnokhodova O, Akselrod E, Dunaeva E, Stolyar M, Gorbenko A, Gritsan G, Olkhovskiy I, Rakova N, Roytman A, Sotnikov A, Raskurazhev A, Maksimova M, Tanashyan M, Illarioshkin S, Shipulin G. Application of the genetic risk model for the analysis of predisposition to nonlacunar ischemic stroke. Per Med 2019; 16:369-378. [PMID: 31552798 DOI: 10.2217/pme-2018-0104] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Aim: The purpose of our study was to analyze the predictive ability of the multiplicative model of genetic risk of nonlacunar ischemic stroke (IS) for independent samples from Russia. Patients & methods: A total of 181 patients and 360 healthy controls were included in this study. The discriminative accuracy of model was evaluated by the area under the receiver operating characteristic curve (AUC). Results: Classification model based on 15 single-nucleotide polymorphisms (SNPs), which are associated with a cardioembolic subtype of IS, had an AUC of 0.62 in patients with corresponding subtypes and an AUC of 0.58 for all patients. Conclusion: Risk calculation approach based on IS-associated SNPs had satisfactory performance in predicting the predisposition to the disease.
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Affiliation(s)
| | | | | | | | - Elina Akselrod
- Central Research Institute of Epidemiology, Moscow, Russia
| | - Elena Dunaeva
- Central Research Institute of Epidemiology, Moscow, Russia
| | - Marina Stolyar
- Department of Health, Krasnoyarsk Branch of the Federal State budgetary Institution 'Hematology Research Center,' Krasnoyarsk, Russia.,Federal Research Center 'Krasnoyarsk Scientific Center' of the Siberian Branch of the Russian Academy of Sciences, Krasnoyarsk, Russia
| | - Aleksey Gorbenko
- Department of Health, Krasnoyarsk Branch of the Federal State budgetary Institution 'Hematology Research Center,' Krasnoyarsk, Russia.,Federal Research Center 'Krasnoyarsk Scientific Center' of the Siberian Branch of the Russian Academy of Sciences, Krasnoyarsk, Russia
| | - Galina Gritsan
- Krasnoyarsk State Medical University named after Prof. V.F. Voino-Yasenetsky, Krasnoyarsk, Russia
| | - Igor Olkhovskiy
- Department of Health, Krasnoyarsk Branch of the Federal State budgetary Institution 'Hematology Research Center,' Krasnoyarsk, Russia.,Federal Research Center 'Krasnoyarsk Scientific Center' of the Siberian Branch of the Russian Academy of Sciences, Krasnoyarsk, Russia
| | - Natalia Rakova
- Moscow City Clinical Hospital named after S.P. Botkin, Moscow, Russia
| | - Alexander Roytman
- Moscow City Clinical Hospital named after S.P. Botkin, Moscow, Russia
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García-Cabo C, Fernández-Domínguez J, García-Rodríguez R, Mateos Marcos V. Alice in Wonderland syndrome as the initial and sole manifestation of ischaemic stroke. NEUROLOGÍA (ENGLISH EDITION) 2019. [DOI: 10.1016/j.nrleng.2018.10.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
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10
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Alamri MS, Waked IS, Amin FM, Al-Quliti KW, Manzar MD. Effectiveness of an early mobility protocol for stroke patients in Intensive Care Unit. ACTA ACUST UNITED AC 2019; 24:81-88. [PMID: 31056538 PMCID: PMC8015460 DOI: 10.17712/nsj.2019.2.20180004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
Objectives: To evaluate the effectiveness of an early mobility protocol for stroke patients in the intensive care unit. Methods: Participants were patients with first or recurrent stroke (n=60, age=49.02±6.36 years, body mass index=32.95±5.67 kg/m2) admitted to the intensive care stroke unit in general hospitals, Riyadh during October and December 2016. Single group pretest-posttest design involving an early mobility protocol was started within first 24 hours admission. Pre and post measurements of muscle strength, pulmonary function and quality of life were carried out. Results: There were significant improvements in muscle strength of upper and lower extremities´ muscles after treatment (p<0.05), pulmonary functions including Forced Vital Capacity, Forced Expiratory Volume 1 (p<0.05) and quality of life, namely, Barthel Index and modified Rankin Scale (p<0.01). Conclusion: This study demonstrates that initiating an early mobility protocol is safe and effective for intensive care unit stroke patients and supports introducing the current protocol as a standard protocol in neurogenic Intensive Care Units.
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Affiliation(s)
- Majed S Alamri
- Department of Nursing, College of Applied Medical Sciences, Majmaah University, Majmaah, Kingdom of Saudi Arabia. E-mail:
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Prevalence of Stroke and Associated Risk Factors in Sleman District of Yogyakarta Special Region, Indonesia. Stroke Res Treat 2019; 2019:2642458. [PMID: 31186829 PMCID: PMC6521526 DOI: 10.1155/2019/2642458] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2018] [Revised: 04/02/2019] [Accepted: 04/11/2019] [Indexed: 12/25/2022] Open
Abstract
Background Stroke remains one of the most common noncommunicable diseases among Indonesian populations. This study aimed to identify the prevalence of stroke and its associated risk factors in the Sleman District of Yogyakarta Special Region, Indonesia. Method This study was a secondary analysis of community-based data collected by the Sleman Health and Demographic Surveillance System (HDSS) in 2016. Basic demographic and socioeconomic data were collected. Additional questions about history of stroke and other chronic diseases were interviewed as a self-reported diagnosis. History of hormonal contraceptives use and dietary patterns were also collected. We examined the association between the prevalence of stroke and risk factors, namely, age, gender, self-reported history of chronic diseases, hormonal contraceptives use, and high-risk dietary patterns. Results The survey included 4,996 households composed of 20,465 individuals. Data regarding stroke incidents were available from 13,605 subjects aged ≥20 years old. Among them, a total of 4,884 subjects also have data regarding stroke risk factors. The overall prevalence of stroke in Sleman District was 1.4% (0.5% men and 0.90% women). The prevalence increased with additional decades of age (p<0.001). In a multivariable model, increasing age, self-reported history of hypertension (OR=8.37, 95%CI: 4.76 to 14.69), and self-reported history of diabetes mellitus (OR=2.87, 95%CI: 1.54 to 5.35) were significantly associated with stroke. Conclusions A community-based survey in Indonesia showed a high prevalence of stroke which was associated with increasing age, hypertension, and diabetes mellitus. These findings suggest that preventive actions against the aforementioned modifiable risk factors should be prioritized.
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Szőcs I, Bereczki D, Ajtay A, Oberfrank F, Vastagh I. Socioeconomic gap between neighborhoods of Budapest: Striking impact on stroke and possible explanations. PLoS One 2019; 14:e0212519. [PMID: 30785925 PMCID: PMC6382147 DOI: 10.1371/journal.pone.0212519] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2018] [Accepted: 02/04/2019] [Indexed: 12/02/2022] Open
Abstract
Introduction Hungary has a single payer health insurance system offering free healthcare for acute cerebrovascular disorders. Within the capital, Budapest, however there are considerable microregional socioeconomic differences. We hypothesized that socioeconomic deprivation reflects in less favorable stroke characteristics despite universal access to care. Methods From the database of the National Health Insurance Fund, we identified 4779 patients hospitalized between 2002 and 2007 for acute cerebrovascular disease (hereafter ACV, i.e. ischemic stroke, intracerebral hemorrhage, or transient ischemia), among residents of the poorest (District 8, n = 2618) and the wealthiest (District 12, n = 2161) neighborhoods of Budapest. Follow-up was until March 2013. Results Mean age at onset of ACV was 70±12 and 74±12 years for District 8 and 12 (p<0.01). Age-standardized incidence was higher in District 8 than in District 12 (680/100,000/year versus 518/100,000/year for ACV and 486/100,000/year versus 259/100,000/year for ischemic stroke). Age-standardized mortality of ACV overall and of ischemic stroke specifically was 157/100,000/year versus 100/100,000/year and 122/100,000/year versus 75/100,000/year for District 8 and 12. Long-term case fatality (at 1,5, and 10 years) for ACV and for ischemic stroke was higher in younger District 8 residents (41–70 years of age at the index event) compared to D12 residents of the same age. This gap between the districts increased with the length of follow-up. Of the risk diseases the prevalence of hypertension and diabetes was higher in District 8 than in District 12 (75% versus 66%, p<0.001; and 26% versus 16%, p<0.001). Discussion Despite universal healthcare coverage, the disadvantaged district has higher ACV incidence and mortality than the wealthier neighborhood. This difference affects primarily the younger age groups. Long-term follow-up data suggest that inequity in institutional rehabilitation and home-care should be investigated and improved in disadvantaged neighborhoods.
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Affiliation(s)
- Ildikó Szőcs
- Semmelweis University, Department of Neurology, Budapest, Hungary
- * E-mail:
| | - Dániel Bereczki
- Semmelweis University, Department of Neurology, Budapest, Hungary
| | - András Ajtay
- Semmelweis University, Department of Neurology, Budapest, Hungary
| | - Ferenc Oberfrank
- Institute of Experimental Medicine of the Hungarian Academy of Sciences, Budapest, Hungary
| | - Ildikó Vastagh
- Semmelweis University, Department of Neurology, Budapest, Hungary
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Analysis of the new code stroke protocol in Asturias after one year. Experience at one hospital. NEUROLOGÍA (ENGLISH EDITION) 2018. [DOI: 10.1016/j.nrleng.2017.12.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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14
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Garre-Olmo J, Garcia-Ptacek S, Calvó-Perxas L, Turró-Garriga O, López-Pousa S, Eriksdotter M. Diagnosis of Dementia in the Specialist Setting: A Comparison Between the Swedish Dementia Registry (SveDem) and the Registry of Dementias of Girona (ReDeGi). J Alzheimers Dis 2018; 53:1341-51. [PMID: 27392854 PMCID: PMC5115613 DOI: 10.3233/jad-160098] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
The aim of this study was to compare the frequency of dementia diagnoses from two dementia registries in Europe. Patients registered between 2007 and 2013 in the Swedish Dementia Registry (SveDem; Sweden) and in the Registry of Dementias of Girona (ReDeGi; North-East of Spain) were selected. We compared sociodemographic data, Mini-Mental State Examination (MMSE) scores, dementia subtype, and medication consumption of 22,384 cases from SveDem and 5,032 cases from ReDeGi. The average age (78.1 years SveDem versus 79.7 years ReDeGi) and the gender (female 58.2% SveDem versus 61.5% ReDeGi) did not greatly differ. MMSE score at diagnosis was higher for SveDem cases (22.1 versus 17.8). Alzheimer’s disease (AD) accounted for the main dementia subtype (36.6% SveDem versus 55.6% ReDeGi). The proportion of vascular dementia (VaD) and mixed dementia was higher in SveDem (18.8% versus 6.4% and 24.9 versus 13.4%), with an odds ratio (OR) and 95% confidence interval (CI) for SveDem relative to the ReDeGi of 3.41 (3.03–3.84) for VaD, and 2.15 (1.97–2.35) for mixed dementia. This was at the expense of a lower frequency of AD in SveDem (OR 0.41; 95% CI 0.39–0.44). Other dementia diagnoses such as frontotemporal dementia or dementia with Lewy bodies did not significantly differ between registries (2.3% versus 2.9%; 1.9 versus 3.1%). Large differences in medication consumption at the time of dementia diagnosis were detected (4.7 treatments SveDem versus 6.8 ReDeGi). Northern and southern European dementia cohorts differ in demographic characteristics, MMSE score at diagnosis, and drug treatment profile.
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Affiliation(s)
- Josep Garre-Olmo
- Girona Biomedical Research Institute [IDIBGI] - Institut d'Assistència Sanitària, Girona, Catalonia, Spain.,Deparment of Medical Sciences, University of Girona, Girona, Catalonia, Spain
| | - Sara Garcia-Ptacek
- Department of Neurobiology, Care Sciences and Society, Center for Alzheimer research, Division of Clinical Geriatrics, Karolinska Institutet, Huddinge, Stockholm, Sweden.,Department of Geriatric Medicine, Karolinska University Hospital, Huddinge, Stockholm, Sweden
| | - Laia Calvó-Perxas
- Girona Biomedical Research Institute [IDIBGI] - Institut d'Assistència Sanitària, Girona, Catalonia, Spain
| | - Oriol Turró-Garriga
- Girona Biomedical Research Institute [IDIBGI] - Institut d'Assistència Sanitària, Girona, Catalonia, Spain
| | - Secundino López-Pousa
- Girona Biomedical Research Institute [IDIBGI] - Institut d'Assistència Sanitària, Girona, Catalonia, Spain
| | - Maria Eriksdotter
- Department of Neurobiology, Care Sciences and Society, Center for Alzheimer research, Division of Clinical Geriatrics, Karolinska Institutet, Huddinge, Stockholm, Sweden.,Department of Geriatric Medicine, Karolinska University Hospital, Huddinge, Stockholm, Sweden
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Stevanovic A, Tasic D, Tasic N, Dragisic D, Mitrovic M, Deljanin-Ilic M, Ilic S, Citakovic Z. Similarities and Differences in Epidemiology and Risk Factors of Cerebral and Myocardial Ischemic Disease. SERBIAN JOURNAL OF EXPERIMENTAL AND CLINICAL RESEARCH 2017. [DOI: 10.1515/sjecr-2017-0045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Abstract
Ischemic heart disease and cerebral ischemia represent the leading causes of mortality worldwide. Both entities share risk factors, pathophisiology and etiologic aspects by means of a main common mechanism, atherosclerosis. The autors aimed to investigate differences and similarities in epidemiology and risk factors that could be found between both entities. In a retrospective sudy 403 patients were included and divided into two groups: group of 289 patients with history of myocardial infarction (AMI), and group of 114 patients with history of ischemic stroke (IS). All patients were evaluated for nonmodifiable risk faktors, which included age and sex, and modifiable, such as hypertension, dyslipidemia, diabetes, obesity, physical activity and smoking. Diff erences in some epidemiological aspects were also considered: occupation, marital status, alcohol consumption, exposure to stress. Patients with history of IS were significantly older then AMI patients (64.0 ± 9.9 vs 64.0 ± 9.9, p=0,028), with higher diastolic blood pressure (87,1 ± 10,2 vs 83,6 ± 10,4, p=0,003) and higher Sokolow-Lyon index in ECG, an also index of left ventricular hypertrophy (19,2 ± 9,1 vs 14,7 ± 6,5). Th ere were no significant differences between groups in the estimated body mass index and waist circumference. Differences between groups in stress exposure, occupation, alcohol consumption or physical activity were no significant. Patients in AMI group were more frequently male (199 (69%) vs 59 (52%), p=0,001), married (252 (87%) vs 88 (77%), p=0,037), smokers (162 (56%) vs 50 (44%), p=0,018) and with higher incidence od dyslipidemia (217 (75%) vs 73 (64%), p=0,019) compared with IS group. Incidence of arterial hypertension and diabetes was similar in both groups. Both entities share similar pathophysiological mechanisms and, consequently, main traditional risk factors. However, incidence of myocardial infarction increases with male sex, dyslipidemia, smoking and marital status, while incidense of ischemic stroke increases with age, higher diastolic blood pressure and also with ECG signs of left ventricular hypertrophy.
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Affiliation(s)
- Angelina Stevanovic
- Hispa - Hypertension, infarction & stroke prevention association, Belgrade , Serbia
| | - Danijela Tasic
- Dedinje Cardiovascular Institute, School of Medicine, Belgrade , Serbia
| | - Nebojsa Tasic
- Dedinje Cardiovascular Institute, School of Medicine, Belgrade , Serbia
| | | | - Miroslav Mitrovic
- Hispa - Hypertension, infarction & stroke prevention association, Belgrade , Serbia
| | | | - Stevan Ilic
- Institute for rehabilitation „Niska Banja“, Nis , Serbia
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Hernández Medrano I, Guillán M, Masjuan J, Alonso Cánovas A, Gogorcena M. Reliability of the minimum basic dataset for diagnoses of cerebrovascular disease. NEUROLOGÍA (ENGLISH EDITION) 2017. [DOI: 10.1016/j.nrleng.2014.12.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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17
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García-Cabo C, Fernández-Domínguez J, García-Rodríguez R, Mateos Marcos V. Alice in Wonderland syndrome as the initial and sole manifestation of ischaemic stroke. Neurologia 2017; 34:487-488. [PMID: 28081974 DOI: 10.1016/j.nrl.2016.10.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2016] [Revised: 10/21/2016] [Accepted: 10/29/2016] [Indexed: 11/17/2022] Open
Affiliation(s)
- C García-Cabo
- Servicio de Neurología, Centro Médico de Asturias, Oviedo, Asturias, España.
| | | | - R García-Rodríguez
- Servicio de Neurología, Centro Médico de Asturias, Oviedo, Asturias, España
| | - V Mateos Marcos
- Servicio de Neurología, Centro Médico de Asturias, Oviedo, Asturias, España
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Monge-Pereira E, Molina-Rueda F, Rivas-Montero F, Ibáñez J, Serrano J, Alguacil-Diego I, Miangolarra-Page J. Electroencephalography as a post-stroke assessment method: An updated review. NEUROLOGÍA (ENGLISH EDITION) 2017. [DOI: 10.1016/j.nrleng.2014.07.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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Analysis of the new code stroke protocol in Asturias after one year. Experience at one hospital. Neurologia 2016; 33:92-97. [PMID: 27469579 DOI: 10.1016/j.nrl.2016.06.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2016] [Revised: 06/01/2016] [Accepted: 06/03/2016] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION Prehospital code stroke (CS) systems have been proved effective for improving access to specialised medical care in acute stroke cases. They also improve the prognosis of this disease, which is one of the leading causes of death and disability in our setting. The aim of this study is to analyse results one year after implementation of the new code stroke protocol at one hospital in Asturias. PATIENTS AND METHODS We prospectively included patients who were admitted to our tertiary care centre as per the code stroke protocol for the period of one year. RESULTS We analysed 363 patients. Mean age was 69 years and 54% of the cases were men. During the same period in the previous year, there were 236 non-hospital CS activations. One hundred forty-seven recanalisation treatments were performed (66 fibrinolysis and 81 mechanical thrombectomies or combined treatments), representing a 25% increase with regard to the previous year. CONCLUSIONS Recent advances in the management of acute stroke call for coordinated code stroke protocols that are adapted to the needs of each specific region. This may result in an increased number of patients receiving early care, as well as revascularisation treatments.
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Godoy D, Piñero G, Cruz-Flores S, Alcalá Cerra G, Rabinstein A. Malignant hemispheric infarction of the middle cerebral artery. Diagnostic considerations and treatment options. NEUROLOGÍA (ENGLISH EDITION) 2016. [DOI: 10.1016/j.nrleng.2013.02.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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21
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Code stroke in Asturias. NEUROLOGÍA (ENGLISH EDITION) 2016. [DOI: 10.1016/j.nrleng.2015.07.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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22
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Cherbuin N, Carey L, Mortby M, Anstey KJ. Predictors of future stroke in adults 60-64 years living in the community. World J Neurol 2016; 6:14-22. [DOI: 10.5316/wjn.v6.i1.14] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2015] [Revised: 10/20/2015] [Accepted: 01/07/2016] [Indexed: 02/06/2023] Open
Abstract
AIM: To investigate predictors of incident stroke in a large epidemiological sample of cognitively healthy individuals in their early 60’s.
METHODS: Cardiovascular (systolic and diastolic blood pressure, hypertension status and medication, body mass index, lung forced vital capacity), lifestyle (alcohol intake, smoking, physical activity), mental health (anxiety and depression status, medication and symptomatology), cognition (executive function, processing speed, working memory, sensorimotor skills), and personality measures (behavioural inhibition and activation, positive and negative affect, neuroticism, psychoticism, extraversion) were investigated as predictors of incident stroke in 1774 participants from the Personality and Total Health Through Life Project over an 8-year follow-up. Logistic regression analyses controlled for age, gender, and education were conducted in the whole cohort as well as in case-control sub-analyses including precisely matched controls to identify factors associated with stroke incidence.
RESULTS: The cohort selected had a mean age of 62.5 years (SD = 1.5) and was 48.6% female with an average of 14.1 years of education (SD = 2.6). When 28 individuals with incident stroke were compared to 1746 cognitively healthy individuals in multivariate logistic regression analyses the only significant predictors of stroke across the five domains considered (cardiovascular, lifestyle, mental health, cognition, personality) and after controlling for gender, age, and education were systolic blood pressure (per unit above 140 mmHg: OR = 1.04, 95%CI: 1.01-1.07, P = 0.002), smoking (trend OR = 2.28, 95%CI: 0.99-5.24, P = 0.052), and sensorimotor skills (purdue pegboard: OR = 0.80, 95%CI: 0.62-0.96, P = 0.037). Similarly, in matched-control analyses significant group differences were found for systolic blood pressure (P = 0.001), smoking (P = 0.036), and sensorimotor skills (P = 0.028).
CONCLUSION: Identified predictors of incident stroke in community-living individuals included high systolic blood pressure and smoking - but also, sensorimotor performance, a measure which has not yet been reported in the literature.
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Muñoz-Rivas N, Méndez-Bailón M, Hernández-Barrera V, de Miguel-Yanes JM, Jimenez-Garcia R, Esteban-Hernández J, Lopez-de-Andrés A. Type 2 Diabetes and Hemorrhagic Stroke: A Population-Based Study in Spain from 2003 to 2012. J Stroke Cerebrovasc Dis 2016; 25:1431-43. [PMID: 27017281 DOI: 10.1016/j.jstrokecerebrovasdis.2016.02.031] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2015] [Revised: 01/16/2016] [Accepted: 02/24/2016] [Indexed: 12/12/2022] Open
Abstract
AIM The objective of this study is to compare trends in outcomes for intracerebral hemorrhagic stroke in people with or without type 2 diabetes in Spain between 2003 and 2012. METHODS We selected all patients hospitalized for hemorrhagic stroke using national hospital discharge data. We evaluated annual incident rates stratified by diabetes status. We analyzed trends in the use of diagnostic and therapeutic procedures, patient comorbidities, in-hospital mortality (IHM), length of hospital stay, and readmission rate in 1 month. RESULTS We identified a total of 173,979 discharges of patients admitted with hemorrhagic stroke (19.1% with diabetes). Incidences were higher among those with than those without diabetes in all the years studied. Diabetes was positively associated with stroke (incidence rate ratio [IRR] = 1.38, 95% confidence interval [CI] 1.35-1.40 for men; IRR = 1.31, 95% CI 1.29-1.34 for women). Length of stay decreased significantly and readmission rate remained stable for both groups (around 5%). We observed a significant increase in the use of decompressive craniectomy from 2002 to 2013. Mortality was positively associated with older age, with higher comorbidity and atrial fibrillation as risk factors. We found a negative association with the use of decompressive craniectomy. Mortality did not change over time among diabetic men and women. In those without diabetes, mortality decreased significantly over time. Suffering diabetes was not associated with higher mortality. CONCLUSIONS Type 2 diabetes is associated with higher incidence of hemorrhagic stroke but not with IHM. Incidence among diabetic people remained stable over time. In both groups, the use of decompressive craniectomy has increased and is associated with a decreased mortality.
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Affiliation(s)
- Nuria Muñoz-Rivas
- Medicine Department, Hospital Universitario Infanta Leonor, Madrid, Spain
| | | | - Valentín Hernández-Barrera
- Preventive Medicine and Public Health Teaching and Research Unit, Health Sciences Faculty, Rey Juan Carlos University, Madrid, Spain
| | | | - Rodrigo Jimenez-Garcia
- Preventive Medicine and Public Health Teaching and Research Unit, Health Sciences Faculty, Rey Juan Carlos University, Madrid, Spain.
| | - Jesus Esteban-Hernández
- Preventive Medicine and Public Health Teaching and Research Unit, Health Sciences Faculty, Rey Juan Carlos University, Madrid, Spain
| | - Ana Lopez-de-Andrés
- Preventive Medicine and Public Health Teaching and Research Unit, Health Sciences Faculty, Rey Juan Carlos University, Madrid, Spain
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Muñoz-Rivas N, Méndez-Bailón M, Hernández-Barrera V, de Miguel-Yanes JM, Jiménez-García R, Esteban-Hernández J, Jiménez-Trujillo I, Alvaro-Meca A, Carrasco-Garrido P, de Miguel-Díez J, López-de-Andrés A. Time Trends in Ischemic Stroke among Type 2 Diabetic and Non-Diabetic Patients: Analysis of the Spanish National Hospital Discharge Data (2003-2012). PLoS One 2015; 10:e0145535. [PMID: 26713435 PMCID: PMC4700977 DOI: 10.1371/journal.pone.0145535] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2015] [Accepted: 12/04/2015] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Type 2 Diabetes (T2DM) is the most rapidly increasing risk factor for ischemic stroke. We aimed to compare trends in outcomes for ischemic stroke in people with or without diabetes in Spain between 2003 and 2012. METHODS We selected all patients hospitalized for ischemic stroke using national hospital discharge data. We evaluated annual incident rates stratified by T2DM status. We analyzed trends in the use of diagnostic and therapeutic procedures, patient comorbidities, and in-hospital outcomes. We calculated in-hospital mortality (IHM), length of hospital stay (LOHS) and readmission rate in one month after discharge. Time trend on the incidence of hospitalization was estimated fitting Poisson regression models by sex and diabetes variables. In-hospital mortality was analyzed using logistic regression models separate for men and women. LOHS were compared with ANOVA or Kruskal-Wallis when necessary. RESULTS We identified a total of 423,475 discharges of patients (221,418 men and 202,057 women) admitted with ischemic stroke as primary diagnosis. Patients with T2DM accounted for 30.9% of total. The estimated incidence rates of discharges increased significantly in all groups. The incidence of hospitalization due to stroke (with ICD9 codes for stroke as main diagnosis at discharge) was higher among those with than those without diabetes in all the years studied. T2DM was positively associated with ischemic stroke with an adjusted incidence rate ratio (IRR) of 2.27 (95% CI 2.24-2.29) for men and 2.15 (95%CI 2.13-2.17) for women. Over the 10 year period LOHS decreased significantly in men and women with and without diabetes. Readmission rate remained stable in diabetic and non diabetic men (around 5%) while slightly increased in women with and without diabetes. We observed a significant increase in the use of fibrinolysis from 2002-2013. IHM was positively associated with older age in all groups, with Charlson Comorbidity Index > 3 and atrial fibrillation as risk factors. The IHM did not change significantly over time among T2DM men and women ranging from 9.25% to 10.56% and from 13.21% to 14.86%, respectively; neither did among non-diabetic women. However, in men without T2DM IHM decreased significantly over time. Diabetes was associated to higher IHM only in women (OR 1.07; 95% CI, 1.05-1.11). CONCLUSIONS Our national data show that incidence rate of ischemic stroke hospitalization increased significantly during the period of study (2003-2012). People with T2DM have more than double the risk of ischemic stroke after adjusting for other risk factors. Women with T2DM had poorer outcomes- IHM and readmission rates- than diabetic men. Diabetes was an independent factor for IHM only in women.
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Affiliation(s)
- Nuria Muñoz-Rivas
- Medicine Department, Hospital Universitario Infanta Leonor, Madrid, Spain
| | - Manuel Méndez-Bailón
- Medicine Department, Hospital Clínico San Carlos, Madrid, Comunidad de Madrid, Spain
| | - Valentín Hernández-Barrera
- Preventive Medicine and Public Health Teaching and Research Unit, Health Sciences Faculty, Rey Juan Carlos University, Alcorcon, Comunidad de Madrid, Spain
| | | | - Rodrigo Jiménez-García
- Preventive Medicine and Public Health Teaching and Research Unit, Health Sciences Faculty, Rey Juan Carlos University, Alcorcon, Comunidad de Madrid, Spain
| | - Jesús Esteban-Hernández
- Preventive Medicine and Public Health Teaching and Research Unit, Health Sciences Faculty, Rey Juan Carlos University, Alcorcon, Comunidad de Madrid, Spain
| | - Isabel Jiménez-Trujillo
- Preventive Medicine and Public Health Teaching and Research Unit, Health Sciences Faculty, Rey Juan Carlos University, Alcorcon, Comunidad de Madrid, Spain
| | - Alejandro Alvaro-Meca
- Preventive Medicine and Public Health Teaching and Research Unit, Health Sciences Faculty, Rey Juan Carlos University, Alcorcon, Comunidad de Madrid, Spain
| | - Pilar Carrasco-Garrido
- Preventive Medicine and Public Health Teaching and Research Unit, Health Sciences Faculty, Rey Juan Carlos University, Alcorcon, Comunidad de Madrid, Spain
| | - Javier de Miguel-Díez
- Pneumology Department, Hospital General Universitario Gregorio Marañón, Universidad Complutense de Madrid, Madrid, Spain
| | - Ana López-de-Andrés
- Preventive Medicine and Public Health Teaching and Research Unit, Health Sciences Faculty, Rey Juan Carlos University, Alcorcon, Comunidad de Madrid, Spain
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Code stroke in Asturias. Neurologia 2015; 31:143-8. [PMID: 26394912 DOI: 10.1016/j.nrl.2015.07.012] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2015] [Revised: 06/21/2015] [Accepted: 07/19/2015] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Intravenous thrombolysis with alteplase is an effective treatment for ischaemic stroke when applied during the first 4.5 hours, but less than 15% of patients have access to this technique. Mechanical thrombectomy is more frequently able to recanalise proximal occlusions in large vessels, but the infrastructure it requires makes it even less available. METHODS We describe the implementation of code stroke in Asturias, as well as the process of adapting various existing resources for urgent stroke care in the region. By considering these resources, and the demographic and geographic circumstances of our region, we examine ways of reorganising the code stroke protocol that would optimise treatment times and provide the most appropriate treatment for each patient. RESULTS We distributed the 8 health districts in Asturias so as to permit referral of candidates for reperfusion therapies to either of the 2 hospitals with 24-hour stroke units and on-call neurologists and providing IV fibrinolysis. Hospitals were assigned according to proximity and stroke severity; the most severe cases were immediately referred to the hospital with on-call interventional neurology care. Patient triage was provided by pre-hospital emergency services according to the NIHSS score. CONCLUSIONS Modifications to code stroke in Asturias have allowed us to apply reperfusion therapies with good results, while emphasising equitable care and managing the severity-time ratio to offer the best and safest treatment for each patient as soon as possible.
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Hernández Medrano I, Guillán M, Masjuan J, Alonso Cánovas A, Gogorcena MA. Reliability of the minimum basic dataset for diagnoses of cerebrovascular disease. Neurologia 2015; 32:74-80. [PMID: 25728952 DOI: 10.1016/j.nrl.2014.12.007] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2014] [Revised: 12/10/2014] [Accepted: 12/19/2014] [Indexed: 10/23/2022] Open
Abstract
INTRODUCTION The minimum basic dataset is the largest available hospital care administrative database that is used in clinical studies and hospital management in association with diagnosis-related groups (DRGs). In 2011, the quality of the national MBDS in hospital discharges was audited, in order to assess its reliability. This paper presents a sub-analysis of the results from that analysis which are referred to cerebrovascular disease (CVD). METHODS Using all discharge reports from the Spanish MBDS in 2009, a representative sample was obtained by stratified sampling and 11 209 records were evaluated. Outcome indicators were obtained to measure any differences observed between the national MBDS being evaluated and the hospital's original MBDS. Analysis of codes for CVD as a primary diagnosis was performed for ICD-9-CM diagnostic categories 430 through 438. We evaluated error rates in the selection and classification of main diagnoses, as well as in DRG assignment. RESULTS There were 397 discharges of cases of CVD which included 21 different DRGs. Diagnostic coding showed a concordance rate of 81.87%; the selection error rate was 2.26% and the classification error rate was 15.87%. The error rate in the DRG was 16.12% and associated with the greatest impact on the mortality risk level. CONCLUSIONS While the errors we observed must be taken into account, data suggest that the quality of the MBDS for CVD is sufficient to ensure delivery of valid information. The hospital discharge registry serves as a valuable tool for use in studies of this disease.
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Affiliation(s)
- I Hernández Medrano
- Servicio de Neurología, Unidad de Ictus, Hospital Universitario Ramón y Cajal. Madrid, España.
| | - M Guillán
- Servicio de Neurología, Unidad de Ictus, Hospital Universitario Ramón y Cajal. Madrid, España
| | - J Masjuan
- Servicio de Neurología, Unidad de Ictus, Hospital Universitario Ramón y Cajal. Madrid, España
| | - A Alonso Cánovas
- Servicio de Neurología, Unidad de Ictus, Hospital Universitario Ramón y Cajal. Madrid, España
| | - M A Gogorcena
- Instituto de Información Sanitaria, Ministerio de Sanidad, Servicios Sociales e Igualdad. Madrid, España
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Monge-Pereira E, Molina-Rueda F, Rivas-Montero FM, Ibáñez J, Serrano JI, Alguacil-Diego IM, Miangolarra-Page JC. Electroencephalography as a post-stroke assessment method: An updated review. Neurologia 2014; 32:40-49. [PMID: 25288536 DOI: 10.1016/j.nrl.2014.07.002] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2014] [Revised: 07/24/2014] [Accepted: 07/30/2014] [Indexed: 01/01/2023] Open
Abstract
Given that stroke is currently a serious problem in the population, employing more reliable and objective techniques for determining diagnosis and prognosis is necessary in order to enable effective clinical decision-making. EEG is a simple, low-cost, non-invasive tool that can provide information about the changes occurring in the cerebral cortex during the recovery process after stroke. EEG provides data on the evolution of cortical activation patterns which can be used to establish a prognosis geared toward harnessing each patient's full potential. This strategy can be used to prevent compensation and maladaptive plasticity, redirect treatments, and develop new interventions that will let stroke patients reach their new maximum motor levels.
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Affiliation(s)
- E Monge-Pereira
- Departamento de Fisioterapia, Terapia Ocupacional, Rehabilitación y Medicina Física, Facultad de CC de la Salud, Universidad Rey Juan Carlos. Alcorcón, Madrid, España; Laboratorio de Análisis del Movimiento, Biomecánica, Ergonomía y Control Motor, Universidad Rey Juan Carlos, Alcorcón, Madrid, España.
| | - F Molina-Rueda
- Departamento de Fisioterapia, Terapia Ocupacional, Rehabilitación y Medicina Física, Facultad de CC de la Salud, Universidad Rey Juan Carlos. Alcorcón, Madrid, España; Laboratorio de Análisis del Movimiento, Biomecánica, Ergonomía y Control Motor, Universidad Rey Juan Carlos, Alcorcón, Madrid, España
| | - F M Rivas-Montero
- Departamento de Fisioterapia, Terapia Ocupacional, Rehabilitación y Medicina Física, Facultad de CC de la Salud, Universidad Rey Juan Carlos. Alcorcón, Madrid, España; Laboratorio de Análisis del Movimiento, Biomecánica, Ergonomía y Control Motor, Universidad Rey Juan Carlos, Alcorcón, Madrid, España
| | - J Ibáñez
- Instituto Cajal, Consejo Superior de Investigaciones Científicas, Madrid, España
| | - J I Serrano
- Grupo de Bioingeniería, Consejo Superior de Investigaciones Científicas, Arganda del Rey, Madrid, España
| | - I M Alguacil-Diego
- Departamento de Fisioterapia, Terapia Ocupacional, Rehabilitación y Medicina Física, Facultad de CC de la Salud, Universidad Rey Juan Carlos. Alcorcón, Madrid, España; Laboratorio de Análisis del Movimiento, Biomecánica, Ergonomía y Control Motor, Universidad Rey Juan Carlos, Alcorcón, Madrid, España
| | - J C Miangolarra-Page
- Departamento de Fisioterapia, Terapia Ocupacional, Rehabilitación y Medicina Física, Facultad de CC de la Salud, Universidad Rey Juan Carlos. Alcorcón, Madrid, España; Laboratorio de Análisis del Movimiento, Biomecánica, Ergonomía y Control Motor, Universidad Rey Juan Carlos, Alcorcón, Madrid, España
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Catalá-López F, Fernández de Larrea-Baz N, Morant-Ginestar C, Álvarez-Martín E, Díaz-Guzmán J, Gènova-Maleras R. The national burden of cerebrovascular diseases in Spain: a population-based study using disability-adjusted life years. Med Clin (Barc) 2014; 144:353-9. [PMID: 24863563 DOI: 10.1016/j.medcli.2013.11.040] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2013] [Revised: 11/26/2013] [Accepted: 11/28/2013] [Indexed: 10/25/2022]
Abstract
BACKGROUND AND OBJECTIVE The aim of the present study was to determine the national burden of cerebrovascular diseases in the adult population of Spain. PATIENTS AND METHODS Cross-sectional, descriptive population-based study. We calculated the disability-adjusted life years (DALY) metric using country-specific data from national statistics and epidemiological studies to obtain representative outcomes for the Spanish population. DALYs were divided into years of life lost due to premature mortality (YLLs) and years of life lived with disability (YLDs). DALYs were estimated for the year 2008 by applying demographic structure by sex and age-groups, cause-specific mortality, morbidity data and new disability weights proposed in the recent Global Burden of Disease study. In the base case, neither YLLs nor YLDs were discounted or age-weighted. Uncertainty around DALYs was tested using sensitivity analyses. RESULTS In Spain, cerebrovascular diseases generated 418,052 DALYs, comprising 337,000 (80.6%) YLLs and 81,052 (19.4%) YLDs. This accounts for 1,113 DALYs per 100,000 population (men: 1,197 and women: 1,033) and 3,912 per 100,000 in those over the age of 65 years (men: 4,427 and women: 2,033). Depending on the standard life table and choice of social values used for calculation, total DALYs varied by 15.3% and 59.9% below the main estimate. CONCLUSIONS Estimates provided here represent a comprehensive analysis of the burden of cerebrovascular diseases at a national level. Prevention and control programmes aimed at reducing the disease burden merit further priority in Spain.
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Affiliation(s)
- Ferrán Catalá-López
- Division of Pharmacoepidemiology and Pharmacovigilance, Spanish Medicines and Healthcare Products Agency (AEMPS), Madrid, Spain; Fundación Instituto de Investigación en Servicios de Salud, Valencia, Spain.
| | - Nerea Fernández de Larrea-Baz
- Health Research, Training and Infrastructures General Directorate, Regional Health Council, Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), Madrid, Spain
| | - Consuelo Morant-Ginestar
- Unidad Docente de Medicina Familiar y Comunitaria Este, Ramón y Cajal University Hospital, Madrid, Spain
| | - Elena Álvarez-Martín
- Department of Preventive Medicine and Public Health, Rey Juan Carlos University, Madrid, Spain
| | - Jaime Díaz-Guzmán
- Stroke Unit, Neurology Department, 12 de Octubre University Hospital, Faculty of Medicine, Complutense University, Madrid, Spain
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Brea A, Laclaustra M, Martorell E, Pedragosa A. [Epidemiology of cerebrovascular disease in Spain]. CLINICA E INVESTIGACION EN ARTERIOSCLEROSIS 2013; 25:211-7. [PMID: 24238835 DOI: 10.1016/j.arteri.2013.10.006] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/16/2013] [Accepted: 10/23/2013] [Indexed: 11/17/2022]
Abstract
In Spain, cerebrovascular disease (CVD) is a very common cause of morbidity and hospitalization. They are the second leading cause of mortality in the general population, and the first in women. They also constitute a very high social spending, which is estimated to increase in coming years, due to the aging of our population. Data from the Hospital Morbidity Survey of the National Statistics Institute recorded, in 2011, 116,017 strokes and 14,933 transient ischemic attacks, corresponding, respectively, to an incidence of 252 and 32 events per 100,000 people. In 2002, the cost of hospitalization for each stroke was estimated at €3,047. The amount of total cost health care throughout the life of a stroke patient is calculated at €43,129. Internationally, the direct costs of stroke constitute 3% of national health spending, this being similar amount in different countries around us. Hypertension was the cardiovascular risk factor (CVRF) more prevalent in both ischemic and hemorrhagic strokes, followed by dyslipidemia and diabetes mellitus. Peripheral arterial disease and hypertension were more frequently associated with atherothrombotic events, atrial fibrillation with cardioembolic strokes, and obesity and high blood pressure to lacunar infarcts. In Spain, as showing several studies, we are far from optimal control of CVRF, especially in secondary prevention of stroke. According to the ICTUSCARE study, achieving recommended values was 17.6% in the case of hypertension, 29.8% in LDL-cholesterol, 74.9% of smoking, and 50.2% in diabetes mellitus. In this review, we analyze in detail the epidemiology, prevention and costs originated by CVD.
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Affiliation(s)
- Angel Brea
- Unidad de Lípidos, Servicio de Medicina Interna, Hospital San Pedro, Logroño, España.
| | - Martín Laclaustra
- Departamento de Epidemiología, Aterotrombosis e Imagen, Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, España
| | | | - Angels Pedragosa
- Servei d'Urgències Mèdiques, Hospital del Mar, Universitat Autònoma de Barcelona, Barcelona, España
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Ramalle-Gomara E, Ruiz E, Serrano M, Bártulos M, González MÁ, Matute B. Hospital Discharges and Mortality Registries: 2 Complementary Databases for the Epidemiological Surveillance of Stroke. J Stroke Cerebrovasc Dis 2013; 22:e441-5. [DOI: 10.1016/j.jstrokecerebrovasdis.2013.04.039] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2013] [Revised: 04/24/2013] [Accepted: 04/29/2013] [Indexed: 11/26/2022] Open
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Ramalle-Gomara E, Ruiz E, Serrano M, Bartulos M, Gonzalez MA, Matute B. Validity of discharge diagnoses in the surveillance of stroke. Neuroepidemiology 2013; 41:185-8. [PMID: 24051447 DOI: 10.1159/000354626] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2013] [Accepted: 07/22/2013] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND Hospital administrative data have been suggested as a valuable cost-effective tool for providing information about the stroke burden. Nevertheless, the choice of the diagnosis codes has been a critical issue in the development of case ascertainment algorithms. METHODS In this study, the Minimum Basic Data Set administrative database was used to analyze the accuracy of different ICD-9-CM algorithms based on the neurologist's clinical judgement as the 'gold standard'. RESULTS The most accurate algorithm observed in our study involved the selection of ICD-9-CM codes 430-438 in the primary diagnosis. It yielded a sensitivity of 96.1%, a specificity of 87.5% and a positive predictive value of 82.5%. CONCLUSIONS The Minimum Basic Data Set is a valuable source to evaluate stroke frequency when using an accurate algorithm to select events.
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Godoy D, Piñero G, Cruz-Flores S, Alcalá Cerra G, Rabinstein A. Malignant hemispheric infarction of the middle cerebral artery. Diagnostic considerations and treatment options. Neurologia 2013; 31:332-43. [PMID: 23601756 DOI: 10.1016/j.nrl.2013.02.009] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2012] [Revised: 02/19/2013] [Accepted: 02/25/2013] [Indexed: 10/26/2022] Open
Abstract
INTRODUCTION Malignant hemispheric infarction (MHI) is a specific and devastating type of ischemic stroke. It usually affects all or part of the territory of the middle cerebral artery although its effects may extend to other territories as well. Its clinical outcome is frequently catastrophic when only conventional medical treatment is applied. OBJECTIVE The purpose of this review is to analyse the available scientific evidence on the treatment of this entity. DEVELOPMENT MHI is associated with high morbidity and mortality. Its clinical characteristics are early neurological deterioration and severe hemispheric syndrome. Its hallmark is the development of space-occupying cerebral oedema between day 1 and day 3 after symptom onset. The mass effect causes displacement, distortion, and herniation of brain structures even when intracranial hypertension is initially absent. Until recently, MHI was thought to be fatal and untreatable because mortality rates with conventional medical treatment could exceed 80%. In this unfavourable context, decompressive hemicraniectomy has re-emerged as a therapeutic alternative for selected cases, with reported decreases in mortality ranging between 15% and 40%. CONCLUSIONS In recent years, several randomised clinical trials have demonstrated the benefit of decompressive hemicraniectomy in patients with MHI. This treatment reduces mortality in addition to improving functional outcomes.
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Affiliation(s)
- D Godoy
- Unidad de Terapia Intensiva, Hospital San Juan Bautista, Catamarca, Argentina; Unidad de Cuidados Neurointensivos, Sanatorio Pasteur, Catamarca, Argentina.
| | - G Piñero
- Unidad de Terapia Intensiva, Hospital Municipal Leonidas Lucero, Bahía Blanca, Buenos Aires, Argentina
| | - S Cruz-Flores
- Department of Neurology & Psychiatry, Saint Louis University School of Medicine, Saint Louis, Estados Unidos
| | - G Alcalá Cerra
- Facultad de Medicina, Universidad de Cartagena, Cartagena, Colombia
| | - A Rabinstein
- Neuroscience ICU and Regional Acute Stroke Program Mayo Clinic, Rochester, MN, Estados Unidos
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Farghaly WM, El-Tallawy HN, Shehata GA, Rageh TA, Abdel-Hakeem NM, Elhamed MAA, Al-Fawal BM, Badry R. Epidemiology of nonfatal stroke and transient ischemic attack in Al-Kharga District, New Valley, Egypt. Neuropsychiatr Dis Treat 2013; 9:1785-90. [PMID: 24273409 PMCID: PMC3836687 DOI: 10.2147/ndt.s48322] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Stroke is a medical emergency. Nonfatal stroke may cause permanent neurologic damage, complications, and disability. The aim of this study was to determine the epidemiology of nonfatal stroke in Al-Kharga District, New Valley, Egypt. METHODS The total population (62,583) was screened via a door-to-door study by three neurology specialists and 15 female social workers for demographic data collection. All subjects with probable stroke were subjected to a full clinical examination, neuroimaging (computed tomography and/or magnetic resonance imaging of the brain), and laboratory investigations including blood sugar, lipid profile, serum uric acid, a complete blood count, blood urea, and serum creatinine. Stroke severity and outcome were assessed using the Scandinavian Stroke Scale and Barthel Index. Carotid Doppler, echocardiography, and thyroid function tests were done in selected cases. RESULTS During the study period (June 1, 2005 to May 31, 2008), 351 subjects were diagnosed as having suffered a cerebrovascular stroke at some point during their lives, yielding a total lifetime prevalence of 5.6 per 1,000 population. Of these, 156 subjects were identified as having suffered a stroke during the year from January 1 to December 31, 2007, with an incidence rate of 2.5 per 1,000. Both prevalence and incidence rates were higher in urban (5.8 per 1,000 and 2.6 per 1,000, respectively) than rural communities (5.2 per 1,000 and 2.3 per 1,000), and were higher in males (6.1 per 1,000 and 2.7 per 1,000, respectively) than in females (5.1 per 1,000 and 2.3 per 1,000). Thrombotic stroke had the highest prevalence and incidence rates (4.2 per 1,000 and 1.7 per 1,000, respectively), whereas subarachnoid hemorrhage had the lowest prevalence and incidence rates (0.03 per 1,000 and 0.02 per 1,000). CONCLUSION The prevalence of cerebrovascular accident in Al-Kharga lies in the lower range of that in developing countries, and is similar to that in industrialized countries.
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Affiliation(s)
- Wafaa Ma Farghaly
- Department of Neurology, Faculty of Medicine, Assiut University, Assiut, Egypt
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Camargo LC, Sánchez KP. [Thalamic Stroke and Associated Behavior Disorders. Possibilities for Integral Management: Case Report]. REVISTA COLOMBIANA DE PSIQUIATRIA 2012; 41:436-443. [PMID: 26573506 DOI: 10.1016/s0034-7450(14)60017-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/25/2012] [Accepted: 04/29/2012] [Indexed: 06/05/2023]
Abstract
INTRODUCTION Since ancient Greece, cerebrovascular accidents have been described with no variation. Even today, they are still a catastrophic event in the lives of patients with a high risk of disabling sequelae. METHODOLOGY Case report of a 56-year male patient with thalamic ischemia. RESULTS The intervention with integral strategies involving pharmacological management and cognitive interventions was decisive for the satisfactory evolution of the patient. CONCLUSIONS The management of patients with cerebrovascular accidents cannot be limited to the emergency room. Pharmacological advances in programs and cognitive intervention methods provide intervention tools from the very beginning of the stroke thus reducing the impact of long-term sequelae, and consequently enabling a better reintegration of the patient to his family.
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Affiliation(s)
- Loida Camargo Camargo
- Neuróloga, servicio de Neurología, Hospital Universitario Clínica San Rafael-OHSJD, Bogotá, Colombia.
| | - Katherine Parra Sánchez
- Residente de Psiquiatría tercer año, Fundación Universitaria Juan N. Corpas, Hospital Universitario Clínica San Rafael-OHSJD, Bogotá, Colombia
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Arboix A, Arbe G, García-Eroles L, Oliveres M, Parra O, Massons J. Infarctions in the vascular territory of the posterior cerebral artery: clinical features in 232 patients. BMC Res Notes 2011; 4:329. [PMID: 21899750 PMCID: PMC3180463 DOI: 10.1186/1756-0500-4-329] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2011] [Accepted: 09/07/2011] [Indexed: 11/14/2022] Open
Abstract
Background Ischemic stroke caused by infarction in the territory of the posterior cerebral artery (PCA) has not been studied as extensively as infarctions in other vascular territories. This single centre, retrospective clinical study was conducted a) to describe salient characteristics of stroke patients with PCA infarction, b) to compare data of these patients with those with ischaemic stroke due to middle cerebral artery (MCA) and anterior cerebral artery (ACA) infarctions, and c) to identify predictors of PCA stroke. Findings A total of 232 patients with PCA stroke were included in the "Sagrat Cor Hospital of Barcelona Stroke Registry" during a period of 19 years (1986-2004). Data from stroke patients are entered in the stroke registry following a standardized protocol with 161 items regarding demographics, risk factors, clinical features, laboratory and neuroimaging data, complications and outcome. The characteristics of these 232 patients with PCA stroke were compared with those of the 1355 patients with MCA infarctions and 51 patients with ACA infarctions included in the registry. Infarctions of the PCA accounted for 6.8% of all cases of stroke (n = 3808) and 9.6% of cerebral infarctions (n = 2704). Lacunar infarction was the most frequent stroke subtype (34.5%) followed by atherothrombotic infarction (29.3%) and cardioembolic infarction (21.6%). In-hospital mortality was 3.9% (n = 9). Forty-five patients (19.4%) were symptom-free at hospital discharge. Hemianopia (odds ratio [OR] = 6.43), lacunar stroke subtype (OR = 2.18), symptom-free at discharge (OR = 1.92), limb weakness (OR = 0.10), speech disorders (OR = 0.33) and cardioembolism (OR = 0.65) were independent variables of PCA stroke in comparison with MCA infarction, whereas sensory deficit (OR = 2.36), limb weakness (OR = 0.11) and cardioembolism as stroke mechanism (OR = 0.43) were independent variables associated with PCA stroke in comparison with ACA infarction. Conclusions Lacunar stroke is the main subtype of infarction occurring in the PCA territory. Several clinical features are more frequent in stroke patients with PCA infarction than in patients with ischaemic stroke due to infarction in the MCA and ACA territories. In-hospital mortality in patients with PCA territory is low.
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Affiliation(s)
- Adrià Arboix
- Unit of Cerebrovascular Diseases, Service of Neurology, Hospital Universitari del Sagrat Cor, Universitat de Barcelona, Barcelona, Spain.
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Ingresos hospitalarios en el área de la Bahía de Algeciras. Comparación con Andalucía y España (2001-2005). GACETA SANITARIA 2011; 25:403-11. [DOI: 10.1016/j.gaceta.2011.04.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/23/2010] [Revised: 02/07/2011] [Accepted: 04/26/2011] [Indexed: 11/24/2022]
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Yepes Temiño MJ, Lillo Cuevas M. [Anesthesia for carotid endarterectomy: a review]. REVISTA ESPANOLA DE ANESTESIOLOGIA Y REANIMACION 2011; 58:34-41. [PMID: 21348215 DOI: 10.1016/s0034-9356(11)70695-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
Cardiovascular diseases are associated with high rates of morbidity and mortality. Carotid artery stenosis causes between 20% and 25% of ischemic strokes, especially when an embolism is the underlying cause. Carotid endarterectomy is the treatment of choice when stenosis exceeds 60%. It is important to have an understanding of how to manage perioperative factors that can decrease the risk of stroke, infarction, and death. In contrast to the findings of earlier meta-analyses, the recent GALA trial of general versus local anesthesia concluded that the rates of stroke, myocardial infarction, and mortality during or soon after surgery are similar for both types of anesthesia.
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Affiliation(s)
- M J Yepes Temiño
- Departamento de Anestesiología y Reanimación de la Clínica Universidad de Navarra, Clínica Universidad de Navarra, Pamplona.
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Miralbell J, Soriano J, López-Cancio E, Arenillas J, Dorado L, Barrios M, Cáceres C, Alzamora M, Torán P, Pera G, Dávalos A, Mataró M. Factores de riesgo vascular y rendimiento cognitivo en personas de 50 a 65 años. Neurologia 2010. [DOI: 10.1016/j.nrl.2010.02.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Rubio Gil E, Martínez Pastor A, López-Picazo Ferrer J, Leal Hernández M, Morales Ortiz A, Martinez Navarro A, Abellán Alemán J. [Quality of records in OMI-AP of the patients with stroke followed in primary care]. ACTA ACUST UNITED AC 2010; 25:341-7. [PMID: 20692862 DOI: 10.1016/j.cali.2010.06.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2010] [Revised: 06/03/2010] [Accepted: 06/04/2010] [Indexed: 11/19/2022]
Abstract
OBJECTIVES 1) To determine the level of registration and control of cardiovascular risk factors in stroke patients treated in primary care in Murcia through electronic medical records. 2) To describe the registered drug treatment in patients with stroke. MATERIAL AND METHODS Observational descriptive, retrospective, evaluated through the records in OMI (electronic medical records) in all areas of Murcia Health Service. A sample of 407 patients with stroke was analyzed. The analyzed variables were type of stroke, time of evolution, registered cardiovascular risk factors, registered cardiovascular disease, medication and degree of control of modifiable risk factors. RESULTS Cardiovascular risk factors recorded were hypertension (81.1%), dyslipemia (72.5%), diabetes (41.3%), abdominal obesity (22.9%) and tobacco (8.8%). Registered cardiovascular diseases were ischemic heart disease (22.1%), atrial fibrillation (13.8%), nephropathy (11.8%), myocardial infarction (5.7%) and left ventricular hypertrophy (3.4%). 2.5% (10) of patients met all criteria for good control. The LDL cholesterol was controlled (<100mg/dl) and recorded in 24.8% of patients and blood pressure in 41.3%. 78.1% of patients were being treated with antihypertensive drugs, 47.4% with lipid-lowering drugs, and 79.1% with antiplatelet or anticoagulant. CONCLUSIONS According to data recorded at OMI-AP the patients who have suffered a stroke have poor control of cardiovascular risk factors.
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Affiliation(s)
- E Rubio Gil
- Gerencia de Atención Primaria, Murcia, Spain
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Lopez-de-Andres A, Carrasco-Garrido P, Hernández-Barrera V, Gil-de-Miguel Á, Jiménez-Trujillo I, Jiménez-García R. Hospitalization trends in Spanish children and adolescents with eating disorders (1998–2007). Appetite 2010; 55:147-51. [DOI: 10.1016/j.appet.2010.05.087] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2010] [Revised: 05/18/2010] [Accepted: 05/19/2010] [Indexed: 11/29/2022]
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Grau M, Subirana I, Elosua R, Fitó M, Covas MI, Sala J, Masiá R, Ramos R, Solanas P, Cordon F, Nieto FJ, Marrugat J. Why should population attributable fractions be periodically recalculated? An example from cardiovascular risk estimation in southern Europe. Prev Med 2010; 51:78-84. [PMID: 20362610 DOI: 10.1016/j.ypmed.2010.03.012] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2009] [Revised: 03/22/2010] [Accepted: 03/24/2010] [Indexed: 10/19/2022]
Abstract
OBJECTIVE To determine the effect of age and study period on coronary heart disease (CHD) risk attributable to cardiovascular risk factors. METHODS A cohort of cardiovascular disease (CVD)-free randomly participants from Girona (Spain) aged 35-74 years recruited in 1995 and 2000 and followed for an average of 6.9 years. A survey conducted in the same area in 2005 was also used for the analysis. Smoking, hypertension, diabetes, sedentary lifestyle, obesity, total cholesterol > or = 240 mg/dl, low-density lipoprotein (LDL) cholesterol > or = 160 mg/dl, and high-density lipoprotein cholesterol <40 mg/dl were the risk factors considered. The composite end-point included myocardial infarction, angina pectoris, and CHD death. RESULTS LDL cholesterol had the highest potential for CHD prevention between 35 and 74 years [42% (95% Confidence Interval: 23,58)]. The age-stratified analysis showed that the population attributable risk (PAF) for smoking was 64% (30,80) in subjects < 55 years; for those > or = 55 years, the PAF for hypertension was 34% (1,61). The decrease observed between 1995 and 2005 in the population's mean LDL cholesterol level reduced that PAF in all age groups. CONCLUSION Overall, LDL cholesterol levels had the highest potential for CHD prevention. Periodic PAF recalculation in different age groups may be required to adequately monitor population trends.
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Affiliation(s)
- María Grau
- Epidemiology and Cardiovascular Genetics, Program of Research on Inflammatory and Cardiovascular Disorders, Institut Municipal d'Investigació Mèdica, 08003 Barcelona, Spain
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Murie-Fernández M, Irimia P, Martínez-Vila E, John Meyer M, Teasell R. Neuro-rehabilitation after stroke. NEUROLOGÍA (ENGLISH EDITION) 2010. [DOI: 10.1016/s2173-5808(10)70036-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
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Vascular Risk Factors and Cognitive Performance in Patients 50 to 65 Years-Old. NEUROLOGÍA (ENGLISH EDITION) 2010. [DOI: 10.1016/s2173-5808(10)70079-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Rigau Comas D, Álvarez-Sabin J, Gil Núñez A, Abilleira Castells S, Borras Pérez FX, Armario García P, Arrieta Antón E, Marañón Fernández E, Martí Canales JC, Morales Ortiz A, Reverter Calatayud JC, Sancristóbal Velasco E, Solà Arnau I, Alonso Coello P. Guía de práctica clínica sobre prevención primaria y secundaria del ictus. Med Clin (Barc) 2009; 133:754-62. [DOI: 10.1016/j.medcli.2009.02.037] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2008] [Accepted: 02/03/2009] [Indexed: 10/20/2022]
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Arboix A, García-Eroles L, Sellarés N, Raga A, Oliveres M, Massons J. Infarction in the territory of the anterior cerebral artery: clinical study of 51 patients. BMC Neurol 2009; 9:30. [PMID: 19589132 PMCID: PMC2714497 DOI: 10.1186/1471-2377-9-30] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2009] [Accepted: 07/09/2009] [Indexed: 11/18/2022] Open
Abstract
Background Little is known about clinical features and prognosis of patients with ischaemic stroke caused by infarction in the territory of the anterior cerebral artery (ACA). This single centre, retrospective study was conducted with the following objectives: a) to describe the clinical characteristics and short-term outcome of stroke patients with ACA infarction as compared with that of patients with ischaemic stroke due to middle cerebral artery (MCA) and posterior cerebral artery (PCA) infarctions, and b) to identify predictors of ACA stroke. Methods Fifty-one patients with ACA stroke were included in the "Sagrat Cor Hospital of Barcelona Stroke Registry" during a period of 19 years (1986–2004). Data from stroke patients are entered in the stroke registry following a standardized protocol with 161 items regarding demographics, risk factors, clinical features, laboratory and neuroimaging data, complications and outcome. The characteristics of these 51 patients with ACA stroke were compared with those of the 1355 patients with MCA infarctions and 232 patients with PCA infarctions included in the registry. Results Infarctions of the ACA accounted for 1.3% of all cases of stroke (n = 3808) and 1.8% of cerebral infarctions (n = 2704). Stroke subtypes included cardioembolic infarction in 45.1% of patients, atherothrombotic infarction in 29.4%, lacunar infarct in 11.8%, infarct of unknown cause in 11.8% and infarction of unusual aetiology in 2%. In-hospital mortality was 7.8% (n = 4). Only 5 (9.8%) patients were symptom-free at hospital discharge. Speech disturbances (odds ratio [OR] = 0.48) and altered consciousness (OR = 0.31) were independent variables of ACA stroke in comparison with MCA infarction, whereas limb weakness (OR = 9.11), cardioembolism as stroke mechanism (OR = 2.49) and sensory deficit (OR = 0.35) were independent variables associated with ACA stroke in comparison with PCA infarction. Conclusion Cardioembolism is the main cause of brain infarction in the territory of the ACA. Several clinical features are more frequent in stroke patients with ACA infarction than in patients with ischaemic stroke due to infarction in the MCA and PCA territories.
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Affiliation(s)
- Adrià Arboix
- Unit of Cerebrovascular Diseases, Service of Neurology, Hospital Universitari del Sagrat Cor, Universitat de Barcelona, Barcelona, Spain.
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Stroke in Spain: Epidemiologic Incidence and Patterns; A Health Sentinel Network Study. J Stroke Cerebrovasc Dis 2009; 18:11-6. [DOI: 10.1016/j.jstrokecerebrovasdis.2008.06.010] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2008] [Revised: 05/19/2008] [Accepted: 06/09/2008] [Indexed: 11/20/2022] Open
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Ribera A, Marsal JR, Ferreira-González I, Cascant P, Pons JM, Mitjavila F, Salas T, Permanyer-Miralda G. Predicción de la mortalidad hospitalaria en la cirugía de derivación aortocoronaria mediante datos administrativos: comparación con un estudio observacional prospectivo. Rev Esp Cardiol 2008. [DOI: 10.1157/13124995] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Grau M, Marrugat J. Funciones de riesgo en la prevención primaria de las enfermedades cardiovasculares. Rev Esp Cardiol 2008. [DOI: 10.1157/13117732] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
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O’Donnell CJ, Elosua R. Factores de riesgo cardiovascular. Perspectivas derivadas del Framingham Heart Study. Rev Esp Cardiol 2008. [DOI: 10.1157/13116658] [Citation(s) in RCA: 153] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
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