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Nigussie EW, Abera EG, Woldemariam MB. Burden and determinants of renal dysfunction and in-hospital mortality among acute stroke patients in Ethiopia: A hospital-based observational study. Medicine (Baltimore) 2024; 103:e39140. [PMID: 39058854 PMCID: PMC11272293 DOI: 10.1097/md.0000000000039140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2024] [Accepted: 07/09/2024] [Indexed: 07/28/2024] Open
Abstract
Stroke, a leading global cause of mortality and neurological impairment, is often complicated by renal failure, exacerbating in-hospital risks and mortality. Limited understanding exists regarding renal failure prevalence in Ethiopian acute stroke patients. This study examines renal function abnormalities in acute stroke patients at Jimma Medical Center (JMC). A hospital-based cross-sectional study was conducted at JMC from December 5, 2023, to March 15, 2024. A structured data collection tool was developed after comprehensive review of pertinent literature, encompassing variables pertinent to the study objectives. Following data quality assurance, information was coded and inputted into EpiData version 3.1, subsequently analyzed using Statistical Package for Social Sciences (SPSS) version 26.0. Multivariable logistic regression analysis was performed to adjust for confounding variables, with statistical significance set at P < .05. The mean age of participants was 60.5 ± 15.5 years, with 129 (64.5%) being male. Forty-five participants (22.5%, 95% confidence interval [CI] = 16.9, 28.9) exhibited renal dysfunction. Advanced age (≥70 years), hypertension, diabetes mellitus (DM), cardiac disease, history of transient ischemic attack (TIA)/stroke, and hemorrhagic stroke type were identified as significant predictors of renal dysfunction among hospitalized stroke patients. The mortality rate was 3.7 times higher in stroke patients with renal dysfunction compared to those with normal renal function (adjusted odds ratio [AOR] = 3.7, 95% CI: 1.41, 6.22). Renal function abnormalities were prevalent among hospitalized acute stroke patients, emphasizing the significance of renal dysfunction as a frequent comorbidity. Older age, hypertension, DM, cardiac disease, history of TIA/stroke, and hemorrhagic stroke type emerged as statistically significant predictors of renal dysfunction. Furthermore, renal dysfunction was identified as a significant predictor of in-hospital mortality following stroke.
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Affiliation(s)
| | - Eyob Girma Abera
- Department of Public Health, Jimma University, Jimma, Oromia, Ethiopia
- Jimma University Clinical Trial Unit, Jimma, Oromia, Ethiopia
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Li JX, Zhong QQ, Zhu T, Jin YL, Pan J, Yuan SX, Zhu F. Associations of cognitive impairment and longitudinal change in cognitive function with the risk of fatal stroke in middle-aged to older Chinese. Heliyon 2024; 10:e29353. [PMID: 38655351 PMCID: PMC11035061 DOI: 10.1016/j.heliyon.2024.e29353] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Revised: 03/28/2024] [Accepted: 04/05/2024] [Indexed: 04/26/2024] Open
Abstract
It is unclear whether cognitive impairment and the longitudinal change in cognition are associated with the risk of fatal stroke in aging populations. Based on the Guangzhou Biobank Cohort Study data a sum of 26,064 participants at baseline and all deaths caused by stroke in a mean follow-up of 14.3 years (standard deviation = 3.2) were included, and the Cox proportional hazard regression was used in this prospective cohort study. Cognitive impairment was respectively associated with an increased risk of fatal strokes (the adjusted hazard ratio (aHR) = 1.38, 95% CI1.16-1.64, P < 0.001) and fatal ischaemic stroke (aHR = 1.39, 95% CI1.10-1.77, P = 0.007), compared to median cognition; the Delayed Word Recall Test (DWRT) score was associated with a decreasing trend for the risk of fatal strokes in a restricted cubic spline analysis; the longitudinal DWRT score decline was associated with the increased risks of fatal strokes (aHR = 1.42, 95% CI 1.11-1.82, P = 0.006) and fatal haemorrhagic stroke (aHR = 1.75, 95% CI 1.10-2.78, P = 0.02), compared to the longitudinal DWRT score rise. In summary, cognitive impairment and the longitudinal decline in DWRT scores were associated with the increased risk of fatal strokes; early screening of cognitive function should be conducive to predictive intervention in fatal stroke among relatively healthy middle-aged to older populations.
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Affiliation(s)
- Jun-xiao Li
- Central Laboratory, Guangzhou Twelfth People's Hospital, Guangzhou, China
- Departments of Public Health and Preventive Medicine, Jinan University, Guangzhou, China
| | - Qiong-qiong Zhong
- Departments of Public Health and Preventive Medicine, Jinan University, Guangzhou, China
| | - Tong Zhu
- Department of Science and Education, Guangzhou Twelfth People's Hospital, Guangzhou, China
| | - Ya-li Jin
- Department of Science and Education, Guangzhou Twelfth People's Hospital, Guangzhou, China
| | - Jing Pan
- Department of Science and Education, Guangzhou Twelfth People's Hospital, Guangzhou, China
| | - Shi-xiang Yuan
- Department of Neurosurgery, Guangzhou Twelfth People's Hospital, Guangzhou, China
| | - Feng Zhu
- Central Laboratory, Guangzhou Twelfth People's Hospital, Guangzhou, China
- Departments of Public Health and Preventive Medicine, Jinan University, Guangzhou, China
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Misirlioglu NF, Uzun N, Ozen GD, Çalik M, Altinbilek E, Sutasir N, Baykara Sayili S, Uzun H. The Relationship between Neutrophil-Lymphocyte Ratios with Nutritional Status, Risk of Nutritional Indices, Prognostic Nutritional Indices and Morbidity in Patients with Ischemic Stroke. Nutrients 2024; 16:1225. [PMID: 38674915 PMCID: PMC11054104 DOI: 10.3390/nu16081225] [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: 03/13/2024] [Revised: 04/15/2024] [Accepted: 04/16/2024] [Indexed: 04/28/2024] Open
Abstract
Background: In recent years, whole blood parameters and derivatives have been used as prognostic criteria in the course of various diseases. The aim of this study was to evaluate the relationship between parameters such as the neutrophil-lymphocyte ratio (NLR), the systemic immune-inflammation index (SII), the prognostic nutritional index (PNI), controlling nutritional status (CONUT) score, nutritional risk index (NRI) and immunonutrition status and disease activity in patients with ischemic stroke of the small-vessel, large-vessel and other etiologies. Methods: We retrospectively evaluated the records of 1454 consecutive ischemic stroke patients hospitalized in the emergency department of Gaziosmanpasa Education and Research Hospital from 2019 to 2023. Results: Of the 1350 patients with ischemic stroke included in the study, 58.8% had small-vessel disease, 29.3% had large-vessel disease and 11.9% had other etiologies. There was a significant difference between the three etiology groups for PNI and CONUT. The mean of PNI was 47.30 ± 8.06 in the other etiology group, 37.25 ± 7.23 in the small-vessel group, and 34.78 ± 8.16 in the large-vessel disease group. The mean of CONUT was 5.49 ± 1.20 in the small-vessel group, 5.12 ± 1.46 in the large-vessel group and 4.22 ± 1.11 in the other etiology group. In addition, CONUT and PNI were also found to be independent risk factors for mortality. A negative significant correlation was observed between PNI and NLR (r: -0.692), SII (r: -0.591), and CONUT (r: -0.511). Significant correlations were observed between CONUT and NLR (r: 0.402), SII (r: 0.312). Conclusions: PNI, CONUT and NRI were found as more accurate prognostic indicators of nutritional status in patients with ischemic stroke. NLR and SII may be important predictive markers in the course and prognosis of stroke.
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Affiliation(s)
- Naile Fevziye Misirlioglu
- Department of Biochemistry, Gaziosmanpaşa Training and Research Hospital, University of Health Sciences, Istanbul 34098, Turkey;
| | - Nedim Uzun
- Department of Emergency, Gaziosmanpaşa Training and Research Hospital, University of Health Sciences, Istanbul 34098, Turkey; (N.U.); (M.Ç.)
| | - Gulenay Defne Ozen
- Department of Psychology, McGill University, Montreal, QC H3A 1G1, Canada;
| | - Mustafa Çalik
- Department of Emergency, Gaziosmanpaşa Training and Research Hospital, University of Health Sciences, Istanbul 34098, Turkey; (N.U.); (M.Ç.)
| | - Ertugrul Altinbilek
- Department of Emergency, Sisli Hamidiye Etfal Education and Research Hospital, University of Health Sciences, Istanbul 34098, Turkey; (E.A.); (N.S.)
| | - Necmettin Sutasir
- Department of Emergency, Sisli Hamidiye Etfal Education and Research Hospital, University of Health Sciences, Istanbul 34098, Turkey; (E.A.); (N.S.)
| | - Sena Baykara Sayili
- Emergency Department, Istanbul Training and Research Hospital, Istanbul 34075, Turkey;
| | - Hafize Uzun
- Department of Medical Biochemistry, Faculty of Medicine, Istanbul Atlas University, Istanbul 34403, Turkey
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Montazeri Namin S, Moradi A, Tavolinejad H, Vasheghani-Farahani A, Jalali A, Pashang M, Sadeghian S, Bagheri J, Mansourian S, Mehrani M, Hosseini K, Rashedi S, Tajdini M. Sex-based association between high-density lipoprotein cholesterol and adverse outcomes after coronary artery bypass grafting. BMC Cardiovasc Disord 2024; 24:194. [PMID: 38580951 PMCID: PMC10996185 DOI: 10.1186/s12872-024-03806-1] [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: 08/18/2023] [Accepted: 02/20/2024] [Indexed: 04/07/2024] Open
Abstract
BACKGROUND High-density lipoprotein cholesterol (HDL-C) is shown to be an independent protective factor against coronary artery diseases (CAD). Yet there are limited studies focusing on the association between HDL-C and coronary artery bypass graft (CABG) surgery outcomes. HYPOTHESIS Low levels of HDL-C are associated with higher incidence of adverse outcomes in patients undergoing CABG. METHODS This registry-based study included 17,772 patients who underwent elective isolated CABG between 2007 and 2017. Patients were classified into low and desirable HDL-C groups based on their serum HDL-C levels at admission and were followed for one-year post-surgery. The study population included 13,321 patients with low HDL-C and 4,451 with desirable HDL-C. proportional hazard Cox models were performed to evaluate the association between HDL-C levels and incidence of mortality as well as major adverse cardiovascular and cerebrovascular events (MACCE), while adjusting for potential confounders. Moreover, participants were stratified based on sex and the association was also investigated in each subgroup separately. RESULTS No significant difference was found between the groups regarding incidence of both mortality and MACCE, after adjusting with Inverse Probability Weighting (IPW) [HR (95%CI): 0.84 (0.46-1.53), p-value:0.575 and HR (95% CI): 0.91 (0.56-1.50), p-value:0.733, respectively]. According to the sex-based subgroup analysis, no significant association was observed after adjustment with IPW analysis. However, as we examined the association between the interaction of HDL-C levels, sex and cardiovascular outcomes, we found a significant association (HR;1.19 (95%CI: 1.04-1.45); p = 0.030). CONCLUSION HDL-C level was not associated with either mortality or MACCE during one year after CABG procedure. Sex-based analysis showed that in males, HDL-C is significantly more protective against these outcomes, compared to females. Further studies are necessary to elucidate the exact mechanisms mediating such association.
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Affiliation(s)
- Sara Montazeri Namin
- Tehran Heart Center, Cardiovascular Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
- Cardiac Primary Prevention Research Center, Cardiovascular Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Ali Moradi
- Tehran Heart Center, Cardiovascular Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Hamed Tavolinejad
- Tehran Heart Center, Cardiovascular Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran.
| | - Ali Vasheghani-Farahani
- Tehran Heart Center, Cardiovascular Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
- Cardiac Primary Prevention Research Center, Cardiovascular Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Arash Jalali
- Tehran Heart Center, Cardiovascular Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Mina Pashang
- Tehran Heart Center, Cardiovascular Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Saeed Sadeghian
- Tehran Heart Center, Cardiovascular Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Jamshid Bagheri
- Tehran Heart Center, Cardiovascular Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Soheil Mansourian
- Tehran Heart Center, Cardiovascular Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Mehdi Mehrani
- Tehran Heart Center, Cardiovascular Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Kaveh Hosseini
- Tehran Heart Center, Cardiovascular Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
- Cardiac Primary Prevention Research Center, Cardiovascular Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Sina Rashedi
- Tehran Heart Center, Cardiovascular Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Masih Tajdini
- Tehran Heart Center, Cardiovascular Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
- Cardiac Primary Prevention Research Center, Cardiovascular Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
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Everard G, Burton Q, Van de Sype V, Bibentyo TN, Auvinet E, Edwards MG, Batcho CS, Lejeune T. Extended reality to assess post-stroke manual dexterity: contrasts between the classic box and block test, immersive virtual reality with controllers, with hand-tracking, and mixed-reality tests. J Neuroeng Rehabil 2024; 21:36. [PMID: 38491540 PMCID: PMC10941416 DOI: 10.1186/s12984-024-01332-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Accepted: 03/03/2024] [Indexed: 03/18/2024] Open
Abstract
BACKGROUND Recent technological advancements present promising opportunities to enhance the frequency and objectivity of functional assessments, aligning with recent stroke rehabilitation guidelines. Within this framework, we designed and adapted different manual dexterity tests in extended reality (XR), using immersive virtual reality (VR) with controllers (BBT-VR-C), immersive VR with hand-tracking (BBT-VR-HT), and mixed-reality (MD-MR). OBJECTIVE This study primarily aimed to assess and compare the validity of the BBT-VR-C, BBT-VR-HT and MD-MR to assess post-stroke manual dexterity. Secondary objectives were to evaluate reliability, usability and to define arm kinematics measures. METHODS A sample of 21 healthy control participants (HCP) and 21 stroke individuals with hemiparesis (IHP) completed three trials of the traditional BBT, the BBT-VR-C, BBT-VR-HT and MD-MR. Content validity of the different tests were evaluated by asking five healthcare professionals to rate the difficulty of performing each test in comparison to the traditional BBT. Convergent validity was evaluated through correlations between the scores of the traditional BBT and the XR tests. Test-retest reliability was assessed through correlations between the second and third trial and usability was assessed using the System Usability Scale (SUS). Lastly, upper limb movement smoothness (SPARC) was compared between IHP and HCP for both BBT-VR test versions. RESULTS For content validity, healthcare professionals rated the BBT-VR-HT (0[0-1]) and BBT-MR (0[0-1]) as equally difficult to the traditional BBT, whereas they rated BBT-VR-C as more difficult than the traditional BBT (1[0-2]). For IHP convergent validity, the Pearson tests demonstrated larger correlations between the scores of BBT and BBT-VR-HT (r = 0.94;p < 0.001), and BBT and MD-MR (r = 0.95;p < 0.001) than BBT and BBT-VR-C (r = 0.65;p = 0.001). BBT-VR-HT and MD-MR usability were both rated as excellent, with median SUS scores of 83[57.5-91.3] and 83[53.8-92.5] respectively. Excellent reliability was found for the BBT-VR-C (ICC = 0.96;p < 0.001), BBT-VR-HT (ICC = 0.96;p < 0.001) and BBT-MR (ICC = 0.99;p < 0.001). The usability of the BBT-VR-C was rated as good with a median SUS of 70[43.8-83.8]. Upper limb movements of HCP were significantly smoother than for IHP when completing either the BBT-VR-C (t = 2.05;p = 0.043) and the BBT-VR-HT (t = 5.21;p < 0.001). CONCLUSION The different XR manual tests are valid, short-term reliable and usable tools to assess post-stroke manual dexterity. TRIAL REGISTRATION https://clinicaltrials.gov/ct2/show/NCT04694833 ; Unique identifier: NCT04694833, Date of registration: 11/24/2020.
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Affiliation(s)
- Gauthier Everard
- Centre interdisciplinaire de recherche en réadaptation et intégration sociale, Université Laval, Québec, Canada
- Department of rehabilitation, Faculty of medicine, Laval University, Quebec, QC, Canada
- Neuro Musculo Skeletal Lab (NMSK), Secteur des Sciences de la Santé, Institut de Recherche Expérimentale et Clinique, Université catholique de Louvain, Brussels, Belgium
| | - Quentin Burton
- Neuro Musculo Skeletal Lab (NMSK), Secteur des Sciences de la Santé, Institut de Recherche Expérimentale et Clinique, Université catholique de Louvain, Brussels, Belgium
| | - Vincent Van de Sype
- Service de médecine physique et réadaptation, Cliniques universitaires Saint-Luc, Avenue Hippocrate 10, Brussels, 1200, Belgium
| | | | | | - Martin Gareth Edwards
- Psychological Sciences Research Institute (IPSY), Université Catholique de Louvain, Louvain‑la‑Neuve, Belgium
- Louvain Bionics, Université catholique de Louvain, Louvain-la-Neuve, Belgium
| | - Charles Sebiyo Batcho
- Centre interdisciplinaire de recherche en réadaptation et intégration sociale, Université Laval, Québec, Canada
- Department of rehabilitation, Faculty of medicine, Laval University, Quebec, QC, Canada
| | - Thierry Lejeune
- Neuro Musculo Skeletal Lab (NMSK), Secteur des Sciences de la Santé, Institut de Recherche Expérimentale et Clinique, Université catholique de Louvain, Brussels, Belgium.
- Service de médecine physique et réadaptation, Cliniques universitaires Saint-Luc, Avenue Hippocrate 10, Brussels, 1200, Belgium.
- Louvain Bionics, Université catholique de Louvain, Louvain-la-Neuve, Belgium.
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Nadzri AN, Nik Mohamed NA, Payne SJ, Mohamed Mokhtarudin MJ. Poroelastic modelling of brain tissue swelling and decompressive craniectomy treatment in ischaemic stroke. Comput Methods Biomech Biomed Engin 2024:1-11. [PMID: 38461460 DOI: 10.1080/10255842.2024.2326972] [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: 11/07/2023] [Accepted: 03/01/2024] [Indexed: 03/12/2024]
Abstract
Brain oedema or tissue swelling that develops after ischaemic stroke can cause detrimental effects, including brain herniation and increased intracranial pressure (ICP). These effects can be reduced by performing a decompressive craniectomy (DC) operation, in which a portion of the skull is removed to allow swollen brain tissue to expand outside the skull. In this study, a poroelastic model is used to investigate the effect of brain ischaemic infarct size and location on the severity of brain tissue swelling. Furthermore, the model will also be used to evaluate the effectiveness of DC surgery as a treatment for brain tissue swelling after ischaemia. The poroelastic model consists of two equations: one describing the elasticity of the brain tissue and the other describing the changes in the interstitial tissue pressure. The model is applied on an idealized brain geometry, and it is found that infarcts with radius larger than approximately 14 mm and located near the lateral ventricle produce worse brain midline shift, measured through lateral ventricle compression. Furthermore, the model is also able to show the positive effect of DC treatment in reducing the brain midline shift by allowing part of the brain tissue to expand through the skull opening. However, the model does not show a decrease in the interstitial pressure during DC treatment. Further improvement and validation could enhance the capability of the proposed poroelastic model in predicting the occurrence of brain tissue swelling and DC treatment post ischaemia.
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Affiliation(s)
- Aina Najwa Nadzri
- Faculty of Manufacturing and Mechatronics Engineering Technology, Universiti Malaysia Pahang, Pekan, Pahang, Malaysia
| | - Nik Abdullah Nik Mohamed
- Faculty of Engineering, Technology and Built Environment, UCSI University Kuala Lumpur, Kuala Lumpur, Malaysia
| | - Stephen J Payne
- Institute of Applied Mechanics, National Taiwan University, Taipei, Taiwan
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Yu AHK, Leung LY, Leung TWH, Abrigo JM, Cheung KH, Cheng CH, Graham CA. The TriAGe + score for vertigo or dizziness: A validation study in a university hospital emergency department in Hong Kong. Am J Emerg Med 2024; 77:39-45. [PMID: 38096638 DOI: 10.1016/j.ajem.2023.10.055] [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: 02/15/2023] [Revised: 10/13/2023] [Accepted: 10/28/2023] [Indexed: 02/16/2024] Open
Abstract
OBJECTIVE Patients with dizziness commonly present to Emergency Departments (ED) and 6% of these patients will be diagnosed with acute stroke. The TriAGe+ score comprises of eight clinical parameters and stratifies patients into four risk groups. The Japanese authors reported that the tool performed well, so our aim was to validate this diagnostic tool in our ED in Hong Kong. MATERIALS AND METHODS A single-center retrospective observational study was conducted in the ED of our university hospital in Hong Kong. The primary outcome was the diagnosis of an acute cerebrovascular event. Receiver operator characteristic (ROC) analysis was performed to determine the best cut-off score. Secondary outcomes included univariable and multivariable analyses of stroke predictors. RESULTS 455 patients aged 18 years or above with dizziness or vertigo at ED triage were recruited between 19 July and 30 September 2021. The overall prevalence of stroke was 11.9%. The median TriAGe+ score was 7 (IQR = 4-9). The AUC was 0.9. At a cut-off >5, sensitivity was 96.4% (95%CI: 87.3-99.5) and the negative likelihood ratio was 0.09 (95%CI: 0.02-0.3). At a cut-off >10, specificity was 99.8% (95%CI: 98.6-100.0), and the positive likelihood ratio was 237.6 (95%CI: 33.1-1704). On multivariable analyses, atrial fibrillation, blood pressure, gender, dizziness (not vertigo) and no history of dizziness, vertigo or labyrinth/vestibular disease were found to be positively associated with stroke outcomes significantly. CONCLUSION The TriAGe+ score is an efficient stroke prediction score for patients presenting to the ED with dizziness.
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Affiliation(s)
- Adrian Ho-Kun Yu
- Department of Accident and Emergency Medicine, Prince of Wales Hospital, Ngan Shing Street, Shatin, New Territories, Hong Kong SAR.
| | - Ling Yan Leung
- Accident and Emergency Medicine Academic Unit, Chinese University of Hong Kong, Prince of Wales Hospital, Ngan Shing Street, Shatin, New Territories, Hong Kong SAR
| | - Thomas W H Leung
- Division of Neurology, Department of Medicine & Therapeutics, Chinese University of Hong Kong, Prince of Wales Hospital, Ngan Shing Street, Shatin, New Territories, Hong Kong SAR.
| | - Jill M Abrigo
- Department of Imaging and Interventional Radiology, Chinese University of Hong Kong, Prince of Wales Hospital, Ngan Shing Street, Shatin, New Territories, Hong Kong SAR.
| | - Koon Ho Cheung
- Department of Accident and Emergency Medicine, Prince of Wales Hospital, Ngan Shing Street, Shatin, New Territories, Hong Kong SAR; Accident and Emergency Medicine Academic Unit, Chinese University of Hong Kong, Prince of Wales Hospital, Ngan Shing Street, Shatin, New Territories, Hong Kong SAR.
| | - Chi Hung Cheng
- Department of Accident and Emergency Medicine, Prince of Wales Hospital, Ngan Shing Street, Shatin, New Territories, Hong Kong SAR; Accident and Emergency Medicine Academic Unit, Chinese University of Hong Kong, Prince of Wales Hospital, Ngan Shing Street, Shatin, New Territories, Hong Kong SAR.
| | - Colin A Graham
- Department of Accident and Emergency Medicine, Prince of Wales Hospital, Ngan Shing Street, Shatin, New Territories, Hong Kong SAR; Accident and Emergency Medicine Academic Unit, Chinese University of Hong Kong, Prince of Wales Hospital, Ngan Shing Street, Shatin, New Territories, Hong Kong SAR.
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Kumari A, Chauhan G, Chaudhuri PK, Kumari S, Prasad A. Genetic Variants Associated with the Risk of Stroke in Sickle Cell Anemia: Systematic Review and Meta-Analysis. Hemoglobin 2024; 48:101-112. [PMID: 38637280 DOI: 10.1080/03630269.2024.2340685] [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: 09/22/2023] [Accepted: 04/01/2024] [Indexed: 04/20/2024]
Abstract
Sickle cell anemia (SCA) is the most common cause of stroke in children. As it is a rare disease, studies investigating the association with complications like stroke in SCD have small sample sizes. Here, we performed a systematic review and meta-analysis of the studies exploring an association of genetic variants with stroke to get a better indication of their association with stroke. PubMed and Google Scholar were searched to identify studies that had performed an association analysis of genetic variants for the risk of stroke in SCA patients. After screening of eligible studies, summary statistics of association analysis with stroke and other general information were extracted. Meta-analysis was performed using the fixed effect method on the tool METAL and forest plots were plotted using the R program. The random effect model was performed as a sensitivity analysis for loci where significant heterogeneity was observed. 407 studies were identified using the search term and after screening 37 studies that cumulatively analyzed 11,373 SCA patients were included. These 37 studies included a total of 2,222 SCA patients with stroke, predominantly included individuals of African ancestry (N = 16). Three of these studies performed whole exome sequencing while 35 performed single nucleotide-based genotyping. Though the studies reported association with 132 loci, meta-analyses could be performed only for 12 loci that had data from two or more studies. After meta-analysis we observed that four loci were significantly associated with risk for stroke: -α3.7 kb Alpha-thalassemia deletion (P = 0.00000027), rs489347-TEK (P = 0.00081), rs2238432-ADCY9 (P = 0.00085), rs11853426-ANXA2 (P = 0.0034), and rs1800629-TNF (P = 0.0003396). Ethnic representation of regions with a high prevalence of SCD like the Mediterranean basin and India needs to be improved for genetic studies on associated complications like stroke. Larger genome-wide collaborative studies on SCD and associated complications including stroke need to be performed.
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Affiliation(s)
- Aradhana Kumari
- Department of Genetics and Genomics, Rajendra Institute of Medical Sciences, Ranchi, Jharkhand, India
- Department of Biochemistry, Rajendra Institute of Medical Sciences, Ranchi, Jharkhand, India
| | - Ganesh Chauhan
- Department of Genetics and Genomics, Rajendra Institute of Medical Sciences, Ranchi, Jharkhand, India
- Central Research Facility, Rajendra Institute of Medical Sciences, Ranchi, Jharkhand, India
| | - Partha Kumar Chaudhuri
- Department of Paediatrics, Rajendra Institute of Medical Sciences, Ranchi, Jharkhand, India
| | - Sushma Kumari
- Department of Transfusion Medicine and Blood Centre, Rajendra Institute of Medical Sciences, Ranchi, Jharkhand, India
| | - Anupa Prasad
- Department of Genetics and Genomics, Rajendra Institute of Medical Sciences, Ranchi, Jharkhand, India
- Department of Biochemistry, Rajendra Institute of Medical Sciences, Ranchi, Jharkhand, India
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Weng YH, Chen J, Yu WT, Luo YP, Liu C, Yang J, Liu HB. lncRNA-MIAT rs9625066 polymorphism could be a potential biomarker for ischemic stroke. BMC Med Genomics 2024; 17:58. [PMID: 38383415 PMCID: PMC10882908 DOI: 10.1186/s12920-024-01830-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2023] [Accepted: 02/10/2024] [Indexed: 02/23/2024] Open
Abstract
BACKGROUND Ischemic stroke (IS) is a common and serious neurological condition that is highly fatal but so far no early diagnostic markers are available. Myocardial infarction-associated transcript (MIAT) is a long non-coding RNA (lncRNA) that could lead to IS by inducing autophagy and apoptosis in neuronal cells. However, there has been no report on the link between susceptibility to IS and the single-nucleotide polymorphisms (SNPs) of MIAT. This study aimed to investigate the association between MIAT gene polymorphisms and IS risk. METHODS A total of 320 IS patients and 310 age-, sex- and race-matched controls were included in this study. Four polymorphisms (rs2157598, rs5761664, rs1894720, and rs9625066) were genotyped by using SNPscan technique. RESULTS Among the 4 polymorphisms of MIAT, only rs9625066 was associated with IS risk (CA vs. CC: adjusted OR = 0.55, 95% CI, 0.37-0.85, P = 0.006; AA vs. CC: adjusted OR = 0.39, 95% CI, 0.16-0.94, P = 0.036; (AA + CA vs. CC: adjusted OR = 0.53, 95% CI, 0.35-0.80, P = 0.002; A vs. C adjusted OR = 0.59, 95% CI, 0.42-0.82, P = 0.002). Haplotype analysis showed a 1.32-fold increase (95% CI, 1.05-1.67, P = 0.017) in IS risk for rs2157598-rs5761664-rs1894720-rs9625066 (A-C-G-C). Logistic regression analysis identified some independent impact factors for IS including rs9625066 AA/AC, TC, TG, HDL-C (P < 0.05). CONCLUSION The rs9625066 polymorphism of MIAT might be associated with IS susceptibility in Chinese population, in which AA/CA plays a protective role in IS, whereas the CC genotype increases the risk of developing IS, suggesting it might be a marker predictive of IS risk.
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Affiliation(s)
- Yin-Hua Weng
- Department of Laboratory Medicine, The Second Affiliated Hospital of Guilin Medical University, Guilin, China
- School of Clinical Medicine, Guilin Medical University, Guilin, China
- College of Medical Laboratory Science, Guilin Medical University, Guilin, China
| | - Jie Chen
- Department of Laboratory Medicine, Affiliated Hospital of Guilin Medical University, Guilin, China
- School of Clinical Medicine, Guilin Medical University, Guilin, China
| | - Wen-Tao Yu
- School of Clinical Medicine, Guilin Medical University, Guilin, China
| | - Yan-Ping Luo
- Department of Laboratory Medicine, Affiliated Hospital of Guilin Medical University, Guilin, China
- School of Clinical Medicine, Guilin Medical University, Guilin, China
| | - Chao Liu
- Department of Laboratory Medicine, The Second Affiliated Hospital of Guilin Medical University, Guilin, China
- School of Clinical Medicine, Guilin Medical University, Guilin, China
- College of Medical Laboratory Science, Guilin Medical University, Guilin, China
| | - Jun Yang
- Department of Laboratory Medicine, Affiliated Hospital of Guilin Medical University, Guilin, China.
| | - Hong-Bo Liu
- Department of Laboratory Medicine, The Second Affiliated Hospital of Guilin Medical University, Guilin, China.
- College of Medical Laboratory Science, Guilin Medical University, Guilin, China.
- Guangxi Key Laboratory of Metabolic Reprogramming and Intelligent Medical Engineering for Chronic Diseases, Guangxi Clinical Research Center for Diabetes and Metabolic Diseases, The Second Affiliated Hospital of Guilin Medical University, Guilin, China.
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10
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Rafiee H, Mohammadifard N, Nouri F, Alavi Tabatabaei G, Najafian J, Sadeghi M, Boshtam M, Roohafza H, Haghighatdoost F, Hassannejad R, Sarrafzadegan N. Association of triglyceride glucose index with cardiovascular events: insights from the Isfahan Cohort Study (ICS). Eur J Med Res 2024; 29:135. [PMID: 38368388 PMCID: PMC10874543 DOI: 10.1186/s40001-024-01728-4] [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: 10/30/2023] [Accepted: 02/12/2024] [Indexed: 02/19/2024] Open
Abstract
BACKGROUND There is limited evidence regarding the evaluation of the association between the triglyceride glucose (TyG) index, an indicator of insulin resistance, and the incident risk of cardiovascular disease (CVD). Therefore, we aimed to examine the relationship between the TyG index and CVD incidence in a cohort of Iranian adults. METHODS This study was performed in the framework of the Isfahan Cohort Study (ICS). The study population included 5,432 individuals aged ≥ 35 years. CVD events, including acute myocardial infarction (MI), stroke, and unstable angina (UA), were diagnosed by physicians. The TyG index was calculated as Ln [fasting triglycerides (mg/dL) × fasting plasma glucose (mg/dL)/2]. The relationship between the TyG index and CVD events was investigated using Cox regression models. Receiver operating characteristics (ROC) curve analysis was used to determine the best cut-off for the TyG index for predicting CVD outcomes. RESULTS During a median follow-up period of 11.2 years, a total number of 819 CVD, 164 MI, 172 stroke, and 384 UA were recorded. Following adjustment for multiple confounders, elevated TyG levels were associated with a higher risk of CVD (HR = 1.48; 95% CI 1.22-1.79; p < 0.001), MI (HR = 2.24; 95% CI 1.42-3.52; p < 0.001), stroke (HR = 1.45; 95% CI 0.96-2.19; p = 0.042), but not UA (HR = 1.28; 95% CI 0.96-1.69). The optimal TyG index cut-off was 8.91 for predicting CVD (sensitivity 58%; specificity 58%), 9.04 for predicting MI (sensitivity 57%; specificity 65%), 8.92 for predicting stroke (sensitivity 57%; specificity 57%), and 8.98 for predicting UA (sensitivity 53%; specificity 61%). CONCLUSION We found a robust, direct association between the TyG index and the incidence of CVD events. This emphasizes the significance of observing the TyG index as an indicator of the occurrence of CVD events.
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Affiliation(s)
- Hamed Rafiee
- Isfahan Cardiovascular Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Noushin Mohammadifard
- Pediatric Cardiovascular Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Fatemeh Nouri
- Isfahan Cardiovascular Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Ghazaal Alavi Tabatabaei
- Pediatric Cardiovascular Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Jamshid Najafian
- Hypertension Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Masoumeh Sadeghi
- Cardiac Rehabilitation Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Maryam Boshtam
- Heart Failure Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Hamidreza Roohafza
- Isfahan Cardiovascular Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Fahimeh Haghighatdoost
- Interventional Cardiology Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, P. O. Box, Isfahan, 81745-15, Iran.
| | - Razieh Hassannejad
- Isfahan Cardiovascular Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Nizal Sarrafzadegan
- Isfahan Cardiovascular Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
- Faculty of Medicine, School of Population and Public Health, University of British Columbia, Vancouver, Canada
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11
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Ansong R, Gazarian P. Healthcare self-management support of stroke patients after discharge: A conceptual analysis using Rodger's evolutionary approach. J Adv Nurs 2024. [PMID: 38297450 DOI: 10.1111/jan.16078] [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: 08/03/2023] [Revised: 12/26/2023] [Accepted: 01/15/2024] [Indexed: 02/02/2024]
Abstract
AIM(S) To explore the meaning of healthcare self-management support for post-discharged stroke patients. METHOD Rodgers' evolutionary approach was used to identify antecedents, attributes, related terms, surrogate terms and consequences. DATA SOURCE Literature from 2012 to 2022 was searched from MEDLINE, CINAHL, PsycINFO and Google Scholar. RESULTS Three antecedents preceded healthcare self-management support for post-discharged stroke patients: loss of inpatient support, preparedness for self-management and presence of self-management support. Healthcare self-management support for post-discharged stroke patients was defined by eight attributes: pre-discharge assessment and planning; provision of continuous education and training; collaborative goal-setting; reinforcement and documentation of vital information; coordination of post-discharge care; provision of rehabilitation support and promoting community reintegration; provision of counselling support; and using clear communication, patient empowerment and promoting self-efficacy. The identified consequences of the concept were as follows: improved patient outcomes; improved life quality; decreased healthcare cost; decreased re-admission rate and inpatient care burden; and decreased complication rate. CONCLUSION Healthcare self-management support for post-discharged stroke patients is an emerging concept that can help to significantly improve stroke patients' health outcomes and life quality. However, its applicability is uncertain considering the workload, time and resources available to healthcare professionals. There is a need for future studies to focus on the feasibility and applicability of this concept in clinical practice and to identify any challenges healthcare providers may have in supporting stroke patients after discharge. IMPACT This concept analysis brings clarity to the concept of healthcare self-management support of post-discharged stroke patients and distinguishes it from other self-management supports. It provides an opportunity for further studies and a pathway for generalized healthcare self-management support for stroke patients after discharge to improve health outcomes and quality of life. NO PATIENT OR PUBLIC CONTRIBUTION No patients, service users, caregivers or members of the public were involved in conducting this concept analysis.
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Affiliation(s)
- Rockson Ansong
- Department of Nursing, Manning College of Nursing and Health Sciences, University of Massachusetts Boston, Boston, Massachusetts, USA
| | - Priscilla Gazarian
- Department of Nursing, Manning College of Nursing and Health Sciences, University of Massachusetts Boston, Boston, Massachusetts, USA
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12
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Shewangizaw S, Fekadu W, Gebregzihabhier Y, Mihretu A, Sackley C, Alem A. Impact of depression on stroke outcomes among stroke survivors: Systematic review and meta-analysis. PLoS One 2023; 18:e0294668. [PMID: 38039323 PMCID: PMC10691726 DOI: 10.1371/journal.pone.0294668] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Accepted: 11/06/2023] [Indexed: 12/03/2023] Open
Abstract
BACKGROUND Depression may negatively affect stroke outcomes and the progress of recovery. However, there is a lack of updated comprehensive evidence to inform clinical practice and directions of future studies. In this review, we report the multidimensional impact of depression on stroke outcomes. METHODS Data sources. PubMed, PsycINFO, EMBASE, and Global Index Medicus were searched from the date of inception. Eligibility criteria. Prospective studies which investigated the impact of depression on stroke outcomes (cognition, returning to work, quality of life, functioning, and survival) were included. Data extraction. Two authors extracted data independently and solved the difference with a third reviewer using an extraction tool developed prior. The extraction tool included sample size, measurement, duration of follow-up, stroke outcomes, statistical analysis, and predictors outcomes. Risk of bias. We used Effective Public Health Practice Project (EPHPP) to assess the quality of the included studies. RESULTS Eighty prospective studies were included in the review. These studies investigated the impact of depression on the ability to return to work (n = 4), quality of life (n = 12), cognitive impairment (n = 5), functioning (n = 43), and mortality (n = 24) where a study may report on more than one outcome. Though there were inconsistencies, the evidence reported that depression had negative consequences on returning to work, functioning, quality of life, and mortality rate. However, the impact on cognition was not conclusive. In the meta-analysis, depression was associated with premature mortality (HR: 1.61 (95% CI; 1.33, 1.96)), and worse functioning (OR: 1.64 (95% CI; 1.36, 1.99)). CONCLUSION Depression affects many aspects of stroke outcomes including survival The evidence is not conclusive on cognition and there was a lack of evidence in low-income settings. The results showed the need for early diagnosis and intervention of depression after stroke. The protocol was pre-registered on the International Prospective Register of Systematic Review (PROSPERO) (CRD42021230579).
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Affiliation(s)
- Seble Shewangizaw
- WHO Collaborating Centre for Mental Health Research and Capacity Building, Department of Psychiatry, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Wubalem Fekadu
- WHO Collaborating Centre for Mental Health Research and Capacity Building, Department of Psychiatry, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Yohannes Gebregzihabhier
- WHO Collaborating Centre for Mental Health Research and Capacity Building, Department of Psychiatry, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
- Department of Nursing, Debre Berhan University, Debre Berhan, Ethiopia
| | - Awoke Mihretu
- WHO Collaborating Centre for Mental Health Research and Capacity Building, Department of Psychiatry, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Catherine Sackley
- Faculty of Medicine and Health Sciences, University of Nottingham, Nottingham, United Kingdom
| | - Atalay Alem
- WHO Collaborating Centre for Mental Health Research and Capacity Building, Department of Psychiatry, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
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Rauniyar VK, Khan SA, Gautam S, Parajuli SB. Clinico-epidemiological profile of cerebrovascular accident in eastern Nepal: A descriptive cross-sectional study. Medicine (Baltimore) 2023; 102:e35569. [PMID: 37832119 PMCID: PMC10578665 DOI: 10.1097/md.0000000000035569] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Accepted: 09/19/2023] [Indexed: 10/15/2023] Open
Abstract
cerebrovascular accident (CVA) has contributed to a significant increase in the morbidity and mortality rates in lower middle-income counties like Nepal. Despite being a common noncommunicable disease in Nepal, little attention has been paid to it, in terms of formulating national health plans and policies by the concerned authorities. This was a descriptive cross-sectional study in patients diagnosed with cerebrovascular accidents at a tertiary care hospital in Eastern Nepal. We analyzed 128 diagnosed cases of cerebrovascular accidents from February 26, 2023 to June 26, 2023 after taking ethical clearance from the Institutional Review Committee (Reference no. IRC-PA-283/2078-79). Data were analyzed by Statistical Package for the Social Sciences version 23. The objective of this study was to explore the age and sex distribution of CVA, its association with medical co-morbidities, and known risk factors like Type-2-Diabetes Mellitus, hypertension, thyroid disorders, smoking and alcohol. Together with calculating the distribution of ischemic CVA and hemorrhagic CVA we had also staged the disease based on the National Institute of Health Stroke Scale.
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Affiliation(s)
- Vivek K. Rauniyar
- Department of Clinical Neurology, Birat Medical College Teaching Hospital, Morang, Nepal
| | | | | | - Surya Bahadur Parajuli
- Department of Community Medicine, Birat Medical College Teaching Hospital, Morang, Nepal
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14
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Jirjees F, Al-Obaidi H, Barakat M, Kharaba Z, AlSalamat H, Khidhair Z, Alfoteih Y, Eltayib E, Mansour S, Hallit S, Malaeb D, Hosseini H. Knowledge and awareness of stroke in the United Arab Emirates: a cross-sectional study of the general population. F1000Res 2023; 12:1112. [PMID: 37868297 PMCID: PMC10587663 DOI: 10.12688/f1000research.134328.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/09/2023] [Indexed: 10/24/2023] Open
Abstract
BACKGROUND The study aimed to assess stroke knowledge among the general population in the United Arab Emirates (UAE) and determine the factors associated with stroke awareness among people. METHODS A cross-sectional study was conducted in the UAE between September and November 2021. The general population has self-administered an online bilingual survey (Arabic and English) distributed via social media platforms. The questionnaire covered general knowledge about stroke risk factors, consequences of stroke, and responding to somebody with acute stroke attack. RESULTS A total of 545 surveys were completed, with more than half of the participants being female (58.5%), married (55.4%) and employed (59.4%). The majority were less than 50 years old (90.5%) and had a university degree (71.0%). Many of the participants (70.8%) had a good general knowledge of stroke; however, around 20% of the participants were able to recognize all symptoms and risk factors of stroke. The most common sources of stroke-related information were the internet/social media (53.6%). Females were better able to correctly identify at least one stroke symptom and outcome than males (p=0.008). University education has significantly affected participants' ability to identify early stroke symptoms (p=0.001) correctly. In addition, diabetic people were more likely to recognize at least one stroke outcome than non-diabetic people (p=0.039). CONCLUSIONS The knowledge of stroke was good among highly educated people and females. However, the awareness of all stroke risk factors, symptoms, consequences and risk factors was inadequate among the general population of the UAE. Thus, there is still a gap between recognition of the relevant stroke and taking action among people.
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Affiliation(s)
- Feras Jirjees
- University of Sharjah, Sharjah, United Arab Emirates
| | | | - Muna Barakat
- Applied Science Private University, Amman, Jordan
| | | | | | | | | | | | - Sara Mansour
- Lebanese International University, Beqaa, Lebanon
| | | | - Diana Malaeb
- Gulf Medical University, Ajman, United Arab Emirates
| | - Hassan Hosseini
- Universite Paris-Est Creteil Val de Marne, Créteil, Île-de-France, France
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15
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Kalita J, Bharadwaz MP, Aditi A. Prevalence, contributing factors, and economic implications of strokes among older adults: a study of North-East India. Sci Rep 2023; 13:16880. [PMID: 37803041 PMCID: PMC10558533 DOI: 10.1038/s41598-023-43977-z] [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: 07/16/2023] [Accepted: 10/01/2023] [Indexed: 10/08/2023] Open
Abstract
Stroke is a significant cause of mortality and disability in India, with its economic impact on the rise. This study aims to investigate the prevalence and factors associated with stroke among the elderly population in seven north-eastern states of India and its economic consequences. Data from the initial phase of the Longitudinal Ageing Study in India (2017-2018) were utilized, and bivariate and multivariate analyses were done. Stroke prevalence (1.53%) was notable among both genders, with approximately 1% in females and 2.3% in males. Individuals with low physical activity, higher socio-economic status, and unemployment faced a higher risk of stroke. Females exhibited a 60% lower likelihood [AOR 0.40; (CI 0.250-0.627)] of stroke compared to males and hypertension was a significant risk factor. Stroke patients incur up to INR 50,000 of financial burden, with a considerable proportion facing disability in comprehension and speech. The economic burden of stroke-related hospitalization was significantly high, emphasizing the need for government-funded health insurance to cover stroke-related medications and reducing out-of-pocket expenses for patients seeking treatment in healthcare facilities. The study highlights the urgency for better schemes to address the growing threat of strokes in the north-eastern parts of India for comprehensively tackling this public health challenge.
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Affiliation(s)
- Jumi Kalita
- Lalit Chandra Bharali College, Guwahati, Assam, India
| | | | - Aditi Aditi
- Department of Survey Research and Data Analytics, International Institute for Population Sciences, Mumbai, 400088, India.
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Morris DR, Singh TP, Zaman T, Velu R, Quigley F, Jenkins J, Golledge J. Rates of Stroke in Patients With Different Presentations of Carotid Artery Stenosis. Eur J Vasc Endovasc Surg 2023; 66:484-491. [PMID: 37295600 DOI: 10.1016/j.ejvs.2023.05.041] [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: 09/18/2022] [Revised: 05/09/2023] [Accepted: 05/30/2023] [Indexed: 06/12/2023]
Abstract
OBJECTIVE Carotid artery stenosis may present without the classical symptoms of transient ischaemic attack or stroke but the rates of stroke for these presentations is unknown. The aim of this study was to examine the rates of stroke in patients with different presentations of carotid artery stenosis. METHODS A multicentre prospective cohort study was conducted across three Australian vascular centres with low rates of surgical treatment of patients without transient ischaemic attack or stroke. Patients with a 50 - 99% carotid artery stenosis presenting with non-focal symptoms (e.g., dizziness or syncope; n = 47), prior contralateral carotid endarterectomy (n = 71), prior ipsilateral symptoms more than six months earlier (n = 82), and no symptoms (n = 304) were recruited. The primary outcome was ipsilateral ischaemic stroke. Secondary outcomes were any ischaemic stroke and cardiovascular death. Data were analysed using Cox proportional hazard and Kaplan-Meier analyses. RESULTS Between 2002 and 2020, 504 patients were enrolled (mean age 71 years, 30% women) and followed for a median of 5.1 years (interquartile range 2.5, 8.8; 2 981 person years). Approximately 82% were prescribed antiplatelet therapy, 84% were receiving at least one antihypertensive drug, and 76% were prescribed a statin at entry. After five years the incidence of ipsilateral stroke was 6.5% (95% confidence interval [CI] 4.3 - 9.5). There were no statistically significant differences in the annual rate of ipsilateral stroke among people with non-focal symptoms (2.1%; 95% CI 0.8 - 5.7), prior contralateral carotid endarterectomy (0.2%; 0.03 - 1.6) or ipsilateral symptoms > 6 months prior (1.0%; 0.4 - 2.5) compared with those with no symptoms (1.2%; 0.7 - 1.8; p = .19). There were no statistically significant differences in secondary outcomes across groups. CONCLUSION This cohort study showed no large differences in stroke rates among people with different presentations of carotid artery stenosis.
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Affiliation(s)
- Dylan R Morris
- Queensland Research Centre for Peripheral Vascular Disease, College of Medicine and Dentistry, James Cook University, Townsville, Queensland, Australia; Department of Vascular and Endovascular Surgery, Townsville University Hospital, Townsville, Queensland, Australia
| | - Tejas P Singh
- Queensland Research Centre for Peripheral Vascular Disease, College of Medicine and Dentistry, James Cook University, Townsville, Queensland, Australia; Department of Vascular and Endovascular Surgery, Townsville University Hospital, Townsville, Queensland, Australia
| | - Tahmid Zaman
- Queensland Research Centre for Peripheral Vascular Disease, College of Medicine and Dentistry, James Cook University, Townsville, Queensland, Australia
| | - Ramesh Velu
- Department of Vascular and Endovascular Surgery, Townsville University Hospital, Townsville, Queensland, Australia; The Mater Hospital, Townsville, Queensland, Australia
| | | | - Jason Jenkins
- Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia
| | - Jonathan Golledge
- Queensland Research Centre for Peripheral Vascular Disease, College of Medicine and Dentistry, James Cook University, Townsville, Queensland, Australia; Department of Vascular and Endovascular Surgery, Townsville University Hospital, Townsville, Queensland, Australia.
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Saraiva J, Rosa G, Fernandes S, Fernandes JB. Current Trends in Balance Rehabilitation for Stroke Survivors: A Scoping Review of Experimental Studies. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:6829. [PMID: 37835099 PMCID: PMC10572981 DOI: 10.3390/ijerph20196829] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Revised: 09/15/2023] [Accepted: 09/23/2023] [Indexed: 10/15/2023]
Abstract
Balance impairment is a common consequence of a stroke, which can significantly hinder individuals' participation in daily activities, social interactions, and leisure pursuits and their ability to return to work. Rehabilitation is vital for minimizing post-stroke sequelae and facilitating the recovery of patients. This review aims to identify current trends in balance rehabilitation of stroke survivors. This Scoping review followed Arksey and O'Malley's methodological framework. The literature search was conducted in electronic databases, including CINAHL Complete, MEDLINE Complete, and Nursing & Allied Health Collection. The search was performed in March 2023, and the inclusion criteria were articles published in English or Portuguese between 2013 and 2023. A total of 446 articles were identified. After selecting and analyzing the reports, fourteen publications were included in this review. Seven distinct categories of balance rehabilitation interventions were identified, covering various approaches. These categories included conventional rehabilitation exercises, gym-based interventions, vibration therapy, rhythmic auditory stimulation training, boxing therapy, dual-task training, and technology-based rehabilitation interventions. Each of these methods presents unique benefits and can significantly impact the recovery of balance in stroke survivors, enhancing their overall well-being and functional capacity.
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Affiliation(s)
- Júlia Saraiva
- Department of Nursing, Hospital Garcia de Orta, 2805-267 Almada, Portugal;
- Nurs* Lab, Caparica, 2829-511 Almada, Portugal; (S.F.); (J.B.F.)
| | - Gonçalo Rosa
- Department of Nursing, Hospital Garcia de Orta, 2805-267 Almada, Portugal;
- Nurs* Lab, Caparica, 2829-511 Almada, Portugal; (S.F.); (J.B.F.)
| | - Sónia Fernandes
- Nurs* Lab, Caparica, 2829-511 Almada, Portugal; (S.F.); (J.B.F.)
- Egas Moniz Center for Interdisciplinary Research (CiiEM), Egas Moniz School of Health & Science, Caparica, 2829-511 Almada, Portugal
| | - Júlio Belo Fernandes
- Nurs* Lab, Caparica, 2829-511 Almada, Portugal; (S.F.); (J.B.F.)
- Egas Moniz Center for Interdisciplinary Research (CiiEM), Egas Moniz School of Health & Science, Caparica, 2829-511 Almada, Portugal
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Jasukaitienė E, Šileikienė L, Augustis Š, Tamošiūnas A, Lukšienė D, Krančiukaitė-Butylkinienė D, Šakalytė G, Žaliaduonytė D, Radišauskas R. Sociodemographic Factors, Comorbidities, In-Hospital Complications, and Outcomes of Ischaemic Stroke Patients in the Context of the COVID-19 Pandemic in Lithuania: A Retrospective, Record-Based, Single-Centre Study. Cureus 2023; 15:e45553. [PMID: 37868513 PMCID: PMC10586473 DOI: 10.7759/cureus.45553] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/14/2023] [Indexed: 10/24/2023] Open
Abstract
INTRODUCTION The role of COVID-19 regarding in-hospital complications and poor outcomes for patients with ischaemic stroke (IS) is still important to explore. The aim of this study was to evaluate the risk of in-hospital lethality for IS patients respectively to their comorbidities and in-hospital complications in the context of the COVID-19 pandemic. METHODS We identified 1898 acute IS patients (749 men and 1149 women) admitted to the Lithuanian University of Health Sciences Kaunas Hospital, Lithuania, from December 2020 to February 2022. The sociodemographic, clinical, and outcome features of the patients were evaluated deploying appropriate statistical tests. Hazard ratios and 95% confidence intervals were estimated by the Cox proportional hazards regression for hospital lethality. RESULTS The risk of in-hospital lethality was 2.22 times higher in men suffering from IS and chronic ischaemic heart disease (cIHD) compared to those with IS and isolated arterial hypertension (iAH) (p < 0.05). COVID-19 elevated the risk of in-hospital lethality in men by 3.16 times (p < 0.05). In comorbid women with type two diabetes mellitus (DM) or cIHD, the risk of in-hospital lethality was two times higher compared to those with iAH (p < 0.05). The risk of in-hospital lethality increased significantly in both men and women, with the total number of in-hospital complications increasing per one unit. CONCLUSIONS Of the comorbidities studied, DM and cIHD together with COVID-19 elevated the risk of in-hospital lethality significantly. Within the acute in-hospital complications, pneumonia with respiratory failure and acute renal failure showed the most significant prognostic value anticipating lethal outcomes for IS patients.
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Affiliation(s)
- Erika Jasukaitienė
- Department of Population Studies, Institute of Cardiology, Medical Academy, Lithuanian University of Health Sciences, Kaunas, LTU
| | - Lolita Šileikienė
- Department of Population Studies, Institute of Cardiology, Medical Academy, Lithuanian University of Health Sciences, Kaunas, LTU
| | - Šarūnas Augustis
- Department of Population Studies, Institute of Cardiology, Medical Academy, Lithuanian University of Health Sciences, Kaunas, LTU
| | - Abdonas Tamošiūnas
- Department of Population Studies, Institute of Cardiology, Medical Academy, Lithuanian University of Health Sciences, Kaunas, LTU
| | - Dalia Lukšienė
- Department of Population Studies, Institute of Cardiology, Medical Academy, Lithuanian University of Health Sciences, Kaunas, LTU
| | - Daina Krančiukaitė-Butylkinienė
- Department of Population Studies, Institute of Cardiology, Medical Academy, Lithuanian University of Health Sciences, Kaunas, LTU
| | - Gintarė Šakalytė
- Institute of Cardiology, Medical Academy, Lithuanian University of Health Sciences, Kaunas, LTU
| | - Diana Žaliaduonytė
- Department of Cardiology, Medical Academy, Lithuanian University of Health Sciences, Kaunas, LTU
| | - Ričardas Radišauskas
- Department of Population Studies, Institute of Cardiology, Medical Academy, Lithuanian University of Health Sciences, Kaunas, LTU
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Misgana S, Asemahagn MA, Atnafu DD, Anagaw TF. Incidence of stroke and its predictors among hypertensive patients in Felege Hiwot comprehensive specialized hospital, Bahir Dar, Ethiopia, a retrospective follow-up study. Eur J Med Res 2023; 28:227. [PMID: 37430339 DOI: 10.1186/s40001-023-01192-6] [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: 09/01/2022] [Accepted: 06/23/2023] [Indexed: 07/12/2023] Open
Abstract
BACKGROUND Globally, one in three adults has hypertension, a condition that causes 51% of all deaths from stroke. Stroke is becoming a major public health problem and the most common cause of morbidity and mortality among non-communicable diseases in the world and Ethiopia. Therefore, this study assesses the incidence of stroke and its predictors among hypertensive patients in Felege Hiwot Comprehensive Specialized Hospital, Bahir Dar, Ethiopia 2021. METHODS A hospital-based retrospective follow-up study design was used, simple random sampling technique was used to select 583 hypertensive patients that had follow-up registration between January 2018 and December 30th, 2020. Data were entered into Epi-data version 3.1 and exported to STATA version 14. The adjusted hazard ratio for each predictor with a 95% confidence interval was calculated using the Cox proportional hazards regression model, and a P-value ≤ 0.05 was used to denote statistical significance. RESULTS From 583 hypertensive patients 106(18.18%) [95% CI 15-20] were developed stroke. The overall incidence rate was 1 per 100 person-years (95% CI 0.79-1.19). Comorbidities (Adjusted hazard ratio(AHR): 1.88, 95% CI 1.0-3.5), stage two hypertension (AHR = 5.21, 95%CI 2.75-9.8), uncontrolled systolic blood pressure (AHR: 2, 95% CI 1.21-354), uncontrolled diastolic blood pressure (AHR:1.9, 95% CI 1.1-3.57), alcohol consumption (AHR = 2.04, 95%CI 1.2-3.49), age 45-65 (AHR = 10.25, 95%CI 7.47-11.1); and drug discontinuation (AHR = 2.05,95% CI 1.26-3.35) were independent predictors for the incidence of stroke among hypertensive patients. CONCLUSION The incidence of stroke among hypertensive patients was high and various modifiable and non-modifiable risk factors highly contributed to its incidence. This study recommends early screening of blood pressure, giving priority to comorbid patients and patients with advanced stage hypertension, and giving health education about behavioral risks and drug adherence.
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Affiliation(s)
- Solomon Misgana
- Amhara Regional Health Beauro,Bahir Dar, Bahir Dar, Ethiopia
| | - Mulusew Andualem Asemahagn
- School of Public health, College of Medicine and Health Science Bahir Dar University, Bahir Dar, Ethiopia
| | - Desta Debalkie Atnafu
- Department of Health System Management and Health Economics, School of Public health, College of Medicine and Health Science Bahir Dar University, Bahir Dar, Ethiopia
| | - Tadele Fentabil Anagaw
- Department of Health Promotion and Behavioral Science, School of Public health, College of Medicine and Health Science Bahir Dar University, 079, Bahir Dar, Ethiopia.
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20
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Saleki K, Mohamadi MH, Alijanizadeh P, Rezaei N. Neurological adverse effects of chimeric antigen receptor T-cell therapy. Expert Rev Clin Immunol 2023; 19:1361-1383. [PMID: 37578341 DOI: 10.1080/1744666x.2023.2248390] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Revised: 08/07/2023] [Accepted: 08/10/2023] [Indexed: 08/15/2023]
Abstract
INTRODUCTION Chimeric antigen receptor (CAR) T-cell is among the most prevalent approaches that act by directing T-cells toward cancer; however, they need to be optimized to minimize side effects and maximize efficacy before being used as standard treatment for malignancies. Neurotoxicity associated with CAR T-cell therapy has been well-documented in recent works. AREAS COVERED In this regard, two established syndromes exist. Immune effector cell-associated neurotoxicity syndrome (ICANS), previously called cytokine release encephalopathy syndrome (CRES), is a neuropsychiatric condition which can occur after therapy by immune effector cells (IEC) and T-lymphocytes utilizing treatments. Another syndrome is cytokine release syndrome (CRS), which may overlap with ICANS. EXPERT OPINION ICANS clinical manifestations include cerebral edema, mild lethargy, aphasia, and seizures. Notably, ICANS is associated with changes to EEG and neuroradiological findings. Therefore, it is necessary to make a timely and accurate diagnosis of neurological complications of CAR T-cells by clinical presentations, neuroimaging, and EEG. Since neurological events by different CAR T-cell products are heterogeneous, guides should be developed according to each product. Here, we provide an updated review of general information on CAR T-cell therapies and applications, neurological syndromes associated with their use, and risk factors contributing to ICANS.
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Affiliation(s)
- Kiarash Saleki
- Student Research Committee, Babol University of Medical Sciences, Babol, Iran
- USERN Office, Babol University of Medical Sciences, Babol, Iran
- Department of e-Learning, Virtual School of Medical Education and Management, Shahid Beheshti University of Medical Sciences(SBMU), Tehran, Iran
| | | | - Parsa Alijanizadeh
- Student Research Committee, Babol University of Medical Sciences, Babol, Iran
- USERN Office, Babol University of Medical Sciences, Babol, Iran
| | - Nima Rezaei
- Research Center for Immunodeficiencies, Children's Medical Center, Tehran University of Medical Sciences, Tehran, Iran
- Department of Immunology, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
- Network of Immunity in Infection, Malignancy and Autoimmunity (NIIMA), Universal Scientific Education and Research Network (USERN), Tehran, Iran
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Jacob L, Smith L, Koyanagi A, Haro JM, Shin JI, Tanislav C, Schnitzler A, Kostev K. Chronic Low Back Pain and Incident Transient Ischemic Attack and Stroke in General Practices in Germany. Healthcare (Basel) 2023; 11:healthcare11101499. [PMID: 37239785 DOI: 10.3390/healthcare11101499] [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: 04/29/2023] [Revised: 05/13/2023] [Accepted: 05/17/2023] [Indexed: 05/28/2023] Open
Abstract
The aim was to investigate the association between chronic low back pain (CLBP) and incident transient ischemic attack (TIA) and stroke in Germany. The present retrospective cohort study included adults aged ≥18 years who were diagnosed for the first time with CLBP in one of 1198 general practices in Germany in 2005-2019 (index date). Patients without CLBP were matched to those with CLBP (1:1) using a propensity score based on age, sex, the index year, the number of medical consultations per year during the follow-up, and the number of years of follow-up. In patients without CLBP, the index date was a randomly selected visit date. Both groups were followed for up to 10 years. There were 159,440 patients included in the study (mean (SD) age: 52.1 (16.5) years; 51.5% women). Within 10 years of the index date, 6.5% and 5.9% of patients with and without CLBP were diagnosed with TIA or stroke, respectively (log-rank p-value < 0.001). The Cox regression analysis corroborated these results, as there was a significant association between CLBP and incident TIA or stroke (HR = 1.28, 95% CI = 1.22-1.35). CLBP was positively and significantly associated with incident TIA and stroke in Germany. More research is warranted to better understand this relationship.
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Affiliation(s)
- Louis Jacob
- Research and Development Unit, Parc Sanitari Sant Joan de Déu, CIBERSAM, ISCIII, Dr. Antoni Pujadas, 42, 08830 Barcelona, Spain
- Department of Physical Medicine and Rehabilitation, Lariboisière-Fernand Widal Hospital, AP-HP, University Paris Cité, 75010 Paris, France
- Epidemiology of Ageing and Neurodegenerative Diseases, Université Paris Cité, Inserm U1153, 75010 Paris, France
| | - Lee Smith
- Centre for Health, Performance and Wellbeing, Anglia Ruskin University, Cambridge CB1 1PT, UK
| | - Ai Koyanagi
- Research and Development Unit, Parc Sanitari Sant Joan de Déu, CIBERSAM, ISCIII, Dr. Antoni Pujadas, 42, 08830 Barcelona, Spain
- Institució Catalana de Recerca i Estudis Avançats (ICREA), Pg. Lluis Companys 23, 08010 Barcelona, Spain
| | - Josep Maria Haro
- Research and Development Unit, Parc Sanitari Sant Joan de Déu, CIBERSAM, ISCIII, Dr. Antoni Pujadas, 42, 08830 Barcelona, Spain
| | - Jae Il Shin
- Department of Pediatrics, Yonsei University College of Medicine, Seoul 03722, Republic of Korea
| | - Christian Tanislav
- Department of Geriatrics and Neurology, Diakonie Hospital Jung Stilling Siegen, 57074 Siegen, Germany
| | - Alexis Schnitzler
- Department of Physical Medicine and Rehabilitation, Lariboisière-Fernand Widal Hospital, AP-HP, University Paris Cité, 75010 Paris, France
- Epidemiology of Ageing and Neurodegenerative Diseases, Université Paris Cité, Inserm U1153, 75010 Paris, France
| | - Karel Kostev
- Epidemiology, IQVIA, 60549 Frankfurt, Germany
- Department of Gynecology and Obstetrics, University Clinic of Marburg, 35043 Marburg, Germany
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22
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Kaddumukasa MN, Kaddumukasa M, Katabira E, Sewankambo N, Namujju LD, Goldstein LB. Prevalence and predictors of post-stroke cognitive impairment among stroke survivors in Uganda. BMC Neurol 2023; 23:166. [PMID: 37098461 PMCID: PMC10127321 DOI: 10.1186/s12883-023-03212-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2023] [Accepted: 04/15/2023] [Indexed: 04/27/2023] Open
Abstract
BACKGROUND Little is known about the characteristics and determinants of post-stroke cognitive impairment in residents of low- and middle-income countries. The objective of this study was to determine the frequencies, patterns, and risk factors for cognitive impairment in a cross-sectional study of consecutive stroke patients cared for at Uganda's Mulago Hospital, located in sub-Saharan Africa. METHODS 131 patients were enrolled a minimum of 3-months after hospital admission for stroke. A questionnaire, clinical examination findings, and laboratory test results were used to collect demographic information and data on vascular risk factors and clinical characteristics. Independent predictor variables associated with cognitive impairment were ascertained. Stroke impairments, disability, and handicap were assessed using the National Institute of Health Stroke Scale (NIHSS), Barthel Index (BI), and modified Rankin scale (mRS), respectively. The Montreal Cognitive Assessment (MoCA) was used to assess participants' cognitive function. Stepwise multiple logistic regression was used to identify variables independently associated with cognitive impairment. RESULTS The overall mean MoCA score was 11.7-points (range 0.0-28.0-points) for 128 patients with available data of whom 66.4% were categorized as cognitively impaired (MoCA < 19-points). Increasing age (OR 1.04, 95% CI 1.00-1.07; p = 0.026), low level of education (OR 3.23, 95% CI 1.25-8.33; p = 0.016), functional handicap (mRS 3-5; OR 1.84, 95% CI 1.28-2.63; p < 0.001) and high LDL cholesterol (OR 2.74, 95% CI 1.14-6.56; p = 0.024) were independently associated with cognitive impairment. CONCLUSIONS Our findings highlight the high burden and need for awareness of cognitive impairment in post stroke populations in the sub-Saharan region and serve to emphasize the importance of detailed cognitive assessment as part of routine clinical evaluation of patients who have had a stroke.
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Affiliation(s)
- Martin N Kaddumukasa
- Department of Medicine, School of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Mark Kaddumukasa
- Department of Medicine, School of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Elly Katabira
- Department of Medicine, School of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Nelson Sewankambo
- Department of Medicine, School of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Lillian D Namujju
- Department of Electrical and Computer Engineering, College of Engineering, Design, Art and Technology, Makerere University, Kampala, Uganda
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23
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Li D, Zha F, Wang Y. Association Between Falling and Activities of Daily Living Measured by the Longshi Scale in Patients Poststroke: A Cross-sectional Study. J Nurs Care Qual 2023; 38:E25-E31. [PMID: 36729956 DOI: 10.1097/ncq.0000000000000679] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND Activities of daily living comprise an important risk factor for falls among patients who have suffered a stroke. PURPOSE To investigate the incidence of falls in patients with stroke, categorized by their Longshi grades (bedridden, domestic, community), and to explore their risk factors for falls. METHODS A cross-sectional descriptive design was used. Patients completed a survey during face-to-face interviews. RESULTS Of the 869 participants, 15.7% experienced a fall. Those in the domestic Longshi group had the highest rate of falls. Approximately 30% experienced either a moderate or severe injury as a result of falling. In addition, being older than 70 years was significantly correlated with fall risk. Intermediate Longshi grades, from moderately dependent to slightly dependent, were also positively correlated with falls. CONCLUSION Patients with stroke in the domestic Longshi group have a higher rate of falls. The risk of falling increased significantly in those with intermediate Longshi grades.
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Affiliation(s)
- Dongxia Li
- Department of Rehabilitation, Shenzhen Second People's Hospital, The First Affiliated Hospital of Shenzhen University, Shenzhen, China
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24
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Aftyka J, Staszewski J, Dębiec A, Pogoda-Wesołowska A, Żebrowski J. Can HRV Predict Prolonged Hospitalization and Favorable or Unfavorable Short-Term Outcome in Patients with Acute Ischemic Stroke? Life (Basel) 2023; 13:life13040856. [PMID: 37109385 PMCID: PMC10140812 DOI: 10.3390/life13040856] [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: 01/23/2023] [Revised: 03/15/2023] [Accepted: 03/21/2023] [Indexed: 04/29/2023] Open
Abstract
The aim of this study was to assess whether the heart rate variability (HRV) could predict a favorable or unfavorable stroke outcome. The endpoint was based on the National Institutes of Health Stroke Scale (NIHSS). The patient's health condition was assessed upon discharge from the hospital. An unfavorable stroke outcome was defined as death or NIHSS ≥ 9, while NIHSS < 9 meant a favorable stroke outcome. The studied group consisted of 59 patients with acute ischemic stroke AIS (mean age of 65.6 ± 13.2; 58% were females). An original and innovative non-linear measure was used to analyze HRV. It was based on symbolic dynamics consisting of comparing the "length of the longest words" in the night recording of HRV. "The length of the longest word" meant the longest sequence of identical adjacent symbols possible for a patient. An unfavorable stroke outcome occurred in 22 patients, whereas the majority of patients (37) had a favorable stroke outcome. The average hospitalization time of patients with clinical progression was 29 ± 14 days, and with favorable outcomes was 10 ± 3 days. Patients with long words (more than 150 adjacent RR intervals having the same symbol) were hospitalized no longer than 14 days and they had no clinical progression. The patients with a favorable stroke outcome were characterized by longer words. Our pilot study may be the beginning of work on the development of a non-linear, symbolic method as a predictor of prolonged hospitalization and increased risk of clinical progression in patients with AIS.
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Affiliation(s)
- Joanna Aftyka
- Faculty of Physics, Warsaw University of Technology, Koszykowa 75, 00-662 Warsaw, Poland
| | - Jacek Staszewski
- Clinic of Neurology, Military Institute of Medicine, Szaserow 128, 04-141 Warsaw, Poland
| | - Aleksander Dębiec
- Clinic of Neurology, Military Institute of Medicine, Szaserow 128, 04-141 Warsaw, Poland
| | | | - Jan Żebrowski
- Faculty of Physics, Warsaw University of Technology, Koszykowa 75, 00-662 Warsaw, Poland
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Inflammation, Microcalcification, and Increased Expression of Osteopontin Are Histological Hallmarks of Plaque Vulnerability in Patients with Advanced Carotid Artery Stenosis. Biomedicines 2023; 11:biomedicines11030881. [PMID: 36979863 PMCID: PMC10045225 DOI: 10.3390/biomedicines11030881] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Revised: 03/03/2023] [Accepted: 03/07/2023] [Indexed: 03/18/2023] Open
Abstract
Background: severe carotid artery stenosis is a major cause of ischemic stroke and consequent neurological deficits. The most important steps of atherosclerotic plaque development, leading to carotid stenosis, are well-known; however, their exact timeline and intricate causal relationships need to be more characterized. Methods: in a cohort of 119 patients, who underwent carotid endarterectomy, we studied the histological correlations between arterial calcification patterns and localization, the presence of the inflammatory infiltrate and osteopontin expression, with ulceration, thrombosis, and intra-plaque hemorrhage, as direct signs of vulnerability. Results: in patients with an inflammatory infiltrate, aphasia was more prevalent, and microcalcification, superficial calcification, and high-grade osteopontin expression were characteristic. Higher osteopontin expression was also correlated with the presence of a lipid core. Inflammation and microcalcification were significantly associated with plaque ulceration in logistic regression models; furthermore, ulceration and the inflammatory infiltrate were significant determinants of atherothrombosis. Conclusion: our results bring histological evidence for the critically important role of microcalcification and inflammatory cell invasion in the formation and destabilization of advanced carotid plaques. In addition, as a calcification organizer, high-grade osteopontin expression is associated with ulceration, the presence of a large lipid core, and may also have an intrinsic role in plaque progression.
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Baraka A, Meda J, Nyundo A. Predictors of post-stroke cognitive impairment at three-month following first episode of stroke among patients attended at tertiary hospitals in Dodoma, central Tanzania: A protocol of a prospective longitudinal observational study metadata. PLoS One 2023; 18:e0273200. [PMID: 36862705 PMCID: PMC9980770 DOI: 10.1371/journal.pone.0273200] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Accepted: 02/03/2023] [Indexed: 03/03/2023] Open
Abstract
INTRODUCTION Neurocognitive deficits after stroke are a common manifestation and pose a significant impact on the quality of life for patients and families; however, little attention is given to the burden and associated impact of cognitive impairment following stroke. The study aims to determine the prevalence and predictors of post-stroke cognitive impairment (PSCI) among adult stroke patients admitted to tertiary hospitals in Dodoma, Tanzania. METHODOLOGY A prospective longitudinal study is conducted at tertiary hospitals in the Dodoma region, central Tanzania. Participants with the first stroke confirmed by CT/MRI brain aged ≥ 18 years who meet the inclusion criteria are enrolled and followed up. Baseline socio-demographic and clinical factors are identified during admission, while other clinical variables are determined during the three-month follow-up period. Descriptive statistics are used to summarize data; continuous data will be reported as Mean (SD) or Median (IQR), and categorical data will be summarized using proportions and frequencies. Univariate and multivariate logistic regression analysis will be used to determine predictors of PSCI.
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Affiliation(s)
- Alphonce Baraka
- Department of Internal Medicine, School of Medicine & Dentistry, The University Dodoma, Dodoma, Tanzania
- Department of Internal Medicine, The Benjamin Mkapa Hospital, Dodoma, Tanzania
| | - John Meda
- Department of Internal Medicine, School of Medicine & Dentistry, The University Dodoma, Dodoma, Tanzania
- Department of Cardiology, The Benjamin Mkapa Hospital, Dodoma, Tanzania
| | - Azan Nyundo
- Department of Psychiatry and Mental Health, School of Medicine, The University of Dodoma, Dodoma, Tanzania
- Division of Psychiatry, Department of Internal Medicine, The Benjamin Mkapa Hospital, Dodoma, Tanzania
- * E-mail: ,
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Bawand R, Ghiasian M, Khazaei M, Samadyan M, Moradi A. Effects of blood pressure unawareness and poor adherence to antihypertensive drugs on outcomes of cerebrovascular accidents among patients with their first-ever stroke. J Hypertens 2023; 41:459-469. [PMID: 36728239 DOI: 10.1097/hjh.0000000000003358] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
AIMS Our main target was to investigate the relationship of blood pressure (BP) unawareness and poor antihypertensive drug adherence with the clinical outcomes of the stroke including hospitalization time, degree of disability, and mortality rate. METHODS AND RESULTS In this cross-sectional study, we evaluated 530 eligible patients (male = 313; female = 217), aged 18 years and older who had a proven diagnosis of nontraumatic first-ever stroke and were referred to the Shahid Beheshti Hospital of Hamadan, Iran, during the period from March 2019 to September 2021. The prevalence of BP unawareness was 19.6%, and 31.8% of antihypertensive drug users (14.3% of all studied population) had poor drug adherence, in which, older age, male gender, marriage, rural residence, and smoking were associated with the lack of appropriate drug adherence. There was no significant difference between patients with diverse stroke types (ischemic or hemorrhagic) from the points of BP awareness and adherence to antihypertensive drugs; nevertheless, patients with a positive history of cardiac diseases had a significantly higher awareness of their BP status ( P = 0.037). BP unawareness was associated with poor clinical prognosis, and could significantly increase stroke mortality ( P = 0.001) and disability ( P < 0.001) rates as well as the duration of hospitalization ( P < 0.001). Moreover, those who survived the stroke (modified Rankin Scale < 6) had the highest odds to be aware of their BP status (adjusted odds ratio [AOR] = 2.380 [95% confidence interval [CI] = 1.39-4.07]). Additionally, nonsmokers (AOR = 7.740), urban residents (AOR = 3.314), and literate patients (AOR = 2.092) had the highest odds of having appropriate drug adherence. CONCLUSION Stroke mortality and morbidity rates can be significantly modified by persuading people to monitor their BP regularly and maximize antihypertensive medication adherence. In the meantime, increasing the literacy level in society and reducing the smoking rate can play important roles in achieving these goals.
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Affiliation(s)
| | | | | | | | - Abbas Moradi
- Department of Social Medicine, School of Medicine, Hamadan University of Medical Sciences, Hamadan, Iran
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Kaddumukasa MN, Kaddumukasa M, Katabira E, Sewankambo N, Namujju LD, Goldstein LB. Prevalence and Predictors of Post-stroke Cognitive Impairment among Stroke Survivors in Uganda. RESEARCH SQUARE 2023:rs.3.rs-2456615. [PMID: 36711491 PMCID: PMC9882649 DOI: 10.21203/rs.3.rs-2456615/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
Background Little is known about the characteristics and determinants of post-stroke cognitive impairments in low- and middle-income countries. The objective of this study was to determine the frequencies, patterns, and risk factors for cognitive impairment in a cross-sectional study of consecutive stroke patients cared for at Uganda's Mulago Hospital, located in sub-Saharan Africa. Methods From August 2019 to July 2020, patients were enrolled a minimum of 3-months post-stroke hospital admission. We collected data on their demographics, vascular risk factors and clinical factors using a questionnaire, clinical examination findings, and test results. Independent predictor variables associated with cognitive impairment were ascertained. Stroke impairments, disability, and handicap were assessed using the National Institute of Health Stroke Scale (NIHSS), Barthel Index (BI), and modified Rankin scale (mRS), respectively. The Montreal Cognitive Assessment (MoCA) was used to assess participants' cognitive function. Stepwise multiple logistic regression was used to identify variables independently associated with cognitive impairment. Results The overall mean MoCA score was 11.7-points (range 0.0-28.0-points) for 128 patients with available data of whom 66.4% were categorized as cognitively impaired (MoCA < 19-points). Increasing age (OR 1.04, 95% CI 1.00-1.07; p = 0.026), low level of education (OR 3.23, 95% CI 1.25-8.33; p = 0.016), functional handicap (mRS 3-5; OR 1.84, 95% CI 1.28-2.63; p < 0.001) and high LDL cholesterol (OR 2.74, 95% CI 1.14-6.56; p = 0.024) were independently associated with cognitive impairment. Discussion Further longitudinal, prospective studies are required to confirm these findings and identify strategies for reducing the risk of post-stroke cognitive impairment in this population.
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Jæger HS, Tranberg D, Larsen K, Valentin JB, Blauenfeldt RA, Luger S, Bache KG, Gude MF. Diagnostic performance of Glial Fibrillary Acidic Protein and Prehospital Stroke Scale for identification of stroke and stroke subtypes in an unselected patient cohort with symptom onset < 4.5 h. Scand J Trauma Resusc Emerg Med 2023; 31:1. [PMID: 36604741 PMCID: PMC9814331 DOI: 10.1186/s13049-022-01065-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Accepted: 12/26/2022] [Indexed: 01/06/2023] Open
Abstract
INTRODUCTION Rapid identification and treatment of stroke is crucial for the outcome of the patient. We aimed to determine the performance of glial fibrillary acidic protein (GFAP) independently and in combination with the Prehospital Stroke Score (PreSS) for identification and differentiation of acute stroke within 4.5 h after symptom onset. PATIENTS AND METHODS Clinical data and serum samples were collected from the Treat-Norwegian Acute Stroke Prehospital Project (Treat-NASPP). Patients with suspected stroke and symptoms lasting ≤ 4.5 h had blood samples collected and were evaluated with the National Institutes of Health Stroke Scale prospectively. In this sub study, NIHSS was retrospectively translated into PreSS and GFAP was measured using the sensitive single molecule array (SIMOA). RESULTS A total of 299 patients with suspected stroke were recruited from Treat-NASPP and included in this study (44% acute ischemic stroke (AIS), 10% intracranial hemorrhage (ICrH), 7% transient ischemic attack (TIA), and 38% stroke mimics). ICrH was identified with a cross-fold validated area under the receiver-operating characteristic curve (AUC) of 0.73 (95% CI 0.62-0.84). A decision tree with PreSS and GFAP combined, first identified patients with a low probability of stroke. Subsequently, GFAP detected patients with ICrH with a 25.0% sensitivity (95% CI 11.5-43.4) and 100.0% specificity (95% CI 98.6-100.0). Lastly, patients with large-vessel occlusion (LVO) were detected with a 55.6% sensitivity (95% CI 35.3-74.5) and 82.4% specificity (95% CI 77.3-86.7). CONCLUSION In unselected patients with suspected stroke, GFAP alone identified ICrH. Combined in a decision tree, GFAP and PreSS identified subgroups with high proportions of stroke mimics, ICrH, LVO, and AIS (non-LVO strokes).
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Affiliation(s)
- Henriette S. Jæger
- grid.420120.50000 0004 0481 3017The Norwegian Air Ambulance Foundation, Research and Development, Oslo, Norway ,grid.5510.10000 0004 1936 8921Institute of Basic Medical Sciences, University of Oslo, Oslo, Norway
| | - Ditte Tranberg
- grid.425869.40000 0004 0626 6125Department of Research and Development, Prehospital Emergency Medical Services, Central Denmark Region and Aarhus University, Olof Palmes Allé 34, 2., 8200 Aarhus N, Denmark
| | - Karianne Larsen
- grid.420120.50000 0004 0481 3017The Norwegian Air Ambulance Foundation, Research and Development, Oslo, Norway ,grid.5510.10000 0004 1936 8921Institute of Basic Medical Sciences, University of Oslo, Oslo, Norway
| | - Jan B. Valentin
- grid.5117.20000 0001 0742 471XDanish Center for Clinical Health Services Research (DACS), Department of Clinical Medicine, Aalborg University and Aalborg University Hospital, Aalborg, Denmark
| | - Rolf A. Blauenfeldt
- grid.154185.c0000 0004 0512 597XDepartment of Neurology and Danish Stroke Center, Aarhus University Hospital, 8200 Aarhus, Denmark
| | - Sebastian Luger
- grid.411088.40000 0004 0578 8220Department of Neurology, University Hospital Frankfurt/Goethe University Frankfurt, Frankfurt am Main, Germany
| | - Kristi G. Bache
- grid.5510.10000 0004 1936 8921Institute of Basic Medical Sciences, University of Oslo, Oslo, Norway ,grid.446040.20000 0001 1940 9648Research and Dissemination, Østfold University College, Halden, Norway
| | - Martin F. Gude
- grid.425869.40000 0004 0626 6125Department of Research and Development, Prehospital Emergency Medical Services, Central Denmark Region and Aarhus University, Olof Palmes Allé 34, 2., 8200 Aarhus N, Denmark
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Onose G, Anghelescu A, Ionescu A, Tataranu LG, Spînu A, Bumbea AM, Toader C, Tuţă S, Carare RO, Popescu C, Munteanu C, Daia C. Translation of the Fugl-Meyer assessment into Romanian: Transcultural and semantic-linguistic adaptations and clinical validation. Front Neurol 2023; 13:1022546. [PMID: 36712448 PMCID: PMC9879050 DOI: 10.3389/fneur.2022.1022546] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Accepted: 11/07/2022] [Indexed: 01/10/2023] Open
Abstract
Purpose The Fugl-Meyer Assessment (FMA) scale, which is widely used and highly recommended, is an appropriate tool for evaluating poststroke sensorimotor and other possible somatic deficits. It is also well-suited for capturing a dynamic rehabilitation process. The aim of this study was to first translate the entire sensorimotor FMA scale into Romanian using the transcultural and semantic-linguistic adaptations of its official afferent protocols and to then validate it using the preliminary clinical evaluation of inter- and intra-rater reliability and relevant concurrent validity. Methods Through three main steps, we completed a standardized procedure for translating FMA's official afferent evaluation protocols into Romanian and their transcultural and semantic-linguistic adaptation for both the upper and lower extremities. For relevant clinical validation, we evaluated 10 patients after a stroke two times: on days 1 and 2. All patients were evaluated simultaneously by two kinesi-physiotherapists (generically referred to as KFT1 and KFT2) over the course of 2 consecutive days, taking turns in the roles of an examiner and observer, and vice versa (inter-rater). Two scores were therefore obtained and compared for the same patient, i.e., being afferent to an inter-rater assay by comparing the assessment outcomes obtained by the two kinesi-physiotherapists, in between, and respectively, to the intra-rater assay: based on the evaluations of the same kinesi-physiotherapist, in two consecutive days, using a rank-based method (Svensson) for statistical analysis. We also compared our final Romanian version of FMA's official protocols for concurrent validity (Spearman's rank correlation statistical method) to both of the widely available assessment instruments: the Barthel Index (BI) and the modified Rankin scale (mRS). Results Svensson's method confirmed overall good inter- and intra-rater results for the main parts of the final Romanian version of FMA's evaluation protocols, regarding the percentage of agreement (≥80% on average) and for disagreement: relative position [RP; values outside the interval of (-0.1, 0.1) in only two measurements out of the 56 comparisons we did], relative concentration [RC; values outside the interval of (-0.1, 0.1) in only nine measurements out of the same 56 comparisons done], and relative rank variation [RV; all values within an interval of (0, 0.1) in only five measurements out of the 56 comparisons done]. High correlation values were obtained between the final Romanian version of FMA's evaluation protocols and the BI (ρ = 0.9167; p = 0.0002) for FMA-upper extremity (FMA-UE) total A-D (motor function) with ρ = 0.6319 and for FMA-lower extremity (FMA-LE) total E-F (motor function) with p = 0.0499, and close to the limit, with the mRS (ρ = -0.5937; p = 0.0704) for FMA-UE total A-D (motor function) and (ρ = -0.6615; p = 0.0372) for FMA-LE total E-F (motor function). Conclusions The final Romanian version of FMA's official evaluation protocols showed good preliminary reliability and validity, which could be thus recommended for use and expected to help improve the standardization of this assessment scale for patients after a stroke in Romania. Furthermore, this endeavor could be added to similar international translation and cross-cultural adaptations, thereby facilitating a more appropriate comparison of the evaluation and outcomes in the management of stroke worldwide.
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Affiliation(s)
- Gelu Onose
- Faculty of Medicine, “Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania,Teaching Emergency Hospital “Bagdasar-Arseni,”Bucharest, Romania
| | - Aurelian Anghelescu
- Faculty of Medicine, “Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania,Teaching Emergency Hospital “Bagdasar-Arseni,”Bucharest, Romania
| | - Anca Ionescu
- Faculty of Medicine, “Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania
| | - Ligia Gabriela Tataranu
- Faculty of Medicine, “Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania,Teaching Emergency Hospital “Bagdasar-Arseni,”Bucharest, Romania
| | - Aura Spînu
- Faculty of Medicine, “Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania,Teaching Emergency Hospital “Bagdasar-Arseni,”Bucharest, Romania
| | - Ana Maria Bumbea
- Faculty of Medicine, University of Medicine and Pharmacy, Craiova, Romania
| | - Corneliu Toader
- Faculty of Medicine, “Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania
| | - Sorin Tuţă
- Faculty of Medicine, “Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania
| | - Roxana O. Carare
- Faculty of Medicine, University of Southampton, Southampton, United Kingdom
| | - Cristina Popescu
- Teaching Emergency Hospital “Bagdasar-Arseni,”Bucharest, Romania,*Correspondence: Cristina Popescu
| | - Constantin Munteanu
- Teaching Emergency Hospital “Bagdasar-Arseni,”Bucharest, Romania,Faculty of Medical Bioengineering, University of Medicine and Pharmacy “Grigore T. Popa” Iasi, Iasi, Romania,Constantin Munteanu
| | | | - Cristina Daia
- Faculty of Medicine, “Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania,Teaching Emergency Hospital “Bagdasar-Arseni,”Bucharest, Romania
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The Associated Factors of Quality of Life among Stroke Survivors: A Study in Indonesia. NURSE MEDIA JOURNAL OF NURSING 2022. [DOI: 10.14710/nmjn.v12i3.45763] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Background: The prevalence and burden of stroke are still high, especially in low and middle-income countries. Stroke affects the economy and physics related to the Quality of Life (QoL). Various QoL-associated factors, including sociodemographic, functional outcome, emotional, and cognitive function, were studied. However, there was very limited information about the QoL-associated factors among stroke survivors in Semarang, Indonesia.Purpose: This study aimed to identify the QoL-associated factors among stroke survivors in Semarang, Indonesia.Methods: This cross-sectional study was conducted in outpatient services and involved 57 ischemic stroke survivors using convenience sampling. Demographic and clinical information were obtained using medical records and questionnaires. The questionnaires were the Short Version of Specific Stroke Quality of Life (SS-QoL) to measure QoL, GRID-HAMD 17 to measure Post Stroke Depression (PSD), Mini-Mental Status Examination (MMSE) to measure cognitive impairment, Barthel–Index (BI) to measure functional outcome, Hamilton Anxiety Rating Scale (HAM-A) to measure anxiety, and Multidimensional Scale of Perceived Social Support (MSPSS) to measure social support. Linear regression was conducted in the model performance of QoL-associated factors.Results: The stroke duration was 155(18) days, and 50.9% of participants were males. The linear regression showed that age (-.164 95% CI -.412 - .084), marital status (3.937 95% CI 1.010 - 6.864), functional outcome (.127 95% CI .013 - .241), PSD (-1.090 95% CI -2.144 - -.036), cognitive function (.308 95% CI -.482 - 1.098) and anxiety (-.408 95% CI -1.125 - .268) were QoL-predictors (p<.001, adjusted R2=52.1). It is assumed that age, marital status, functional outcome, PSD, cognition, and anxiety significantly predict the QoL among ischemic stroke survivors.Conclusion: The QoL-associated factors were age, marital status, functional outcome, PSD, cognition, and anxiety. These associated factors of QoL should be considered as elements in formulating nursing interventions that aim to improve the good QoL among stroke survivors.
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Favorable Effects of Virgin Coconut Oil on Neuronal Damage and Mortality after a Stroke Incidence in the Stroke-Prone Spontaneously Hypertensive Rat. LIFE (BASEL, SWITZERLAND) 2022; 12:life12111857. [PMID: 36430992 PMCID: PMC9694050 DOI: 10.3390/life12111857] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Revised: 11/04/2022] [Accepted: 11/09/2022] [Indexed: 11/16/2022]
Abstract
Stroke is consistently one of the top ten causes of morbidity and mortality globally, whose outcomes are quite variable, necessitating case-specific management. Prophylactic diets before the onset of stroke have been implicated to work. In this research, the effects of virgin coconut oil (VCO) on stroke were evaluated using a stroke-prone spontaneously hypertensive rat (SHRSP) model. Eight-week-old SHRSPs were subjected to the repeated oral administration (5 mL/kg/day) of either 1% Tween 80 (group A) or VCO (group B). An early stroke onset was observed due to hypertension that was aggravation by the administration of 1% NaCl in water ad libitum. The following data were collected: the days until stroke occurred, the survival rate until the animal died, and blood pressure (BP) every two weeks using the tail-cuff method. After necropsy, the organs were harvested, and the brain was processed for a routine histopathological analysis. VCO delayed the incidence of it and prolonged their survival. Compared to group A, group B showed a significantly lowered BP by 20 mmHg at four weeks after the start of VCO treatment. Lastly, the brain histopathology showed that the structurally damaged areas were smaller in group B than they were in group A. The VCO could have protective effects on the brain before and even after stroke incidence.
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Ischemic Stroke, Lessons from the Past towards Effective Preclinical Models. Biomedicines 2022; 10:biomedicines10102561. [PMID: 36289822 PMCID: PMC9599148 DOI: 10.3390/biomedicines10102561] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Revised: 10/07/2022] [Accepted: 10/09/2022] [Indexed: 11/17/2022] Open
Abstract
Ischemic stroke is a leading cause of death worldwide, mainly in western countries. So far, approved therapies rely on reperfusion of the affected brain area, by intravenous thrombolysis or mechanical thrombectomy. The last approach constitutes a breakthrough in the field, by extending the therapeutic window to 16-24 h after stroke onset and reducing stroke mortality. The combination of pharmacological brain-protective strategies with reperfusion is the future of stroke therapy, aiming to reduce brain cell death and decrease patients' disabilities. Recently, a brain-protective drug-nerinetide-reduced brain infarct and stroke mortality, and improved patients' functional outcomes in clinical trials. The success of new therapies relies on bringing preclinical studies and clinical practice close together, by including a functional outcome assessment similar to clinical reality. In this review, we focused on recent upgrades of in vitro and in vivo stroke models for more accurate and effective evaluation of therapeutic strategies: from spheroids to organoids, in vitro models that include all brain cell types and allow high throughput drug screening, to advancements in in vivo preclinical mouse stroke models to mimic the clinical reality in surgical procedures, postsurgical care, and functional assessment.
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Muacevic A, Adler JR. Effectiveness of Pelvic Proprioceptive Neuromuscular Facilitation Techniques on Balance and Gait Parameters in Chronic Stroke Patients: A Randomized Clinical Trial. Cureus 2022; 14:e30630. [PMID: 36426303 PMCID: PMC9682972 DOI: 10.7759/cureus.30630] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2022] [Accepted: 10/24/2022] [Indexed: 11/30/2022] Open
Abstract
Background Stroke is the second leading reason for death and the third most common reason for disability. Stroke is a source of possible substantial harm and is often more disabling than lethal. Common stroke defects include stiffness, tiredness, loss of balance on the afflicted side, as well as gait impairment, resulting in an inability to sustain postural alignment. Pelvic proprioceptive neuromuscular facilitation (PNF) is a physical rehabilitation that combines functionally dependent diagonal activity patterns with neuromuscular facilitator strategies to improve motor behaviour, endurance, and muscle activity and control. This protocol was created to describe the experimental study design for evaluating the combined impact of pelvic PNF and task-oriented exercises in chronic stroke patients to improve balance and gait parameters. Aim and objective The purpose of our study is to investigate the effectiveness of pelvic PNF as well as task-oriented exercises on balance, gait parameters, and in pelvic asymmetry. Methods The participants (n=30) were stroke survivors who fulfilled the inclusion criteria for research and were divided into two groups. The regimen lasted four weeks and took 30 minutes each day. Patients were evaluated at the beginning and end of their treatment. In both groups, pre- and post-intervention outcome measures were recorded and the data was analyzed. Result Following four weeks of rehabilitation, subjects showed remarkable improvement in balance, gait parameters, and pelvic inclination in both groups, i.e., pelvic PNF and task-oriented exercises in group A and task-oriented exercises in group B, but Group A showed a major improvement in outcome measures. A p-value of less than 0.05 was considered significant. Despite the fact that both treatment regimens were successful for the patient, pelvic PNF combined with task-oriented exercises exhibits a statistically significant difference from task-oriented exercises. Conclusion Pelvic PNF along with task-oriented exercises proved to be beneficial and can help in the restoration of balance and gait parameters as a result of normalisation in the geometry and symmetry of the pelvis in stroke patients. The pelvis, which is a connecting link between the trunk and lower limbs, plays a crucial role in balance and also in lower limb performance exclusively in gait.
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Athar I, Malik AM, Khattak NN, Anis A, Iqbal M, Majid H, Badshah M. Reliability of Siriraj stroke score to distinguish between hemorrhagic and ischemic stroke. BRAIN HEMORRHAGES 2022. [DOI: 10.1016/j.hest.2022.07.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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Bahrudin M, Yudha Pratama Putra P, Amalia Eka Putri D. Comparison of accuracy, sensitivity and specifity of Bahrudin score vs Siriraj score vs Gajah Mada algorithm in diagnosing type of stroke. BRAIN HEMORRHAGES 2022. [DOI: 10.1016/j.hest.2022.07.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Mariman JJ, Lorca E, Biancardi C, Burgos P, Álvarez-Ruf J. Brain’s Energy After Stroke: From a Cellular Perspective Toward Behavior. Front Integr Neurosci 2022; 16:826728. [PMID: 35651830 PMCID: PMC9149581 DOI: 10.3389/fnint.2022.826728] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Accepted: 03/18/2022] [Indexed: 11/13/2022] Open
Abstract
Stroke is a neurological condition that impacts activity performance and quality of life for survivors. While neurological impairments after the event explain the performance of patients in specific activities, the origin of such impairments has traditionally been explained as a consequence of structural and functional damage to the nervous system. However, there are important mechanisms related to energy efficiency (trade-off between biological functions and energy consumption) at different levels that can be related to these impairments and restrictions: first, at the neuronal level, where the availability of energy resources is the initial cause of the event, as well as determines the possibilities of spontaneous recovery. Second, at the level of neural networks, where the “small world” operation of the network is compromised after the stroke, implicating a high energetic cost and inefficiency in the information transfer, which is related to the neurological recovery and clinical status. Finally, at the behavioral level, the performance limitations are related to the highest cost of energy or augmented energy expenditure during the tasks to maintain the stability of the segment, system, body, and finally, the behavior of the patients. In other words, the postural homeostasis. In this way, we intend to provide a synthetic vision of the energy impact of stroke, from the particularities of the operation of the nervous system, its implications, as one of the determinant factors in the possibilities of neurological, functional, and behavioral recovery of our patients.
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Affiliation(s)
- Juan José Mariman
- Laboratorio de Cognición y Comportamiento Sensoriomotor, Departamento de Kinesiología, Facultad de Artes y Educación Física, Universidad Metropolitana de Ciencias de la Educación, Santiago, Chile
- Departamento de Kinesiología, Facultad de Medicina, Universidad de Chile, Santiago, Chile
| | - Enrique Lorca
- Laboratorio de Cognición y Comportamiento Sensoriomotor, Departamento de Kinesiología, Facultad de Artes y Educación Física, Universidad Metropolitana de Ciencias de la Educación, Santiago, Chile
- Escuela de Enfermería, Facultad de Medicina, Universidad Finis Terrae, Santiago, Chile
| | - Carlo Biancardi
- Biomechanics Lab, Departamento de Ciencias Biológicas, CENUR Litoral Norte, Universidad de la República, Paysandú, Uruguay
| | - Pablo Burgos
- Departamento de Kinesiología, Facultad de Medicina, Universidad de Chile, Santiago, Chile
- Departamento de Neurociencias, Facultad de Medicina, Universidad de Chile, Santiago, Chile
| | - Joel Álvarez-Ruf
- Laboratorio de Cognición y Comportamiento Sensoriomotor, Departamento de Kinesiología, Facultad de Artes y Educación Física, Universidad Metropolitana de Ciencias de la Educación, Santiago, Chile
- Laboratorio de Biomecánica Clínica, Facultad de Medicina Clínica Alemana, Universidad del Desarrollo, Santiago, Chile
- *Correspondence: Joel Álvarez-Ruf,
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Gude MF, Blauenfeldt RA, Behrndtz AB, Nielsen CN, Speiser L, Simonsen CZ, Johnsen SP, Kirkegaard H, Andersen G. The Prehospital Stroke Score and telephone conference: A prospective validation. Acta Neurol Scand 2022; 145:541-550. [PMID: 35023151 DOI: 10.1111/ane.13580] [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: 06/19/2021] [Revised: 12/08/2021] [Accepted: 12/26/2021] [Indexed: 11/30/2022]
Abstract
OBJECTIVES The main aim of the study is to investigate the performance of a two-part stroke scale for screening and subsequent severity assessment combined with a telephone conference (teleconference). MATERIALS AND METHODS During a 6-month period, we prospectively tested the Prehospital Stroke Score (PreSS). PreSS part 1 is designed to identify stroke or TIA in a prehospital setting. PreSS part 2 is a stroke severity scale designed to identify large-vessel occlusion (LVO). PreSS was performed by emergency medical service (EMS) providers prior to a teleconference with a stroke neurologist. RESULTS Combined teleconference and PreSS part 1 were performed on 79.3% of all patients diagnosed with stroke/TIA, and 99.1% of the patients with positive scores were subsequently PreSS part 2 scored. PreSS part 1 and teleconference had a sensitivity to identify stroke/TIA of 89.3% (95% CI 85.7-92.2), specificity of 64.5% (95% CI 59.3-69.5), and an area under the curve (AUC) of 0.80 (95% CI 0.77-0.83). Regarding LVO, PreSS part 1 with teleconference recognized 96.7% (95% CI 88.7-99.6) of all cases as stroke. PreSS part 2 had a sensitivity of 55.7% (95% CI 42.4-68.5), specificity of 91.5% (95% CI 89.0-93.6), and AUC of 0.86 (95% CI 0.82-0.90) for identification of LVO. CONCLUSIONS PreSS was feasible and the sensitivity for stroke/TIA and LVO was high to moderate providing an overall high precision. Almost all LVO cases were ensured acute stroke admission. The high specificity for LVO could be useful for determining transfers strategies. CLASSIFICATION OF EVIDENCE This study provides Class I evidence when evaluating PreSS combined with teleconference.
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Affiliation(s)
- Martin F. Gude
- Department of Research and Development Prehospital Emergency Medical Services Central Denmark Region and Aarhus University Aarhus Denmark
| | - Rolf A. Blauenfeldt
- Danish Stroke Center Department of Neurology Aarhus University Hospital Aarhus Denmark
| | - Anne B. Behrndtz
- Danish Stroke Center Department of Neurology Aarhus University Hospital Aarhus Denmark
| | - Casper N. Nielsen
- Department of Research and Development Prehospital Emergency Medical Services Central Denmark Region and Aarhus University Aarhus Denmark
| | - Lasse Speiser
- Department of Radiology Aarhus University Hospital Aarhus Denmark
| | - Claus Z. Simonsen
- Danish Stroke Center Department of Neurology Aarhus University Hospital Aarhus Denmark
- Department of Clinical Medicine Aarhus University Aarhus Denmark
| | - Søren P. Johnsen
- Danish Center for Clinical Health Services Research Department of Clinical Medicine Aalborg University Aalborg Denmark
| | - Hans Kirkegaard
- Department of Research and Development Prehospital Emergency Medical Services Central Denmark Region and Aarhus University Aarhus Denmark
- Department of Clinical Medicine Aarhus University Aarhus Denmark
| | - Grethe Andersen
- Danish Stroke Center Department of Neurology Aarhus University Hospital Aarhus Denmark
- Department of Clinical Medicine Aarhus University Aarhus Denmark
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Zou Y, Wang Y, Wu Y, Zhang S, Liu H, Yin T. Prediction of residual ischemic risk in ticagrelor-treated patients with acute coronary syndrome. Thromb J 2022; 20:21. [PMID: 35448998 PMCID: PMC9022318 DOI: 10.1186/s12959-022-00380-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Accepted: 04/08/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Despite strong antiplatelet therapy with ticagrelor, serious ischemic events still occur in patients with acute coronary syndrome (ACS). The predictability of platelet reactivity to the residual risk of ischemic events during ticagrelor treatment remains uncertain. OBJECTIVES We aimed to investigate the predictability of the thromboelastography (TEG)-measured adenosine disphosphate (ADP)-induced platelet inhibition rate (ADP%) to the ischemic events in ticagrelor-treated patients with ACS. METHODS A cohort of ticagrelor-treated patients with ACS were consecutively recruited. ADP% was measured by TEG after 3 days of ticagrelor maintenance treatment. The primary ischemic event was defined as rehospitalization for unstable angina (UA) within 1 year, and the secondary ischemic event was a composite of the primary ischemic event plus all-cause death, nonfatal myocardial infarction (MI), stent thrombosis, stroke, and unplanned revascularization within 1 year. RESULTS A total of 751 eligible patients with ACS were included in the analysis, with 336 patients randomly assigned to the derivation group and 415 to the validation group. The overall rates of primary and secondary ischemic events were 14.51% (n = 109) and 16.91% (n = 127), respectively. Compared to the patients without ischemic events, those with ischemic events had a significantly lower ADP% both in the derivation group (for primary ischemic events: 66.05% vs. 92.80%, p < 0.001; for secondary ischemic events: 66.05% vs. 93.20%, p < 0.001) and in the validation group (for primary ischemic events: 66.40% vs. 89.20%, p < 0.001; for secondary ischemic events: 66.90% vs. 89.20%, p < 0.001). Receiver operating characteristic curve (ROC) analysis showed that an ADP% < 76% was the optimal cut-off value for predicting 1-year primary ischemic events, with an area under the curve (AUC) of 0.80 (95% CI: 0.72-0.86, p < 0.001) in the derivation group and 0.77 (95% CI: 0.69-0.85, p < 0.001) in the validation group. The multivariate Cox regression hazard analysis consistently identified an ADP% < 76% as an independent predictor of primary ischemic events in the derivation group (HR: 8.21, 95% CI: 4.82-13.99, p < 0.001) and in the validation group (HR: 6.34 95% CI: 3.32-12.11, p < 0.001). There was also a strong association between an ADP% < 76 and the occurrence of secondary ischemic events in the derivation group (HR: 7.33, 95% CI: 4.47-12.00, p < 0.001) and in the validation group (HR: 4.76, 95% CI: 2.73-8.32, p < 0.001). CONCLUSION The ADP-induced platelet inhibition rate measured by TEG could predict ischemic events in ticagrelor-treated patients with ACS.
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Affiliation(s)
- Yuting Zou
- Institute of Geriatrics, The Second Medical Center & National Clinical Research Center for Geriatric Diseases, Chinese PLA General Hospital, 100853, Beijing, China.,Medical School of Chinese PLA, Chinese PLA General Hospital, 100853, Beijing, China.,Department of Cardiology, the 6th Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Yuyan Wang
- Institute of Geriatrics, The Second Medical Center & National Clinical Research Center for Geriatric Diseases, Chinese PLA General Hospital, 100853, Beijing, China.,Medical School of Chinese PLA, Chinese PLA General Hospital, 100853, Beijing, China
| | - Yangxun Wu
- Institute of Geriatrics, The Second Medical Center & National Clinical Research Center for Geriatric Diseases, Chinese PLA General Hospital, 100853, Beijing, China.,Medical School of Chinese PLA, Chinese PLA General Hospital, 100853, Beijing, China
| | - Shizhao Zhang
- Institute of Geriatrics, The Second Medical Center & National Clinical Research Center for Geriatric Diseases, Chinese PLA General Hospital, 100853, Beijing, China.,Medical School of Chinese PLA, Chinese PLA General Hospital, 100853, Beijing, China
| | - Haiping Liu
- Institute of Geriatrics, The Second Medical Center & National Clinical Research Center for Geriatric Diseases, Chinese PLA General Hospital, 100853, Beijing, China.,Medical School of Chinese PLA, Chinese PLA General Hospital, 100853, Beijing, China
| | - Tong Yin
- Institute of Geriatrics, The Second Medical Center & National Clinical Research Center for Geriatric Diseases, Chinese PLA General Hospital, 100853, Beijing, China. .,Medical School of Chinese PLA, Chinese PLA General Hospital, 100853, Beijing, China.
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Measuring of Advanced Glycation End Products in Acute Stroke Care: Skin Autofluorescence as a Predictor of Ischemic Stroke Outcome in Patients with Diabetes Mellitus. J Clin Med 2022; 11:jcm11061625. [PMID: 35329949 PMCID: PMC8955850 DOI: 10.3390/jcm11061625] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Revised: 03/08/2022] [Accepted: 03/10/2022] [Indexed: 02/04/2023] Open
Abstract
Background: Patients with diabetes mellitus (DM) are known to show poor recovery after stroke. This specific burden might be due to acute and chronic hyperglycemic effects. Meanwhile, the underlying mechanisms are a cause of discussion, and the best measure to predict the outcome is unclear. Skin autofluorescence (SAF) reflects the in-patient load of so-called advanced glycation end products (AGEs) beyond HbA1c and represents a valid and quickly accessible marker of chronic hyperglycemia. We investigated the predictive potential of SAF in comparison to HbA1c and acute hyperglycemia on the functional outcome at 90 days after ischemic stroke in a cohort of patients with DM. Methods: We prospectively included 113 patients with DM type 2 hospitalized for acute ischemic stroke. SAF was measured on each patient’s forearm by a mobile AGE-Reader mu© in arbitrary units. HbA1c and the area under the curve (AUC) of the blood sugar profile after admission were assessed. Functional outcome was assessed via phone interview after 90 days. A poor outcome was defined as a deterioration to a modified Rankin Scale score ≥ 3. A good outcome was defined as a modified Rankin Scale score < 3 or as no deterioration from premorbid level. Results: Patients with a poor outcome presented with higher values of SAF (mean 3.38 (SD 0.55)) than patients with a good outcome (mean 3.13 (SD 0.61), p = 0.023), but did not differ in HbA1c and acute glycemia. In logistic regression analysis, age (p = 0.021, OR 1.24 [1.12−1.37]) and SAF (p = 0.021, OR 2.74 [1.16−6.46]) significantly predicted a poor outcome, whereas HbA1c and acute glycemia did not. Patients with a poor 90-day outcome and higher SAF experienced more infections (4.2% vs. 33.3% (p < 0.01)) and other various in-hospital complications (21.0% vs. 66.7% (p < 0.01)) than patients with a good outcome and lower SAF levels. Conclusions: SAF offers an insight into glycemic memory and appears to be a significant predictor of poor stroke outcomes in patients with DM exceeding HbA1c and acute glycemia. Measuring SAF could be useful to identify specifically vulnerable patients at high risk of complications and poor outcomes.
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Woo PYM, Au D, Ko NMW, Wu O, Chan EKY, Cheng KKF, Wong AKS, Kirollos RW, Ribas G, Chan KY. Gods and monsters: Greek mythology and Christian references in the neurosurgical lexicon. Surg Neurol Int 2022; 13:67. [PMID: 35242433 PMCID: PMC8888308 DOI: 10.25259/sni_70_2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2022] [Accepted: 01/24/2022] [Indexed: 11/14/2022] Open
Abstract
Background: Myths and religion are belief systems centered around supernatural entities that attempt to explain the observed world and are of high importance to certain communities. The former is a collection of stories that belong to a cultural tradition and the latter are organized faiths that determine codes of ethics, rituals and philosophy. Deities or monstrous creatures in particular act as archetypes instructing an individual’s conduct. References to them in Greek mythology and Christianity are frequently manifested in the modern neurosurgical vernacular. Methods: A review of the medical literature was performed using the PubMed and MEDLINE bibliographic databases. Publications from 1875 to 2021 related to neurosurgery or neuroanatomy with the medical subject headings (MeSH) terms mythology, religion, Christianity and Catholicism were reviewed. References pertaining to supernatural beings were classified to either a deity or a monstrosity according to their conventional cultural context. Results: Twelve narratives associated with neurosurgery were identified, nine relating to Greek mythology and three associated with the Christian-Catholic faith. Eight accounts concerned deities and the remaining with monstrous creatures. Conclusion: This article explores the etymology of commonly utilized terms in daily neurosurgical practice in the context of mythology and religion. They reveal the ingenuity and creativity of early pioneers who strived to understand the brain.
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Affiliation(s)
| | - Danise Au
- Department of Neurosurgery, Kwong Wah Hospital, Hong Kong,
| | | | - Oscar Wu
- Department of Neurosurgery, Kwong Wah Hospital, Hong Kong,
| | - Emily K. Y. Chan
- Division of Neurosurgery, Department of Surgery, Prince of Wales Hospital, Hong Kong,
| | - Kevin K. F. Cheng
- Division of Neurosurgery, Department of Surgery, Queen Mary Hospital, Hong Kong,
| | | | | | - Guilherme Ribas
- Department of Neurosurgery, Albert Einstein Hospital, Sao Paulo, Brazil
| | - Kwong-Yau Chan
- Department of Neurosurgery, Kwong Wah Hospital, Hong Kong,
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Ahmad A, Islam Z, Manzoor Ahmad S, Sarfraz Z, Sarfraz A, Felix M, Cherrez-Ojeda I. The correlation of D-dimer to stroke diagnosis within 24 hours: A meta-analysis. J Clin Lab Anal 2022; 36:e24271. [PMID: 35118733 PMCID: PMC8906038 DOI: 10.1002/jcla.24271] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Revised: 01/20/2022] [Accepted: 01/21/2022] [Indexed: 11/15/2022] Open
Abstract
Background Diagnosing D‐Dimer early is essential to optimize clinical treatment and quality of life and reduce mortality. This study aims to identify the difference of D‐Dimer levels (ng/ml) in patients with stroke within the 6‐ and 24‐h period compared to patients that mimic stroke. Methods An electronic database search across PubMed/MEDLINE, Cochrane, Web of Science, CINAHL, EMBASE, and Scopus was conducted until December 10, 2021. Studies were eligible if they included adult patients with stroke compared to stroke mimics or controls reporting D‐Dimer values. Quality assessment was conducted using GRADE. The standardized mean difference and 95% confidence intervals were calculated in addition to the difference of means in the crude form. Heterogeneity was assessed using Cochran's Q statistic and the I2 index. A random‐effects model was used. The statistical analysis was conducted using RevMan 5.4. Results Out of 2901, there were 318 (11%) participants from upper‐middle‐income countries, whereas the others were from high‐income countries. Large positive effect size was found for D‐Dimer in the stroke group (Cohen's d = 2.82 [1.73–3.9]; p < 0.00001), meaning that those with stroke had higher D‐Dimer values on presentation compared to the stroke mimics/controls. A large difference in means was found in the two groups (MD = 685.1 [324.2, 1045.99]; p < 0.00001), suggesting that there was a significantly higher laboratory value in the stroke group. Conclusion Our findings must be used in caution as the most reliable diagnostic tests for stroke are CT and MRI. Laboratory testing such as D‐Dimer values is a valuable clinical adjuvant in diagnosing total stroke.
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Affiliation(s)
- Adeel Ahmad
- Shalamar Medical and Dental College, Lahore, Pakistan
| | - Zara Islam
- Sahiwal Medical College, Sahiwal, Pakistan
| | | | | | | | - Miguel Felix
- Universidad Espíritu Santo, Samborondón, Ecuador.,Respiralab Research Center, Guayaquil, Ecuador
| | - Ivan Cherrez-Ojeda
- Universidad Espíritu Santo, Samborondón, Ecuador.,Respiralab Research Center, Guayaquil, Ecuador
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Kramer AI, Akioyamen LE, Lee S, Bélanger A, Ruel I, Hales L, Genest J, Brunham LR. Major adverse cardiovascular events in homozygous familial hypercholesterolaemia: a systematic review and meta-analysis. Eur J Prev Cardiol 2021; 29:817-828. [PMID: 34957506 DOI: 10.1093/eurjpc/zwab224] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Revised: 11/30/2021] [Accepted: 12/14/2021] [Indexed: 11/14/2022]
Abstract
AIMS Homozygous familial hypercholesterolaemia (HoFH) is a genetic condition characterized by extremely elevated levels of low-density lipoprotein cholesterol and premature atherosclerotic cardiovascular disease and death. Due to its rarity, accurate assessment of cardiovascular outcomes associated with HoFH and how they have changed over time has been challenging. The goal of this study was to assess the prevalence and age-of-onset of major adverse cardiovascular events (MACE) among patients with HoFH. METHODS AND RESULTS We searched MEDLINE, EMBASE, Pubmed, Cochrane Central Register of Controlled Trials, Scopus, Africa-Wide, Google Scholar, Open Grey, and various clinical trial registries from inception to February 2020 to identify studies reporting on MACE in HoFH patients. We determined the pooled prevalence and mean age-of-onset of MACE outcomes individually using a random effects inverse variance model. We identified 94 studies that met our eligibility criteria. Myocardial infarction and coronary revascularization were common with a prevalence of 15.1% [95% confidence interval (95% CI) 10.7-20.0] and 28.3% (95% CI 22.5-34.3), respectively. The mean age-of-onset was 24.5 (95% CI 19.2-29.8) years for myocardial infarction and 32.2 (95% CI 26.6-37.8) years for revascularization. Sub-group analyses based on the year of publication revealed significant delays in the onset of MACE outcomes post-1990 compared to pre-1990. Egger's regression suggested possible bias, likely due to small study effects. CONCLUSIONS Atherosclerotic cardiovascular disease is common among HoFH patients and occurs at a young age. Age-of-onset of myocardial infarction was delayed by more than a decade from pre-1990 to post-1990, likely attributable to widespread use of statins and other therapies, reflecting substantial progress in the management of this rare but severe disorder.
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Affiliation(s)
- Adam I Kramer
- Department of Medicine, University of British Columbia, Vancouver V5Z 1M9, Canada
| | - Leo E Akioyamen
- Department of Medicine, University of Toronto, Toronto, ON M5S 1A8, Canada
| | - Seohyuk Lee
- Department of Internal Medicine, Yale University School of Medicine, New Haven, CT 06510, USA
| | - Alexandre Bélanger
- Research Institute of the McGill University Health Centre, Montreal, QC H4A 3J1, Canada
| | - Isabelle Ruel
- Research Institute of the McGill University Health Centre, Montreal, QC H4A 3J1, Canada
| | - Lindsay Hales
- McGill University Health Center Medical Libraries, Montreal, QC H3G 1A4, Canada
| | - Jacques Genest
- Research Institute of the McGill University Health Centre, Montreal, QC H4A 3J1, Canada
| | - Liam R Brunham
- Department of Medicine, University of British Columbia, Vancouver V5Z 1M9, Canada.,Centre for Heart Lung Innovation, University of British Columbia, 1081 Burrard Street - Room 166, Vancouver V6Z 1Y6, Canada
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Coutts E, Cooper K. Interventions, barriers, and facilitators associated with return to work for adults following stroke: a scoping review protocol. JBI Evid Synth 2021; 19:3332-3339. [PMID: 34907147 DOI: 10.11124/jbies-20-00386] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
OBJECTIVE The purpose of this scoping review is to map what has been reported on interventions, barriers, and facilitators associated with return to work for adults with and without communication disorders following a stroke. INTRODUCTION Difficulties in returning to work following a stroke can have a significant impact on people's lives, not only in terms of the individual's finances (and the economy as a whole), but also in terms of the person's psychosocial adjustment, for example, their sense of role and purpose and their self-esteem. This scoping review aims to map the literature examining interventional approaches, barriers, and facilitators relevant to this topic. INCLUSION CRITERIA This review will include literature on the return to work for adults aged 16 years or older who have had a stroke. It will be restricted to research conducted in developed countries. METHODS Databases that will be searched include MEDLINE, CINAHL, Embase, AMED, Cochrane Database of Systematic Reviews, Cochrane Central Register of Controlled Trials, PEDRo, and OTSeeker. Gray literature or unpublished studies will be searched in OpenGrey and ProQuest Dissertations and Theses, as well as professional bodies and organizations whose remit includes stroke and vocational rehabilitation. The search will be limited to studies written in English since 2010. Titles and abstracts will be screened by two independent reviewers and full-text articles assessed against the inclusion criteria by two independent reviewers. Data will be extracted and the findings will be presented in tabular and graphical format along with a narrative summary.
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Affiliation(s)
- Emma Coutts
- Speech and Language Therapy, NHS Grampian, Fraserburgh, UK
| | - Kay Cooper
- School of Health Sciences, Robert Gordon University, Aberdeen, UK.,The Scottish Centre for Evidence-based, Multi-professional Practice: A JBI Centre of Excellence, Aberdeen, UK
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Poveda-García A, Moret-Tatay C, Gómez-Martínez M. The Association between Mental Motor Imagery and Real Movement in Stroke. Healthcare (Basel) 2021; 9:healthcare9111568. [PMID: 34828614 PMCID: PMC8620455 DOI: 10.3390/healthcare9111568] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Revised: 11/09/2021] [Accepted: 11/11/2021] [Indexed: 11/16/2022] Open
Abstract
Background: Stroke is the main cause of disability in adults; the most common and long-term sequela is upper-limb hemiparesis. Many studies support the idea that mental motor imagery, which is related to the visualization of movement patterns, activates the same areas of the cortex as if the movement occurred. Objectives: This study aims to examine the capacity to elaborate mental motor images, as well as its relationship to loss of movement in the upper limbs after a stroke. Method: An observational study, in a sample of 39 adults who suffered a stroke, was carried out. The upper limb movement and functionality, cognitive disorders, the ability to visualize mental images, and activities of daily living were examined. Results: The results depicted a statistically significant correlation between the ability to visualize upper limb mental motor images with movement, functionality, and strength. In addition, a correlation between visual–spatial skills and mental visualization of motor ability and upper limb movement was found. Conclusions: These results suggest that the rehabilitation approach focused on the improvement of mental motor imagery could be of interest for the upper limb rehabilitation of movement and functionality.
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Affiliation(s)
- Ana Poveda-García
- Escuela de Doctorado, Universidad Católica de Valencia San Vicente Mártir, San Agustín 3, Esc. A, Entresuelo 1, 46002 València, Spain
- Correspondence:
| | - Carmen Moret-Tatay
- Facultad de Psicología, Universidad Católica de Valencia San Vicente Mártir, Avenida de la Ilustración, Burjassot, 46100 Valencia, Spain;
- Dipartimento di Neuroscienze Salute Mentale e Organi di Senso, La Sapienza Università di Roma, 00185 Rome, Italy
| | - Miguel Gómez-Martínez
- Departamento de Terapia Ocupacional, Centro Superior de Estudios Universitarios La Salle, 28023 Madrid, Spain;
- Occupational Thinks Research Group, Centro Superior de Estudios Universitarios La Salle, 28023 Madrid, Spain
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Barzegar M, Stokes KY, Chernyshev O, Kelley RE, Alexander JS. The Role of the ACE2/MasR Axis in Ischemic Stroke: New Insights for Therapy. Biomedicines 2021; 9:1667. [PMID: 34829896 PMCID: PMC8615891 DOI: 10.3390/biomedicines9111667] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2021] [Revised: 11/02/2021] [Accepted: 11/08/2021] [Indexed: 12/15/2022] Open
Abstract
Ischemic stroke remains the leading cause of neurologically based morbidity and mortality. Current stroke treatment is limited to two classes of FDA-approved drugs: thrombolytic agents (tissue plasminogen activator (tPA)) and antithrombotic agents (aspirin and heparin), which have a narrow time-window (<4.5 h) for administration after onset of stroke symptoms. While thrombolytic agents restore perfusion, they carry serious risks for hemorrhage, and do not influence damage responses during reperfusion. Consequently, stroke therapies that can suppress deleterious effects of ischemic injury are desperately needed. Angiotensin converting enzyme-2 (ACE2) has been recently suggested to beneficially influence experimental stroke outcomes by converting the vasoconstrictor Ang II into the vasodilator Ang 1-7. In this review, we extensively discuss the protective functions of ACE2-Ang (1-7)-MasR axis of renin angiotensin system (RAS) in ischemic stroke.
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Affiliation(s)
- Mansoureh Barzegar
- Molecular and Cellular Physiology, Ochsner-LSU Health Sciences Center, Shreveport, LA 71130-3932, USA; (M.B.); (K.Y.S.)
| | - Karen Y. Stokes
- Molecular and Cellular Physiology, Ochsner-LSU Health Sciences Center, Shreveport, LA 71130-3932, USA; (M.B.); (K.Y.S.)
| | - Oleg Chernyshev
- Neurology, Ochsner-LSU Health Sciences Center, Shreveport, LA 71130-3932, USA; (O.C.); (R.E.K.)
| | - Roger E. Kelley
- Neurology, Ochsner-LSU Health Sciences Center, Shreveport, LA 71130-3932, USA; (O.C.); (R.E.K.)
| | - Jonathan S. Alexander
- Molecular and Cellular Physiology, Ochsner-LSU Health Sciences Center, Shreveport, LA 71130-3932, USA; (M.B.); (K.Y.S.)
- Neurology, Ochsner-LSU Health Sciences Center, Shreveport, LA 71130-3932, USA; (O.C.); (R.E.K.)
- Medicine, LSU Health Center, 1501 Kings Highway, Shreveport, LA 71130-3932, USA
- Oral and Maxillofacial Surgery, Ochsner-LSU Health Sciences Center, Shreveport, LA 71130-3932, USA
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The Role of Thromboxane in the Course and Treatment of Ischemic Stroke: Review. Int J Mol Sci 2021; 22:ijms222111644. [PMID: 34769074 PMCID: PMC8584264 DOI: 10.3390/ijms222111644] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Revised: 10/25/2021] [Accepted: 10/26/2021] [Indexed: 12/13/2022] Open
Abstract
Cardiovascular diseases are currently among the leading causes of morbidity and mortality in many developed countries. They are distinguished by chronic and latent development, a course with stages of worsening of symptoms and a period of improvement, and a constant potential threat to life. One of the most important disorders in cardiovascular disease is ischemic stroke. The causes of ischemic stroke can be divided into non-modifiable and modifiable causes. One treatment modality from a neurological point of view is acetylsalicylic acid (ASA), which blocks cyclooxygenase and, thus, thromboxane synthesis. The legitimacy of its administration does not raise any doubts in the case of the acute phase of stroke in patients in whom thrombolytic treatment cannot be initiated. The measurement of thromboxane B2 (TxB2) in serum (a stable metabolic product of TxA2) is the only test that measures the effect of aspirin on the activity of COX-1 in platelets. Measurement of thromboxane B2 may be a potential biomarker of vascular disease risk in patients treated with aspirin. The aim of this study is to present the role of thromboxane B2 in ischemic stroke and to present effective therapies for the treatment of ischemic stroke. Scientific articles from the PubMed database were used for the work, which were selected on the basis of a search for “thromboxane and stroke”. Subsequently, a restriction was introduced for works older than 10 years, those concerning animals, and those without full text access. Ultimately, 58 articles were selected. It was shown that a high concentration of TXB2 may be a risk factor for ischemic stroke or ischemic heart disease. However, there is insufficient evidence to suggest that thromboxane could be used in clinical practice as a marker of ischemic stroke. The inclusion of ASA in the prevention of stroke has a beneficial effect that is associated with the effect on thromboxane. However, its insufficient power in 25% or even 50% of the population should be taken into account. An alternative and/or additional therapy could be a selective antagonist of the thromboxane receptor. Thromboxane A2 production is inhibited by estrogen; therefore, the risk of CVD after the menopause and among men is higher. More research is needed in this area.
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Yu F, He R. The effect of fluoxetine combined with repetitive transcranial magnetic stimulation on the psychological emotions and cognitive and neurological functions of acute post-stroke depression patients. Am J Transl Res 2021; 13:11883-11889. [PMID: 34786118 PMCID: PMC8581883] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2021] [Accepted: 02/24/2021] [Indexed: 06/13/2023]
Abstract
OBJECTIVE This research was designed to probe into the effects of fluoxetine combined with repetitive transcranial magnetic stimulation (rTMS) on the psychological emotions and the cognitive and neurological functions of acute post-stroke depression patients. METHODS This experiment recruited 115 acute post-stroke depression patients who were treated in our hospital from February 2018 to April 2020 as the study cohort. 55 of the patients were treated with fluoxetine, and 60 were treated with fluoxetine combined with rTMS. Both groups were treated for 2 months. The self-rating anxiety scale (SAS), the self-rating depression scale (SDS), the National Institutes of Health stroke scale (NIHSS), the mini mental state scale (MMSE), the Barthel index, and the quality of life scale (SF-36) scores were observed. RESULTS Compared with the control group (CG), the SAS, SDS, and NIHSS scores in the research group (RG) decreased, while the MMSE and Barthel index scores increased (P < 0.05). After the treatment, the SF-36 scores in the RG were higher than they were in the CG (P < 0.05). CONCLUSION Fluoxetine combined with rTMS can effectively improve the psychological emotions and the cognitive and neurological functions of acute post-stroke depression patients, so it is worthy of clinical promotion.
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Affiliation(s)
- Fangzhou Yu
- Department of Psychology, The People's Hospital of Liaoning Province Shenyang 110016, Liaoning Province, China
| | - Ru He
- Department of Psychology, The People's Hospital of Liaoning Province Shenyang 110016, Liaoning Province, China
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M'barek L, Sakka S, Megdiche F, Farhat N, Maalla K, Turki D, Feki S, Rebai A, Dammak M, Kallel C, Mhiri C. Traditional risk factors and combined genetic markers of recurrent ischemic stroke in adults. J Thromb Haemost 2021; 19:2596-2604. [PMID: 34241942 DOI: 10.1111/jth.15448] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Accepted: 07/06/2021] [Indexed: 02/04/2023]
Abstract
BACKGROUND The involvement of traditional risk factors and combined genetic markers of recurrent arterial ischemic stroke (AIS) in adults remains unclear. OBJECTIVE This study aims to determine significant clinical and genetic factors of AIS recurrence, and to investigate the combined effect of genotypes on the occurrence of a second cerebral ischemic attack. METHODS We investigated a cohort study of AIS patients (18-50 years old) followed in the neurology department over 5 years. Traditional and genetic risk factors were carried through a multivariable logistic regression model. We used a Cox proportional hazard model for identifying predictors of recurrence. RESULTS Two hundred and seventy patients were enrolled in our study. The risk of AIS recurrence was 36.2% within 5 years. The potential risk of recurrence of AIS increased with traditional and genetic risk factors such as hypertension, diabetes mellitus, heart failure, and family history of cerebrovascular diseases. This risk increased with increasing number of genetic factors. The hazard ratio (HR) was 0.66 (95% confidence interval [CI] 0.97-2.67) for the subject with one genetic factor, 1.61 (95% CI 0.97-2.25) for combined methylenetetrahydrofolate reductase (MTHFR) polymorphisms, and 2.57 (95% CI 1.32-4.99) for combined factor V Leiden (FVL) and MTHFR polymorphisms (677 or 1298). The HR for the three polymorphisms combined was 6.04 (95% CI 2.40-15.16). CONCLUSIONS Our findings suggest that cumulative effect of both traditional and common genetic risk factors was associated with recurrence of ischemic stroke. We demonstrated for the first time that a combined genotype FVL/MTHFR profile increase the risk of a second cerebral ischemic attack.
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Affiliation(s)
- Lamia M'barek
- Laboratory of Neurogenetics, Parkinson's Disease and Cerebrovascular Disease (LR-12-SP-19), University of Sfax, Sfax, Tunisia
- Clinical Investigation Center (CIC), Habib Bourguiba University Hospital, Sfax, Tunisia
| | - Salma Sakka
- Laboratory of Neurogenetics, Parkinson's Disease and Cerebrovascular Disease (LR-12-SP-19), University of Sfax, Sfax, Tunisia
| | - Fatma Megdiche
- Laboratory of Hematology, Habib Bourguiba University Hospital, Sfax, Tunisia
- Faculty of Pharmacy, University of Monastir, Monastir, Tunisia
| | - Nouha Farhat
- Laboratory of Neurogenetics, Parkinson's Disease and Cerebrovascular Disease (LR-12-SP-19), University of Sfax, Sfax, Tunisia
| | - Khadija Maalla
- Laboratory of Neurogenetics, Parkinson's Disease and Cerebrovascular Disease (LR-12-SP-19), University of Sfax, Sfax, Tunisia
| | - Dhaker Turki
- Laboratory of Neurogenetics, Parkinson's Disease and Cerebrovascular Disease (LR-12-SP-19), University of Sfax, Sfax, Tunisia
| | - Sawsan Feki
- Autoimmunity, Cancer and Immunogenetics" Research Laboratory (LR18SP12), Immunology Department, Habib Bourguiba Hospital, University of Sfax, Sfax, Tunisia
| | - Ahmed Rebai
- Molecular and Cellular Screening Process Laboratory, Centre of Biotechnology of Sfax, Sfax, Tunisia
| | - Mariem Dammak
- Laboratory of Neurogenetics, Parkinson's Disease and Cerebrovascular Disease (LR-12-SP-19), University of Sfax, Sfax, Tunisia
| | - Choumous Kallel
- Laboratory of Hematology, Habib Bourguiba University Hospital, Sfax, Tunisia
- Faculty of Pharmacy, University of Monastir, Monastir, Tunisia
| | - Chokri Mhiri
- Laboratory of Neurogenetics, Parkinson's Disease and Cerebrovascular Disease (LR-12-SP-19), University of Sfax, Sfax, Tunisia
- Clinical Investigation Center (CIC), Habib Bourguiba University Hospital, Sfax, Tunisia
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Nik Ramli NN, Asokan A, Mayakrishnan D, Annamalai H. Exploring Stroke Rehabilitation in Malaysia: Are Robots Better than Humans for Stroke Recuperation? Malays J Med Sci 2021; 28:14-23. [PMID: 34512127 PMCID: PMC8407787 DOI: 10.21315/mjms2021.28.4.3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Accepted: 10/16/2020] [Indexed: 11/13/2022] Open
Abstract
Ranked as the second leading cause of death and the primary factor to adult disability worldwide, stroke has become a global epidemic problem and burden. As a developing country, Malaysia still faces challenges in providing ideal rehabilitation services to individuals with physical disabilities including stroke survivors. Conventional post-stroke care is often delivered in a team-based approach and involves several disciplines, such as physical therapy, occupational therapy, speech and language therapy, depending on the nature and severity of the deficits. Robots are potential tools for stroke rehabilitation as they can enhance existing conventional therapy by delivering a precise and consistent therapy of highly repetitive movements. In addition, robot-assisted physiotherapy could facilitate the effectiveness of unsupervised rehabilitation and thus, may reduce the cost and duration of therapist-assisted rehabilitation. Research on robot-assisted physiotherapy for stroke in Malaysia is slowly coming into the limelight in the past two decades. This review explores the effectiveness of robot-assisted physiotherapy particularly in improving motor functions of stroke survivors in Malaysia.
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Affiliation(s)
- Nik Nasihah Nik Ramli
- International Medical School, Management & Science University, Shah Alam, Selangor, Malaysia
| | - Amhsavenii Asokan
- International Medical School, Management & Science University, Shah Alam, Selangor, Malaysia
| | - Daniel Mayakrishnan
- International Medical School, Management & Science University, Shah Alam, Selangor, Malaysia
| | - Hariharasudan Annamalai
- International Medical School, Management & Science University, Shah Alam, Selangor, Malaysia
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