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Opoku S, Eliason C, Akpalu A. Why Me?: A Qualitative Study on the Experiences of Young Stroke Survivors in the Accra Metropolis of Ghana, West Africa. J Patient Exp 2020; 7:1788-1796. [PMID: 33457644 PMCID: PMC7786678 DOI: 10.1177/2374373520967505] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Young stroke survivors are affected gravely when diagnosed with stroke between the ages of 18 to 45 years. The psychological and social effects of young stroke require stringent coping factors geared toward recovery and regeneration of self. A qualitative exploratory design was used to explore coping experiences and purposive sampling technique was employed to recruit 10 participants. Data were collected using tape recorded interviews which lasted between 45 minutes to 1 hour 30 minutes and guided by a semistructured interview guide which was informed by the research objectives and literature review. Thematic content analysis was used to analyze the transcribed data and 6 themes namely: psychological disruption, disruption to social identity, spiritual practices and beliefs, self-determination, support, and herbal medicine were derived. These themes gave insight into how these young stroke victims experienced and coped with physical signs and symptoms which negatively impacted their activities of daily living and resulted in social isolation, fear, anxiety, depression, guilt, and suicidal ideations. Provision of continuity of care for young adults living with stroke is highly recommended.
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Affiliation(s)
- Sussana Opoku
- Department of Nursing, Narh-Bita College, Tema, Ghana
| | | | - Albert Akpalu
- University of Ghana, School of Medical Sciences, Accra, Ghana
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Spence JD. Recent advances in preventing recurrent stroke. F1000Res 2020; 9. [PMID: 32864099 PMCID: PMC7443787 DOI: 10.12688/f1000research.23199.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/12/2020] [Indexed: 11/30/2022] Open
Abstract
Since a 2017 update, there have been important advances in stroke prevention. These include new evidence about nutrition, antiplatelet therapy, anticoagulation, lipid-lowering therapy, hypertension control, pioglitazone, and carotid endarterectomy and stenting. Evidence regarding toxic metabolites produced by the intestinal microbiome from egg yolk and red meat has important dietary implications, particularly for patients with impaired renal function, including the elderly. They should avoid egg yolk and red meat and limit the intake of animal flesh. Higher doses of folic acid may be needed for patients with the T allele of MTHFR, so it may not be sufficient to give vitamin B12 (methylcobalamin) alone, even in countries with folate fortification. There is now good evidence that lipid-lowering therapy is even more beneficial in the elderly than in younger patients; we should be using lipid-lowering therapy more intensively, often/usually combining statins with ezetimibe. There is new evidence that lower systolic blood pressure targets are better for most patients, but a subgroup with stiff arteries, a wide pulse pressure, and a diastolic pressure of <60 would be more likely to be harmed than helped by aiming for a systolic target of <120 mmHg. There is a better understanding of how the pharmacological properties of direct-acting oral anticoagulants and the metabolism of antiplatelet agents should inform decisions about the use of these agents. Pioglitazone markedly reduces the risk of stroke, both in diabetics and prediabetics; it should be used more widely. It is now clear that carotid endarterectomy is safer than stenting and that the difference is strongly affected by age. Most patients, and in particular older patients, would be better served by endarterectomy than stenting.
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Affiliation(s)
- J David Spence
- Western University, and Stroke Prevention & Atherosclerosis Research Centre, Robarts Research Institute, Ontario, Canada
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Lenahan C, Huang L, Travis ZD, Zhang JH. Scavenger Receptor Class B type 1 (SR-B1) and the modifiable risk factors of stroke. Chin Neurosurg J 2019; 5:30. [PMID: 32922929 PMCID: PMC7398188 DOI: 10.1186/s41016-019-0178-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2019] [Accepted: 10/30/2019] [Indexed: 01/11/2023] Open
Abstract
Stroke is a devastating disease that occurs when a blood vessel in the brain is either blocked or ruptured, consequently leading to deficits in neurological function. Stroke consistently ranked as one of the top causes of mortality, and with the mean age of incidence decreasing, there is renewed interest to seek novel therapeutic treatments. The Scavenger Receptor Class B type 1 (SR-B1) is a multifunctional protein found on the surface of a variety of cells. Research has found that that SR-B1 primarily functions in an anti-inflammatory and anti-atherosclerotic capacity. In this review, we discuss the characteristics of SR-B1 and focus on its potential correlation with the modifiable risk factors of stroke. SR-B1 likely has an impact on stroke through its interaction with smoking, diabetes mellitus, diet, physical inactivity, obesity, hypercholesterolemia, atherosclerosis, coronary heart disease, hypertension, and sickle cell disease, all of which are critical risk factors in the pathogenesis of stroke.
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Affiliation(s)
- Cameron Lenahan
- Burrell College of Osteopathic Medicine, Las Cruces, NM 88003 USA
- Center for Neuroscience Research, School of Medicine, Loma Linda University, Loma Linda, CA 92324 USA
| | - Lei Huang
- Center for Neuroscience Research, School of Medicine, Loma Linda University, Loma Linda, CA 92324 USA
- Department of Neurosurgery, School of Medicine, Loma Linda University, Loma Linda, CA 92350 USA
- Department of Physiology & Pharmacology, School of Medicine, Loma Linda University, Loma Linda, CA 92350 USA
| | - Zachary D. Travis
- Center for Neuroscience Research, School of Medicine, Loma Linda University, Loma Linda, CA 92324 USA
- Department of Earth and Biological Sciences, School of Medicine, Loma Linda University, Loma Linda, CA 92350 USA
| | - John H. Zhang
- Center for Neuroscience Research, School of Medicine, Loma Linda University, Loma Linda, CA 92324 USA
- Department of Neurosurgery, School of Medicine, Loma Linda University, Loma Linda, CA 92350 USA
- Department of Physiology & Pharmacology, School of Medicine, Loma Linda University, Loma Linda, CA 92350 USA
- Department of Anesthesiology, School of Medicine, Loma Linda University, Loma Linda, CA 92324 USA
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Serum folate and vitamin B12 levels are not associated with the incidence risk of atherosclerotic events over 12 years: the Korean Genome and Epidemiology Study. Nutr Res 2019; 63:34-41. [DOI: 10.1016/j.nutres.2018.12.009] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2018] [Revised: 12/17/2018] [Accepted: 12/18/2018] [Indexed: 11/18/2022]
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In-Hospital Mortality among Ischemic Stroke Patients in Gondar University Hospital: A Retrospective Cohort Study. Stroke Res Treat 2019; 2019:7275063. [PMID: 30693082 PMCID: PMC6332873 DOI: 10.1155/2019/7275063] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2018] [Revised: 11/23/2018] [Accepted: 12/11/2018] [Indexed: 12/15/2022] Open
Abstract
Introduction Ischemic stroke is the third leading cause of mortality in low-income countries and the sixth in Ethiopia. The aim of this study was to determine the rate and predictors of in-hospital mortality due to ischemic stroke in Gondar University Hospital. Methods The study was conducted from April 1, 2017, to May 15, 2017, at Gondar University Hospital. A census using retrospective cohort study design was conducted on medical records of adult patients with the diagnosis of ischemic stroke attending the medical inpatient ward of Gondar University Hospital between November 2012 and September 2016. Cox hazard regression was used to determine the predictors of in-hospital mortality. A two-sided statistical test at 5% level of significance was used. Results The mean (±SD) duration of hospital stay was 11.55 (10.040) days. Of the total 208 patients, 26 (12.5%) patients died in the hospital. Cox regression revealed that only a decrease in renal function, particularly elevated serum creatinine (AHR=8.848, 95% CI: 1.616-67.437), was associated with a statistically significant increase of in-hospital mortality. The symptom onset-to-admission time varied greatly among patients and ranged from 1 hour to 168 hours. Conclusion The in-hospital mortality associated with ischemic stroke was found to be high. Mainly, elevation in serum creatinine was highly associated with poorer outcomes in terms of in-hospital mortality. Much work should be done on improving the knowledge and awareness of the community regarding ischemic stroke and stroke in general to encourage early medical seeking behavior and reduce mortality and long-term disability.
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Zhang S, Wang N, Chen L, Zhang P, Shen L, Huang S, Zhang C, Deng B. Serum Aldosterone Is Associated with Cerebral Artery Atherosclerosis and Calcification. J Stroke Cerebrovasc Dis 2018; 28:523-530. [PMID: 30528672 DOI: 10.1016/j.jstrokecerebrovasdis.2018.09.053] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2018] [Revised: 09/18/2018] [Accepted: 09/30/2018] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND AND PURPOSE Elevated serum aldosterone concentration is known to be linked with elevated risk of cerebrovascular events as a result of vascular senescence. We studied the association between serum aldosterone concentration and cerebral arteriosclerosis status involving cerebral atherosclerosis burden and cerebral vascular calcification. METHODS A total of 207 patients (mean age = 62.40 ± 10.54, 70 female patients) admitted with acute ischemic stroke from a single center-based stroke registry were included in the study. The participants were categorized into 4 groups in accordance to the serum aldosterone concentration. Cerebral atherosclerosis burden was derived as the stenosis degree of main intracranial arteries, and cerebral artery calcification was investigated from the cavernous portions of both internal carotid arteries from brain computed tomography angiography. RESULTS The median aldosterone was 146.00 pg/mL; interquartile range was 133.18-172.10 pg/mL. Advanced intracranial atherosclerosis was present in 134 patients (64.7%) and advanced intracranial arterial calcification was present in 77 patients (37.2%). The prevalence of cerebral atherosclerosis burden and cerebral artery calcification showed increasing tendency through the aldosterone quartiles. Multivariable logistic regression analysis including age, sex, vascular risk factors, estimated glomerular filtration rate and aldosterone quartiles disclosed that the highest serum aldosterone quartile was an independent predictor of advanced intracranial atherosclerosis (odds ratio, 5.07; 95% confidence interval, 1.82-14.17; Ptrend = .001) and advanced intracranial arterial calcification (odds ratio, 6.24; 95% confidence interval, 2.03-19.22; Ptrend = .001). CONCLUSIONS An increased serum aldosterone concentration was independently associated with intracranial atherosclerosis burden and arterial calcification. Future studies should investigate whether aldosterone antagonists prevent stroke in at risk population.
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Affiliation(s)
- Shoulong Zhang
- Stroke Center, Changhai Hospital, Second Military Medical University, Shanghai, China; Heping Hospital, Shijiazhuang, China.
| | - Nuo Wang
- Stroke Center, Changhai Hospital, Second Military Medical University, Shanghai, China.
| | - Lei Chen
- Stroke Center, Changhai Hospital, Second Military Medical University, Shanghai, China.
| | - Ping Zhang
- Stroke Center, Changhai Hospital, Second Military Medical University, Shanghai, China.
| | - Lei Shen
- Stroke Center, Changhai Hospital, Second Military Medical University, Shanghai, China.
| | - Shiren Huang
- Stroke Center, Changhai Hospital, Second Military Medical University, Shanghai, China.
| | - Chunyang Zhang
- Stroke Center, Changhai Hospital, Second Military Medical University, Shanghai, China.
| | - Benqiang Deng
- Stroke Center, Changhai Hospital, Second Military Medical University, Shanghai, China.
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Kim JS, Bang OY. Medical Treatment of Intracranial Atherosclerosis: An Update. J Stroke 2017; 19:261-270. [PMID: 29037012 PMCID: PMC5647642 DOI: 10.5853/jos.2017.01830] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2017] [Revised: 09/07/2017] [Accepted: 09/14/2017] [Indexed: 12/13/2022] Open
Abstract
For patients with symptomatic intracranial atherosclerosis (ICAS), antithrombotic agents are the mainstay of therapy. Anticoagulation (warfarin) is not widely used since it is not more effective than aspirin and carries a high risk of bleeding. New oral anticoagulants are showing promise, but their use has not been investigated in appropriate clinical trials. Since the recurrent stroke risk is high with aspirin monotherapy, dual antiplatelets are considered in the early stage of symptomatic ICAS. Based on the Clopidogrel in High-Risk Patients with Acute Nondisabling Cerebrovascular Events (CHANCE) and Stenting and Aggressive Medical Management for Preventing Recurrent Stroke in Intracranial Stenosis (SAMMPRIS) results, aspirin plus clopidogrel has been recommended. However, this combination was not superior to aspirin monotherapy in patients with ICAS in the CHANCE substudy. Progression of ICAS is common, and it is associated with recurrent strokes. In the Trial of Cilostazol in Symptomatic Intracranial Arterial Stenosis (TOSS) study, aspirin plus cilostazol was more effective than aspirin monotherapy in preventing progression. The TOSS II trial showed that the overall change in stenosis was better with aspirin plus cilostazol than with aspirin plus clopidogrel. Aside from antithrombotic therapy, risk factor management is critical for secondary prevention, and high blood pressure is clearly linked to recurrent stroke. However, blood pressure may have to be cautiously managed in the early stage of stroke. Considering that ICAS is the major cause of stroke worldwide, further investigations are needed to establish optimal management strategies for patients with ICAS.
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Affiliation(s)
- Jong S Kim
- Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Oh Young Bang
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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