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Li C, Xu BF, Zhang M, Song YM, Liu R. Severe Thrombocytopenia with Acute Cerebral Infarction: A Case Report and Literature Review. Niger J Clin Pract 2023; 26:1040-1044. [PMID: 37635593 DOI: 10.4103/njcp.njcp_844_22] [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] [Indexed: 08/29/2023]
Abstract
Common causes of thrombocytopenia include pseudo-thrombocytopenia, splenomegaly, decreased bone marrow production, and increased platelet destruction or depletion. The main clinical manifestation is bleeding, and thrombosis-related complications are rare. This article reports an 87-year-old woman with severe thrombocytopenia for more than 7 years. On day 6 in the hospital, the patient suddenly fell into a coma, and emergency head computed tomography (CT) displayed acute cerebral infarction of the left cerebellar hemisphere, brainstem, and left thalamus. Although thrombocytopenia is often associated with bleeding, there is still a need for vigilance against ischemic diseases. We analyzed the possible causes of acute cerebral infarction with thrombocytopenia and reviewed the literature. Our case is different from the causes of cerebral infarction reported in previous articles, so the relationship between thrombocytopenia and acute cerebral infarction needs further study. The patient, in this case, was not given anticoagulant or antiplatelet therapy but recovered well. It shows that individualized treatment is effective.
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Affiliation(s)
- C Li
- Department of VIP Unit, China-Japan Union Hospital of Jilin University, Changchun, Jilin Province, China
| | - B F Xu
- Department of Stroke Center, First Hospital of Jilin University, Changchun, Jilin Province, China
| | - M Zhang
- Department of VIP Unit, China-Japan Union Hospital of Jilin University, Changchun, Jilin Province, China
| | - Y M Song
- Department of VIP Unit, China-Japan Union Hospital of Jilin University, Changchun, Jilin Province, China
| | - R Liu
- Department of VIP Unit, China-Japan Union Hospital of Jilin University, Changchun, Jilin Province, China
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Atkins PW, Perez HA, Spence JD, Muñoz SE, Armando LJ, García NH. Increased carotid plaque burden in patients with family medical history of premature cardiovascular events in the absence of classical risk factors. Arch Med Sci 2019; 15:1388-1396. [PMID: 31749866 PMCID: PMC6855146 DOI: 10.5114/aoms.2019.84677] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2017] [Accepted: 04/03/2018] [Indexed: 12/12/2022] Open
Abstract
INTRODUCTION The hypothesis that relates atherosclerosis to traditional risk factors (TRF) seems to be not as adequate as previously thought; other risk factors (RF) need to be considered to prevent atherosclerosis progression. Although a family medical history of premature cardiovascular events (FHx) has been considered the putative RF for decades, it has not been incorporated routinely into cardiovascular risk evaluation along with another RF. The objective of this study was to investigate whether FHx is associated with a higher atherosclerotic burden, measured as carotid total plaque area (TPA) in a population having no traditional RF. MATERIAL AND METHODS The study included 4,351 primary care patients in Argentina. After excluding a personal history of cardiovascular disease (CVD) and TRF: hypertension, diabetes mellitus, hypercholesterolemia, smoking history, and body mass index (BMI) > 25 kg/cm2, 34 patients with FHx were identified. Compared to 56 matched controls TPA was 86% higher in FHx patients (p < 0.05). A second analysis performed in hypertensive patients but no other TRF; 32 patients with FHx were identified. RESULTS Compared with 44 matched controls, TPA was 77% higher in FHx patients (p < 0.05). A final analysis using a generalized linear model with TPA progression as the response variable suggests that TPA progresses more rapidly in FHx patients compared to controls. CONCLUSIONS The FHx was associated with increased TPA burden and progression in the absence of other TRF. This supports ultrasound screening in FHx patients in order to detect high-risk patients who may benefit from early intervention.
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Affiliation(s)
- Paul W. Atkins
- Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
| | | | - J. David Spence
- Stroke Prevention and Atherosclerosis Research Centre, Robarts Research Institute, Western University, London, Ontario, Canada
| | - Sonia E. Muñoz
- Instituto de Investigaciones en Ciencias de la Salud FCM (INICSA-CONICET), Córdoba, Argentina
| | | | - Néstor H. García
- Instituto de Investigaciones en Ciencias de la Salud FCM (INICSA-CONICET), Córdoba, Argentina
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Staszewski J, Bilbin-Bukowska A, Szypowski W, Mejer-Zahorowski M, Stępień A. Cerebrovascular accidents differ between patients with atrial flutter and patients with atrial fibrillation. Arch Med Sci 2019; 17:1590-1598. [PMID: 34900038 PMCID: PMC8641519 DOI: 10.5114/aoms.2019.81669] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2018] [Accepted: 11/01/2018] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION Few studies have explored the potential impact of atrial flutter (AFl) on ischaemic stroke (IS) outcome. The aim of the present study was to compare the clinical course of IS in patients with AFl and patients with atrial fibrillation (AF). MATERIAL AND METHODS A retrospective analysis of patients consecutively admitted to a tertiary care centre between 2013 and 2015 due to IS or transient ischaemic attack with permanent AFl or permanent or persistent AF was performed. RESULTS The study groups consisted of 528 patients, including 490 (92.8%) patients with AF and 38 (7.2%) patients with AFl. The mean age and prestroke CHA2DS2-VASc scores were similar between the patients with AFl and those with AF. Most IS cases in the AF group were classified as cardioembolic strokes (74.9% vs. 39.5% in AFl, p < 0.01), and lacunar strokes were the most common in the AFl group (47.4% vs. 14.3% in AF, p < 0.01). The multivariable analysis revealed that the presence of AF (OR = 8.6, 95% CI: 1.2-57, p = 0.02), lacunar stroke (OR = 0.1, 95% CI: 0.03-0.31, p < 0.001), baseline Rankin scale score (OR = 16.6, 95% CI: 9.8-28), lack of prestroke therapeutic anticoagulation (OR = 6.1, 95% CI: 1.1-33), diabetes (OR = 2.9, 95% CI: 1.3-6.5, p < 0.01), chronic heart failure (OR = 14.2, 95% CI: 5.8-34, p < 0.001), and current smoking (OR = 0.92, 95% CI: 0.39-0.99, p < 0.01) were significantly associated with the stroke outcome. CONCLUSIONS Disabling or fatal IS was observed less often in patients with AFl than in patients with AF. This finding can possibly be explained by the more frequent occurrence of lacunar strokes in the AFl group compared with that in the AF group.
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Affiliation(s)
- Jacek Staszewski
- Department of Neurology, Military Institute of Medicine, Warsaw, Poland
| | | | | | | | - Adam Stępień
- Department of Neurology, Military Institute of Medicine, Warsaw, Poland
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Miazgowski T, Kopec J, Widecka K, Miazgowski B, Kaczmarkiewicz A. Epidemiology of hypertensive heart disease in Poland: findings from the Global Burden of Disease Study 2016. Arch Med Sci 2019; 17:874-880. [PMID: 34336015 PMCID: PMC8314396 DOI: 10.5114/aoms.2019.85222] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2018] [Accepted: 09/16/2018] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION Hypertension may cause target organ damage leading to hypertensive heart disease (HHD). The burden caused by HHD in Poland has not been studied systematically. The purpose of this study was to describe the burden of HHD in Poland in terms of prevalence, mortality, disability-adjusted life years lost (DALY) and key risk factors. MATERIAL AND METHODS Data were obtained from the Global Burden of Diseases, Injuries and Risk Factors (GBD) Study database. The GBD uses a wide range of data sources and complex statistical methods to estimate disease burden for all countries by age, sex, and year. HHD was defined by ICD-9 codes 402-402.91 and ICD-10 codes I11-I11.9. From the GBD 2016 estimates, we extracted data for Poland between 1990 and 2016. RESULTS Hypertensive heart disease is the fourth most important cause of cardio- and cerebrovascular death, after ischemic heart disease, stroke and cardiomyopathy. In 2016, there were about 180 000 people diagnosed with HHD in Poland and close to 5000 HHD-related deaths. HHD prevalence increased from 0.29% in 1990 to 0.47% in 2016 and was higher in women, while mortality increased from 11.2 to 12.7 per 100 000, largely due to population aging. Age-standardized death and DALY rates declined between 1990 and 2016 and were lower than in Central Europe but higher than in Western Europe. CONCLUSIONS Our data suggest a need for national initiatives to improve the diagnosis and treatment of hypertension, slow the progression of HHD, and reduce the related risks and premature deaths.
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Affiliation(s)
- Tomasz Miazgowski
- Department of Hypertension and Internal Diseases, Pomeranian Medical University, Szczecin, Poland
| | - Jacek Kopec
- School of Population and Public Health, University of British Columbia, Canada
| | - Katarzyna Widecka
- Department of Cardiology, Pomeranian Medical University, Szczecin, Poland
| | - Bartosz Miazgowski
- Centre for Medical Simulations, Pomeranian Medical University, Szczecin, Poland
| | - Anna Kaczmarkiewicz
- Department of Hypertension and Internal Diseases, Pomeranian Medical University, Szczecin, Poland
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Zhang X, Li H, Kou W, Tang K, Zhao D, Zhang J, Zhuang J, Zhao Y, Ji S, Peng W, Xu Y. Increased plasma microfibrillar-associated protein 4 is associated with atrial fibrillation and more advanced left atrial remodelling. Arch Med Sci 2019; 15:632-640. [PMID: 31110528 PMCID: PMC6524186 DOI: 10.5114/aoms.2018.74953] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2018] [Accepted: 03/14/2018] [Indexed: 01/08/2023] Open
Abstract
INTRODUCTION This study aimed to evaluate the relationship of plasma microfibrillar-associated protein 4 (MFAP4) to atrial fibrillation (AF) and atrial structural remodelling. MATERIAL AND METHODS Plasma MFAP4 levels were measured in 92 patients with AF (61 paroxysmal AF (PAF) patients and 31 persistent AF (PersAF) patients) and 71 control subjects without AF. Linear and logistic multivariate regression analyses were performed to determine the potential value of MFAP4 for predicting the incidence of AF and left atrial size. Then, plasma and atrial protein levels of MFAP4 and its association with atrial fibrosis ratio were analysed in an atrial-specific fibrosis rat model. RESULTS There were significant differences in MFAP4 levels based on clinical group, with a gradient from control (1.71 ±0.53 ng/ml) to PAF (1.98 ±0.53 ng/ml) to PersAF (2.09 ±0.76 ng/ml) (p < 0.01). With multivariate analyses, plasma MFAP4 was found to be an independent determinant of left atrial diameter in AF patients. In atrial fibrosis rats, both plasma MFAP4 and atrial MFAP4 protein levels increased in atrial fibrosis rats and positively correlated with atrial fibrosis severity. CONCLUSIONS Plasma MFAP4 was increased in patients with AF and was highest in those with PersAF; both plasma MFAP4 and atrial MFAP4 protein expression were directly associated with the extent of LA structural remodelling.
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Affiliation(s)
- Xianlin Zhang
- Department of Cardiology, Shanghai Tenth People’s Hospital of Nanjing Medical University; Shanghai Tenth People’s Hospital, Tongji University School of Medicine, Shanghai, China
- Department of Cardiology, the People’s Hospital of Maanshan, Maanshan City, Anhui Province, China
| | - Hailing Li
- Department of Cardiology, Shanghai Tenth People’s Hospital of Nanjing Medical University; Shanghai Tenth People’s Hospital, Tongji University School of Medicine, Shanghai, China
| | - Wenxin Kou
- Department of Cardiology, Shanghai Tenth People’s Hospital of Nanjing Medical University; Shanghai Tenth People’s Hospital, Tongji University School of Medicine, Shanghai, China
| | - Kai Tang
- Department of Cardiology, Shanghai Tenth People’s Hospital of Nanjing Medical University; Shanghai Tenth People’s Hospital, Tongji University School of Medicine, Shanghai, China
| | - Dongdong Zhao
- Department of Cardiology, Shanghai Tenth People’s Hospital of Nanjing Medical University; Shanghai Tenth People’s Hospital, Tongji University School of Medicine, Shanghai, China
| | - Jingying Zhang
- Department of Cardiology, Shanghai Tenth People’s Hospital of Nanjing Medical University; Shanghai Tenth People’s Hospital, Tongji University School of Medicine, Shanghai, China
| | - Jianhui Zhuang
- Department of Cardiology, Shanghai Tenth People’s Hospital of Nanjing Medical University; Shanghai Tenth People’s Hospital, Tongji University School of Medicine, Shanghai, China
| | - Yifan Zhao
- Department of Cardiology, Shanghai Tenth People’s Hospital of Nanjing Medical University; Shanghai Tenth People’s Hospital, Tongji University School of Medicine, Shanghai, China
| | - Shuya Ji
- Department of Cardiology, Shanghai Tenth People’s Hospital of Nanjing Medical University; Shanghai Tenth People’s Hospital, Tongji University School of Medicine, Shanghai, China
| | - Wenhui Peng
- Department of Cardiology, Shanghai Tenth People’s Hospital of Nanjing Medical University; Shanghai Tenth People’s Hospital, Tongji University School of Medicine, Shanghai, China
| | - Yawei Xu
- Department of Cardiology, Shanghai Tenth People’s Hospital of Nanjing Medical University; Shanghai Tenth People’s Hospital, Tongji University School of Medicine, Shanghai, China
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Farhoudi M, Mehrvar K, Sadeghi-Bazargani H, Hashemilar M, Seyedi-Vafaee M, Sadeghi-Hokmabad E, Rikhtegar R, Saber-Maroof B, Abutalebi M, Rezaei M, Vaferi S, Aghili A, Ebrahimi O. Stroke subtypes, risk factors and mortality rate in northwest of Iran. IRANIAN JOURNAL OF NEUROLOGY 2017; 16:112-117. [PMID: 29114365 PMCID: PMC5673982] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Background: Stroke is the second most common cause of death and first cause of disability in adults in the world. About 80% of all stroke deaths occur in developing countries. So far, the data on stroke epidemiology have been limited in Iran. Therefore, this study was focused on stroke demographic data, risk factors, types and mortality. Methods: A retrospective study was done in two university tertiary referral hospitals in Tabriz, northwest of Iran, from March 2008 to April 2013. Patients diagnosed with stroke were enrolled in the study. Demographic data, stroke subtypes, duration of hospitalization, stroke risk factors and hospital mortality rate were recorded for all the patients. Results: A total number of 5355 patients were evaluated in the present study. Mean age of the patients was 67.5 ± 13.8 years, and 50.6% were men. Final diagnosis of ischemic stroke was made in 76.5% of the patients, intra-cerebral hemorrhage (ICH) with or without intra-ventricular hemorrhage (IVH) in 14.3% and subarachnoid hemorrhage (SAH) in 9.2%. Stroke risk factors among the patients were hypertension in 68.8% of the patients, diabetes mellitus (DM) in 23.9%, smoking in 12.6% and ischemic heart diseases (IHD) in 17.1%. Mean hospital stay was 17.3 days. Overall, the in-hospital mortality was 20.5%. Conclusion: Compared to other studies, duration of hospital stay was longer and mortality rate was higher in this study. Hypertension was the most common risk factor and cardiac risk factors and DM had relatively lower rate in comparison to other studies. Because of insufficient data on the epidemiology, patterns, and risk factors of stroke in Iran, there is a necessity to develop and implement a national registry system.
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Affiliation(s)
- Mehdi Farhoudi
- Neurosciences Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Kaveh Mehrvar
- Neurosciences Research Center, Tabriz University of Medical Sciences, Tabriz, Iran,Iranian Social Security Organization, Tabriz University of Medical Sciences, Tabriz, Iran
| | | | - Mazyar Hashemilar
- Neurosciences Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | | | | | - Reza Rikhtegar
- Neurosciences Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Babak Saber-Maroof
- Neurosciences Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Mohammad Abutalebi
- Neurosciences Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Mahsa Rezaei
- Neurosciences Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Sahar Vaferi
- Neurosciences Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Alireza Aghili
- Neurosciences Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Omid Ebrahimi
- Neurosciences Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
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