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Li J, Xie C, Lan J, Tan J, Tan X, Chen N, Wei L, Liang J, Pan R, Zhu T, Pei P, Sun D, Su L, Zhou L. Spicy food consumption reduces the risk of ischaemic stroke: a prospective study. Br J Nutr 2024; 131:1777-1785. [PMID: 38287709 DOI: 10.1017/s0007114524000229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2024]
Abstract
Previous studies revealed that consuming spicy food reduced mortality from CVD and lowered stroke risk. However, no studies reported the relationship between spicy food consumption, stroke types and dose–response. This study aimed to further explore the association between the frequency of spicy food intake and the risk of stroke in a large prospective cohort study. In this study, 50 174 participants aged 30–79 years were recruited. Spicy food consumption data were collected via a baseline survey questionnaire. Outcomes were incidence of any stroke, ischaemic stroke (IS) and haemorrhagic stroke (HS). Multivariable-adjusted Cox proportional hazard models estimated the association between the consumption of spicy food and incident stroke. Restricted cubic spline analysis was used to examine the dose–response relationship. During the median 10·7-year follow-up, 3967 strokes were recorded, including 3494 IS and 516 HS. Compared with those who never/rarely consumed spicy food, those who consumed spicy food monthly, 1–2 d/week and 3–5 d/week had hazard ratio (HR) of 0·914 (95 % CI 0·841, 0·995), 0·869 (95 % CI 0·758, 0·995) and 0·826 (95 % CI 0·714, 0·956) for overall stroke, respectively. For IS, the corresponding HR) were 0·909 (95 % CI 0·832, 0·994), 0·831 (95 % CI 0·718, 0·962) and 0·813 (95 % CI 0·696, 0·951), respectively. This protective effect showed a U-shaped dose–response relationship. For obese participants, consuming spicy food ≥ 3 d/week was negatively associated with the risk of IS. We found the consumption of spicy food was negatively associated with the risk of IS and had a U-shaped dose–response relationship with risk of IS. Individuals who consumed spicy food 3–5 d/week had a significantly lowest risk of IS.
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Affiliation(s)
- Jiale Li
- School of Public Health of Guangxi Medical University, 22 Shuangyong Road, Nanning, Guangxi, 530021, People's Republic of China
| | - Changping Xie
- Liuzhou Center for Disease Control and Prevention, Liuzhou, Guangxi, 545005, People's Republic of China
| | - Jian Lan
- Liuzhou Center for Disease Control and Prevention, Liuzhou, Guangxi, 545005, People's Republic of China
| | - Jinxue Tan
- Liuzhou Center for Disease Control and Prevention, Liuzhou, Guangxi, 545005, People's Republic of China
| | - Xiaoping Tan
- Liuzhou Center for Disease Control and Prevention, Liuzhou, Guangxi, 545005, People's Republic of China
| | - Ningyu Chen
- Liuzhou Center for Disease Control and Prevention, Liuzhou, Guangxi, 545005, People's Republic of China
| | - Liuping Wei
- Liuzhou Center for Disease Control and Prevention, Liuzhou, Guangxi, 545005, People's Republic of China
| | - Jiajia Liang
- Liuzhou Center for Disease Control and Prevention, Liuzhou, Guangxi, 545005, People's Republic of China
| | - Rong Pan
- Liuzhou Center for Disease Control and Prevention, Liuzhou, Guangxi, 545005, People's Republic of China
| | - Tingping Zhu
- Liuzhou Center for Disease Control and Prevention, Liuzhou, Guangxi, 545005, People's Republic of China
| | - Pei Pei
- Peking University Center for Public Health and Epidemic Preparedness and Response, Beijing100191, People's Republic of China
| | - Dianjianyi Sun
- Peking University Center for Public Health and Epidemic Preparedness and Response, Beijing100191, People's Republic of China
- Department of Epidemiology & Biostatistics, School of Public Health, Peking University, Xueyuan Road, Haidian District, Beijing100191, People's Republic of China
| | - Li Su
- School of Public Health of Guangxi Medical University, 22 Shuangyong Road, Nanning, Guangxi, 530021, People's Republic of China
| | - Lifang Zhou
- Liuzhou Center for Disease Control and Prevention, Liuzhou, Guangxi, 545005, People's Republic of China
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Mishra A, Tandon R, Paliwal V, Jha S. How well does peripheral blood neutrophil-to-lymphocyte ratio predict the severity and prognosis of hemorrhagic Stroke. Clin Neurol Neurosurg 2024; 239:108211. [PMID: 38452715 DOI: 10.1016/j.clineuro.2024.108211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Revised: 02/24/2024] [Accepted: 02/26/2024] [Indexed: 03/09/2024]
Abstract
OBJECTIVE We explored the blood neutrophil-to-lymphocyte ratio (NLR) as a prognostic marker and its relation with mortality and Modified Rankin Scale (mRS) score at discharge and at 3 months following ICH and also compared NLR with intracerebral hemorrhage (ICH) score, Sequential Organ Failure Assessment (SOFA) score and National Institutes of Health Stroke Scale (NIHSS) score. METHODS The investigators calculated the NIHSS score, SOFA score, ICH score and NLR of 90 adult patients within 3 days of onset of stroke with evidence of hemorrhagic stroke in brain imaging and correlated it with in-hospital mortality, 3-month mortality and mRS at 3 months following stroke using regression analysis. RESULTS Out of 90 individuals, there were 54 (60%) males and 36 (40%) females. The mRS score at 3 months significantly related to the admission NLR ratio >7 and SOFA score. Similarly, the in-hospital death and 3-month mortality was related to the admission NLR ratio >7 and ICH score. However, at a cut off value of NLR>3 for assessing the prognosis of the patients, we did not get significant results for mRS at 3 months following stroke and for in-hospital and 3-month mortality. CONCLUSION A high NLR ratio >7 predicted worse outcomes in terms of mortality and morbidity at 3-months following haemorrhagic stroke. Hence, like ICH score, NLR can predict 3-month mortality following an acute haemorrhagic stroke and can also predict morbidity following 3 months of brain haemorrhage.
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Affiliation(s)
- Anadi Mishra
- Department of Neurology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow 226014, India
| | - Ruchika Tandon
- Department of Neurology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow 226014, India.
| | - Vimal Paliwal
- Department of Neurology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow 226014, India
| | - Sanjeev Jha
- Department of Neurology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow 226014, India
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Tong TYN, Clarke R, Schmidt JA, Huybrechts I, Noor U, Forouhi NG, Imamura F, Travis RC, Weiderpass E, Aleksandrova K, Dahm CC, van der Schouw YT, Overvad K, Kyrø C, Tjønneland A, Kaaks R, Katzke V, Schiborn C, Schulze MB, Mayen-Chacon AL, Masala G, Sieri S, de Magistris MS, Tumino R, Sacerdote C, Boer JMA, Verschuren WMM, Brustad M, Nøst TH, Crous-Bou M, Petrova D, Amiano P, Huerta JM, Moreno-Iribas C, Engström G, Melander O, Johansson K, Lindvall K, Aglago EK, Heath AK, Butterworth AS, Danesh J, Key TJ. Dietary amino acids and risk of stroke subtypes: a prospective analysis of 356,000 participants in seven European countries. Eur J Nutr 2024; 63:209-220. [PMID: 37804448 PMCID: PMC10799144 DOI: 10.1007/s00394-023-03251-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Accepted: 09/08/2023] [Indexed: 10/09/2023]
Abstract
PURPOSE Previously reported associations of protein-rich foods with stroke subtypes have prompted interest in the assessment of individual amino acids. We examined the associations of dietary amino acids with risks of ischaemic and haemorrhagic stroke in the EPIC study. METHODS We analysed data from 356,142 participants from seven European countries. Dietary intakes of 19 individual amino acids were assessed using validated country-specific dietary questionnaires, calibrated using additional 24-h dietary recalls. Multivariable-adjusted Cox regression models were used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) of ischaemic and haemorrhagic stroke in relation to the intake of each amino acid. The role of blood pressure as a potential mechanism was assessed in 267,642 (75%) participants. RESULTS After a median follow-up of 12.9 years, 4295 participants had an ischaemic stroke and 1375 participants had a haemorrhagic stroke. After correction for multiple testing, a higher intake of proline (as a percent of total protein) was associated with a 12% lower risk of ischaemic stroke (HR per 1 SD higher intake 0.88; 95% CI 0.82, 0.94). The association persisted after mutual adjustment for all other amino acids, systolic and diastolic blood pressure. The inverse associations of isoleucine, leucine, valine, phenylalanine, threonine, tryptophan, glutamic acid, serine and tyrosine with ischaemic stroke were each attenuated with adjustment for proline intake. For haemorrhagic stroke, no statistically significant associations were observed in the continuous analyses after correcting for multiple testing. CONCLUSION Higher proline intake may be associated with a lower risk of ischaemic stroke, independent of other dietary amino acids and blood pressure.
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Affiliation(s)
- Tammy Y N Tong
- Cancer Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Richard Doll Building, Old Road Campus, Oxford, OX3 7LF, UK.
| | - Robert Clarke
- Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Julie A Schmidt
- Cancer Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Richard Doll Building, Old Road Campus, Oxford, OX3 7LF, UK
- Departments of Clinical Epidemiology, Clinical Medicine, Aarhus University Hospital and Aarhus University, Aarhus, Denmark
| | - Inge Huybrechts
- Nutrition and Metabolism Branch, International Agency for Research on Cancer (IARC), World Health Organization (WHO), Lyon, France
| | - Urwah Noor
- Cancer Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Richard Doll Building, Old Road Campus, Oxford, OX3 7LF, UK
| | - Nita G Forouhi
- MRC Epidemiology Unit, University of Cambridge School of Clinical Medicine, Cambridge, UK
| | - Fumiaki Imamura
- MRC Epidemiology Unit, University of Cambridge School of Clinical Medicine, Cambridge, UK
| | - Ruth C Travis
- Cancer Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Richard Doll Building, Old Road Campus, Oxford, OX3 7LF, UK
| | - Elisabete Weiderpass
- International Agency for Research on Cancer (IARC), World Health Organization (WHO), Lyon, France
| | - Krasimira Aleksandrova
- Department Epidemiological Methods and Etiological Research, Leibniz Institute for Prevention Research and Epidemiology-BIPS, Bremen, Germany
- Faculty of Human and Health Sciences, University of Bremen, Grazer Straße 2, 28359, Bremen, Germany
| | | | - Yvonne T van der Schouw
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Kim Overvad
- Department of Public Health, Aarhus University, Aarhus, Denmark
| | - Cecilie Kyrø
- Danish Cancer Society Research Center, Copenhagen, Denmark
| | | | - Rudolf Kaaks
- Division of Cancer Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Verena Katzke
- Division of Cancer Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Catarina Schiborn
- Department of Molecular Epidemiology, German Institute of Human Nutrition Potsdam-Rehbruecke, Nuthetal, Germany
- German Center for Diabetes Research (DZD), Neuherberg, Germany
| | - Matthias B Schulze
- Department of Molecular Epidemiology, German Institute of Human Nutrition Potsdam-Rehbruecke, Nuthetal, Germany
- Institute for Nutritional Science, University of Potsdam, Nuthetal, Germany
| | - Ana-Lucia Mayen-Chacon
- Nutrition and Metabolism Branch, International Agency for Research on Cancer (IARC), World Health Organization (WHO), Lyon, France
| | - Giovanna Masala
- Institute for Cancer Research, Prevention and Clinical Network (ISPRO), Florence, Italy
| | - Sabina Sieri
- Epidemiology and Prevention Unit, Fondazione IRCCS Istituto Nazionale Dei Tumori Di Milano, Milan, Italy
| | | | - Rosario Tumino
- Hyblean Association for Epidemiological Research AIRE-ONLUS, Ragusa, Italy
| | - Carlotta Sacerdote
- Unit of Cancer Epidemiology, Città della Salute e della Scienza University-Hospital, Turin, Italy
| | - Jolanda M A Boer
- National Institute for Public Health and the Environment, Bilthoven, The Netherlands
| | - W M Monique Verschuren
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
- National Institute for Public Health and the Environment, Bilthoven, The Netherlands
| | - Magritt Brustad
- Department of Community Medicine, Faculty of Health Sciences, UiT the Arctic University of Norway, Tromsø, Norway
- The Public Dental Service Competence Centre of Northern Norway (TkNN), Tromsø, Norway
| | - Therese Haugdahl Nøst
- Department of Community Medicine, Faculty of Health Sciences, UiT the Arctic University of Norway, Tromsø, Norway
- K.G. Jebsen Centre for Genetic Epidemiology, Department of Public Health and Nursing, Norwegian University of Science and Technology, Trondheim, Norway
| | - Marta Crous-Bou
- Unit of Nutrition and Cancer, Cancer Epidemiology Research Program, Catalan Institute of Oncology (ICO)-Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Dafina Petrova
- Escuela Andaluza de Salud Pública (EASP), Granada, Spain
- Instituto de Investigación Biosanitaria Ibs.GRANADA, Granada, Spain
- Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Instituto de Salud Carlos III, C. de Melchor Fernández Almagro, Madrid, Spain
| | - Pilar Amiano
- Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Instituto de Salud Carlos III, C. de Melchor Fernández Almagro, Madrid, Spain
- Ministry of Health of the Basque Government, Sub Directorate for Public Health and Addictions of Gipuzkoa, San Sebastian, Spain
- Biodonostia Health Research Institute, Epidemiology of Chronic and Communicable Diseases Group, San Sebastián, Spain
| | - José María Huerta
- Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Instituto de Salud Carlos III, C. de Melchor Fernández Almagro, Madrid, Spain
- Department of Epidemiology, Murcia Regional Health Council, IMIB-Arrixaca, Murcia, Spain
| | - Conchi Moreno-Iribas
- Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Instituto de Salud Carlos III, C. de Melchor Fernández Almagro, Madrid, Spain
- Navarra Institute for Health Research (IdiSNA), Pamplona, SpainInstituto de Salud Pu´Blica de Navarra, IdiSNA, Navarre Institute for Health Research, Pamplona, Spain
| | - Gunnar Engström
- Department of Clinical Science in Malmö, Lund University, Clinical Research Center, Malmö, Sweden
| | - Olle Melander
- Department of Clinical Science in Malmö, Lund University, Clinical Research Center, Malmö, Sweden
- Department of Emergency and Internal Medicine, Skåne University Hospital, Malmö, Sweden
| | - Kristina Johansson
- Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - Kristina Lindvall
- Department of Epidemiology and Global Health, Umeå University, Umeå, Sweden
| | - Elom K Aglago
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK
| | - Alicia K Heath
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK
| | - Adam S Butterworth
- British Heart Foundation Cardiovascular Epidemiology Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
- National Institute for Health Research Blood and Transplant Research Unit in Donor Health and Genomics, University of Cambridge, Cambridge, UK
- British Heart Foundation Centre of Research Excellence, University of Cambridge, Hills Road, Cambridge, UK
- Health Data Research UK Cambridge, Wellcome Genome Campus and University of Cambridge, Cambridge, UK
| | - John Danesh
- British Heart Foundation Cardiovascular Epidemiology Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
- National Institute for Health Research Blood and Transplant Research Unit in Donor Health and Genomics, University of Cambridge, Cambridge, UK
- British Heart Foundation Centre of Research Excellence, University of Cambridge, Hills Road, Cambridge, UK
- Health Data Research UK Cambridge, Wellcome Genome Campus and University of Cambridge, Cambridge, UK
- Department of Human Genetics, Wellcome Sanger Institute, Hinxton, UK
| | - Timothy J Key
- Cancer Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Richard Doll Building, Old Road Campus, Oxford, OX3 7LF, UK
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Lasa-Berasain P, Salas PR, Azparren EE, Sanz ER. Myocardial infarction and haemorrhagic stroke as a rare presentation of acute aortic dissection: a fatal case report. Eur Heart J Case Rep 2023; 7:ytad529. [PMID: 37954566 PMCID: PMC10635585 DOI: 10.1093/ehjcr/ytad529] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Revised: 10/11/2023] [Accepted: 10/20/2023] [Indexed: 11/14/2023]
Abstract
Background Type A acute aortic dissection (AAD) is an extremely severe condition, having a high risk of mortality. Initial diagnosis can be deceptive, especially in patients with other confounding presentations. Case summary We present the case of a 60-year-old male with a history of endovascular aortic repair for abdominal aortic dissection, in whom a diagnosis of AAD was made, but almost missed, after he presented with stroke signs and left coronary myocardial infarction. Thorough clinical evaluation and point-of-care ultrasound (POCUS) were fundamental to the diagnosis of the underlying condition, which showed the intimal flap in the ascending aorta, aortic insufficiency, and a dissected left common carotid artery. The diagnosis was confirmed with a head and thoracic computed tomography scan, which also showed bilateral haemorrhagic strokes. Treatment options can be limited in patients with AAD with associated complications. After a careful multidisciplinary evaluation, life-sustaining therapy was withdrawn and the patient passed away. Discussion Our case depicts the diagnosis challenge presented by patients with AAD. We emphasize the importance of clinical suspicion and POCUS examination for the diagnosis of the underlying condition, as it is frequently missed during first evaluation. We discuss the available literature regarding the prevalence and described mechanisms by which AAD can associate occlusion myocardial infarction, which more commonly involves the right coronary artery, as well as haemorrhagic stroke. We briefly mention management options, which are limited and controversial.
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Affiliation(s)
- Pablo Lasa-Berasain
- Department of Critical Care Medicine, Navarre University Hospital, Irunlarrea 3, 31008, Pamplona, Navarre, Spain
| | - Pablo Raposo Salas
- Department of Cardiology, Navarre University Hospital, Irunlarrea 3, 31008, Pamplona, Navarre, Spain
| | - Edurne Erice Azparren
- Department of Critical Care Medicine, Navarre University Hospital, Irunlarrea 3, 31008, Pamplona, Navarre, Spain
| | - Eva Regidor Sanz
- Department of Critical Care Medicine, Navarre University Hospital, Irunlarrea 3, 31008, Pamplona, Navarre, Spain
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Liu H, Li J, Liu F, Huang K, Cao J, Chen S, Li H, Shen C, Hu D, Huang J, Lu X, Gu D. Efficacy and safety of low levels of low-density lipoprotein cholesterol: trans-ancestry linear and non-linear Mendelian randomization analyses. Eur J Prev Cardiol 2023; 30:1207-1215. [PMID: 37040432 DOI: 10.1093/eurjpc/zwad111] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Revised: 04/05/2023] [Accepted: 04/07/2023] [Indexed: 04/13/2023]
Abstract
AIMS LDL cholesterol (LDL-C) is a well-established risk factor for coronary artery disease (CAD). However, the optimal LDL-C level with regard to efficacy and safety remains unclear. We aimed to investigate the causal relationships between LDL-C and efficacy and safety outcomes. METHODS AND RESULTS We analyzed 353 232 British from the UK Biobank and 41 271 Chinese from the China-PAR project. Linear and non-linear Mendelian randomization (MR) analyses were performed to evaluate the causal relation between genetically proxied LDL-C and CAD, all-cause mortality, and safety outcomes (including haemorrhagic stroke, diabetes mellitus, overall cancer, non-cardiovascular death, and dementia). No significant non-linear associations were observed for CAD, all-cause mortality, and safety outcomes (Cochran Q P > 0.25 in British and Chinese) with LDL-C levels above the minimum values of 50 and 20 mg/dL in British and Chinese, respectively. Linear MR analyses demonstrated a positive association of LDL-C with CAD [British: odds ratio (OR) per unit mmol/L increase, 1.75, P = 7.57 × 10-52; Chinese: OR, 2.06, P = 9.10 × 10-3]. Furthermore, stratified analyses restricted to individuals with LDL-C levels less than the guideline-recommended 70 mg/dL demonstrated lower LDL-C levels were associated with a higher risk of adverse events, including haemorrhagic stroke (British: OR, 0.72, P = 0.03) and dementia (British: OR, 0.75, P = 0.03). CONCLUSION In British and Chinese populations, we confirmed a linear dose-response relationship of LDL-C with CAD and found potential safety concerns at low LDL-C levels, providing recommendations for monitoring adverse events in people with low LDL-C in the prevention of cardiovascular disease.
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Affiliation(s)
- Hongwei Liu
- Key Laboratory of Cardiovascular Epidemiology & Department of Epidemiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, 167 Beilishi Road, Xicheng District, Beijing, 100037, China
| | - Jianxin Li
- Key Laboratory of Cardiovascular Epidemiology & Department of Epidemiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, 167 Beilishi Road, Xicheng District, Beijing, 100037, China
| | - Fangchao Liu
- Key Laboratory of Cardiovascular Epidemiology & Department of Epidemiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, 167 Beilishi Road, Xicheng District, Beijing, 100037, China
| | - Keyong Huang
- Key Laboratory of Cardiovascular Epidemiology & Department of Epidemiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, 167 Beilishi Road, Xicheng District, Beijing, 100037, China
| | - Jie Cao
- Key Laboratory of Cardiovascular Epidemiology & Department of Epidemiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, 167 Beilishi Road, Xicheng District, Beijing, 100037, China
| | - Shufeng Chen
- Key Laboratory of Cardiovascular Epidemiology & Department of Epidemiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, 167 Beilishi Road, Xicheng District, Beijing, 100037, China
| | - Hongfan Li
- Key Laboratory of Cardiovascular Epidemiology & Department of Epidemiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, 167 Beilishi Road, Xicheng District, Beijing, 100037, China
| | - Chong Shen
- Department of Epidemiology and Biostatistics, School of Public Health, Nanjing Medical University, Nanjing, 211166, China
| | - Dongsheng Hu
- Department of Epidemiology and Health Statistics, College of Public Health, Zhengzhou University, Zhengzhou, 450001, China
- Department of Biostatistics and Epidemiology, School of Public Health, Shenzhen University Health Science Center, Shenzhen, 518060, China
| | - Jianfeng Huang
- Key Laboratory of Cardiovascular Epidemiology & Department of Epidemiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, 167 Beilishi Road, Xicheng District, Beijing, 100037, China
| | - Xiangfeng Lu
- Key Laboratory of Cardiovascular Epidemiology & Department of Epidemiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, 167 Beilishi Road, Xicheng District, Beijing, 100037, China
| | - Dongfeng Gu
- Key Laboratory of Cardiovascular Epidemiology & Department of Epidemiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, 167 Beilishi Road, Xicheng District, Beijing, 100037, China
- School of Medicine, Southern University of Science and Technology, 1088 Xueyuan Avenue, Nanshan District, Shenzhen, 518055, China
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Mankoo A, Roy S, Davies A, Panerai RB, Robinson TG, Brassard P, Beishon LC, Minhas JS. The role of the autonomic nervous system in cerebral blood flow regulation in stroke: A review. Auton Neurosci 2023; 246:103082. [PMID: 36870192 DOI: 10.1016/j.autneu.2023.103082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2021] [Revised: 11/22/2022] [Accepted: 02/22/2023] [Indexed: 03/02/2023]
Abstract
Stroke is a pathophysiological condition which results in alterations in cerebral blood flow (CBF). The mechanism by which the brain maintains adequate CBF in presence of fluctuating cerebral perfusion pressure (CPP) is known as cerebral autoregulation (CA). Disturbances in CA may be influenced by a number of physiological pathways including the autonomic nervous system (ANS). The cerebrovascular system is innervated by adrenergic and cholinergic nerve fibers. The role of the ANS in regulating CBF is widely disputed owing to several factors including the complexity of the ANS and cerebrovascular interactions, limitations to measurements, variation in methods to assess the ANS in relation to CBF as well as experimental approaches that can or cannot provide insight into the sympathetic control of CBF. CA is known to be impaired in stroke however the number of studies investigating the mechanisms by which this occurs are limited. This literature review will focus on highlighting the assessment of the ANS and CBF via indices derived from the analyses of heart rate variability (HRV), and baroreflex sensitivity (BRS), and providing a summary of both clinical and animal model studies investigating the role of the ANS in influencing CA in stroke. Understanding the mechanisms by which the ANS influences CBF in stroke patients may provide the foundation for novel therapeutic approaches to improve functional outcomes in stroke patients.
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Affiliation(s)
- Alex Mankoo
- University of Leicester, Department of Cardiovascular Sciences, Leicester, United Kingdom
| | - Sankanika Roy
- University of Leicester, Department of Cardiovascular Sciences, Leicester, United Kingdom.
| | - Aaron Davies
- University of Leicester, Department of Cardiovascular Sciences, Leicester, United Kingdom
| | - Ronney B Panerai
- University of Leicester, Department of Cardiovascular Sciences, Leicester, United Kingdom; NIHR Leicester Biomedical Research Centre, British Heart Foundation Cardiovascular Research Centre, Glenfield Hospital, Leicester, United Kingdom
| | - Thompson G Robinson
- University of Leicester, Department of Cardiovascular Sciences, Leicester, United Kingdom; NIHR Leicester Biomedical Research Centre, British Heart Foundation Cardiovascular Research Centre, Glenfield Hospital, Leicester, United Kingdom
| | - Patrice Brassard
- Department of Kinesiology, Faculty of Medicine, Université Laval, Québec, QC, Canada; Research center of the Institut universitaire de cardiologie et de pneumologie de Québec-Université Laval, Québec, QC, Canada
| | - Lucy C Beishon
- University of Leicester, Department of Cardiovascular Sciences, Leicester, United Kingdom
| | - Jatinder S Minhas
- University of Leicester, Department of Cardiovascular Sciences, Leicester, United Kingdom; NIHR Leicester Biomedical Research Centre, British Heart Foundation Cardiovascular Research Centre, Glenfield Hospital, Leicester, United Kingdom
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Abdel-Fattah AR, Pana TA, Tiamkao S, Sawanyawisuth K, Kasemsap N, Mamas MA, Myint PK. [Sex differences in stroke mortality in Thailand : A National cohort study]. Ann Cardiol Angeiol (Paris) 2023; 72:1-7. [PMID: 36435621 DOI: 10.1016/j.ancard.2022.11.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Revised: 10/31/2022] [Accepted: 11/04/2022] [Indexed: 11/24/2022]
Abstract
BACKGROUND Over half of the growing global stroke-mortality burden is accounted for by the East-Asian-subcontinent alone. Sex differences in stroke-mortality in the Asian population is yet to be assessed in the literature. We aimed to assess the sex-differences in mortality following stroke in a large cohort of Thai-patients. METHOD All stroke admissions between 2004-2015 were included from the Thailand public-health-insurance-database. The association between sex and mortality was assessed in-hospital, at 1 month, 1 year and 5 years, using multivariable Cox-regressions, separately for ischaemic-stroke (IS), haemorrhagic-stroke (HS) and stroke-of-undetermined-type(SUT), adjusting for confounders. RESULTS 608,890 patients were included: 370,527 patients with IS(60.9%), 173,236 with HS(28.5%) and 65,127 with SUT(10.6%). Women were older than men in all three groups and had higher prevalence of comorbidities. Adjusted hazard-ratios(HRs) of mortality showed women had higher mortality post-IS compared to men (in-hospital: HR: 1.20; 95% CI: 1.17-1.23; 1 month: HR: 1.17; 95% CI: 1.15-1.20; 1 year: HR: 1.10; 95% CI: 1.09-1.12 and 5 years: HR: 1.02; 95% CI: 1.01-1.03). Women also had higher mortality after HS (in-hospital: HR: 1.02; 95% CI: 1.00-1.04; 1 month: HR: 1.08; 95% CI: 1.06-1.10; 1 year: HR: 1.04; 95% CI: 1.03-1.06 and 5 years: HR: 1.09; 95% CI: 1.08-1.11), and SUT (in-hospital: HR: 1.04; 95% CI: 1.03-1.06; 1 month: HR: 1.20; 95% CI: 1.14-1.27; 1 year: HR: 1.14; 95% CI: 1.09-1.18 and 5 years: HR: 1.06; 95% CI: 1.03-1.10). CONCLUSIONS Compared to men, women were older at time of stroke-diagnosis and had higher burden of stroke risk-factors. Women also had higher mortality after stroke regardless of stroke-type or duration since stroke-onset. Post-IS, excess stroke-mortality in women was greatest during the in-hospital period, whereas excess stroke-mortality increased with time in women who had HS. No clear relationship was found between duration since stroke-onset and mortality in patients who had SUT.
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Affiliation(s)
- Abdel-Rahman Abdel-Fattah
- Ageing Clinical and Experimental Research (ACER) Team, Institute of Applied Health Sciences, School of Medicine, Medical Sciences & Nutrition, University of Aberdeen, Foresterhill, Aberdeen, AB25 2ZD, Scotland, UK.
| | - Tiberiu A Pana
- Ageing Clinical and Experimental Research (ACER) Team, Institute of Applied Health Sciences, School of Medicine, Medical Sciences & Nutrition, University of Aberdeen, Foresterhill, Aberdeen, AB25 2ZD, Scotland, UK
| | - Somsak Tiamkao
- Neurology Division, Department of Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand; North-Eastern Stroke Research Group, Khon Kaen University, Khon Kaen, Thailand
| | - Kittisak Sawanyawisuth
- Ambulatory Medicine Division, Department of Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | - Narongrit Kasemsap
- Neurology Division, Department of Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand; North-Eastern Stroke Research Group, Khon Kaen University, Khon Kaen, Thailand
| | - Mamas A Mamas
- Keele Cardiovascular Research Group, Centre for Prognosis Research, Institute for Primary Care and Health Sciences, Keele University, Stoke-on-Trent, UK
| | - Phyo K Myint
- Ageing Clinical and Experimental Research (ACER) Team, Institute of Applied Health Sciences, School of Medicine, Medical Sciences & Nutrition, University of Aberdeen, Foresterhill, Aberdeen, AB25 2ZD, Scotland, UK
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8
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Stefanou Ε, Karvelas N, Bennett S, Kole C. Cerebrovascular Manifestations of SARS-CoV-2: A Comprehensive Review. Curr Treat Options Neurol 2023; 25:71-92. [PMID: 36950279 PMCID: PMC9984763 DOI: 10.1007/s11940-023-00747-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/12/2023] [Indexed: 03/06/2023]
Abstract
Purpose of review The risks of cerebrovascular manifestations due to SARS-CoV-2 infection are significantly increased within the first 6 months of the infection. Our work aims to give an update on current clinical aspects of diagnosis and treatment of cerebrovascular manifestations during acute and long-term SARS-CoV-2 infection. Recent findings The incidence of acute ischemic stroke and haemorrhagic stroke during acute SARS-CoV-2 patients is estimated at 0.9 to 4.6% and 0.5-0.9%, respectively, and were associated with increased mortality. The majority presented with hemiparesis, dysarthria, sensory deficits, and a NIHSS score within 5-15. In addition, beyond the first 30 days of infection people with COVID-19 exhibited increased risk of stroke. During acute phase, age, hypertension, diabetes, and medical history of vascular disease were increased in patients with COVID-19 with new onset of cerebrovascular manifestations, while during long-COVID-19, the risk of cerebrovascular manifestations were found increased regardless of these factors. The management of patients with large-vessel ischemic stroke fulfilling the intravenous thrombolysis criteria are successfully treated according to the guidelines, while hyperosmolar therapy is typically administered in 4- to 6-h intervals. In addition, prophylaxis of anticoagulation therapy is associated with a better prognosis and low mortality during acute and post hospital discharge of patients with COVID-19. Summary In this work, we provide a comprehensive review of the current literature on acute and post-acute COVID-19 cerebrovascular sequelae, symptomatology, and its pathophysiology mechanisms. Moreover, we discuss therapeutic strategies for these patients during acute and long-term care and point populations at risk. Our findings suggest that older patients with risk factors such as hypertension, diabetes, and medical history of vascular disease are more likely to develop cerebrovascular complications.
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Affiliation(s)
- Εleni Stefanou
- Artificial Kidney Unit, General Hospital of Messinia, Kalamata, Greece
| | - Nikolaos Karvelas
- grid.5216.00000 0001 2155 0800Faculty of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Samuel Bennett
- grid.189967.80000 0001 0941 6502Emory University School of Medicine, Atlanta, GA USA
| | - Christo Kole
- grid.5216.00000 0001 2155 0800Faculty of Medicine, National and Kapodistrian University of Athens, Athens, Greece
- grid.416018.a0000 0004 0623 0819Cardiology Department, Sismanoglio General Hospital of Attica, Athens, Greece
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9
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Hopkins K, Price B, Ziogas J, Adamides A, Mangum J. Comparative proteomic analysis of ventricular and cisternal cerebrospinal fluid in haemorrhagic stroke patients. J Clin Neurosci 2023; 107:84-90. [PMID: 36525746 DOI: 10.1016/j.jocn.2022.11.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Revised: 11/04/2022] [Accepted: 11/10/2022] [Indexed: 12/23/2022]
Abstract
BACKGROUND Analysis of cerebrospinal fluid (CSF) using mass spectrometry is a relatively novel analytical tool, and comparisons of ventricular and cisternal proteomes are yet to be performed. This may have implications for clinical medicine, particularly in demonstrating continuity of the ventricular system with preserved flow in the presence of ventricular blood. Other uses include the identification of novel biomarkers, including for diagnosis of subarachnoid haemorrhage and of aetiology. The primary objective was therefore to characterise and compare the proteomes of ventricular and CSF after haemorrhagic stroke. METHODS Paired CSF samples were prospectively collected from the optico-carotid cistern and the frontal horn of the lateral ventricle at the time of craniotomy and clipping in 8 patients with haemorrhagic stroke. Six patients had an aneurysmal subarachnoid haemorrhage (aSAH) from a ruptured saccular aneurysm, one patient had an aSAH after rupture of a mycotic aneurysm and one patient had a spontaneous intracerebral haemorrhage (IPH) with an adjacent unruptured saccular aneurysm. Samples were processed and proteins identified and quantified using data-dependent liquid chromatography tandem mass spectrometry (DDA LC-MSMS). RESULTS There was no systematic difference between the cisternal and ventricular proteomes. However, blinded principal component analysis (PCA) of the cisternal and ventricular samples separated patients according to pathophysiology. Additionally CSF D-Dimer levels were not detected in the IPH patient but were reliably measured in aSAH patients. CONCLUSIONS Ventricular CSF is representative of cisternal CSF after aSAH. CSF proteomic PCA analysis can distinguish between haemorrhage types. CSF D-dimer levels may represent a novel diagnostic marker for aSAH. Label free DDA LC-MSMS CSF analysis may inform possible biomarkers.
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Affiliation(s)
- Katherine Hopkins
- Department of Biochemistry and Pharmacology, The University of Melbourne, Melbourne, VIC, Australia
| | - Benjamin Price
- Department of Biochemistry and Pharmacology, The University of Melbourne, Melbourne, VIC, Australia; Department of Neurosurgery, The Royal Melbourne Hospital, Melbourne, VIC, Australia.
| | - James Ziogas
- Department of Biochemistry and Pharmacology, The University of Melbourne, Melbourne, VIC, Australia
| | - Alexios Adamides
- Department of Neurosurgery, The Royal Melbourne Hospital, Melbourne, VIC, Australia
| | - Jonathan Mangum
- Department of Biochemistry and Pharmacology, The University of Melbourne, Melbourne, VIC, Australia
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Okekunle AP, Asowata OJ, Fakunle AG, Akpa OM, Sarfo FS, Akpalu A, Wahab K, Obiako R, Komolafe M, Owolabi L, Osaigbovo GO, Tiwari HK, Akinyemi J, Jenkins C, Arulogun O, Ibinaiye P, Appiah L, Agunloye AM, Adeoye AM, Yaria J, Calys-Tagoe B, Uvere EO, Ogbole G, Agyekum F, Sanni TA, Amusa GA, Ogunronbi M, Olowookere S, Balogun O, Ogunmodede JA, Olalusi OV, Samuel D, Mande A, Rabiu M, Adebayo P, Sunday A, Imoh LC, Oguntade AS, Ajose A, Singh A, Adeegbe OT, Mensah Y, Fawale MB, Abdul S, Ikubor J, Tolulope A, Yahaya IS, Akisanya C, Odo CJ, Efidi R, Chukwuonye II, Shidali V, Adebowale A, Ohagwu KA, Adeleye OO, Iheonye H, Akintunde A, Olabinri E, Akpalu J, Adesina J, Onyeonoro U, Onasanya A, Arnett DK, Lackland D, Akinyemi R, Ovbiagele B, Owolabi M. Secondhand smoke exposure is independently associated with stroke among non-smoking adults in West Africa. J Neurol Sci 2022; 443:120489. [PMID: 36399928 PMCID: PMC9712270 DOI: 10.1016/j.jns.2022.120489] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Revised: 10/15/2022] [Accepted: 11/02/2022] [Indexed: 11/11/2022]
Abstract
BACKGROUND Stroke is a leading cause of disability and mortality worldwide, but little is known about the contribution of secondhand smoke exposure (SHSE) to stroke epidemiology among indigenous Africans. OBJECTIVE To evaluate the association of SHSE with stroke among indigenous Africans. METHODS We analyzed the relationship of SHSE with stroke among 2990 case-control pairs of adults who had never smoked (identified in the SIREN study) using conditional logistic regression at a two-sided P < 0.05. RESULTS Multivariable-adjusted odds ratio and 95% confidence interval; 1.25 (1.04, 1.50; P = 0.02) revealed SHSE was positively associated with stroke independent of stroke subtypes. CONCLUSION Culturally relevant primary prevention strategies targeted at SHSE might be promising in preventing stroke among Africans.
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Affiliation(s)
- Akinkunmi Paul Okekunle
- Department of Medicine, University of Ibadan, Nigeria; Department of Food and Nutrition, Seoul National University, Republic of Korea.
| | | | - Adekunle G Fakunle
- Department of Medicine, University of Ibadan, Nigeria; Department of Public Health, Osun State University, Osogbo, Nigeria
| | - Onoja Matthew Akpa
- Department of Epidemiology and Medical Statistics, University of Ibadan, Nigeria; Institute of Cardiovascular Diseases, University of Ibadan, Nigeria
| | - Fred S Sarfo
- Kwame Nkrumah University of Science and Technology, Ghana
| | - Albert Akpalu
- Department of Medicine, University of Ghana Medical School, Accra, Ghana
| | - Kolawole Wahab
- Department of Medicine, University of Ilorin, Ilorin, Nigeria
| | - Reginald Obiako
- Department of Medicine, Ahmadu Bello University, Zaria, Nigeria
| | | | - Lukman Owolabi
- Department of Medicine, Aminu Kano Teaching Hospital, Kano, Nigeria
| | | | | | - Joshua Akinyemi
- Department of Epidemiology and Medical Statistics, University of Ibadan, Nigeria
| | | | - Oyedunni Arulogun
- Department of Health Promotion and Education, University of Ibadan, Nigeria
| | - Philip Ibinaiye
- Department of Medicine, Ahmadu Bello University, Zaria, Nigeria
| | - Lambert Appiah
- Kwame Nkrumah University of Science and Technology, Ghana
| | | | - Abiodun M Adeoye
- Department of Medicine, University of Ibadan, Nigeria; Institute of Cardiovascular Diseases, University of Ibadan, Nigeria; Center for Genomic and Precision Medicine, University of Ibadan, Nigeria
| | - Joseph Yaria
- Department of Medicine, University of Ibadan, Nigeria
| | | | | | - Godwin Ogbole
- Department of Radiology, University of Ibadan, Nigeria
| | - Francis Agyekum
- Department of Medicine, University of Ghana Medical School, Accra, Ghana
| | | | | | | | | | - Olayemi Balogun
- Department of Medicine, Ahmadu Bello University, Zaria, Nigeria
| | | | | | - Diala Samuel
- Department of Medicine, University of Ibadan, Nigeria
| | - Aliyu Mande
- Department of Medicine, Aminu Kano Teaching Hospital, Kano, Nigeria
| | - Musbahu Rabiu
- Department of Medicine, Aminu Kano Teaching Hospital, Kano, Nigeria
| | | | - Adeniyi Sunday
- Department of Medicine, University of Ilorin, Ilorin, Nigeria
| | | | - Ayodipupo S Oguntade
- Department of Medicine, University of Ibadan, Nigeria; Clinical Trial Service Unit & Epidemiological Studies Unit (CTSU), Big Data Institute, Oxford Population Health, University of Oxford, UK
| | - Abiodun Ajose
- Department of Medicine, University of Ibadan, Nigeria
| | - Arti Singh
- Kwame Nkrumah University of Science and Technology, Ghana
| | | | - Yaw Mensah
- Department of Medicine, University of Ghana Medical School, Accra, Ghana
| | | | | | - Joyce Ikubor
- Delta State University Teaching Hospital, Oghara, Delta State, Nigeria
| | | | - Isah S Yahaya
- Department of Medicine, Aminu Kano Teaching Hospital, Kano, Nigeria
| | | | - Chidi J Odo
- Department of Radiology, University of Ibadan, Nigeria
| | - Richard Efidi
- Department of Radiology, University College Hospital, Ibadan, Nigeria
| | | | | | | | | | | | - Henry Iheonye
- Department of Medicine, Federal Medical Centre, Lokoja, Nigeria
| | - Adeseye Akintunde
- Ladoke Akintola University of Technology/Teaching Hospital, Ogbomosho, Nigeria
| | | | - Josephine Akpalu
- Department of Medicine, University of Ghana Medical School, Accra, Ghana
| | | | | | | | | | - Daniel Lackland
- Department of Neurology, Medical University of South Carolina, USA
| | - Rufus Akinyemi
- Federal Medical Centre, Abeokuta, Nigeria; Center for Genomic and Precision Medicine, University of Ibadan, Nigeria; Institute for Advanced Medical Research and Training, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Bruce Ovbiagele
- Weill Institute for Neurosciences, University of California San Francisco, USA
| | - Mayowa Owolabi
- Department of Medicine, University of Ibadan, Nigeria; Center for Genomic and Precision Medicine, University of Ibadan, Nigeria.
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Hallenberger TJ, Guzman R, Soleman J. Minimally invasive image-guided endoscopic evacuation of intracerebral haemorrhage: How I Do it. Acta Neurochir (Wien) 2022. [PMID: 35930078 DOI: 10.1007/s00701-022-05326-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Accepted: 07/24/2022] [Indexed: 11/01/2022]
Abstract
BACKGROUND Minimally invasive endoscopic hematoma evacuation (MEHE) is an emerging surgical technique for treating spontaneous supratentorial intracerebral haemorrhage (SSICH). Multiple studies, analysing whether the outcome after such a procedure is improved, are still ongoing. METHOD We herein present the indications, advantages, and perioperative considerations for the surgical technique of MEHE applied at our institution. CONCLUSION MEHE with a view through a transparent brain access device is a valid and safe approach for the surgical evacuation of SSICH.
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Zhu BL, Wu YZ, Cai ZM, Liao CW, Sun LQ, Liu ZP, Chen HM, Huang XR, Feng RQ, Ye SL, Lin QL, Zhou XD, Wang L, Zhang MM, Yang B. A prospective epidemiological analysis of controlling nutritional status score with the poor functional outcomes in Chinese patients with haemorrhagic stroke. Br J Nutr 2022; 128:192-9. [PMID: 34409929 DOI: 10.1017/S0007114521003184] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Nutritional Risk Screening index is a standard tool to assess nutritional risk, but epidemiological data are scarce on controlling nutritional status (CONUT) as a prognostic marker in acute haemorrhagic stroke (AHS). We aimed to explore whether the CONUT may predict a 3-month functional outcome in AHS. In total, 349 Chinese patients with incident AHS were consecutively recruited, and their malnutrition risks were determined using a high CONUT score of ≥ 2. The cohort patients were divided into high-CONUT (≥ 2) and low-CONUT (< 2) groups, and primary outcomes were a poor functional prognosis defined as the modified Rankin Scale (mRS) score of ≥ 3 at post-discharge for 3 months. Odds ratios (OR) with 95 % confidence intervals (CI) for the poor functional prognosis at post-discharge were estimated by using a logistic analysis with additional adjustments for unbalanced variables between the high-CONUT and low-CONUT groups. A total of 328 patients (60·38 ± 12·83 years; 66·77 % male) completed the mRS assessment at post-discharge for 3 months, with 172 patients at malnutrition risk at admission and 104 patients with a poor prognosis. The levels of total cholesterol and total lymphocyte counts were significantly lower in high-CONUT patients than low-CONUT patients (P = 0·012 and < 0·001, respectively). At 3-month post discharge, there was a greater risk for the poor outcome in the high-CONUT compared with the low-CONUT patients at admission (OR: 2·32, 95 % CI: 1·28, 4·17). High-CONUT scores independently predict a 3-month poor prognosis in AHS, which helps to identify those who need additional nutritional managements.
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Abdel-Fattah AR, Pana TA, Smith TO, Pasdar Z, Aslam M, Mamas MA, Myint PK. Gender differences in mortality of hospitalised stroke patients. Systematic review and meta-analysis. Clin Neurol Neurosurg 2022; 220:107359. [PMID: 35835023 DOI: 10.1016/j.clineuro.2022.107359] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Revised: 06/22/2022] [Accepted: 07/03/2022] [Indexed: 11/18/2022]
Abstract
OBJECTIVE Gender differences in mortality after stroke remains unclear in the current literature. We therefore aimed to systematically review the gender differences in mortality up to five years after ischaemic (IS) or haemorrhagic stroke (HS) to address this evidence gap. METHODS The literature was systematically searched using Ovid EMBASE, Ovid Medline, and Web of Science databases, from inception-November 2021. The quality of evidence was appraised using the CASP Cohort-study checklist. Unadjusted and adjusted odds and hazard ratios were meta-analysed, separately for IS and HS and a subgroup analysis of age-stratified mortality data was conducted. RESULTS Forty-one studies were included (n = 8,128,700; mean-age 68.5 yrs; 47.1% female). 37 studies were included in meta-analysis (n = 8, 8008, 110). Compared to men, women who had an IS had lower mortality risk in-hospital (0.94; 95%CI 0.91-0.97), at one-month (0.87; 95%CI 0.77-0.98), 12-months (0.94; 95%CI 0.91-0.98) and five-years (0.93 95%CI 0.90-0.96). The subgroup analysis showed that this gender difference in mortality was present in women ≥ 70 years up to one-month post-IS (in-hospital: 0.94; 95%CI 0.91-0.97; one-month: 0.87; 95% CI 0.77-0.98), however, in women < 70 years this difference was no longer present. Nevertheless, analysis of crude data showed women were at higher risk of mortality in-hospital, at 12-months and five-years (in-hospital: 1.05; 95%CI 1.03-1.07, 12-months: 1.10; 95%CI 1.06-1.14, five-years: 1.06; 95%CI 1.02-1.10). After HS, women had higher mortality risk in-hospital (1.03; 95%CI 1.01-1.04) however, no gender differences were found post-discharge. CONCLUSION The gender differences in post-stroke mortality differ by stroke type, age group and follow-up. Crude stroke mortality in women is higher than in men and this appears to be driven by pre-existing comorbidities. In adjusted models, women have a lower mortality risk following IS, independent of duration of follow-up. After HS, women had higher mortality in hospital however, no gender differences after hospital discharge were found.
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Affiliation(s)
- Abdel-Rahman Abdel-Fattah
- Ageing Clinical and Experimental Research (ACER) Team, Institute of Applied Health Sciences, School of Medicine, Medical Sciences & Nutrition, University of Aberdeen, Aberdeen, UK.
| | - Tiberiu A Pana
- Ageing Clinical and Experimental Research (ACER) Team, Institute of Applied Health Sciences, School of Medicine, Medical Sciences & Nutrition, University of Aberdeen, Aberdeen, UK
| | - Toby O Smith
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Zahra Pasdar
- Ageing Clinical and Experimental Research (ACER) Team, Institute of Applied Health Sciences, School of Medicine, Medical Sciences & Nutrition, University of Aberdeen, Aberdeen, UK
| | - Maha Aslam
- Ageing Clinical and Experimental Research (ACER) Team, Institute of Applied Health Sciences, School of Medicine, Medical Sciences & Nutrition, University of Aberdeen, Aberdeen, UK
| | - Mamas A Mamas
- Keele Cardiovascular Research Group, Centre for Prognosis Research, Institute for Primary Care and Health Sciences, Keele University, Stoke-on-Trent, UK
| | - Phyo K Myint
- Ageing Clinical and Experimental Research (ACER) Team, Institute of Applied Health Sciences, School of Medicine, Medical Sciences & Nutrition, University of Aberdeen, Aberdeen, UK
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Lambea-Gil Á, Martínez-de-Morentín-Narvarcorena AL, Tejada-Meza H, Zapatero-González D, Madurga-Revilla P, Bestué-Cardiel M. Paediatric stroke in the northern Spanish region of Aragon: incidence, clinical characteristics, and outcomes. Neurologia 2022:S2173-5808(22)00067-0. [PMID: 35691906 DOI: 10.1016/j.nrleng.2021.10.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Accepted: 10/17/2021] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Recent years have seen considerable changes in the prevention and treatment of acute ischaemic stroke in adult patients. However, the low incidence of paediatric stroke makes the development of specific guidelines more challenging. This study aims to clarify the situation of these children in our region in order to establish a regional protocol to improve the care provided to these patients. METHODS We performed a regional incidence study of pediatric stroke (≤ 15 years of age) in Aragon, Spain (1308728 population, 15% aged ≤ 15 years) between 2008 and 2019. Data were obtained from hospital discharge records, including deaths, from the regional health service of Aragón, according to ICD codes for cerebrovascular disease. We analysed demographic, clinical, diagnostic/therapeutic, and prognostic variables. RESULTS A total of 21 events were recorded: 8 ischaemic (38.1%) and 13 haemorrhagic strokes (61.9%). The mean age (SD) was 9.3 years (1.0). The sample included 12 boys and nine girls. No statistically significant differences were found between ischaemic and haemorrhagic strokes, except in the chief complaint (language and motor impairment in ischaemic stroke and headache in haemorrhagic stroke). None of the patients with ischaemic stroke received reperfusion therapies. Including the 3 patients who died during hospitalisation, eight patients (42.1%) had modified Rankin Scale scores > 2 at 12 months. Motor deficits were the most common sequela (n=9). CONCLUSION Though infrequent, paediatric stroke has an important functional impact. In Spain, Madrid was the first region to adapt the existing code stroke care networks for adult patients. In Aragon, this review has enabled us to work closely with the different stakeholders to offer a care plan for acute paediatric ischaemic stroke. Nevertheless, prospective national registries would be valuable to continue improving the care provided to these patients.
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Affiliation(s)
- Á Lambea-Gil
- Servicio de Neurología, Hospital Universitario Miguel Servet, Zaragoza, Spain; Grupo de Investigación en Neurociencias, Instituto de Investigación Sanitaria (IIS) Aragón, Aragón, Spain.
| | | | - H Tejada-Meza
- Servicio de Neurología, Hospital Universitario Miguel Servet, Zaragoza, Spain; Grupo de Investigación en Neurociencias, Instituto de Investigación Sanitaria (IIS) Aragón, Aragón, Spain
| | - D Zapatero-González
- Servicio de Estrategias en Salud de la Dirección General de Sanidad, Gobierno de Aragón, Aragón, Spain
| | - P Madurga-Revilla
- Servicio de Pediatría, Hospital Materno Infantil - Hospital Universitario Miguel Servet, Zaragoza, Spain
| | - M Bestué-Cardiel
- Servicio de Neurología, Hospital Universitario Miguel Servet, Zaragoza, Spain; Servicio de Estrategias en Salud de la Dirección General de Sanidad, Gobierno de Aragón, Aragón, Spain
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Doehner W, Scherbakov N, Schellenberg T, Jankowska EA, Scheitz JF, von Haehling S, Joebges M. Iron deficiency is related to low functional outcome in patients at early rehabilitation after acute stroke. J Cachexia Sarcopenia Muscle 2022; 13:1036-1044. [PMID: 35166066 PMCID: PMC8977949 DOI: 10.1002/jcsm.12927] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Revised: 01/04/2022] [Accepted: 01/07/2022] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Iron deficiency (ID) is a common co-morbidity in patients with cardiovascular disease and contributes to impaired functional capacity. The relevance of ID in patients in recovery after acute stroke is not known. We assessed the prevalence of ID and anaemia in relation to functional capacity and to recovery during early rehabilitation after stroke. METHODS This observational study enrolled consecutively 746 patients with ischaemic or haemorrhagic stroke at in-patient early rehabilitation (age 68 ± 13 years, female 47%, ischaemic stroke 87%). Functional capacity was assessed before and after rehabilitation using Barthel index (reha-BI), motricity index (MI), trunk control test (TCT), and functional ambulatory category (FAC). ID was defined as ferritin <100 μg/L or as transferrin saturation (TSAT) < 20% if ferritin was 100- < 300 μg/L or if CrP > 5 mg/L. Anaemia was defined as Hb < 12 g/dL (women) and <13 g/dL (men). RESULTS The prevalence of ID and anaemia before rehabilitation were 45% and 46%, respectively, and remained high at discharge (after 27 ± 17 days) at 40% and 48%, respectively. Patients with ID had lower functional capacity compared with patients without ID (reha-BI 20 [±86] vs. 40 [±80], MI 64 [±66] vs. 77 [±41], TCT 61 [±76] vs. 100 [±39], FAC 1 [±4] vs. 4 [±4]; median [IQR], all P < 0.001). ID was related to inflammation (OR 2.68 [95% CI 1.98-3.63], P < 0.001), female sex (OR 2.13 [95% CI 1.59-2.85], P < 0.001), haemorrhagic stroke (OR 1.70 [95% CI 1.11-2.61], P = 0.015), initial treatment on stroke unit (OR 3.59 [95% CI 1.08-11.89], P < 0.001), and anaemia (OR 2.94 [95% CI 2.18-3.96], P < 0.001), while age, BMI, and renal function were not related to ID. In adjusted analysis, ID was associated with low functional capacity in all functional scores: reha-BI (OR 1.66 [95% CI 1.08-2.54], P = 0.02), motricity index (OR 1.94 [95% CI 1.36-2.76], P < 0.001), trunk control test (OR 2.34 [95% CI] 1.64-3.32, P < 0.001) and functional ambulatory category (OR 1.77 [95% CI 1.2-2.63], P < 0.02). Functional capacity improved during rehabilitation regardless of presence of ID, but functional outcome remained significantly lower in patients with ID at the end of rehabilitation (rehab BI and MI, both P < 0.001). CONCLUSIONS Iron deficiency and anaemia are common and persistent findings in patients after acute stroke. ID and anaemia are independently related to lower functional capacity after acute stroke and to poor functional outcome after rehabilitation. Regular assessment of iron status may identify patients at risk of low functional recovery.
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Affiliation(s)
- Wolfram Doehner
- BIH Center for Regenerative Therapies (BCRT), Berlin Institute of Health at Charité - Universitätsmedizin Berlin, Berlin, Germany.,Department of Cardiology (Virchow Klinikum), Charité Universitätsmedizin Berlin, and German Centre for Cardiovascular Research (DZHK), partner site Berlin, Berlin, Germany.,Center for Stroke Research Berlin, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Nadja Scherbakov
- BIH Center for Regenerative Therapies (BCRT), Berlin Institute of Health at Charité - Universitätsmedizin Berlin, Berlin, Germany.,Center for Stroke Research Berlin, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Tim Schellenberg
- Center for Stroke Research Berlin, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Ewa A Jankowska
- Institute of Heart Diseases, Wroclaw Medical University, Wroclaw, Poland.,Institute of Heart Diseases, University Hospital, Wroclaw, Poland
| | - Jan F Scheitz
- Center for Stroke Research Berlin, Charité-Universitätsmedizin Berlin, Berlin, Germany.,Department of Neurology with Experimental Neurology, Charité-Universitätsmedizin Berlin, Berlin, Germany.,German Centre for Cardiovascular Research (DZHK), partner site Berlin, Berlin, Germany
| | - Stephan von Haehling
- Department of Cardiology and Pneumology, University of Göttingen Medical Center (UMG), Göttingen, Germany.,German Centre for Cardiovascular Research (DZHK), partner site Göttingen, Göttingen, Germany
| | - Michael Joebges
- Department of Neurology, Brandenburg Klinik, Bernau, Germany
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Cruz-Góngora VDL, Chiquete E, Gómez–Dantés H, Cahuana-Hurtado L, Cantú-Brito C. Trends in the burden of stroke in Mexico: A national and subnational analysis of the global burden of disease 1990-2019. Lancet Reg Health Am 2022; 10:100204. [PMID: 36777683 PMCID: PMC9904132 DOI: 10.1016/j.lana.2022.100204] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Background Scarce epidemiological information on stroke in Mexico impedes evidence-based decisions and debilitates the design of effective prevention programmes at the local level. Methods Ecological and secondary analysis of Global Burden of Disease national and subnational data for Mexico, from 1990 to 2019. We analysed the incidence, prevalence, deaths, premature mortality, disability, and DALYs due to cerebrovascular disease included to identify the differences in the burden of stroke in Mexico by type of stroke (ischaemic [IS], intracerebral haemorrhage [ICH] and subarachnoid haemorrhage [SAH]), sex, age groups, and state levels ordered by quartiles of Sociodemographic Index (SDI). Means and 95% uncertainty intervals are reported. Findings Reductions in all metrics of total stroke occurred during the 1990 to 2005 period; however, this declining trend was followed up by stagnation of progress from 2006 to 2019, except for premature mortality. This pattern of the declining trend was observed also for IS and to a lesser extent for ICH, while SAH showed no major changes during the 1990-2019 period. The magnitude of decline was higher in females for total stroke for incidence, prevalence and YLDs rates. The less developed states by SDI exhibited the lowest improvements during the period, particularly for ICH metrics. Interpretation The reduction in stroke burden in Mexico did not follow the same pace for all types of stroke, with regional differences by SDI and by sex. Study findings reveal the need for strengthening prevention policies to address health disparities in the burden of stroke by sex and states, within the fragmented Mexican Healthcare System. Funding Bill & Melinda Gates Foundation.
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Affiliation(s)
| | - Erwin Chiquete
- Department of Neurology, The Salvador Zubirán National Institute of Medical Sciences and Nutrition, Mexico City, México
| | - Héctor Gómez–Dantés
- Health Systems Research Centre, National Institute of Public Health, Cuernavaca, Mexico
| | - Lucero Cahuana-Hurtado
- School of Public Health and Administration, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Carlos Cantú-Brito
- Department of Neurology, The Salvador Zubirán National Institute of Medical Sciences and Nutrition, Mexico City, México,Corresponding author at: Departamento de Neurología y Psiquiatría, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Vasco de Quiroga #15, Col. Sección XVI, Tlalpan. Ciudad de México, México.
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Lim MJR, Quek RHC, Ng KJ, Loh NHW, Lwin S, Teo K, Nga VDW, Yeo TT, Motani M. Machine Learning Models Prognosticate Functional Outcomes Better than Clinical Scores in Spontaneous Intracerebral Haemorrhage. J Stroke Cerebrovasc Dis 2021; 31:106234. [PMID: 34896819 DOI: 10.1016/j.jstrokecerebrovasdis.2021.106234] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Revised: 11/11/2021] [Accepted: 11/17/2021] [Indexed: 10/19/2022] Open
Abstract
OBJECTIVE This study aims to develop and compare the use of deep neural networks (DNN) and support vector machines (SVM) to clinical prognostic scores for prognosticating 30-day mortality and 90-day poor functional outcome (PFO) in spontaneous intracerebral haemorrhage (SICH). MATERIALS AND METHODS We conducted a retrospective cohort study of 297 SICH patients between December 2014 and May 2016. Clinical data was collected from electronic medical records using standardized data collection forms. The machine learning workflow included imputation of missing data, dimensionality reduction, imbalanced-class correction, and evaluation using cross-validation and comparison of accuracy against clinical prognostic scores. RESULTS 32 (11%) patients had 30-day mortality while 177 (63%) patients had 90-day PFO. For prognosticating 30-day mortality, the class-balanced accuracies for DNN (0.875; 95% CI 0.800-0.950; McNemar's p-value 1.000) and SVM (0.848; 95% CI 0.767-0.930; McNemar's p-value 0.791) were comparable to that of the original ICH score (0.833; 95% CI 0.748-0.918). The c-statistics for DNN (0.895; DeLong's p-value 0.715), and SVM (0.900; DeLong's p-value 0.619), though greater than that of the original ICH score (0.862), were not significantly different. For prognosticating 90-day PFO, the class-balanced accuracies for DNN (0.853; 95% CI 0.772-0.934; McNemar's p-value 0.003) and SVM (0.860; 95% CI 0.781-0.939; McNemar's p-value 0.004) were better than that of the ICH-Grading Scale (0.706; 95% CI 0.600-0.812). The c-statistic for SVM (0.883; DeLong's p-value 0.022) was significantly greater than that of the ICH-Grading Scale (0.778), while the c-statistic for DNN was 0.864 (DeLong's p-value 0.055). CONCLUSION We showed that the SVM model performs significantly better than clinical prognostic scores in predicting 90-day PFO in SICH.
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Affiliation(s)
- Mervyn Jun Rui Lim
- Division of Neurosurgery, University Surgical Centre, National University Hospital, Singapore.
| | | | - Kai Jie Ng
- Yong Loo Lin School of Medicine, National University of Singapore
| | - Ne-Hooi Will Loh
- Department of Anaesthesia, National University Hospital, Singapore
| | - Sein Lwin
- Division of Neurosurgery, University Surgical Centre, National University Hospital, Singapore
| | - Kejia Teo
- Division of Neurosurgery, University Surgical Centre, National University Hospital, Singapore
| | - Vincent Diong Weng Nga
- Division of Neurosurgery, University Surgical Centre, National University Hospital, Singapore
| | - Tseng Tsai Yeo
- Division of Neurosurgery, University Surgical Centre, National University Hospital, Singapore
| | - Mehul Motani
- Department of Electrical and Computer Engineering, National University of Singapore; N.1 Institute for Health, National University of Singapore; Institute for Data Science, National University of Singapore
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Hause S, Schönefuß R, Assmann A, Neumann J, Meyer F, Tautenhahn J, Schreiber S, Heinze HJ, Halloul Z, Goertler M. Relevance of Infarct Size, Timing of Surgery, and Peri-operative Management for Non-ischaemic Cerebral Complications After Carotid Endarterectomy. Eur J Vasc Endovasc Surg 2021; 63:268-274. [PMID: 34872814 DOI: 10.1016/j.ejvs.2021.09.044] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Revised: 09/12/2021] [Accepted: 09/28/2021] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To assess the incidence of post-operative non-ischaemic cerebral complications as a pivotal outcome parameter with respect to size of cerebral infarction, timing of surgery, and peri-operative management in patients with symptomatic carotid stenosis who underwent carotid endarterectomy (CEA). METHODS Retrospective analysis of prospectively collected single centre CEA registry data. Consecutive patients with symptomatic carotid stenosis were subjected to standard patch endarterectomy. Brain infarct size was measured from the axial slice of pre-operative computed tomography/magnetic resonance imaging demonstrating the largest infarct dimension and was categorised as large (> 4 cm2), small (≤ 4 cm2), or absent. CEA was performed early (within 14 days) or delayed (15 - 180 days) after the ischaemic event. Peri-operative antiplatelet regimen (none, single, dual) and mean arterial blood pressure during surgery and at post-operative stroke unit monitoring were registered. Non-ischaemic post-operative cerebral complications were recorded comprising haemorrhagic stroke and encephalopathy, i.e., prolonged unconsciousness, delirium, epileptic seizure, or headache. RESULTS 646 symptomatic patients were enrolled of whom 340 (52.6%) underwent early CEA; 367 patients (56.8%) demonstrated brain infarction corresponding to stenosis induced symptoms which was small in 266 (41.2%) and large in 101 (15.6%). Post-operative non-ischaemic cerebral complications occurred in 12 patients (1.9%; 10 encephalopathies, two haemorrhagic strokes) and were independently associated with large infarcts (adjusted odds ratio [OR] 6.839; 95% confidence interval [CI] 1.699 - 27.534) and median intra-operative mean arterial blood pressure in the upper quartile, i.e., above 120 mmHg (adjusted OR 13.318; 95% CI 2.749 - 64.519). Timing of CEA after the ischaemic event, pre-operative antiplatelet regimen, and post-operative blood pressure were not associated with non-ischaemic cerebral complications. CONCLUSION Infarct size and unintended high peri-operative blood pressure may increase the risk of non-ischaemic complications at CEA independently of whether performed early or delayed.
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Affiliation(s)
- Stephan Hause
- Department of Neurology, Magdeburg University Vascular and Stroke Centre, Magdeburg, Germany.
| | - Robert Schönefuß
- Department of Neurology, Magdeburg University Vascular and Stroke Centre, Magdeburg, Germany
| | - Anne Assmann
- Department of Neurology, Magdeburg University Vascular and Stroke Centre, Magdeburg, Germany
| | - Jens Neumann
- Department of Neurology, Magdeburg University Vascular and Stroke Centre, Magdeburg, Germany
| | - Frank Meyer
- Department of General, Abdominal, Vascular and Transplant Surgery, Magdeburg University Hospital, Magdeburg, Germany
| | - Joerg Tautenhahn
- Department of Vascular Surgery, Municipal Hospital at Magdeburg ("Klinikum Magdeburg gGmbH"), Magdeburg, Germany
| | - Stefanie Schreiber
- Department of Neurology, Magdeburg University Vascular and Stroke Centre, Magdeburg, Germany
| | - Hans-Jochen Heinze
- Department of Neurology, Magdeburg University Vascular and Stroke Centre, Magdeburg, Germany
| | - Zuhir Halloul
- Department of General, Abdominal, Vascular and Transplant Surgery, Magdeburg University Hospital, Magdeburg, Germany
| | - Michael Goertler
- Department of Neurology, Magdeburg University Vascular and Stroke Centre, Magdeburg, Germany
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Abstract
A stroke occurs when the blood flow to the brain is suddenly interrupted, depriving brain cells of oxygen and glucose and leading to further cell death. Neuroimaging techniques, such as computed tomography and magnetic resonance imaging, have greatly improved our ability to visualise brain structures and are routinely used to diagnose the affected vascular region of a stroke patient's brain and to inform decisions about clinical care. Currently, these multimodal imaging techniques are the backbone of the clinical management of stroke patients and have immensely improved our ability to visualise brain structures. Here, we review recent developments in the field of neuroimaging and discuss how different imaging techniques are used in the diagnosis, prognosis and treatment of stroke. Summary: Stroke imaging has undergone seismic shifts in the past decade. Although magnetic resonance imaging (MRI) is superior to computed tomography in providing vital information, further research on MRI is still required to bring its full potential into clinical practice.
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Affiliation(s)
- Pragati Kakkar
- Leeds Institute of Cardiovascular and Metabolic Medicine, Faculty of Medicine and Health, University of Leeds, Leeds LS2 9JT, UK
| | - Tarun Kakkar
- Leeds Institute of Cardiovascular and Metabolic Medicine, Faculty of Medicine and Health, University of Leeds, Leeds LS2 9JT, UK
| | | | - Sikha Saha
- Leeds Institute of Cardiovascular and Metabolic Medicine, Faculty of Medicine and Health, University of Leeds, Leeds LS2 9JT, UK
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20
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Xu BC, Abeyaratne A, Wong YHS, Majoni SW. Benefit and harm of anticoagulation in the prevention of thromboembolic stroke for non- valvular atrial fibrillation in haemodialysis patients - a Top End of Northern Australia study. Intern Med J 2021; 53:517-524. [PMID: 34748260 DOI: 10.1111/imj.15605] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Revised: 10/19/2021] [Accepted: 10/26/2021] [Indexed: 11/05/2022]
Abstract
BACKGROUND Warfarin for the prevention of non-valvular atrial fibrillation related thromboembolic stroke in patients on maintenance haemodialysis is controversial. Despite the exclusion of haemodialysis patients in randomised control trials, the American Heart Association/American College of Cardiology has recommended warfarin in high-risk AF patients. AIM We retrospectively examined the utility of warfarin anticoagulation therapy in our prevalent haemodialysis patients over 10 years of follow-up. METHODS Eligible patients were retrospectively identified and stratified to two cohorts based on whether warfarin was prescribed. The outcomes of interest were ischaemic stroke, haemorrhagic stroke and death from any cause. Rate ratio and cox proportional hazard regression model were compare the differences in outcome between the two cohorts. The Kaplan-Meier method was used to analyse survival. RESULTS Three ischaemic strokes and four haemorrhagic strokes occurred in the unexposed group of 166 patients over 484.44 patient-years follow-up. One ischaemic stroke and no cases of haemorrhagic stroke occurred in the exposed warfarin group of 16 patients over 39.32 patient-years of follow-up. 87% of patients in both groups were indigenous. More than 90% of each cohort was had CHA2DS2VaSc score ≥2. 101 deaths occurred in the follow-up period, ninety in the unexposed group and eleven in the warfarin group. A non-statistically significant trend towards increasing mortality was observed in the warfarin group (Hazard ratio =1.63, p=0.13). CONCLUSION This retrospective study of prevalent haemodialysis patients with co-existing history of non-valvular AF failed to demonstrate sufficient evidence for the routine use of warfarin for prophylaxis of thromboembolic stroke. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- By Chi Xu
- Department of Nephrology, Division of Medicine, Royal Darwin Hospital, Darwin, Northern Territory, Australia
| | - Asanga Abeyaratne
- Department of Nephrology, Division of Medicine, Royal Darwin Hospital, Darwin, Northern Territory, Australia.,Flinders University and Northern Territory Medical Program, Royal Darwin Hospital Campus, Darwin, Northern Territory, Australia.,Wellbeing and Preventable Chronic Diseases, Menzies School of Health Research, Charles Darwin University, Northern Territory, Australia
| | - Yun Hui Sheryl Wong
- Department of Nephrology, Division of Medicine, Royal Darwin Hospital, Darwin, Northern Territory, Australia
| | - Sandawana William Majoni
- Department of Nephrology, Division of Medicine, Royal Darwin Hospital, Darwin, Northern Territory, Australia.,Flinders University and Northern Territory Medical Program, Royal Darwin Hospital Campus, Darwin, Northern Territory, Australia.,Wellbeing and Preventable Chronic Diseases, Menzies School of Health Research, Charles Darwin University, Northern Territory, Australia
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21
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Ueda A, Chigusa Y, Mogami H, Nakita B, Ohtera S, Kato G, Horie A, Mandai M, Kondoh E. Maternal near-miss attributable to haemorrhagic stroke in patients with hypertensive disorders of pregnancy in Japan: A national cohort study. Pregnancy Hypertens 2021; 25:240-243. [PMID: 34315129 DOI: 10.1016/j.preghy.2021.07.244] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Revised: 06/28/2021] [Accepted: 07/19/2021] [Indexed: 11/25/2022]
Abstract
OBJECTIVES To investigate the epidemiologic and clinical characteristics of maternal near-misses attributable to haemorrhagic stroke (HS) occurring in patients with hypertensive disorders of pregnancy (HDP), with a focus on severe neurological morbidity. METHODS A national retrospective cohort study was conducted using the national database of health insurance claims for the period 2010 to 2017. The subjects were all insured women with a diagnosis of both HDP and HS. Severe neurological morbidity requiring rehabilitation, types of HDP, types of HS, and magnesium sulphate use were tabulated. RESULTS The number of women with HDP who were diagnosed with HS was 3.4 per 100,000 deliveries between 2010 and 2017. Forty percent of HDP-related HS cases had neurological morbidities requiring rehabilitation (1.4 per 100,000 deliveries), and 4.4% were in a persistent vegetative state after HS. Of the HDP cases who developed HS, 69.2% were severe HDP, of which 55.6% were without eclampsia. The most common type of HS was intracerebral haemorrhage (2.5 per 100,000 deliveries), followed by subarachnoid haemorrhage due to cerebral aneurysm (1.2 per 100,000 deliveries). The frequency of magnesium sulphate use increased in all patients with HDP-related HS in the second half of the study period (2014-2017) compared with the first half (2010-2013) (p < 0.0001). This was more evident in cases of HDP-related HS with eclampsia (31.9% to 83.8%) compared to those without eclampsia (25.0% to 42.9%). CONCLUSION Of the maternal near-miss cases due to HDP-related HS, 40.0% were rehabilitated and 69.2% were HDP without either eclampsia or severe hypertension.
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Affiliation(s)
- Akihiko Ueda
- Department of Gynaecology and Obstetrics, Kyoto University, Kyoto, Japan
| | - Yoshitsugu Chigusa
- Department of Gynaecology and Obstetrics, Kyoto University, Kyoto, Japan
| | - Haruta Mogami
- Department of Gynaecology and Obstetrics, Kyoto University, Kyoto, Japan
| | - Baku Nakita
- Department of Gynaecology and Obstetrics, Kyoto University, Kyoto, Japan
| | - Shosuke Ohtera
- Division of Medical Information Technology and Administration Planning, Kyoto University Hospital/National Institute of Public Health, Japan
| | - Genta Kato
- Solutions Centre for Health Insurance Claims, Kyoto University Hospital, Kyoto, Japan
| | - Akihito Horie
- Department of Gynaecology and Obstetrics, Kyoto University, Kyoto, Japan
| | - Masaki Mandai
- Department of Gynaecology and Obstetrics, Kyoto University, Kyoto, Japan
| | - Eiji Kondoh
- Department of Gynaecology and Obstetrics, Kyoto University, Kyoto, Japan.
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Namale G, Kamacooko O, Makhoba A, Mugabi T, Ndagire M, Ssanyu P, Ddamulira J, Yperzeele L, Cras P, Ddumba E, Seeley J, Newton R. HIV sero-positivity and risk factors for ischaemic and haemorrhagic stroke in hospitalised patients in Uganda: A prospective-case-control study. Public Health Pract (Oxf) 2021; 2:100128. [PMID: 36101575 PMCID: PMC9461590 DOI: 10.1016/j.puhip.2021.100128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Revised: 03/01/2021] [Accepted: 04/13/2021] [Indexed: 12/15/2022] Open
Abstract
Objectives We examined HIV sero-positivity and risk factors in patients admitted with ischaemic stroke (IS) and haemorrhagic stroke (HS) in Kampala, Uganda. Study design We conducted a matched case-control study between December 2016 and December 2018 at St Francis Hospital, Nsambya. Methods The study population comprised of stroke cases (adults aged ≥18 years with IS or HS confirmed by neuroimaging) and controls (age- and sex-matched stroke-free adults aged ≥18 years who were recruited from the same hospital as the cases). A comprehensive assessment for sociodemographic, lifestyle and clinical factors was performed using the World Health Organization (WHO) STEP-wise approach to Surveillance (STEPS) for stroke risk factor surveillance. We used conditional logistic regression to identify risk factors associated with IS or HS. Results We enrolled 137 matched case-control pairs; 48 (35%) were men, and the mean ages were 62.4 years (SD ± 14.8) for cases and 61.1 years (SD ± 14.1) for controls. Of stroke patients, 86 (63%) had IS and 51 (37%) had HS. Overall, HIV sero-positivity was 10% among stroke cases versus 7% among controls. HIV sero-positivity was not significantly associated with stroke (unadjusted odds ratio [uOR] = 1.49, 95% confidence interval [CI] 0.59-3.78). A self-reported family history of diabetes mellitus was associated with an increased risk of all stroke (adjusted odds ratio [aOR] = 4.41, 95% CI 1.47-13.2), as well as for IS and HS separately (aOR = 3.66, 95% CI 1.09-12.4 and aOR = 4.99, 95% CI 1.02-24.4, respectively). High blood pressure (≥140/90 mmHg) was associated with an increased risk of all stroke (aOR = 12.3, 95% CI 42-44.1), and this was also true for IS and HS individually (aOR = 6.48, 95% CI 1.15-36.7 and aOR = 5.63, 95% CI 1.74-18.2, respectively). Conclusions No association was found between HIV sero-positivity and stroke occurrence among Ugandan stroke patients. Hypertension and a self-reported family history of diabetes mellitus were significant risk factors for both IS and HS. Interventions to reduce hypertension and diabetes mellitus in the Ugandan population are urgently required. Much larger studies are required to demonstrate if any association exists between HIV and stroke.
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Affiliation(s)
- G. Namale
- MRC/UVRI and LSHTM Uganda Research Unit, Entebbe, Uganda,Corresponding author. MRC/UVRI and LSHTM Uganda Research Unit, P.O Box 49, Entebbe, Uganda.
| | - O. Kamacooko
- MRC/UVRI and LSHTM Uganda Research Unit, Entebbe, Uganda
| | - A. Makhoba
- St. Francis Hospital Nsambya Affiliated to Uganda Martyrs University, Kampala, Uganda
| | - T. Mugabi
- St. Francis Hospital Nsambya Affiliated to Uganda Martyrs University, Kampala, Uganda
| | - M. Ndagire
- St. Francis Hospital Nsambya Affiliated to Uganda Martyrs University, Kampala, Uganda
| | - P. Ssanyu
- St. Francis Hospital Nsambya Affiliated to Uganda Martyrs University, Kampala, Uganda
| | - J.B.M. Ddamulira
- School of Public Health, College of Health Sciences, Makerere University, Kampala, Uganda
| | - L. Yperzeele
- University of Antwerp, Department of Neurology, Antwerp, Belgium
| | - P. Cras
- University of Antwerp, Department of Neurology, Antwerp, Belgium
| | - E. Ddumba
- St. Francis Hospital Nsambya Affiliated to Uganda Martyrs University, Kampala, Uganda
| | - J. Seeley
- MRC/UVRI and LSHTM Uganda Research Unit, Entebbe, Uganda,London School of Hygiene &Tropical Medicine, London, UK
| | - R. Newton
- MRC/UVRI and LSHTM Uganda Research Unit, Entebbe, Uganda,University of York, York, UK
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Vencloviene J, Radisauskas R, Kranciukaite-Butylkiniene D, Tamosiunas A, Vaiciulis V, Rastenyte D. Association between stroke occurrence and changes in atmospheric circulation. BMC Public Health 2021; 21:42. [PMID: 33407282 PMCID: PMC7789358 DOI: 10.1186/s12889-020-10052-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Accepted: 12/10/2020] [Indexed: 11/10/2022] Open
Abstract
Background The impact of weather on morbidity from stroke has been analysed in previous studies. As the risk of stroke was mostly associated with changing weather, the changes in the daily stroke occurrence may be associated with changes in atmospheric circulation. The aim of our study was to detect and evaluate the association between daily numbers of ischaemic strokes (ISs) and haemorrhagic strokes (HSs) and the teleconnection pattern. Methods The study was performed in Kaunas, Lithuania, from 2000 to 2010. The daily numbers of ISs, subarachnoid haemorrhages (SAHs), and intracerebral haemorrhages (ICHs) were obtained from the Kaunas Stroke Register. We evaluated the association between these types of stroke and the teleconnection pattern by applying Poisson regression and adjusting for the linear trend, month, and other weather variables. Results During the study period, we analysed 4038 cases (2226 men and 1812 women) of stroke. Of these, 3245 (80.4%) cases were ISs, 533 (13.2%) cases were ICHs, and 260 (6.4%) cases were SAHs. An increased risk of SAH was associated with a change in mean daily atmospheric pressure over 3.9 hPa (RR = 1.49, 95% CI 1.14–1.96), and a stronger El Niño event had a protective effect against SAHs (RR = 0.34, 95% CI 0.16–0.69). The risk of HS was positively associated with East Atlantic/West Russia indices (RR = 1.13, 95% CI 1.04–1.23). The risk of IS was negatively associated with the Arctic Oscillation index on the same day and on the previous day (RR = 0.97, p < 0.033). During November–March, the risk of HS was associated with a positive North Atlantic Oscillation (NAO) (RR = 1.29, 95% CI 1.03–1.62), and the risk of IS was negatively associated with the NAO index (RR = 0.92, 95% CI 0.85–0.99). Conclusions The results of our study provide new evidence that the North Atlantic Oscillation, Arctic Oscillation, East Atlantic/West Russia, and El Niño-Southern Oscillation pattern may affect the risk of stroke. The impact of these teleconnections is not identical for various types of stroke. Emergency services should be aware that specific weather conditions are more likely to prompt calls for more severe strokes.
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Affiliation(s)
- Jone Vencloviene
- Department of Environmental Sciences, Vytautas Magnus University, Donelaicio St. 58, LT-44248, Kaunas, Lithuania. .,Institute of Cardiology, Lithuanian University of Health Sciences, Sukileliu St. 15, LT-50103, Kaunas, Lithuania.
| | - Ricardas Radisauskas
- Institute of Cardiology, Lithuanian University of Health Sciences, Sukileliu St. 15, LT-50103, Kaunas, Lithuania.,Department of Environmental and Occupational Medicine, Lithuanian University of Health Sciences, Tilzes St. 18, LT-47181, Kaunas, Lithuania
| | - Daina Kranciukaite-Butylkiniene
- Institute of Cardiology, Lithuanian University of Health Sciences, Sukileliu St. 15, LT-50103, Kaunas, Lithuania.,Department of Family Medicine, Lithuanian University of Health Sciences, Eiveniu St. 2, LT-50009, Kaunas, Lithuania
| | - Abdonas Tamosiunas
- Institute of Cardiology, Lithuanian University of Health Sciences, Sukileliu St. 15, LT-50103, Kaunas, Lithuania.,Department of Preventive Medicine, Lithuanian University of Health Sciences, Tilzes St. 18, LT-47181, Kaunas, Lithuania
| | - Vidmantas Vaiciulis
- Department of Environmental and Occupational Medicine, Lithuanian University of Health Sciences, Tilzes St. 18, LT-47181, Kaunas, Lithuania.,Health Research Institute, Lithuanian University of Health Sciences, Tilzes St. 18, LT-47181, Kaunas, Lithuania
| | - Daiva Rastenyte
- Department of Neurology, Lithuanian University of Health Sciences, Eiveniu St. 2, LT-50009, Kaunas, Lithuania
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Hjalmarsson C, Fu M, Zverkova Sandström T, Schaufelberger M, Ljungman C, Andersson B, Bollano E, Dahlström U, Rosengren A. Risk of stroke in patients with heart failure and sinus rhythm: data from the Swedish Heart Failure Registry. ESC Heart Fail 2020; 8:85-94. [PMID: 33169527 PMCID: PMC7835566 DOI: 10.1002/ehf2.13091] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Revised: 09/11/2020] [Accepted: 10/22/2020] [Indexed: 11/11/2022] Open
Abstract
AIMS We investigated the 2 year rate of ischaemic stroke/transient ischaemic attack (IS) in patients with heart failure (HF) who were in sinus rhythm (HF-SR) and aimed to develop a score for stratifying risk of IS in this population. METHODS AND RESULTS A total of 15 425 patients (mean age 71.5 years, 39% women) with HF-SR enrolled in the Swedish Heart Failure Register were included; 28 815 age-matched and sex-matched controls, without a registered diagnosis of HF, were selected from the Swedish Population Register. The 2 year rate of IS was 3.0% in patients and 1.4% in controls. In the patient group, a risk score including age (1p for 65-74 years; 2p for 75-84 years; 3p for ≥85 years), previous IS (2p), ischaemic heart disease, diabetes, hypertension, kidney dysfunction, and New York Heart Association III/IV class (1p each) was generated. Over a mean follow-up of 20.1 (SD 7.5) months, the cumulative incidences (per 1000 person-years) of IS in patients with score 0 to ≥7 were 2.2, 5.3, 8.9, 13.2, 15.7, 20.4, 26.4, and 33.0, with hazard ratios for score 1 to ≥7 (with 0 as reference): 2.4, 4.1, 6.1, 7.2, 9.4, 12.2, and 15.3. The risk score performed modestly (area under the curve 63.7%; P = 0.4711 for lack of fit with a logistic model; P = 0.7062 with Poisson, scaled by deviance). CONCLUSIONS In terms of absolute risk, only 27.6% of patients had an annual IS incidence of ≤1%. To which extent this would be amenable to anticoagulant treatment remains conjectural. A score compiling age and specific co-morbidities identified HF-SR patients with increased risk of IS with modest discriminative ability.
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Affiliation(s)
- Clara Hjalmarsson
- Department of Cardiology, Sahlgrenska University Hospital and Sahlgrenska Academy, Gothenburg, Sweden
| | - Michael Fu
- Sahlgrenska Academy, Cardiology Unit, Department of Medicine, Östra Hospital, Gothenburg, Sweden
| | | | - Maria Schaufelberger
- Sahlgrenska Academy, Cardiology Unit, Department of Medicine, Östra Hospital, Gothenburg, Sweden
| | - Charlotta Ljungman
- Department of Cardiology, Sahlgrenska University Hospital and Sahlgrenska Academy, Gothenburg, Sweden
| | - Björn Andersson
- Department of Internal Medicine, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Entela Bollano
- Department of Cardiology, Sahlgrenska University Hospital and Sahlgrenska Academy, Gothenburg, Sweden
| | - Ulf Dahlström
- Department of Cardiology and Department of Health, Medicine and Caring Sciences, Linköping University, Linkoping, Sweden
| | - Annika Rosengren
- Sahlgrenska Academy, Cardiology Unit, Department of Medicine, Östra Hospital, Gothenburg, Sweden
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25
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Li J, Huang J, Wang Y, Yin P, Wang L, Liu Y, Pan X, Zhou M, Li G. Years of life lost from ischaemic and haemorrhagic stroke related to ambient nitrogen dioxide exposure: A multicity study in China. Ecotoxicol Environ Saf 2020; 203:111018. [PMID: 32888591 PMCID: PMC8174774 DOI: 10.1016/j.ecoenv.2020.111018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/19/2020] [Revised: 07/03/2020] [Accepted: 07/07/2020] [Indexed: 05/03/2023]
Abstract
Few multicity studies have been conducted in developing countries to distinguish the acute effects of ambient nitrogen dioxide (NO2) on the years of life lost (YLL) from different subtypes of stroke. We aimed to differentiate the associations between NO2 exposure and YLL from major pathological types of stroke in China, and estimate the relevant economic loss. A time-series study was conducted to explore the associations between short-term NO2 exposure and YLL from ischaemic and haemorrhagic stroke from 2013 to 2017 in 48 Chinese cities. Daily NO2 data and stroke mortality counts for each city were obtained from the National Urban Air Quality Real-time Publishing Platform and Chinese Center for Disease Control and Prevention, respectively. Generalized additive models were applied to estimate the cumulative effects of NO2 in each city, and meta-analysis was used to combine the city-specific estimates. The relevant economic loss was estimated using the method of the value per statistical life year (VSLY). A 10 μg/m3 increase in ambient NO2 concentration on the present day and previous day (lag 0-1) would lead to relatively higher increments in percentage change of YLL from ischaemic stroke (0.82%, 95% CI: 0.46%, 1.19%) than haemorrhagic stroke (0.46%, 95% CI: 0.09%, 0.84%). The association was significantly stronger in the low-education population than high-education population for ischaemic stroke. Furthermore, significantly higher association was found in South China than those in North China for both subtypes of stroke. Economic loss due to excess YLL from ischaemic stroke related to NO2 exposure was higher than that for haemorrhagic stroke. Our study indicated higher association and economic loss of ischaemic than haemorrhagic stroke related to NO2 exposure in China, which informed priorities for type-specific stroke prevention strategies related to NO2 pollution and vulnerable population protection.
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Affiliation(s)
- Jie Li
- National Center for Chronic and Noncommunicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, 27 Nanwei Road, Xicheng District, Beijing, 100050, China
| | - Jing Huang
- Department of Occupational and Environmental Health Sciences, Peking University School of Public Health, 38 Xueyuan Road, Haidian District, Beijing, 100191, China
| | - Yuxin Wang
- Department of Occupational and Environmental Health Sciences, Peking University School of Public Health, 38 Xueyuan Road, Haidian District, Beijing, 100191, China
| | - Peng Yin
- National Center for Chronic and Noncommunicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, 27 Nanwei Road, Xicheng District, Beijing, 100050, China
| | - Lijun Wang
- National Center for Chronic and Noncommunicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, 27 Nanwei Road, Xicheng District, Beijing, 100050, China
| | - Yang Liu
- Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, USA
| | - Xiaochuan Pan
- Department of Occupational and Environmental Health Sciences, Peking University School of Public Health, 38 Xueyuan Road, Haidian District, Beijing, 100191, China
| | - Maigeng Zhou
- National Center for Chronic and Noncommunicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, 27 Nanwei Road, Xicheng District, Beijing, 100050, China.
| | - Guoxing Li
- Department of Occupational and Environmental Health Sciences, Peking University School of Public Health, 38 Xueyuan Road, Haidian District, Beijing, 100191, China.
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26
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Tan CHN, Choy D, Venketasubramanian N. NeuroAid II (MLC901) in Haemorrhagic Stroke. Case Rep Neurol 2020; 12:212-217. [PMID: 33505298 DOI: 10.1159/000508588] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2019] [Accepted: 05/09/2020] [Indexed: 11/19/2022] Open
Abstract
Stroke is a leading cause of death and disability. NeuroAid (MLC601), which originates from Traditional Chinese Medicine, comprises herbal and animal components, and has been shown to improve the functional status of patients after ischaemic stroke. The use of NeuroAid II (MLC901), which comprises only the herbal components of MLC601, in haemorrhagic stroke has not been previously reported. Our patient is a 63-year-old male with a significant stroke risk factor of hypertension. He developed visual field defect, aphasia, unilateral weakness, and hemisensory loss. CT scan showed a left thalamic haemorrhage. In addition to anti-hypertensive therapy and intensive rehabilitation, he was prescribed MLC901. Over a period of 6 months, he had significant improvements in his motor, sensory, and speech function. There were no adverse events, serial brain CT scans showed resolution of the haemorrhage. MLC901 may have a role in post-stroke recovery after intracranial haemorrhage.
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Affiliation(s)
- Chai-Hoon Nowel Tan
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - David Choy
- Raffles Neuroscience Centre, Raffles Hospital, Singapore, Singapore
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27
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Tong TYN, Appleby PN, Key TJ, Dahm CC, Overvad K, Olsen A, Tjønneland A, Katzke V, Kühn T, Boeing H, Karakatsani A, Peppa E, Trichopoulou A, Weiderpass E, Masala G, Grioni S, Panico S, Tumino R, Boer JMA, Verschuren WMM, Quirós JR, Agudo A, Rodríguez-Barranco M, Imaz L, Chirlaque MD, Moreno-Iribas C, Engström G, Sonestedt E, Lind M, Otten J, Khaw KT, Aune D, Riboli E, Wareham NJ, Imamura F, Forouhi NG, di Angelantonio E, Wood AM, Butterworth AS, Perez-Cornago A. The associations of major foods and fibre with risks of ischaemic and haemorrhagic stroke: a prospective study of 418 329 participants in the EPIC cohort across nine European countries. Eur Heart J 2020; 41:2632-2640. [PMID: 32090257 PMCID: PMC7377582 DOI: 10.1093/eurheartj/ehaa007] [Citation(s) in RCA: 53] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2019] [Revised: 09/20/2019] [Accepted: 01/10/2020] [Indexed: 01/12/2023] Open
Abstract
AIM To investigate the associations between major foods and dietary fibre with subtypes of stroke in a large prospective cohort. METHODS AND RESULTS We analysed data on 418 329 men and women from nine European countries, with an average of 12.7 years of follow-up. Diet was assessed using validated country-specific questionnaires which asked about habitual intake over the past year, calibrated using 24-h recalls. Multivariable-adjusted Cox regressions were used to estimate hazard ratios (HRs) for ischaemic and haemorrhagic stroke associated with consumption of red and processed meat, poultry, fish, dairy foods, eggs, cereals, fruit and vegetables, legumes, nuts and seeds, and dietary fibre. For ischaemic stroke (4281 cases), lower risks were observed with higher consumption of fruit and vegetables combined (HR; 95% CI per 200 g/day higher intake, 0.87; 0.82-0.93, P-trend < 0.001), dietary fibre (per 10 g/day, 0.77; 0.69-0.86, P-trend < 0.001), milk (per 200 g/day, 0.95; 0.91-0.99, P-trend = 0.02), yogurt (per 100 g/day, 0.91; 0.85-0.97, P-trend = 0.004), and cheese (per 30 g/day, 0.88; 0.81-0.97, P-trend = 0.008), while higher risk was observed with higher red meat consumption which attenuated when adjusted for the other statistically significant foods (per 50 g/day, 1.07; 0.96-1.20, P-trend = 0.20). For haemorrhagic stroke (1430 cases), higher risk was associated with higher egg consumption (per 20 g/day, 1.25; 1.09-1.43, P-trend = 0.002). CONCLUSION Risk of ischaemic stroke was inversely associated with consumption of fruit and vegetables, dietary fibre, and dairy foods, while risk of haemorrhagic stroke was positively associated with egg consumption. The apparent differences in the associations highlight the importance of examining ischaemic and haemorrhagic stroke subtypes separately.
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Affiliation(s)
- Tammy Y N Tong
- Cancer Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Richard Doll Building, Roosevelt Drive, Oxford OX3 7LF, UK
| | - Paul N Appleby
- Cancer Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Richard Doll Building, Roosevelt Drive, Oxford OX3 7LF, UK
| | - Timothy J Key
- Cancer Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Richard Doll Building, Roosevelt Drive, Oxford OX3 7LF, UK
| | - Christina C Dahm
- Department of Public Health, Aarhus University, Nordre Ringgade 1, 8000 Aarhus, Demark
| | - Kim Overvad
- Department of Public Health, Aarhus University, Nordre Ringgade 1, 8000 Aarhus, Demark
- Department of Cardiology, Aalborg University Hospital, Reberbansgade 15, 9000 Aalborg, Denmark
| | - Anja Olsen
- Diet, Genes and Environment, Danish Cancer Society Research Center, Copenhagen, Denmark
| | - Anne Tjønneland
- Diet, Genes and Environment, Danish Cancer Society Research Center, Copenhagen, Denmark
- Department of Public Health, Faculty of Health and Medical Sciences, University of Copenhagen, Strandboulevarden 49, 2100 Copenhagen, Denmark
| | - Verena Katzke
- Division of Cancer Epidemiology, German Cancer Research Center (DKFZ), Im Neuenheimer Feld 580, 69120 Heidelberg Germany
| | - Tilman Kühn
- Division of Cancer Epidemiology, German Cancer Research Center (DKFZ), Im Neuenheimer Feld 580, 69120 Heidelberg Germany
| | - Heiner Boeing
- Department of Epidemiology, German Institute of Human Nutrition (DIfE) Postdam-Rehbrücke, Arthur-Scheunert-Allee 114, 14558 Nuthetal, Germany
| | - Anna Karakatsani
- Hellenic Health Foundation, Kaisareias 13 & Alexandroupoleos, 11527 Athens, Greece
- 2nd Pulmonary Medicine Department, School of Medicine, National and Kapodistrian University of Athens, “ATTIKON” University Hospital, 1, Rimini Str, Haidari, 12462 Athens, Greece
| | - Eleni Peppa
- Hellenic Health Foundation, Kaisareias 13 & Alexandroupoleos, 11527 Athens, Greece
| | - Antonia Trichopoulou
- Hellenic Health Foundation, Kaisareias 13 & Alexandroupoleos, 11527 Athens, Greece
| | - Elisabete Weiderpass
- International Agency for Research on Cancer (IARC), World Health Organization (WHO), 150 Cours Albert Thomas, 69372, Lyon CEDEX 08, France
| | - Giovanna Masala
- Cancer Risk Factors and Life-Style Epidemiology Unit, Institute for Cancer Research, Prevention and Clinical Network - ISPRO, Via Cosimo Il Vecchio
| | - Sara Grioni
- Epidemiology and Prevention Unit, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Via Giacomo Venezian, 1, 20133 Milan, Italy
| | - Salvatore Panico
- Dipartimento Di Medicina Clinica E Chirurgia Federico II University, Corso Umberto I, 40, 80138 Naples, Italy
| | - Rosario Tumino
- Cancer Registry and Histopathology Department, “M.P.Arezzo” Hospital, ASP Contrada Rito, 97100 Ragusa, Italy
| | - Jolanda M A Boer
- National Institute for Public Health and the Environment, Antonie van Leeuwenhoeklaan 9, 3721 MA Bilthoven, the Netherlands
| | - W M Monique Verschuren
- National Institute for Public Health and the Environment, Antonie van Leeuwenhoeklaan 9, 3721 MA Bilthoven, the Netherlands
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Heidelberglaan 100, 3584 Utrecht, the Netherlands
| | - J Ramón Quirós
- Public Health Directorate, General Elorza 32, 33001 Oviedo, Asturias, Spain
| | - Antonio Agudo
- Unit of Nutrition and Cancer. Cancer Epidemiology Research Program. Catalan Institute of Oncology-IDIBELL. Avinguda de la Gran Via de l'Hospitalet 199-203, 08908 L'Hospitalet de Llobregat, Barcelona, Spain
| | - Miguel Rodríguez-Barranco
- Andalusian School of Public Health. Biomedical Research Institute ibs.GRANADA, University of Granada, Cuesta del Observatorio, 4, 18011 Granada, Spain
- CIBER of Epidemiology and Public Health. Av. Monforte de Lemos, 3-5. Pabellón 11. Planta 0 28029 Madrid, Spain
| | - Liher Imaz
- Ministry of Health of the Basque Government, Public Health Division of Gipuzkoa, Andia 13, 20004 Donostia-San Sebastian, Spain
- Biodonostia Health Research Institute, Paseo Doctor Begiristain, s/n, 20014 Donostia-San Sebastian, Spain
| | - María-Dolores Chirlaque
- CIBER of Epidemiology and Public Health. Av. Monforte de Lemos, 3-5. Pabellón 11. Planta 0 28029 Madrid, Spain
- Department of Epidemiology, Regional Health Council, IMIB-Arrixaca, Murcia University, Ronda de Levante, 11, 30008 Murcia, Spain
| | - Conchi Moreno-Iribas
- Instituto de Salud Pública de Navarra, IdiSNA, Navarre Institute for Health Research, Calle de Irunlarrea 3, 31008 Pamplona, Spain
- Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), Recinto Hospitalario de Navarra, Calle de Irunlarrea s/n, 31621 Pamplona, Spain
| | - Gunnar Engström
- Department of Clinical Science in Malmö, Lund University, Bergsgatan 31 B, 21445 Malmö, Sweden
| | - Emily Sonestedt
- Nutritional Epidemiology, Department of Clinical Sciences Malmö, Lund University, Jan Waldenströms gata 35, CRC, hus 60 plan 13 205 02 Malmö, Sweden
| | - Marcus Lind
- Department of Public Health and Clinical Medicine, Umeå University, 901 87 Umeå, Sweden
| | - Julia Otten
- Department of Public Health and Clinical Medicine, Umeå University, 901 87 Umeå, Sweden
| | - Kay-Tee Khaw
- Department of Public Health and Primary Care, University of Cambridge, Strangeways Research Laboratory, Worts Causeway, Cambridge CB1 8RN, UK
| | - Dagfinn Aune
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, South Kensington Campus, London SW7 2AZ, UK
- Department of Nutrition, Bjørknes University College, Lovisenberggata 13, N- 0456 Oslo, Norway
- Department of Endocrinology, Morbid Obesity and Preventive Medicine, Oslo University Hospital Ullevål, OUS HF Aker sykehus, Postboks 4959 Nydalen, 0424 Oslo, Norway
| | - Elio Riboli
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, South Kensington Campus, London SW7 2AZ, UK
| | - Nicholas J Wareham
- MRC Epidemiology Unit, University of Cambridge School of Clinical Medicine, Cambridge Biomedical Campus, Cambridge CB2 0QQ, UK
| | - Fumiaki Imamura
- MRC Epidemiology Unit, University of Cambridge School of Clinical Medicine, Cambridge Biomedical Campus, Cambridge CB2 0QQ, UK
| | - Nita G Forouhi
- MRC Epidemiology Unit, University of Cambridge School of Clinical Medicine, Cambridge Biomedical Campus, Cambridge CB2 0QQ, UK
| | - Emanuele di Angelantonio
- MRC/BHF Cardiovascular Epidemiology Unit, Department of Public Health and Primary Care, University of Cambridge, Strangeways Research Laboratory, Wort's Causeway, Cambridge CB1 8RN, UK
| | - Angela M Wood
- MRC/BHF Cardiovascular Epidemiology Unit, Department of Public Health and Primary Care, University of Cambridge, Strangeways Research Laboratory, Wort's Causeway, Cambridge CB1 8RN, UK
| | - Adam S Butterworth
- MRC/BHF Cardiovascular Epidemiology Unit, Department of Public Health and Primary Care, University of Cambridge, Strangeways Research Laboratory, Wort's Causeway, Cambridge CB1 8RN, UK
| | - Aurora Perez-Cornago
- Cancer Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Richard Doll Building, Roosevelt Drive, Oxford OX3 7LF, UK
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Barter PJ, Yamashita S, Laufs U, Ruiz AJ, Sy R, Fang MDG, Folco E, Libby P, Matsuzawa Y, Santos RD. Gaps in beliefs and practice in dyslipidaemia management in Japan, Germany, Colombia and the Philippines: insights from a web-based physician survey. Lipids Health Dis 2020; 19:131. [PMID: 32522192 PMCID: PMC7285462 DOI: 10.1186/s12944-020-01265-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2020] [Accepted: 04/22/2020] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND Implementing evidence-based management of dyslipidaemia is a challenge worldwide. OBJECTIVES To understand physician beliefs and behaviour and identify uncertainties in dyslipidaemia management across four world regions. METHODS Web-based survey of 1758 physicians in Japan, Germany, Colombia and the Philippines who were selected randomly from existing databases. Key inclusion criteria were 1) for cardiologists and diabetes/endocrinology specialists: ≥50 dyslipidaemia patients examined in the last month; 2) for specialists in neurology/neurosurgery/stroke medicine: ≥50 dyslipidaemia patients and ≥ 20 patients with a history of ischaemic stroke examined in the last month; and 3) for specialists in nephrology and general medicine: based at centres with ≥20 beds and ≥ 50 dyslipidaemia patients examined in the last month. The self-report survey covered dyslipidaemia management, target low-density lipoprotein cholesterol (LDL-C) levels in different patient groups, and statin safety. All physicians gave voluntary consent and all data were anonymised. Analysis was solely descriptive. RESULTS The survey highlighted key areas of uncertainty in dyslipidaemia management in the four countries. These related to LDL-C targets in different patient groups, the safety of low LDL-C levels, the safety of statins, especially for effects on cognitive, renal and hepatic function and for haemorrhagic stroke risk, and lipid management strategies in patients with chronic kidney disease, including those with concomitant hypertriglyceridaemia. CONCLUSIONS This survey of physicians in Japan, Germany, Colombia and the Philippines has identified key gaps in knowledge about dyslipidaemia management. These relate to the safety of low LDL-C levels, the safety of statins, and lipid management of chronic kidney disease. The findings from this survey highlight the need for further education to improve the implementation of guideline recommendations for dyslipidaemia management.
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Affiliation(s)
- Philip J Barter
- School of Medical Sciences, University of New South Wales, Sydney, Australia
| | - Shizuya Yamashita
- Rinku General Medical Center and Osaka University Graduate School of Medicine, Osaka, Japan
| | | | | | - Rody Sy
- College of Medicine, University of the Philippines-Manila, Manila, the Philippines
| | - Mark David G Fang
- Cardinal Santos Medical Center, San Juan City, MetroManila, the Philippines
| | - Emanuela Folco
- International Atherosclerosis Society, Viale Piave 35, Milan, Italy
| | - Peter Libby
- Brigham and Women's Hospital, Harvard Medical School, Boston, USA
| | | | - Raul D Santos
- Hospital Israelita Albert Einstein, São Paulo, Brazil. .,Heart Institute -InCor, University of São Paulo Medical School Hospital, Av Dr Enéas C. Aguiar 44, Sao Paulo, SP, CEP-05403-900, Brazil.
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29
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Perdomo-Lampignano JA, Pana TA, Sleeman I, Clark AB, Sawanyawisuth K, Tiamkao S, Myint PK. Parkinson's disease and patient related outcomes in stroke: A matched cohort study. J Stroke Cerebrovasc Dis 2020; 29:104826. [PMID: 32402719 DOI: 10.1016/j.jstrokecerebrovasdis.2020.104826] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2020] [Revised: 03/19/2020] [Accepted: 03/22/2020] [Indexed: 12/23/2022] Open
Abstract
OBJECTIVE To evaluate post-stroke outcomes in patients with Parkinson's disease (PD). METHODS A matched cohort study was performed. Stroke patients with PD and non-PD controls were extracted from the Thailand Universal Insurance Database. Logistic regressions were used to evaluate the association between PD and in-hospital outcomes (mortality and complications). The PD-associated long-term mortality was evaluated using Royston-Parmar models. RESULTS A total of 1967 patients with PD were identified between 2003 and 2015 and matched to controls (1:4) by age, sex, admission year, and stroke type. PD patients had decreased odds of in-hospital death: OR (95% CI) 0.66 (0.52 - 0.84) and 0.61 (0.43 - 0.85) after ischaemic and haemorrhagic strokes, respectively. PD was associated with a length-of-stay greater than median (4 days) after both stroke types: 1.37 (1.21 - 1.56) and 1.45 (1.05 - 2.00), respectively. Ischaemic stroke patients with PD also had increased odds of developing pneumonia, sepsis and AKI: 1.52 (1.2 - 1.83), 1.54 (1.16 - 2.05), and 1.33 (1.02 - 1.73). In haemorrhagic stroke patients, PD was associated with pneumonia: 1.89 (1.31 - 2.72). Survival analyses showed that PD was protective against death in the short term (HR=0.66; 95% CI 0.53-0.83 ischaemic, and HR=0.50; 95% CI 0.37 - 0.68 haemorrhagic stroke), but leads to an increased mortality risk approximately 1 and 3 months after ischaemic and haemorrhagic stroke, respectively. CONCLUSION PD is associated with a reduced mortality risk during the first 2-4 weeks post-admission but an increased risk thereafter, in addition to increased odds of in-hospital complications and prolonged hospitalisation.
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Christersson C, Ståhle E, Lindhagen L, James S. Haemorrhagic stroke and major bleeding after intervention with biological aortic valve prosthesis: risk factors and antithrombotic treatment. Eur Heart J Suppl 2020; 22:C26-C33. [PMID: 32368196 PMCID: PMC7189738 DOI: 10.1093/eurheartj/suaa007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
The majority of patients with severe aortic stenosis are recommended intervention with a surgical biological prosthesis (bioSAVR) or a transcatheter aortic valve intervention (TAVI). The antithrombotic strategies after aortic valve intervention vary and include drugs targeting both platelets and the coagulation cascade. Long-term exposure and changes of antithrombotic treatment influence the risk of both bleeding and thromboembolic events.The aim was to describe an unselected sample of patients who have experienced haemorrhagic stroke and other major bleeding events after biological aortic prosthesis, their antithrombotic treatment and changes of treatments in relation to the bleeding event.All patients performing an bioSAVR or a TAVI 2008–2014 were identified in the SWEDEHEART registry and included in the study (n = 10 711). The outcome events were haemorrhagic stroke and other major bleeding event. Information of drug exposure was collected from the dispensed drug registry.The incidence rate of any bleeding event was 2.85/100 patient-years the first year after aortic valve intervention. Heart failure and atrial fibrillation were present more often in patients with a first haemorrhagic stroke or other major bleeding event compared to without. The proportion of exposure to warfarin was 28.7% vs. 21.3% in patients with and without a haemorrhagic stroke. Comparable figures were 31.2% vs. 19.0% in patients with and without other major bleeding event. During 1 month prior a haemorrhagic stroke or other major bleeding event 39.4% and 38.0%, respectively, of the patients not previously exposed to antithrombotic treatment started warfarin or single antiplatelet therapy.Major bleeding events are not uncommon after aortic valve intervention with a biological prosthesis. Evaluation of comorbidities and previous bleeding might improve risk stratification for bleeding in these elderly patients. The pattern of change of antithrombotic treatment was similar in the groups with and without a bleeding event and in most patients the antithrombotic regime was unchanged the month before an event.
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Affiliation(s)
- Christina Christersson
- Department of Medical Sciences, Cardiology, Uppsala University, SE 75185 Uppsala, Sweden
| | - Elisabeth Ståhle
- Department of Surgical Sciences, Thoracic surgery, Uppsala University, SE 75185 Uppsala, Sweden
| | - Lars Lindhagen
- Uppsala Clinical Research Center, Uppsala University, SE 75185 Uppsala, Sweden
| | - Stefan James
- Department of Medical Sciences, Cardiology, Uppsala University, SE 75185 Uppsala, Sweden.,Uppsala Clinical Research Center, Uppsala University, SE 75185 Uppsala, Sweden
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Denby CE, Chatterjee K, Pullicino R, Lane S, Radon MR, Das KV. Is four-dimensional CT angiography as effective as digital subtraction angiography in the detection of the underlying causes of intracerebral haemorrhage: a systematic review. Neuroradiology 2020; 62:273-81. [PMID: 31901972 DOI: 10.1007/s00234-019-02349-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2019] [Accepted: 12/15/2019] [Indexed: 01/30/2023]
Abstract
PURPOSE To determine whether the sensitivity and specificity of four-dimensional CTA (4D-CTA) are equivalent to digital subtraction angiography (DSA) in the detection of underlying vascular abnormalities in patients with intracerebral haemorrhage (ICH). METHODS A systematic review of studies comparing 4D-CTA with DSA in the detection of the underlying structural causes of ICH was performed on the literature published between 1998 and 2019. RESULTS We identified a total of 237 articles from PubMed, SCOPUS and Web of Science using the following Medical Subject Headings (MeSH) terms: primary intracerebral haemorrhage, 4D-CTA, DSA, cerebral haemorrhage, angiography, digital subtraction, arteriovenous malformations, 4D, CTA, dynamic-CTA and time-resolved CTA. Following the removal of duplicate publications and articles failing to meet our inclusion criteria, there were four articles potentially viable for analysis. Therefore, there were not sufficient studies to provide a statistically meaningful meta-analysis. CONCLUSION The review of current literature has demonstrated that there are few published studies comparing 4D-CTA with DSA in spontaneous ICH, with only four suitable studies identified for potential analysis. However, due to the restricted number of patients and high sensitivity and specificity of 3 studies (100%), performing a meta-analysis was not meaningful. Qualitative analysis of the data concluded that 4D-CTA has the diagnostic potential to replace invasive DSA in certain cases with vascular abnormalities. However, further research studies directly comparing 4D-CTA with DSA using larger prospective patient cohorts are required to strengthen the evidence base.
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Söderholm M, Borné Y, Hedblad B, Persson M, Barregard L, Engström G. Blood cadmium concentration and risk of subarachnoid haemorrhage. Environ Res 2020; 180:108826. [PMID: 31654906 DOI: 10.1016/j.envres.2019.108826] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/14/2019] [Revised: 10/08/2019] [Accepted: 10/14/2019] [Indexed: 06/10/2023]
Abstract
BACKGROUND Cadmium is a toxic metal and exposure is mainly from diet and tobacco smoke. Cadmium is accumulated in blood vessels and may reduce synthesis of procollagen and inhibit proliferation of vascular smooth muscle cells. High blood cadmium has been associated with increased risk of myocardial infarction, stroke and unruptured intracranial aneurysms. We examined whether blood cadmium increase the risk of subarachnoid haemorrhage (SAH). METHODS The Malmö Diet and Cancer cohort (n = 28,449) was examined in 1991-1996 and blood samples were taken. Incidence of SAH was followed up to 2014. Cadmium was measured in stored blood samples from incident SAH cases and matched controls (n = 93 vs n = 276) and odds ratio (OR) for SAH was assessed in a nested case control design. RESULTS Subjects with cadmium concentration in the highest quartile had increased risk of SAH compared to those in the first quartile (OR: 3.22, 95%CI: 1.67-6.22). However, after adjusting for smoking, results were weakened and non-significant (OR: 1.57, 95%CI: 0.51-4.80). CONCLUSIONS Cadmium concentration was associated with increased risk of SAH but this association was largely explained by smoking. Whether cadmium in tobacco may contribute to the vascular pathology and increased risk of SAH in smokers should be further studied.
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Affiliation(s)
- Martin Söderholm
- Department of Clinical Science, Lund University, Malmö, Sweden; Department of Neurology, Skåne University Hospital, Malmö, Sweden.
| | - Yan Borné
- Department of Clinical Science, Lund University, Malmö, Sweden
| | - Bo Hedblad
- Department of Clinical Science, Lund University, Malmö, Sweden
| | | | - Lars Barregard
- Occupational and Environmental Medicine, Sahlgrenska University Hospital, University of Gothenburg, Gothenburg, Sweden
| | - Gunnar Engström
- Department of Clinical Science, Lund University, Malmö, Sweden
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Abstract
In this study, we present the design considerations of a device to assist in the
potential treatment of hemorrhagic stroke with the aim of stopping blood from
flowing out into brain tissue. We present and model three designs for the
clinical scenarios when saccular aneurysms rupture in the middle cerebral artery
in the brain. We evaluate and model these three designs using computer aided
design software, SolidWorks, which allows the devices to be tested using finite
element analysis and also enables us to justify that the materials chosen were
suitable for potential use. Computational fluid dynamics modelling were used to
demonstrate and analyse the flow of blood through the artery under conditions of
normal and ruptured states. We conclude that our device could potentially be
useful in the treatment of hemorrhagic stroke, and the modelling process is
useful in assisting in determining the performance of our devices.
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Affiliation(s)
| | - Gillian Pearce
- School of Engineering and Applied Science, Aston University, Birmingham, UK
| | - Rachel Hepton
- The School of Life & Health Sciences, Aston University, Birmingham, UK
| | - Julian Wong
- Department of Cardiac, Thoracic and Vascular Surgery, National University Heart Centre, Singapore
| | - Iham F Zidane
- Mechanical Engineering Department, College of Engineering and Technology, Arab Academy for Science, Technology and Maritime Transport (AASTMT), Alexandria, Egypt
| | - Xianghong Ma
- School of Engineering and Applied Science, Aston University, Birmingham, UK
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Tolefac PN, Awungafac NS, Minkande JZ. Spontaneous haemorrhagic stroke complicating severe pre-eclampsia in pregnancy: a case report in a resource-limited setting in Cameroon. BMC Pregnancy Childbirth 2018; 18:506. [PMID: 30587133 PMCID: PMC6307190 DOI: 10.1186/s12884-018-2157-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2018] [Accepted: 12/17/2018] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Spontaneous intracerebral haemorrhage is a rare complication of preeclampsia during pregnancy associated with a high morbidity and mortality. Compared with the non-pregnant women stroke rates are relatively rare during pregnancy. CASE PRESENTATION We report the case of a 32-year-old female Cameroonian gravida 4 para 3 who presented at 34 weeks of gestation with sudden onset of right sided hemiplegia associated with headache, blurred vision and a blood pressure of 182/126. Cerebral CT scan confirmed a left parietal spontaneous haemorrhage. Emergency caesarean delivery was done and the recovery uneventful. CONCLUSION This case highlights the importance of good neurological examination in pregnant women presenting with neurological symptoms as well as the place of multidisciplinary management in severe life threatening conditions.
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Affiliation(s)
- Paul Nkemtendong Tolefac
- Faculty of Medicine and Biomedical Sciences, University of Yaoundé 1, Yaoundé, Cameroon
- Mbalmayo District Hospita, Mbalmayo, Cameroon
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Boselli M, Aquilani R, Maestri R, Achilli MP, Arrigoni N, Pasini E, Condino AM, Boschi F, Dossena M, Buonocore D, Verri M. Inflammation and rehabilitation outcomes in patients with nontraumatic intracranial haemorrhage. NeuroRehabilitation 2018; 42:449-456. [PMID: 29966209 DOI: 10.3233/nre-172362] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
BACKGROUND Systemic inflammation and its impact on rehabilitation for patients with non-traumatic haemorrhagic injury (HBI) sequelae has not yet been adequately documented. OBJECTIVE AND METHODS We therefore considered 31 patients with HBI, to determine the serum levels of inflammatory markers (C-Reactive Protein, CRP and or interleukine-6, IL-6) to establish their impact on functional status (Functional Independence Measure, FIM: 18 indicating the worst performance and 126, a normal score). RESULTS The results showed an inflammation prevalence (CRP >0.5 mg/dl and/or IL 6 >7 pg/ml) of 74.2% at admission to Rehab. FIM reduction was more pronounced in inflamed compared to non-inflamed subjects (p < 0.05) and significantly correlated with blood variables sensitive to inflammation, such as alpha 1 globulin (r = - 0.565) and neutrophil/ lymphocyte ratio (r = - 0.52), CRP (r = - 0.365). At discharge from Rehab, the inflammation rate diminished. Inflamed patients showed similar gains in FIM score as their controls. In the entire population, the FIM gain was significantly associated with a gain in serum albumin, only (r = +0.56). CONCLUSIONS We conclude that systemic inflammation is prevalent in HBI patients and contributes to reduce patient functional status. However, during the Rehab stage, inflammation does not hinder the improvement rate of functional capacity.
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Affiliation(s)
- Mirella Boselli
- Unità di Riabilitazione Neuromotoria Gravi Cerebrolesioni Acquisite, Istituti Clinici Scientifici Maugeri Spa Società Benefit, IRCCS Montescano, Pavia, Italy
| | - Roberto Aquilani
- Dipartimento di Biologia e Biotecnologie "Lazzaro Spallanzani" Università degli Studi di Pavia, Pavia, Italy
| | - Roberto Maestri
- Dipartimento di Ingegneria Biomedica, Istituti Clinici Scientifici Maugeri Spa Società Benefit, IRCCS Montescano, Pavia, Italy
| | - Maria Pia Achilli
- Unità di Riabilitazione Neuromotoria Gravi Cerebrolesioni Acquisite, Istituti Clinici Scientifici Maugeri Spa Società Benefit, IRCCS Montescano, Pavia, Italy
| | - Nadia Arrigoni
- Unità di Riabilitazione Neuromotoria Gravi Cerebrolesioni Acquisite, Istituti Clinici Scientifici Maugeri Spa Società Benefit, IRCCS Montescano, Pavia, Italy
| | - Evasio Pasini
- Divisione di Riabilitazione Cardiaca, Istituti Clinici Scientifici Maugeri, IRCCS Lumezzane, Brescia, Italy
| | - Anna Maria Condino
- Dipartimento di Scienze del Farmaco, Università degli Studi di Pavia, Pavia, Italy
| | - Federica Boschi
- Dipartimento di Scienze del Farmaco, Università degli Studi di Pavia, Pavia, Italy
| | - Maurizia Dossena
- Dipartimento di Biologia e Biotecnologie "Lazzaro Spallanzani" Università degli Studi di Pavia, Pavia, Italy
| | - Daniela Buonocore
- Dipartimento di Biologia e Biotecnologie "Lazzaro Spallanzani" Università degli Studi di Pavia, Pavia, Italy
| | - Manuela Verri
- Dipartimento di Biologia e Biotecnologie "Lazzaro Spallanzani" Università degli Studi di Pavia, Pavia, Italy
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Boselli M, Aquilani R, Maestri R, Achilli MP, Arrigoni N, Pasini E, Condino AM, Boschi F, Dossena M, Buonocore D, Verri M. Inflammation and rehabilitation outcomes in patients with nontraumatic intracranial haemorrhage. NeuroRehabilitation 2018:NRE182362. [PMID: 29660970 DOI: 10.3233/nre-182362] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Systemic inflammation and its impact on rehabilitation for patients with non-traumatic haemorrhagic injury (HBI) sequelae has not yet been adequately documented. OBJECTIVE AND METHODS We therefore considered 31 patients with HBI, to determine the serum levels of inflammatory markers (C-Reactive Protein, CRP and or interleukine-6, IL-6) to establish their impact on functional status (Functional Independence Measure, FIM: 18 indicating the worst performance and 126, a normal score). RESULTS The results showed an inflammation prevalence (CRP >0.5 mg/dl and/or IL 6 >7 pg/ml) of 74.2% at admission to Rehab. FIM reduction was more pronounced in inflamed compared to non-inflamed subjects (p < 0.05) and significantly correlated with blood variables sensitive to inflammation, such as alpha 1 globulin (r = - 0.565) and neutrophil/ lymphocyte ratio (r = - 0.52), CRP (r = - 0.365). At discharge from Rehab, the inflammation rate diminished. Inflamed patients showed similar gains in FIM score as their controls. In the entire population, the FIM gain was significantly associated with a gain in serum albumin, only (r = +0.56). CONCLUSIONS We conclude that systemic inflammation is prevalent in HBI patients and contributes to reduce patient functional status. However, during the Rehab stage, inflammation does not hinder the improvement rate of functional capacity.
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Affiliation(s)
- Mirella Boselli
- Unità di Riabilitazione Neuromotoria Gravi Cerebrolesioni Acquisite, Istituti Clinici Scientifici Maugeri Spa Società Benefit, IRCCS Montescano, Pavia, Italy
| | - Roberto Aquilani
- Dipartimento di Biologia e Biotecnologie "Lazzaro Spallanzani" Università degli Studi di Pavia, Pavia, Italy
| | - Roberto Maestri
- Dipartimento di Ingegneria Biomedica, Istituti Clinici Scientifici Maugeri Spa Società Benefit, IRCCS Montescano, Pavia, Italy
| | - Maria Pia Achilli
- Unità di Riabilitazione Neuromotoria Gravi Cerebrolesioni Acquisite, Istituti Clinici Scientifici Maugeri Spa Società Benefit, IRCCS Montescano, Pavia, Italy
| | - Nadia Arrigoni
- Unità di Riabilitazione Neuromotoria Gravi Cerebrolesioni Acquisite, Istituti Clinici Scientifici Maugeri Spa Società Benefit, IRCCS Montescano, Pavia, Italy
| | - Evasio Pasini
- Divisione di Riabilitazione Cardiaca, Istituti Clinici Scientifici Maugeri, IRCCS Lumezzane, Brescia, Italy
| | - Anna Maria Condino
- Dipartimento di Scienze del Farmaco, Università degli Studi di Pavia, Pavia, Italy
| | - Federica Boschi
- Dipartimento di Scienze del Farmaco, Università degli Studi di Pavia, Pavia, Italy
| | - Maurizia Dossena
- Dipartimento di Biologia e Biotecnologie "Lazzaro Spallanzani" Università degli Studi di Pavia, Pavia, Italy
| | - Daniela Buonocore
- Dipartimento di Biologia e Biotecnologie "Lazzaro Spallanzani" Università degli Studi di Pavia, Pavia, Italy
| | - Manuela Verri
- Dipartimento di Biologia e Biotecnologie "Lazzaro Spallanzani" Università degli Studi di Pavia, Pavia, Italy
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Carandini T, Bozzano V, Scarpini E, Montano N, Solbiati M. Intensive versus standard lowering of blood pressure in the acute phase of intracranial haemorrhage: a systematic review and meta-analysis. Intern Emerg Med 2018; 13:95-105. [PMID: 28776173 DOI: 10.1007/s11739-017-1716-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2017] [Accepted: 07/24/2017] [Indexed: 12/16/2022]
Abstract
The optimal target of blood pressure (BP) in the acute phase of intracranial haemorrhage (ICH) is still controversial. Our aim was to evaluate safety and efficacy of intensive BP lowering compared to standard BP treatment in ICH. We conducted a systematic review and meta-analysis of all available randomized controlled trials recruiting patients with elevated BP in acute spontaneous ICH to intensive or standard BP-lowering treatment. Our primary outcomes were 3-month mortality, disability (modified Rankin Scale 3-5) and combined death or disability. Secondary outcomes were early neurological deterioration at 24 h, substantial haematoma enlargement within 24-72 h and 3-month non-fatal serious adverse events. We included six studies for a total of 4385 patients (mean age 62 years, 62.3% men). No differences were detected between the two treatment groups in 3-month mortality (RR = 0.99, 95% CI 0.83-1.17), disability (RR = 0.96, 95% CI 0.89-1.03) and combined death and disability (RR = 0.97, 95% CI 0.90-1.03). The rate of patients with early neurological deterioration, substantial haematoma enlargement and non-fatal serious adverse events was similar in the two treatment groups (RR = 1.03, 95% CI 0.88-1.19, RR = 0.85, 95% CI 0.70-1.03, RR = 1.07, 95% CI 0.90-1.28, respectively). An intensive BP control in the acute phase of ICH is not beneficial and should not be recommended. Therefore, the systolic BP target of less than 140 mmHg that is now suggested by guidelines needs to be reconsidered.
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Affiliation(s)
- Tiziana Carandini
- Department of Neurology, Università degli Studi di Milano, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - Viviana Bozzano
- Department of Internal Medicine, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Università degli Studi di Milano, via Francesco Sforza 35, 20122, Milan, Italy.
| | - Elio Scarpini
- Department of Neurology, Università degli Studi di Milano, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - Nicola Montano
- Department of Internal Medicine, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Università degli Studi di Milano, via Francesco Sforza 35, 20122, Milan, Italy
- Department of Emergency Medicine, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Università degli Studi di Milano, Milan, Italy
| | - Monica Solbiati
- Department of Internal Medicine, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Università degli Studi di Milano, via Francesco Sforza 35, 20122, Milan, Italy
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Graham C, Lewis S, Forbes J, Mead G, Hackett ML, Hankey GJ, Gommans J, Nguyen HT, Lundström E, Isaksson E, Näsman P, Rudberg AS, Dennis M. The FOCUS, AFFINITY and EFFECTS trials studying the effect(s) of fluoxetine in patients with a recent stroke: statistical and health economic analysis plan for the trials and for the individual patient data meta-analysis. Trials 2017; 18:627. [PMID: 29282099 PMCID: PMC5745973 DOI: 10.1186/s13063-017-2385-6] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2017] [Accepted: 12/01/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Small trials have suggested that fluoxetine may improve neurological recovery from stroke. FOCUS, AFFINITY and EFFECTS are a family of investigator-led, multicentre, parallel group, randomised, placebo-controlled trials which aim to determine whether the routine administration of fluoxetine (20 mg daily) for six months after an acute stroke improves patients' functional outcome. METHODS/DESIGN The core protocol for the three trials has been published (Mead et al., Trials 20:369, 2015). The trials include patients aged 18 years and older with a clinical diagnosis of stroke and persisting focal neurological deficits at randomisation 2-15 days after stroke onset. Patients are randomised centrally via each trials' web-based randomisation system using a common minimisation algorithm. Patients are allocated fluoxetine 20 mg once daily or matching placebo capsules for six months. The primary outcome measure is the modified Rankin scale (mRS) at six months. Secondary outcomes include: living circumstances; the Stroke Impact Scale; EuroQol (EQ5D-5 L); the vitality subscale of the 36-Item Short Form Health Survey (SF36); diagnosis of depression; adherence to medication; serious adverse events including death and recurrent stroke; and resource use at six and 12 months and the mRS at 12 months. DISCUSSION Minor variations have been tailored to the national setting in the UK (FOCUS), Australia, New Zealand and Vietnam (AFFINITY) and Sweden (EFFECTS). Each trial is run and funded independently and will report its own results. A prospectively planned individual patient data meta-analysis of all three trials will provide the most precise estimate of the overall effect and establish whether any effects differ between trials or subgroups. This statistical analysis plan describes the core analyses for all three trials and that for the individual patient data meta-analysis. Recruitment and follow-up in the FOCUS trial is expected to be completed by the end of 2018. AFFINITY and EFFECTS are likely to complete follow-up in 2020. TRIAL REGISTRATION FOCUS: ISRCTN , ISRCTN83290762 . Registered on 23 May 2012. EudraCT, 2011-005616-29. Registered on 3 February 2012. AFFINITY Australian New Zealand Clinical Trials Registry, ACTRN12611000774921 . Registered on 22 July 2011. EFFECTS ISRCTN , ISRCTN13020412 . Registered on 19 December 2014. Clinicaltrials.gov, NCT02683213 . Registered on 2 February 2016. EudraCT, 2011-006130-16 . Registered on 8 August 2014.
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Affiliation(s)
| | - Steff Lewis
- Edinburgh Clinical Trials Unit, University of Edinburgh, Edinburgh, UK
| | - John Forbes
- Health Research Institute, University of Limerick, Limerick, Ireland
| | - Gillian Mead
- Centre for Clinical Brain Sciences, University of Edinburgh, Chancellors Building FU303h, 49 Little France Crescent, Edinburgh, EH16 4SB, UK
| | - Maree L Hackett
- The George Institute for Global Health, University of Sydney, Sydney, NSW, Australia
| | - Graeme J Hankey
- School of Medicine, The University of Western Australia, Crawley, WA, Australia
| | - John Gommans
- Hawke's Bay District Health Board, Hastings, New Zealand
| | - Huy Thang Nguyen
- Department of Cerebro-Vascular Disease, The People's 115 Hospital, Ho Chi Minh City, Vietnam
| | - Erik Lundström
- Department of Clinical Neuroscience, Neurology, Karolinska Institutet, Stockholm, Sweden
| | - Eva Isaksson
- Department of Clinical Neuroscience, Neurology, Karolinska Institutet, Stockholm, Sweden
| | - Per Näsman
- Center for Safety Research, KTH Royal Institute of Technology, Stockholm, Sweden
| | - Ann-Sofie Rudberg
- Department of Clinical Neuroscience, Neurology, Karolinska Institutet, Stockholm, Sweden
| | - Martin Dennis
- Centre for Clinical Brain Sciences, University of Edinburgh, Chancellors Building FU303h, 49 Little France Crescent, Edinburgh, EH16 4SB, UK.
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Al Fauzi A, Sumorejo P, Suroto NS, Parenrengi MA, Wahyuhadi J, Turchan A, Mahyudin F, Suroto H, Rantam FA, Machfoed MH, Bajamal AH, Lumenta CB. Clinical Outcomes of Repeated Intraventricular Transplantation of Autologous Bone Marrow Mesenchymal Stem Cells in Chronic Haemorrhagic Stroke. A One-Year Follow Up. Open Neurol J 2017; 11:74-83. [PMID: 29290837 PMCID: PMC5738743 DOI: 10.2174/1874205x01711010074] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2017] [Revised: 11/11/2017] [Accepted: 11/23/2017] [Indexed: 01/09/2023] Open
Abstract
Object: Stroke, one of the most devastating diseases, is a leading cause of death and disability throughout the world and is also associated with emotional and economic problems. The main goal of this study was to investigate the clinical outcome of the intraventricular transplantation of bone marrow mesenchymal stem cells (BM-MSCs) in post-haemorrhagic stroke patients. Method: This study was done consisting of eight patients with supratentorial haemorrhagic stroke, who had undergone 24 weeks of standard treatment of stroke with stable neurological deficits. All of the patients received stem cell transplantation intraventricularly using autologous BM-MSCs. Six months and Twelve months after stem cells treatment, the clinical outcomes were measured using the National Institute of Health Stroke Scale (NIHSS) and adverse effect also observed. Result: The results of this study showed improvement of NIHSS score values before and after the treatment in five patients. No adverse effects or complications were detected during the 1-year observation. Conclusion: Intraventricular transplantation of BM-MSCs has shown benefits in improving the functional status of post-haemorrhagic stroke patients with no adverse effect.
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Affiliation(s)
- Asra Al Fauzi
- Department of Neurosurgery, Faculty of Medicine, Universitas Airlangga, Dr. Soetomo General Hospital, Surabaya Neuroscience Institute, Surabaya, Indonesia
| | - Purwati Sumorejo
- Cell and Tissue Bank, Dr. Soetomo General Hospital, Surabaya, Indonesia
| | - Nur Setiawan Suroto
- Department of Neurosurgery, Faculty of Medicine, Universitas Airlangga, Dr. Soetomo General Hospital, Surabaya Neuroscience Institute, Surabaya, Indonesia
| | - Muhammad Arifin Parenrengi
- Department of Neurosurgery, Faculty of Medicine, Universitas Airlangga, Dr. Soetomo General Hospital, Surabaya Neuroscience Institute, Surabaya, Indonesia
| | - Joni Wahyuhadi
- Department of Neurosurgery, Faculty of Medicine, Universitas Airlangga, Dr. Soetomo General Hospital, Surabaya Neuroscience Institute, Surabaya, Indonesia
| | - Agus Turchan
- Department of Neurosurgery, Faculty of Medicine, Universitas Airlangga, Dr. Soetomo General Hospital, Surabaya Neuroscience Institute, Surabaya, Indonesia
| | | | - Heri Suroto
- Cell and Tissue Bank, Dr. Soetomo General Hospital, Surabaya, Indonesia
| | - Fedik Abdul Rantam
- Stem Cell Research and Development Center, Universitas Airlangga, Surabaya, Indonesia
| | - Mochammad Hasan Machfoed
- Department of Neurology, Faculty of Medicine, Universitas Airlangga, Dr. Soetomo General Hospital, Surabaya, Indonesia
| | - Abdul Hafid Bajamal
- Department of Neurosurgery, Faculty of Medicine, Universitas Airlangga, Dr. Soetomo General Hospital, Surabaya Neuroscience Institute, Surabaya, Indonesia
| | - Christianto Benjamin Lumenta
- Department of Neurosurgery, Academic Teaching Hospital Munich-Bogenhausen, Technical University of Munich, Germany
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Fauzi AA, Suroto NS, Bajamal AH, Machfoed MH. Intraventricular Transplantation of Autologous Bone Marrow Mesenchymal Stem Cells via Ommaya Reservoir in Persistent Vegetative State Patients after Haemorrhagic Stroke: Report of Two Cases & Review of the Literature. J Stem Cells Regen Med 2016. [PMID: 28096634 PMCID: PMC5227101 DOI: 10.46582/jsrm.1202014] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Background: One of the most devastating diseases, stroke, is a leading cause of death and disability worldwide with severe emotional and economic consequences. The purpose of this article is mainly to report the effect of intraventricular transplantation via an Ommaya reservoir using autologous bone marrow mesenchymal stem cells (BM-MSCs) in haemorrhagic stroke patients. Case Presentations: Two patients, aged 51 and 52, bearing sequels of haemorrhagic stroke were managed by intraventricular transplantation of BM-MSCs obtained from their own bone marrow. Before the procedure, both patients were bedridden, tracheostomised, on nasogastric (NG) tube feeding and in hemiparesis. The cells were transplanted intraventricularly (20 x 106 cells/2.5 ml) using an Ommaya reservoir, and then repeated transplantations were done after 1 and 2 months consecutively. The safety and efficacy of the procedures were evaluated 3, 6 and 12 months after treatment. The National Institute of Health Stroke Scale (NIHSS) was used to evaluate the patients' neurological status before and after treatment. No adverse events derived from the procedures or transplants were observed in the one-year follow-up period, and the neurological status of both patients improved after treatment. Conclusions: Our report demonstrates that the intraventricular transplantation of BM-MSCs via an Ommaya reservoir is safe and it improves the neurological status of post-haemorrhagic stroke patients. The repeated transplantation procedure is easier and safer to perform via a subcutaneously implanted Ommaya reservoir. Key Words: Haemorrhagic stroke, bone marrow mesenchymal stem cells (BM-MSCs), intraventricular transplantation.
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Affiliation(s)
| | | | | | - Moh Hasan Machfoed
- Department of Neurology, Airlangga University, Dr. Soetomo General Hospital , Surabaya, Indonesia
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Das S, Kaul S, Jyothy A, Munshi A. Association of APOE (E2, E3 and E4) gene variants and lipid levels in ischemic stroke, its subtypes and hemorrhagic stroke in a South Indian population. Neurosci Lett 2016; 628:136-41. [PMID: 27329241 DOI: 10.1016/j.neulet.2016.06.032] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2016] [Revised: 05/31/2016] [Accepted: 06/17/2016] [Indexed: 11/24/2022]
Abstract
In the present study we evaluated the association of APOE (E2/E3/E4) polymorphism with ischemic stroke (n=620), its subtypes and hemorrhagic stroke (n=250) in a South Indian population from Telangana. The genotypes were determined using PCR-RFLP while lipid levels were measured using commercially available kits. We found significant difference in the genotypic distribution between hemorrhagic stroke patients and controls for certain genetic models [E2/E2 vs. E2/E4; E3/E3 vs. E2/E3; E3/E3 vs. E2/E4; E4/E4 vs. E2/E3; E4/E4 vs.E2/E4 and E3 vs. E4]. However, no significant difference was observed in genotypic distribution between ischemic stroke patients and controls. On analysing the genotypic distribution between ischemic and hemorrhagic stroke patients, statistically significant difference was observed in specific genetic models [E2/E2 vs. E2/E4; E3/E3 vs. E2/E3; E3/E3 vs. E2/E4; E4/E4 vs. E2/E3 and E4/E4 vs. E2/E4]. In ischemic stroke subtypes analysing for alleles E3 vs. E2 and E3 vs. E4, we found significant association with intracranial large artery (p=0.01), cardioembolic stroke (p=0.001 and p=0.0004) and lacunar stroke (p=0.02). Analysing the association of various genotypes with different lipid levels significant association was observed for VLDL (P=0.000) and for triglyceride (P=0.000) levels with E2/E4 and E3/E4 genotypes in ischemic stroke but not in hemorrhagic stroke. In conclusion, our results suggest that APOE polymorphism does seem to play a role in hemorrhagic stroke and also in the development of specific subtypes of ischemic stroke. Further, in ischemic stroke VLDL and triglycerides levels were found to be significantly associated with E2/E4 and E3/E4 genotypes.
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Affiliation(s)
- Satrupa Das
- Institute of Genetics and Hospital for Genetic Diseases, Osmania University, Begumpet, Hyderabad 500016, India; Dr. NTR University of Health Sciences, Vijayawada, Andhra Pradesh, India
| | - Subhash Kaul
- Nizam's Institute of Medical Sciences, Punjagutta, Hyderabad 500082, India
| | - Akka Jyothy
- Institute of Genetics and Hospital for Genetic Diseases, Osmania University, Begumpet, Hyderabad 500016, India
| | - Anjana Munshi
- Centre for Human Genetics and Molecular Medicine, School of Health Sciences, Central University of Punjab, Bathinda, Punjab, India.
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Rohrmann S, Garmo H, Malmström H, Hammar N, Jungner I, Walldius G, Van Hemelrijck M. Association between serum calcium concentration and risk of incident and fatal cardiovascular disease in the prospective AMORIS study. Atherosclerosis 2016; 251:85-93. [PMID: 27289190 DOI: 10.1016/j.atherosclerosis.2016.06.004] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2016] [Revised: 05/20/2016] [Accepted: 06/01/2016] [Indexed: 10/21/2022]
Abstract
BACKGROUND AND AIMS Previous epidemiological studies have shown positive associations between serum calcium concentration and risk of cardiovascular disease (CVD), but results differ by definition of CVD. We examined the association of circulating calcium with incident and fatal CVD, myocardial infarction (MI), and stroke in the Swedish AMORIS cohort. METHODS We included 441,738 participants of the AMORIS database linked for follow-up information on morbidity and mortality. Concentrations of total calcium were fully automated measured using a colorimetric method; concentrations of albumin were measured with a bromocresol green method between 1985 and 1995. The association of albumin-corrected calcium concentration and risk of incident and fatal CVD, MI, and stroke, respectively, was assessed with multivariable adjusted Cox proportional hazards models. RESULTS Until December 31, 2011, during a median follow-up time of 21 years, 90,866 incident cases of CVD, 21,271 of MI, and 25,810 of stroke were identified. High serum calcium concentrations were associated with increased risk of non-fatal CVD (Hazard ratio [HR] = 1.12, 95% CI 1.10-1.14, top [≥2.40 nmol/L] vs. bottom [≤2-25 nmol/L] quintile), MI (1.19, 1.14-1.25), and stroke (1.11, 1.06-1.15) and fatal disease (CVD: 1.41, 1.35-1.47; MI: 1.41, 1.31-1.51; stroke: 1.30, 1.20-1.41). Effect modification by sex was observed for incident disease such that associations were stronger among women than men. Serum calcium was positively associated with both incident and fatal ischemic stroke and with fatal hemorrhagic stroke, but not with incident hemorrhagic stroke. In a sub-groups analysis, the results remained significant after adjustment for smoking. CONCLUSIONS The results support a modest positive association between serum calcium and risk of CVD, but the underlying mineral metabolism and the exact mechanisms are currently unclear.
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Affiliation(s)
- Sabine Rohrmann
- Division of Chronic Disease Epidemiology, Epidemiology, Biostatistics and Prevention Institute (EPBI), University of Zurich, Zurich, UK.
| | - Hans Garmo
- Cancer Epidemiology Unit, Division of Cancer Studies, Kings College London, London, UK; Regional Cancer Centre, Uppsala University Hospital, Uppsala, Sweden
| | - Håkan Malmström
- Unit of Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Niklas Hammar
- Unit of Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden; AstraZeneca, Södertälje, Sweden
| | - Ingmar Jungner
- Department of Medicine, Clinical Epidemiological Unit, Karolinska Institutet and CALAB Research, Stockholm, Sweden
| | - Göran Walldius
- Unit of Cardiovascular Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Mieke Van Hemelrijck
- Cancer Epidemiology Unit, Division of Cancer Studies, Kings College London, London, UK
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Patgiri D, Pathak MS, Sharma P, Kutum T, Mattack N. Serum hsCRP: A Novel Marker for Prediction of Cerebrovascular Accidents (Stroke). J Clin Diagn Res 2014; 8:CC08-11. [PMID: 25653940 PMCID: PMC4316246 DOI: 10.7860/jcdr/2014/10386.5302] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2014] [Accepted: 09/05/2014] [Indexed: 11/24/2022]
Abstract
INTRODUCTION AND OBJECTIVES Strokes are caused by disruption of the blood supply to the brain. This may result from either blockage or rupture of a blood vessel. Yearly 15 million people worldwide suffer a stroke. India ranks second worldwide in terms of deaths from stroke. The incidence of stroke increases with age affecting the economically productive middle aged population. Hypertension and male sex are other risk factors for stroke. C-Reactive Protein (CRP) is an acute phase protein whose concentration rises in blood following inflammation. Formerly, assays for CRP detected its rise only after significant inflammation. However, recently developed high sensitivity assays (hsCRP) enable the measurement of CRP in individuals who are apparently healthy. Several studies indicate that hsCRP is elevated in individuals who are at risk of developing Coronary Artery Disease or Cerebrovascular events, the elevation may be found years before the first detection of vascular problems. In the absence of other biochemical markers, the present study aimed to evaluate the predictive and diagnostic role of hsCRP in stroke. MATERIALS AND METHODS The study consisted of 50 patients of acute stroke admitted in Gauhati Medical College and Hospital. The control population consisted of two groups - 50 age and sex matched controls with hypertension (Hypertensive control group) and 50 age and sex matched controls with no obvious disease constituted the Normal control group. hsCRP levels were measured in all the groups and compared statistically. CONCLUSION hsCRP is an acute phase reactant whose concentration rises in stroke as well as in those at risk. The rise may be identified even before the appearance of risk factors. Hence, hsCRP may be useful as a predictive and diagnostic marker in stroke.
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Affiliation(s)
- Dibyaratna Patgiri
- Demonstrator, Department of Biochemistry, Gauhati Medical College & Hospital, Guwahati, Assam, India
| | - Mauchumi Saikia Pathak
- Professor, Department of Biochemistry, Gauhati Medical College & Hospital, Guwahati, Assam, India
| | - Pradeep Sharma
- Assistant Professor, Department of Biochemistry, Mayo Institute of Medical Sciences, U.P, India
| | - Tridip Kutum
- Post-Graduate Trainee, Department of Biochemistry, Gauhati Medical College & Hospital, Guwahati, Assam, India
| | - Nirmali Mattack
- Post-Graduate Trainee, Department of Biochemistry, Gauhati Medical College & Hospital, Guwahati, Assam, India
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Jagiełła J, Dardiotis E, Gąsowski J, Pera J, Dziedzic T, Klimkowicz-Mrowiec A, Golenia A, Wnuk M, Fountas K, Paterakis K, Hadjigeorgiou G, Słowik A. The FGA Thr312Ala polymorphism and risk of intracerebral haemorrhage in Polish and Greek populations. Neurol Neurochir Pol 2014; 48:105-10. [PMID: 24821635 DOI: 10.1016/j.pjnns.2013.12.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2013] [Accepted: 12/06/2013] [Indexed: 11/25/2022]
Abstract
BACKGROUND AND PURPOSE Spontaneous intracerebral haemorrhage (ICH) is the most fatal form of stroke with the highest morbidity and disability rate of all stroke types. Recent data suggest that the genetic background has a sizeable and mostly undiscovered effect on the brain haemorrhage risk. Since the coagulation system is crucial to ICH pathology, we studied the significance of the FGA Thr312Ala polymorphism in two European populations. MATERIALS AND METHODS We genotyped 550 and 224 controls as well as 261 and 242 stroke patients in Polish and Greek populations, respectively. The ICH diagnosis was confirmed by computed tomography. The FGA Thr312Ala polymorphism was analysed using real-time polymorphism chain reaction. RESULTS Both crude and multivariable regression analyses showed that the studied polymorphism is a protective factor in the Polish population under the dominant and additive models of inheritance. Those results did not replicate in the Greek population. The meta-analysis of results from the Polish and the Greek populations proved that FGA Thr312Ala polymorphism affects the risk of ICH in the dominant model of inheritance. CONCLUSIONS The FGA Thr312Ala polymorphism affects a risk for ICH in the Polish but not in the Greek population. An advanced meta-analysis of well-designed studies with a significant number of cases might provide useful information of novel polymorphisms, including the FGA Thr312Ala polymorphism, and their role in ICH pathology.
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Affiliation(s)
- Jeremiasz Jagiełła
- Department of Neurology, The University Hospital in Krakow, Krakow, Poland.
| | - Efthimios Dardiotis
- Department of Neurology, Laboratory of Neurogenetics, University of Thessaly, University Hospital of Larissa, Larissa, Greece
| | - Jerzy Gąsowski
- Chair of Internal Medicine and Gerontology, Jagiellonian University Medical College, Krakow, Poland
| | - Joanna Pera
- Department of Neurology, Jagiellonian University Medical College, Krakow, Poland
| | - Tomasz Dziedzic
- Department of Neurology, Jagiellonian University Medical College, Krakow, Poland
| | | | - Aleksandra Golenia
- Department of Neurology, Jagiellonian University Medical College, Krakow, Poland
| | - Marcin Wnuk
- Department of Neurology, Jagiellonian University Medical College, Krakow, Poland
| | - Kostas Fountas
- Department of Neurosurgery, University of Thessaly, University Hospital of Larissa, Larissa, Greece
| | - Konstantinos Paterakis
- Department of Neurology, Laboratory of Neurogenetics, University of Thessaly, University Hospital of Larissa, Larissa, Greece
| | - Georgios Hadjigeorgiou
- Department of Neurology, Laboratory of Neurogenetics, University of Thessaly, University Hospital of Larissa, Larissa, Greece
| | - Agnieszka Słowik
- Department of Neurology, Jagiellonian University Medical College, Krakow, Poland
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Sairanen T, Kanerva M, Valanne L, Lyytinen J, Pekkonen E. Churg-strauss syndrome as an unusual aetiology of stroke with haemorrhagic transformation in a patient with no cardiovascular risk factors. Case Rep Neurol 2011; 3:32-8. [PMID: 21468361 PMCID: PMC3064863 DOI: 10.1159/000323214] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
Background We present here a case of haemorrhagic brain infarction in a middle-aged and physically active male, who had never smoked. This case report aims to remind the internist and neurologist to bear in mind unusual aetiologies of brain infarcts in patients without classical cardiovascular risk factors. Case Description A 49-year-old male with pulmonary asthma and a prior history of nasal polyps had a wake-up stroke with left-sided symptoms and speech disturbance. A head MRI and MR angiography revealed a recent haemorrhagic infarct in the right putamen and corona radiata. The left hemiparesis progressed to sensory-motor hemiplegia on the 4th day. In the head CT, it was shown that the haemorrhagic infarct had progressed to a large haematoma. A pansinusitis was also diagnosed. The aetiological investigations revealed a minor atrial septal defect (ASD) with shunting and a heterozygotic clotting factor V R506Q mutation. A remarkable blood eosinophilia of 9.80 E9/l (42%) together with fever, sinusitis, wide-spread bilateral nodular pulmonary infiltrates that did not respond to wide-spectrum antimicrobial treatment, positive anti-neutrophilic cytoplasmic antibodies, a high myeloperoxidase antibody level and slightly positive anti-proteinase 3 antibodies suggested the diagnosis of Churg-Strauss syndrome. These inflammatory symptoms and findings promptly responded to treatment with corticosteroids and cyclophosphamide. Conclusions Even after the concomitant findings of the low risk factors, i.e. small ASD and heterozygotic clotting factor mutation, continued search for the final aetiology of stroke revealed Churg-Strauss syndrome, which was the key to the treatment.
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Affiliation(s)
- Tiina Sairanen
- Department of Neurology, Helsinki University Central Hospital, Helsinki, Finland
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