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1.
BMC Neurol ; 9: 31, 2009 Jul 15.
Artigo em Inglês | MEDLINE | ID: mdl-19604359

RESUMO

BACKGROUND: Intracranial stenosis is the most common cause of stroke among Asians. It has a poor prognosis with a high rate of recurrence. No effective medical or surgical treatment modality has been developed for the treatment of stroke due to intracranial stenosis. We aim to identify risk factors and biomarkers for intracranial stenosis and to develop techniques such as use of transcranial doppler to help diagnose intracranial stenosis in a cost-effective manner. METHODS/DESIGN: The Karachi Intracranial Stenosis Study (KISS) is a prospective, observational, case-control study to describe the clinical features and determine the risk factors of patients with stroke due to intracranial stenosis and compare them to those with stroke due to other etiologies as well as to unaffected individuals. We plan to recruit 200 patients with stroke due to intracranial stenosis and two control groups each of 150 matched individuals. The first set of controls will include patients with ischemic stroke that is due to other atherosclerotic mechanisms specifically lacunar and cardioembolic strokes. The second group will consist of stroke free individuals. Standardized interviews will be conducted to determine demographic, medical, social, and behavioral variables along with baseline medications. Mandatory procedures for inclusion in the study are clinical confirmation of stroke by a healthcare professional within 72 hours of onset, 12 lead electrocardiogram, and neuroimaging. In addition, lipid profile, serum glucose, creatinine and HbA1C will be measured in all participants. Ancillary tests will include carotid ultrasound, transcranial doppler and magnetic resonance or computed tomography angiogram to rule out concurrent carotid disease. Echocardiogram and other additional investigations will be performed at these centers at the discretion of the regional physicians. DISCUSSION: The results of this study will help inform locally relevant clinical guidelines and effective public health and individual interventions.


Assuntos
Artérias Cerebrais/patologia , Transtornos Cerebrovasculares/complicações , Protocolos Clínicos , Acidente Vascular Cerebral/epidemiologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos de Casos e Controles , Córtex Cerebral/irrigação sanguínea , Córtex Cerebral/patologia , Transtornos Cerebrovasculares/epidemiologia , Transtornos Cerebrovasculares/patologia , Constrição Patológica , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Paquistão/epidemiologia , Estudos Prospectivos , Fatores de Risco , Acidente Vascular Cerebral/etiologia , Acidente Vascular Cerebral/patologia
2.
J Coll Physicians Surg Pak ; 19(10): 640-3, 2009 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-19811716

RESUMO

OBJECTIVE: To determine the relationship between venoarterial carbon dioxide gradient (DeltapCO2) and central venous oxygen saturation (ScvO2) in children after cardiac surgery. STUDY DESIGN: A cohort study. PLACE AND DURATION OF STUDY: The Paediatric cardiac intensive care unit of the Aga Khan University Hospital, Karachi, from June 2006 to May 2007. METHODOLOGY: All children admitted in the paediatric cardiac intensive care after complete repair of congenital heart defect using cardiopulmonary bypass were included in the study. Simultaneous arterial and central venous blood gas samples were obtained from a catheter placed in the artery (either radial or femoral) and superior vena cava respectively. Linear regression analysis was performed between ScvO2 and DeltapCO2. RESULTS: Fifty seven children aged from 5 days to 14 years were included and 272-paired simultaneous arterial and central venous samples were analyzed. Mean venous pCO2 was 47.82+/-9.03 mmHg and mean arterial pCO2 was 40.50+/-9.06 mmHg. One hundred seventy four samples had ScvO2 > 70% with mean DeltapCO2 of 5.44+/-2.55 mmHg and 98 samples had ScvO2 < 70% with mean DeltapCO2 of 9.07+/-3.90 mmHg. With ScvO2 < 70%, 77 samples had DeltapCO2 of > 6 mmHg while only 21 samples had DeltapCO2 of < 6 mmHg (p < 0.001). On the contrary with ScvO2 > 70%, 71 samples had DeltapCO2 of > 6 mmHg and 103 samples had DeltapCO2 of < 6 mmHg. Coefficient of correlation (R2) between 0.340 was ScvO2 and DeltapCO2. CONCLUSION: Elevated DeltapCO2 is practical and can be utilized as a useful adjunct to low ScvO2 in the assessment of low cardiac output syndrome in children after cardiac surgery.


Assuntos
Dióxido de Carbono/sangue , Baixo Débito Cardíaco/diagnóstico , Débito Cardíaco , Cardiopatias Congênitas , Oxigênio/sangue , Complicações Pós-Operatórias/diagnóstico , Adolescente , Biomarcadores , Gasometria , Baixo Débito Cardíaco/sangue , Criança , Pré-Escolar , Estudos de Coortes , Feminino , Cardiopatias Congênitas/sangue , Cardiopatias Congênitas/fisiopatologia , Cardiopatias Congênitas/cirurgia , Humanos , Lactente , Recém-Nascido , Unidades de Terapia Intensiva Pediátrica/estatística & dados numéricos , Masculino , Consumo de Oxigênio , Complicações Pós-Operatórias/sangue , Período Pós-Operatório , Estudos Retrospectivos , Fatores de Risco , Veia Cava Superior
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