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INTRODUCTION: The impact of coexisting chronic obstructive lung disease (COPD) in patients with stroke remains unclear. This study aims to investigate the effect of COPD on survival and hospital outcomes among stroke patients. METHODS: The outcomes of patients with stroke between fiscal years 2005 and 2017 from Thailand's Universal Coverage Scheme database were compared between COPD and non-COPD patients using propensity score matching and flexible parametric survival model. RESULTS: A total of 805,561 patients were admitted with stroke during the study period, 12,650 (1.92%) of whom had been diagnosed with COPD. Participants with COPD were significantly older, were more likely to be male, and had higher prevalences of pre-existing atrial fibrillation, ischemic heart disease, and heart failure and a higher incidence of ischemic stroke (p < 0.001). The propensity score-matched groups were well balanced in terms of all observed covariates. Participants with COPD had higher incidences of pneumonia (odds ratio [OR] 1.98, 95% confidence interval [CI]: 1.83-2.15), urinary tract infection (OR 1.27, 95% CI: 1.14-1.42), sepsis (OR 1.50, 95% CI: 1.32-1.70), cardiac arrest (OR 1.50, 95% CI: 1.19-1.88), respiratory failure (OR 1.82, 95% CI: 1.69-1.96), acute kidney injury (OR 1.29, 95% CI: 1.14-1.46), and in-hospital death (OR 1.21, 95% CI: 1.13-1.30) than those without. The impact of COPD on mortality was highest at day 93 (hazard ratio [HR] 1.73, 95% CI: 1.60-1.87) and nonsignificant at day 965 of follow-up (HR 1.08, 95% CI: 1.00-1.16). CONCLUSIONS: COPD was associated with respiratory, cardiac, renal, and infectious complications and significantly impacted survival for up to 2.6 years.
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Doença Pulmonar Obstrutiva Crônica , Acidente Vascular Cerebral , Feminino , Mortalidade Hospitalar , Humanos , Masculino , Pontuação de Propensão , Doença Pulmonar Obstrutiva Crônica/complicações , Doença Pulmonar Obstrutiva Crônica/diagnóstico , Doença Pulmonar Obstrutiva Crônica/epidemiologia , Acidente Vascular Cerebral/complicações , Acidente Vascular Cerebral/diagnóstico , Acidente Vascular Cerebral/epidemiologia , Tailândia/epidemiologiaRESUMO
There have been no published studies examining the epidemiology of Guillain-Barré syndrome (GBS) in large populations in Thailand. This study aimed to explore the incidence, patient characteristics, seasonality, treatments, and outcomes of GBS in Thailand. The National Health Security Office (NHSO) provided data on in-patient admission between fiscal year 2005 and 2017. We selected all patients with a primary diagnosis of GBS. We retrieved data regarding the total population from the Department of Provincial Administration. A total of 4521 patients with GBS were included. The median age was 42 years (IQR 22-56), and 61.5% were male. The incidence rate increased from 0.48 to 0.93 per 100 000 population over the 13 years. The incidence was increased with age and a male-to-female ratio of 1.6:1. There was seasonal variation in the rate of admission for GBS, with significantly more patients admitted in rainy vs summer (IRR 1.94, 95%CI 1.80-2.10, P < .001) and winter vs summer (IRR 1.48, 95%CI 1.36-1.60, P < .001). Treatment with IVIg increased from 4.4% to 29.6% (P < .001), whereas plasmapheresis decreased significantly from 4% to 1.32% (P = .017). The mortality rate was 3.5%. Elderly and young adults had a significantly higher mortality rate when compared to children and teenagers (P < .001 and P = .003). The incidence of GBS in Thailand was steady over 13 years and was greater in rainy and winter season. Treatment with IVIg increased while plasmapheresis decreased. Mortality was higher in elderly patients.
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Síndrome de Guillain-Barré , Adolescente , Adulto , Idoso , Criança , Feminino , Síndrome de Guillain-Barré/epidemiologia , Humanos , Imunoglobulinas Intravenosas , Incidência , Masculino , Estudos Retrospectivos , Tailândia/epidemiologia , Adulto JovemRESUMO
BACKGROUND: There is lack of data on the association between infective endocarditis (IE) and outcomes of mortality and complications in stroke. We aimed to compare characteristics and outcomes of stroke patients with and without IE. METHODS: We retrospectively examined the above association using data obtained from an insurance database which covers ~75% of the Thai population. All hospitalised strokes between 8 January 2003 and 31 December 2013 were included in the current study. Characteristics and outcomes were compared between stroke patients with or without IE, and then between two main stroke types. Multiple logistic regression models including propensity score-matched analyses were constructed to assess study outcomes controlling for age, sex, stroke type and comorbidities. RESULTS: A total of 590 115 stroke patients (mean (SD) age = 64.2 ± 13.7 years; ischaemic = 51.7%; haemorrhagic = 32.6%; undetermined = 15.7%) were included, of whom 2129 (0.36%) had stroke associated with IE. After adjustment, we found that IE was significantly associated with the following complications: arrhythmias (adjusted odds ratio (95% CI) 6.94 (6.29-7.66)), sepsis (1.24 (1.01-1.52)), pneumonia (1.34 (1.17-1.53)), respiratory failure (1.43 (1.24-1.66)) and in-hospital mortality (1.29 (1.13-1.47)) (P for all <.001). Patients with haemorrhagic stroke with IE had poorer outcomes for in-hospital mortality and respiratory failure compared with their counterparts with ischaemic stroke. Propensity score-matched analysis showed similar results. CONCLUSIONS: Our results suggest that stroke patients with IE differ from that of the general stroke population and these patients have worse outcomes. Future studies are needed to determine the best treatment strategies for stroke patients with IE.
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Isquemia Encefálica , Endocardite , Acidente Vascular Cerebral , Idoso , Endocardite/complicações , Endocardite/epidemiologia , Humanos , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de Risco , Acidente Vascular Cerebral/complicações , Acidente Vascular Cerebral/epidemiologia , Tailândia/epidemiologiaRESUMO
BACKGROUND: The impact of stroke associated pneumonia (SAP) on stroke complications is not well understood; we aimed to study the association between SAP and adverse outcomes including in-hospital mortality, prolonged length of stay and the risk of developing common serious complications (sepsis, respiratory failure, and convulsions). METHODS: We retrospectively analyzed data from a cohort of 610,668 stroke patients drawn from the Universal Coverage Health Security Scheme (a national insurance database) in Thailand which covers â¼80% of the Thai population. Patients were hospitalized between October 2004 and January 2013. RESULTS: Pneumonia was present in 9.6 % (nâ¯=â¯58,586) of patients. Aspiration pneumonia was present in 6.2% (nâ¯=â¯38,060) and nonaspiration pneumonia in 3.4% (nâ¯=â¯20,526). After adjusting for age, sex, stroke type, and comorbidities, patients with SAP had significantly higher odds of in-hospital mortality (odds ratio [OR] 2.90: 2.83-2.96), long length of stay (OR 13.11: 12.83-13.40), sepsis (OR 8.49: 8.22-8.76), respiratory failure (OR 4.37: 4.27-4.48), and convulsions (OR 2.09: 2.00-2.17). On subanalysis, patients with nonaspiration pneumonia were found to have higher odds of adverse outcomes compared to aspiration pneumonia; the corresponding ORs (95% confidence interval) for above outcomes were 1.25 (1.21-1.30), 2.40 (2.32-2.49), 1.34 (1.28-1.40), 1.80 (1.73-1.88), and 1.19 (1.11-1.28), respectively. CONCLUSIONS: SAP is associated with higher odds of inpatient mortality, long length of stay, and risk of developing serious stroke complications. Nonaspiration pneumonia is associated with significantly higher likelihood of adverse outcomes compared to aspiration pneumonia in this patient population. Early identification and treatment of SAP is vital in reducing adverse outcomes in acute stroke.
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Admissão do Paciente , Pneumonia Aspirativa/epidemiologia , Acidente Vascular Cerebral/epidemiologia , Idoso , Bases de Dados Factuais , Progressão da Doença , Feminino , Mortalidade Hospitalar , Humanos , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Pneumonia Aspirativa/diagnóstico , Pneumonia Aspirativa/mortalidade , Pneumonia Aspirativa/terapia , Prognóstico , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Acidente Vascular Cerebral/diagnóstico , Acidente Vascular Cerebral/mortalidade , Acidente Vascular Cerebral/terapia , Tailândia/epidemiologia , Fatores de TempoRESUMO
BACKGROUND AND PURPOSE: Rheumatic valvular heart disease is associated with the increased risk of cerebrovascular events, although there are limited data on the prognosis of patients with rheumatic mitral valve disease (RMVD) after stroke. METHODS: We examined the association between RMVD and both serious and common cardiovascular and noncardiovascular (respiratory and infective) complications in a cohort of hospitalized stroke patients based in Thailand. Factors associated with in-hospital mortality were also explored. Data were obtained from a National Insurance Database. All hospitalized strokes between October 1, 2004, and January 31, 2013, were included in the current study. Characteristics and outcomes were compared for RMVD and non-RMVD patients. Logistic regression, propensity score matching, and multivariate models were used to assess study outcomes. RESULTS: In total, 594 681 patients (mean [SD] age=64 [14.5] years) with a diagnosis of stroke (ischemic=306 154; hemorrhagic=195 392; undetermined=93 135) were included in this study, of whom 5461 had RMVD. Results from primary analyses showed that after ischemic stroke, and controlling for potential confounding covariates, RMVD was associated (P<0.001) with increased odds for cardiac arrest (odds ratio [95% confidence interval]=2.13 [1.68-2.70]), shock (2.13 [1.64-2.77]), arrhythmias (1.70 [1.21-2.39]), respiratory failure (2.09 [1.87-2.33]), pneumonia (2.00 [1.81-2.20]), and sepsis (1.39 [1.19-1.63]). In hemorrhagic stroke patients, RMVD was associated with increased odds (fully adjusted model) for respiratory failure (1.26 [1.01-1.57]), and in patients with undetermined stroke, RMVD was associated with increased odds (fully adjusted analyses) for shock (3.00 [1.46-6.14]), respiratory failure (2.70 [1.91-3.79]), and pneumonia (2.42 [1.88-3.11]). CONCLUSIONS: RMVD is associated with the development of cardiac arrest, shock, arrhythmias, respiratory failure, pneumonia, and sepsis after acute stroke.
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Isquemia Encefálica/epidemiologia , Hemorragia Cerebral/epidemiologia , Insuficiência da Valva Mitral/epidemiologia , Estenose da Valva Mitral/epidemiologia , Avaliação de Resultados em Cuidados de Saúde/estatística & dados numéricos , Acidente Vascular Cerebral/complicações , Acidente Vascular Cerebral/epidemiologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Arritmias Cardíacas/epidemiologia , Arritmias Cardíacas/etiologia , Isquemia Encefálica/complicações , Hemorragia Cerebral/complicações , Bases de Dados Factuais/estatística & dados numéricos , Feminino , Parada Cardíaca/epidemiologia , Parada Cardíaca/etiologia , Humanos , Masculino , Pessoa de Meia-Idade , Programas Nacionais de Saúde/estatística & dados numéricos , Pneumonia/epidemiologia , Pneumonia/etiologia , Insuficiência Respiratória/epidemiologia , Insuficiência Respiratória/etiologia , Cardiopatia Reumática , Sepse/epidemiologia , Sepse/etiologia , Choque/epidemiologia , Choque/etiologia , Acidente Vascular Cerebral/etiologia , Tailândia/epidemiologiaRESUMO
PURPOSE: To study factors associated with poor outcomes in acute ischemic stroke patients with atrial fibrillation (AF) by using a national database. MATERIALS AND METHODS: This study was a retrospective analytical study by retrieving data from the Thailand national database system for universal coverage (UC) health insurance system. All adult patients aged over 18 years who were admitted with acute ischemic stroke during the fiscal years 2004-2012 by the appropriate ICD codes were searched. Eligible patients with AF were categorized as alive or dead during hospital stay. The mortality rate and factors associated with in-hospital mortality were studied. RESULTS: There were 522,699 patients diagnosed as acute stroke; 277,291 patients (53.1%) had acute ischemic stroke. Of those with ischemic stroke, 25,319 patients (9.1%) had AF. The mortality rates of acute ischemic stroke with AF were 14.1% and without AF were 6.2%, (p < 0.001). Significant factors associated with mortality in acute stroke patients with AF by multivariate logistic regression were female gender (adjusted odds ratio; AOR 1.28), co-morbid diseases such as diabetes (AOR 1.28), hypertension (AOR 1.26), rt-PA treatment (AOR 0.55), and stroke complications, such as pneumonia (AOR 2.60), septicemia (AOR 6.50), or gastrointestinal bleeding (AOR 2.16). CONCLUSIONS: At the national level, AF caused a higher mortality rate in acute ischemic stroke than in non-AF patients. Gender, co-morbid diseases, rt-PA treatment, and stroke complications were associated with mortality in acute ischemic stroke with AF.
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Fibrilação Atrial , Mortalidade Hospitalar , Acidente Vascular Cerebral/complicações , Acidente Vascular Cerebral/epidemiologia , Adulto , Distribuição por Idade , Idoso , Idoso de 80 Anos ou mais , Análise de Variância , Fibrilação Atrial/epidemiologia , Fibrilação Atrial/etiologia , Fibrilação Atrial/mortalidade , Isquemia Encefálica/complicações , Feminino , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Programas Nacionais de Saúde/estatística & dados numéricos , Distribuição por Sexo , Acidente Vascular Cerebral/etiologia , TailândiaRESUMO
Tuberculous meningitis (TBM) is a common infectious disease of the central nervous system. Detection of cerebrospinal fluid (CSF) adenosine deaminase (ADA) activity for the diagnosis of TBM has a relatively high accuracy. Most previous reports determined ADA levels by following the colorimetric method of Giusti (endpoint assay). Recently, a Diazyme ADA assay kit was developed to determine CSF ADA levels. This study aimed to define the cutoff value of CSF ADA that is diagnostic for TBM with the Diazyme ADA assay kit. Adults with meningitis were included in the study. The diagnostic properties of CSF ADA for TBM as determined by the Diazyme ADA assay kit were assessed by the receiver operating characteristic curve, area under the curve, sensitivity, specificity, and likelihood ratios. There were 97 patients enrolled in the study, comprising 15 cases of TBM and 82 cases of non-TBM meningitis. The median CSF ADA activity level in the TBM group was significantly higher than in the non-TBM group (P = 0.002), with a mean difference of 14.5 U/L (95% CI: 5.3-23.8 U/L). A CSF ADA level of 6.1 U/L was the best cutoff value to differentiate between the TBM and non-TBM groups, with a sensitivity of 53.33%, a specificity of 89.02%, a positive likelihood ratio of 4.86, a negative likelihood ratio of 0.52, and an area under the curve of 0.75. A CSF ADA level of 6.1 U/L determined by the Diazyme ADA assay kit could be used as a diagnostic tool in the early diagnosis of TBM.
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BACKGROUND: Tuberculous meningitis (TBM) is a common central nervous system infectious disease. Polymerase chain reaction (PCR) assay is a useful method for the rapid diagnosis of TBM. The Seegene Anyplex MTB/NTM real-time detection assay has good sensitivity and specificity for detection of tuberculosis in respiratory specimens, though, data regarding other specimens are lacking. This study aims to define the diagnostic role of Seegene Anyplex MTB/NTM real-time detection assay in TBM in adults. METHODS: This was a retrospective study of 367 adults with symptomatic community acquired meningitis between December 2013 and December 2019. Cerebrospinal fluid (CSF) had been sent for conventional diagnosis, including culture to identify Mycobacterium tuberculosis, and Seegene Anyplex MTB/NTM real-time detection assay. Other diagnostic examinations were performed as necessary. RESULTS: Of the 367 patients in the study, 37 were diagnosed with TBM (14 with definite TBM and 23 with probable TBM). Between the total TBM cases (n = 37) and non-TBM cases (n = 330), clinical sensitivity was 32.4% and specificity was 100%, the positive predictive value was 100%, and the negative predictive value was 93.0%. Between the definite TBM cases (n = 14) and non-TBM cases (n = 330), clinical sensitivity was 50.0% and specificity was 100%, the positive predictive value was 100%, and the negative predictive value was 97.9%. CONCLUSION: Due to lack of sensitivity, we suggest Seegeen Anyplex MTB/NTM real-time detection assay should not be used to rule out TBM but is useful for definite diagnosis.
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Mycobacterium tuberculosis , Tuberculose Meníngea , Adulto , Humanos , Tuberculose Meníngea/diagnóstico , Tuberculose Meníngea/líquido cefalorraquidiano , Estudos Retrospectivos , Reação em Cadeia da Polimerase em Tempo Real/métodos , Mycobacterium tuberculosis/genética , Sensibilidade e EspecificidadeRESUMO
This study aimed to evaluate the effect of COVID-19 outbreak on stroke admission by using a national database. A quasi-experimental, ecological study using the national database of Thailand was conducted. The study period was between January 2017 and August 2020 before and after COVID-19 outbreak starting from March 2020. Numbers of stroke admission were evaluated before and after the COVID-19 outbreak by an interrupted time series analysis for both pre- and post-COIVD-19 outbreak. There were 381,891 patients admitted throughout Thailand. Of those, 292,382 patients (76.56%) were admitted due to thrombotic stroke followed by hemorrhagic stroke (73,130 patients; 19.15%) and embolic stroke (16,379 patients; 4.29%). During pre-COVID-19 outbreak, all stroke subtypes had an increasing trend with a coefficient of 0.076 (p value < 0.001) for thrombotic stroke, 0.003 (p value < 0.001) for embolic stroke and 0.012 (p value = 0.025) for hemorrhagic stroke. The COVID-19 outbreak had significantly effect on reductions of incidence rates of thrombotic and hemorrhagic stroke with a coefficient of -2.412 (p value < 0.001) and -0.803 (p value = 0.023). The incidence rates of three stroke subtypes were increasing prior to the COVID-19 outbreak. The COVID-19 outbreak significantly impacts hospital admission rates of both thrombotic and hemorrhagic stroke subtypes.
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Introduction: Post thrombolytic symptomatic intracerebral haemorrhage (sICH) is a major concern in patients who had acute ischaemic stroke. Leukoaraiosis (LA) is reported to be related with sICH after intravenous thrombolytic treatment. However, the influence of LA and stroke neurological and imaging severity scores is still debated. Objective: To evaluate if LA or severity scores are related with sICH in patients who had acute ischaemic stroke who received thrombolytic therapy. And, predictors for sICH were also studied with adjustment of baseline severity scores. Methods: This was a retrospective, analytical study. The inclusion criteria were adult patients diagnosed as acute ischaemic stroke who received the recombinant tissue plasminogen activator (rtPA) treatment within 4.5 hours. The study period was between May 2007 and November 2016. Predictors for sICH were determined using logistic regression analysis. Results: During the study period, there were 504 eligible patients. Of those, 45 patients (8.92%) had sICH. Among nine factors in the final model for predicting sICH, there were four independent factors including previous antiplatelet therapy, previous anticoagulant therapy, presence of LA and hyperdense artery sign. The highest adjusted OR was previous anticoagulant therapy (5.08 with 95% CI of 1.18 to 11.83), while the LA factor had adjusted OR (95% CI) of 2.52 (1.01 to 6.30). Conclusions: LA, hyperdense artery sign, previous antiplatelet therapy and previous anticoagulant therapy were associated with post-rtPA sICH. Further studies are required to confirm the results of this study.
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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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Caracteres Sexuais , Acidente Vascular Cerebral , Humanos , Feminino , Masculino , Estudos de Coortes , Tailândia/epidemiologia , Acidente Vascular Cerebral/epidemiologia , Fatores de RiscoRESUMO
Thrombolytic therapy is useful in severe stroke, but it increases the risk of intracerebral hemorrhage. In addition, it may have limited use in resource-limited due to a lack of trained neurologists and equipment to perform CT scans. There are limited data available from studies of national databases on stroke outcomes and predictors of severe stroke. This study, therefore, aimed to evaluate acute severe ischemic stroke outcomes in a real-world setting. Additionally, predictors of favorable stroke outcomes were explored using a retrospective cohort. Data were extracted from the National Health Security Office (NHSO) in Thailand. The inclusion criteria were: Aged ≥18 years or older, diagnosis of acute severe ischemic stroke (defined by an admission National Institutes of Health Stroke Scale score of 15-24), and available data on stroke outcomes. Outcomes were evaluated at discharge using a modified Rankin score at discharge. Factors associated with good outcomes were determined using multivariate logistic regression analysis. During the study period, 268 severe stroke patients met the inclusion criteria. Of those, 38 (14.18%) had good outcomes at discharge. A total of 223 patients received intravenous recombinant tissue plasminogen activator (83.21%). Of those, 38 (17.04%) had favorable outcomes. A predictive model for good outcomes revealed two independent factors: Male sex and atrial fibrillation with adjusted odds ratios (95% confidence interval) of 2.30 (1.10-4.82) and 0.38 (0.16-0.91), respectively. Predictors for good stroke outcomes in severe stroke patients included rtPA treatment, atrial fibrillation, and male sex.
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Lemierre's syndrome is a rare multisystemic infection beginning in oropharynx commonly caused by oral anaerobic organisms and leading to internal jugular vein thrombosis with septic emboli. Here, we describe a 45-year-old woman with hypertension and unrecognised type 2 diabetes who presented to a community hospital with fever, double vision and septic shock. Examination showed neck pain aggravated by neck flexion, limited ocular movement of right lateral rectus, left medial rectus and left superior oblique and incomplete ptosis of the left eye. These symptoms were suggestive of bilateral cavernous sinus syndrome. CT of the brain showed bilateral proximal internal jugular vein and cavernous sinus thrombosis. CT angiography revealed septic emboli at both upper lungs. The patient had good improvement of neurological symptoms after dental extraction, intravenous antibiotic and anticoagulant.
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Trombose do Corpo Cavernoso , Diabetes Mellitus Tipo 2 , Síndrome de Lemierre , Trombose Venosa , Trombose do Corpo Cavernoso/diagnóstico por imagem , Trombose do Corpo Cavernoso/etiologia , Feminino , Humanos , Veias Jugulares/diagnóstico por imagem , Síndrome de Lemierre/diagnóstico , Síndrome de Lemierre/diagnóstico por imagem , Pessoa de Meia-Idade , Trombose Venosa/diagnóstico por imagem , Trombose Venosa/tratamento farmacológico , Trombose Venosa/etiologiaRESUMO
INTRODUCTION: Stroke is a common neurological disease. Thrombolytic therapy has been shown to be beneficial in acute ischemic stroke. This treatment can be given in various hospital levels. This study aimed to evaluate the quality of acute ischemic stroke care among various hospital levels. METHODS: Data were randomly selected from the medical records that were sent to the National Health Security Office (NHSO) for reimbursement purposes between October 2015 and August 2016. Patient demographics, risk factors, stroke subtypes, stroke severity, quality of care indicators, and complications were recorded. Paired comparisons between two groups were carried out using the Bonferroni correction. RESULTS: A total of 947 patients, including 169 patients from community hospitals (CHs), 629 from regional hospitals (RHs), and 149 from tertiary hospitals (THs), were included in the final analysis. The CH group had a higher median age but lower median initial National Institutes of Health Stroke Scale (NIHSS) score than the RH and TH groups (median age = 70, 66, and 67 years, respectively, and initial NIHSS = 6, 8, and 9, respectively). The CH group had shorter onset-to-needle times for intravenous recombinant tissue plasminogen activator (rt-PA) treatment than the other two groups (147 vs. 178.5 and 180 min). After adjustment for baseline characteristics, stroke type, and stroke severity, the CH group was significantly associated with lower mortality and presence of complications. The adjusted odds ratios (95% confidence intervals) for the two factors were 0.13 (0.03, 0.67) and 0.59 (0.35, 0.99). None of the patients received endovascular therapy or non-thrombolytic interventional therapy. CONCLUSION: CHs may have the potential for acute ischemic stroke care in the same way as RHs or THs, with faster rt-PA treatment, in northeast Thailand. However, further studies should be performed to evaluate appropriate patient characteristics for CHs.
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Previous studies have found an association between chronic kidney disease and poor outcomes in stroke patients. However, there is a paucity of literature evaluating this association by stroke type. We therefore aimed to explore the association between CKD and stroke outcomes according to type of stroke. The data consisting of 594,681 stroke patients were acquired from Universal Coverage Health Security Insurance Scheme Database in Thailand. Binary logistic regression was used to assess the relationship of CKD and outcomes, which were as follows; in-hospital mortality, long length of stay (>3 days), pneumonia, sepsis, respiratory failure and myocardial infarction. Results: after fully adjusting for covariates, CKD was associated with increased odds of in-hospital mortality in patients with ischemic (OR 1.32; 95% CI = 1.27-1.38), haemorrhagic (OR 1.31; 95% CI = 1.24-1.39), and other undetermined stroke type (OR 1.44; 95% CI = 1.21-1.73). CKD was found to be associated with increased odds of pneumonia, sepsis, respiratory failure and myocardial infarction in ischaemic stroke. While CKD was found to be associated with increase odds of sepsis, respiratory failure, and myocardial infarction, decrease odds of pneumonia was observed in patients with haemorrhagic stroke. In other undetermined stroke type, CKD was found to only be associated with increase odds of sepsis and respiratory failure, while there is no significant association of CKD and increase or decrease odds with pneumonia and myocardial infarction. CKD was associated with poor outcomes in all stroke types. CKD should be considered as part of stroke prognosis as well as identifying at risk patient population for in-hospital complications.
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Acidente Vascular Cerebral Hemorrágico/epidemiologia , AVC Isquêmico/epidemiologia , Insuficiência Renal Crônica/epidemiologia , Idoso , Idoso de 80 Anos ou mais , Comorbidade , Feminino , Acidente Vascular Cerebral Hemorrágico/mortalidade , Mortalidade Hospitalar , Humanos , AVC Isquêmico/mortalidade , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Prognóstico , Insuficiência Renal Crônica/mortalidade , Taxa de Sobrevida , Tailândia/epidemiologiaRESUMO
OBJECTIVES: We examined the existence and potential burden of seasonality of stroke admissions and mortality within a tropical climate using cohort data collected between 1â¯st November 2003 and 31â¯st October 2012. PATIENTS AND METHODS: In a prospective cohort of hospitalised stroke patients from the catchment of â¼75 % of the Thai population (nâ¯=â¯569,307; mean SD ageâ¯=â¯64(14.5)), incident stroke admissions, in-hospital mortality, prolonged hospitalisations, and stroke related complications by season were determined. Rates of incident stroke admissions by month and season were plotted. Winter excess indexes for study outcomes expressed as a percentage were calculated. Using logistic regression we examined the association between winter admission and in-hospital mortality (non-winter admission as reference) adjusting for age, sex, stroke type, year of admission, and presence of pre-existing comorbidities. RESULTS: We observed a winter excess in mortality during hospitalisation (+10.3 %) and prolonged length of stay (+7.3 %). Respective winter excess indexes for dyslipidaemias, arrhythmias, anaemia, and alcohol related disorders in patients that died during hospitalisation were +1.4 %, +6.2 %, +0.2 %, +1.5 %. In these patients, respective winter excess indexes for post-stroke complications of pneumonia and sepsis were +6.7 % and +3.2 %. In fully adjusted analyses, winter admission (compared to non-winter admission) was associated with increased odds of in-hospital mortality (OR (95 % CI)â¯=â¯1.023 (1.006-1.040)). CONCLUSIONS: We provide robust evidence for the existence of an excess in winter stroke admissions and subsequent in-hospital deaths within a tropical region.
Assuntos
Gerenciamento de Dados , Mortalidade Hospitalar/tendências , Admissão do Paciente/tendências , Vigilância da População , Estações do Ano , Acidente Vascular Cerebral/mortalidade , Idoso , Idoso de 80 Anos ou mais , Estudos de Coortes , Gerenciamento de Dados/métodos , Feminino , Seguimentos , Humanos , Tempo de Internação/tendências , Masculino , Pessoa de Meia-Idade , Vigilância da População/métodos , Estudos Prospectivos , Acidente Vascular Cerebral/diagnóstico , Acidente Vascular Cerebral/terapia , TailândiaRESUMO
Large cerebral infarctions have high morbidity and mortality. Patients with large cerebral infarctions may have recurrent ischemia as high as 8.1% within 7 days; highest among other types of strokes. Data regarding risk factors for large cerebral infarction in Asian populations are still scant. All adult (age ≥15 years old) patients with the diagnosis of thrombotic ischemic stroke who were treated at Srinagarind Hospital, Khon Kaen University, Thailand from January 2012 to December 2013 were studied. Large cerebral infarctions are defined by clinical criteria of having cerebral cortical impairment, brain stem or cerebellar dysfunction with infarction sizes of more than 1.5 cm. The association of various stroke risk factors and large infarction strokes were calculated using multiple logistic regression analysis. There were 276 thrombotic stroke patients who met the study criteria; classified as large cerebral infarctions in 59 patients (21.38%) and small cerebral infarctions in 217 patients (78.62%). Baseline characteristics and risk factors for stroke were comparable between both groups. The large cerebral infarction group had a significantly larger proportions of right internal carotid artery stenosis, plaques on the left side, left internal carotid artery stenosis, and internal carotid artery stenosis at any side than the small cerebral infarction group. Among various stroke risk factors, only internal carotid artery stenosis at any side was the only significant factor associated with large cerebral infarction with an adjusted odds ratio of 11.14 (95% CI: 3.46, 35.82). In conclusion, significant internal carotid artery stenosis is associated with large cerebral infarction.
RESUMO
OBJECTIVE: We aimed to examine the impact of heart failure (HF) on stroke mortality (in-hospital and postdischarge) and recurrence in a national stroke cohort from Thailand. METHODS: We used a large, insurance-based database including all stroke admissions in the public health sector in Thailand between 2004 and 2015. Logistic and Royston-Parmar regressions were used to quantify the effect of HF on in-hospital and long-term outcomes, respectively. All models were adjusted for age, sex and comorbidities and stratified by stroke type: acute ischaemic stroke (AIS) or intracerebral haemorrhage (ICH). Multistate models were constructed using flexible survival techniques to predict the impact of HF on the disease course of a patient with stroke (baseline-[recurrence]-death). Only first-ever cases of AIS or ICH were included in the multistate analysis. RESULTS: 608 890 patients (mean age 64.29±13.72 years, 55.07% men) were hospitalised (370 527 AIS, 173 236 ICH and 65 127 undetermined pathology). There were 398 663 patients with first-ever AIS and ICH. Patients were followed up for a median (95% CI) of 4.47 years (4.45 to 4.49). HF was associated with an increase in postdischarge mortality in AIS (HR [99% CI] 1.69 [1.64 to 1.74]) and ICH (2.59 [2.07 to 3.26]). HF was not associated with AIS recurrence, while ICH recurrence was only significantly increased within the first 3 years after discharge (1.79 [1.18 to 2.73]). CONCLUSIONS: HF increases the risk of mortality in both AIS and ICH. We are the first to report on high-risk periods of stroke recurrence in patients with HF with ICH. Specific targeted risk reduction strategies may have significant clinical impact for mortality and recurrence in stroke.
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Prisoners are at risk for both physical and psychological diseases. Here, we report an outbreak of peripheral neuropathy in a prison in northeast Thailand. Between July and December 2014, there were 88 male prisoners at Bueng Kan Provincial Prison in Bueng Kan, Thailand suffering from peripheral neuropathy out of a total of 1,464 prisoners (6.01%). The common age range was 20-39 years (58 patients; 65.91%). The three most common features were hyporeflexia/areflexia of the lower extremities (36 patients; 83.72%). On laboratory vitamin B1 deficiency was detected in 4/5 patients, positive rhinovirus polymerase chain reaction in 3/4 patients, positive Mycoplasma pneumoniae IgM in 1/12 patients, and positive urinary arsenic in 4/7 patients. A dT vaccination was given on October 14 during the outbreak. This was a large outbreak of peripheral neuropathy in male prisoners. There are several possible causes of this outbreak including vitamin B1 deficiency, dT vaccination, arsenic toxicity, rhinovirus, and Mycoplasma infection.
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BACKGROUND: There are limited data available on factors associated with length of stay (LOS) in cases of acute ischemic stroke according to Poisson analysis, which is more appropriate than other methods. MATERIALS AND METHODS: We retrospectively reviewed medical summary charts of patients with acute ischemic stroke in 30 hospitals across northeast Thailand, with the main outcome as LOS. Poisson regression was used to examine factors associated with LOS. RESULTS: We included 898 patients in the analysis; 460 (51.2%) were male. The median age (interquartile; IQR) was 58 (67-75) years and the median LOS was 5 (4-7) days. The median National Institute of Health Stroke Scale (NIHSS [IQR]) was 8 (4-13). Results of the analysis showed that, after controlling for age, stroke severity, atrial fibrillation, and thrombolytic use, significant variables associated with LOS were moderate stroke (incidence rate ratio [IRR] 95% confidence interval [CI] =1.15 [range 1.01-1.30], P=0.040), severe stroke (IRR [95% CI] =1.27 [1.09-1.47], P=0.002), thrombolytic use (IRR [95% CI] =0.68 [0.60-0.76], P<0.001), and atrial fibrillation (IRR [95% CI] =1.15 [1.02-1.30], P=0.023). After adjusting for complications, thrombolytic use remained significantly associated with decreased LOS (IRR [95% CI] =0.74 [0.67-0.83], P=0.001). Other significant factors were atrial fibrillation (IRR [95% CI] =1.14 [1.02-1.28], P=0.018), pneumonia (IRR [95% CI] =1.48 [1.30-1.68], P<0.001), and urinary tract infection (IRR [95% CI] =1.41 [1.14-1.74], P=0.001). CONCLUSION: According to Poisson analysis, intravenous thrombolysis, atrial fibrillation, pneumonia, and urinary tract infection are associated with LOS in cases of acute ischemic stroke, regardless of age, stroke severity, comorbidities, or complications.