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1.
J Assoc Physicians India ; 68(3): 54-58, 2020 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-32138485

RESUMEN

Introduction: Cerebrovascular disorders (CVD) are increasing in prevalence and incidence in Indian population. Global burden of disease study shows that of the 9.4 million deaths in India, 619,000 were due to stroke. A matter of concern is that in the last two decades there is a significant increase in prevalence rate of stroke. Aim: To find the demographic characteristics along with clinico-radiological profile and of patients presenting with stroke in a tertiary care hospital in Rajasthan. Methodology: This cross sectional study was conducted for a period of 6 months from Aug 2015 to Jan 2016 in a tertiary care hospital .A sample size of 360 patients with aged >18 years were recruited after obtaining written consent from those who attended the medical OPD or were admitted to the government hospital with the newly diagnosed stroke and confirmed by neuroimaging. Result: The mean age of stroke in present study was 60.46 ± 14.84 years. The stroke in the young age group defined as 40 years or less comprised only 6%. Hypertension as a risk factor was present in 52.5% of our patients followed by Dyslipidaemia (25.8%). 79.4% had ischemic stroke and 19.4 % haemorrhagic stroke. Supratentorial lesions were seen in 86.4% patients, infratentorial lesions in only 10% anterior circulation strokes (MCA>ACA) are more common than posterior circulation strokes. Motor and sensory symptoms are common in acute strokes rather than change in consciousness or speech abnormalities. 70.2% patients had moderate disability at the end of 28 days. Early presentation to hospital (<3hrs) is associated with better outcome and less morbidity in a stroke patient.


Asunto(s)
Accidente Cerebrovascular/epidemiología , Adolescente , Adulto , Anciano , Estudios Transversales , Humanos , India/epidemiología , Persona de Mediana Edad , Radiografía , Factores de Riesgo , Factores Socioeconómicos , Centros de Atención Terciaria , Atención Terciaria de Salud , Adulto Joven
2.
Zhonghua Xin Xue Guan Bing Za Zhi ; 48(2): 148-153, 2020 Feb 24.
Artículo en Chino | MEDLINE | ID: mdl-32135616

RESUMEN

Objective: To explore the prevalence and risk factors of ischemic stroke in rural areas of Liaoning province. Methods: The study was a cross-sectional survey. From September 2017 to May 2018, a total of 10 926 rural residents aged ≥40 years were investigated in Chaoyang county, Lingyuan, Liaoyang county and Donggang city of Liaoning province. The investigation included questionnaire survey, physical examination and laboratory examination.Univariate and multivariate logistic regression models were used to analyze the risk factors of ischemic stroke. Results: The prevalence of ischemic stroke in the rural areas of Liaoning province was 5.51% (602/10 926), and the standardized prevalence rate was 4.04%. The standardized prevalence rate of male (5.05%) is higher than that of female (3.44%). The prevalence of ischemic stroke increased with age in both males (P<0.01) and females (P<0.01). Multivariate logistic regression analysis showed that age increase(compared with 40-49 years old group, 50-59 years old, OR=2.08, 95%CI 1.31-3.30, P=0.02; 60-69 years old, OR=3.90, 95%CI 2.51-6.05, P<0.01; 70-79 years old, OR=5.32, 95%CI 3.37-8.34, P<0.01; ≥80 years old, OR=3.64, 95%CI 2.00-6.62, P<0.01), male(OR=2.35, 95%CI 1.95-2.84, P<0.01),family history of stroke(OR=2.18, 95%CI 1.83-2.60, P<0.01),coronary heart disease (OR=2.01, 95%CI 1.52-2.66, P<0.01), hypertension (OR=2.82, 95%CI 2.21-3.60, P<0.01), diabetes mellitus (OR=1.36, 95%CI 1.11-1.67, P=0.03) and overweight/obese (OR=1.22, 95%CI 1.02-1.47, P=0.03) were the major risk factors of ischemic stroke. Conclusions: The prevalence of ischemic stroke in rural areas of Liaoning province is high. Age, male, family history of stroke, coronary heart disease, hypertension, diabetes mellitus, overweight/obesity are the risk factors of ischemic stroke in rural areas of Liaoning province.


Asunto(s)
Isquemia Encefálica , Accidente Cerebrovascular , Adulto , Anciano , Anciano de 80 o más Años , Isquemia Encefálica/epidemiología , China/epidemiología , Estudios Transversales , Femenino , Humanos , Hipertensión , Masculino , Persona de Mediana Edad , Prevalencia , Factores de Riesgo , Población Rural , Accidente Cerebrovascular/epidemiología
3.
Medicine (Baltimore) ; 99(12): e19467, 2020 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-32195946

RESUMEN

BACKGROUND: The findings on the association between elevated plasma homocysteine levels and the risk of the trial of org 10172 in acute stroke treatment (TOAST) of ischemic stroke have been inconsistent in Chinese. So far, there is no meta-analysis about the association between Hcy and the TOAST subtypes of ischemic stroke in Chinese. This study; therefore, aimed to evaluate whether elevated homocysteine levels are associated with the TOAST subtypes of ischemic stroke using a meta-analysis. MATERIALS AND METHODS: A systematic search of electronic databases were conducted for studies reporting homocysteine levels in ischemic stroke and the TOAST of ischemic stroke to April 18, 2018. The data were extracted after the application of inclusion and exclusion criteria. All the data were analyzed using Stata software version 9.0 (Stata Corp LP, College Station, TX). The standardized mean difference (SMD) and 95% confidence interval (CI) were used to compare continuous variables. RESULTS: Thirteen studies comprising 3114 participants (2243 patients and 871controls) met the eligibility criteria and were included in the meta-analysis. The meta-analysis revealed that the ischemic stroke group had significantly higher levels of homocysteine than controls (SMD = 1.15, 95% CI = 0.85-1.45, P < .05). The subgroup analyses suggested that the groups of patients with large-artery atherosclerosis, small-vessel occlusion, cardioembolism, stroke of other determined etiology and stroke of undetermined etiology had significantly higher levels of homocysteine compared to those in the control group (large-artery atherosclerosis: SMD = 2.12, 95% CI = 1.40-2.84, P < .05; small-vessel occlusion: SMD = 1.10, 95% CI = 0.72-1.48, P < .05; CE: SMD = 1.17, 95% CI = 0.64-1.71, P < .05; stroke of other determined etiology: SMD = 0.88, 95% CI = 0.53-1.24, P < .05; stroke of undetermined etiology: SMD = 1.50, 95% CI = 0.66-2.33, P < .05, respectively). CONCLUSION: This meta-analysis found that ischemic stroke patients and the TOAST of ischemic stroke patients in Chinese had significantly higher homocysteine levels than the controls, suggesting that serum homocysteine levels may be a risk factor for ischemic stroke and the TOAST subtypes of ischemic stroke in Chinese.


Asunto(s)
Isquemia Encefálica/metabolismo , Homocisteína/sangre , Accidente Cerebrovascular/metabolismo , Aterosclerosis/complicaciones , Aterosclerosis/patología , Isquemia Encefálica/epidemiología , Isquemia Encefálica/patología , China/epidemiología , Humanos , Hiperhomocisteinemia/complicaciones , Hiperhomocisteinemia/epidemiología , Factores de Riesgo , Accidente Cerebrovascular/epidemiología , Accidente Cerebrovascular/etiología , Accidente Cerebrovascular/patología
4.
Medicine (Baltimore) ; 99(11): e19460, 2020 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-32176078

RESUMEN

Transient ischemic attack (TIA) is often recurrent, and about one-third of patients will progress to cerebral infarction. Rapidly identifying high-risk patients is pivotal to prevent the development of cerebral infarction. Therefore, this study aimed to evaluate the value of ABCD score, ABCD score combined with magnetic resonance diffusion weighted imaging (DWI) and intracranial arterial magnetic resonance angiography (MRA) in predicting cerebral infarction after 2 to 30 days of transient ischemic attack (TIA).182 patients with TIA from August 2011 to August 2014 were enrolled as study subjects, and their clinical data, test results of DWI and MRA were collected. The incidence of cerebral infarction was observed at 2 days, 7 days and 30 days after TIA in patients with TIA, through scoring according to the 7-point ABCD score method proposed by Johnston. The relationship between ABCD score, performances of DWI and MRA and the early incidence of cerebral infarction after TIA was analyzed. The accuracy rating of ABCD score and ABCD + DWI + MRA score used for predicting the early incidence of cerebral infarction after TIA were compared with each other.The incidence of cerebral infarction after TIA was 19 cases (10.4%) in 2 days, 42 cases (23.1%) in 7 days, 56 cases (30.8%) in 30 days respectively. For the ABCD score of incidence of cerebral infarction 2 to 30 days after TIA, that of those with high risk was higher than that with medium risk, and that with the medium risk was higher than that with low risk (P < .05). The area under the curve of ABCD + DWI + MRA score and ABCD score predicting the incidence of cerebral infarction was: in 2 days: 0.782 and 0.748, in 7 days: 0.839 and 0.801, in 30 days: 0.780 and 0.757, P < .05.Compared with ABCD score, ABCD score combined with DWI and MRA can further improve the accuracy of prediction for cerebral infarction after TIA.


Asunto(s)
Ataque Isquémico Transitorio/complicaciones , Accidente Cerebrovascular/etiología , China/epidemiología , Imagen de Difusión por Resonancia Magnética , Femenino , Humanos , Incidencia , Ataque Isquémico Transitorio/diagnóstico por imagen , Angiografía por Resonancia Magnética , Masculino , Persona de Mediana Edad , Valor Predictivo de las Pruebas , Medición de Riesgo , Factores de Riesgo , Accidente Cerebrovascular/diagnóstico por imagen , Accidente Cerebrovascular/epidemiología
5.
Ann Acad Med Singapore ; 49(1): 26-36, 2020 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-32200394

RESUMEN

INTRODUCTION: Air pollution is a global problem and seasonal haze from forest clearing and peat land burning in Indonesia is an annual phenomenon in Southeast Asia. As neurological disorders comprise 6.3% of the burden of disease globally, we reviewed evidence of the association between common neurological conditions and air pollution exposure, and summarised existing data on the impact of the haze phenomenon in Southeast Asia. MATERIALS AND METHODS: A PubMed search for relevant studies on air pollution, Alzheimer's disease (AD), dementia, epilepsy, haze, headache, migraine, stroke, Parkinson's disease (PD) and neuromuscular conditions was performed. There were 52 articles which were relevant and were reviewed. RESULTS: There were associations between short-term air pollution exposure with AD, epilepsy, ischaemic stroke and migraine. Long-term air pollution exposure was associated with AD, amyotrophic lateral sclerosis, dementia and ischaemic stroke. Evidence on the link between air pollution and PD was inconsistent. Currently, there is no specific data on the effects haze has on neurological conditions in Southeast Asia. CONCLUSION: Air pollution is associated with increased risk of certain common neurological disorders. More specific studies are needed to investigate the impact of seasonal haze on neurological conditions in Southeast Asia.


Asunto(s)
Contaminantes Atmosféricos/toxicidad , Contaminación del Aire/efectos adversos , Isquemia Encefálica/epidemiología , Enfermedades del Sistema Nervioso/epidemiología , Accidente Cerebrovascular/epidemiología , Asia Sudoriental , Humanos , Estaciones del Año
6.
Medicine (Baltimore) ; 99(8): e19209, 2020 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-32080110

RESUMEN

Blood pressure (BP) control is the most established practice for preventing the progression and complications of chronic kidney disease (CKD). We examined the influence of BP patterns on target organ damage in hypertensive patients with CKD by using long-term follow-up data of the APrODiTe-2 study.We collected 5 years of data of APrODiTe-2 study (1 year longitudinal study) participants after the enrollment on the progression of estimated glomerular filtration (eGFR), renal outcomes (doubling of serum creatinine, 50% decrease of eGFR, maintenance dialysis, and kidney transplantation), cerebro-cardiovascular (CCV) accidents, and all-cause mortality (n=378) to evaluate the long-term influence of BP patterns on target organ damages.Initially, more than 2/3 of patients showed masked (50.0%) and sustained uncontrolled (30.6%) BP control states as well as non- (31.3%) and reverse-dipping (35.0%) states. Only 18.8% and 20.8% of participants showed a better change in BP control patterns and a dipping pattern change to dippers over 1 year, respectively. Composite of new CCV accidents occurred in 43 patients (11.4%), and no BP patterns were associated with the occurrence of new CCV accidents. A worse change in BP control categories over 1 year was associated with increased occurrence of composites of renal outcomes after adjustment for age, sex, and the cause of CKD (HR 5.997 [1.454-24.742], P = .013 and HR 4.331 [1.347-13.927], P = .014, respectively). Patients with a worse initial BP control category, a worse change in BP control categories over 1 year, and higher clinic systolic BP and pulse pressure (PP) (> median level) were more likely to have faster eGFR progression (absolute eGFR and eGFR ratio).Higher BP burden (a worse change in BP control categories, higher initial clinic systolic BP and PP) was associated with faster eGFR progression and increased occurrence of renal outcomes.


Asunto(s)
Presión Sanguínea/fisiología , Hipertensión/epidemiología , Insuficiencia Renal Crónica/epidemiología , Insuficiencia Renal Crónica/fisiopatología , Anciano , Creatinina/sangre , Femenino , Tasa de Filtración Glomerular , Humanos , Estudios Longitudinales , Masculino , Persona de Mediana Edad , Insuficiencia Renal Crónica/mortalidad , Accidente Cerebrovascular/epidemiología
7.
Medicine (Baltimore) ; 99(7): e19057, 2020 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-32049804

RESUMEN

Although cholecystectomy is generally recommended for acute acalculous cholecystitis (AAC) treatment, non-surgical management can be considered in patients at a high risk for surgery. This study compared outcomes of surgical and non-surgical management and analyzed the long-term outcomes of AAC patients managed non-surgically.We retrospectively analyzed 89 patients diagnosed with AAC between January 1, 2007 and April 30, 2014. These patients were divided into 2 groups: non-surgical (n = 41) and surgical (n = 48). Non-surgical management methods were percutaneous cholecystostomy (PC, n = 14) and antibiotics only (n = 27). The non-surgical group was followed up for >3 years after treatment.The mean age was slightly higher in the non-surgical group than in the surgical group without significant difference. The prevalence of cerebrovascular accident in the non-surgical group was significantly higher than that in the surgical group (26.8% vs 8.3%, P = .020). Mean hospital stay was not statistically different between two groups. The surgical group had a significantly higher incidence of posttreatment complications than the non-surgical group (18.8% vs 2.4%, P = .015). During the mean follow-up of 5.7 years, AAC recurred in 4 (9.8%) patients in the non-surgical group. Three patients underwent cholecystectomy, 1 was treated with antibiotics, and no recurrence-related death occurred. The recurrence rate of AAC was not different between PC and antibiotics only groups (14.3% vs 7.4%, P = .596).Recurrence was observed in 9.8% of AAC patients treated non-surgically and the outcome in the non-surgical group was not inferior to that in the surgical group.


Asunto(s)
Colecistitis Alitiásica/terapia , Antibacterianos/efectos adversos , Colecistostomía/efectos adversos , Accidente Cerebrovascular/epidemiología , Anciano , Anciano de 80 o más Años , Antibacterianos/uso terapéutico , Femenino , Humanos , Tiempo de Internación , Masculino , Persona de Mediana Edad , Prevalencia , Recurrencia , Estudios Retrospectivos , Accidente Cerebrovascular/etiología , Resultado del Tratamiento
8.
Emergencias (Sant Vicenç dels Horts) ; 32(1): 33-39, feb. 2020. tab, graf
Artículo en Español | IBECS | ID: ibc-185851

RESUMEN

Objetivo. Identificar los factores asociados con una respuesta inicial inmediata a los síntomas en los pacientes que han padecido un ictus isquémico. Método. Estudio observacional transversal en el que se incluyeron a todos los pacientes con ictus isquémico ingresados de forma consecutiva en el Hospital Universitario de Burgos (España) durante 1 año. Se recogieron parámetros sociodemográficos, clínicos, conductuales, cognitivos y contextuales, y se estudió su posible relación con el tiempo de reacción del paciente (TR) mediante análisis univariante y multivariante. Resultados. Se incluyeron 425 pacientes (mediana del TR de 140 minutos). El TR supuso un 72,6% del tiempo prehospitalario total (TPH), con una respuesta inmediata si el paciente se encontraba acompañado (OR 9,57; IC95% 3,89-23,52), si los síntomas se iniciaban durante el día (OR 8,77; 3,40-22,63), si el paciente sabía cómo actuar ante un posible ictus (OR 3,84; 2,77-7,09), si el primer contacto médico era con el servicio de emergencias médicas (SEM) (OR 3,03; 1,62-5,68), si el paciente percibía la situación como grave o muy grave (OR 2,38; 1,17-4,83) o si el ictus ocurría en el ámbito urbano (OR 2,17; 1,16-4,06). Conclusión. El intervalo de tiempo entre el inicio de los síntomas y la respuesta inicial del paciente se relaciona con factores conductuales, cognitivos y contextuales, los cuales deberían ser considerados en la planificación de futuras campañas educacionales


Objective. To identify factors related to a rapid response to the onset of symptoms and a call for help for patients with ischemic stroke. Methods. Observational cross-sectional study of all patients with ischemic stroke admitted consecutively to Hospital Universitario de Burgos in Spain during 1 year. We collected sociodemographic, clinical, behavioral, cognitive, and contextual data for all patients and applied uni- and multivariate analysis to explore possible associations with the patient's response time. Results. A total of 425 patients were included. The mean patient response time was 140.00 minutes. Patient delay accounted for 72.6% of the total prehospital response time. Factors associated with a rapid call for help were the presence of an accompanying person (OR, 9.57; 95% CI, 3.89-23.52), daytime onset of symptoms (OR, 8.77; 3.40-22.63), patient knowledge of how to act in case of stroke symptoms (OR, 3.84; 2.77-7.09), first medical contact through the public health system's emergency medical service (OR, 3.03; 1.62-5.68), patient perception of symptoms as severe or very severe (OR, 2.38; 1.17-4.83), and stroke onset in an urban area (OR, 2.17; 1.16-4.06). Conclusions. The patient's response time between onset of symptoms is related to behavioral, cognitive and contextual factors that should be taken into account when planning future patient education campaigns


Asunto(s)
Humanos , Masculino , Femenino , Anciano , Accidente Cerebrovascular/epidemiología , Isquemia Encefálica/complicaciones , Factores de Tiempo , Tiempo de Tratamiento , Estudios Transversales , Análisis Multivariante , Atención Prehospitalaria/estadística & datos numéricos , Conducta de Búsqueda de Ayuda
9.
N Engl J Med ; 382(9): 799-809, 2020 02 27.
Artículo en Inglés | MEDLINE | ID: mdl-31995682

RESUMEN

BACKGROUND: There are scant data on long-term clinical outcomes and bioprosthetic-valve function after transcatheter aortic-valve replacement (TAVR) as compared with surgical aortic-valve replacement in patients with severe aortic stenosis and intermediate surgical risk. METHODS: We enrolled 2032 intermediate-risk patients with severe, symptomatic aortic stenosis at 57 centers. Patients were stratified according to intended transfemoral or transthoracic access (76.3% and 23.7%, respectively) and were randomly assigned to undergo either TAVR or surgical replacement. Clinical, echocardiographic, and health-status outcomes were followed for 5 years. The primary end point was death from any cause or disabling stroke. RESULTS: At 5 years, there was no significant difference in the incidence of death from any cause or disabling stroke between the TAVR group and the surgery group (47.9% and 43.4%, respectively; hazard ratio, 1.09; 95% confidence interval [CI], 0.95 to 1.25; P = 0.21). Results were similar for the transfemoral-access cohort (44.5% and 42.0%, respectively; hazard ratio, 1.02; 95% CI, 0.87 to 1.20), but the incidence of death or disabling stroke was higher after TAVR than after surgery in the transthoracic-access cohort (59.3% vs. 48.3%; hazard ratio, 1.32; 95% CI, 1.02 to 1.71). At 5 years, more patients in the TAVR group than in the surgery group had at least mild paravalvular aortic regurgitation (33.3% vs. 6.3%). Repeat hospitalizations were more frequent after TAVR than after surgery (33.3% vs. 25.2%), as were aortic-valve reinterventions (3.2% vs. 0.8%). Improvement in health status at 5 years was similar for TAVR and surgery. CONCLUSIONS: Among patients with aortic stenosis who were at intermediate surgical risk, there was no significant difference in the incidence of death or disabling stroke at 5 years after TAVR as compared with surgical aortic-valve replacement. (Funded by Edwards Lifesciences; PARTNER 2 ClinicalTrials.gov number, NCT01314313.).


Asunto(s)
Estenosis de la Válvula Aórtica/cirugía , Implantación de Prótesis de Válvulas Cardíacas/métodos , Prótesis Valvulares Cardíacas , Reemplazo de la Válvula Aórtica Transcatéter , Anciano , Anciano de 80 o más Años , Válvula Aórtica/diagnóstico por imagen , Válvula Aórtica/cirugía , Insuficiencia de la Válvula Aórtica/etiología , Insuficiencia de la Válvula Aórtica/fisiopatología , Estenosis de la Válvula Aórtica/complicaciones , Estenosis de la Válvula Aórtica/diagnóstico por imagen , Estenosis de la Válvula Aórtica/mortalidad , Estudios de Cohortes , Ecocardiografía , Femenino , Estado de Salud , Humanos , Incidencia , Análisis de Intención de Tratar , Estimación de Kaplan-Meier , Masculino , Análisis Multivariante , Complicaciones Posoperatorias/mortalidad , Factores de Riesgo , Accidente Cerebrovascular/epidemiología , Accidente Cerebrovascular/etiología , Resultado del Tratamiento
10.
Eur J Clin Invest ; 50(3): e13200, 2020 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-31953953

RESUMEN

BACKGROUND: Atrial fibrillation (AF) is common amongst the elderly, but this group tends to be suboptimally treated. Limited data are available on the stroke prevention strategies in the elderly, especially in the Balkan region. AIM: We investigated the use of oral anticoagulant therapy (OAC) amongst elderly AF patients in clinical practice in the Balkan region. METHOD: A 12-week prospective snapshot survey (2014-2015) of consecutive non-valvular AF patients was conducted in Albania, Bosnia and Herzegovina, Bulgaria, Croatia, Montenegro, Romania and Serbia. Data were collected via an electronic case report form. RESULTS: Of 2671 patients, 418 (15.6%) were ≥80 years old. Overall, OAC was used in 1965 patients (73.6%). Compared with younger patients, the elderly (age ≥ 80) had a higher mean CHA2 DS2 -VASc score (3.22 ± 1.71 vs 4.89 ± 1.35, P < .001) and more often a HAS-BLED score of ≥3 (n = 198 [47.0%] vs n = 625 [27.3%], P < .001), but were less likely to receive OAC (n = 269 [64.4%] vs n = 1696 [75.3%], odds ratio [OR] 0.91; 95%CI 0.86-0.97, P = .003). There was no significant association between OAC use and mean CHA2 DS2 -VASc (OR 0.86; 95%CI 0.75-1.00, P = .053) or HAS-BLED score (OR 1.21; 95%CI 0.81-1.81, P = .349) in the elderly. CONCLUSION: In the BALKAN-AF Survey, elderly AF patients were less likely to receive the guideline-adherent treatment despite their less favourable risk profile. Since OAC nonuse among the elderly was not associated with increased HAS-BLED score, factors other than patients' risk profile could influence the implementation of guideline-adherent treatment for thromboprophylaxis in the elderly AF patients.


Asunto(s)
Accidente Cerebrovascular/prevención & control , Anciano , Anciano de 80 o más Años , Fibrilación Atrial , Peninsula Balcánica/epidemiología , Comorbilidad , Femenino , Humanos , Masculino , Factores de Riesgo , Accidente Cerebrovascular/epidemiología
11.
BMC Neurol ; 20(1): 4, 2020 Jan 07.
Artículo en Inglés | MEDLINE | ID: mdl-31910805

RESUMEN

BACKGROUND: Stroke is one of the most common cause of disability worldwide. Pain is common in both stroke survivors and in the general population. Consequences of post-stroke pain (PSP) include reduced quality of life and are important to consider. The aim of the current study was to explore the experience of pain 5 years after stroke, and factors associated with the experience of pain. METHODS: Inclusion criteria were: First ever stroke, treated at Sahlgrenska University Hospital, Sweden, during an 18 months period in 2009-2010, aged 18 years or older. Furthermore, the participants had to respond to a set of questionnaires 5 years post-stroke. Baseline data were collected from medical records and follow-up data from the set of questionnaires. The primary outcome was based on the question Do you experience pain? Predictors and explanatory factors for experiencing more frequent pain were analysed with logistic regression. RESULTS: A total of 281 participants were included. Almost 40% experienced pain to some degree 5 years post-stroke (15% reported pain frequently), and 25% felt that their needs for pain treatment were not met. The participants experiencing more frequent pain reported poorer quality of life, self-perceived health status and recovery post-stroke. Functional dependency at discharge from hospital, experiencing depression at follow up and restricted mobility at follow up were all associated with more frequent pain. CONCLUSION: Pain is common 5 years post-stroke and the treatment is not perceived as optimal. The persons experiencing more frequent pain seem to rate their health and recovery worse than the persons experiencing less frequent pain. Most of the factors associated with more frequent pain were treatable and this emphasize the importance of standardised follow-up care that takes pain into consideration.


Asunto(s)
Dolor , Accidente Cerebrovascular , Anciano , Estudios Transversales , Femenino , Estudios de Seguimiento , Estado de Salud , Humanos , Masculino , Persona de Mediana Edad , Dolor/epidemiología , Dolor/etiología , Dolor/psicología , Calidad de Vida , Accidente Cerebrovascular/complicaciones , Accidente Cerebrovascular/epidemiología , Accidente Cerebrovascular/psicología , Encuestas y Cuestionarios , Suecia/epidemiología
12.
BMC Neurol ; 20(1): 5, 2020 Jan 07.
Artículo en Inglés | MEDLINE | ID: mdl-31910820

RESUMEN

BACKGROUND: Stroke and its risk factors epidemiological survey can help identify individuals at higher risk and therefore promote stroke prevention strategies. The aim of this study was to estimate the current prevalence of stroke and high risk stroke population, and evaluate stroke associated risk factors in southwestern China. METHODS: This was a multi-center, cross sectional survey in southwestern China from May 2015 to September 2015. The eight communities were selected at random, and 17,413 residents aged ≥40 years volunteered to participate in this survey. Data were collected through face-to-face survey using a structured questionnaire. Five hundred twenty-one participants with incomplete questionnaires on stroke history or risk factors records were excluded. RESULTS: A total of 16,892 people included in analysis. The overall prevalence of stroke was 3.1% (95% CI 2.6-3.9%), 17.1% of participants were the high risk stroke population. After full adjustments, hypertension, diabetes, dyslipidemia, overweight, lack of exercise and family history of stroke were significantly associated with overall stroke and ischemic stroke. The largest contributor was hypertension (population-attributable risk 23.6%), followed by dyslipidemia, physical inactivity, family history of stroke, diabetes, and overweight. However, only hypertension (OR = 3.66, 95% CI 1.82-8.23) was significantly associated with hemorrhagic stroke. CONCLUSIONS: The prevalence of stroke and high risk stroke population was high among adults aged ≥40 years in southwestern China. Hypertension, dyslipidemia and lack of exercise were stronger contributors for stroke, these findings suggest that individual-level and population-level interventions for these leading risk factors are necessary to prevent stroke.


Asunto(s)
Accidente Cerebrovascular/epidemiología , Adulto , Anciano , Anciano de 80 o más Años , China/epidemiología , Estudios Transversales , Femenino , Humanos , Masculino , Persona de Mediana Edad , Prevalencia , Factores de Riesgo , Encuestas y Cuestionarios
13.
Medicine (Baltimore) ; 99(4): e18779, 2020 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-31977868

RESUMEN

The aim of this study was to evaluate the risk factors and elucidate the clinical characteristics of cancer-associated ischemic stroke to differentiate it from conventional ischemic stroke in China and East Asia. Between June 2012 and June 2016, a retrospective analysis was performed on 609 stroke patients with cancer. They were divided into 3 groups: cancer-stroke group (CSG, 203 cases), stroke group (SG, 203 cases), and cancer group (CG, 203 cases). The D-dimer levels and diffusion-weighted imaging lesion (DWI) pattern were compared to an age- and sex-matched control group. The most common cancer types were colorectal cancer (20.2%) and lung cancer (18.72%). The average D-dimer level in stroke patients and cancer patients were 0.34 and 1.50 mg/L, respectively. The descending levels of D-dimer from cancer types were lung cancer (2.06 mg/L), pancreas (1.74 mg/L), gastric (1.61 mg/L), among others. Univariate analysis of the CSG and the others shows there were significant differences in the prevalence of the levels of D-dimer and DWI pattern, hypertension, diabetes mellitus, and thrombus. CSG has a unique pathological characteristic including high plasma D-dimer levels and multiple vascular lesions. The results show that D-dimer and DWI can be used as diagnostic index in clinical practice.


Asunto(s)
Productos de Degradación de Fibrina-Fibrinógeno/metabolismo , Neoplasias/metabolismo , Accidente Cerebrovascular/diagnóstico , Anciano , Anciano de 80 o más Años , Estudios de Casos y Controles , China/epidemiología , Comorbilidad , Imagen de Difusión por Resonancia Magnética , Femenino , Humanos , Masculino , Neoplasias/epidemiología , Curva ROC , Factores de Riesgo , Accidente Cerebrovascular/clasificación , Accidente Cerebrovascular/epidemiología , Accidente Cerebrovascular/etiología
14.
Medicine (Baltimore) ; 99(4): e18859, 2020 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-31977885

RESUMEN

To investigate the relationship between indoor radon level and stroke, which is a major factor for background radiation.This study combines 2 nationwide studies. Demographic characteristics and medical history of participants were obtained from Korean National Health and Nutrition Examination Survey (KNHANES) from 2007 to 2012. Participants over 40 years old and who completed the questionnaire were included in the study. Indoor radon concentration was analyzed using the mean value of winter housing radon concentration from 2012 to 2016 published by the National Institute of Environmental Research. The average values of each metropolitan city and province were assigned to the residence of the participant. To eliminate the potential confounding factors, participants' age, sex, hypertension, diabetes, dyslipidemia, ischemic heart disease, education level, occupation, smoking, drinking, exercise, and dietary intake were adjusted in multivariable logistic regression.Total of 28,557 participants were included in this study. Indoor radon levels were significantly higher in the participants with stroke, and the prevalence of stroke increased as indoor radon levels increased (P < .001, P for linear trend <.001). Indoor radon level was associated with stroke even after adjusting potential confounding factors (OR: 1.004 [95CI: 1.001-1.007], P = .010) and high radon exposure (indoor radon over 100Bq/m3) was also associated with stroke (OR: 1.242 [95CI: 1.069-1.444], P = .005). Trend analysis showed linear correlation of increased odds between radon quartile and stroke (P for linear trend < .001). In subgroup analysis, elevated indoor radon was most strongly associated in participants with age over 76(OR: 1.872[95%CI:1.320-2.654], P < .001).High indoor radon concentration may be associated with stroke. Specifically, elevated radon was associated with stroke in participants over 76 years old. In high-risk population, home modification to reduce indoor radon may help decreasing the risk of stroke.


Asunto(s)
Radón/análisis , Accidente Cerebrovascular/epidemiología , Adulto , Factores de Edad , Anciano , Contaminación del Aire Interior/estadística & datos numéricos , Estudios de Casos y Controles , Estudios Transversales , Femenino , Encuestas Epidemiológicas , Humanos , Masculino , Persona de Mediana Edad , Radón/toxicidad , República de Corea/epidemiología , Medición de Riesgo , Accidente Cerebrovascular/inducido químicamente
15.
J Stroke Cerebrovasc Dis ; 29(1): 104465, 2020 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-31704123

RESUMEN

BACKGROUND: The Kingdom of Saudi Arabia has a young but ageing population, leading to concerns for planning for future growth in the number of strokes to provide necessary care. An understanding of the expected evolution of stroke incidence is therefore necessary to plan infrastructure changes. Our aim was to predict the number of first strokes occurring in Saudi Arabia over a 10-year period. METHODS: An epidemiological model was developed, using local mortality and population data to model changes in the population. Gender- and age-specific stroke rates were then applied to the population projections to estimate the number of first strokes occurring over a 10-year period. Stroke incidence data from a range of sources were applied to obtain a plausible range for the change in expected number of first strokes. RESULTS: The model predicted population growth of 12.8% over the 10-year period. Depending on the stroke incidence data applied, the number of first strokes occurring during this time was predicted to increase within the range 57%-67%. CONCLUSIONS: A growing and ageing population is expected to lead to a substantial increase in the number of first strokes occurring in Saudi Arabia in the coming decade. Our results suggest that stroke care services will need to be expanded to continue to ensure high quality care, and that strategies for stroke prevention will play an important role in reducing the overall burden. This type of analysis can be applied to other countries' stroke policy planning.


Asunto(s)
Accidente Cerebrovascular/epidemiología , Distribución por Edad , Femenino , Predicción , Necesidades y Demandas de Servicios de Salud/tendencias , Humanos , Incidencia , Masculino , Cadenas de Markov , Evaluación de Necesidades/tendencias , Formulación de Políticas , Dinámica Poblacional , Arabia Saudita/epidemiología , Distribución por Sexo , Accidente Cerebrovascular/diagnóstico , Accidente Cerebrovascular/mortalidad , Accidente Cerebrovascular/terapia , Factores de Tiempo
16.
J Stroke Cerebrovasc Dis ; 29(2): 104491, 2020 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-31761736

RESUMEN

BACKGROUND AND PURPOSE: Various pathogenesis are presumed to be involved in the etiology of embolic stroke of undetermined source (ESUS), which has a high recurrence rate, and much remains unknown about the clinical subtype of recurrent stroke. The purpose of this study was to clarify the pathogenesis of ESUS using the ASCOD classification for ESUS patients and to examine the factors involved in the recurrence of ischemic stroke. METHODS: The subjects of this study were 236 of these patients who fulfilled the criteria for ESUS. The rate of stroke recurrent, subtype of recurrent ischemic stroke, and new-onset atrial fibrillation (AF) in these patients were surveyed retrospectively, and each patient was graded for the A, S, and C categories of the ASCOD classification. RESULTS: Ischemic stroke recurred in 32 patients during the follow-up period (7 days to 12.9 years [median 54.3 months]), and new-onset AF was seen in 44 (18.6%) patients. The most subtype of recurrent ischemic stroke was ESUS again (19 patients). Multivariate analysis with a Cox proportional hazards model, the S score (hazard ratio 5.21; 95% confidence interval (CI) 2.38-11.42; P < .001) and the number of A, S, C categories (hazard ratio 1.90; 95% CI 1.14-3.10; P = .013) were factors significantly related to recurrent ischemic stroke. CONCLUSIONS: Assessment of comorbid conditions in ESUS patients based on the ASCOD classification may be useful in predicting the likelihood of recurrence of ischemic stroke.


Asunto(s)
Fibrilación Atrial/epidemiología , Isquemia Encefálica/epidemiología , Embolia Intracraneal/epidemiología , Accidente Cerebrovascular/epidemiología , Anciano , Anciano de 80 o más Años , Fibrilación Atrial/diagnóstico , Fibrilación Atrial/terapia , Isquemia Encefálica/diagnóstico , Isquemia Encefálica/terapia , Comorbilidad , Femenino , Humanos , Embolia Intracraneal/diagnóstico , Embolia Intracraneal/terapia , Japón/epidemiología , Masculino , Persona de Mediana Edad , Fenotipo , Supervivencia sin Progresión , Recurrencia , Estudios Retrospectivos , Medición de Riesgo , Factores de Riesgo , Accidente Cerebrovascular/diagnóstico , Accidente Cerebrovascular/terapia , Factores de Tiempo
17.
J Stroke Cerebrovasc Dis ; 29(2): 104476, 2020 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-31806450

RESUMEN

BACKGROUND AND PURPOSE: To search for novel pathophysiological pathways related to ischemic stroke using a metabolomics approach. METHODS: We identified 204 metabolites in plasma by liquid chromatography mass spectrometry in 3 independent population-based samples (TwinGene, Prospective Investigation of the Vasculature in Uppsala Seniors (PIVUS) and Uppsala Longitudinal Study of Adult Men). TwinGene was used for discovery and the other 2 samples were meta-analyzed as replication. In PIVUS, traditional cardiovascular (CV) risk factors, multiple markers of subclinical CV disease, markers of coagulation/fibrinolysis were measured and analyzed in relation to top metabolites. RESULTS: In TwinGene (177 incident cases, median follow-up 4.3 years), levels of 28 metabolites were associated with incident ischemic stroke at a false discover rate (FDR) of 5%. In the replication (together 194 incident cases, follow-up 10 and 12 years, respectively), only sphingomyelin (32:1) was significantly associated (HR .69 per SD change, 95% CI .57-0.83, P value = .00014; FDR <5%) when adjusted for systolic blood pressure, diabetes, smoking, low density lipoportein (LDL)- and high density lipoprotein (HDL), body mass index (BMI) and atrial fibrillation. In PIVUS, sphingomyelin (32:1) levels were significantly related to both LDL- and HDL-cholesterol in a positive fashion, and to serum triglycerides, BMI and diabetes in a negative fashion. Furthermore, sphingomyelin (32:1) levels were related to vasodilation in the forearm resistance vessels, and inversely to leukocyte count (P < .0069 and .0026, respectively). CONCLUSIONS: An inverse relationship between sphingomyelin (32:1) and incident ischemic stroke was identified, replicated, and characterized. A possible protective role for sphingomyelins in stroke development has to be further investigated in additional experimental and clinical studies.


Asunto(s)
Isquemia Encefálica/sangre , Metabolómica/métodos , Esfingomielinas/sangre , Accidente Cerebrovascular/sangre , Anciano , Biomarcadores/sangre , Isquemia Encefálica/diagnóstico , Isquemia Encefálica/epidemiología , Cromatografía Liquida , Femenino , Humanos , Incidencia , Masculino , Persona de Mediana Edad , Pronóstico , Accidente Cerebrovascular/diagnóstico , Accidente Cerebrovascular/epidemiología , Suecia/epidemiología , Espectrometría de Masas en Tándem , Factores de Tiempo
18.
Sci Total Environ ; 703: 135538, 2020 Feb 10.
Artículo en Inglés | MEDLINE | ID: mdl-31759725

RESUMEN

The purpose of this study was to assess the impact to human health of air pollutants, through the integration of different technics: data statistics (spatial and temporal trends), population attributable fraction using AIRQ+ model developed by the WHO, and burden of disease using Disability-Adjusted Life Years (DALYs). The levels of SO2, NO, NO2, O3, H2S, benzene, PM10, PM2.5, CO, benzo(a)pyrene and metals, obtained between 2005 and 2017 from the air quality monitoring network across Camp de Tarragona County, were temporally and spatially determined. Health impacts were evaluated using the AIRQ+ model. Finally, the burden of disease was assessed through the calculation of Years of Lost life (YLL) and Years Lost due to Disability (YLD). In general terms, air quality was good according to European quality standards, but it did not fulfil the WHO guidelines, especially for O3, PM10 and PM2.5. Several decreasing (NO, NO2, SO2, PM10 and benzene) and an increasing (O3) temporal trend were found. Correlation between unemployment rate and air pollutant levels was found, pointing that the economic crisis (2008-2014) was a factor influencing the air pollutant levels. Reduction of air pollutant levels (PM2.5) to WHO guidelines in the Camp de Tarragona County would decrease the adult mortality between 23 and 297 cases per year, which means between 0.5 and 7% of all mortality in the area. In this County, for lung cancer, ischemic heart disease, stroke, and chronic obstructive pulmonary disease due to levels of PM2.5 above the WHO threshold limits, DAYLs were 240 years. This means around 80 DALYs for 100,000 persons every year -between 2005 and 2017. Population attributable fraction (PAF) and burden of disease (DALYs) methodologies are suitable tools for regional and national policymakers, who must take decisions to prevent and to control air pollution and to analyse the cost-effectiveness of interventions.


Asunto(s)
Contaminación del Aire/estadística & datos numéricos , Costo de Enfermedad , Exposición a Riesgos Ambientales/estadística & datos numéricos , Adulto , Contaminantes Atmosféricos/análisis , Femenino , Humanos , Neoplasias Pulmonares/epidemiología , Masculino , Isquemia Miocárdica/epidemiología , Material Particulado/análisis , Enfermedad Pulmonar Obstructiva Crónica/epidemiología , España/epidemiología , Accidente Cerebrovascular/epidemiología
19.
J Stroke Cerebrovasc Dis ; 29(2): 104510, 2020 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-31767524

RESUMEN

BACKGROUND AND PURPOSE: Evidence of an association between sleep apnea (SA) and early neurological deterioration (END) in acute phase ischemic stroke is scant. We investigated the prevalence of SA and the impact of SA severity on END in acute ischemic stroke (AIS) patients. METHODS: We prospectively enrolled consecutive AIS patients admitted to our stroke unit within 72 hours of symptom onset. SA severity was assessed with ApneaLink-a validated portable respiratory monitor. SA was defined as an apnea-hypopnea index (AHI) of greater than or equal to 5 per hour. END was defined as an incremental increase in the National Institutes of Health Stroke Scale (NIHSS) score by greater than or equal to 1 point in motor power, or greater than or equal to 2 points in the total score within the first week after admission. RESULTS: Of the 305 patients studied, 254 (83.3%) patients had SA (AHI ≥ 5 per hour), and of these, 114 (37.4%) had mild SA (AHI 5-14 per hour), 59 (19.3%) had moderate SA (AHI 15-29 per hour), and 81 (26.6%) had severe SA (AHI ≥ 30 per hour). Thirty-six (11.8%) patients experienced END: 2 of the 51 (3.9%) patients without SA and 34 of the 254 (14.4%) patients with SA. Multivariable regression analysis showed AHI independently predicted END (odds ratio 1.024; 95% confidence interval 1.006 to 1.042; P = .008). CONCLUSIONS: SA is common in the acute phase of ischemic stroke, and SA severity is associated with the risk of END.


Asunto(s)
Isquemia Encefálica/fisiopatología , Síndromes de la Apnea del Sueño/fisiopatología , Accidente Cerebrovascular/fisiopatología , Anciano , Isquemia Encefálica/diagnóstico , Isquemia Encefálica/epidemiología , Evaluación de la Discapacidad , Progresión de la Enfermedad , Femenino , Estado de Salud , Humanos , Masculino , Persona de Mediana Edad , Prevalencia , Estudios Prospectivos , República de Corea/epidemiología , Medición de Riesgo , Factores de Riesgo , Índice de Severidad de la Enfermedad , Síndromes de la Apnea del Sueño/diagnóstico , Síndromes de la Apnea del Sueño/epidemiología , Accidente Cerebrovascular/diagnóstico , Accidente Cerebrovascular/epidemiología , Factores de Tiempo
20.
J Stroke Cerebrovasc Dis ; 29(2): 104503, 2020 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-31818680

RESUMEN

BACKGROUND: It is not known if risk factors differ between ischemic stroke (IS) subtypes in Central and Eastern Europe. AIMS: We performed a community-based analysis of risk factors in patients admitted with IS over a 1 year period in Brno, the second largest city in the Czech Republic (CR). METHODS: Based on the National Register of Hospitalized Patients, all patients with IS admitted in Brno in 2011 were identified. Comprehensive discharge summaries from hospital admissions were collected and reviewed. IS subtype and relevant risk factors were ascertained for all patients. The age- and sex-adjusted association of risk factors with IS subtypes was determined. RESULTS: Overall, 682 patients with IS were admitted in 2011 to Brno hospitals. The distribution of IS subtypes was: 35% cardioembolism, 28% large-artery atherosclerosis, 23% small-artery occlusion, 7% stroke of undetermined etiology, 7% stroke of other determined etiology. Several of the risk factors showed high prevalence in the overall sample - e.g. hypertension (84%) and hyperlipidemia (61%). Cardioembolism as compared to other subtypes was positively associated with a history of myocardial infarction, cardiac failure, and atrial fibrillation. Small-artery occlusion was positively associated with history of dementia. No significant association was found between IS subtypes and history of IS, hypertension, diabetes, obesity, alcohol abuse or smoking. CONCLUSIONS: We found high frequency of stroke risk factors in all IS subtypes. These findings have implications for stroke prevention strategies in the CR and across Central Europe.


Asunto(s)
Isquemia Encefálica/epidemiología , Estilo de Vida , Accidente Cerebrovascular/epidemiología , Adulto , Anciano , Anciano de 80 o más Años , Isquemia Encefálica/diagnóstico , Comorbilidad , República Checa/epidemiología , Femenino , Humanos , Masculino , Persona de Mediana Edad , Admisión del Paciente , Prevalencia , Sistema de Registros , Factores de Riesgo , Accidente Cerebrovascular/diagnóstico , Factores de Tiempo
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