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2.
Neurol India ; 69(4): 916-922, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34507412

RESUMO

Background: Coronary artery disease (CAD) and ischemic stroke share the same risk factors. Objective: The aim of the study was to explore the prevalence and predictors of concomitant CAD in acute ischemic stroke patients. Methods: One hundred and five patients (64.3 ± 15.0 years, 61 male) presenting with acute ischemic stroke documented by neuroimaging were consecutively included. All patients were carefully evaluated to determine their cardiovascular disease risk scores. The patients who had been previously shown to have ≥50% stenosis in at least one of the major coronary arteries by coronary angiography were grouped as CAD patients. Results: Of the 105 stroke patients, 27 patients had documented concomitant CAD. The stroke patients with CAD had higher cardiovascular risk scores and troponin I levels and carotid plaques were more prevalent. ROC analysis determined cut-off values as ≥22% for Framingham Heart Study Risk Score, ≥0.05 ng/mL for Troponin I, and ≥0.80 mm for carotid artery intima-media thickness to predict concomitant CAD. During 6 months of follow-up, among the 78 stroke patients without documented CAD, 16 patients had experienced major cardiovascular events including myocardial infarction, recurrent stroke, or cardiovascular death. These patients had higher Framingham Heart Study Risk Score and high-sensitive C reactive protein levels. Conclusion: Our study suggests stroke patients with higher Framingham Heart Study Risk Score and troponin I levels and carotid plaques be further investigated for the presence of concomitant CAD.


Assuntos
Isquemia Encefálica , Doença da Artéria Coronariana , AVC Isquêmico , Acidente Vascular Cerebral , Isquemia Encefálica/complicações , Isquemia Encefálica/epidemiologia , Espessura Intima-Media Carotídea , Angiografia Coronária , Doença da Artéria Coronariana/complicações , Doença da Artéria Coronariana/diagnóstico por imagem , Doença da Artéria Coronariana/epidemiologia , Humanos , Masculino , Prognóstico , Fatores de Risco , Acidente Vascular Cerebral/complicações , Acidente Vascular Cerebral/epidemiologia
3.
JNMA J Nepal Med Assoc ; 59(240): 775-778, 2021 Aug 12.
Artigo em Inglês | MEDLINE | ID: mdl-34508472

RESUMO

INTRODUCTION: Ischemic strokes in young patients have been increasing. Younger patients with ischemic stroke tend to have a different long-term prognosis than older patients. Young patients who have residual neurological deficits following ischemic stroke affect their quality of life. This study was carried out to find out the prevalence of hypertension among patients with ischemic stroke in a tertiary care hospital. METHODS: This descriptive cross-sectional study was conducted in all the patients who were admitted with young ischemic stroke in the Department of Neurology, Nobel Medical College Biratnagar from December 2019 to December 2020 after taking ethical clearance from the Institutional Review Committee (reference number: 332/2019). Convenience sampling was done and data was collected, entered in Microsoft Excel, and analysis was done using Statistical Package for the Social Science software version 16. Point estimate at 95% Confidence Interval was calculated along with frequency and proportion for binary data. RESULTS: Out of the total patients with ischemic stroke in the young adults 30 (40%) (95% Confidence Interval= 28.91-51.08) had hypertension. During follow-up at 6 months, 20 (66.7%) of the patients with hypertension had favorable outcomes with a Modified Rankin Score of 0 or 1. Death during a hospital stay or during follow-up was observed in 2 (7%) of patients with hypertension. Mean age of the patients was 40±4.87 years. Most patients were in the age range of 36-45, 24 (80%). CONCLUSIONS: Prevalence of hypertension among young patients with ischemic stroke was high compared to other studies.


Assuntos
Isquemia Encefálica , Hipertensão , AVC Isquêmico , Acidente Vascular Cerebral , Adulto , Isquemia Encefálica/epidemiologia , Estudos Transversais , Humanos , Hipertensão/epidemiologia , Nepal/epidemiologia , Qualidade de Vida , Acidente Vascular Cerebral/epidemiologia , Centros de Atenção Terciária , Adulto Jovem
4.
JNMA J Nepal Med Assoc ; 59(240): 779-782, 2021 Aug 12.
Artigo em Inglês | MEDLINE | ID: mdl-34508483

RESUMO

INTRODUCTION: Stroke is broadly classified as cerebral infarction, intracerebral hemorrhage and subarachnoid hemorrhage. Neuroendocrine profile is altered in acute ischemic stroke and there is a link between hypothyroidism and atherosclerosis which in turn may lead to stroke. The objective of this study was to find out the prevalence of alteration of thyroid hormones in patients with ischemic stroke in a tertiary care center. METHODS: This descriptive cross-sectional study was conducted from June to December 2019 in a tertiary care center. Ethical approval was taken from Institutional review board of National Academy of Medical Sciences (reference number: IM 175). Patients with a diagnosis of stroke, without evidence of cardioembolic source, history of liver disease, renal failure and thyroid disease and who do not use thyroidal supplementation within 180 days prior the event were included. Convenience sampling was done. Data was entered in Microsoft Excel and analyzed using Statistical Package for the Social Sciences version 22. Point estimate at 90% Confidence Interval was calculated along with frequency and percentage for binary data. RESULTS: The prevalence of altered thyroid levels among 73 patients was 13 (17.8%) (90% Confidence Interval= 10.44-25.16). Among them 11 (15.1%) were hypothyroid and 2 (2.7%) were hyperthyroid. Among severity of hypothyroid cases, subclinical hypothyroidism grade IA was seen in 51 (70%), subclinical hypothyroidism grade IB was seen in 22 (30%). CONCLUSIONS: The prevalence of altered thyroid levels among patients undergoing ischemic stroke was similar to the findings of other international studies.


Assuntos
Isquemia Encefálica , AVC Isquêmico , Acidente Vascular Cerebral , Isquemia Encefálica/epidemiologia , Estudos Transversais , Humanos , Acidente Vascular Cerebral/epidemiologia , Centros de Atenção Terciária , Hormônios Tireóideos
5.
BMC Geriatr ; 21(1): 458, 2021 08 09.
Artigo em Inglês | MEDLINE | ID: mdl-34372766

RESUMO

OBJECTIVES: This study aimed to construct and validate a prediction model of acute ischemic stroke in geriatric patients with primary hypertension. METHODS: This retrospective file review collected information on 1367 geriatric patients diagnosed with primary hypertension and with and without acute ischemic stroke between October 2018 and May 2020. The study cohort was randomly divided into a training set and a testing set at a ratio of 70 to 30%. A total of 15 clinical indicators were assessed using the chi-square test and then multivariable logistic regression analysis to develop the prediction model. We employed the area under the curve (AUC) and calibration curves to assess the performance of the model and a nomogram for visualization. Internal verification by bootstrap resampling (1000 times) and external verification with the independent testing set determined the accuracy of the model. Finally, this model was compared with four machine learning algorithms to identify the most effective method for predicting the risk of stroke. RESULTS: The prediction model identified six variables (smoking, alcohol abuse, blood pressure management, stroke history, diabetes, and carotid artery stenosis). The AUC was 0.736 in the training set and 0.730 and 0.725 after resampling and in the external verification, respectively. The calibration curve illustrated a close overlap between the predicted and actual diagnosis of stroke in both the training set and testing validation. The multivariable logistic regression analysis and support vector machine with radial basis function kernel were the best models with an AUC of 0.710. CONCLUSION: The prediction model using multiple logistic regression analysis has considerable accuracy and can be visualized in a nomogram, which is convenient for its clinical application.


Assuntos
Isquemia Encefálica , Hipertensão , AVC Isquêmico , Acidente Vascular Cerebral , Idoso , Isquemia Encefálica/diagnóstico , Isquemia Encefálica/epidemiologia , Humanos , Hipertensão/diagnóstico , Hipertensão/epidemiologia , Estudos Retrospectivos , Acidente Vascular Cerebral/diagnóstico , Acidente Vascular Cerebral/epidemiologia
6.
Zhonghua Yu Fang Yi Xue Za Zhi ; 55(8): 952-957, 2021 Aug 06.
Artigo em Chinês | MEDLINE | ID: mdl-34445832

RESUMO

Objective: To investigate the epidemiological characteristics and adherence to hypoglycemic agents of the ischemic stroke patients combined with diabetes. Methods: The study recruited 23 044 ischemic stroke cases from 2013-2015 screening period of China National Stroke Screening Survey. Standardized questionnaires were used to obtain information on demographic data, stroke history, the presence of influence factors, as well as the type of stroke, diagnosis date, frequency, chronic diseases history and hypoglycemic therapy. We used logistics model to investigate the possible risk factors of ischemic stroke combined with diabetes, and calculated the population attributable risk proportion (PARP). We also investigate the adherence to hypoglycemic agents. Results: The mean age of 23 044 ischemic stroke patients was (64.99±9.42) years old, 50.91% were males (11 731). In ischemic stroke patients, 21.52% had diabetes. According to the results of logistics model, ischemic stroke patients with hypertension, dyslipidemia, atrial fibrillation or family history of stroke had higher risk to combine with diabetes, their Odds Ratios (OR) were 2.18 (1.87-2.55), 1.99 (1.78-2.23), 1.64 (1.39-1.92) and 1.19 (1.06-1.33). Considering the prevalence of each influence factor in ischemic stroke patients, atrial fibrillation had the highest PARP (95%CI) of 62.65% (61.27%-63.76%). In ischemic stroke patients combined with diabetes, 70.73% (3 463/4 896) had taken hypoglycemic agents. Conclusion: There still were a large number of ischemic stroke patients combined with diabetes and a low rate of adherence to hypoglycemic agents.


Assuntos
Isquemia Encefálica , Diabetes Mellitus , AVC Isquêmico , Acidente Vascular Cerebral , Idoso , Isquemia Encefálica/complicações , Isquemia Encefálica/epidemiologia , Diabetes Mellitus/epidemiologia , Humanos , Hipoglicemiantes/uso terapêutico , Masculino , Pessoa de Meia-Idade , Fatores de Risco , Acidente Vascular Cerebral/epidemiologia
7.
Medicina (B Aires) ; 81(4): 588-596, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34453801

RESUMO

Up to 15% of all strokes affect young patients and the incidence of ischemic stroke in this population is rising. Nevertheless, there is limited information of cerebrovascular events in this population both in our country and in Latin America. The aim of our study was to evaluate the clinical characteristics and risk factors of young adults with stroke in Argentina. This is a prospective, multicenter study of stroke in young adults (18 - 55 years) in Argentina. Patients presenting with a cerebrovascular event within 180 days were included. Stroke subtypes were classified according to TOAST criteria. A total number of 311 patients were enrolled (men 53.9%, mean age: 43.3 years). Ischemic strokes occurred in 91.8% (brain infarcts 82.6%, transient ischemic attack 9.2%) and hemorrhagic strokes in 8.2%. The most frequent vascular risk factors (including ischemic and hemorrhagic strokes) were: hypertension 120 (41%), smoking 92 (31.4%), dyslipidemia 81 (27.6%) and, overweight/obesity: 74 (25.3%). Stroke subtypes were: large artery disease 12.3%, cardioembolism 7.5%, small artery occlusion 11.5%, other defined etiology 27.1%, and undetermined etiology 41.6%. Our study demonstrates that vascular risk factors are very frequent in young adults with stroke. Our findings underline that urgent strategies are required for primary and secondary stroke prevention in this group of patients.


Assuntos
Isquemia Encefálica , Hipertensão , Ataque Isquêmico Transitório , Acidente Vascular Cerebral , Adulto , Argentina/epidemiologia , Isquemia Encefálica/epidemiologia , Isquemia Encefálica/etiologia , Humanos , Hipertensão/complicações , Hipertensão/epidemiologia , Masculino , Estudos Prospectivos , Fatores de Risco , Acidente Vascular Cerebral/epidemiologia , Acidente Vascular Cerebral/etiologia , Adulto Jovem
8.
J Pak Med Assoc ; 71(7): 1882-1884, 2021 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-34410266

RESUMO

Stroke results in the death of around 6.5 million people annually with a majority of these occurring in developing countries. Serum calcium has been hypothesised to play a significant role in causing ischaemic stroke. This retrospective observational study was conducted to determine the correlation, if any, between serum calcium and the severity of acute ischaemic stroke in our population. Two hundred and seventy-nine patients admitted with acute ischaemic stroke were enrolled in the study. Of the 279 patients 162 (58%) were male and mean age was 62.4 ± 3.8 years. Characteristics of stroke patients were compared with stroke severity. Mean albumin corrected serum calcium and Scandinavian stroke severity score was 9.1 (± 5.6) and 33.67 (± 15.2), respectively. Hypertension and mean GCS on admission were significantly associated with increased stroke severity score. However, no correlation was observed between serum calcium and severity of acute ischaemic stroke.


Assuntos
Isquemia Encefálica , AVC Isquêmico , Acidente Vascular Cerebral , Idoso , Isquemia Encefálica/epidemiologia , Cálcio , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Índice de Gravidade de Doença , Acidente Vascular Cerebral/epidemiologia
9.
BMC Public Health ; 21(1): 1571, 2021 08 19.
Artigo em Inglês | MEDLINE | ID: mdl-34412612

RESUMO

BACKGROUND: Occupational class is an integral part of socioeconomic status. The studies focused on the occupational difference in ischemic stroke outcome in a Chinese population are limited. We aimed to investigate the associations between occupational class and the prognosis of patients with ischemic stroke in China. METHODS: We included 1484 ischemic stroke participants (mean age: 63.42 ± 11.26 years) from the prospective cohort study: Infectious Factors, Inflammatory Markers and Prognosis of Acute Ischemic Stroke (IIPAIS). Occupational class was categorized into white-collar workers, blue-collar workers and farmers in our study. Study outcomes were cardiovascular events and all-cause mortality within 12 months after ischemic stroke onset. We applied Cox proportional hazard model to evaluate the associations between the occupational class and study outcomes after ischemic stroke. RESULTS: Within 12 months after ischemic stroke, there were 106 (7.5%) cardiovascular events and 69 (4.9%) all-cause deaths. The Kaplan-Meier plots showed that white-collar workers had highest risk of cardiovascular events after 12-month follow-up (Log-rank P = 0.02). Multivariate adjusted hazard ratio and 95% confidence intervals (CIs) of farmers versus white-collar workers was 0.43(0.20-0.91) for cardiovascular events. No significant difference showed in blue-collar workers versus white-collar workers, with fully adjusted hazard ratio 0.62(95% CIs, 0.23-1.67). CONCLUSIONS: Compared with white-collar workers, farmers are associated with less risk of cardiovascular events at 12 months after ischemic stroke, while there are no significant differences in blue-collar workers.


Assuntos
Isquemia Encefálica , AVC Isquêmico , Acidente Vascular Cerebral , Idoso , Isquemia Encefálica/epidemiologia , Humanos , Pessoa de Meia-Idade , Estudos Prospectivos , Fatores de Risco , Classe Social , Acidente Vascular Cerebral/epidemiologia
10.
Neurol Sci ; 42(9): 3605-3613, 2021 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-34236554

RESUMO

BACKGROUND: Atherosclerosis is the most common cause of ischemia stroke. Computed tomographic angiography (CTA) and digital subtraction angiography (DSA) are used to evaluate the degree of lumen stenosis. However, these examinations are invasive and can only reveal mild to moderate stenosis. High-resolution magnetic resonance imaging (HRMRI) seems a more intuitive way to show the pathological changes of vascular wall. Hence, we conducted a systematic retrospective study to determine the characteristics of symptomatic plaques in patients with intracranial atherosclerosis on HRMRI and their association with the occurrence and recurrence of ischemic stroke events. METHODS: The PubMed database was searched for relevant studies reported from January 31, 2010, to October 31, 2020. RESULTS: We selected 14 clinical outcome studies. We found that plaque enhancement and positive remodeling on HRMRI indicate symptomatic plaques. Besides, intraplaque hemorrhage and positive remodeling index are closely related to the occurrence of stroke. However, it is still controversial whether the initial enhancement of plaque and the occurrence and recurrence of stroke are related. There is also no significant correlation between vascular stenosis and symptomatic plaque or the occurrence and recurrence of ischemic stroke. CONCLUSION: High-resolution magnetic resonance imaging can be used as an assessment tool to predict the risk of stroke onset and recurrence in patients with atherosclerosis, but further research is also needed.


Assuntos
Isquemia Encefálica , Arteriosclerose Intracraniana , AVC Isquêmico , Placa Aterosclerótica , Acidente Vascular Cerebral , Isquemia Encefálica/complicações , Isquemia Encefálica/diagnóstico por imagem , Isquemia Encefálica/epidemiologia , Humanos , Arteriosclerose Intracraniana/complicações , Arteriosclerose Intracraniana/diagnóstico por imagem , Angiografia por Ressonância Magnética , Imageamento por Ressonância Magnética , Placa Aterosclerótica/diagnóstico por imagem , Estudos Retrospectivos , Acidente Vascular Cerebral/diagnóstico por imagem , Acidente Vascular Cerebral/epidemiologia
11.
Adv Ther ; 38(9): 4695-4708, 2021 09.
Artigo em Inglês | MEDLINE | ID: mdl-34312813

RESUMO

INTRODUCTION: The impact of additional risk factors on major cardiovascular event (MACE) rates in patients with a history of myocardial infarction (MI) or ischaemic stroke (IS) treated with statins is not well defined. METHODS: In this retrospective population-based cohort study, patients with a history of MI or IS treated with moderate- or high-intensity statins were identified using Swedish national register data. Patients were incident (index event between July 2006 and December 2014 and followed from diagnosis) or prevalent (MI or IS before July 2006 and followed thereafter). Four subgroups were defined on the basis of additional risk factors associated with increased cardiovascular risk: diabetes mellitus with target organ damage; chronic kidney disease stages 3-4; index event within 2 years after prior MI or IS; and polyvascular disease. First and total MACE rates (i.e. MI, IS, or cardiovascular death) were calculated, and first MACE 10-year risks (prevalent cohort only) were predicted. RESULTS: Numerically, MACE rates in subgroups were 1.5-3 times higher than in overall populations, and were highest in the 2 years after the index event. First MACE rates in the additional risk factor subgroups were 17.2-33.5 per 100 person-years for the incident cohorts and 9.9-13.2 per 100 person-years for the prevalent cohorts. Total MACE rates per 100 person-years were 20.1-39.8 per 100 person-years and 12.4-17.6 per 100 person-years, respectively. CONCLUSION: Despite previous use of moderate- or high-intensity statins, patients with a history of MI or IS, and additional risk factors remain at very high cardiovascular risk.


Assuntos
Isquemia Encefálica , Doenças Cardiovasculares , AVC Isquêmico , Infarto do Miocárdio , Acidente Vascular Cerebral , Isquemia Encefálica/epidemiologia , Doenças Cardiovasculares/epidemiologia , Estudos de Coortes , Humanos , Infarto do Miocárdio/epidemiologia , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Acidente Vascular Cerebral/epidemiologia
12.
J Neurol Sci ; 427: 117557, 2021 08 15.
Artigo em Inglês | MEDLINE | ID: mdl-34214920

RESUMO

BACKGROUND: There is contradicting evidence on the outcome of emergency patients treated during weekends versus weekdays. We studied if outcome of ischemic stroke patients receiving intravenous thrombolysis (IVT) differs according to the treatment time. METHODS: Our retrospective study included consecutive patients receiving IVT within 4.5 h of stroke onset between June 1995 and December 2018 at the Helsinki University Hospital. The patients were compared based on the treatment initiation either during weekdays (Monday to Friday) or weekend (Saturday and Sunday). The primary outcome was 3-month mortality and secondary outcomes comprised 3-month modified Rankin Scale (mRS) and incidence of symptomatic intracerebral hemorrhage (sICH). Additional analyses studied the effect of IVT treatment according to non-office hours, time of day, and season. RESULTS: Of the 3980 IVT-treated patients, 28.0% received treatment during weekends. Mortality was similar after weekend (10.0%) and weekday (10.6%) admissions in the multivariable regression analysis (OR 0.78; 95% CI 0.59-1.03). Neither 3-month mRS (OR 0.98; 95% CI 0.86-1.12), nor the occurrence of sICH (4.2% vs 4.6%; OR 0.87; 95% CI 0.60-1.26) differed between the groups. No outcome difference was observed between the office vs non-office hours or by the time of day. However, odds for worse outcome were higher during autumn (OR 1.19; 95% CI 1.04-1.35) and winter (OR 1.15; 95% CI 1.01-1.30). CONCLUSION: We did not discover any weekend effect for IVT-treated stroke patients. This confirms that with standardized procedures, an equal quality of care can be provided to patients requiring urgent treatment irrespective of time.


Assuntos
Isquemia Encefálica , Acidente Vascular Cerebral , Administração Intravenosa , Isquemia Encefálica/complicações , Isquemia Encefálica/tratamento farmacológico , Isquemia Encefálica/epidemiologia , Hemorragia Cerebral/tratamento farmacológico , Hemorragia Cerebral/epidemiologia , Fibrinolíticos/uso terapêutico , Humanos , Estudos Retrospectivos , Acidente Vascular Cerebral/tratamento farmacológico , Acidente Vascular Cerebral/epidemiologia , Terapia Trombolítica , Fatores de Tempo , Resultado do Tratamento
13.
BMJ Open ; 11(7): e048734, 2021 07 07.
Artigo em Inglês | MEDLINE | ID: mdl-34233994

RESUMO

OBJECTIVE: To develop and internally validate a prediction model for 6-year risk of stroke and its primary subtypes in middle-aged and elderly Chinese population. DESIGN: This is a retrospective cohort study from a prospectively collected database. PARTICIPANTS: We included a total 3124 adults aged 45-80 years, free of stroke or myocardial infarction at baseline in the 2009-2015 cohort of China Health and Nutrition Survey. PRIMARY AND SECONDARY OUTCOME MEASURES: The outcome of the prediction model was stroke. Investigated predictors were: age, gender, body mass index (BMI), low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C), total cholesterol (TC), hypertension (HBP), drinking status, smoking status, diabetes and site. Stepwise multiple Cox regression was applied to identify independent predictors. A nomogram was constructed to predict 6-year risk of stroke based on the multiple analysis results. Bootstraps with 1000 resamples were applied to both C-index and calibration curve. RESULT: The overall incidence of overall stroke was 2.98%. Age, gender, HBP and TC were found as significant risk predictors for overall stroke; age, gender, HBP and LDL-C were found as significant risk predictors for ischaemic stroke; age, gender, HBP, BMI and HDL-C were found as significant risk predictors for haemorrhagic stroke. The nomogram was constructed using significant variables included in the model, with a C-index of 0.74 (95% CI: 0.72 to 0.76), 0.74 (95% CI: 0.71 to 0.77), and 0.81 (95% CI: 0.78 to 0.84) for overall stroke, ischaemic stroke, and haemorrhagic stroke model, respectively. The calibration curves demonstrated the good agreements between predicted and observed 6-year risk probability. CONCLUSION: Our nomogram could be convenient, easy to use and effective prognoses for predicting 6-year risk of stroke in middle-aged and elderly Chinese population.


Assuntos
Isquemia Encefálica , Acidente Vascular Cerebral , Adulto , Idoso , Isquemia Encefálica/epidemiologia , China/epidemiologia , Estudos de Coortes , Humanos , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de Risco , Acidente Vascular Cerebral/epidemiologia , Acidente Vascular Cerebral/etiologia
14.
BMC Neurol ; 21(1): 229, 2021 Jun 22.
Artigo em Inglês | MEDLINE | ID: mdl-34157993

RESUMO

BACKGROUND: Ischemic events are the most common postoperative complication in bypass surgery for moyamoya disease (MMD), but the risk factors for pediatric MMD remain unclear. The goal of the study was to investigate the risk factors for postoperative ischemic complications in pediatric MMD patients. METHODS: We retrospectively reviewed a consecutive series of pediatric MMD cases at Beijing Tiantan Hospital, Capital Medical University from June 2010 through June 2019. Preoperative clinical variables and radiographic findings were recorded, and logistic regression analysis was carried out to identify the risk factors for postoperative ischemic events. RESULTS: A total of 533 operations in 336 patients were included in this study. Postoperative complications occurred after 51 operations (9.6%), including 40/447 indirect bypass procedures, 9/70 direct bypass procedures, and 2/16 combined bypass procedures. Postoperative ischemic events were the most common complication and occurred in 30 patients after 31 procedures (8.9% per patient; 5.8% per operation), including 26/447 indirect bypass procedures, 4/70 direct bypass procedures, and 1/16 combined bypass procedures, and the incidence of these events did not differ significantly between indirect and non-indirect bypass (5.8% vs 5.8%; p = 0.999). Multivariate logistic regression analyses revealed that older age at operation (OR 1.129, 95% CI 1.011-1.260, p = 0.032) and posterior cerebral artery involvement (OR 2.587, 95% CI 1.030-6.496, p = 0.043) were significantly associated with postoperative ischemic events. CONCLUSION: We speculate that older age at operation and posterior cerebral artery involvement are risk factors for postoperative ischemic events in pediatric MMD patients.


Assuntos
Isquemia Encefálica/etiologia , Revascularização Cerebral/efeitos adversos , Doença de Moyamoya/cirurgia , Adolescente , Fatores Etários , Isquemia Encefálica/diagnóstico , Isquemia Encefálica/epidemiologia , Criança , Pré-Escolar , Feminino , Humanos , Incidência , Modelos Logísticos , Angiografia por Ressonância Magnética , Masculino , Artéria Cerebral Posterior/cirurgia , Complicações Pós-Operatórias , Estudos Retrospectivos , Fatores de Risco
15.
J Neurol Sci ; 427: 117512, 2021 Aug 15.
Artigo em Inglês | MEDLINE | ID: mdl-34082148

RESUMO

Background Recognizing the post-stroke fracture risk factors is crucial for targeted intervention and primary fracture prevention. We aimed to investigate whether stroke types, stroke severity, and pre-stroke osteoporosis are associated with post-stroke fracture. Methods In a nationwide cohort, we identified previously fracture-free patients who suffered from first-ever stroke, either acute ischemic stroke (AIS) or intracerebral hemorrhage (ICH), between 2003 and 2015. Information regarding stroke severity, osteoporosis, comorbidity, and medication information was collected. The outcomes analyzed included hip fracture, spine fracture, and other fractures. Cumulative incidence functions (CIFs) were used to estimate the cumulative incidence of fractures over time after accounting for competing risk of death. Multivariable Fine and Gray models were used to determine the adjusted hazard ratio (HR) and 95% confidence interval (CI). Results Of the 41,895 patients with stroke, the 5-year CIFs of any incident fracture, hip fracture, spine fracture, and other fractures were 8.03%, 3.42%, 1.87%, and 3.05%, respectively. The fracture risk did not differ between patients with AIS and ICH. While osteoporosis increased the risk of post-stroke fracture (adjusted HR [95% CI],1.42 [1.22-1.66]), stroke severity was inversely associated with post-stroke fracture (moderate, 0.88 [0.81-0.96] and severe, 0.39 [0.34-0.44], compared with mild stroke severity). Conclusions Stroke survivors had an over 8% fracture risk at 5 years after stroke. Mild stroke severity and osteoporosis were significantly associated with post-stroke fracture risk, whereas stroke type was not. Our results call for effective measures for bone health screening and fracture prevention in patients with stroke.


Assuntos
Isquemia Encefálica , Fraturas do Quadril , Osteoporose , Acidente Vascular Cerebral , Isquemia Encefálica/complicações , Isquemia Encefálica/epidemiologia , Fraturas do Quadril/complicações , Fraturas do Quadril/epidemiologia , Humanos , Incidência , Osteoporose/epidemiologia , Osteoporose/etiologia , Fatores de Risco , Acidente Vascular Cerebral/complicações , Acidente Vascular Cerebral/epidemiologia
16.
Int J Chron Obstruct Pulmon Dis ; 16: 1851-1862, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34168444

RESUMO

Purpose: To compare the incidence, clinical characteristics and outcomes of patients admitted with ischemic stroke (IS) according to the presence of COPD and sex in Spain (2016-2018). Patients and Methods: We selected all admissions with IS (≥35 years) included in the Spanish National Hospital Discharge Database. We matched each patient suffering COPD with a non-COPD patient with identical age, sex, IS type and year of hospitalization. Results: IS was coded in 92,524 men and 79,731 women (8.67% with COPD). The incidence of IS was higher in COPD men than in non-COPD men (IRR 1.04; 95% CI 1.03-1.06), although the differences were not significant among women. COPD men had twice higher incidence of IS than COPD women (IRR 2.00; 95% CI 1.93-2.07). After matching, COPD men had a higher in-hospital mortality (IHM) than non-COPD men (11.48% vs 9.80%; p<0.001), and the same happened among women (14.09% vs 11.96%; p=0.002). COPD men received thrombolytic therapy less frequently than non-COPD men. For men and women, the risk of dying in the hospital increased with age, some comorbidities and mechanical ventilation use. After multivariable adjustment, COPD increased the risk of IHM in men (OR 1.16; 95% CI 1.06-1.28) and women (OR 1.12; 95% CI 1.01-1.27). Finally, among COPD patients, being women increased the risk of dying during the hospitalization with IS by 15% (OR 1.15; 95% CI 1.03-1.28). Conclusion: Incidence of IS was higher in COPD patients, although the difference was only significant for men. COPD was associated with an increased risk of IHM. Among COPD patients, women had higher IHM.


Assuntos
Isquemia Encefálica , AVC Isquêmico , Doença Pulmonar Obstrutiva Crônica , Acidente Vascular Cerebral , Isquemia Encefálica/diagnóstico , Isquemia Encefálica/epidemiologia , Isquemia Encefálica/terapia , Feminino , Mortalidade Hospitalar , Hospitalização , Humanos , Incidência , Masculino , Doença Pulmonar Obstrutiva Crônica/diagnóstico , Doença Pulmonar Obstrutiva Crônica/epidemiologia , Doença Pulmonar Obstrutiva Crônica/terapia , Estudos Retrospectivos , Fatores de Risco , Caracteres Sexuais , Espanha/epidemiologia , Acidente Vascular Cerebral/diagnóstico , Acidente Vascular Cerebral/epidemiologia , Acidente Vascular Cerebral/terapia
17.
Neurologia (Engl Ed) ; 36(7): 531-536, 2021 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-34099423

RESUMO

INTRODUCTION: The COVID-19 pandemic has had an impact on ischaemic stroke management, with a reported decrease in hospital admissions, and even disruptions in healthcare and increased in-hospital mortality. However, there is a lack of evidence on the impact of the pandemic on functional prognosis. The aim of this study is to analyse the effect of the COVID-19 pandemic on the 3-month functional outcomes of patients hospitalised due to acute ischaemic stroke in Aragon (Spain). METHODS: We reviewed the data of all patients admitted due to ischaemic stroke to any hospital in our regional healthcare system between 30 December 2019 and 3 May 2020. We compared modified Rankin Scale scores and mortality at 3 months in patients hospitalised before and after the declaration of a state of emergency due to the COVID-19 pandemic. RESULTS: In total, 318 patients with acute ischaemic stroke met our inclusion criteria. No differences were observed between periods in global or specific characteristics, with the exception of a higher proportion of patients older than 80 years during the first period (42.2% vs 29.0%, P = .028). In the comparative analysis, we found no significant differences in mortality (12.3 vs 7.9, P = .465) or in the proportion of patients with modified Rankin Scale scores ≤ 2 (57.7% vs 57.1%, P = .425) at 3 months. CONCLUSION: To our knowledge, this is the first study to analyse the impact of COVID-19 pandemic on the 3-month functional outcomes of patients with ischaemic stroke. In our region, there has been no increase in rates of mortality or disability at 3 months in patients admitted due to ischaemic stroke during the pandemic.


Assuntos
Isquemia Encefálica , COVID-19 , AVC Isquêmico , Acidente Vascular Cerebral , Isquemia Encefálica/epidemiologia , Humanos , Pandemias , Prognóstico , SARS-CoV-2 , Acidente Vascular Cerebral/epidemiologia , Resultado do Tratamento
18.
BMC Public Health ; 21(1): 1059, 2021 06 03.
Artigo em Inglês | MEDLINE | ID: mdl-34082746

RESUMO

BACKGROUND: As a country with one-fifth of the global population, China has experienced explosive growth in ischaemic stroke (IS) burden with significant ethnic and geographic disparities. The aim of this study was to examine the differences in potentially modifiable risk factors for ischaemic stroke among the Han population and two ethnic minorities (Tujia and Miao). METHODS: A case-control study was conducted with 324 cases of first-ever ischaemic stroke from the hospitals of the Xiangxi Tujia and Miao Autonomous Prefecture and 394 controls from communities covering the same area between May 1, 2018, and April 30, 2019. Structured questionnaires were administered, and physical examinations were performed in the same manner for cases and controls. Univariate and multivariate logistic regression analyses with adjusted odds ratios (ORs) and 95% confidence intervals (CIs) were used to examine the association between risk factors and ischaemic stroke. An additive model was used to study the interaction between the modifiable risk factors and ethnicity with R software. RESULTS: Higher high-sensitivity C-reactive protein levels (OR 50.54, 95%CI 29.76-85.85), higher monthly family income (4.18, 2.40-7.28), increased frequency of hot pot consumption (2.90, 1.21-6.93), diabetes mellitus (2.62, 1.48-4.62), a higher apolipoprotein (Apo)B/ApoA1 ratio (2.60, 1.39-4.85), hypertension (2.52, 1.45-4.40) and moderate-intensity physical activity (0.50, 0.28-0.89) were associated with ischaemic stroke. There was an additive interaction between the ApoB/ApoA1 ratio and ethnicity in the Tujia and Miao populations with first-ever ischaemic stroke (the relative excess risk due to the interaction was 5.75, 95% CI 0.58 ~ 10.92; the attributable proportion due to the interaction was 0.65, 95% CI 0.38 ~ 0.91; the synergy index was 3.66, 95% CI 1.35 ~ 9.93). CONCLUSIONS: This is the first case-control study examining modifiable risk factors for ischaemic stroke among the Han population and two ethnic minorities (Tujia and Miao) in China. Some differences were observed in the impact of risk factors among these ethnic groups. Our results may help interpret health-related data, including surveillance and research, when developing strategies for stroke prevention.


Assuntos
Isquemia Encefálica , AVC Isquêmico , Acidente Vascular Cerebral , Isquemia Encefálica/epidemiologia , Estudos de Casos e Controles , China/epidemiologia , Grupos Étnicos , Humanos , Fatores de Risco , Acidente Vascular Cerebral/epidemiologia
19.
Rev Prat ; 71(1): 75-78, 2021 Jan.
Artigo em Francês | MEDLINE | ID: mdl-34160951

RESUMO

Arterial ischemic stroke in children Stroke in children is an event of sudden occurrence with severe impact on the child's life. Most children will have consequences, lasting all lifelong. Early recognition of first symptoms, most often unilateral sudden motor deficit, is crucial to launch a pediatric stroke alert. MRI is the first and only imaging modality in this setting. Written protocols of early management improve early management for all patients. Rapid management permits the opportunity to consider recanalization treatments (intravenous thrombolysis, endovascular thrombectomy) in selected patients. Follow-up must be prolonged, adjusted to the age of stroke occurrence and to the personal developmental trajectory. Not only motor and cognitive deficits are considered, but also social participation and the preparation of the child's adult life.


Assuntos
Isquemia Encefálica , AVC Isquêmico , Acidente Vascular Cerebral , Adulto , Isquemia Encefálica/diagnóstico , Isquemia Encefálica/epidemiologia , Isquemia Encefálica/terapia , Criança , Humanos , Imageamento por Ressonância Magnética , Acidente Vascular Cerebral/diagnóstico por imagem , Acidente Vascular Cerebral/epidemiologia , Trombectomia , Resultado do Tratamento
20.
Egypt J Immunol ; 28(1): 33-45, 2021 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-34147052

RESUMO

Some studies reported a high prevalence of ischemic stroke in hepatitis C virus patients, other several studies have suggested that hepatitis C virus (HCV) may act as a trigger for autoimmune diseases and autoantibodies including Anti-Neutrophil Cytoplasmic Antibody (ANCA) which predispose to vasculitis. Because vasculitis is a risk factor for ischemic stroke, we investigated the association of the hepatitis C virus with ANCA in first-ever ischemic stroke patients. This study included 67 Egyptian patients with first-ever ischemic stroke. These patients were clinically examined and investigated for HCV infection by chemiluminescence & Real Time-PCR, and ANCA antibodies by ELISA. Forty-two patients (62.7%) had HCV infection. Twenty-nine (43.2%) of them were cytoplasmic- Antineutrophil Cytoplasmic Antibodies (c-ANCA) positive, while none was perinuclear- Antineutrophil Cytoplasmic Antibodies (p-ANCA) positive. Comparison between c-ANCA positive and ANCA negative patients showed that 82.8% and 47.4% had anti-HCV antibody, respectively, with P-value 0.003. The c-ANCA level correlated significantly with age, and HCV antibody level. No statistically significant difference was found in both the consciousness and stroke severity between the negative and positive c- ANCA patients. However, patients with positive c-ANCA had smaller and multiple cerebral infarctions with P-value 0.002 and 0.01 respectively. Multiple regression analysis showed that the number and size of cerebral infarctions were independent predictors of c-ANCA positivity with P value 0.02, and 0.03 respectively. In conclusion, c-ANCA level correlates with HCV antibody and may predispose to ischemic stroke by a possible ANCA associated vasculitis.


Assuntos
Isquemia Encefálica , Hepatite C , AVC Isquêmico , Acidente Vascular Cerebral , Anticorpos Anticitoplasma de Neutrófilos , Isquemia Encefálica/epidemiologia , Egito/epidemiologia , Ensaio de Imunoadsorção Enzimática , Hepacivirus , Hepatite C/complicações , Hepatite C/epidemiologia , Humanos , Acidente Vascular Cerebral/epidemiologia
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