Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 4.854
Filtrar
2.
J Formos Med Assoc ; 120(1 Pt 2): 327-336, 2021 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-33268157

RESUMO

BACKGROUND/PURPOSE: Endometriosis (EM) is linked to cardiovascular disease (CVD). However, whether this finding can be applied to the Taiwanese population remained unanswered. To investigate the association between EM and major adverse cardiovascular and cerebrovascular events (MACCE) and the therapeutic effect on the risk of MACCE in Asian women with EM. A retrospective population-based cohort study was performed. METHODS: A total of 17 543 patients with EM aged between 18 and 50 years were identified from a general population of 1 million Taiwanese after excluding diagnoses of major CVD and cerebrovascular accident (CVA) prior to EM. The comparison group (n = 70 172) without EM was selected by matching the study cohort with age, sex, and income and urbanization levels in a 4:1 ratio. RESULTS: During a median follow-up period of 9.2 years, Taiwanese women with EM had a significantly higher frequency of comorbidities, medical and surgical treatment, and MACCE than did their non-EM counterparts (2.76% vs 2.18%, P < .0001). After adjustment for comorbidities, patients with EM had an approximately 1.2-fold increased risk of MACCE (95% CI 1.05-1.29; P = .0053) and a higher cumulative incidence of MACCE compared with the normal population. Neither medical nor surgical treatment increased the risk of MACCE. Furthermore, medical treatment for EM appeared to be protective against MACCE. CONCLUSION: Taiwanese women with EM not only had a substantially higher frequency of comorbidities but also an increased risk of MACCE compared with the general population.


Assuntos
Doenças Cardiovasculares , Transtornos Cerebrovasculares , Endometriose , Adolescente , Adulto , Doenças Cardiovasculares/complicações , Doenças Cardiovasculares/epidemiologia , Transtornos Cerebrovasculares/complicações , Transtornos Cerebrovasculares/epidemiologia , Estudos de Coortes , Endometriose/epidemiologia , Endometriose/etiologia , Feminino , Humanos , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de Risco , Adulto Jovem
4.
PLoS Med ; 17(12): e1003467, 2020 12.
Artigo em Inglês | MEDLINE | ID: mdl-33373359

RESUMO

BACKGROUND: Aortic stiffness is closely linked with cardiovascular diseases (CVDs), but recent studies suggest that it is also a risk factor for cognitive decline and dementia. However, the brain changes underlying this risk are unclear. We examined whether aortic stiffening during a 4-year follow-up in mid-to-late life was associated with brain structure and cognition in the Whitehall II Imaging Sub-study. METHODS AND FINDINGS: The Whitehall II Imaging cohort is a randomly selected subset of the ongoing Whitehall II Study, for which participants have received clinical follow-ups for 30 years, across 12 phases. Aortic pulse wave velocity (PWV) was measured in 2007-2009 (Phase 9) and at a 4-year follow-up in 2012-2013 (Phase 11). Between 2012 and 2016 (Imaging Phase), participants received a multimodal 3T brain magnetic resonance imaging (MRI) scan and cognitive tests. Participants were selected if they had no clinical diagnosis of dementia and no gross brain structural abnormalities. Voxel-based analyses were used to assess grey matter (GM) volume, white matter (WM) microstructure (fractional anisotropy (FA) and diffusivity), white matter lesions (WMLs), and cerebral blood flow (CBF). Cognitive outcomes were performance on verbal memory, semantic fluency, working memory, and executive function tests. Of 542 participants, 444 (81.9%) were men. The mean (SD) age was 63.9 (5.2) years at the baseline Phase 9 examination, 68.0 (5.2) at Phase 11, and 69.8 (5.2) at the Imaging Phase. Voxel-based analysis revealed that faster rates of aortic stiffening in mid-to-late life were associated with poor WM microstructure, viz. lower FA, higher mean, and radial diffusivity (RD) in 23.9%, 11.8%, and 22.2% of WM tracts, respectively, including the corpus callosum, corona radiata, superior longitudinal fasciculus, and corticospinal tracts. Similar voxel-wise associations were also observed with follow-up aortic stiffness. Moreover, lower mean global FA was associated with faster rates of aortic stiffening (B = -5.65, 95% CI -9.75, -1.54, Bonferroni-corrected p < 0.0125) and higher follow-up aortic stiffness (B = -1.12, 95% CI -1.95, -0.29, Bonferroni-corrected p < 0.0125). In a subset of 112 participants who received arterial spin labelling scans, faster aortic stiffening was also related to lower cerebral perfusion in 18.4% of GM, with associations surviving Bonferroni corrections in the frontal (B = -10.85, 95% CI -17.91, -3.79, p < 0.0125) and parietal lobes (B = -12.75, 95% CI -21.58, -3.91, p < 0.0125). No associations with GM volume or WMLs were observed. Further, higher baseline aortic stiffness was associated with poor semantic fluency (B = -0.47, 95% CI -0.76 to -0.18, Bonferroni-corrected p < 0.007) and verbal learning outcomes (B = -0.36, 95% CI -0.60 to -0.12, Bonferroni-corrected p < 0.007). As with all observational studies, it was not possible to infer causal associations. The generalisability of the findings may be limited by the gender imbalance, high educational attainment, survival bias, and lack of ethnic and socioeconomic diversity in this cohort. CONCLUSIONS: Our findings indicate that faster rates of aortic stiffening in mid-to-late life were associated with poor brain WM microstructural integrity and reduced cerebral perfusion, likely due to increased transmission of pulsatile energy to the delicate cerebral microvasculature. Strategies to prevent arterial stiffening prior to this point may be required to offer cognitive benefit in older age. TRIAL REGISTRATION: ClinicalTrials.gov NCT03335696.


Assuntos
Encéfalo/irrigação sanguínea , Circulação Cerebrovascular , Transtornos Cerebrovasculares/fisiopatologia , Cognição , Disfunção Cognitiva/psicologia , Doença Arterial Periférica/fisiopatologia , Rigidez Vascular , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Encéfalo/diagnóstico por imagem , Velocidade da Onda de Pulso Carótido-Femoral , Transtornos Cerebrovasculares/diagnóstico por imagem , Transtornos Cerebrovasculares/epidemiologia , Envelhecimento Cognitivo , Disfunção Cognitiva/diagnóstico , Disfunção Cognitiva/epidemiologia , Função Executiva , Feminino , Humanos , Londres/epidemiologia , Imagem por Ressonância Magnética , Masculino , Memória de Curto Prazo , Pessoa de Meia-Idade , Testes Neuropsicológicos , Doença Arterial Periférica/diagnóstico , Doença Arterial Periférica/epidemiologia , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Fatores de Tempo
5.
Zh Nevrol Psikhiatr Im S S Korsakova ; 120(10. Vyp. 2): 54-60, 2020.
Artigo em Russo | MEDLINE | ID: mdl-33205931

RESUMO

Heart failure is one of the most frequent causes predisposing to cognitive impairment where its prevalence varies from 25 to 80% of cases. In this review, the mechanisms of microcirculatory abnormalities, which play a potential role in the development of cognitive impairment in patients with heart failure, are considered. Understanding of these mechanisms will help in the development of targeted therapy of cardiovascular and cerebrovascular diseases.


Assuntos
Transtornos Cerebrovasculares , Disfunção Cognitiva , Insuficiência Cardíaca , Transtornos Cerebrovasculares/complicações , Transtornos Cerebrovasculares/epidemiologia , Disfunção Cognitiva/etiologia , Insuficiência Cardíaca/complicações , Humanos , Microcirculação
7.
BMJ Open ; 10(9): e041079, 2020 09 16.
Artigo em Inglês | MEDLINE | ID: mdl-32938604

RESUMO

OBJECTIVES: Our research question was: what are the most frequent baseline clinical characteristics in adult patients with COVID-19? Our major aim was to identify common baseline clinical features that could help recognise adult patients at high risk of having COVID-19. DESIGN: We conducted a scoping review of all the evidence available at LitCovid, until 23 March 2020. SETTING: Studies conducted in any setting and any country were included. PARTICIPANTS: Studies had to report the prevalence of sociodemographic characteristics, symptoms and comorbidities specifically in adults with a diagnosis of infection by SARS-CoV-2. RESULTS: In total, 1572 publications were published on LitCovid. We have included 56 articles in our analysis, with 89% conducted in China and 75% containing inpatients. Three studies were conducted in North America and one in Europe. Participants' age ranged from 28 to 70 years, with balanced gender distribution. The proportion of asymptomatic cases were from 2% to 79%. The most common reported symptoms were fever (4%-99%), cough (4%-92%), dyspnoea/shortness of breath (1%-90%), fatigue (4%-89%), myalgia (3%-65%) and pharyngalgia (2%-61%), while regarding comorbidities, we found cardiovascular disease (1%-40%), hypertension (0%-40%) and cerebrovascular disease (1%-40%). Such heterogeneity impaired the conduction of meta-analysis. CONCLUSIONS: The infection by COVID-19 seems to affect people in a very diverse manner and with different characteristics. With the available data, it is not possible to clearly identify those at higher risk of being infected with this condition. Furthermore, the evidence from countries other than China is, at the moment, too scarce.


Assuntos
Infecções Assintomáticas/epidemiologia , Infecções por Coronavirus/fisiopatologia , Tosse/fisiopatologia , Dispneia/fisiopatologia , Fadiga/fisiopatologia , Febre/fisiopatologia , Pneumonia Viral/fisiopatologia , Betacoronavirus , Doenças Cardiovasculares/epidemiologia , Transtornos Cerebrovasculares/epidemiologia , Comorbidade , Infecções por Coronavirus/epidemiologia , Humanos , Hipertensão/epidemiologia , Mialgia/fisiopatologia , Pandemias , Faringite/fisiopatologia , Pneumonia Viral/epidemiologia
8.
Clin Neurol Neurosurg ; 197: 106183, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32919240

RESUMO

BACKGROUND AND OBJECTIVES: Past history of stroke has been associated with an increased risk of a new ischemic stroke. Several studies have indicated increased prevalence of strokes among coronavirus patients. However, the role of past history of stroke in COVID19 patients is still unclear. The purpose of this systematic review is to evaluate and summarize the level of evidence on past history of stroke in COVID19 patients. METHODS: A systematic review was performed according to the PRISMA guidelines was performed in PubMed, Embase, EBSCO Host, Scopus, Science Direct, Medline, and LILACS. Eligibility criteria: We evaluated studies including patients with diagnosis of COVID 19 and a past history of stroke. Risk of bias: was evaluated with the Newcastle- Ottawa Scale (NOS) and experimental studies were evaluated using the ROBINS-I scale. RESULTS: Seven articles out of the total 213 articles were evaluated and included, involving 3244 patients with SARS VOC 2 Disease (COVID19) of which 198 had a history of cerebrovascular disease. Meta-analysis of the data was performed, observing an increase in mortality in patients with a history of cerebrovascular disease compared to those with different comorbidities or those without underlying pathology (OR 2.78 95 % CI [1.42-5.46] p = 0.007; I2 = 49 %) showing adequate heterogeneity. The presence of publication bias was evaluated using the Egger test in a funnel plot, showing adequate. Asymmetry, indicating that there is no publication bias; however, due to the low number of included studies, we could not rule out or confirm the presence of bias. CONCLUSIONS: The history of cerebrovascular disease was associated with a 2.78-fold increased risk of mortality compared to patients with other comorbidities or without underlying pathologies.


Assuntos
Isquemia Encefálica/epidemiologia , Infecções por Coronavirus/mortalidade , Pneumonia Viral/mortalidade , Acidente Vascular Cerebral/epidemiologia , Betacoronavirus , Transtornos Cerebrovasculares/epidemiologia , Humanos , Pandemias , Fatores de Risco , Índice de Gravidade de Doença
11.
Eur J Clin Invest ; 50(10): e13378, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32860457

RESUMO

BACKGROUND: To systematically review clinical and biochemical characteristics associated with the severity of the novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)-related disease (COVID-19). MATERIALS AND METHODS: Systematic review of observational studies from PubMed, ISI Web of Science, SCOPUS and Cochrane databases including people affected by COVID-19 and reporting data according to the severity of the disease. Data were combined with odds ratio (OR) and metanalysed. Severe COVID-19 was defined by acute respiratory distress syndrome, intensive care unit admission and death. RESULTS: We included 12 studies with 2794 patients, of whom 596 (21.33%) had severe disease. A slightly higher age was found in severe vs non-severe disease. We found that prevalent cerebrovascular disease (odds ratio [OR] 3.66, 95% confidence interval [CI] 1.73-7.72), chronic obstructive pulmonary disease (OR: 2.39, 95% CI 1.10-5.19), prevalent cardiovascular disease (OR: 2.84, 95% CI 1.59-5.10), diabetes (OR: 2.78, 95% CI 2.09-3.72), hypertension (OR: 2.24, 95% CI 1.63-3.08), smoking (OR: 1.54, 95% CI 1.07-2.22) and male sex (OR: 1.22, 95% CI 1.01-1.49) were associated with severe disease. Furthermore, increased procalcitonin (OR: 8.21, 95% CI 4.48-15.07), increased D-Dimer (OR: 5.67, 95% CI 1.45-22.16) and thrombocytopenia (OR: 3.61, 95% CI 2.62-4.97) predicted severe infection. CONCLUSION: Characteristics associated with the severity of SARS-CoV-2 infection may allow an early identification and management of patients with poor outcomes.


Assuntos
Doenças Cardiovasculares/epidemiologia , Infecções por Coronavirus/metabolismo , Diabetes Mellitus/epidemiologia , Produtos de Degradação da Fibrina e do Fibrinogênio/metabolismo , Pneumonia Viral/metabolismo , Pró-Calcitonina/metabolismo , Doença Pulmonar Obstrutiva Crônica/epidemiologia , Fumar/epidemiologia , Trombocitopenia/epidemiologia , Betacoronavirus , Transtornos Cerebrovasculares/epidemiologia , Comorbidade , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/fisiopatologia , Humanos , Hipertensão/epidemiologia , Pandemias , Pneumonia Viral/epidemiologia , Pneumonia Viral/fisiopatologia , Prevalência , Fatores de Risco , Índice de Gravidade de Doença , Fatores Sexuais
12.
Stroke Vasc Neurol ; 5(3): 211-239, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32826385

RESUMO

China faces the greatest challenge from stroke in the world. The death rate for cerebrovascular diseases in China was 149.49 per 100 000, accounting for 1.57 million deaths in 2018. It ranked third among the leading causes of death behind malignant tumours and heart disease. The age-standardised prevalence and incidence of stroke in 2013 were 1114.8 per 100 000 population and 246.8 per 100 000 person-years, respectively. According to the Global Burden of Disease Study 2017, the years of life lost (YLLs) per 100 000 population for stroke increased by 14.6%; YLLs due to stroke rose from third highest among all causes in 1990 to the highest in 2017. The absolute numbers and rates per 100 000 population for all-age disability-adjusted life years (DALYs) for stroke increased substantially between 1990 and 2017, and stroke was the leading cause of all-age DALYs in 2017. The main contributors to cerebrovascular diseases include behavioural risk factors (smoking and alcohol use) and pre-existing conditions (hypertension, diabetes mellitus, dyslipidaemia and atrial fibrillation (AF)). The most prevalent risk factors among stroke survivors were hypertension (63.0%-84.2%) and smoking (31.7%-47.6%). The least prevalent was AF (2.7%-7.4%). The prevalences for major risk factors for stroke are high and most have increased over time. Based on the latest national epidemiological data, 26.6% of adults aged ≥15 years (307.6 million adults) smoked tobacco products. For those aged ≥18 years, age-adjusted prevalence of hypertension was 25.2%; adjusted prevalence of hypercholesterolaemia was 5.8%; and the standardised prevalence of diabetes was 10.9%. For those aged ≥40 years, the standardised prevalence of AF was 2.31%. Data from the Hospital Quality Monitoring System showed that 3 010 204 inpatients with stroke were admitted to 1853 tertiary care hospitals during 2018. Of those, 2 466 785 (81.9%) were ischaemic strokes (ISs); 447 609 (14.9%) were intracerebral haemorrhages (ICHs); and 95 810 (3.2%) were subarachnoid haemorrhages (SAHs). The average age of patients admitted was 66 years old, and nearly 60% were male. A total of 1555 (0.1%), 2774 (0.6%) and 1347 (1.4%) paediatric strokes (age <18 years) were identified among IS, ICH and SAH, respectively. Over one-third (1 063 892 (35.3%)) of the patients were covered by urban resident basic medical insurance, followed by urban employee basic medical insurance (699 513 (23.2%)) and new rural cooperative medical schema (489 361 (16.3%)). The leading risk factor was hypertension (67.4% for IS, 77.2% for ICH and 49.1% for SAH), and the leading comorbidity was pneumonia or pulmonary infection (10.1% for IS, 31.4% for ICH and 25.2% for SAH). In-hospital death/discharge against medical advice rate was 8.3% for stroke inpatients, ranging from 5.8% for IS to 19.5% for ICH. The median and IQR of length of stay was 10.0 (7.0-14.0) days, ranging from 10.0 (7.0-13.0) in IS to 14.0 (8.0-22.0) in SAH. Data from the Chinese Stroke Center Alliance demonstrated that the composite scores of guideline-recommended key performance indicators for patients with IS, ICH and SAH were 0.77±0.21, 0.72±0.28 and 0.59±0.32, respectively.


Assuntos
Transtornos Cerebrovasculares/epidemiologia , Adolescente , Adulto , Distribuição por Idade , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Transtornos Cerebrovasculares/diagnóstico , Transtornos Cerebrovasculares/mortalidade , Transtornos Cerebrovasculares/terapia , Criança , Pré-Escolar , China/epidemiologia , Comorbidade , Feminino , Disparidades nos Níveis de Saúde , Humanos , Incidência , Lactente , Recém-Nascido , Estilo de Vida , Masculino , Pessoa de Meia-Idade , Prevalência , Medição de Risco , Fatores de Risco , Distribuição por Sexo , Fatores Sexuais , Fatores de Tempo , Resultado do Tratamento , Adulto Jovem
13.
Stroke Vasc Neurol ; 5(3): 270-278, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32792457

RESUMO

AIM: Cerebrovascular disease is the leading cause of death and disability in China, causing a huge burden among patients and their families. Hence, stroke prevention is critical, especially in the high-risk population. Here, we present the evidence-based guideline suitable for the Chinese population. METHODS: Literature search of PubMed and Cochrane library (from January 1964 to June 2019) was done. After thorough discussion among the writing group members, recommendations were listed and summarised. This guideline was reviewed and discussed by the fellow writing committees of the Chinese Stroke Association's Stroke. RESULTS: This evidence-based guideline was written in three parts: controlling the risk factors of stroke, utilisation of antiplatelet agents and assessing the risks of first-ever stroke. All recommendations were listed along with the recommending classes and levels of evidence. CONCLUSIONS: This guideline provides recommendations for primary prevention of cerebrovascular disease among high-risk population in China. Controlling related risk factors, appropriately using antiplatelet agents, assessing the risk of developing first-ever stroke should help reduce the rate of cerebrovascular disease in China.


Assuntos
Transtornos Cerebrovasculares/prevenção & controle , Medicina Baseada em Evidências/normas , Neurologia/normas , Inibidores da Agregação de Plaquetas/uso terapêutico , Prevenção Primária/normas , Comportamento de Redução do Risco , Transtornos Cerebrovasculares/diagnóstico , Transtornos Cerebrovasculares/epidemiologia , China/epidemiologia , Consenso , Avaliação da Deficiência , Humanos , Inibidores da Agregação de Plaquetas/efeitos adversos , Recuperação de Função Fisiológica , Medição de Risco , Fatores de Risco , Resultado do Tratamento
14.
Am J Cardiol ; 130: 15-23, 2020 09 01.
Artigo em Inglês | MEDLINE | ID: mdl-32693918

RESUMO

Patients presenting with acute coronary syndrome (ACS) are frequently co-morbid. However, there is limited data on how co-morbidity burden impacts their receipt of invasive management and subsequent outcomes. We analyzed all patients with a discharge diagnosis of ACS from the National Inpatient Sample (2004 to 2014), stratified by Charlson Co-morbidity Index (CCI) into 4 classes (CCI 0, 1, 2, and ≥3). Regression analyses were performed to examine associations between co-morbidity burden and receipt of invasive intervention and in-hospital clinical outcomes. Of all 6,613,623 ACS patients analyzed, the prevalence of patients with severe co-morbidity (CCI ≥3) increased from 10.8% (2004) to 18.1% (2014). CCI class negatively correlated with receipt of invasive management, with CCI ≥3 group being the least likely to receive coronary angiography and percutaneous coronary intervention (odds ratio (OR) 0.42 95% confidence interval [CI] 0.41 to 0.43 and OR 0.47, 95% CI 0.46 to 0.48, respectively). CCI class was independently associated with an increased risk of mortality and complications, especially CCI ≥3 that was associated with significantly increased odds of Major Acute Cardiovascular & Cerebrovascular Events (OR 1.70, 95% CI 1.66 to 1.75), mortality (OR 1.74, 95% CI 1.68 to 1.79), acute ischemic stroke (OR 2.35, 95% CI 2.23 to 2.46), and major bleeding (OR 1.64, 95% CI 1.59 to 1.69). Co-morbidity burden has significantly increased amongst those presenting with ACS over an 11-year period and correlates with reduced likelihood of receipt of invasive management and increased odds of mortality and adverse outcomes. In conclusion, objective assessment of co-morbidities using CCI score identifies high-risk ACS patients in whom targeted risk reduction strategies may reduce their inherent risk of mortality and complications.


Assuntos
Síndrome Coronariana Aguda/epidemiologia , Síndrome Coronariana Aguda/cirurgia , Doenças Cardiovasculares/epidemiologia , Transtornos Cerebrovasculares/epidemiologia , Intervenção Coronária Percutânea , Idoso , Idoso de 80 Anos ou mais , Comorbidade/tendências , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Prognóstico , Resultado do Tratamento , Estados Unidos/epidemiologia
15.
Am J Cardiol ; 128: 28-34, 2020 08 01.
Artigo em Inglês | MEDLINE | ID: mdl-32650921

RESUMO

Involvement of atherosclerosis in extracardiac vascular territories may identify coronary artery disease (CAD) patients at higher risk for adverse events. We investigated the long-term prognostic implications of polyvascular disease in patients with CAD, and further analyzed lipid goal attainment and its relation to patient outcomes. The study was a retrospective analysis of 10,297 patients who underwent coronary revascularization, categorized as having CAD alone (83.1%) or with multisite artery disease (MSAD) (16.9%) including cerebrovascular disease (CBVD) and/or peripheral artery disease (PAD). Incidence rates and hazard ratios (HR) for major adverse cardiovascular events (MACE) (myocardial infarction, ischemic stroke, or all-cause death) according to vascular territories involved, and in relation to most-recent lipid levels attained, were analyzed. Patients with MSAD were older with higher burden of co-morbidities. The rate of MACE (myocardial infarction, ischemic stroke, or all-cause death) and its individual components increased with the number of affected vascular beds. Adjusted HR (95% confidence interval) for MACE was 1.41 (1.24 to 1.59) in patients with CAD and CBVD, 1.46 (1.33 to 1.62) in CAD and PAD, and 1.69 (1.49 to 1.92) in those with CAD and CBVD and PAD, compared with CAD alone. Most-recent low-density lipoprotein cholesterol (LDL-C) levels <55 mg/dl and <70 mg/dl were attained by 21.8% and 44.6% of patients with CAD alone, in comparison to 22.7% and 43.3% in MSAD. Compared with patients with most-recent LDL-C > 100 mg/dl, attaining LDL-C < 70 mg/dl had an adjusted HR for MACE of 0.52 (0.47 to 0.57) in CAD only patients and 0.66 (0.57 to 0.78) in MSAD patients. In conclusion, the presence of CBVD and/or PAD in patients with CAD is associated with higher burden of co-morbidities and progressive increase in long-term MACE. More than half of CAD patients with or without MSAD do not achieve lipid goals, which are associated with a significantly lower risk for adverse events.


Assuntos
Transtornos Cerebrovasculares/epidemiologia , Doença da Artéria Coronariana/cirurgia , Hipercolesterolemia/terapia , Infarto do Miocárdio/epidemiologia , Revascularização Miocárdica , Doença Arterial Periférica/epidemiologia , Acidente Vascular Cerebral/epidemiologia , Idoso , Idoso de 80 Anos ou mais , Angina Instável/epidemiologia , Angina Instável/cirurgia , Aneurisma da Aorta Abdominal/epidemiologia , Causas de Morte , LDL-Colesterol/sangue , Comorbidade , Doença da Artéria Coronariana/sangue , Doença da Artéria Coronariana/epidemiologia , Feminino , Humanos , Hipercolesterolemia/sangue , Hipercolesterolemia/epidemiologia , Incidência , Israel/epidemiologia , Estimativa de Kaplan-Meier , Masculino , Pessoa de Meia-Idade , Mortalidade , Infarto do Miocárdio sem Supradesnível do Segmento ST/epidemiologia , Infarto do Miocárdio sem Supradesnível do Segmento ST/cirurgia , Prognóstico , Modelos de Riscos Proporcionais , Estudos Retrospectivos , Infarto do Miocárdio com Supradesnível do Segmento ST/epidemiologia , Infarto do Miocárdio com Supradesnível do Segmento ST/cirurgia
16.
Cerebrovasc Dis ; 49(4): 361-368, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32674110

RESUMO

INTRODUCTION: Cerebral hyperperfusion syndrome (CHS) is one of the most serious complications after revascularization surgery in patients with moyamoya disease (MMD). However, there are few effective measures to prevent the occurrence of CHS. OBJECTIVE: The present study aims to examine the effect of the method about matching selection of donor-recipient vessels during revascularization surgery on the incidence of postoperative CHS in adult MMD patients. METHODS: 216 Chinese adult patients with MMD received surgery treatment between January 2018 and December 2019 in our hospital were enrolled in this study. 191 out of 216 patients were included in this study. Matching selection method was defined as follows: (1) blood flow: the direction of blood flow and speed of the donor artery and potential receptor arteries were measured by flow 800 indocyanine green video angiography; (2) vascular diameter: the diameters of the donor artery and potential receptor arteries by a miniature ruler. Only the artery with antegrade flow and with smallest difference in flow speed and diameter with the donor artery will be selected as the receptor artery to perform anastomosis. Matching selection was performed from January 2019. Digital subtraction angiography was performed in all patients for initial MMD diagnosis. Perioperative cerebral perfusion and related clinical symptoms were monitored. Clinical characteristics, contralateral progression, and risk factors were reviewed. The incidence of CHS and the correlation of CHS with baseline characteristics or clinical conditions were analyzed. RESULTS: Of these 191 patients, 82 patients received matching selection of donor-recipient vessels during revascularization surgery and 109 patients without. The postoperative CHS incidence in the matching group was 3.66%, which was much lower than that in the nonmatching group (15.60%). Multivariate analysis did not reveal a significant risk factor between the progression group and the nonprogression group. Correlation analysis revealed only the matching selection method was significantly associated with the reduced postoperative CHS incidence in MMD patients. CONCLUSIONS: The matching selection of donor-recipient vessels during revascularization surgery effectively reduces the incidence of postoperative CHS in adult patients with MMD.


Assuntos
Revascularização Cerebral , Circulação Cerebrovascular , Transtornos Cerebrovasculares/prevenção & controle , Doença de Moyamoya/cirurgia , Adulto , Velocidade do Fluxo Sanguíneo , Revascularização Cerebral/efeitos adversos , Transtornos Cerebrovasculares/diagnóstico por imagem , Transtornos Cerebrovasculares/epidemiologia , China/epidemiologia , Feminino , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Doença de Moyamoya/diagnóstico por imagem , Doença de Moyamoya/fisiopatologia , Estudos Retrospectivos , Fatores de Risco , Síndrome , Fatores de Tempo , Resultado do Tratamento , Adulto Jovem
17.
Stroke ; 51(9): e219-e222, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32684145

RESUMO

BACKGROUND AND PURPOSE: Initial reports suggest a significant risk of thrombotic events, including stroke, in patients hospitalized with coronavirus disease 2019 (COVID-19). However, there is little systematic data on stroke incidence and mechanisms, particularly in racially diverse populations in the United States. METHODS: We performed a retrospective, observational study of stroke incidence and mechanisms in all patients with COVID-19 hospitalized from March 15 to May 3, 2020, at 3 Philadelphia hospitals. RESULTS: We identified 844 hospitalized patients with COVID-19 (mean age 59 years, 52% female, 68% Black); 20 (2.4%) had confirmed ischemic stroke; and 8 (0.9%) had intracranial hemorrhage. Of the ischemic stroke patients, mean age was 64 years, with only one patient (5%) under age 50, and 80% were Black. Conventional vascular risk factors were common, with 95% of patients having a history of hypertension and 60% a history of diabetes mellitus. Median time from onset of COVID symptoms to stroke diagnosis was 21 days. Stroke mechanism was cardioembolism in 40%, small vessel disease in 5%, other determined mechanism in 20%, and cryptogenic in 35%. Of the 11 patients with complete vascular imaging, 3 (27%) had large vessel occlusion. Newly positive antiphospholipid antibodies were present in >75% of tested patients. Of the patients with intracranial hemorrhage, 5/8 (63%) were lobar intraparenchymal hemorrhages, and 3/8 (38%) were subarachnoid hemorrhage; 4/8 (50%) were on extracorporeal membrane oxygenation. CONCLUSIONS: We found a low risk of acute cerebrovascular events in patients hospitalized with COVID-19. Most patients with ischemic stroke had conventional vascular risk factors, and traditional stroke mechanisms were common.


Assuntos
Transtornos Cerebrovasculares/complicações , Transtornos Cerebrovasculares/epidemiologia , Infecções por Coronavirus/complicações , Infecções por Coronavirus/epidemiologia , Pneumonia Viral/complicações , Pneumonia Viral/epidemiologia , Grupo com Ancestrais do Continente Africano , Idoso , Isquemia Encefálica/complicações , Isquemia Encefálica/epidemiologia , Complicações do Diabetes/epidemiologia , Feminino , Humanos , Hipertensão/complicações , Incidência , Pacientes Internados , Hemorragias Intracranianas/complicações , Hemorragias Intracranianas/epidemiologia , Masculino , Pessoa de Meia-Idade , Pandemias , Philadelphia/epidemiologia , Estudos Retrospectivos , Fatores de Risco , Acidente Vascular Cerebral/complicações , Acidente Vascular Cerebral/epidemiologia , Trombose/complicações , Trombose/epidemiologia
18.
J Stroke Cerebrovasc Dis ; 29(8): 105003, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32689610

RESUMO

INTRODUCTION: A syndrome of focal neurologic deficits with characteristic imaging features, acute encephalopathy, and seizures after cardiac and thoracic interventions has been previously briefly reported in the literature. In a retrospective observational study, we aim to identify the prevalence and characteristics of this syndrome, in addition to discussing the possible underlying pathophysiology. METHODS: In a retrospective study, we reviewed records of consecutive adult patients (≥18 years old) who underwent cardiac and thoracic procedures at a single institution between September 2014 to September 2019 and found to have evidence of focal cerebral edema following their procedure. We included and reported clinical course of patients who developed post-operative neurologic dysfunction and underwent magnetic resonance imaging (MRI) showing (1) asymmetric cerebral edema with (2) cortical diffusion restriction and (3) T2 cortical or subcortical hyperintensity and (4) no proximal vascular occlusion. RESULTS: Three out of 107 patients (2.8%) met our inclusion criteria. These represented one male and two females with age at presentation of 63, 81 and 69, respectively. All patients developed severe neurologic impairment on the same day following their procedure (sternotomy with valve or bypass surgery in 2 patients; esophageal dilatation procedure in 1 patient). All patients underwent MRI of the brain and vessel imaging qualifying our inclusion criteria. Two patients improved neurologically prior to discharge, and one patient expired after family elected to withdraw care. CONCLUSION: We present a series of cases with a rare syndrome after cardiac and thoracic interventions. Although the exact mechanism of this syndrome remains unclear, we believe it to be related to relative cerebral hyperperfusion and cerebral dysautoregulation following anesthesia and thoracic manipulation. Future studies should focus on understanding the true prevalence and pathophysiology of this syndrome.


Assuntos
Edema Encefálico/fisiopatologia , Encéfalo/fisiopatologia , Procedimentos Cirúrgicos Cardíacos/efeitos adversos , Transtornos Cerebrovasculares/fisiopatologia , Convulsões/fisiopatologia , Procedimentos Cirúrgicos Torácicos/efeitos adversos , Idoso , Idoso de 80 Anos ou mais , Encéfalo/diagnóstico por imagem , Edema Encefálico/diagnóstico , Edema Encefálico/epidemiologia , Edema Encefálico/terapia , Transtornos Cerebrovasculares/diagnóstico , Transtornos Cerebrovasculares/epidemiologia , Transtornos Cerebrovasculares/terapia , Feminino , Humanos , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Exame Neurológico , Ohio/epidemiologia , Prevalência , Recuperação de Função Fisiológica , Estudos Retrospectivos , Fatores de Risco , Convulsões/diagnóstico , Convulsões/epidemiologia , Convulsões/terapia , Síndrome , Tomografia Computadorizada por Raios X , Resultado do Tratamento
19.
Eur J Clin Invest ; 50(10): e13362, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32726868

RESUMO

BACKGROUND: Identification of reliable outcome predictors in coronavirus disease 2019 (COVID-19) is of paramount importance for improving patient's management. METHODS: A systematic review of literature was conducted until 24 April 2020. From 6843 articles, 49 studies were selected for a pooled assessment; cumulative statistics for age and sex were retrieved in 587 790 and 602 234 cases. Two endpoints were defined: (a) a composite outcome including death, severe presentation, hospitalization in the intensive care unit (ICU) and/or mechanical ventilation; and (b) in-hospital mortality. We extracted numeric data on patients' characteristics and cases with adverse outcomes and employed inverse variance random-effects models to derive pooled estimates. RESULTS: We identified 18 and 12 factors associated with the composite endpoint and death, respectively. Among those, a history of CVD (odds ratio (OR) = 3.15, 95% confidence intervals (CIs) 2.26-4.41), acute cardiac (OR = 10.58, 5.00-22.40) or kidney (OR = 5.13, 1.78-14.83) injury, increased procalcitonin (OR = 4.8, 2.034-11.31) or D-dimer (OR = 3.7, 1.74-7.89), and thrombocytopenia (OR = 6.23, 1.031-37.67) conveyed the highest odds for the adverse composite endpoint. Advanced age, male sex, cardiovascular comorbidities, acute cardiac or kidney injury, lymphocytopenia and D-dimer conferred an increased risk of in-hospital death. With respect to the treatment of the acute phase, therapy with steroids was associated with the adverse composite endpoint (OR = 3.61, 95% CI 1.934-6.73), but not with mortality. CONCLUSIONS: Advanced age, comorbidities, abnormal inflammatory and organ injury circulating biomarkers captured patients with an adverse clinical outcome. Clinical history and laboratory profile may then help identify patients with a higher risk of in-hospital mortality.


Assuntos
Lesão Renal Aguda/epidemiologia , Doenças Cardiovasculares/epidemiologia , Infecções por Coronavirus/terapia , Produtos de Degradação da Fibrina e do Fibrinogênio/metabolismo , Pneumonia Viral/terapia , Pró-Calcitonina/metabolismo , Fumar/epidemiologia , Trombocitopenia/epidemiologia , Doença Aguda , Corticosteroides/uso terapêutico , Adulto , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Betacoronavirus , Proteína C-Reativa/metabolismo , Transtornos Cerebrovasculares/epidemiologia , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/metabolismo , Infecções por Coronavirus/mortalidade , Diabetes Mellitus/epidemiologia , Feminino , Ferritinas/metabolismo , Cardiopatias , Mortalidade Hospitalar , Hospitalização , Humanos , Hipertensão/epidemiologia , Unidades de Terapia Intensiva , Interleucina-6/metabolismo , Hepatopatias/epidemiologia , Linfopenia/epidemiologia , Masculino , Pessoa de Meia-Idade , Neoplasias/epidemiologia , Obesidade/epidemiologia , Pandemias , Pneumonia Viral/epidemiologia , Pneumonia Viral/metabolismo , Pneumonia Viral/mortalidade , Prognóstico , Doença Pulmonar Obstrutiva Crônica/epidemiologia , Respiração Artificial , Índice de Gravidade de Doença , Fatores Sexuais , Adulto Jovem
20.
Acta Med Port ; 33(11): 720-725, 2020 Nov 02.
Artigo em Inglês | MEDLINE | ID: mdl-32707029

RESUMO

INTRODUCTION: COVID-19 is a viral respiratory disease, which became a global threat to public health. Specific subsets of the population are more vulnerable, namely those with chronic diseases. We aimed to estimate the share of the Portuguese population at the highest risk for complications following COVID-19 infection due to both old age and specific comorbidities. MATERIAL AND METHODS: Our sample included all people aged 65 years and above (2215 men and 3486 women) who participated in the fifth Portuguese National Health Interview Survey, conducted in 2014. In order to project the potential population at highest risk for COVID-19, we used the latest available official demographic estimates from the National Institute of Statistics - INE 2018. We used a more restrictive definition of risk combining old age criteria and the following chronic conditions as potential risk factors for COVID-19 according to the available literature: hypertension, diabetes, chronic obstructive pulmonary disease, cardio- and cerebrovascular disease. RESULTS: We estimated that 15.5% (n = 1 560 667) of the Portuguese population might be at increased risk for complications from COVID-19 because of old age and existing chronic conditions. Such estimates vary across the country (from 1.7% in Azores to 33.7% in Northern Portugal). Northern Portugal not only has the highest prevalence of selected morbidity (72.8%) within mainland Portugal, but also has the largest population at risk for COVID-19 (n = 526 607). This was followed by the Lisbon and Tagus Valley region (n = 408 564) and Central Portugal (n = 388 867). DISCUSSION: Our results should encourage authorities to continue protecting those more vulnerable to the pandemic threat, particularly on those areas of the country which are more likely to be further affected. CONCLUSION: We projected a considerable number of Portuguese people at the highest risk for severe COVID-19 disease due to both old age and pre-existing chronic conditions. Such estimates vary across the country.


Assuntos
Betacoronavirus , Infecções por Coronavirus/epidemiologia , Pneumonia Viral/epidemiologia , Idoso , Idoso de 80 Anos ou mais , Doenças Cardiovasculares/epidemiologia , Transtornos Cerebrovasculares/epidemiologia , Doença Crônica , Comorbidade , Estudos Transversais , Diabetes Mellitus/epidemiologia , Feminino , Humanos , Hipertensão/epidemiologia , Masculino , Pandemias , Portugal , Prevalência , Doença Pulmonar Obstrutiva Crônica/epidemiologia , Medição de Risco , Fatores de Risco
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA