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1.
Environ Pollut ; 292(Pt B): 118482, 2022 Jan 01.
Artigo em Inglês | MEDLINE | ID: mdl-34763020

RESUMO

Living in walkable neighborhoods has been reported to be associated with a lower risk of cardiovascular disease. Features of walkable neighborhoods, however, may be related to particulate matter with an aerodynamic diameter ≤2.5 µm (PM2.5), which could increase risk of cardiovascular disease. The interaction effect between walkability and PM2.5 on risk of ischemic stroke remains to be elucidated. In this study, we recruited a total of 27,375 participants aged ≥40 years from Yinzhou District, Ningbo, Zhejiang Province, China to investigate the associations of walkability and PM2.5 with risk of ischemic stroke. We used amenity categories and decay functions to evaluate walkability and high-spatiotemporal-resolution land-use regression models to assess PM2.5 concentrations. We used Cox proportional hazards regression models to calculate hazard ratios (HRs) and 95% confidence intervals (CIs). During a median follow-up of 4.08 years, we identified a total of 637 incident cases of ischemic stroke in the entire cohort. Higher walkability was associated with a lower risk of ischemic stroke (quartile, Q4 vs. Q1 walkability: HR = 0.59, 95% CI: 0.47-0.75), whereas PM2.5 was positively associated with risk of ischemic stroke (Q4 vs. Q1 PM2.5: HR = 1.70, 95% CI: 1.29-2.25). Furthermore, we observed a significant interaction between walkability and PM2.5 on risk of ischemic stroke. Walkability was inversely associated with risk of ischemic stroke at lower PM2.5 concentrations, but this association was attenuated with increasing PM2.5 concentrations. Although walkable neighborhoods appear to decrease the risk of ischemic stroke, benefits may be offset by adverse effects of PM2.5 exposure in the most polluted areas. These findings are meaningful for future neighborhood design, air pollution control, and stroke prevention.


Assuntos
Isquemia Encefálica , AVC Isquêmico , Acidente Vascular Cerebral , Isquemia Encefálica/epidemiologia , China/epidemiologia , Estudos de Coortes , Humanos , Material Particulado/análise , Estudos Prospectivos , Acidente Vascular Cerebral/epidemiologia
2.
Clin Imaging ; 81: 79-86, 2022 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-34649081

RESUMO

Multimodal Magnetic Resonance Imaging (MRI) techniques of Perfusion-Weighted Imaging (PWI) and Diffusion-Weighted Imaging (DWI) data are integral parts of the diagnostic workup in the acute stroke setting. The visual interpretation of PWI/DWI data is the most likely procedure to triage Acute Ischemic Stroke (AIS) patients who will access reperfusion therapy, especially in those exceeding 6 h of stroke onset. In fact, this process defines two classes of tissue: the ischemic core, which is presumed to be irreversibly damaged, visualized on DWI data and the penumbra which is the reversibly injured brain tissue around the ischemic tissue, visualized on PWI data. AIS patients with a large ischemic penumbra and limited infarction core have a high probability of benefiting from endovascular treatment. However, it is a tedious and time-consuming procedure. Consequently, it is subject to high inter- and intra-observer variability. Thus, the assessment of the potential risks and benefits of endovascular treatment is uncertain. Fast, accurate and automatic post-processing of PWI and DWI data is important for clinical diagnosis and is necessary to help the decision making for therapy. Therefore, an automated procedure that identifies stroke slices, stroke hemisphere, segments stroke regions in DWI, and measures hypoperfused tissue in PWI enhances considerably the reproducibility and the accuracy of stroke assessment. In this work, we draw an overview of several applications of Artificial Intelligence (AI) for the automation processing and their potential contributions in clinical practices. We compare the current approaches among each other's with respect to some key requirements.


Assuntos
Isquemia Encefálica , AVC Isquêmico , Acidente Vascular Cerebral , Inteligência Artificial , Isquemia Encefálica/diagnóstico por imagem , Imagem de Difusão por Ressonância Magnética , Humanos , Imageamento por Ressonância Magnética , Reprodutibilidade dos Testes , Acidente Vascular Cerebral/diagnóstico por imagem , Acidente Vascular Cerebral/terapia
3.
Chemosphere ; 287(Pt 3): 132043, 2022 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-34543905

RESUMO

With the prevalence of stroke rising due to both aging societies and more people getting strokes at a younger age, a comprehensive investigation into the relationship between urban characteristics and age-specific stroke mortality for the development of a healthy built environment is necessary. Specifically, assessment of various dimensions of urban characteristics (e.g. short-term environmental change, long-term environmental conditions) is needed for healthy built environment designs and protocols. A multifactorial assessment was conducted to evaluate associations between environmental and sociodemographic characteristics with age-stroke mortality in Hong Kong. We found that short-term (and temporally varying) daily PM10, older age and being female were more strongly associated with all types of stroke deaths compared to all-cause deaths in general. Colder days, being employed and being married were more strongly associated with hemorrhagic stroke deaths in general. Long-term (and spatially varying) regional-level air pollution were more strongly associated with non-hemorrhagic stroke deaths in general. These associations varied by age. Employment (manual workers) and low education were risk factors for stroke mortality at younger ages (age <65). Greenness and open space did not have a significant association with stroke mortality. Since a significant connection was expected, this leads to questions about the health-inducing efficacy of Hong Kong's compact open spaces (natural greenery being limited to steep slopes, and extensive impervious surfaces on public open spaces). In conclusion, urban plans and designs for stroke mortality prevention should implement age-specific health care to neighborhoods with particular population segments.


Assuntos
Poluição do Ar , Acidente Vascular Cerebral , Fatores Etários , Idoso , Poluição do Ar/análise , Ambiente Construído , Feminino , Hong Kong/epidemiologia , Humanos
4.
Clin EEG Neurosci ; 53(1): 79-90, 2022 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-33913351

RESUMO

Background. A number of recent randomized controlled trials reported the efficacy of brain-computer interface (BCI) for upper-limb stroke rehabilitation compared with other therapies. Despite the encouraging results reported, there is a significant variance in the reported outcomes. This paper aims to investigate the effectiveness of different BCI designs on poststroke upper-limb rehabilitation. Methods. The effect sizes of pooled and individual studies were assessed by computing Hedge's g values with a 95% confidence interval. Subgroup analyses were also performed to examine the impact of different BCI designs on the treatment effect. Results. The study included 12 clinical trials involving 298 patients. The analysis showed that the BCI yielded significant superior short-term and long-term efficacy in improving the upper-limb motor function compared to the control therapies (Hedge's g = 0.73 and 0.33, respectively). Based on our subgroup analyses, the BCI studies that used the intention of movement had a higher effect size compared to those used motor imagery (Hedge's g = 1.21 and 0.55, respectively). The BCI studies using band power features had a significantly higher effect size than those using filter bank common spatial patterns features (Hedge's g = 1.25 and - 0.23, respectively). Finally, the studies that used functional electrical stimulation as the BCI feedback had the highest effect size compared to other devices (Hedge's g = 1.2). Conclusion. This meta-analysis confirmed the effectiveness of BCI for upper-limb rehabilitation. Our findings support the use of band power features, the intention of movement, and the functional electrical stimulation in future BCI designs for poststroke upper-limb rehabilitation.


Assuntos
Interfaces Cérebro-Computador , Reabilitação do Acidente Vascular Cerebral , Acidente Vascular Cerebral , Eletroencefalografia , Humanos , Ensaios Clínicos Controlados Aleatórios como Assunto , Recuperação de Função Fisiológica , Extremidade Superior
5.
Multimedia | Recursos Multimídia | ID: multimedia-9399

RESUMO

Priscilla Souza, CGPClin, sobre uso de Evidências em Saúde sobre o uso de Trombectomia em casos de AVC.


Assuntos
Trombectomia/normas , Acidente Vascular Cerebral/terapia , Política Informada por Evidências
6.
BMJ Case Rep ; 14(11)2021 Nov 01.
Artigo em Inglês | MEDLINE | ID: mdl-34725065

RESUMO

An elderly patient presented with acute-onset right-sided weakness and aphasia. A large penumbra was noted in the left middle cerebral artery (MCA) territory without any infarct core. The patient was noted to have a carotid-carotid bypass. This posed certain technical challenge in accessing the intracranial circulation across the carotid bypass; however, the guiding catheter with soft distal segment was successfully navigated coaxially over the aspiration catheter across the bypass and intracranial circulation was accessed for mechanical thrombectomy. Complete recanalisation and reperfusion were achieved with significant neurological recovery of the patient post-thrombectomy. The aim of this report is to emphasise on this rarely encountered situation in thrombectomy and its successful management. The procedure should not be delayed or deferred due to lack of operator experience.


Assuntos
Acidente Vascular Cerebral , Trombectomia , Idoso , Humanos , Infarto da Artéria Cerebral Média/diagnóstico por imagem , Infarto da Artéria Cerebral Média/cirurgia , Artéria Cerebral Média/diagnóstico por imagem , Artéria Cerebral Média/cirurgia , Stents , Resultado do Tratamento
7.
BMJ Case Rep ; 14(11)2021 Nov 02.
Artigo em Inglês | MEDLINE | ID: mdl-34728512

RESUMO

MELAS, a mitochondrially inherited multisystem disorder, can present with acute stroke-like episodes. The literature thus far supports the use of L-arginine therapy in acute MELAS flares to alleviate and shorten the duration of symptoms. This is the case of a patient who presented with ataxia and worsening confusion on a background of genetically confirmed MELAS syndrome. In this instance, intravenous L-arginine therapy, along with corticosteroids, was administered in keeping with best practice. However, in a metabolically vulnerable patient, L-arginine therapy resulted in a further deterioration in his clinical status and the development of a non-anion gap metabolic acidosis.


Assuntos
Acidose Tubular Renal , Síndrome MELAS , Acidente Vascular Cerebral , Acidose Tubular Renal/complicações , Acidose Tubular Renal/diagnóstico , Acidose Tubular Renal/tratamento farmacológico , Arginina , Humanos , Síndrome MELAS/complicações , Síndrome MELAS/diagnóstico , Síndrome MELAS/tratamento farmacológico , Acidente Vascular Cerebral/tratamento farmacológico , Acidente Vascular Cerebral/etiologia
8.
J Neurosci Nurs ; 53(6): 244-250, 2021 Dec 01.
Artigo em Inglês | MEDLINE | ID: mdl-34748520

RESUMO

ABSTRACT: BACKGROUND: Motivational interviewing has become a popular approach for relieving mood disturbances. We aimed to investigate whether motivational interviewing can effectively improve depression, anxiety, and quality of life among stroke patients. METHODS: Seven electronic databases were searched from inception to March 15, 2021. Other potentially related studies were identified through manually searching the reference lists of empirical articles and relevant review articles. Randomized controlled trials that investigated the effects of motivational interviewing on stroke patients with mood disturbances were deemed eligible. The Cochrane Handbook 5.1.0 was used to assess the risk of bias. Meta-analyses were conducted using the Review Manager Version 5.3. RESULTS: Six articles with 1419 participants were included. The subgroup analysis revealed that motivational interviewing was associated with improvement of depression (P < .00001) and quality of life (P = .0007) among patients having stroke at less than 12 months of follow-up. No significant differences were detected for improving depression (P = .40) and quality of life (P = .38) at 12 months of follow-up. Furthermore, the meta-analysis showed that motivational interviewing was not associated with alleviation of anxiety (P = .81) among stroke patients. CONCLUSION: This meta-analysis indicated that motivational interviewing might have beneficial effects on depression and quality of life in stroke patients at less than 12 months of follow-up. However, large and well-designed randomized controlled trials are needed to confirm these findings.


Assuntos
Entrevista Motivacional , Acidente Vascular Cerebral , Ansiedade , Depressão/terapia , Humanos , Qualidade de Vida , Ensaios Clínicos Controlados Aleatórios como Assunto , Acidente Vascular Cerebral/terapia
10.
Sensors (Basel) ; 21(21)2021 Oct 22.
Artigo em Inglês | MEDLINE | ID: mdl-34770320

RESUMO

Electroencephalography (EEG) and electromyography (EMG) are widespread and well-known quantitative techniques used for gathering biological signals at cortical and muscular levels, respectively. Indeed, they provide relevant insights for increasing knowledge in different domains, such as physical and cognitive, and research fields, including neuromotor rehabilitation. So far, EEG and EMG techniques have been independently exploited to guide or assess the outcome of the rehabilitation, preferring one technique over the other according to the aim of the investigation. More recently, the combination of EEG and EMG started to be considered as a potential breakthrough approach to improve rehabilitation effectiveness. However, since it is a relatively recent research field, we observed that no comprehensive reviews available nor standard procedures and setups for simultaneous acquisitions and processing have been identified. Consequently, this paper presents a systematic review of EEG and EMG applications specifically aimed at evaluating and assessing neuromotor performance, focusing on cortico-muscular interactions in the rehabilitation field. A total of 213 articles were identified from scientific databases, and, following rigorous scrutiny, 55 were analyzed in detail in this review. Most of the applications are focused on the study of stroke patients, and the rehabilitation target is usually on the upper or lower limbs. Regarding the methodological approaches used to acquire and process data, our results show that a simultaneous EEG and EMG acquisition is quite common in the field, but it is mostly performed with EMG as a support technique for more specific EEG approaches. Non-specific processing methods such as EEG-EMG coherence are used to provide combined EEG/EMG signal analysis, but rarely both signals are analyzed using state-of-the-art techniques that are gold-standard in each of the two domains. Future directions may be oriented toward multi-domain approaches able to exploit the full potential of combined EEG and EMG, for example targeting a wider range of pathologies and implementing more structured clinical trials to confirm the results of the current pilot studies.


Assuntos
Processamento de Sinais Assistido por Computador , Acidente Vascular Cerebral , Eletroencefalografia , Eletromiografia , Humanos
11.
Sensors (Basel) ; 21(21)2021 Oct 25.
Artigo em Inglês | MEDLINE | ID: mdl-34770362

RESUMO

Analysis of kinematic features related to clinical assessment scales may qualitatively improve the evaluation of upper extremity movements of stroke patients. We aimed to investigate kinematic features that could correlate the change in the Fugl-Meyer Assessment (FMA) score of stroke survivors through upper extremity robotic rehabilitation. We also analyzed whether changes in kinematic features by active and active-assisted robotic rehabilitation correlated differently with changes in FMA scores. Fifteen stroke patients participated in the upper extremity robotic rehabilitation program, and nine kinematic features were calculated from reach tasks for assessment. Simple and multiple linear regression analyses were used to characterize correlations. Features representing movement speed were associated with changes in FMA scores for the group that used an active rehabilitation robot. In contrast, in the group that used an active-assisted rehabilitation robot, features representing movement smoothness were associated with changes in the FMA score. These estimates can be an important basis for kinematic analysis to complement clinical scales.


Assuntos
Procedimentos Cirúrgicos Robóticos , Robótica , Reabilitação do Acidente Vascular Cerebral , Acidente Vascular Cerebral , Fenômenos Biomecânicos , Humanos , Recuperação de Função Fisiológica , Resultado do Tratamento , Extremidade Superior
12.
Sensors (Basel) ; 21(21)2021 Oct 28.
Artigo em Inglês | MEDLINE | ID: mdl-34770479

RESUMO

Ischemic stroke is one of the leading causes of death among the aged population in the world. Experimental stroke models with rodents play a fundamental role in the investigation of the mechanism and impairment of cerebral ischemia. For its celerity and veracity, the 2,3,5-triphenyltetrazolium chloride (TTC) staining of rat brains has been extensively adopted to visualize the infarction, which is subsequently photographed for further processing. Two important tasks are to segment the brain regions and to compute the midline that separates the brain. This paper investigates automatic brain extraction and hemisphere segmentation algorithms in camera-based TTC-stained rat images. For rat brain extraction, a saliency region detection scheme on a superpixel image is exploited to extract the brain regions from the raw complicated image. Subsequently, the initial brain slices are refined using a parametric deformable model associated with color image transformation. For rat hemisphere segmentation, open curve evolution guided by the gradient vector flow in a medial subimage is developed to compute the midline. A wide variety of TTC-stained rat brain images captured by a smartphone were produced and utilized to evaluate the proposed segmentation frameworks. Experimental results on the segmentation of rat brains and cerebral hemispheres indicated that the developed schemes achieved high accuracy with average Dice scores of 92.33% and 97.15%, respectively. The established segmentation algorithms are believed to be potential and beneficial to facilitate experimental stroke study with TTC-stained rat brain images.


Assuntos
Isquemia Encefálica , Cérebro , Acidente Vascular Cerebral , Algoritmos , Animais , Encéfalo/diagnóstico por imagem , Isquemia Encefálica/diagnóstico por imagem , Processamento de Imagem Assistida por Computador , Ratos , Acidente Vascular Cerebral/diagnóstico por imagem , Sais de Tetrazólio
13.
Sensors (Basel) ; 21(21)2021 Oct 29.
Artigo em Inglês | MEDLINE | ID: mdl-34770524

RESUMO

Walking function disorders are typical for patients after cerebral stroke. Biofeedback technology (BFB) is currently considered effective and promising for training walking function, including in patients after cerebral stroke. Most studies recognize that BFB training is a promising tool for improving walking function; however, the data on the use of highly selective walking parameters for BFB training are very limited. The aim of our study was to investigate the feasibility of using BFB training targeting one of the basic parameters of gait symmetry-stance phase duration-in cerebral stroke patients in the early recovery period. The study included 20 hemiparetic patients in the early recovery period after the first hemispheric ischemic stroke. The control group included 20 healthy subjects. The BFB training and biomechanical analysis of walking (before and after all BFB sessions) were done using an inertial system. The mean number of BFB sessions was nine (from 8 to 11) during the three weeks in clinic. There was not a single negative response to BFB training among the study patients, either during the sessions or later. The spatiotemporal parameters of walking showed the whole syndrome complex of slow walking and typical asymmetry of temporal walking parameters, and did not change significantly as a result of the study therapy. The changes were more significant for the functioning of hip and knee joints. The contralateral hip amplitude returned to the normal range. For the knee joint, the amplitude of the first flexion increased and the value of the amplitude of hyperextension decreased in the middle of the stance phase. Concerning muscle function, the observed significant decrease in the function of m. Gastrocnemius and the hamstring muscles on the paretic side remained without change at the end of the treatment course. We obtained positive dynamics of the biomechanical parameters of walking in patients after the BFB training course. The feasibility and efficacy of their use for targeted correction need further research.


Assuntos
Reabilitação do Acidente Vascular Cerebral , Acidente Vascular Cerebral , Biorretroalimentação Psicológica , Fenômenos Biomecânicos , Marcha , Humanos , Acidente Vascular Cerebral/terapia , Caminhada
14.
J Med Internet Res ; 23(11): e28946, 2021 11 09.
Artigo em Inglês | MEDLINE | ID: mdl-34751659

RESUMO

BACKGROUND: Nonvalvular atrial fibrillation (NVAF) affects almost 6 million Americans and is a major contributor to stroke but is significantly undiagnosed and undertreated despite explicit guidelines for oral anticoagulation. OBJECTIVE: The aim of this study is to investigate whether the use of semisupervised natural language processing (NLP) of electronic health record's (EHR) free-text information combined with structured EHR data improves NVAF discovery and treatment and perhaps offers a method to prevent thousands of deaths and save billions of dollars. METHODS: We abstracted 96,681 participants from the University of Buffalo faculty practice's EHR. NLP was used to index the notes and compare the ability to identify NVAF, congestive heart failure, hypertension, age ≥75 years, diabetes mellitus, stroke or transient ischemic attack, vascular disease, age 65 to 74 years, sex category (CHA2DS2-VASc), and Hypertension, Abnormal liver/renal function, Stroke history, Bleeding history or predisposition, Labile INR, Elderly, Drug/alcohol usage (HAS-BLED) scores using unstructured data (International Classification of Diseases codes) versus structured and unstructured data from clinical notes. In addition, we analyzed data from 63,296,120 participants in the Optum and Truven databases to determine the NVAF frequency, rates of CHA2DS2­VASc ≥2, and no contraindications to oral anticoagulants, rates of stroke and death in the untreated population, and first year's costs after stroke. RESULTS: The structured-plus-unstructured method would have identified 3,976,056 additional true NVAF cases (P<.001) and improved sensitivity for CHA2DS2-VASc and HAS-BLED scores compared with the structured data alone (P=.002 and P<.001, respectively), causing a 32.1% improvement. For the United States, this method would prevent an estimated 176,537 strokes, save 10,575 lives, and save >US $13.5 billion. CONCLUSIONS: Artificial intelligence-informed bio-surveillance combining NLP of free-text information with structured EHR data improves data completeness, prevents thousands of strokes, and saves lives and funds. This method is applicable to many disorders with profound public health consequences.


Assuntos
Fibrilação Atrial , Acidente Vascular Cerebral , Idoso , Anticoagulantes , Inteligência Artificial , Fibrilação Atrial/tratamento farmacológico , Fibrilação Atrial/prevenção & controle , Estudos de Casos e Controles , Registros Eletrônicos de Saúde , Humanos , Processamento de Linguagem Natural , Medição de Risco , Fatores de Risco , Acidente Vascular Cerebral/prevenção & controle
15.
Zhongguo Zhen Jiu ; 41(11): 1211-5, 2021 Nov 12.
Artigo em Chinês | MEDLINE | ID: mdl-34762372

RESUMO

OBJECTIVE: To compare the clinical efficacy between scalp acupuncture electrical stimulation and routine scalp acupuncture for motor aphasia in subacute stage of cerebral infarction. METHODS: A total of 54 patients with motor aphasia in subacute stage of cerebral infarction were randomly divided into an observation group (27 cases, 1 case dropped off) and a control group (27 cases, 2 cases dropped off ). Both groups were treated with routine medication and language training. In the observation group, scalp acupuncture was given at bilateral lower 2/5 of the parietal and temporal anterior oblique line and temporal frontline; after the arrival of qi, the electrical stimulation with disperse-dense wave was given at the affected side and continuous wave was given at healthy side. The control group was treated with routine scalp acupuncture at lower 2/5 of the parietal and temporal anterior oblique line and temporal frontline of the affected side, once a day, five times as a course, totaling two courses of treatment. The aphasia battery of Chinese (ABC) score and Boston diagnostic aphasia examination (BDAE) grade were observed before and after treatment. The levels of oxygenated hemoglobin (HbO2), deoxyhemoglobin (D-Hb) and total hemoglobin (T-Hb) in local cerebral cortex of the two groups were measured in real time using functional near-infrared spectroscopy (fNIRS) before and after treatment. The clinical efficacy of the two groups was compared. RESULTS: After treatment, the scores of listening comprehension, retelling, naming, spontaneous conversation and BDAE grade in the two groups were improved compared with those before treatment (P<0.01, P<0.05), and those in the observation group were better than the control group (P<0.05). Compared before treatment, the levels of HbO2 and T-Hb were increased (P<0.01), and the levels of D-Hb were decreased (P<0.01) after treatment in the two groups. The levels of HbO2 and T-Hb in the observation group were higher than those in the control group (P<0.05), and the level of D-Hb was lower than that in the control group (P<0.05). The total effective rate was 92.3% (24/26) in the observation group, which was higher than 84.0% (21/25) in the control group (P<0.05). CONCLUSION: The scalp acupuncture electrical stimulation could improve cerebral circulation, activate specific functional areas of cerebral cortex, and promote the reconstruction and recovery of brain language function. Its curative effect is better than conventional scalp acupuncture.


Assuntos
Terapia por Acupuntura , Acidente Vascular Cerebral , Pontos de Acupuntura , Afasia de Broca , Infarto Cerebral/complicações , Infarto Cerebral/terapia , Estimulação Elétrica , Humanos , Couro Cabeludo , Resultado do Tratamento
16.
Georgian Med News ; (319): 87-92, 2021 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-34749329

RESUMO

The study focuses on investigation of the role of polymorphic variants of MTHFR (C677T), MTHFR (A1298C), MTR (A2756G) folate metabolism genes and their combinations in the development of ischemic stroke in young people. The study included 2 groups of patients: 61 young patients aged 18 - 44 years old with acute ischemic stroke (main group) and 29 middle-age patients, 45 to 59 years old with ischemic stroke (control group). To analyze polymorphic DNA loci, the standardized test systems TagMan Mutation Detection Assays Lifa-Technology (USA) were used. MTHFR C677T (rs 1801133), MTHFR A1298C (rs 1801131), and MTR A2756G (rs1805087) polymorphisms were involved. Polymorphic variants of MTHFR (C677T), MTHF (A1298C), MTR (A2756G) genes were analyzed, using the polymerase chain reaction (PCR) method. The study of homocysteine level ​​in blood plasma was carried out, using the method of enzyme-linked immunosorbent analysis. The patients of the main group with the homozygous variant G/G showed a statistically significant high level of homocysteine ​- 18.9±4.8 ng/ml compared with patients with the A/A genotype - 12.4±4.2 ng/ml and A/G - 12.9±4.8 ng/ml, (p=0.045). The main group showed an increased risk of ischemic stroke associated with 677CT (OR=2.39; CI=1.12-5.06) and 677TT genotypes (OR=4.45; CI=1.08-25.44) for the MTHFR gene. When carrying out a comparative analysis of the А1298С polymorphism of the MTHFR gene, 1298CC genotype (OR=1.45; CI=0.46-3.99) and 1298AC genotype (OR=2.4; CI=1.6-5.9) were statistically significant. Comparative analysis of А2756G polymorphism of the МТR gene showed that the GG genotype was statistically significant (OR=2.68; CI=1.10-7.069). An increase in the development of ischemic brain lesions was associated with polymorphic variants of CT for the MTHFR gene, AC for the MTHFR gene, and GG for the MTR gene. An increase in the risk of developing ischemic brain lesions was associated with polymorphic variants of CT + TT (CI=1.8-10.9) for the MTHFR gene, AC + CC (CI=1.31-6.32) for the MTHFR gene, AG + GG (CI=1.57-10.08) for the MTR gene. The study shows that in young people homozygote for minor alleles C/C for A1298C of the MTHFR gene polymorphism and T/T for C677T of the MTHFR gene and G/G for A2756G of the MTR gene polymorphism increases the risk of ischemic stroke, compared with carriers of A/A for A1298C, C/C for C677T of the MTHFR gene and А/А by А2756G of the МТR gene.


Assuntos
5-Metiltetra-Hidrofolato-Homocisteína S-Metiltransferase , Isquemia Encefálica , AVC Isquêmico , Metilenotetra-Hidrofolato Redutase (NADPH2) , Acidente Vascular Cerebral , 5-Metiltetra-Hidrofolato-Homocisteína S-Metiltransferase/genética , Adolescente , Adulto , Idoso , Isquemia Encefálica/genética , Estudos de Casos e Controles , Predisposição Genética para Doença , Genótipo , Humanos , Metilenotetra-Hidrofolato Redutase (NADPH2)/genética , Pessoa de Meia-Idade , Polimorfismo de Nucleotídeo Único , Fatores de Risco , Acidente Vascular Cerebral/genética , Adulto Jovem
18.
J Pak Med Assoc ; 71(11): 2511-2514, 2021 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-34783727

RESUMO

OBJECTIVE: To determine the effects of whole body vibration therapy on gait in chronic stroke patients. METHODS: The randomised, assessor-blinded, controlled clinical study was conducted at the Physiotherapy Department, Lahore General Hospital, Lahore, Pakistan, from November 2017 to April 2019, and comprised chronic stroke patients wh were randomly divided into two equal groups, with group A reciving routine physiotherapy and group B reciving whole-body vibration therapy. Both the groups received 12 sessions each. Vibration therapy was given with an amplitude of 3mm and frequency of 20Hz. Sessions comprised 5 bouts of 120 seconds with 60s rest intervals for 6 days/week for 2 weeks in erect standing position. The outcome measure was the score of timed up and go test and 10-meter walk test before and after intervention. Data was analysed using SPSS 21. RESULTS: Of the 64 patients, there were 32(50%) in each of the two groups. Significant difference was seen post-intervention in both the groups (p<0.05) although both groups were statistically same in terms of Timed Up and go Test, 10 Meter walk Test Slow Speed and 10 Meter walk Test Fast Speed (p>0.05). CONCLUSIONS: Walking speed improved with both treatments i.e. whole-body vibration therapy and routine physiotherapy in chronic stroke survivors. Clinical Trial Number: Identifier: IRCT20190328043131N1:https://www.irct.ir/user/trial/38832/view.


Assuntos
Reabilitação do Acidente Vascular Cerebral , Acidente Vascular Cerebral , Terapia por Exercício , Marcha , Humanos , Equilíbrio Postural , Acidente Vascular Cerebral/terapia , Estudos de Tempo e Movimento , Vibração/uso terapêutico , Caminhada
19.
Cien Saude Colet ; 26(suppl 3): 5089-5098, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34787201

RESUMO

This article aims to investigate whether difficulty in taking medication is associated with stroke among older adults with Systemic Arterial Hypertension (SAH) and to explore their association with living arrangements. Cross-sectional study was based on 3,502 older adults with SAH from the four universities pole of Frailty in Brazilian Older People (Fibra) Study, Brazil, including 14 municipalities of the five Brazilian regions. We used the medical diagnosis of stroke and difficulty in taking medications (self-reported difficulty and financial difficulty affording prescribed medications). Multivariate analysis was performed using logistic regression. Differently from women, older men with SAH, which report difficulty in taking medication (unintentional non-adherence), have higher odds of stroke. When stratified by living arrangements, those living with a partner have even higher odds of stroke compared to those without difficulty in taking medication and living alone. None association was found for difficulty affording prescribed medication for both men and women. Unintentional difficulty in taking medication plays a role in SAH treatment among men. Primary care strategies for controlling blood pressure should not be focus only on patients but targeting spouses as well.


Assuntos
Fragilidade , Hipertensão , Acidente Vascular Cerebral , Idoso , Pressão Sanguínea , Estudos Transversais , Feminino , Humanos , Hipertensão/epidemiologia , Masculino , Adesão à Medicação , Acidente Vascular Cerebral/epidemiologia
20.
BMC Geriatr ; 21(1): 620, 2021 11 02.
Artigo em Inglês | MEDLINE | ID: mdl-34727876

RESUMO

BACKGROUND: In the very elderly, "the lower the better" hypothesis has constantly been contradicted by randomized control trials and various cohort studies, but inconsistency in results led to unclear blood pressure treatment targets. This study aimed to assess the relationship between baseline blood pressure (BP) and ischemic stroke, myocardial infarction, and all-cause mortality in very elderly people treated for hypertension. METHODS: This large population-based retrospective cohort study was based on the national claims database of the Korean National Health Insurance System, which covers the entire Korean population. 374,250 participants aged ≥ 75 years taking antihypertensive agents were recruited, excluding patients with a history of previous ischemic stroke or myocardial infarction. RESULTS: Systolic BP (SBP) followed a J curve for ischemic stroke and a U curve for all-cause mortality, with nadir ranges of 120 to 129 mmHg and 140 to 149 mmHg, respectively. While increasing diastolic BP (DBP) generally resulted in higher HRs for ischemic stroke, HRs for myocardial infarction and all-cause mortality significantly increased only when DBP was ≥ 80 mmHg and ≥ 90 mmHg, respectively. The SBP/DBP combination analysis showed that even with SBP < 130 mmHg, higher DBP ≥ 90 mmHg had higher HRs for all three outcomes compared to the reference group (130 to 149 / < 80 mmHg). CONCLUSIONS: There were no further benefits or even harm below certain BP levels for ischemic stroke, myocardial infarction, and all-cause mortality in very elderly hypertensive patients.


Assuntos
Isquemia Encefálica , AVC Isquêmico , Infarto do Miocárdio , Acidente Vascular Cerebral , Idoso , Anti-Hipertensivos/farmacologia , Anti-Hipertensivos/uso terapêutico , Pressão Sanguínea , Estudos de Coortes , Humanos , Infarto do Miocárdio/diagnóstico , Infarto do Miocárdio/tratamento farmacológico , Estudos Retrospectivos , Fatores de Risco , Acidente Vascular Cerebral/diagnóstico , Acidente Vascular Cerebral/tratamento farmacológico
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