Top PDF EVALUATION OF RISK FACTORS IN ACUTE STROKE

EVALUATION OF RISK FACTORS IN ACUTE STROKE

EVALUATION OF RISK FACTORS IN ACUTE STROKE

ABSTRACT: Introduction: Cerebrovascular disease is the third most common cause of death in the developed world after cancer and ischemic heart disease. In India, community surveys have shown a crude prevalence rate of 200 per 100000 population for hemiplegia. Aims and objectives: Identification of risk factors for cerebrovascular disease. Materials and Methods: Inclusion Criteria: Cases of acute stroke admitted in S.V.R.R.G.G.H, Tirupati were taken for the study. Exclusion Criteria: Head injury cases, neoplasm cases producing cerebrovascular disease were excluded. Results: Stroke was more common in male, 54% patients were male 46% were female. It was more common in 6 th and 7 th decade. More common risk factors were hypertension
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Risk factors for post-acute myocardial infarction depression in elderly

Risk factors for post-acute myocardial infarction depression in elderly

Abstract. Objective: To determine risk factors for development of post-acute ST elevation myocardial infarction (STEMI) depression in elderly. Material and Methods: We included 104 elderly patients diagnosed with STEMI. Clinical, lab and imagistic data was recorded in the first week after STEMI. Six months after STEMI patients were evaluated for the presence of depression. Results: Bivariate analysis showed statistically significant association between post-STEMI depression and sex, arterial hypertension, type 2 diabetes, socio-economic status, presence of family, left ventricular ejection fraction, Lown classification and HDL-cholesterol values. Multivariate analysis determined that following parameters increased the probability of onset of depression six months post-STEMI in elderly: sex (OR – 3.2), type 2 diabetes (OR – 2.6), poor socio-economic status (OR – 3.5) and absence of family (OR – 4.2). Conclusion: diabetes, precarious socio-economic status, absence of family and female sex were risk factors for post-STEMI depression.
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Elevation of troponin I in acute ischemic stroke

Elevation of troponin I in acute ischemic stroke

The newly developed high-sensitivity assay of troponin allows for precise detection of troponin even at concentrations 10-fold lower than conventional assays (Wu & Jaffe, 2008). A high-sensitivity troponin test improves the diagnosis of patients with acute myocardial infarct. However, reduction of specificity comes with improvement in sensitivity. In Scheitz’s series, troponin T elevation above the 99th percentile was detected with a high-sensitivity assay in more than 50% of patients with acute ischemic stroke, and even moderately elevated troponin T was associated with an unfavorable outcome (Scheitz et al., 2014). The presence of high positive or dynamic change troponin levels might indicate ischemic myocardial injury. Stroke patients with dynamic changes in troponin levels (>50%) within 24 h showed a higher risk for in-hospital mortality than patients with increased troponin levels who were stable over time (Scheitz et al., 2014). Serial measurements should be performed to establish whether troponin is acutely or chronically elevated. For patients with non-acute elevation of troponin levels, out-patients evaluation for structural or coronary heart disease is recommended. For patients with high positive or a dynamic pattern of elevated troponin levels, prompt measures for prevention of cardiovascular disease should be intensified or reevaluated. Noninvasive echocardiography, cardiac magnetic resonance imaging or computed tomography may help to identify possible unstable coronary disease, heart failure, or cardiomyopathy. Invasive coronary angiography may be indicated for patients with acute myocardial infarction (Scheitz et al., 2015a).
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The incidence and risk factors of associated acute myocardial infarction (AMI) in acute cerebral ischemic (ACI) events in the United States.

The incidence and risk factors of associated acute myocardial infarction (AMI) in acute cerebral ischemic (ACI) events in the United States.

The academic literature has demonstrated clear associations between cerebral ischemic events and myocardial ischemia. The most common cause of death in stroke is cardiovascular disease (41%). Long-term survival after stroke may be improved by early, active, and sustained implementation of effective strategies for preventing subsequent cardiovascular events. [25] Cerebrovascu- lar disease and many systemic vascular diseases share similar underlying vasculo-occlusive pathology and risk factors such as diabetes and hypertension. In patients with known cerebrovascular disease, there is a risk of developing comorbid occlusive vascular disease due to underlying vasculopathy (ie. coronary artery disease or peripheral vascular disease) which negatively impacts overall outcome. [26,27,28] Cerebrovascular events may also affect the insular cortex and increase the risk of myocardial ischemia due to autonomic dysregulation and a preceding catecholamine surge. [29] The effects secondary to ACI, and the added cardiac insults secondary to this catecholamine surge, may cumulatively increase morbidity and mortality especially in older patients. These factors may impact medical decision making including the need for reperfusion therapy [30,31,32].
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Arq. NeuroPsiquiatr.  vol.67 número3B

Arq. NeuroPsiquiatr. vol.67 número3B

evaluation of aphasia and dysarthria in the acute stroke phase, consisting on tests for attentional deicits, handed- ness, visual perception, phonemic perception, spontaneous speech, luency, comprehension, word and sentence repeti- tion, naming, automatic speech, ideomotor praxis and con- structional praxis. Recruitment was carried out for 12 months (May 2007 to April 2008) at the Hospital das Clínicas – UNI- CAMP, initially with the enrollment of ischemic stroke pa- tients at the Emergency Unit. Thirty-seven irst-stroke pa- tients (22 male, 15 female) were submitted to the test in the irst 72 hours after the brain injury, with the following addi- tional inclusion criteria : adults over 18 years-old, any educa- tional level, not comatose, no evidence of previous strokes or other brain diseases, no decompensated systemic diseas- es, no history of chronic alcoholism or neurotoxic substance abuse. The examiner was blind to stroke topography during the query. Subjects were paired with thirty-seven healthy controls according to age (±5 years) and schooling (±2 years). All patients underwent radiological evaluation (cerebral com- puted tomography and/or magnetic resonance) for topo- graphic correlation between speech and language assess- ment results and the brain injury site, both in the acute and the chronic stroke phases. In statistical analysis, either chi- square test was employed for comparison of categorical vari- ables or Fisher’s exact test when necessary; for continuous measures to be ordered in two groups the Mann-Whitney test was used; ANOVA was applied for comparisons among three or more groups, while Tukey’s test was employed for multiple comparisons. For identiication of variables with the capacity to discriminate lesion side (left or right), multiple logistic regression analysis was used. The threshold of sig- niicance was set at p<0.05. All survivors were followed for
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Influence of acute complications on outcome 3 months after ischemic stroke.

Influence of acute complications on outcome 3 months after ischemic stroke.

demographic factors on 3-months mortality and poor outcome. To estimate odds ratios (OR) and resulting 95% confidence intervals (CI) of poor outcome or mortality three months after stroke, we performed multivariable logistic regression analyses including the number of early complications, age, sex, pre- stroke dependency, comorbidities and stroke severity as independent variables. Variables were eliminated using backward selection methods. We calculated attributable fractions (AFs) to examine the relevance of the factors included in the model in terms of mortality and poor outcome after stroke. Attributable fractions are defined as the proportional reduction of an outcome if the exposure to a risk factor was reduced to zero. They consider not only the association between exposure and disease, but also the frequency of the exposure in the population and thus help to estimate the risk factor’s relevance on the population level. The method of average sequential attributable fractions applied allows obtaining estimates for several risk factors which do not add up to more than 100% directly from logistic regression analyses and the attributable fractions are independent from the order in which they are inserted.[4,27] AFs were calculated for all variables included in the final logistic regression model. The independent variables were dichotomized before being included in the model.
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Risk factors for acute childhood diarrhea in the highlands of Chiapas, Mexico: A strategy for intervention

Risk factors for acute childhood diarrhea in the highlands of Chiapas, Mexico: A strategy for intervention

A case-control study was conducted in the highlands of Chiapas, Mexico, to identify factors associated with acute diarrhea in children less than six years old.. T[r]

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Clinical Profile &amp; Risk Factors in Acute Coronary Syndrome

Clinical Profile &amp; Risk Factors in Acute Coronary Syndrome

The present study shows that with increasing age the preponderance of male patients admitted with ACS decreases and sex ratio becomes smaller. This possibly reflexes a higher percentage of female and elderly population and more equal distribution of risk factors for ACS in both genders at high age group. 7,8

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Rev. Bras. Psiquiatr.  vol.26 número1 en a11v26n1

Rev. Bras. Psiquiatr. vol.26 número1 en a11v26n1

Acute pancreatitis is a severe disease with considerable morbidity and mortality. Many risk factors are causally related to acute pancreatitis. In this report, a case of acute pancreatitis with possible causal relationship with the use of a selective serotonin reuptake inhibitor, sertraline, will be discussed. After one month of treatment with sertraline, a female patient, 55 years-old, developed a severe abdominal pain and showed a serum amylase elevation. She was admitted to the hospital and the use of sertraline was interrupted. After that, the symptoms remitted and the serum amylase level returned to normal. Because of the potential severity of this disease and the widespread use of sertraline, this association should be reminded when investigating possible causes for acute pancreatitis.
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Study of Risk Factors of Acute Respiratory Infection (ARI) in Underfives in Solapur

Study of Risk Factors of Acute Respiratory Infection (ARI) in Underfives in Solapur

These controls were matched for sex, age (more than 2 months age for case – 1 month on either side for control & less than 2 months age for case – 15 days on either side for control) and religion. These controls were not suffering from similar illness (A.R.I.) at the time of interview. After locating child’s home, information was collected in a pre-tested & pre-designed same proforma, which was used for obtaining a history from cases. Recording of height, weight and grading of nutritional status: Height was measured in nearest centimeter by drawing a metric scale on the wall and in case of small children by standard measuring tape.
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Early psychiatric morbidity in a Brazilian sample of acute ischemic stroke patients

Early psychiatric morbidity in a Brazilian sample of acute ischemic stroke patients

pressure values, despite the use of medication, draws atten- tion to the unsatisfactory clinical management of patients prior to admission. The Framingham score for the sample was calculated from the recorded clinical variables. This score was developed based on information collected in epidemiological population studies performed over 36 years and estimates the probability of stroke from clinical infor- mation (7). The mean score observed was 21.27. This value indicates that the probability of stroke in 10 years is over 30% for men and 14% for women, and this value confirms the high-risk profile for the development of stroke in this sample. Interviews occurred, on average, 5.4 days after the ische- mic event, in accordance with the purpose of evaluating patients during the acute period after stroke. Most of the observed individuals presented with lacunar stroke, with a predominance of lesions in the middle cerebral arterial topography of the right hemisphere. The NIHSS, mRS and FIM scales were used to measure the initial severity of the ischemic event and its resulting disability. The mean results were below 5 for the NIHSS and below 3 for the mRS, indicating a mild impact of stroke in the sample. This fact is reflected in the measurement of patient dysfunction obtained Table 3 - Features of acute ischemic stroke in a sample of
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Evaluation of Cardiovascular Risk Factors in the Wistar Audiogenic Rat (WAR) Strain.

Evaluation of Cardiovascular Risk Factors in the Wistar Audiogenic Rat (WAR) Strain.

end-systolic and end-diastolic volumes (ESV and EDV) as well as cardiac output (CO) were calculated using a cardiac pressure-volume analysis software (PVAN Ultra v3.2, Millar Instru- ments, Houston, TX, USA) [34]. The total peripheral resistance (TPR) was also calculated as the ratio between MBP and CO. A range of left ventricle pressure-volume curves at different pre-load status was assessed by transiently compressing the inferior vena cava. Pre-load inde- pendent indices of heart contractility and stiffness {preload recruitable stroke work (PRSW), +dP/dt vs. end-diastolic volume relationship (+dP/dt-EDV), slopes of end-systolic and end-di- astolic pressure-volume relations [ESPVR and EDPVR]} as well as the efficiency of left ventri- cle work [pressure-volume area] were calculated using PVAN v3.2. Good quality recordings of ventricular pressure and volume were obtained in only 7 WAR and 8 Wistar rats.
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Association of cardiovascular risk factors with thedifferent presentations of acute coronary syndrome

Association of cardiovascular risk factors with thedifferent presentations of acute coronary syndrome

they demonstrate the importance of knowing the manifestations of the different presentations of ACS, as these show varying rates of complications and mortality. In the present study, women predominated among the individuals diagnosed with UA. It is believed that the persistence of symptoms of myocardial ischemia eventually led them to seek assistance, avoiding further progression of the disease. Compared with patients being hospitalized for the irst time with a diagnosis of AMI, individuals with UA recognized at an earlier stage that they must seek professional help, as they present greater limitations for day-to-day activities in the week that precedes hospitalization due to ACS (19) .
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Arq. Bras. Cardiol.  vol.82 número1 en a05v82n1

Arq. Bras. Cardiol. vol.82 número1 en a05v82n1

As a methodology, the patient or a relative answered a questionnaire about the patient’s current health status and about risk factors for ischemic stroke. All patients under- went transesophageal echocardiography performed by an experienced echocardiographer. Patients were sedated with midazolam before esophageal intubation, with doses ran- ging from 2 to 15 mg IV. Examinations were performed with XP10 from Acuson-USA, using a multiplanar esophageal transducer with a 5-MHz frequency. For diagnosis of patent foramen ovale, saline solution was injected into a peripheral vein in the study group patients. Examinations were recor- ded on VCR tapes and assessed by another echocardiogra- pher. The second observer was unaware of the diagnosis. In the cases where disagreement existed regarding the pre- sence or absence of contrast in the aorta, observers tried to reach a consensus, and when they could not, the patient was excluded from the study.
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Braz. J. Cardiovasc. Surg.  vol.27 número3 en v27n3a14

Braz. J. Cardiovasc. Surg. vol.27 número3 en v27n3a14

Kurki et al. to propose the CABDEAL, evaluated 21 risk factors and extracted 7 as the most frequent (creatinine level, age, body mass index, diabetes, emergency surgery, ECG abnormalities and pulmonary disease) [15]. However, by analyzing scores of specific predictors of neurological morbidities, such as the one developed by the Northern New England Cardiovascular Disease Study Group and the Stroke Risk Index [11,12], it is observed that these variables are also part of these two models, which could explain the association of high risk CABDEAL with the occurrence of encephalopathy as noted in previous studies and in the present study.
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The influence of patient’s knowledge about stroke in Brazil: a cross sectional study

The influence of patient’s knowledge about stroke in Brazil: a cross sectional study

Interviews with patients and family members were con- ducted within 48 hours of hospital admission. Data collected included demographics, mode of arrival (emergency medical services versus patients own means), presence of stroke risk factors, National Institutes of Health Stroke Scale (NIHSS) scores, thrombolysis status and knowledge of stroke warning signs and therapeutic time window using a standardized, structured questionnaire. Admission time was recorded for every patient. The time of symptoms onset or time from last seen well was obtained from the patient or available witness. Door to neuroimaging time ( for all patients) and door to needle time ( for patients treated with thrombolysis) were also registered.
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INTRA-ABDOMINAL HYPERTENSION AS A RISK FACTOR FOR ACUTE KIDNEY INJURY IN  CRITICALLY ILL PATIENTS

INTRA-ABDOMINAL HYPERTENSION AS A RISK FACTOR FOR ACUTE KIDNEY INJURY IN CRITICALLY ILL PATIENTS

Increased intra-abdominal pressure (IAP), also referred to as intra-abdominal hypertension (IAH), affects organ function in critically ill patients. The prevalence of IAH is between 32% - 65% in intensive care units. Normal IAP is ≈ 5–7 mmHg. According to WSACS definition, IAH = IAP ≥12 mmHg and is divided into 4 grades. They are Grade I (12-15 mmHg), Grade II (16-20 mmHg), Grade III (21-25 mmHg), Grade IV (>25 mmHg). Transvesical measurement of IAP currently is the most popular technique. Several systems with or without the need for electronic equipment are available that allow IAP measurement. The aim is to study the incidence of IAH in critically ill patients, to assess the risk factors for development of IAH, to study the role of IAH as a risk factor for Acute Kidney Injury (AKI), to assess the role of IAH as a risk factor for increased (Intensive Care Unit) ICU mortality.
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Arq. NeuroPsiquiatr.  vol.73 número5

Arq. NeuroPsiquiatr. vol.73 número5

Objective: To evaluate the risk factors and comorbid conditions associated with the development of pneumonia in patients with acute stroke. To determine the independent predictors of pneumonia. Method: Retrospective study from July to December 2011. We reviewed all medical charts with diagnosis of stroke. Results: 159 patients (18-90 years) were admitted. Prevalence of pneumonia was 32%. Pneu- monia was more frequent in patients with hemorrhagic stroke (OR: 4.36; 95%CI: 1.9-10.01, p < 0.001), higher National Institute of Health Stroke Scale (NIHSS) (p = 0.047) and, lower Glasgow Coma Score (GCS) (p < 0.0001). Patients with pneumonia had longer hospitalization (p < 0.0001). Multivariable logistic regression analysis identiied NIHSS as an independent predictor of pneumonia (95%CI: 1.049-1.246, p = 0.002). Conclusion: Pneumonia was associated with severity and type of stroke and length of hospital stay. The severity of the deicit as evaluated by the NIHSS was shown to be the only independent risk factor for pneumonia in acute stroke patients.
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Low HDL-C level is associated with the development of intracranial artery stenosis: analysis from the Chinese IntraCranial AtheroSclerosis (CICAS) study.

Low HDL-C level is associated with the development of intracranial artery stenosis: analysis from the Chinese IntraCranial AtheroSclerosis (CICAS) study.

with acute ischemic stroke. Despite several previous studies indicating an independent inverse relationship between serum HDL-C levels and overall stroke risk [16,17], no study has demonstrated the specific relationship between low HDL-C level and the risk of ICAS. The results of our study suggested that low HDL-C level, not high LDL-C level, was independently associated with an increased risk of developing ICAS. Furthermore, there was a quantitative interaction. In our study, we have found that the lower the level of HDL-C, the higher the chance of developing ICAS. As shown in Table 4, patients with the lowest quartile of HDL-C had a 52% increased risk of ICAS as compared to the highest quartile, after adjusting for the covariates. Our data also implied an inverse relationship between HDL-C level and the severity of stenosis. Low HDL-C level highly correlated with severity of stenosis of occlusion, indicating a protective role of HDL-C against ICAS. In contrary, we found no relationship between high LDL-C level and the risk of ICAS, similar to a recent report in the Korean population [18].
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Lipids And Hscrp As Markers Of Coronary Heart Disease Risk In HIV Infected Adults

Lipids And Hscrp As Markers Of Coronary Heart Disease Risk In HIV Infected Adults

patients, and of more serious concern is the fact that coronary heart disease has been reported as major non-AIDS causes of death in HIV-infected individuals [3]. Metabolic and morphological changes that may occur in HIV-infected individuals include dyslipidaemia, insulin resistance and visceral fat deposition, which may all contribute to coronary heart disease [1, 3] and are thought to be related to medication [4]. Further, traditionally recognised risk factors such as: smoking, hypertension, old age and male sex are thought to contribute to formation of atherosclerotic lesions which predisposes to coronary heart disease in the era of HIV/AIDS [5]. Development of atherosclerotic lesions is a slow progressive process marked by low grade inflammation [4]. From a pathological viewpoint initiation, growth and complication of the atherosclerotic plaque might be considered to be an inflammatory response to injurious factors that promote artherogenesis [6]. Risk factors, including antiretroviral therapy, give rise to an increase in pro- inflammatory cytokines (e.g. interlukin-1, tissue necrosis factor-α); adhesion molecules (e.g. selectins); inflammatory stimuli with hepatic effects (e.g. interlukin-6) or other products of hepatic stimulation (e.g. serum amyloid A, and C-reactive protein) [7]. New patho-physiological insights have provided potential targets for measurement as a means to identify and monitor ongoing inflammatory process [8], [9]. New analyses have examined analytes such as highly sensitive C-reactive protein (hs-CRP), serum amyloid A and other acute-phase reactants or cytokines [2], [10], [11]. hs-CRP is thought to predict future coronary events in asymptomatic (healthy) individuals with no previous history of coronary heart disease [10]. Several studies now support a strong link between baseline elevation of hs-CRP and future coronary events [9]. It has been suggested that hs-CRP may offer more reliable estimate of coronary heart disease in well controlled HIV infections than standard risk markers and may detect early risk of coronary heart disease independently of traditional risk factors [5], [12]. The ability of hs-CRP to add to the predictive capacity of other established risk factors has been examined in many studies and hs-CRP retains an independent association with incidence of coronary heart disease [5], [12]. The hs-CRP test is a qualitative analysis of very low levels of C-reactive protein in blood measured in mg/L. Risk is categorised as low, average and high with hs-CRP __________________________
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