165 research outputs found
Body Temperature and Inflammation in Acute Stroke: implications for prognosis and treatment
Safe, cheap, and broadly applicable therapies for acute stroke are urgently needed.
Stroke ranks second as a cause of death worldwide and is the main cause of disability in
high-income countries. In the Netherlands alone, more than 37.000 patients are admitted
to hospital for acute stroke each year. As the incidence of stroke rises exponentially
with age, the demographic change in world’s population will increase its socio-economic
impact.
Strokes are either ischemic or hemorrhagic. Treatment of ischemic stroke and intracerebral
hemorrhage has remained unsatisfactory. Stroke unit care has been proven
effective for all stroke patients, with an absolute risk reduction of death of 3% and longterm
dependency of 5%.In patients with ischemic stroke, treatment with recombinant
tissue-plasminogen activator (rt-PA) reduces the number of patients with poor outcome
at three months by about 9%, but the short time window for administration (4.5 hours)
and the associated bleeding risk restrict treatment with rt-PA to a minority of patients.
Surgical decompression improves outcome in a very small selected group of patients
aged up to 60 years who deteriorate because of space-occupying edema within 48 hours
of stroke onset. Aspirin, started within 48 hours of symptom onset, is probably effective
across the entire range of patients with ischemic stroke, but the benefit is small, with a
number needed to treat of 79 to prevent death or dependency in a single patient
The optimal timing of supporting patients in health-related behavior change after TIA or ischemic stroke:A prospective cohort study to determinants of health-related intention to change over time
Occurrence and predictors of persistent impaired glucose tolerance after acute ischemic stroke or transient ischemic attack
Background Impaired glucose tolerance is often present in patients with a transient ischemic attack (TIA) or ischemic stroke and doubles the risk of recurrent stroke. This impaired glucose tolerance can be transient, reflecting an acute stress response, or persistent, representing undiagnosed impaired glucose metabolism possibly requiring treatment. We aimed to assess the occurrence of persistent impaired glucose tolerance after a stroke or TIA and to develop a prediction model to identify patients at risk of persistent impaired glucose tolerance. Methods Patients admitted to the str
Clinical Practice Variation Needs to be Considered in Cost-Effectiveness Analyses
Background and Objective: The cost-effectiveness of clinical interventions is often assessed using current care as the comparator, with national guidelines as a proxy. However, this comparison is inadequate when clinical practice differs from guidelines, or when clinical practice differs between hospitals. We examined the degree of variation in the way patients w
Variation in the C-reactive protein gene is associated with serum levels of CRP in patients with acute ischemic stroke
Background and Purpose: Elevated levels of C-reactive protein (CRP) are found in up to three quarters of patients with acute ischemic stroke and are associated with poor outcome. We investigated whether haplotypes representing common variations in the CRP gene are associated with levels of CRP in patients with acute ischemic stroke. Methods: We included 185 patients with ischemic stroke in whom CRP was measured within 24 h of symptom onset. Common haplotypes within the CRP gene were determined by 3 genotype-tagging single-nucleotide polymorphisms (SNPs). Results: Four haplotypes with frequencies >5% covered 99.2% of the genetic variation. Haplotype 4 (CCG, frequency 8.3%) was associated with a 20.6 mg/l (95% CI, 9.8-30.4) stronger increase in CRP level as compared with haplotype 1 (CTC, frequency 33.7%). Conclusion: Variation in the CRP gene is associated with levels of CRP in acute ischemic stroke. Copyrigh
Atrial fibrillation detected with outpatient cardiac rhythm monitoring in patients with ischemic stroke or TIA of undetermined cause
Metformin and sitAgliptin in patients with impAired glucose tolerance and a recent TIA or minor ischemic Stroke (MAAS): study protocol for a randomized controlled trial
Background: Impaired glucose tolerance is present in one third of patients with a TIA or ischemic stroke and is associated with a two-fold risk of recurrent stroke. Metformin improves glucose tolerance, but often leads to side effects. The aim of this study is to explore the feasibility, safety, and effects on glucose metabolism of metformin and sitagliptin in patients with TIA or minor ischemic stroke and impaired glucose tolerance. We will also assess whether a slow increase in metformin dose and better support and information on this treatment will reduce the incidence of side effects in these patients. Methods/Design: The Metformin and sitAgliptin in patients with impAired glucose tolerance and a recent TIA or minor ischemic Stroke trial (MAAS trial) is a phase II, multicenter, randomized, controlled, open-label trial with blinded outcome assessment. Non-diabetic patients (n = 100) with a recent (<6 months) TIA, amaurosis fugax or minor ischemic stroke (modified Rankin scale ≤ 3) and impaired glucose tolerance, defined as 2-hour post-load glucose levels between 7.8 and 11.0 mmol/L after repeated standard oral glucose tolerance test, will be included. Patients with renal or liver impairment, heart failure, chronic hypoxic lung disease stage III-IV, history of lactate acidosis or diabetic ketoacidosis, pregnancy or breastfeeding, pancreatitis and use of digoxin will be excluded. The patients will be randomly assigned in a 1:1:2 ratio to metformin, sitagliptin or "no treatment." Patients allocated to metformin will start with 500 mg twice daily, which will be slowly increased during a 6-week period to a twice daily dose of 1000 mg. Patients allocated to sitagliptin will be treated with a daily fixed dose of 100 mg. The study has been registered as NTR 3196 in The Netherlands Trial Register. Primary outcomes include percentage still on treatment, percentage of (serious) adverse events, and the baseline adjusted difference in 2-hour post-load glucose levels at 6 months. Discussion: This study will give more information about the feasibility and safety of metformin and sitagliptin as well as the effect on 2-hour post-load glucose levels at 6 months in patients with TIA or ischemic stroke and impaired glucose tolerance
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