Paroxysmal atrial fibrillation in cryptogenic stroke

Neha S Dangayach1, Kevin Kane2, Majaz Moonis31Saint Vincent Hospital, 2University of Massachusetts Medical School, 3University of Massachusetts Memorial Health Center, Worcester, MA, USAIntroduction: Paroxysmal atrial fibrillation (PAF) is perhaps the most underdiagnosed mechanism of apparent cryptogenic stroke (CS). Various studies have shown that increasing the duration of monitoring can increase the diagnosis of PAF in CS.Methods: We compared demographic and risk factors for ischemic stroke across different TOAST (Trial of ORG 10172 in Acute Stroke Treatment) stroke subtypes to look for clinical differences between other subtypes and CS and subsequently performed periodic Holter monitoring and imaging studies in apparent CS patients.Results: Of the 298 patients with ischemic stroke, 17% had CS. Periodic holter monitoring enabled diagnosis of PAF in 29% of patients. Five of 51 patients with CS had recurrent ischemic stroke and all 5 were demonstrated as PAF on repeated Holter monitoring.Conclusions: Long-term periodic rhythm monitoring in patients with apparent CS showed PAF in a significant percentage of CS patients, which altered subsequent treatment.Keywords: cryptogenic stroke, atrial fibrillation, stroke of undetermined etiolog

Phytochemical analysis and evaluation of antioxidant activity of the leaves of Begonia picta smith

Like most other plants begonia picta smith  contains various secondary metabolites with great potentials. The aim of this paper is to evaluate the phytochemicals by using quantitative and qualitative analysis of Petroleum ether , Chloroform, Methanol  extracts ,with the help of standard methods as well solvent residual analysis byGCHS The findings from quantification and phytochemical screening showed the presence of alkaloids, flavonoids, reducing sugars, Phenols, proteins, amino acids, saponins, tannins, terpenoids,Antioxidant activity was determined by 1, 1-diphenyl-2-picryl hydrazyl (DPPH)scavenging method, nitric oxide scavenging method, reducing power assay method and  Inhibitory concentrations (IC50) were calculated. the residual solvents present in the three herbal extract also in current specified limits. Evaluation of In Vitro Anti-Oxidant activity reveals that methanolic extract is most potent as compare to other extracts by taking Ascorbic acid as standard. This information clearly represent that the plant Begonia picta smith  is the good source of dietary antioxidant

Risk factors and hospitalization costs of Dementia patients: Examining race and gender variations

Aims: To examine the variation in risk factors and hospitalization costs among four elderly dementia cohorts by race and gender. Materials and Methods: The 2008 Tennessee Hospital Discharged database was examined. The prevalence, risk factors and cost of inpatient care of dementia were examined for individuals aged 65 years and above, across the four race gender cohorts - white males (WM), black males (BM), white females (WF), and black females (BF). Results: 3.6% of patients hospitalized in 2008 had dementia. Dementia was higher among females than males, and higher among blacks than whites. Further, BF had higher prevalence of dementia than WF; similarly, BM had a higher prevalence of dementia than WM. Overall, six risk factors were associated with dementia for the entire sample including HTN, DM, CKD, CHF, COPD, and stroke. These risk factors varied slightly in predicting dementia by race and gender. Hospital costs were 14% higher among dementia patients compared to non-dementia patients. Conclusions: There exist significant race and gender disparities in prevalence of dementia. A greater degree of co-morbidity, increased duration of hospital stay, and more frequent hospitalizations, may result in a higher cost of inpatient dementia care. Aggressive management of risk factors may subsequently reduce stroke and cost of dementia care, especially in the black population. Race and gender dependent milestones for management of these risk factors should be considered

Depression effects on hospital cost of heart failure patients in California: An analysis by ethnicity and gender

Background: Depression often interferes with self-management and treatment of medical conditions. This may result in serious medical complications and escalated health-care cost. Objectives: Study distribution of heart failure (HF) cases estimates the prevalence of depression and its effects on HF-related hospital costs by ethnicity and gender. Methods: Secondary data files of California Hospital Discharge System for he year 2010 were examined. For patients with a HF diagnosis, details regarding depression, demographics, comorbid conditions, and hospital costs were studied. Age-adjusted HF rates and depression were examined for whites, blacks, Hispanics, and Asians/Pacific Islanders (AP) by comparing HF patients with depression (HF +D) versus HF without depression (HFND). Results: HF cases (n = 62,685; average age: 73) included nearly an equal number of males and females. HF rates were higher (P < 0.001) among blacks compared to Hispanics, AP, and whites and higher among males than females. One-fifth of HF patients had depression, higher among females and whites compared to males and other ethnic groups. Further, HF hospital costs for blacks and AP were higher (P < 0.001) compared to other groups. The cost for HF +D was 22% higher compared to HFND, across all gender and ethnic groups, largely due to higher comorbidities, more admissions, and longer hospitalization. Conclusion: Depression, ethnicity, and gender are all associated with increased hospital costs of HF patients. The higher HF and HF +D costs among blacks, AP, and males reflect additional burden of comorbidities (hypertension and diabetes). Prospective studies to assess if selective screening and treating depression among HF patients can reduce hospital costs are warranted

Smoking, depression, and hospital costs of respiratory cancers: Examining race and sex variation

Objective To investigate the effect of smoking and depression on hospital costs for lung cancer (LC). Methods We extracted data on depression, smoking history, demographics, and hospital charges for patients with respiratory cancers (ICD-9 codes 161–163, 165) from the 2008 Tennessee Hospital Discharge Data System. The sample (n=6665) was mostly white (86%) and male (57%). Age-adjusted rates were developed in accordance with Centers for Disease Control and Prevention methods, and hospital costs were compared for patients with LC with versus without depression and a smoking history. Results Three findings (P\u3c0.001) emerged: (1) the LC rate was higher among blacks than among whites, and higher among men than among women; (2) while 66% of LC patients smoked (more men than women without racial variation), 24% had depression (more females and whites were depressed); (3) the LC hospital cost was 54% higher than the non-LC hospital cost, and this cost doubled for patients with LC with depression and smoking versus those without such characteristics. Conclusion While LC is more prevalent among blacks and men, depression is higher among female and white patients. Since depression with higher costs existed among LC patients, our findings point to (1) the possibility of cost savings by diagnosing and treating depression among LC patients, and (2) implementation of proven smoking cessation programs to reduce LC morbidity and hospital costs

Impact of Leukoaraiosis Severity on the Association of Time to Successful Reperfusion with 90-Day Functional Outcome After Large Vessel Occlusion Stroke

The chance for a favorable outcome after mechanical thrombectomy (MT) for large vessel occlusion stroke decreases with the symptom onset-to-reperfusion time (OTR). Patients with severe leukoaraiosis are at increased risk for a poor outcome after MT. However, whether leukoaraiosis modulates to the association between OTR and 90-day functional outcome is uncertain. We retrospectively analyzed 144 consecutive patients with successful (TICI \u3e /= 2b/3) MT for anterior circulation large vessel occlusion within 24 h form OTR between January 2012 to November 2016. Leukoaraiosis was dichotomized to absent-to-mild (van Swieten scale score 0-2) versus moderate-to-severe (3-4) as assessed on admission head CT. Multiple linear, logistic, and ordinal regression analyses were used to determine the association between leukoaraiosis, OTR, and 90-day modified Rankin Scale (mRS) score, after adjustment for pertinent covariates. Leukoaraiosis was independently associated with the OTR on multivariable linear regression (p = 0.003). The association between OTR and 90-day outcome depended on the degree of pre-existing leukoaraiosis burden as shown by a significant leukoaraiosis-by-OTR interaction on multivariable logistic regression (OR 0.76, 95% CI 0.58-0.98, p = 0.037) and multivariable ordinal regression (OR 0.87, 95% CI 0.78-0.97, p = 0.011). Pre-existing leukoaraiosis is associated with the 90-day functional outcome after successful reperfusion and impacts the association between the OTR and 90-day mRS among patients undergoing MT. Patients with high leukoaraiosis burden need to present earlier than patients with low leukoaraiosis burden for a similar favorable outcome. Pending confirmation, these results may have important implications for optimizing patient selection for acute stroke therapies