Prevention and treatment of ischemic stroke in patients with atrial fibrillation

Atrial fibrillation (AF) is the most common sustained arrhythmia. It affects a considerable number of patients in the world and is responsible for ischemic stroke (IS) in many of them. Age greater than 75 years, congestive heart failure, arterial hypertension, diabetes mellitus, tobacco smoking and other structural lesions of the heart represent the main risk factors for IS in AF patients. Long-term anticoagulation therapy with warfarin is considered the most effective therapy for IS prevention in selected patients with AF and other risk factors. However, management of the drug presents with some challenges such as need for frequent monitoring, interactions with food and other medications, variability in metabolism and delayed onset of action. Antiplatelet therapy may provide some benefit for patients who can't tolerate warfarin. Recently, direct oral thrombin inhibitor dabigatran and oral factor Xa inhibitors rivaroxaban and apixaban are approved by the Food and Drug Administration (FDA). Non-pharmacologic approaches to IS prevention in AF focus on occlusion or ligation of the left atrial appendage, which is often the location of thrombus formation and on percutaneous techniques that may not require anticoagulation afterwards as well. New diagnostic modalities detect paroxysmal AF and expand the potential impact of preventive strategies on the population.Scripta Scientifica Medica 2013; 45(3): 7-15

Serum lipid anomalies in adult patients with acute ischemic stroke

Introduction: There is rising evidence of the role of hyperlipidemia and dyslipidemia in the development of acute ischemic stroke (AIS). There is a considerable risk for AIS in adult individuals with these abnormalities. Our purpose was to reveal the incidence rate of the disorders of lipid metabolism in adult AIS patients.Material and methods: We examined 129 male and 129 female patients with AIS at a mean age of 70.59±7.22 years hospitalized in the First Clinic of Neurology, St. Marina University Hospital of Varna in 2007-2013. The serum levels of total cholesterol, triglycerides, HDL- and LDL-cholesterol at admission were examined. Statistical data processing was performed by ANOVA as t-criterion was considered significant if p<0.05.Results: The mean values of total cholesterol and LDL-cholesterol were slightly elevated while those of triglycerides were slightly reduced. The mean values of total cholesterol and triglycerides were higher in males than in females. Total cholesterol values were considerably more commonly higher in females than in males as the mean total cholesterol concentrations were higher in the female patients with normal, decreased and increased levels of this parameter. LDL-cholesterol was more commonly elevated as its mean values were higher in the female patients with its normal, decreased and increased levels.Conclusion: A regular control of the parameters of lipid metabolism and keeping-up the healthy life-style in adult individuals and in patients with cardiovascular diseases could ensure a successful prevention of ischemic stroke

Age-related metabolic disturbances in adult patients with acute ischemic stroke

INTRODUCTION. There is rising evidence of the role of hyperglycemia, hyperlipidemia and dyslipidemia in the etiopathogenesis of acute ischemic stroke (AIS). There is a considerable risk for AIS in adult individuals in advanced and senile age with these abnormalities. Our purpose was to reveal the incidence rate of the disorders of glucose and lipid metabolism in the adult patients with AIS.Material and methods. We examined 129 male and 129 female AIS patients at a mean age of 71 years hospitalized in the First Clinic of Neurology, St. Marina University Hospital of Varna, in 2007-2013. The levels of blood glucose and of serum total cholesterol, triglycerides, HDL- and LDL-cholesterol at admission were examined. Statistical data processing was performed by variation (ANOVA as t-criterion was considered significant if p<0.05) and correlation (Pearson`s coefficient) analyses.Results. Males aged ≤65 years and females aged 71-75 years presented with the highest mean blood glucose values. There are much more males with higher blood glucose concentrations than females aged ≤70 and 76-80 years. Both mean and maximal concentrations of total cholesterol were highest at the age 71-75 years, those of HDL-cholesterol - in males aged 66-70 years and those of LDL-cholesterol - in females aged 71-75 years. The differences between the mean levels of total cholesterol in males and females aged ≤65 years as well as those of LDL-cholesterol in males and females aged ≥81 years were statistically significant (p<0.01).Conclusion. A regular control of the parameters of glucose and lipid metabolism in adults is necessary. Keeping-up individual`s healthy life-style could ensure a more effective AIS prevention

Disorders of blood glucose levels in adult patients with acute Ischemic stroke

Introduction: Effective and timely prevention of acute ischemic stroke (AIS) is characterized by a rising socio-medical importance as this is the most common cerebrovascular disease worldwide and in Bulgaria as well. Our purpose was to reveal the incidence rate of the disorders of glucose metabolism in AIS development among adult patients.Material and methods: We examined 129 male and 129 female patients with AIS at a mean age of 70.59±7.22 years hospitalized in the First Clinic of Neurology, St. Marina University Hospital of Varna in 2007-2013. Blood glucose concentrations at admission were examined. Statistical data processing was performed by variation (ANOVA as t-criterion was considered significant if p<0.05) and correlation (Pearson`s coefficient) analyses.Results: Mean fasting blood glucose levels were most commonly elevated and total ones were higher in males than in females except for the minimal value. The males with abnormally elevated blood glucose values present with higher mean and maximal values than the females. The number and relative share of the patients with increased blood glucose values at admission considerably prevailed. The difference between the number of the males with increased values and that of those with normal values was statistically significant (t=3.33; p<0.01). There was moderate correlation between the level of blood glucose and the preceding diabetes mellitus (r=0.431) and a strong one between this level and the newly-diagnosed diabetes mellitus (r=0.733) among our AIS patients.Conclusion: The regular control of blood glucose by the general practitioners and the promotion of the healthy life-style in cardiovascular disease patients could successfully prevent AIS in Bulgaria

Autonomic cardiovascular disorders in stroke - electrocardiographic changes and risk of sudden cardiac death

Нарушенията на кардиоваскуларните автономни функции са често срещани при мозъчно-съдова болест, имат голямо клинично значение и са най-отчетливо проявени в острата фаза на инсулта. При пациенти с мозъчен инсулт се наблюдават електрокардиографски промени; повишава се честотата на ритъмните нарушения на сърцето, плазмените нива на катехоламините и сърдечните ензими. Вариабилността на сърдечната честота (ВСЧ) предсказва в по-голяма степен ранната, внезапна смъртност.Disturbances of cardiovascular autonomic function are common in patients with cerebrovascular disease (CVDs), have great clinical importance and are most clearly manifested in the acute phase of stroke. In patients experienced stroke are observed electrocardiographic (ECG) changes, increased frequency of heart rhythm disorders, plasma catecholamine levels and cardiac enzymes. Heart rate variability (HRV) shows higher risk of sudden cardiac death

Application of the Rey-Osterrieth complex figure test for assessment of cognitive impairment in multiple sclerosis

INTRODUCTION: Cognitive impairment is frequent in multiple sclerosis and predominantly affects visuospatial abilities, memory, attention, and executive functions. Because of the specific cognitive profile, different from that in Alzheimer's disease and other frequent disorders presenting with dementia, specific neuropsychological instruments need to be used in multiple sclerosis. The aim of the present study is to assess the applicability of the Rey-Osterrieth complex figure test (ROCFT) for assessing cognitive impairment in patients with multiple sclerosis in comparison with a control group.MATERIAL AND METHODS: One hundred and two persons, 70 patients with MS and 32 healthy control subjects were assessed using ROCFT. A standardized system for assessment by points and percentiles was used. The results of both groups were compared statistically using independent samples t-test.RESULTS: On the copying task, the differences between patients and controls reached statistical significance, p<0.05 for the raw score, and p<0.001 after results were grouped by percentiles. On the drawing by memory task the differences between the two groups also showed statistical significance, p<0.01.CONCLUSION: ROCFT shows statistically significant differences between patients with multiple sclerosis and healthy subjects. Highest levels of significance were observed for copying, scored by percentiles, and for drawing by memory. The application of ROCFT can provide valuable information about cognitive dysfunction in multiple sclerosis

Cardiovascular autonomic dysfunction in acute stroke - Biochemical markers

Кардиоваскуларната автономна дисфункция след инсулт има голямо клинично значение, тъй като влошава прогнозата и може до доведе до внезапна ритъмна смърт. Повишената симпатикова активност след инсулт може да доведе до абнормности в ЕКГ, сърдечни аритмии и некроза на миокарда.Наред с проявите на метаболитна ацидоза се повишават плазмените нива на редица биохимични маркери- норепинефрин, епинефрин и допамин; сърдечни ензими и маркери:креатин киназата и креатин киназата -МВ, тропонин I и B-тип натриуретичен пептид.Повишените нива накатехоламинитесанай-ясно изразенипри пациенти с лезии в територията на дясна средна мозъчна артерия и са значимо по-високи по време на острата фаза на инсулт.Cardiovascular autonomic dysfunction after stroke has great clinical importance because worse prognosis and may lead to sudden arrhythmic death. Increased sympathetic activity after a stroke may lead to abnormalities in ECG, cardiac arrhythmias and myocardial necrosis. Along with the manifestations of metabolic acidosis increased plasma levels of several biochemical markers- norepinephrine, epinephrine and dopamine; cardiac enzymes and markers: creatine kinase and creatine kinase -MV, troponin I and B-type natriuretic peptide. Elevated levels of catecholamines are most pronounced in patients with lesions in the territory of the right middle cerebral artery, and were significantly higher during the acute phase of stroke

Association between blood glucose on admission and 2-hour glucose during oral glucose tolerance test in patients with acute coronary syndrome without known diabetes

Въведение: Хипергликемията по време на остър коронарен синдром (ОКС) при пациенти без известен диабет е честа и се счита, че е `стресова`. От друга страна тя може да е първата индикация за предходно неразпознато гликемично нарушение.Цел: Да се потърси връзка между кръвната глюкоза (КГ) при спешна хоспитализация поради ОКС и глюкозните показатели в хода на орален глюкозотолерантен тест (ОГТТ).Материали и методи: При 96 лица с проведена KAPCI и без анамнеза за гликемични нарушения се приложи стандартен ОГТТ между 3и-10и ден след дехоспитализацията. Глюкозният статус се класифицира според критериите на СЗО - 2006 г., за плазмена глюкоза на гладно (ПГГ) и плазмена глюкоза на 2ри час (2-ч-ПГ). Анализирана е КГ по време на спешен прием при 39 пациенти с ОКС.Резултати: Установихме нарушен глюкозен метаболизъм при 64.58%, a хипергликемия на 2ри час (≥7,8 ммол/л) - при 52.1% от изследваните след проведения ОГТТ. Средната КГ при спешно приемане на лицата с новооткрит тип 2 захарен диабет (нТ2ЗД) беше 9,55±1,93 ммол/л, която беше значимо по-висока спрямо тази на лицата с предиабет (7,22±2,01 ммол/л; p=0,006) и нормален глюкозен толеранс (6,31±2,08 ммол/л; p=0,0007). КГ при спешно приемане показа по-силна права връзка с 2-ч-ПГ (r=0,55; p=0,0003), отколкото с ПГГ и HbA1c. Чрез ROC анализ оценихме стойностите на КГ при спешен прием за откриване на диабет. Праговата стойност (сut off) >7,4 ммол/л показа най-добра комбинация от 91.7% чувствителност и 67.9% специфичност (area under the ROC=0,82; SE 0,06; 95% CI 0.698÷0.953; p=0,001).Заключение: КГ при спешен прием показа най-силна корелация с 2-ч-ПГ, определена в хода на ОГТТ. Намерихме, че стойността на 2-ч-ПГ (ОГТТ) е дори по-висока от КГ при спешна хоспитализация. За отхвърляне на гликемично нарушение при стойност на КГ при спешен прием > 7,4 ммол/л изглежда по-подходящо провеждането на ОГТТ.Introduction: Hyperglycemia during acute coronary syndrome (ACS) in patients without known diabetes is common and is considered `stress hyperglycemia`. On the other hand, it could be the first indication for previous unrecognized glycemic abnormality.Aim: To search for correlation between blood glucose (BG) at acute admission due to ACS and glycemic parameters during oral glucose tolerance test (OGTT). Materials and methods: A standard OGTT 3-10 days after hospital discharge was applied in 96 patients without history of glucose abnormalities who underwent coronary angiography (CA) percutaneous coronary intervention (PCI). Glucose tolerance was defined according to WHO-2006 criteria for fasting plasma glucose (FPG) and 2-hour-plasma glucose (2-h-PG). The BG at acute admission in 39 ACS patients was analyzed.Results: We found impaired glucose metabolism in 64.58% and 2-hour-hyperglycemia (≥7,8 mmol/L) in 52,1% of study participants after the OGTT. Mean BG at acute admission in subjects with newlydiagnosed type 2 diabetes mellitus (nT2DM) was 9,551,93 mmol/L. It was significantly higher co

Clinico>statistical study of patients with Diseases related with an increased risk for Ischemic stroke lbased on the material of first Clinic of neurology, st. Marina university Hospital of varnar

In the present paper, the results from the clinical analysis of the patients with ischemic stroke and diagnosed risk diseases were analysed. During the period from 2007 to 2012, a total of 960 patients who had survived ischemic stroke, 456 males (47,50%) and 504 females (52,50%), aged between 32 and 94 years and hospitalized in the First Clinic of Neurology, St. Marina University Hospital of Varna, were examined. Some cerebrovascular, cardiovascular and metabolic diseases belonged to the most common pathology related with enhanced risk for ischemic stroke. The patients within the age groups between 40 and 59 years represented a considerable part among this contingent. There were statistically significant differences between males and females concerning the incidence rate of heart rhythm disturbances (p<0,001). A further more detailed analysis of the mutual relationships between ischemic stroke and the diseases related with higher risk for it will be carried out