626 research outputs found
Differences in carotid artery atherosclerosis between men and women in the early phase after ischemic event
Objectives
There is little data about sex differences in carotid atherosclerosis in the early phase after an ischemic event. The aim of this study was to examine the carotid artery atherosclerosis differences between men and women in early phase after TIA or stroke.
Methods
Consecutive patients with recent ischemic event, admitted during the first week after symptom onset were examined with ultrasound. Sex differences in degree of stenosis, number of plaques and plaque morphology were compared. Plaque morphology was assessed by gray-scale median (GSM), according to which lower values were associated with hemorrhagic/necrotic core indicating plaque instability.
Results
Of the 316 patients with ischemic events, 196 (50.5% male) entered the study. Men had more often moderate as well as severe ipsilateral carotid stenosis (12.1% vs 7.2% for moderate and 12.1% vs 2.1% for severe; p=0.024). Men had more often the largest plaque hypoechogenic contralateral (62.6% vs 37.1%, p=0.0008), but not ipsilateral. Men had 3 or more hypoechogenic plaques (24.2% vs 4.1%, p=0.0001; 17.2% vs 4.1%, p<0.0001) both ipsi and contralateral respectively. Male sex was a risk factor for having 3 or more ipsilateral hypoechogenic plaques (p=0.002, OR=20 CI 95% [5.5ā75].
Conclusions
Men had more often carotid stenosis and higher number of hypoechogenic plaques
Spolne razlike u raspodjeli riziÄnih Äimbenika, težini i ishodu ishemijskog moždanog udara
The aim of the study was to identify differences in baseline characteristics and outcomes of men and women with acute ischemic stroke. Ischemic stroke was confirmed by CT scan or autopsy in patients admitted to the 2nd Department of Neurology, Institute of Psychiatry and Neurology in Warsaw, Poland from 1995 to 2007. Male and female patients were compared for risk factors, state of activity prior to stroke, stroke type according to Oxfordshire Community Stroke Project classification, diagnostic test findings, and early 30-day outcome. Data on 1379 women and 1155 men admitted with ischemic stroke were analyzed. The mean age of female and male patients was 74.3 and 68.8 years, respectively. Women were more often disabled prior to stroke, hypertensive, diagnosed with atrial fibrillation or heart failure, and had impaired consciousness at admission, whereas men were more likely to smoke, abuse alcohol and have a history of myocardial infarction or transient ischemic attack. A higher percentage of female stroke patients suffered from total anterior circulation syndrome than males (21.2% and 14.0%, respectively). Internal carotid artery stenosis over 70% was reported in 10.8% of women and 19.1% of men. The 30-day mortality and poor outcome rates were significantly higher in women than men (17.2% vs. 13.1% and 59.9% vs. 46.2%). After adjusting for casemix in multivariate analysis, female sex was independently associated with a higher risk of an early poor outcome. In conclusion, the risk factor distribution, clinical characteristics, diagnostic test findings, and early outcomes were different between female and male ischemic stroke patients. Female sex was associated with poorer prognosis, indicating that more intensive acute and long-term global care may be needed to improve the outcome among female stroke patients.Cilj studije bio je utvrditi razlike u osnovnim znaÄajkama i ishodu izmeÄu muÅ”karaca i žena s akutnim ishemijskim moždanim udarom. Ishemijski moždani udar potvrÄen je kompjutorskom tomografijom ili pri autopsiji u bolesnika primljenih na Drugi neuroloÅ”ki odjel Zavoda za psihijatriju i neurologiju u VarÅ”avi, Poljska, od 1995. do 2007. godine. Bolesnici i bolesnice usporeÄeni su u odnosu na riziÄne Äimbenike, stanje aktivnosti prije moždanog udara, vrst moždanog udara prema klasifikaciji Oxfordshire Community Stroke projekta, nalaze dijagnostiÄkih pretraga i rani 30-dnevni ishod. Analizirali su se podatci za 1379 žena i 1155 muÅ”karaca s ishemijskim moždanim udarom. Srednja dob bolesnica bila je 74,3 godine, a bolesnika 68,8 godina. Žene su ÄeÅ”Äe imale invalidnost prije moždanog udara, kao i hipertenziju, atrijsku fibrilaciju ili srÄano zatajenje, te poremeÄaj svijesti kod prijma, dok je kod muÅ”karaca ÄeÅ”Äe zabilježena navika puÅ”enja, zlouporaba alkohola te povijest infarkta miokarda ili prolaznog ishemijskog napadaja. Bolesnice su u veÄem postotku patile od sindroma ukupne prednje cirkulacije nego muÅ”karci (21,2% prema 14,0%). Stenoza unutarnje karotidne arterije veÄa od 70% zabilježena je u 10,8% žena i 19,1% muÅ”karaca. Smrtnost unutar 30 dana i stope loÅ”eg ishoda bile su znaÄajno viÅ”e u žena negoli u muÅ”karaca (17,2% prema 13,1%, odnosno 59,9% prema 46,2%). Nakon prilagodbe za casemix u multivarijatnoj analizi ženski spol bio je neovisno udružen s veÄim rizikom za rani loÅ” ishod. U zakljuÄku, raspodjela riziÄnih Äimbenika, te kliniÄke znaÄajke, nalazi dijagnostiÄkih pretraga i rani ishodi razlikovali su se izmeÄu muÅ”kih i ženskih bolesnika s ishemijskim moždanim udarom. Ženski spol bio je udružen s loÅ”ijom prognozom, ukazujuÄi na potrebu intenzivnije akutne i dugoroÄne opÄe skrbi kako bi se poboljÅ”ao ishod bolesti meÄu bolesnicama s ishemijskim moždanim udarom
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Dysregulated Choline, Methionine, and Aromatic Amino Acid Metabolism in Patients with Wilson Disease: Exploratory Metabolomic Profiling and Implications for Hepatic and Neurologic Phenotypes.
Wilson disease (WD) is a genetic copper overload condition characterized by hepatic and neuropsychiatric symptoms with a not well-understood pathogenesis. Dysregulated methionine cycle is reported in animal models of WD, though not verified in humans. Choline is essential for lipid and methionine metabolism. Defects in neurotransmitters as acetylcholine, and biogenic amines are reported in WD; however, less is known about their circulating precursors. We aimed to study choline, methionine, aromatic amino acids, and phospholipids in serum of WD subjects. Hydrophilic interaction chromatography-quadrupole time-of-flight mass spectrometry was employed to profile serum of WD subjects categorized as hepatic, neurologic, and pre-clinical. Hepatic transcript levels of genes related to choline and methionine metabolism were verified in the Jackson Laboratory toxic milk mouse model of WD (tx-j). Compared to healthy subjects, choline, methionine, ornithine, proline, phenylalanine, tyrosine, and histidine were significantly elevated in WD, with marked alterations in phosphatidylcholines and reductions in sphingosine-1-phosphate, sphingomyelins, and acylcarnitines. In tx-j mice, choline, methionine, and phosphatidylcholine were similarly dysregulated. Elevated choline is a hallmark dysregulation in WD interconnected with alterations in methionine and phospholipid metabolism, which are relevant to hepatic steatosis. The elevated phenylalanine, tyrosine, and histidine carry implications for neurologic manifestations and are worth further investigation
Poznavanje Äinjenica o moždanom udaru meÄu bolesnicima bez moždanog udara
The aim of the study was to evaluate the knowledge among patients at non-neurologic wards about the risk factors for stroke, warning signs, and initial actions that must be taken when a stroke occurs. Data were collected from 75 inpatients suffering from a range of diseases, mean age 49.57Ā±14.87 years. Study subjects were asked to fill in a standardized questionnaire containing 46 questions subdivided into two sections. The answers concerning warning symptoms, risk factors, causes of stroke, and initial action were quasi-quantified according to an arbitrary scoring system. Of 75 patients, only 5.3% were not aware of any medical risk factor, and 12% were not aware of any warning signals. On the other hand, only 2.6% and 10.66% of subjects listed correctly all risk factors and warning signs, respectively. Anyhow, many patients gave wrong answers. Most respondents (89.54%) would choose a desirable action if stroke was suspected. The scores for knowledge about stroke were better among higher educated respondents and among women. The factors such as belonging to a high-risk group for stroke, age, and other characteristics did not influence the score. Family, friends, and mass media provided major sources of the patientsā knowledge. It is concluded that, despite the fact that the respondents knew a lot about stroke, the nature of stroke and the problems involved often caused confusion or misunderstanding. Further public education is needed to increase the awareness of the warning signals and risk factors, especially among patients who are at an increased risk of stroke.Cilj ispitivanja bio je procijeniti poznavanje Äinjenica o moždanom udaru, znakovima upozorenja i hitnim mjerama koje treba poduzeti u sluÄaju moždanog udara, meÄu bolesnicima ne-neuroloÅ”kih odjela. Prikupljeni su podaci za 75 bolniÄki lijeÄenih osoba zbog razliÄitih bolesti, srednje dobi 49,57Ā±14,87 godina. Ispitanici su bili zamoljeni da ispune standardizirani upitnik koji je sadržavao 46 pitanja podijeljenih u dvije skupine. Odgovori su se odnosili na simptome upozorenja, riziÄne Äimbenike, uzroke moždanog udara i prve mjere koje valja poduzeti u sluÄaju moždanog udara, a bili su polukvantificirani prema proizvoljnom bodovnom sustavu. Od 75 bolesnika, samo ih 5,3% nije bilo upoznato ni s kojim medicinskim riziÄnim Äimbenikom, dok ih 12% nije poznavalo bilo koji znak upozorenja. S druge strane, samo je 2,6% odnosno 10,66% ispitanika ispravno navelo sve riziÄne Äimbenike i znakove upozorenja, dok su mnogi ispitanici naveli krive odgovore. VeÄina ispitanika(89,54%) odabrala bi prave mjere u sluÄaju sumnje na moždani udar. Osobe viÅ”eg obrazovanja i žene poluÄile su bolji bodovni rezultat glede znanja o moždanom udaru. Äimbenici kao Å”to su pripadanje visoko riziÄnoj skupini za moždani udar, starosna dob i druga obilježja nisu imala utjecaj na bodovni rezultat. Obitelj, prijatelji i sredstva javnog priopÄavanja bili su glavni izvori znanja za ispitanike. ZakljuÄujemo kako, usprkos Äinjenici da su ispitanici znali dosta o moždanom udaru, narav moždanog udara i s njim povezani problemi Äesto izazivaju zbunjenost ili krivo tumaÄenje. Potrebna je daljnja izobrazba javnosti kako bi se poboljÅ”alo raspoznavanje znakova upozorenja i riziÄnih Äimbenika, poglavito meÄu bolesnicima s poveÄanim rizikom za moždani udar
The Clinical Development of Cerebrolysin: New Approaches in Stroke Studies: A Commentary to The Cars Study
Additional efficacious treatment options for stroke are urgently needed as thrombolysis and endovascular thrombectomy are too rarely utilised due to the narrow time window. This article reviews the clinical profile of CerebrolysinĀ® (EVER Pharma, Austria), a well-documented compound indicated for the treatment of acute stroke, which has also shown promising results in neurorecovery. Well-conducted clinical trials have shown strong and encouraging treatment signals, either as a single therapy or in combination with recombinant tissue plasminogen activator. This review focusses on the latest research results, especially on the randomised, controlled CARS study, which combined pharmacological and rehabilitation therapy. Furthermore, this study reached the primary endpoint at Day 90 in the Action Research Arm Test and showed significant improvements in modified Rankin Scale (mRS) at Day 90. The same applies to important secondary endpoints such as the National Institutes of Health Stroke Scale (NIHSS) at Day 21 (early benefit). CARS is a rehabilitation study with a larger sample size and gives neurologists as well as rehabilitation specialists renewed confidence in this class of neuroprotective/ neurorecovery-enhancing compounds. Furthermore, ongoing research projects like CREGS-S are discussed, a large-scale prospective registry that adds valuable real-world data to the existing portfolio of Cerebrolysin studies
Wilson's disease: update on pathogenesis, biomarkers and treatments
Wilsonās disease is an autosomalārecessive disorder of copper metabolism caused by mutations in ATP7B and associated with neurological, psychiatric, ophthalmological and hepatic manifestations. Decoppering treatments are used to prevent disease progression and reduce symptoms, but neurological outcomes remain mixed. In this article, we review the current understanding of pathogenesis, biomarkers and treatments for Wilsonās disease from the neurological perspective, with a focus on recent advances. The genetic and molecular mechanisms associated with ATP7B dysfunction have been well characterised, but despite extensive efforts to identify genotypeāphenotype correlations, the reason why only some patients develop neurological or psychiatric features remains unclear. We discuss pathological processes through which copper accumulation leads to neurodegeneration, such as mitochondrial dysfunction, the role of brain iron metabolism and the broader concept of selective neuronal vulnerability in Wilsonās disease. Delayed diagnoses continue to be a major problem for patients with neurological presentations. We highlight limitations in our current approach to making a diagnosis and novel diagnostic biomarkers, including the potential for newborn screening programmes. We describe recent progress in developing imaging and wet (fluid) biomarkers for neurological involvement, including findings from quantitative MRI and other neuroimaging studies, and the development of a semiquantitative scoring system for assessing radiological severity. Finally, we cover the use of established and novel chelating agents, paradoxical neurological worsening, and progress developing targeted molecular and gene therapy for Wilsonās disease, before discussing future directions for translational research
A Prospective Community-Based Study of Stroke in Warsaw, Poland
Background and Purpose Poland is a Country with High Morbidity and Mortality Rates from Cardiovascular Diseases. No Recent Studies Have Evaluated the Contribution of Cerebrovascular Diseases to This Morbidity and Mortality. Our Aim Was to Accurately Determine Stroke Incidence Rates in Warsaw, Poland. Methods a 2-Year Prospective and Population-Based Stroke Registry Was Maintained for Health Care Units 2 and 3 in Warsaw, Poland (Population, 182 285). Case Subjects Were Ascertained by Surveying Hospital Admissions, Outpatient Visits, and Death Certificates. Results during the 2 Years of the Study (1991 to 1992), 633 Cases of First-Event Strokes Were Registered, 462 of Which Were First Ever in a Lifetime. Computed Tomography or Necropsy Was Performed in 72% of First-Ever Stroke Cases. the Crude Annual Incidence Rate for First-Ever Stroke Was 127/100 000 (95% Confidence Intervals, 111 to 145); the Rate Standardized to the European Population Was 111 (95% Confidence Intervals, 96 to 128). Our Incidence Rates for First-Event Strokes Were Found to Be in the Middle of the Range among Other First-Event Studies. When Comparing Our First-Ever Stroke Incidence Rates with Those of Comparable Studies Performed throughout Europe, They Were Found to Be Similar for Groups Aged Younger Than 65 Years But Lower in the Older Age Groups. the Distribution of Ischemic and Hemorrhagic Stroke Subtypes Was Similar to that of Other Countries. Conclusions This First Population-Based Prospective Stroke Registry in Poland Showed that Incidence Rates Were Not High Compared with Other Studies throughout Europe and the World. These Stroke Incidence Rates Are Not a Large Contributing Factor to High Cardiovascular Morbidity Rates in Poland. Ā© 1994 American Heart Association, Inc. All Rights Reserved
Noninfectious complications of acute stroke and their impact on hospital mortality in patients admitted to a stroke unit in Warsaw from 1995 to 2015
Background
Medical complications often worsen the prognosis after stroke. Our aim was to investigate the association between particular noninfectious complications and hospital mortality of acute stroke patients admitted to an urban Polish stroke center, and changes in their occurrence from 1995 to 2015.
Methods
This is a retrospective analysis of 5174 consecutive patients admitted for acute ischemic stroke or cerebral hemorrhage to a Polish urban stroke center between 1995 and 2015. The occurrence of complications was reported for years 1995ā2000 (n=883), 2001ā2006 (n=1567), 2006ā2010 (n=1539) and 2011ā2015 (n=1183). Odds ratios (OR) with 95% confidence interval (95% CI) for stroke unit death were calculated after adjustment for age, congestive heart failure (CHF), pre-existing disability, stroke type and baseline neurological deficit in three different time periods.
Results
Over time there was a significant decrease in the occurrence of myocardial infarction (MI) (2.2%, 1.4%, 1.0% and 0.3%, respectively), exacerbated CHF (4.6%, 5.1%, 2.6% and 2.0%) and deep vein thrombosis (DVT) (4.6%, 2.7%, 1.2% and 1.1%). Adjusted odds for stroke unit death were increased by myocardial infarction (MI) (OR 17.5, 95% CI: 8.5ā35.7), exacerbated CHF (OR 15.0, 95% CI: 9.8ā23.0), pulmonary embolism (PE) (OR 11.5, 95% CI: 6.1ā21.6), gastrointestinal bleeding (OR 9.2, 95% CI: 4.4ā18.9) and recurrent stroke (OR 5.4, 95% CI: 3.1ā9.3).
Conclusions
Over the last two decades Polish urban stroke units may have achieved a significant reduction of the occurrence of some noninfectious complications (i.e. MI, exacerbated CHF and DVT). However, the list of conditions associated with stroke unit mortality includes not only MI and exacerbated CHF but also PE, gastrointestinal bleeding and recurrent stroke
Comparative assessment of clinical rating scales in Wilsonās disease
Background: Wilsonās disease (WD) is an autosomal recessive disorder of copper metabolism resulting in multifaceted neurological, hepatic, and psychiatric symptoms. The objective of the study was to comparatively assess two clinical rating scales for WD, the Unified Wilsonās Disease Rating Scale (UWDRS) and the Global Assessment Scale for Wilsonās disease (GAS for WD), and to test the feasibility of the patient reported part of the UWDRS neurological subscale (termed the āminimal UWDRSā). Methods: In this prospective, monocentric, cross-sectional study, 65 patients (median age 35 [range: 15ā62] years; 33 female, 32 male) with treated WD were scored according to the two rating scales. Results: The UWDRS neurological subscore correlated with the GAS for WD Tier 2 score (rĀ =Ā 0.80; pĀ <Ā 0.001). Correlations of the UWDRS hepatic subscore and the GAS for WD Tier 1 score with both the Model for End Stage Liver Disease (MELD) score (rĀ =Ā 0.44/rĀ =Ā 0.28; pĀ <Ā 0.001/pĀ =Ā 0.027) and the Child-Pugh score (rĀ =Ā 0.32/rĀ =Ā 0.12; pĀ =Ā 0.015/pĀ =Ā 0.376) were weak. The āminimal UWDRSā score significantly correlated with the UWDRS total score (rĀ =Ā 0.86), the UWDRS neurological subscore (rĀ =Ā 0.89), and the GAS for WD Tier 2 score (rĀ =Ā 0.86). Conclusions: The UWDRS neurological and psychiatric subscales and the GAS for WD Tier 2 score are valuable tools for the clinical assessment of WD patients. The āminimal UWDRSā is a practical prescreening tool outside scientific trials
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