Different Types Of Stroke Research Articles

Association between plasma total homocysteine (tHcy) and strokes: A meta-analysis

Abstract Objective Inconsistent findings have been reported regarding the association between elevated plasma total homocysteine (tHcy) and the risk of different types of strokes. We conducted this meta-analysis to identify the association between tHcy and different kinds of strokes or recurrences of strokes, and provide evidence for preventing. Methods Relevant studies published before May 1, 2022 in databases such as PubMed, EMBASE, the Cochrane Library, CNKI, and Wanfang were retrieved. Two researchers independently searched and extracted the data, and used Stata 16.0 statistical software for analysis. Results were presented as the odds risk (OR) and the corresponding 95% confidence intervals (CI). Results In total, 24 articles were included, involving 51,426 subjects, of which 4,983 had stroke events during follow-up. Relative to lower tHcy, higher tHcy were associated with increased stroke (OR = 1.95, 95% CI: 1.59–2.37), ischemic stroke (OR = 1.71, 95% CI: 1.39–2.11), hemorrhagic stroke (OR = 1.99, 95% CI: 1.03–3.84), and recurrent stroke (OR = 1.25, 95% CI: 1.12–1.39), respectively. Conclusions This study shows that elevated tHcy increases the risk of stroke, including ischemic stroke and hemorrhagic stroke, and is closely related to the recurrence of stroke. It is recommended to pay attention to the detection of tHcy in the management of stroke patients in the future, and take effective measures to prevent and delay the progression of stroke.

A Review Paper on Predicting Different Types of Strokes

Abstract: Now-a-days stroke is one of the most life threatening disease to all most all theage groups. It injures the brain similar to “heart attack” which injures the heart. Stroke is given the second leading cause of death in many of the developing countries. Every four minutes someone dies because of stroke, and itis said that up to 80% of strokes can be prevented if we identify them in early stages orpredict the occurrence of stroke in its early stage. The majority of research has focused onthe prediction of heart stroke, while just a few studies have looked at the likelihood of a brainstroke. Brain disorders can represent a tickingbomb under Europe’s economy due to their enormous societal costs, which are set to growwith the aging of the European population. Addressing these large costs for the societyrequires an intensified research and novel solutions. To face this societal emergency, we need to develop a strong network for both basicand clinical brain research.

Differences in Left atrial stain, endothelial glycocalyx, arterial elasticity and myocardial efficiency between ESUS, lacunar and atherosclerotic type of stroke

Abstract Background and aims Patients with stroke are at high risk to develop cardiovascular complications. We assessed endothelial glycocalyx, aortic elastic properties, left atrial and ventricular function in patients with lacunar, atherosclerotic and stroke of undetermined source (ESUS). Patients and methods In 111 patients (age 57,1±10.6) with acute cerebral stroke (37 lacunar, 36 atherosclerotic and 38 ESUS) and 20 controls with similar risk factors, we measured: (1) perfused boundary region (PBR) of the sublingual arterial microvessels (range 5–25 μm), a marker inversely related with glycocalyx thickness, (2) pulse wave velocity (PWV), central systolic blood pressure (cSBP), and augmentation index (AIx), (3) Left atrial (LA) strain using speckle-tracking imaging, (4) left ventricular global longitudinal strain and (5) left ventricular myocardial work index (GWI), constructive work (GCW), wasted work (GWW) and work efficiency (GWE). Results Compared with controls, patients with stroke had higher PWV (11.74±3.18 vs 9.61±1.28 m/sec, p=0.003), PBR (2.16±0.28 vs 1.94±0.20, p=0.029) and central SBP (142±25 vs 121±17 mmHg, p=0.025), while ventricular (−18.31±3.21 vs −20.89±2.45%, p=0.001) and atrial deformation (28.59±6.99 vs 37.05±5.08%, p<0.001) were impaired in patients with stroke (p<0.05). GWI and GCW were similar between two groups and GWW and GWE were worse in patients with stroke (106.98±81.52 vs 68.92±36.52 mmHg%, p=0.022, 94.00±4.51 vs 96.46±1.75%, p=0.007, respectively). LA reservoir strain and contraction strain were more impaired in patients with thromboembolic strain compared to other 2 stroke types (ESUS 30.55±6.02%, −15.57±3.57%, Lacunar 28.19±6.92%, −13.76±3,74%, atherosclerotic 24.73±7.86%, −12.65±2,53%, p<0.05). Regarding endothelial glycocalyx, PBR5–25 was similar between all stroke types (ESUS 2.12±0.21 μm, LACUNAR 2.23±0.32 μm, ATHEROSCLEROTIC 2.11±0.30 μm, p>0.05). PWV was significantly higher in patients with atherosclerotic stroke (13.50±3.83 m/sec, p=0.007), while in patients with lacunar (11.31±3.01 m/sec) and in ESUS patients it was mildly elevated (11.66±2.63 m/sec). Despite there was no significant difference in GWI, GCW and GWW between patients with different types of stroke, GWE was higher in patients with ESUS (95.41±2.32%) than in patients with lacunar 92.86±6.13%) and atherothrombotic stoke (92.27±6.21%) (p<0.05). Conclusions Patients with stroke have impaired atrial strain, endothelial glycocalyx and arterial elasticity, compared with controls. Arterial stiffness and LA deformation are more affected in atherosclerotic stroke, while GWE is preserved in ESUS patients. Funding Acknowledgement Type of funding sources: None.

Effect of the Trunk and Upper Limb Passive Stabilization on Hand Movements and Grip Strength Following Various Types of Strokes-An Observational Cohort Study.

Almost half of the patients surveyed report impaired function of the upper limbx and handx after stroke. The effect of the passive trunk and shoulder stabilization on the recovery of coordinated hand movement is unclear. This study examined whether passive stabilization of the trunk and shoulder could improve the functional state of the hands after various types of strokes. It is an observational prospective cohort study conducted at the Rehabilitation Clinic in two parallel groups of patients with four different types of strokes (hemorrhagic and ischemic of the brain, similar to the cerebellum). A total of 120 patients were analyzed. Patients were examined in various positions: sitting without a backrest with the upper limb adjacent to the body, supine with the upper limb perpendicular to the body, and supine with the arm stabilized in relation to the patient’s body. Hand Tutor devices and a hand dynamometer were used for the measurements. The frequency and maximum range of motion as well as the grip strength were measured in three different positions of the trunk and upper limb. Passive stabilization of the trunk and shoulder showed more statistically significant differences in Group II. In group II, both in patients after hemorrhagic stroke (wrist Hz p = 0.019; wrist ROM p = 0.005; Hz F5 p = 0.021; Hz F4 p = 0.016; Hz F3 p = 0.019; Hz F2 p = 0.021) and ischemic stroke (p = 0.001 for wrist Hz, wrist ROM, Hz F from 5 to F2; and ROM F1; ROM F3 p = 0.009; ROM F2 p = 0.010), and hemorrhagic cerebellum, improvement of parameters was observed. Stabilization of the upper limb and passive stabilization of the trunk improved the frequency and range of movements in the radiocarpal joint and in the fingers of patients after stroke, regardless of the type of stroke.

Vasomotor reactivity in patients with cerebral small vessel disease vs. internal border zone infarction and its correlation with disease outcome

BackgroundAvailable data collected from patients of different types of cerebrovascular strokes can detect risk factors, severity and clinical outcome of these patients. Differentiating between different types of strokes is mandatory for early diagnosis and proper management. The aim of this study is to compare between cerebral small vessel disease with lacunar infarctions and internal border zone infarctions regarding vasomotor reactivity by using transcranial color-coded duplex and its correlation with their MRI perfusion, disease severity and outcome.ResultsOn admission, 56.7% of patients in lacunar stroke had impaired reactivity vs. 100% of patients in internal border zone group. At 3 months follow-up, this number dropped to 23.3% in lacunar group, but persisted as 100% in internal border zone group. On comparing the 3 perfusion parameters between the 2 groups, there was statistically significant impairment in all parameters in patients with internal border zone infarction than patients with lacunar infarction (longer time to peak, decreased cerebral blood flow and cerebral blood volume). By comparing the severity of the stroke by using National Institute of Health and Stroke Scale, it was found that patients with internal border zone infarction had higher disability than patients with lacunar infarction on admission and on discharge. At 3 months follow-up, the lacunar group had a better outcome than of the border zone group.ConclusionPatients having internal border zone infarction had higher clinical disability and worse prognosis, together with more impairment in vasomotor reactivity and MRI perfusion parameters than patients having lacunar infarction.

Accurate estimation of stroke risk with fuzzy clustering and ensemble learning methods

ObjectivesStroke is a serious health condition that is among the leading causes of death and permanent disability worldwide. Despite this, a generally valid, effective treatment method has not been found in the struggle against stroke, leaving preventive treatment as the most viable option. Due to its acute nature, it is practically impossible to conduct pre-symptomatic diagnosis of stroke events while they occur. For this reason, determining the patients with high stroke risk is considered as the first step towards taking necessary precautions, which is the main objective of this study. Materials and methodsIn this study, a novel model consisting of a fuzzy clustering stage followed by an ensemble learning based estimation stage is proposed for stroke risk estimation. The proposed model is trained and tested using a novel dataset with 124 features and 3000 patients, formed retrospectively within the context of this study. Stroke events are handled in 4 types and risk of each stroke type is estimated separately. ResultsThe accuracy of the model in predicting general stroke, ischemic stroke, hemorrhagic stroke and transient ischemic attack events is obtained as 99.85%, 99.89%, 99.77% and 99.24%; respectively. ConclusionsThe proposed model showed almost perfect performance. In this context, it has the ability to perform risk estimation accurately for 4 different types of stroke while considering a large set of risk factors. Therefore, it possesses the potential to aid the medical experts by functioning as a decision support system.

Study on Seasonal Variation in Stroke

Introduction: After coronary artery disease and cancer, stroke is the third commonest cause of death in the developed countries. There have been descriptions of a seasonal variation in the frequency of different types of stroke. This variation may be related to a variation in the frequency of risk factors of stroke. Objective: To find out the seasonal variation of different type of strokes. Materials & methods: This cross sectional observational study was carried out at the department of medicine, mymensingh medical college hospital, mymensingh over a period of one year between June 2011 to May 2012. A total 292 patients of CT scan proven acute stroke of both sexes who were hospitalized within one weeks of acute stroke were included in this study within this period. data were processed and analyzed by computer software SPSS. Level of significance was considered as p value less than 0.05. Results: The frequency of ischaemic stroke during summer (62.4%) was significantly greater than that during winter (37.8%). The frequency of haemorrhagic stroke during winter (62.2%) was significantly greater than that during summer (37.6%). Hypertension was the most important risk factor and other risk factors were smoking, diabetes mellitus, tobacco chewing, ischemic heart disease, dyslipidemia, oral contraceptive pill, alcohol consumption, atrial fibrillation and past history of stroke. Conclusion: This study found stroke is influenced by the variation of seasons. The frequency of ischaemic stroke during summer was significantly greater than winter. The frequency of haemorrhagic stroke during winter was significantly greater than summer. Medicine Today 2022 Vol.34(1): 22-26

Association of ambient PM1 with hospital admission and recurrence of stroke in China

BackgroundParticulate matter (PM) pollution is a well-known risk factor of stroke. However, little is known about the association between PM1 (aerodynamic diameter ≤ 1.0 μm) and stroke. We estimated the associations of short-term exposure to PM1 with hospital admission and recurrence of stoke in China. MethodsStroke data were derived from the Chinese Stroke Center Alliance (CASA) program conducted in 1458 hospitals in 292 Chinese cities from 2015 to 2019. Daily air pollution and meteorological data were collected in the cities where studied hospitals were located. Daily PM1 concentration was estimated by a generalized additive model (GAM) using PM2.5 and meteorological variables. A time-stratified case-crossover design was applied to estimate the associations of short-term exposure to PM1 with hospital admission of stroke. A GAM model was used to estimate the association between average PM1 exposure during hospitalization and the recurrence of stroke. ResultsA total of 989,591 stroke cases were included in the study. Each 10 μg/m3 increase in PM1 (lag06-day) was associated with a 0.53% (95%CI, 0.39%, 0.67%) increment in hospital admission for stroke. The adverse effects of PM1 on ischemic stroke was stronger than on intracerebral hemorrhage. We found the associations were significant in Northeast (0.94%, 95%CI, 0.51%, 1.38%), North (0.47%, 95%CI, 0.20%, 0.75%), Central (0.57%, 95%CI, 0.30%, 0.85%), and East China (0.63%, 95%CI, 0.27%, 0.99%). Of all stroke cases, 62,988 (6.4%) had recurrent stoke attack during their hospitalization. Each 10 μg/m3 increase in PM1 was associated with a 1.64% (95%CI, 1.28%, 2.01%) increment in recurrence of stroke during hospitalization. ConclusionsShort-term exposure to PM1 may increase the risk of incidence and recurrence of stroke in China, and the effects varied across different types of stroke and regions. Geographically targeted strategies and measures are needed to control air pollution for reducing the burden of stroke from PM1.

Prognostic indicators for the onset of ischaemic versus haemorrhagic stroke in stable coronary artery disease

Abstract Funding Acknowledgements Type of funding sources: None. Background The incidence of stroke may be increased in patients with coronary artery disease (CAD). We aimed to investigate the specific risk factors for the development of ischaemic and haemorrhagic stroke in stable CAD patients. Methods Patients with stable CAD were prospectively enrolled for future cardiovascular events in Taiwan. All the patients had received coronary interventions and were stable for least 1 month before enrolment. The incidence of ischaemic stroke was identified and confirmed by telephone and hospital records. Baseline characteristics, including demographic data, lipid profiles, medications, and biomarkers for potential inflammatory and atherosclerosis, were analysed. Results In total, 1428 patients (age, 63.07 ± 11.4 years; 1207 males) were under standard medical treatment and regularly followed-up for at least 4 years. Multivariate logistic regression analysis showed that baseline serum myeloperoxidase (MPO) level (HR: 1.89, 95% CI: 1.16-3.10, p = 0.01) and statin use (HR: 0.37; 95% CI: 0.17-0.79, p = 0.01) were independently associated with the onset of ischaemic stroke. Age (HR: 1.07, 95% CI: 1.00-1.14, p = 0.04) and angiotensin receptor blocker (ARB) use (HR: 0.37, 95% CI: 0.17-0.79, p = 0.01) were independently associated with future onset of intracranial haemorrhage (ICH), implying the different mechanisms of ischaemic stroke and ICH. Conclusion Age and ARB use were related to ICH onset. Baseline MPO level and statin use were independently associated with longer and shorter future ischaemic stroke onset in stable CAD patients, respectively. Further studies are indicated to confirm the potential mechanisms and advance individual risk stratification for the onset of different types of stroke in clinical CAD.

Analyzing and detecting hemorrhagic and ischemic strokebased on bit plane slicing and edge detection algorithms

Nowadays, in the medical world, analyzing and diagnosing acute brain stroke and its location is a difficult process. In many hospitals, however, striking symptoms with the use of computed tomography (CT) imaging for patients is an important step in screening and diagnosis. Furthermore, computer-assisted accurate detection of diseased brain regions Because of the several sorts of strokes, their uneven form, and their great intensity and size, aided design is extremely challenging. Using the bit plan slice technique and the canny detector, we created and suggested a novel approach. Our algorithm produces excellent outcomes. The results demonstrate that our proposed algorithm is an accurate and reliable technique. This study also indicates that this system can detect two different types of strokes: hemorrhagic and ischemic strokes. The results of a comparison study of our suggested technique and other methods such as negative and logarithmic transformation methods are also included in this article.

The association between sleep disturbances and tooth loss among post-stroke patients.

Loss of teeth has been associated with neurological and sleep disorders. It is considered to be a predictor of stroke and leads to modifications of airway patency and predisposition to obstructive sleep apnea. To investigate sleep quality, risk of obstructive sleep apnea and excessive sleepiness among post-stroke patients with tooth loss attending the Neurovascular Clinic of the Federal University of São Paulo. The prevalence rates of different types of stroke were assessed among 130 patients with different degrees of tooth loss, along with the presence of sleep disturbances, risk of obstructive sleep apnea and excessive daytime sleepiness. The prevalence of ischemic stroke was 94.6%, with either no significant disability or slight disability. Our sample had poor sleep quality, and a high risk of obstructive sleep apnea, but without excessive daytime sleepiness. Half of our sample had lost between 9 and 31 teeth, and more than 25% had edentulism. The majority used full removable dental prostheses, and more than half of these individuals slept without removing the prosthesis. We found high prevalence of poor sleep quality and high risk of obstructive sleep apnea among post-stroke patients with tooth loss. This indicates the need for further studies on treating and preventing sleep disturbances in stroke patients with tooth loss.

Knowledge And Perception Of Stroke Among Nursing Students

Stroke is a severe health condition that causes morbidity and death all over the world, and nurses have a significant role in the care of patients admitted with stroke. The study aimed to explore knowledge and perception of stroke among nursing students to provide high quality of care. A descriptive, quantitative study was conducted among 192 participants between May 2018 and January 2019. The study included female students, aged 18 and older. The Self- structured questionnaire was used for data collection, composed of socio-demographic and stroke related-knowledge.. The Pilot study was carried out among 10% of volunteers. Descriptive and inferential statistics were conducted using a computer software program (SPSS) version 20. The T-test and chi-squared tests were used with a P-value of 0.05 to ensure the significances of the results. The study was approved by the Institutional Review Board at the college of nursing, and written consent was taken from all participants. More than 90% of participants were single and knew what a stroke was, and more than 50% knew the different types of stroke. Also, participants had moderate knowledge about risk factors, signs, symptoms, and stroke prevention with 45.3%, 47.4%, and 38.0% respectively, and (50.0%) had poor knowledge of post-stroke complications and medications for treatment. Education level had a positive effect on participants’ knowledge, most of the participants in at the fourth class had a moderate level of knowledge about risk factors for stroke, which was statistically significant (p-value was is 0.037), while third and fourth class students had a moderate level of knowledge about’ signs and symptoms of stroke, which was statistically not significant (p-value > 0.005). Overall, students had a moderate knowledge score of stroke perception. Education level has a positive effect on fourth-year students' knowledge compared with students from third and second year classes.

Relationship between low-density lipoprotein cholesterol, lipid-lowering agents and risk of stroke: a meta-analysis of observational studies (n = 355,591) and randomized controlled trials (n = 165,988).

IntroductionThe impact of low-density lipoprotein cholesterol (LDL-C) on the risk of different types of strokes is unclear. Therefore, we systematically evaluated the impact of LDL-C levels (cohort studies) and lipid-lowering agents (LLAs) (randomized controlled trials) on the different types of stroke.Material and methodsPubMed, SCOPUS, Web of Science and Google Scholar were searched up to 1st September 2019. The DerSimonian-Laird method and generic inverse variance methods were used for quantitative data synthesis. The leave-one-out method was performed as sensitivity analysis. Trial sequential analysis (TSA) was used to evaluate the optimal sample size to detect a 35% reduction in outcomes after administration of LLAs.ResultsParticipants in the highest category of LDL-C had a lower risk of hemorrhagic stroke (RR = 0.91, 95% CI: 0.85–0.98, I2 = 0%) compared with the lowest category of LDL-C. Subjects with the highest category of LDL-C had a higher risk of ischemic stroke (RR = 1.11, 95% CI: 1.07–1.14, I2 = 0%) compared to the lowest LDL-C category. LLAs decreased the risk of all types of strokes for those who achieved LDL-C < 1.8 mmol/l (< 70 mg/dl; RR = 0.88, 95% CI: 0.80–0.96, absolute risk reduction (ARR): 0.7%, number needed to treat (NNT): 143, I2 = 53%, n = 13). Statin therapy decreased the risk of all strokes (RR = 0.88, 95% CI: 0.80–0.97, ARR = 0.6%, NNT = 167, I2 = 56%). With regard to ischemic stroke only, LLAs decreased the risk of ischemic stroke for those who achieved LDL-C < 1.8 mmol/l (< 70 mg/dl; RR = 0.75, 95% CI: 0.67–0.83, ARR = 1.3%, NNT = 77, I2 = 0%); the same was observed for statins (RR = 0.76, 95% CI: 0.69–0.84, ARR = 1.3%, NNT = 77, I2 = 32%). TSA indicated that both benefit boundaries and optimal sample size were reached. There was no significant effect of LLAs regardless of the achieved level of LDL-C on the risk of hemorrhagic stroke; however, TSA indicated that further studies are needed to settle the question and most of the effects were subject to high levels of heterogeneity.ConclusionsOur study sheds light on the debatable association between low LDL-C and different type of strokes. This information can help determine the optimal LDL-C range for stroke prevention, and help plan future LLA studies.

Stroke in Middle Eastern children with cancer: prevalence and risk factors

ObjectiveTo determine the prevalence and to characterize the different types of strokes in children with cancer at the Children’s Cancer Center of Lebanon (CCCL), in addition to assess the factors and clinical findings leading to stroke in children.Methods We retrospectively reviewed the medical records and brain images (MRIs and CTs) of children admitted to the CCCL and diagnosed with cancer between years 2008 and 2017. Brain images were reviewed for the strokes’ onset, size, location, possible origin, its recurrence and type: intracranial hemorrhage (ICH), acute arterial ischemic stroke, and cerebral sinus venous thrombosis (CSVT) with and without venous infarct. Medical charts of the patients were reviewed for age, sex, their type of cancer, the treatment protocol they followed, and abnormal findings on their laboratory studies and neurological exams.ResultsOut of the 905 charts reviewed, twenty-seven children with variable types of cancer had strokes, with a prevalence of 2.9%. Their median age at cancer diagnosis was 9.4 (4.8-13.7) years and the median age at stroke onset was 10.6 (6.7-15.5) years. The median time between the cancer diagnosis and the stroke episode was 6 months. CSVT cases were the most common (60%) followed by acute arterial ischemic (22%) and hemorrhagic strokes (18%), with CSVT being the latest to occur. We observed that the different types of strokes were related to some types of cancer. Of the children that had acute arterial ischemic stroke in this cohort, 83% had brain tumors, of the children who had CSVT, 87.5% had leukemia, and of the children who had hemorrhagic stroke, 40% had leukemia. Neurological abnormalities were more prevalent in acute arterial ischemic stroke (80%). Patients with CSVT recovered better than those with other types of strokes. Strokes recurred in 60% of ischemic strokes. L-Asparaginase was significantly associated with CSVT.ConclusionsThe prevalence of strokes was 2.9% in children with cancer. We were able to identify factors related to the types of the stroke that occurred in children including the type and location of the cancer the type of treatment received, and stroke recurrence.

Prognostic indicators for the onset of ischaemic versus haemorrhagic stroke in stable coronary artery disease.

The incidence of stroke may be increased in patients with coronary artery disease (CAD). We aimed to investigate the specific risk factors for the development of ischaemic and haemorrhagic stroke in stable CAD patients.Patients with stable CAD were prospectively enrolled for future cardiovascular events in Taiwan. All the patients had received coronary interventions and were stable for least 1 month before enrolment. The incidence of ischaemic stroke was identified and confirmed by telephone and hospital records. Baseline characteristics, including demographic data, lipid profiles, medications, and biomarkers for potential inflammatory and atherosclerosis, were analysed.In total, 1428 patients (age, 63.07 ± 11.4 years; 1207 males) were under standard medical treatment and regularly followed-up for at least 4 years. Multivariate logistic regression analysis showed that baseline serum myeloperoxidase (MPO) level (hazard ratio [HR]: 1.89, 95% CI: 1.16–3.10, P = .01) and statin use (HR: 0.37; 95% CI: 0.17–0.79, P = .01) were independently associated with the onset of ischaemic stroke. Age (HR: 1.07, 95% CI: 1.00–1.14, P = .04) and angiotensin receptor blocker (ARB) use (HR: 0.37, 95% CI: 0.17–0.79, P = .01) were independently associated with future onset of intracranial haemorrhage (ICH), implying the different mechanisms of ischaemic stroke and ICH.Age and ARB use were related to ICH onset. Baseline MPO level and statin use were independently associated with longer and shorter future ischaemic stroke onset in stable CAD patients, respectively. Further studies are indicated to confirm the potential mechanisms and advance individual risk stratification for the onset of different types of stroke in clinical CAD.

Predicting Risk of Stroke From Lab Tests Using Machine Learning Algorithms: Development and Evaluation of Prediction Models.

BackgroundStroke, a cerebrovascular disease, is one of the major causes of death. It causes significant health and financial burdens for both patients and health care systems. One of the important risk factors for stroke is health-related behavior, which is becoming an increasingly important focus of prevention. Many machine learning models have been built to predict the risk of stroke or to automatically diagnose stroke, using predictors such as lifestyle factors or radiological imaging. However, there have been no models built using data from lab tests.ObjectiveThe aim of this study was to apply computational methods using machine learning techniques to predict stroke from lab test data.MethodsWe used the National Health and Nutrition Examination Survey data sets with three different data selection methods (ie, without data resampling, with data imputation, and with data resampling) to develop predictive models. We used four machine learning classifiers and six performance measures to evaluate the performance of the models.ResultsWe found that accurate and sensitive machine learning models can be created to predict stroke from lab test data. Our results show that the data resampling approach performed the best compared to the other two data selection techniques. Prediction with the random forest algorithm, which was the best algorithm tested, achieved an accuracy, sensitivity, specificity, positive predictive value, negative predictive value, and area under the curve of 0.96, 0.97, 0.96, 0.75, 0.99, and 0.97, respectively, when all of the attributes were used.ConclusionsThe predictive model, built using data from lab tests, was easy to use and had high accuracy. In future studies, we aim to use data that reflect different types of stroke and to explore the data to build a prediction model for each type.

Estimation of the Lightning Performance of Overhead Lines Accounting for Different Types of Strokes and Multiple Strike Points

Dealing with lightning performance computation, researchers usually consider only negative downward first return strokes and the relevant channel-base peak current distribution. The aim of this article is to account for the lightning flash mechanism, which means to include also downward negative subsequent strokes and downward positive strokes, taking into account available distributions of the number of strokes per flash (i.e., the flash multiplicity) and of the distance among the impact points of the strokes within the same flash (i.e., the channel terminations distance). In this regard, to the best of the authors’ knowledge, the present study is the first one taking into account the multiple ground channel terminations in the lightning performance assessment. The obtained results show that both the negative subsequent strokes and multiple channel termination determine a significant increase in the estimated number of flashovers per year, and they need to be considered in the lightning performance assessment. On the other hand, considering positive downward strokes, a less remarkable increase in the estimated number of flashovers per year is observed.

Polycystic kidney disease increases the stoke incidence in Taiwan: A retrospective population-based cohort study using National Health Insurance Database

BackgroundFew studies documented incidence rates of different types of stroke among patients with polycystic kidney disease (PKD). MethodsWe conducted a retrospective cohort study based on the National Health Insurance (NHI) Database of Taiwan. The PKD cohort comprised patients aged≥20 years diagnosed with PKD using inpatient claims from 1998 to 2011, excluding prior stroke. The reference cohort was established by inpatients without PKD using 1:4 frequency-matched with age, gender, and baseline comorbidities. The two cohorts were followed-up until stroke hospitalization, death, withdrawal from the NHI program, or the end of 2012. To account for competing risks of death, we used multivariable competing risks regression models to estimate sub-distribution hazard ratio (SHR) adjusted for age, gender, baseline comorbidities and end stage renal disease. Results7837 PKD patients and 31,211 reference subjects were followed up through 2012. A total of 955 cases of stroke were identified in the PKD cohort, including 441 ischemic stroke (IS), 289 intracranial hemorrhage (ICH), 73 subarachnoid hemorrhage (SAH) and 232 other stroke. The incidence rates of overall stroke, IS, ICH, and SAH were 21.3, 10.2, 6.8, and 1.7 per 1000 person-years, respectively. The SHR for overall stroke was 1.39 [95% confidence interval (CI) 1.28–1.50]. SAH had the highest SHR, 4.55 [95% CI 3.26–6.37], followed by ICH (1.84), other stroke (1.24), and IS (1.22). ConclusionThis study illustrated the incidence rates of stroke among inpatient of PKD. The PKD patients had a significantly increased risk of all kinds of stroke after adjusting baseline comorbidities.

Imaging of Acute Stroke patient with Covid-19: A serial case

Background: Coronavirus Disease 2019 (COVID-19) has been declared as a pandemic in March 2020 by WHO. Apart from respiratory symptoms, COVID-19 is also associated with various neurological manifestations, one of which is stroke. We reported three cases with diagnosis of stroke in confirmed COVID-19 patients.&#x0D; Case Presentation: Head CT scan without contrast in the three reported cases showed different types of strokes. The first case showed ischemia in the right insular lobe and right parietal lobe. The second case showed intracerebral hemorrhage in the left thalamus and intraventricular hemorrhage, whereas the third case showed acute infarction in right frontotemporal lobe, right lentiform nucleus, right insular cortex, that supports prelenticulostriate segment I MCA embolism.&#x0D; Conclusion: CT scan is an important imaging modality in stroke cases both in COVID-19 and non-COVID-19 cases. CT scans are good at detecting the presence of bleeding, widely available, faster to operate, and less expensive than MRI. The types of stroke in COVID-19 patients can appear as different types of stroke. Generally, it appears as ischemic stroke, but hemorrhagic stroke can also occur with a less frequent occurrence. Further research is needed to explain the exact correlation between stroke and COVID-19.

Renal impairment in stroke; a retrospective comparison between ischaemic and haemorrhagic variants

Background: Cerebrovascular accident (also known as stroke) is a leading cause of mortality and morbidity in India. Renal dysfunction may be associated with increased recurrence of stroke and poorer long-term outcomes.&#x0D; Aims and Objectives: a) To find the relationship between CKD and occurrence of acute stroke b) To estimate the incidence of AKI in patients admitted with acute ischemic and hemorrhagic stroke.&#x0D; Materials and Methods: This is a retrospective analysis of renal function in patients admitted in K.V.G. Medical College Hospital with the diagnosis of “Acute stroke.” All patients admitted in Medical Intensive Care Unit (M-ICU) and general wards from 1st November 2018 to 31st March 2020 were included in the study.&#x0D; Results: In this study, we included 80 patients who were admitted with the diagnosis of acute stroke. Sixty-four patients (80%) had ischemic stroke and remaining sixteen (20%) had haemorrhagic stroke. Twenty-eight patients (35%) had renal dysfunction. The distribution of different types of renal dysfunction among different types of stroke was statistically insignificant (p value = 0.529). Incidence of acute kidney injury (AKI) in our study is 25%. 12 patients (15%) were found to have chronic kidney disease (CKD). The prevalence of CKD varies from 20 to 35% in ischemic stroke and 20 to 46% in haemorrhagic stroke.&#x0D; Conclusion: Renal dysfunction occurs frequently in patients with stroke. There was a significant proportion of patients with renal dysfunction. However, further prospective cohort studies are needed to find out the effect of renal dysfunction on stroke recovery and mortality.