History Of Cerebrovascular Disease Research Articles

Mammalian sterile 20-like kinase 1 acts as a candidate biomarker of mortality of emergency surgical repair for acute type a aortic dissection

BackgroundAcute type A aortic dissection (ATAAD) is a life-threatening pathological change of the aorta. Patients who have undergone aortic surgery are usually at high risk of mortality.AimWe investigated the predictive value of serum Mammalian sterile 20-like kinase 1 (MST1) as a biomarker for the risk of mortality of ATAAD patients.MethodsIn this retrospective cohort study, we analyzed 160 consecutive ATAAD patients who had undergone emergency surgery from July 2016 to April 2017. Medical records and blood samples were collected and analyzed. ELISA assays were performed to detect the concentrations of several proteins including MST1. The relationship between these potential biomarkers and the primary endpoint of death was evaluated using Cox proportional hazard regression analysis.ResultsCompared with a low level (< 1330.8 ng/L), high serum MST1 level (≥ 1330.8 ng/L) was positively associated with the 30-day mortality (OR = 5.233, 95%CI, 1.843–14.862, P < 0.01) and retained predictive after adjustment for sex, age, BMI, nasopharyngeal temperature and deep hypothermia circulatory arrest time (OR = 4.628 95% CI, 1.572–13.625, P < 0.01). A pre-existing basic clinical prediction model was improved with the inclusion of preoperative serum MST1. Specifically, the area under the ROC curve for base model (history of cerebrovascular disease, creatinine, time of operation) was 0.708 (95%CI, 0.546–0.836) and markedly increased to 0.823 when taking MST1 into consideration (95%CI, 0.700–0.912, P = 0.02).ConclusionOur study suggests that high preoperative circulating MST1, with a concentration greater than 1330.8 ng/L, was correlated with the 30-day mortality of ATAAD patients who underwent emergency surgery.

Preeclampsia history and postpartum risk of cerebrovascular disease and cognitive impairment: Potential mechanisms.

Hypertensive disorders of pregnancy such as preeclampsia, eclampsia, superimposed preeclampsia, and gestational hypertension are major causes of fetal and maternal morbidity and mortality. Women with a history of hypertensive pregnancy disorders have increased risk of stroke and cognitive impairments later in life. Moreover, women with a history of preeclampsia have increased risk of mortality from diseases including stroke, Alzheimer's disease, and cardiovascular disease. The underlying pathophysiological mechanisms are currently not fully known. Here, we present clinical, epidemiological, and preclinical studies focused on evaluating the long-term cerebrovascular and cognitive dysfunction that affect women with a history of hypertensive pregnancy disorders and discuss potential underlying pathophysiological mechanisms.

Investigating the effect of history of fractures and hypertension on the risk of all-cause death from osteoporosis: A retrospective cohort study.

To assess the coexistence effect between history of fractures and hypertension on the all-cause death risk of osteoporosis. In this retrospective cohort study, some characteristics of osteoporosis patients aged ≥ 20 years were extracted from the National Health and Nutrition Examination Survey (NHANES) database (2005-2010, 2013-2014), such as age, gender, smoking, drinking, the history of diabetes, cardiovascular and cerebrovascular diseases, fractures and hypertension. The outcome of this study was defined as all-cause death of osteoporosis. These patients were followed up until 2015 with an average follow-up time of 62.00 ± 34.79 months. Univariate and multivariate logistic regression was utilized to evaluate the association of history of fractures and hypertension on all-cause death risk of osteoporosis, respectively. The death risk factors were presented by using relative risk (RR) and 95% confidence interval (CI). The attributable proportion (AP) to explore the interaction between history of fractures and hypertension on the all-cause death risk of osteoporosis. Of the total 801 osteoporosis patients, 227 died. After adjusting age, gender, marital status, education background, annual household income, diabetes, the prior use of prednisone or cortisone medication, cardiovascular and cerebrovascular diseases, the history of fractures (RR = 1.502, 95% CI: 1.035-2.180), spine fracture (RR = 2.944, 95% CI: 1.244-6.967), hip fracture (RR = 2.033, 95% CI: 1.066-3.875) was significantly associated with the increased death risk of osteoporosis. However, there was no significant difference between hypertension and the all-cause death risk of osteoporosis (P > .05). Additionally, there was a significant interaction between the history of fractures and hypertension on the all-cause death risk of osteoporosis, and the interaction was an enhancement effect (AP = 0.456, 95% CI: 0.005-0.906). The co-existence of the history of fractures and hypertension could increase the all-cause death risk of osteoporosis, which indicated that osteoporosis patients with the history of fractures should actively monitor blood pressure levels and prevent the occurrence of hypertension.

The Utility of Glasgow Prognostic Score as an Indicator of Mortality After Transcatheter Aortic Valve Implantation

Aim&#x0D; The Glasgow Prognostic Score (GPS) is a scoring system obtained by using inflammatory (C-reactive protein) and nutritional (albumin) parameters together, and it has been shown to have prognostic value in various cardiac pathologies in previous studies. In this study, we aimed to investigate the usability of the Glasgow Prognostic Score (GPS) in predicting 1-year mortality in patients who underwent transcatheter aortic valve implantation (TAVI).&#x0D; Method&#x0D; Patients who underwent TAVI with the diagnosis of severe, symptomatic aortic stenosis in our hospital between 2013 and 2017 were included in this single center study retrospectively. Demographic, clinical and laboratory data were obtained by reviewing patient files. GPS value was calculated by using C-reactive protein and albumin values which was obtained on admission to. Two groups were formed as survivors and non-survivors according to 1-year mortality data. &#x0D; Results&#x0D; A total of 170 patients were included in this retrospective study and 59 patients constituted the non-survivors group. History of chronic obstructive pulmonary disease and cerebrovascular disease were higher in non-survivors’ group. High STS-TAVR, Euro SCORE II and GPS levels were also higher in non-survivors group. High GPS value calculated with pre-procedural data was determined as a predictor of 1-year mortality.&#x0D; Conclusion&#x0D; The Glasgow Prognostic Score allows the evaluation of inflammation and nutritional status together, is a practical method that can be obtained from routine laboratory parameters. It can be used as a predictor of mortality in patients undergoing TAVI. It can guide clinicians in taking preventive measures to reduce mortality before the procedure.

Dynamic Alterations in Cerebral Hemodynamics Measured by Portable Near-Infrared Spectroscopy in Orthostatic Hypotension and Intolerance.

We aimed to evaluate dynamic alterations in cerebral total hemoglobin concentration (HbT) in individuals with orthostatic hypotension (OH) and orthostatic intolerance (OI) symptoms using a portable near-infrared spectroscopy (NIRS) system. Participants comprised 238 individuals (mean age, 47.9 years) without a history of cardiovascular, neurodegenerative, or cerebrovascular diseases, including those with unexplained OI symptoms and healthy volunteers. Participants were categorized by the presence of OH based on the supine-to-stand blood pressure (BP) drop and OI symptoms using on OH questionnaires: classic OH (OH-BP), OH symptoms alone (OH-Sx), and control groups. Random case-control matching sets were constructed, resulting in 16 OH-BP and 69 OH-Sx-control sets. The time-derivative of HbT change in the prefrontal cortex during the squat-to-stand maneuver was measured using a portable NIRS system. There were no differences in demographics, baseline BP, and heart rate among matched sets. The peak time of maximum slope variation in HbT change, indicating the recovery rate and speed of cerebral blood volume (CBV) change, was significantly longer in OH-Sx and OH-BP groups than in the control group under transition to a standing position after squatting. In the OH-BP subgrouping, the peak time of maximum slope variation in HbT change was significantly longer only in OH-BP with OI symptoms, but did not differ between OH-BP without OI symptoms and controls. Our results suggest that OH and OI symptoms are associated with dynamic alterations in cerebral HbT. Regardless of the severity of the postural BP drop, OI symptoms are associated with prolonged CBV recovery.

Frailty and comorbidity burden in Atrial Fibrillation.

With the aging of the population, the characterization of frailty and comorbidity burden is increasingly taking on particular importance. The aims of the present study are to analyze such conditions in a population affected by Atrial Fibrillation (AF), matching it with a population without AF, and to recognize potential independent factors associated with such common cardiovascular disease. This study included subjects consecutively evaluated over 5 years at the Geriatric Outpatient Service, University Hospital of Monserrato, Cagliari, Italy. A sum of 1981 subjects met the inclusion criteria. The AF-group was made up of 330 people, and another 330 people were randomly selected to made up the non-AF-group. The sample was subjected to Comprehensive Geriatric Assessment (CGA). In our sample, severe comorbidity burden (p = 0.01) and frailty status (p = 0.04) were significantly more common in patients with AF than without AF, independently on gender and age. Furthermore, the 5-years follow-up demonstrated that survival probability was significantly higher in AF-group (p = 0.03). The multivariate analysis (AUC: 0.808) showed that the presence of AF was independently positively associated with a history of coronary heart disease (OR: 2.12) and cerebrovascular disease (OR: 1.64), with the assumption of Beta Blockers (OR: 3.39), and with the number of drugs taken (OR: 1.12), and negatively associated with the assumption of antiplatelets (OR: 0.09). Elderly people with AF are frailer, have more severe comorbidities, and take more drugs, in particular beta blockers, than people without AF, who conversely have a higher survival probability. Furthermore, it is necessary to pay attention to antiplatelets, especially in AF-group, in order to avoid dangerous under- or over-prescriptions.

Say Yes or No to N2O?

Complex Information for Anesthesiologists Presented Quickly and Clearly*ENIGMA II trial cardiac risk factors included history of coronary artery disease, heart failure, cerebrovascular disease, or peripheral vascular disease, or age ≥70 yr with other comorbiditiesInfographic created by Holly B. Ende, Vanderbilt University Medical Center; James P. Rathmell, Brigham and Women’s Health Care/Harvard Medical School; and Jonathan P. Wanderer, Vanderbilt University Medical Center. Illustration by Annemarie Johnson, Vivo Visuals Studio. Address correspondence to Dr. Ende: holly.ende@vumc.org.

The effect of CT-based cardiothoracic ratio on survival of COVID-19 patients

Objectives: We aimed to investigate the relationship between computed tomography (CT)- based cardiothoracic ratio (CTR) with mortality rates of COVID-19 patients. Methods: Our study was a single-center retrospective analysis of 484 patients (aged ≥ 18) who were admitted to our hospital’s emergency department. We included only laboratory-confirmed COVID-19 patients who underwent chest CT. Data of demographic information, laboratory findings, survivals, and chest CT imaging findings were recorded. The radiologist calculated CTR by dividing the greatest transverse cardiac diameter by the greatest transverse thoracic diameter on the initial chest CT. Cardiomegaly was defined if “CTR &amp;gt; 0.5”. Results: Thirty (6.2%) patients were treated as outpatients, and 135/484 (%27.9) patients were treated in the intensive care unit (ICU). A total of 147 /484 (30.4%) patients died. We found a statistical association between cardiomegaly with mortality rates (p &amp;lt; 0.001) and ICU admission (p = 0.008). In multivariate analysis, older age was 1.07-fold (p &amp;lt; 0.001), cardiomegaly 1.75-fold (p = 0.015), history of cerebrovascular diseases 2.929-fold (p = 0.018), and elevated serum LDH level 1.003-fold (p = 0.011) associated with higher risks of mortality. Conclusions: Since the presence of cardiomegaly on chest CT is associated with a worse prognosis for COVID-19 patients, more caution should be exercised in the evaluation, follow-up, and treatment of COVID-19 patients with cardiomegaly.

THE EFFECT OF INTRA-AORTIC BALLOON PUMP IN PATIENTS WITH LOW EJECTION FRACTION UNDERGOING CORONARY ARTERY BYPASS GRAFTING

This study aimed to assess risk factors that predict the length of stay and 30-day mortality in subjects undergoing CAGB to evaluate the impact of IABP support in patients with low ejection fraction. The prospective study was conducted in the Cardiology Department of Punjab Institute of Cardiology Lahore from January 2022 to January 2023. A total of 315 patients were included in the study. The sample was divided into a study group (n=110, having LVEF ≤ 30%) and a control group (n=205, having EF &gt; 30%). Pre-operative and intraoperative data of the patients were recorded. Post-operative complications were recorded, including LOS in the hospital and 30-day mortality. Patients in the study group required more emergency CABG ( P = .005), and IABP was also used more frequently in patients having EF&lt; 30% (P&lt;.001). LOS in hospital (P&lt;.001) and ICU (P&lt;.001) and 30-day mortality (P=.009) were higher in the study group. According to multivariate logistic regression analysis, in the study group history of cerebrovascular disease ( P = .018), peripheral vascular disease ( P = .004), congestive heart failure ( P = .027), and IABP use ( P = .002) were associated with the rate of 30-day mortality. Moreover, the increased length of hospital stay in these patients was associated with an increase in age (P&lt;.001), hypertension (P=.040), and IABP use (P=.009). Based on the results, it can be concluded that the low ejection fraction positively affects increased LOS and 30-day mortality in subjects undergoing CABG; IABP insertion is a significant predictor of increased LOS and 30-day mortality and increases post-operative complications.

Clinical characteristics and prognostic analysis of female patients with Stanford type B aortic dissection

Objective: To explore the clinical characteristics and prognostic factors of female patients with Stanford type B aortic dissection. Methods: This is a single-centre retrospective study. Consecutive patients diagnosed with Stanford type B aortic dissection in General Hospital of Northern Theater Command from June 2002 to August 2021 were enrolled, and grouped based on sex. According to the general clinical conditions and complications of aortic dissection tear, patients were treated with thoracic endovascular aortic repair, surgery, or optimal medication. The clinical characteristics and aortic imaging data of the patients at different stages were collected, adverse events including all-cause deaths, stroke, and occurrence of aortic-related adverse events were obtained during hospitalization and within 30 days and at 1 and 5 years after discharge. According to the time of death, death was classified as in-hospital death, out-of-hospital death, and in-hospital death was divided into preoperative death, intraoperative death and postoperative death. According to the cause of death, death was classified as aortic death, cardiac death and other causes of death. Aortic-related adverse events within 30 days after discharge included new paraplegia, post-luminal repair syndrome, and aortic death; long-term (≥1 year after discharge) aortic-related adverse events included aortic death, recurrent aortic dissection, endoleak and distal ulcer events. The clinical characteristics, short-term and long-term prognosis was compared between the groups. Logistic regression analysis was used to explore the association between different clinical factors and all-cause mortality within 30 days in female and male groups separately. Results: A total of 1 094 patients with Stanford type B aortic dissection were enrolled, mean age was (53.9±12.1) years, and 861 (78.7%) were male and 233 (21.3%) were female. (1) Clinical characteristics: compared with male patients, female patients were featured with older average age, higher proportion of aged≥60 years old, back pain, anemia, optimal medication treatment, and higher cholesterol level; while lower proportion of smoking and drinking history, body mass index, calcium antagonists use, creatine kinase level, and white blood cell count (all P<0.05). However, there was no significant difference in dissection tear and clinical stage, history of coronary heart disease, diabetes, hypertension, and cerebrovascular disease between female and male patients (all P>0.05). (2) Follow-up result: compared with male patients, female patients had a higher rate of 30-day death [6.9% (16/233) vs. 3.8% (33/861), P=0.047], in-hospital death (5.6% (13/233) vs. 2.7% (23/861), P=0.027), preoperative death (3.9% (9/233) vs. 1.5% (12/861), P=0.023) and aorta death (6.0% (14/233) vs. 3.1% (27/861), P=0.041). The 1-year and 5-year follow-up results demonstrated that there were no significant differences in death, cerebrovascular disease, and aorta-related adverse events between the two groups (all P>0.05). (3) Prognostic factors: the results of the univariate logistic regression analysis showed that body mass index>24 kg/m2 (HR=1.087, 95%CI 1.029-1.149, P=0.013), history of anemia (HR=2.987, 95%CI 1.054-8.468, P=0.032), hypertension (HR=1.094, 95%CI 1.047-1.143, P=0.040) and troponin-T>0.05 μg/L (HR=5.818, 95%CI 1.611-21.018, P=0.003)were associated with an increased risk of all-cause mortality within 30 days in female patients. Conclusions: Female patients with Stanford type B aortic dissection have specific clinical characteristics, such as older age at presentation, higher rates of anemia and combined back pain, and higher total cholesterol levels. The risk of death within 1 month is higher in female patients than in male patients, which may be associated with body mass index, hypertension, anemia and troponin-T, but the long-term prognosis for both female and male patients is comparable.

Is a unified blood pressure threshold feasible in the current scenario?: Commentary on the article"130/80mmHg as a unifying hypertension threshold for office brachial, office central and ambulatory daytime brachial blood pressure": Commentary on the article"130/80mmHg as a unifying hypertension threshold for office brachial, office central and ambulatory daytime brachial blood pressure".

Is a unified blood pressure threshold feasible in the current scenario?: Commentary on the article"130/80mmHg as a unifying hypertension threshold for office brachial, office central and ambulatory daytime brachial blood pressure": Commentary on the article"130/80mmHg as a unifying hypertension threshold for office brachial, office central and ambulatory daytime brachial blood pressure".

Physical function, nutritional status, and quality of life before and after chemotherapy in patients with malignant lymphoma.

This study investigates the efficacy of and gender differences in exercise therapy in patients with malignant lymphoma undergoing chemotherapy. Twenty-six patients (13 men, 13 women) received physical therapy (based on the Borg Scale 13) during hospitalization. Physical function was measured using grip and knee extension strength, 6-minute walking distance, and body composition; nutritional status assessed via Mini Nutritional Assessment (MNA®); and serum albumin levels analyzed. Fatigue was evaluated using the Brief Fatigue Inventory, and health-related quality of life was assessed with the Medical Outcome Study 36-Item Short-Form Health Survey (SF-36v2). The analysis of all patients indicated that the right grip strength, skeletal muscle mass, skeletal muscle index, and leg muscle mass significantly decreased, whereas the serum albumin level, MNA® score, and scores of many items of the SF-36v2 significantly increased after chemotherapy. In a gender-specific analysis, only men showed significant declines in the skeletal muscle mass and skeletal muscle index, and improvement in the MNA® score after chemotherapy. In the SF-36v2, there were significant improvements in general health and physical component summary scores among men, and general health and mental component summary scores among women. Exercise therapy at a Borg Scale intensity of 13 may not prevent muscle mass decline in patients with malignant lymphoma, especially male patients. In addition, this study revealed that there is a gender difference in the effect of exercise therapy on quality of life. Thus, gender should be considered in exercise therapy for patients with malignant lymphoma.

Longitudinal change of serum inter-alpha-trypsin inhibitor heavy chain H4, and its correlation with inflammation, multiorgan injury, and death risk in sepsis.

Inter-alpha-trypsin inhibitor heavy chain H4 (ITIH4) inhibits infection-induced inflammation and multiorgan injury through several methods. The present study aimed to estimate the association of serum ITIH4 with inflammatory cytokines, multiorgan injury, and death risk in sepsis patients. Serum samples were collected to detect ITIH4 by enzyme-linked immunosorbent assay in 127 sepsis patients at admission (baseline), day (D)1, D3, and D7 after admission, as well as in 30 healthy controls (HCs). Additionally, 28-day mortality was recorded in sepsis patients. ITIH4 was reduced in sepsis patients versus HCs (median [interquartile range]: 147.9 [78.2-208.8] vs. 318.8 [237.2-511.4] ng/ml) (p < 0.001). In sepsis patients, ITIH4 was associated with the absence of cardiovascular and cerebrovascular disease history (p=0.021). Additionally, ITIH4 was negatively correlated with tumor necrosis factor-α (p < 0.001), interleukin (IL)-1β (p < 0.001), IL-6 (p=0.019), IL-17A (p=0.002), and C-reactive protein (p=0.001), but positively related to IL-10 (p=0.007). Moreover, ITIH4 was also inversely associated with Acute Physiology and Chronic Health Evaluation II score (p=0.002), Sequential Organ Failure Assessment (SOFA) score (p < 0.001), SOFA-respiratory system score (p=0.023), and SOFA-renal system score (p=0.007). Interestingly, ITIH4 gradually increased from baseline to D7 (p < 0.001); besides, ITIH4 at baseline (p=0.009), D1 (p=0.002), D3 (p < 0.001), and D7 (p=0.015) were all decreased in sepsis deaths versus sepsis survivors. Serum ITIH4 is raised from baseline to D7 after disease onset, and it reflects the reduction of systemic inflammation, disease severity, and 28-day mortality for sepsis. However, further verification is required.

Sex Differences in Serum 25-hydroxyvitamin D Reflect Differences in 25-hydroxyvitamin D&lt;sub&gt;3&lt;/sub&gt; Levels but not in D&lt;sub&gt;2&lt;/sub&gt; Levels

Background & Aims: Serum 25-hydroxyvitamin D (25(OH)D) comprises 25(OH)D3 and 25(OH)D2. Although sex differences in 25(OH)D levels have been reported, it remains unclear whether the difference lies in the profiles of 25(OH)D. We determined serum 25(OH)D3, 25(OH)D2, 3-epi-25-hydroxyvitamin D3 (3-epi-25(OH)D3), and (24R)-24,25-dihydroxyvitamin D3 (24,25(OH)2D3) levels measured by LC-MS/MS in healthy adults not consuming supplements and analyzed their profiles.Methods: The serum 25(OH)D levels of 5,959 participants were measured by CLEIA. Levels of vitamin D metabolites (25(OH)D3, 25(OH)D2, 3-epi-25(OH)D3, and 24,25(OH)2D3) of 96 participants with no history of osteoporosis, hypertension, cardiac disease, cerebrovascular disease or diabetes and whose alanine transaminase, serum creatinine, total cholesterol, and hemoglobin A1c levels were within the reference ranges were measured.Results: Serum 25(OH)D, 25(OH)D3, 3-epi-25(OH)D3, and 24,25(OH)2D3 levels were significantly higher in men than those in women, but there was no significant difference in the 25(OH)D2 levels. Strong correlations were observed between 25(OH)D and 25(OH)D3, 3-epi-25(OH)D3, and 24,25(OH)2D3 levels in both sexes. Serum 25(OH)D and 25(OH)D2 levels and serum 25(OH)D3 and 25(OH)D2 levels were not correlated.Conclusions: Serum 25(OH)D3, 25(OH)D2, 3-epi-25(OH)D3, and 24,25(OH)2D3 profiles were determined for healthy participants not consuming supplements. Sex differences in 25(OH)D levels reflected differences in 25(OH)D3, not 25(OH)D2.

Guideline-Concordant Antibiotic Therapy for the Hospital Treatment of Community-Acquired Pneumonia and 1-Year All-Cause and Cardiovascular Mortality in Older Adult Patients Surviving to Discharge

Selection of empiric antibiotic treatment for community-acquired pneumonia (CAP) that is concordant with clinical practice guidelines has been associated with improved short-term outcomes of this infection, but whether it is also associated with longer-term outcomes is unknown. Is guideline-concordance of the initial antibiotic treatment given to older adult patients hospitalized with CAP associated with the 1-year all-cause and cardiovascular mortality risk of those patients who survive hospitalization for this infection? A total of 1,909 older (> 65 years of age) patients were identified who survived hospitalization for CAP at The Ottawa Hospital (Ontario, Canada) between 2004 and 2015. Linking patients' information to hospital and provincial data sets, this study analyzed whether the selection of the initial antibiotic therapy for their CAP was concordant with current clinical practice guidelines, and whether guideline-concordance was associated with 1-year all-cause and cardiovascular mortality following their index CAP hospitalization. Adjustments were made forthe patients' overall 1-year expected death risk; CAP severity; and history of previous pneumonia admissions, myocardial infarction, heart failure, or cerebrovascular disease. Selection of guideline-concordant antibiotic therapy was associated with a trend towards lower all-cause mortality at 1 year post-CAP (hazard ratio, 0.82; 95%CI, 0.65-1.04; P= .099). Furthermore, the use of guideline-concordant antibiotic therapy was associated with a significant almost 50%reduction in cardiovascular death risk 1 year following CAP admission (hazard ratio, 0.53; 95%CI, 0.34-0.80; P= .003). Use of guideline-concordant antibiotic therapy for CAP treatment in older hospitalized patients is associated with a significant reduction in the risk of cardiovascular death at 1 year post-CAP. This finding further supports current clinical practice guideline recommendations for CAP treatment.

Incidence and Features of Acute Ischemic Stroke in Patients Hospitalized with COVID-19: A Multi-center Study in Turkey.

Acute ischemic stroke (AIS) is a devastating complication of COVID-19 with high morbidity and mortality. In this study, we reported the frequency, characteristics, and outcome of AIS in patients with COVID-19. This multicenter and cross-sectional study was conducted between April 2020 and February 2021. Among the hospitalized patients with COVID-19, the detailed characteristics of those with and without AIS were recorded and compared. Six hundred ninety-three patients were included in the study. Acute ischemic stroke was detected in 16 (2.31%) patients, the median age was 77 (range, 48-91) years, and 10 (62.5%) were female. The median NIHSS score at admission was 9 (range, 3-17). Total anterior circulation infarction (TACI) was the most common (37.5%) type and cardioembolism was the most common etiology (37.5%). Nine patients (56.25%) developed AIS within 24 hours of having COVID-19. COVID-19 severity was severe or critical in seven patients (43.75%). Eight patients died, and eight were discharged. Patients with AIS had a higher rate of hypertension, coronary artery disease, heart failure, a history of myocardial infarction, a history of cerebrovascular disease, severe and critical COVID-19, a higher mean age, and a longer ICU stay compared with those without AIS (p<0.001 for each). AIS can occur in patients with COVID-19 and is associated with mortality. Acute ischemic stroke is encountered at any stage of COVID-19, especially within the first 72 hours of the diagnosis, in older patients with comorbidities and severe COVID-19. There is an increased risk of AIS in patients with COVID-19 with a history of stroke.

Depression and Associated Factors Among the Elderly Population in an Urban Tertiary Geriatric Hospital in Bangladesh.

Background: Geriatric depression becoming a serious concern worldwide, but no studies addressed depression among patients attending outpatient department of a tertiary geriatric care hospital in Bangladesh. Methods: This cross-sectional study was conducted in face-to-face interview using the Geriatric Depression Scale (GDS-15) to measure depression among 230 elderly outpatients (60-80 years old) who visited the hospital for medical reasons in Dhaka city; a variety of socio-demographic, behavioral, and psycho-social variables as well as history of chronic diseases were assessed to detect factors associated with depression. Results: The prevalence of depression was 81.7%; 52.6%, 25.2%, and 3.9% showed mild, moderate and severe depression (the GDS scores 5-8, 9-11, and 12-15), respectively. In logistic regression models, the associated factors included marital status, occupational status, educational status, physical activity, and history of cerebrovascular diseases or stroke. The prevalence of depression was generally higher than other reports elsewhere, and the reason behind this may include the use of the GDS-15 and the setting to carry out this study. Conclusion: Nationally representative investigations are warranted to further address depression among the elderly in Bangladesh; these findings would be helpful for future studies and intervention programs.

Arterial stiffness and its influence on cerebral morphology and cognitive function.

Recently, arterial stiffness has been associated with cerebral small vessel disease (SVD), brain atrophy and vascular dementia. Arterial stiffness is assessed via pulse wave velocity (PWV) measurement and is strongly dependent on arterial blood pressure. While circadian blood pressure fluctuations are important determinants of end-organ damage, the role of 24-h PWV variability is yet unclear. We here investigated the association between PWV and its circadian changes on brain morphology and cognitive function in community-dwelling individuals. Single-centre, prospective, community-based follow-up study. The study cohort comprised elderly community-based participants of the Austrian Stroke Prevention Family Study which was started in 2006. Patients with any history of cerebrovascular disease or dementia were excluded. The study consists of 84 participants who underwent ambulatory 24-h PWV measurement. White matter hyperintensity volume and brain volume were evaluated by 3-Tesla magnetic resonance imaging (MRI). A subgroup of patients was evaluated for cognitive function using an extensive neuropsychological test battery. PWV was significantly related to reduced total brain volume (p = 0.013), which was independent of blood pressure and blood pressure variability. We found no association between PWV with markers of cerebral SVD or impaired cognitive functioning. Only night-time PWV values were associated with global brain atrophy (p = 0.005). This study shows a relationship of arterial stiffness and reduced total brain volume. Elevations in PWV during night-time are of greater importance than day-time measures.

Necrotizing Pancreatitis: A comprehensive review of the presentation, management, and complications

Necrotizing pancreatitis (NP) is a life-threatening complication of acute pancreatitis. It requires an extended hospital stay, aggressive management, and has a higher risk of mortality. Risk factors such as comorbidities in the patient’s history including history of coronary artery disease and cerebrovascular disease can increase the risk of developing necrotizing pancreatitis. The presentation of necrotizing pancreatitis is similar to acute pancreatitis, but specific labs such as hematocrit level can be monitored to anticipate the development of necrotizing pancreatitis. In addition, diagnostic imaging must be obtained to classify necrotizing pancreatitis and aid in management choice. Fluid hydration, adequate pain management, and nutritional support are the principles of treating necrotizing pancreatitis. Deciding whether to drain the necrotic collection or not is usually determined based on the type of necrosis present and whether it is infected. Infected necrotizing pancreatitis can also occur, and patients usually need to be monitored closely with appropriate antibiotics for a long duration. Patients affected by necrotizing pancreatitis can potentially develop complications that can lead to devastating outcomes. Necrotizing pancreatitis complications can occur due to an inflammatory reaction on the adjacent structure such as splanchnic vein thrombosis, gastrointestinal fistula or inflammatory reaction within the pancreas leading to an exocrine and an endocrine pancreatic insufficiency. We present here a literature review of necrotizing pancreatitis and the complications that can arise from it.

PROGNOSIS AND RISK FACTORS FOR GERIATRIC STROKE PATIENTS IN EACH DECADE

Introduction: We aimed to compare the demographic characteristics, stroke localizations, stroke risk factors, and prognoses of geriatric stroke patients in different age groups. Materials and Methods: Geriatric patients who had a neurological consultation following an acute ischemic stroke were evaluated in the study. Patients were divided into age groups of 65–69, 70–79, 80–89, and 90 years and older. The demographic findings, the diseases of the patients, pre-stroke antiaggregant or anticoagulant treatment, previous history of cerebrovascular disease, presence of atrial fibrillation, laboratory data, imaging reports from initial presentation, Echocardiography and Carotid-Vertebral Doppler Ultrasonography results were recorded. Neurological deficits were evaluated using the National Institutes of Health Stroke Scale and the Modified Rankin Score. Results: The study evaluated 298 patients (161 females, 137 males). Significant differences were found in all four age groups in terms of the presence of diabetes mellitus. In relation to infarct localization, there were no significant differences between the four age groups. Previous antiaggregant or anticoagulant treatments were similar in all age groups. There were significant differences between the groups in terms of the presence of atrial fibrillation at presentation. In the 90 years and over age group, the values for the National Institutes of Health Stroke Scale and Modified Rankin Score were significantly higher. Conclusion: The incidence of stroke can be reduced by the regular evaluation of elderly individuals for modifiable risk factors and their management. In elderly individuals who had ischemic strokes, we recommend to comprehensive cardiac assessment, including procedures like a 24-hour Holter monitor and transesophageal echocardiography for cardioembolic origins. Keywords: Stroke; Geriatric; Risk factors; Prognosis.