Status Of Stroke Patients Research Articles

Exercise Training Enhances Platelet Mitochondrial Bioenergetics in Stroke Patients: A Randomized Controlled Trial.

Exercise training (ET) may impact physical fitness by affecting mitochondrial functions. This study aimed to elucidate the effect of ET on aerobic capacity and platelet mitochondrial bioenergetics (MTB) in stroke patients. Among the 30 stroke patients who underwent the traditional rehabilitation program (TRP), 15 were randomly assigned to have ET (50–60% VO2peak for 30 min/day, 5 days/week for 4 weeks), and those remaining received only the TRP (control group). The peak exercise capacity (VO2peak) and platelet MTB, including oxidative phosphorylation (OXPHOS) and the electron transport chain (ETC), were measured through automatic gas analysis and high-resolution respirometry, respectively. The results demonstrated that ET significantly increased the VO2peak (17.7%) and O2 uptake efficiency slope (31.9%) but decreased the ventilation versus CO2 production slope (−7.65%). Patients who underwent ET also had significantly enhanced platelet mitochondrial OXPHOS and ETC by activating the FADH2 (Complex II)-dependent pathway, but depressed plasma myeloperoxidase (−28.4%) and interleukin-6 levels (−29.9%). Moreover, changes in VO2peak levels were positively correlated with changes in platelet OXPHOS and ETC capacities. In conclusion, ET increases the platelet MTB by enhancing Complex II activity in stroke patients. The exercise regimen also enhances aerobic fitness and depresses oxidative stress/pro-inflammatory status in stroke patients.

Does the nutritional status of acute stroke patients affect the neurological status in the early post-stroke period?

ABSTRACTAccording to recent reports, malnutrition may be associated with a worse prognosis in stroke patients. The aim of this study was to determine the nutritional status of stroke patients and its impact on neurological and functional status of patients in the early post-stroke period. Our prospective study included a total of 128 patients admitted to the Stroke Unit. The assessment was made in the patients within the first week after the onset of stroke symptoms. Groups of patients with abnormal body mass index (BMI <20kg/m2 or >25kg/m2) were compared to the group of normal BMI, serum albumin, total cholesterol, HDL and LDL levels were determined in each patient within 24h following admission. The analysis showed that the patients with lower levels of serum albumin and triglycerides had higher scores in the National Institutes of Health Stroke Scale (NIHSS) on admission. Patients with a higher risk of malnutrition, confirmed by the Subjective Global Assessment scale, had higher NIHSS scores. The study showed a positive relationship between the nutritional status and worse neurological status of patients in the early post-stroke period.Abbreviation: NIHSS; Rankin scale

Poststroke depression and risk of recurrent stroke: A meta-analysis of prospective studies.

Background:Conflicting results have been reported on the association of poststroke depression with recurrent stroke events. This meta-analysis of prospective studies aims to evaluate whether poststroke depression is an independent predictor of stroke recurrence among stroke patients.Methods:A systematic search of articles in PubMed and Embase databases from their inception to October 2018 was conducted. Prospective studies reporting risk estimates of stroke recurrence by depression status in stroke patients were included and pooled risk ratio (RR) with 95% confidence intervals (CIs) of stroke recurrence was calculated for patients with or without poststroke depression.Results:Six studies with 4648 stroke patients were finally included, and the prevalence of poststroke depression was found to from 15.9% to 40.5%. The pooled adjusted RR for stroke recurrence in patients suffering from poststroke depression was 1.48 (1.22–1.79) in a fixed-effect model. Subgroup analyses indicated that poststroke depression significantly increased stroke recurrence (RR 1.64; 95% CI, 1.28–2.10) among ischemic stroke patients but not in total stroke patients (RR 1.28; 95% CI, 0.96–1.73).Conclusions:This meta-analysis suggests that poststroke depression may be an independent predictor of stroke recurrence among ischemic stroke patients. Further studies are required to investigate whether treatment of poststroke depression can reduce the risk of stroke recurrence.

Prevalence and Prognosis of Cerebrovascular Accidents and its Subtypes: A Cross-Sectional Study in the Hail Region, Saudi Arabia

Cerebrovascular accidents or stroke is an important healthcare concern. Ischemic stroke is an acute neurologic deficit that results from focal cerebral ischemia leading to permanent tissue damage (infarction). The cause is commonly associated with atherothrombotic occlusion of large arteries, cerebral embolism (embolic infarction), nonthrombotic occlusion of small, deep cerebral arteries (lacunar infarction), and proximal arterial stenosis with hypotension that decreases cerebral blood flow in arterial watershed zones (hemodynamic stroke). Stroke is being observed as a rapidly growing problem and an important cause of illness and death in Saudi Arabia. The aims of this cross-sectional study were to establish the prevalence and prognosis of cerebrovascular accidents and its subtypes in the Hail Region, Saudi Arabia. Data were collected on all patients who experienced CVAs between September 2017–January 2018, used the diagnosis coding program in King Khalid Hospital in Hail, Saudi Arabia. Out of 190 patients, 63.7% were male and 36.3% were female. The overall incidence of ischemic stroke after acute myocardial infarction was 85.26%. Hypertension, diabetes mellitus were shown as more risk factors for ischemic stroke type compared with hemorrhagic stroke and embolic stroke. The overall status of stroke patients was shown 92.1% live and 7.9% were dead. The incidence of complicating hospitalizations with cerebrovascular accident continues to grow and is associated with increased mortality and adverse discharge. This highlights the need for early diagnosis, better risk stratification, and preparedness for the need for complex long-term care in this vulnerable population.

Role of Gender on Quality of Life and Functional Status in Stroke Patients with Urinary Incontinance

Role of Gender on Quality of Life and Functional Status in Stroke Patients with Urinary Incontinance

Prevalence and prognosis of cerebrovascular accidents and its subtypes: A cross-sectional study in Hail region, Saudi Arabia

Cerebrovascular accidents or stroke is an important healthcare concern. Ischemic stroke is an acute neurologic deficit that results from focal cerebral ischemia leading to permanent tissue damage (infarction). The cause is commonly associated with atherothrombotic occlusion of large arteries, cerebral embolism (embolic infarction), non-thrombotic occlusion of small, deep cerebral arteries (lacunar infarction), and proximal arterial stenosis with hypotension that decreases cerebral blood flow in arterial watershed zones (hemodynamic stroke). Stroke is being observed as a rapidly growing problem and an important cause of illness and death in Saudi Arabia. The aims of this cross-sectional study were to establish the prevalence and prognosis of cerebrovascular accidents and its subtypes in Hail Region, Saudi Arabia. Data were collected on all patients who experienced CVAs between September 2017–January 2018, used the diagnosis coding program in King Khalid Hospital in Hail, Saudi Arabia. Out of 190 patients 63.7% were male and 36.3% were female. The overall incidence of ischemic stroke after acute myocardial infarction was 85.26%. Hypertension, diabetes mellitus were shows as more risk factors for ischemic stroke type compared with hemorrhagic stroke, and embolic stroke. The overall status of stroke patients were shown 92.1% live and 7.9% were dead. Incidence of complicating hospitalizations with cerebrovascular accident continues to grow and is associated with increased mortality and adverse discharge. This highlights the need for early diagnosis, better risk stratification, and preparedness for need for complex long-term care in this vulnerable population.

Post-stroke lower urinary system dysfunction and its relation with functional and mental status: a multicenter cross-sectional study

ABSTRACTBackground: Review of the literature clearly reveals that little is known about the association between functional and mental status, and Lower Urinary Tract Dysfunction (LUTD) in patients with stroke.Objective: The aim of this study was to assess functional and mental status in stroke patients and to identify possible associations with the prevalence, severity and bother of LUTD.Material and methods: This study was designed as a cross-sectional study and included 260 stroke patients enrolled from six different hospitals in Turkey. The patients were questioned using the Danish Prostatic Symptom Score (DAN-PSS) Questionnaire to evaluate LUTD, and evaluated using the Modified Barthel Index (MBI), Incontinence Quality of Life Questionnaire (I-QoL), and the Mini Mental State Examination (MMSE).Results: At least one LUTD finding was reported in 243 (93.5%) patients; the most commonly encountered complaint in these patients was nocturia (75.8%). The mean MBI, MMSE, and I-QoL scores were found to be significantly lower in LUTD (+) patients compared to LUTD (−) patients (p = 0.000, p = 0.005, and p < 0.01, respectively). Similarly all parameters (MBI, MMSE, and I-QoL scores) assessed were found to be significantly lower for patients with urinary incontinence than those without incontinence (p = 0.000, p = 0.000, and p < 0.01, respectively).Conclusion: LUTD is a common problem in patients with stroke. LUTD is associated with poorer cognitive and functional status and the quality of life in these patients. We, therefore, suggest that bladder dysfunction should not be overlooked during rehabilitation of stroke patients.

The impact of post-acute care rehabilitation on functional status in stroke patients from different hospital accreditation level

In order to construct a medical transfer system for the stroke, Taiwan Ministry of Health and Welfare implemented a national program of Post-acute Care for Cerebrovascular Diseases (PAC-CVD) in March 2014. Under the intensive in-patient rehabilitation programs and per diem payment, the healthcare utilization was expected to be improved. The purpose of this study was to investigate the impact of intensive post-acute stroke rehabilitation on functional status in different hospital accreditation level. The stroke patients who were admitted to post-acute ward in two hospitals during 2014/03/01 to 2017/8/31 were indicated to the study. The patients was separated to group 1 (a rural regional hospital) and group 2 (a metropolitan district hospital). The modified Rankin Scale (mRS) score, Barthal Index (BI), Instrumental Activities of Daily Living Scale (IADL) and Berg Balance Scale (BBS) were used to evaluate functional status. In total, 740 stroke patients (311 patients in group 1, and 429 patients in group 2) were included. The length of days (LOS) between stroke onset and post-acute care (PAC) ward admission were 11.60 days in group 1, and 21.41 days in group 2. The length of days in PAC ward were 27.02 days in group 1, and 36.85 days in group 2. The percentage of patients referred from other acute hospitals were 23.47% in group 1, and 89.51% in group 2. The severity (MRS grading on PAC admission day) was 3.53 in group 1, and 3.88 in group 2. The functional improvement after rehabilitation training was noted in both groups. Under the intensive post-acute in-patient rehabilitation programs, the stroke patients got functional improvement. No matter the accreditation level of the hospital, the same payment may make more chance for the district hospitals to develop. The healthcare utilization may work efficiently under the medical transfer system.

Efeito do Toque Terapêutico na Dor, Autocuidado, Depressão e Cortisol: Estudo de um Caso Clínico

Enquadramento: o Toque Terapêutico (TI) ou método Krieger-Kunz tem demonstrado benefícios na saúde das pessoas como a redução da dor e ansiedade, ou o aumento da hemoglobina. Objetivo: avaliar o efeito do TI na dor, nível de dependência no autocuidado, níveis de cortisol e depressão numa doente com Acidente Vascular Cerebral (AVC) e sintomatologia depressiva grave. Metodologia: estudo de um caso clínico com avaliação pré, durante e pós intervenção, realizado em março e abril de 2015. Foram realizadas dezasseis sessões de TI. Nos três momentos foram aplicados: Mini Mental State Examination; Escala Visual Analógica da dor; Escala de depressão geriátrica e Escala do autocuidado. Foram também avaliados os níveis de cortisol salivar de manhã e à noite. Os procedimentos éticos foram cumpridos. Resultados: observou-se uma melhoria das seguintes variáveis: sintomatologia depressiva, nível de dependência no autocuidado, com ganhos mais significativos na higiene, arranjar-se e alimentar-se, e uma diferença significativa no cortisol matinal diminuindo os seus valores a cada nova avaliação. Conclusão: os achados sugerem que o TI, como terapia complementar, pode ser eficaz na melhoria da condição de saúde em doentes que sofreram AVC, nomeadamente na diminuição da sintomatologia na depressão grave e no nível de dependência no autocuidado.

CD271+, CXCR7+, CXCR4+, and CD133+ Stem/Progenitor Cells and Clinical Characteristics of Acute Ischemic Stroke Patients

Ischemic stroke causes mobilization of various groups of progenitor cells from bone marrow to bloodstream and this correlates with the neurological status of stroke patients. The goal of our study was to identify the activity of chosen progenitor/stem cells in the peripheral blood of acute ischemic stroke patients in the first 7 days after the incident, through associations between the levels of the cells and clinical features of the patients. Thirty-three acute ischemic stroke patients and 15 non-stroke control subjects had their venous blood collected repeatedly in order to assess the levels of the CD45–CD34 + CD271+, the CD45–CD34 + CXCR4+, the CD45–CD34 + CXCR7+, and the CD45–CD34 + CD133+ stem/progenitor cells by means of flow cytometry. The patients underwent repeated neurological and clinical assessments, pulse wave velocity (PWV) assessment on day 5, and MRI on day 1 and 5 ± 2. The levels of the CD45–CD34 + CXCR7+ and the CD45–CD34 + CD271+ cells were lower in the stroke patients compared with the control subjects. Only the CD45–CD34 + CD271+ cells correlated positively with lesion volume in the second MRI. The levels of the CD45–CD34 + CD133+ cells on day 2 correlated negatively with PWV and NIHSS score on day 9. The patients whose PWV was above 10 m/s had significantly higher levels of the CD45–CD34 + CXCR4+ and the CD45–CD34 + CXCR7+ cells on day 1 than those with PWV below 10 m/s. This study discovers possible activity of the CD45–CD34 + CD271+ progenitor/stem cells during the first 7 days after ischemic stroke, suggests associations of the CD45–CD34 + CD133+ cells with the neurological status of stroke patients, and some activity of the CD45–CD34 + CD133+, the CD45–CD34 + CXCR4+, and the CD45–CD34 + CXCR7+ progenitor/stem cells in the process of arterial remodeling.

Cognitive Function and Oral Health Status in Stroke Patients

Cognitive Function and Oral Health Status in Stroke Patients

Abstract P351: Evaluation of Analytic Approaches to Ceiling Effect in Patient-Reported Functional Status After Stroke

Setting: Researchers use several tools to measure functional status in stroke patients. Analyses often use simple linear models, which assume a common treatment effect regardless of stroke severity. However, patients with mild stroke or TIA may perform at the maximum of an instrument, or the ceiling. The presence of a so-called ceiling effect conflicts with the normality assumption of linear models and can diminish the ability to detect efficacy, unless addressed in study design and analyses. Objectives: Our objectives were to (1) review the literature describing the instruments used to measure functional status and the analytic methods used in the presence of ceiling effect; and to (2) valuate methods which may be used to account for treatment effect heterogeneity induced by ceiling effect in comparative effectiveness trials of post-stroke functional status outcomes. Methods: The literature review was conducted by two reviewers using PubMed. To compare type I error control and power in the presence of a ceiling effect, we used simulation studies and compared linear, logistic, and cumulative logistic models. Data were simulated to mirror the empirical distribution of instrumental activities of daily living (IADL) scores found in the published data from the Secondary Prevention of Small Subcortical Strokes (SPS3) clinical trial, a study of lacunar stroke patients, in which there was a pronounced ceiling effect. To accommodate treatment effect heterogeneity induced by ceiling effect, we explored stratification by stroke severity. Results: Our literature review yielded 262 stroke clinical trials that included patient reported outcomes. Only 41% of trials cited ceiling effect in the functional status instrument used; most did not account for it in their analyses. Our simulation studies demonstrate that while linear modeling may result in well controlled type 1 error rates in the presence of pronounced ceiling effect, study power may be unacceptably low. Dichotomizing the outcome and directly modeling the probability of maximum scores with logistic models may be preferred. In contrast, when outcome scores in the untreated group cover the range of the instrument, use of a linear model may be advantageous over logistic models that categorize the outcome. Conclusions: It is important to consider the distribution of functional outcome scores in target stroke population when developing the analysis strategy for a study, perhaps by conducting a pilot study. Specifically, it is important to evaluate if the instrument being used can identify change in outcomes in low-severity groups. Lastly, powering the study to identify lesser treatment effect in low-severity patients may be useful as a secondary trial aim rather than attempting to establish benefit in all patients as a primary outcome.

Abstract TP355: Rapid Cycle Implementation of a Standard Stroke Neurological Check Before Comprehensive Stroke Re-certification Survey

Background: Components of ongoing stroke neurological assessment are remarkably controversial. Gap analysis preceding a Joint Commission (TJC) Comprehensive Stroke Re-Certification (CSC) survey identified organizational deficiency in defining a neurological check that trends neurological status of stroke patients. A standard stroke neuro check was implemented 30 days prior to the CSC survey. During the CSC survey, closed chart review performed on a patient hospitalized prior to the implementation revealed lack of trending patient’s original symptoms. Real time patient tracers also revealed lack of consistency of assessment between healthcare providers, missing documentation of notification to providers for a status change, missing groin checks and pulse checks. These issues resulted in a Requirement for Improvement (RFI) from TJC. Purpose: Determine if the rapid cycle implementation of standard neuro check one month prior to CSC survey was successful, and if other documentation requirements as defined by TJC were completed for the 30 day period prior to CSC Survey. Methods: Charts from 30 days prior to the survey between May 6 and June 6, 2016, were audited for compliance with standard neuro checks, groin checks, pulse checks, NIHSS agreement between healthcare providers, and status change provider notification. All ischemic stroke patients treated with IV alteplase and/or mechanical thrombectomy, Subarachnoid Hemorrhage, Craniotomy, Coiling, Clipping, Carotid Endarterectomy were included (n=30). Frequency of needed assessments varied based on stroke type and treatment. Results: A total of 30 cases revealed 89.7% overall compliance with all required documentation elements. Of 11 ischemic stroke treatment patients there were 1077 opportunities for neuro checks with 907 (84%) of those opportunities completed. Compliance with all remaining components were: NIHSS agreement between providers 92%; status change resulting in notification 96%; and vital signs 96%. Conclusions: Rapid cycle implementation of a standard neuro check was feasible in a large CSC, well received by staff and satisfied the requirements for TJC CSC 10 day clarification process in 2016. Implementation of a standard stroke neuro check needs further research.

Interprofessional collaboration to improve professional practice and healthcare outcomes.

Poor interprofessional collaboration (IPC) can adversely affect the delivery of health services and patient care. Interventions that address IPC problems have the potential to improve professional practice and healthcare outcomes. To assess the impact of practice-based interventions designed to improve interprofessional collaboration (IPC) amongst health and social care professionals, compared to usual care or to an alternative intervention, on at least one of the following primary outcomes: patient health outcomes, clinical process or efficiency outcomes or secondary outcomes (collaborative behaviour). We searched CENTRAL (2015, issue 11), MEDLINE, CINAHL, ClinicalTrials.gov and WHO International Clinical Trials Registry Platform to November 2015. We handsearched relevant interprofessional journals to November 2015, and reviewed the reference lists of the included studies. We included randomised trials of practice-based IPC interventions involving health and social care professionals compared to usual care or to an alternative intervention. Two review authors independently assessed the eligibility of each potentially relevant study. We extracted data from the included studies and assessed the risk of bias of each study. We were unable to perform a meta-analysis of study outcomes, given the small number of included studies and their heterogeneity in clinical settings, interventions and outcomes. Consequently, we summarised the study data and presented the results in a narrative format to report study methods, outcomes, impact and certainty of the evidence. We included nine studies in total (6540 participants); six cluster-randomised trials and three individual randomised trials (1 study randomised clinicians, 1 randomised patients, and 1 randomised clinicians and patients). All studies were conducted in high-income countries (Australia, Belgium, Sweden, UK and USA) across primary, secondary, tertiary and community care settings and had a follow-up of up to 12 months. Eight studies compared an IPC intervention with usual care and evaluated the effects of different practice-based IPC interventions: externally facilitated interprofessional activities (e.g. team action planning; 4 studies), interprofessional rounds (2 studies), interprofessional meetings (1 study), and interprofessional checklists (1 study). One study compared one type of interprofessional meeting with another type of interprofessional meeting. We assessed four studies to be at high risk of attrition bias and an equal number of studies to be at high risk of detection bias.For studies comparing an IPC intervention with usual care, functional status in stroke patients may be slightly improved by externally facilitated interprofessional activities (1 study, 464 participants, low-certainty evidence). We are uncertain whether patient-assessed quality of care (1 study, 1185 participants), continuity of care (1 study, 464 participants) or collaborative working (4 studies, 1936 participants) are improved by externally facilitated interprofessional activities, as we graded the evidence as very low-certainty for these outcomes. Healthcare professionals' adherence to recommended practices may be slightly improved with externally facilitated interprofessional activities or interprofessional meetings (3 studies, 2576 participants, low certainty evidence). The use of healthcare resources may be slightly improved by externally facilitated interprofessional activities, interprofessional checklists and rounds (4 studies, 1679 participants, low-certainty evidence). None of the included studies reported on patient mortality, morbidity or complication rates.Compared to multidisciplinary audio conferencing, multidisciplinary video conferencing may reduce the average length of treatment and may reduce the number of multidisciplinary conferences needed per patient and the patient length of stay. There was little or no difference between these interventions in the number of communications between health professionals (1 study, 100 participants; low-certainty evidence). Given that the certainty of evidence from the included studies was judged to be low to very low, there is not sufficient evidence to draw clear conclusions on the effects of IPC interventions. Neverthess, due to the difficulties health professionals encounter when collaborating in clinical practice, it is encouraging that research on the number of interventions to improve IPC has increased since this review was last updated. While this field is developing, further rigorous, mixed-method studies are required. Future studies should focus on longer acclimatisation periods before evaluating newly implemented IPC interventions, and use longer follow-up to generate a more informed understanding of the effects of IPC on clinical practice.

Healthcare resource utilization and clinical outcomes associated with acute care and inpatient rehabilitation of stroke patients in Japan.

To investigate healthcare resource utilization and changes in functional status in stroke patients during hospitalization in an acute hospital and a rehabilitation hospital. Retrospective cohort study. One acute and one rehabilitation hospital in Japan. Patients who were admitted to the acute hospital due to stroke onset and then transferred to the rehabilitation hospital (n = 263, 56% male, age 70 ± 12 years). Hospitalization costs and functional independence measure (FIM) were evaluated according to stroke subtype and severity of disability at discharge from the acute hospital. Median (IQR) costs at the acute hospital were dependent on the length of stay (LOS) and implementation of neurosurgery, which resulted in higher costs in subarachnoid hemorrhage [$52 413 ($49 166-$72 606) vs $14 129 ($11 169-$19 459) in cerebral infarction; and vs $15 035 ($10 920-$21 864) in intracerebral hemorrhage]. The costs at the rehabilitation hospital were dependent on LOS, and higher in patients with moderate disability than in those with mild disability [$30 026 ($18 419-$39 911) vs $18 052 ($10 631-$24 384)], while those with severe disability spent $25 476 ($13 340-$43 032). Patients with moderate disability gained the most benefits during hospitalization in the rehabilitation hospital, with a median (IQR) total FIM gain of 16 (5-24) points, compared with a modest improvement in patients with mild (6, 2-14) or severe disability (0, 0-5). The costs for in-hospital stroke care were substantial and the improvement in functional status varied by severity of disability. Our findings would be valuable to organize efficient post-acute stroke care.

Preliminary investigation of cardiopulmonary function in stroke patients with stable heart failure and exertional dyspnea

The aim of this study was to investigate the relationships between pulmonary function, respiratory muscle strength, perceived dyspnea, degree of fatigue, and activity of daily living with motor function and neurological status in stroke patients with stable congestive heart failure (CHF).This was a cohort study in a tertiary care medical center. Stroke patients with CHF and exertional dyspnea (New York Heart Association class I–III) were recruited. The baseline characteristics included duration of disease, Brunnstrom stage, spirometry, resting heart rate, resting oxyhemoglobin saturation (SpO2), maximal inspiratory pressure (MIP), maximal expiratory pressure (MEP), Borg scale, fatigue scale, and Barthel index.A total of 47 stroke patients (24 males, 23 females, mean age 65.9 ± 11.5 years) were included. The average Brunnstrom stages of affected limbs were 3.6 ± 1.3 over the proximal parts and 3.5 ± 1.4 over the distal parts of upper limbs, and 3.9 ± 0.9 over lower limbs. The average forced vital capacity (FVC) was 2.0 ± 0.8 L, with a predicted FVC% of 67.9 ± 18.8%, forced expiratory volume in the first second (FEV1) of 1.6 ± 0.7 L, predicted FEV1% of 70.6 ± 20.1%, FEV1/FVC of 84.2 ± 10.5%, and maximum mid-expiratory flow of 65.4 ± 29.5%. The average MIP and MEP were −52.9 ± 33.3 cmH2O and 60.8 ± 29.0 cmH2O, respectively. The Borg scale was 1.5 ± 0.8. MIP was negatively associated with the average Brunnstrom stage of the proximal (r = −0.318, P < 0.05) and distal (r = −0.391, P < 0.01) parts of the upper extremities and lower extremities (r = −0.288, P < 0.05), FVC (r = −0.471, P < 0.01), predicted FVC% (r = −0.299, P < 0.05), and FEV1 (r = −0.397, P < 0.01). MEP was positively associated with average Brunnstrom stage of the distal area of the upper extremities (r = 0.351, P < 0.05), FVC (r = 0.526, P < 0.01), FEV1 (r = 0.429, P < 0.01), and FEV1/FVC (r = −0.482, P < 0.01). FEV1/FVC was negatively associated with the average Brunnstrom stage over the proximal (r = −0.414, P < 0.01) and distal (r = −0.422, P < 0.01) parts of the upper extremities and lower extremities (r = −0.311, P < 0.05) and Barthel index (r = −0.313, P < 0.05).Stroke patients with stable CHF and exertional dyspnea had restrictive lung disorder and respiratory muscle weakness, which were associated with the neurological status of the affected limbs. FVC was more strongly associated with MIP and MEP than predicted FVC%. FEV1/FVC may be used as a reference for the pulmonary dysfunction.

Analysis of Occupational Goals According to Participation and Functional Status in Stroke Patients

Analysis of Occupational Goals According to Participation and Functional Status in Stroke Patients

Review of Stroke: The 2nd International and the 8th National Iranian Stroke Congress : Shiraz, Iran

Dear reader,Stroke is a major health problem in Iran as other developing countries. Meanwhile, epidemiological characteristics of stroke in Iranian population are different with other countries. Both population-based and hospital-based studies showed that incidence and mortality of stroke in Iran is higher than most western countries [1,2]. Higher rates of patients with young-adult stroke in Iranian population are a prominent feature too [3]. In the same time, prevalence of cerebral venous sinus thrombosis is higher than western populations [4] but the frequency of the intracranial stenosis is more or less same as Europeans [5]. The high prevalence of atherosclerotic disease in Iran can be attributed to social and economic factors, including increased life span, changes in dietary habits and an increasingly sedentary lifestyle [6]. In the light of these changes, Iranian health policymakers should consider concerted primary and secondary preventive measures to reduce the impact of this increasingly problematic public health issue.Iranians who have had a stroke consider their social, financial and rehabilitative support to be inadequate. Moreover, awareness of the manifestations of stroke is poor in the Iranian general population [7]. Consequently, the clinical status of stroke patients by the time they are transferred to the referral center may be worse than it could have been. There is an urgent need for Iranian hospitals to develop better measures to manage acute stroke patients.The second international Iranian stroke congress was held from 23-25 September 2015 in Shiraz, Iran. This Conference was a joint effort of the Clinical Neurology Research Center of Shiraz University of Medical Sciences and Iranian Stroke Association.Here we presented some selected reviews from outstanding platforms of this congress. Ghandehari presented the epidemiology of stroke in Iran [8]. Safari et al presented a comprehensive review about immunology of stroke [9]. Abolhasani-Foroughi and Nazeri summarized the role of Computed topography scan for diagnosis and treatment planning of stroke patients [10].Lotfi discussed about pearls and pitfalls of color doppler sonography of cervical arteries [11]. We also have three reviews about clinical and radiologic aspects of cerebral venous sinus thrombosis [12-14]. Two reviews focused on importance of rehabilitation in new stroke era [15,16].

Oxidative Stress and Antioxidant Markers in Serum and Red Blood Cell of Patients with Ischemic and Hemorrhagic Stroke: A Case-Control Study

Background and Aim: Oxidative stress is a major mechanism involved in stroke pathogenesis. The present study evaluated and compared oxidative stress parameters in patients with ischemic and hemorrhagic stroke (IS and HS) at the time of hospitalization and 1 week after hospitalization. Methods: This was a case-control study with 87 stroke patients (58 IS and 29 HS) as the case and 58 normal individuals as the control group. Sampling was done at the time of hospitalization and after 1 week. The serum total antioxidant capacity (TAC), thiol group, and F2-isoprostan levels were measured using Ferric Reducing Antioxidant Power (FRAP), Elman, and Enzyme Linked Immunosorbent Assay ELISA methods, respectively. Results: At the time of hospitalization, there was no significant difference in TAC and F2-isoprostan levels between the case and control groups (TAC for IS = 852.4 ± 238.9, HS = 1064.1 ± 271.1, and control = 947.6 ± 203.1 µmol/L; P = 0.074), yet, the thiol group levels were significantly lower (P < 0.001) in the case groups (IS and HS) compared to the control group (IS = 360.3 ± 139.8, HS = 357.8 ± 94.4, and control = 568.4 ± 201.4 mmol/L; P < 0.001). At 1 week after the time of hospitalization, the case patients showed a significant increase in thiol levels (IS at p = 0.005; HS at P = 0.02), yet, TAC values decreased (P < 0.015) only in patients with HS compared to levels at the time of hospitalization. There were no significant differences between groups for antioxidant enzymes (SOD, GPx, and CAT) or the National institute of health stroke scale (NIHSS) score of patients at the time of hospitalization and 1 week later, except for superoxide dismutase (SOD), which increased in patients with HS (P = 0.05). Conclusions: The results showed that antioxidant defense status in stroke patients was lower than for the control group. Improving the antioxidant defense system, especially for HS patients by strategies such as natural antioxidant consumption is suggested.

SUN-PP082: A Clinical Audit of the Nutritional Management of Stroke Patients

Rationale: The nutritional status of stroke patients may adversely affect morbidity and mortality. The standard of nutritional care received by UK stroke patients has not been fully evaluated. This clinical audit aimed to evaluate the quality of nutritional care on a UK stroke unit. Methods: A nutritional care pathway was developed and audit criteria defined using local and national guidelines. Case notes for patients admitted to the stroke unit in March 2014 were audited (n = 16; stroke type: 94% ischaemic, 6% haemorrhagic; mean age: 76±9 years; mean length of stay: 40±43 days). Audit themes included: nutrition screening (Malnutrition Universal Screening Tool), nutrition support and secondary prevention. Areas of good practice and those requiring improvement were identified. Results: Most patients (80%) were screened for malnutrition on admission. Malnutrition risk increased from 20% on admission to 46% by discharge. Most patients received nasogastric (NG) tube feeding during admission (81%). The mean time from first NG tube placement to first feed commencement was 11±1 hours (mean delay first NGT placement to first x-ray confirmation; 9±4 hours; mean delay first x-ray confirmation to first feed commencement; 3.7±4.7 hours). Enteral feed prescription varied (Mean kcal/d: 1804±1252). Many patients did not receive their entire energy prescription through NGT feeding [mean volume deficit over admission (prescribed v. received) = 43%]. Dietetic reviews did not routinely monitor percentage of feed delivery. Vitamin D status was not routinely assessed during admission and only 50% received lipid profile testing during admission (dyslipidaemia diagnosed; 25%). Only one patient received dietetic secondary prevention advice. Conclusion: The quality of nutritional care provided to stroke patients could be improved. Amultidisciplinary team approach will ensure the necessary improvements are made, and monitored through quality improvement cycles.