Episode Of Stroke Research Articles

Flow-Mediated Dilatation of the Brachial Artery for Assessing Endothelial Dysfunction in Children with Moyamoya Disease

Background: Moyamoya disease is a progressive, steno-occlusive arteriopathy involving the internal carotid artery and its branches and causing recurrent stroke episodes in children. Patients with moyamoya disease may be more susceptible to influences that cause endothelial dysfunction. We evaluated whether flow-mediated dilatation (FMD) of the brachial artery is useful for assessing endothelial dysfunction in children with moyamoya disease. Methods: This prospective observational study included 30 children with moyamoya disease and 30 controls. After anesthesia induction, a blood pressure cuff was applied to the forearm and inflated to a pressure that was 50 mm Hg above the baseline systolic blood pressure for 5 min. From 30 s before to 2 min after deflation, the brachial artery diameter was recorded on ultrasound. The increase in internal diameter was expressed as the percentage of the baseline diameter. Results: Fifty-nine patients were analyzed. Baseline brachial artery diameters in the moyamoya and control groups were 3.00 and 3.37 mm, respectively (p = 0.004; difference, 0.38; 95% CI 0.12–0.63), while those after deflation were 3.06 and 3.48 mm, respectively (p = 0.003; difference, 0.42; 95% CI 0.15–0.68). The percent change of the baseline diameter value was 4.0% in the disease group and 8.3% in the control group (p = 0.10). There was a group and time interaction for brachial artery diameter (p = 0.01; main effect of group, p = 0.009; main effect of time, p = 0.007). Conclusion: FMD of the brachial artery may not be enough for determining endothelial dysfunction under general anesthesia in children with moyamoya disease.

A Pseudoaneurysm of Middle Cerebral Artery Which Triggered Recurrent Episodes of Acute Ischemic Stroke

A Pseudoaneurysm of Middle Cerebral Artery Which Triggered Recurrent Episodes of Acute Ischemic Stroke

Genetic modifiers of long-term survival in sickle cell anemia.

BackgroundSickle cell anemia (SCA) is a clinically heterogeneous, monogenic disorder. Medical care has less‐than‐optimal impact on clinical outcomes in SCA in Africa due to several factors, including patient accessibility, poor access to resources, and non‐availability of specific effective interventions for SCA.MethodsAgainst this background, we investigated 192 African participants who underwent whole exome sequencing. Participants included 105 SCA patients spanning variable clinical expression: a “long survivor” group (age over 40 years), a “stroke” group (at least one episode of overt stroke), and a “random” group (patients younger than 40 years without overt cerebrovascular disease). Fifty‐eight ethnically matched homozygous hemoglobin A controls were also studied. Findings were validated in an independently recruited sample of 29 SCA patients. Statistical significance of the mutational burden of deleterious and loss‐of‐function variants per gene against a null model was estimated for each group, and gene‐set association tests were conducted to test differences between groups.ResultsIn the “long survivor” group, deleterious/loss‐of‐function variants were enriched in genes including CLCN6 (a voltage‐dependent chloride channel for which rare deleterious variants have been associated with lower blood pressure) and OGHDL (important in arginine metabolism, which is a therapeutic target in SCA). In the “stroke” group, significant genes implicated were associated with increased activity of the blood coagulation cascade and increased complement activation, for example, SERPINC1, which encodes antithrombin. Oxidative stress and glutamate biosynthesis pathways were enriched in “long survivors” group. Published transcriptomic evidence provides functional support for the role of the identified pathways.ConclusionsThis study provides new gene sets that contribute to variability in clinical expression of SCA. Identified genes and pathways suggest new avenues for other interventions.

Prospective observational cohort study of early recurrent TIA: Features, frequency, and outcome.

To evaluate the frequency, clinical and etiologic features, and short- and long-term outcomes of early recurrent TIA. This prospective observational cohort study enrolled all consecutive patients with TIA referred to our emergency department and diagnosed by a vascular neurologist. Expedited assessment and best secondary prevention were performed within 24 hours. Primary endpoints were stroke and a composite outcome including stroke, acute coronary syndrome, and vascular death at 3, 12, and, for a subset of patients, 60 months; secondary outcomes were TIA relapse, cerebral hemorrhage, new-onset atrial fibrillation, and death resulting from other causes. Concordance between index TIA and subsequent stroke etiologies was also evaluated. A total of 1,035 patients (822 with a single TIA, 213 with recurrent TIA = 21%) were enrolled from August 2010 to December 2017. Capsular warning syndrome and large artery atherosclerosis showed the strongest relationship with early recurrent TIA. The risk of stroke was significantly higher in the early recurrent TIA subgroup at each follow-up, and most stroke episodes occurred within 48 hours of index TIA. TIAs with lesion, dysarthria, and leukoaraiosis were the 3- and 12-month independent predictors of stroke incidence after early recurrent TIA subgroup. Index TIA and subsequent stroke etiologies showed substantial concordance. An ABCD3 score >6 predicted a higher risk of stroke recurrence over the entire follow-up. Our study evaluated long-term outcome after early recurrent TIA. Our observations support the importance of promptly detecting and treating patients with early recurrent TIAs to reduce the high early and long-term risk of poor clinical outcomes.

Effect of Lomerizine Hydrochloride on Preventing Strokes in Patients With Cerebral Autosomal Dominant Arteriopathy With Subcortical Infarcts and Leukoencephalopathy.

Cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL) is an orphan disease clinically characterized by migraine, recurrent strokes, and dementia. Currently, there are no disease-modifying therapies, and it is difficult to prevent cerebral ischemic events in CADASIL patients by conventional antithrombotic medication. We hypothesized that an antimigraine agent, lomerizine hydrochloride, may prevent strokes in CADASIL patients, based on its effect on increasing cerebral blood flow. This was an open-labeled clinical trial in which 30 adult CADASIL patients received lomerizine at 10 mg/d. Numbers of symptomatic strokes during the 2 years after the start of lomerizine administration were compared with those in the 2 years before its initiation. The effect of lomerizine on preventing strokes was evaluated based on the incidence rate ratio (IR) calculated with the Mantel-Haenszel method. When including all 30 patients (analysis 1), the IR was less than 1 (0.46; 95% confidence interval [CI], 0.19-1.12) but did not reach significance. To evaluate the effect of lomerizine on secondary prevention, subgroups of 15 patients with stroke episodes occurring any time before lomerizine administration (analysis 2) and 10 patients with stroke episodes during the 2 years before lomerizine administration (analysis 3) were analyzed. The IR values were 0.33 (95% CI, 0.12-0.94) in analysis 2 and 0.17 (95% CI, 0.04-0.67) in analysis 3. Our results suggest the effect of lomerizine on preventing secondary stroke in CADASIL patients.

Comparison of Diaphragmatic Breathing Exercises, Volume, and Flow-Oriented Incentive Spirometry on Respiratory Function in Stroke Subjects: A Non-randomized Study.

Background:Reduced respiratory muscle strength leads to reduced pulmonary function, chest wall movements in the affected side, and increased chest infections, which thereby reduces oxygenation and ventilation. Respiratory muscle training can be used in acute stroke subjects to increase their pulmonary function.Purpose:To compare the short-term effects of diaphragmatic breathing exercise, flow, and volume-oriented incentive spirometry on respiratory function following stroke.Methods:A non-randomized hospital-based study was conducted at Kasturba Medical College Hospitals, Mangalore, India. Forty-two sub-acute subjects of either gender, with the first episode of stroke within six months, were assigned to three groups by the consultant, i.e., diaphragmatic breathing group (DBE), Flow oriented-incentive spirometry group (FIS), and volume oriented-incentive spirometry group (VIS; N = 14) each. All subjects received intervention thrice daily, along with conventional stroke rehabilitation protocols throughout the study period. Pre- and post-intervention values were taken on alternate days until day 5 for all the three groups.Results:The pulmonary function and maximal respiratory pressures were found to be significantly increased by the end of intervention in all three groups, but FIS and DBE groups had better results than VIS (FVC = FIS group, 13.71%; VIS group, 14.89%; DBE group, 21.27%, FEV1 = FIS group, 25.97%; VIS group, 22.52%; DBE group, 19.38%, PEFR = FIS group, 38.76%; VIS group,9.75%; DBE group, 33.16%, MIP = FIS group, 28.23%; VIS group, 19.36%; DBE group, 52.14%, MEP = FIS group, 43.00%; VIS group, 22.80%; DBE group, 28.68%).Conclusion:Even though all interventions had positive outcomes in all variables, flow incentive spirometry had better results across all outcomes (pulmonary function and maximal respiratory pressures) when compared to the other two interventions making it a valuable tool for stroke rehabilitation.

Elastin-Based Materials: Promising Candidates for Cardiac Tissue Regeneration.

Stroke and cardiovascular episodes are still some of the most common diseases worldwide, causing millions of deaths and costing billions of Euros to healthcare systems. The use of new biomaterials with enhanced biological and physical properties has opened the door to new approaches in cardiovascular applications. Elastin-based materials are biomaterials with some of the most promising properties. Indeed, these biomaterials have started to yield good results in cardiovascular and angiogenesis applications. In this review, we explore the latest trends in elastin-derived materials for cardiac regeneration and the different possibilities that are being explored by researchers to regenerate an infarcted muscle and restore its normal function. Elastin-based materials can be processed in different manners to create injectable systems or hydrogel scaffolds that can be applied by simple injection or as patches to cover the damaged area and regenerate it. Such materials have been applied to directly regenerate the damaged cardiac muscle and to create complex structures, such as heart valves or new bio-stents that could help to restore the normal function of the heart or to minimize damage after a stroke. We will discuss the possibilities that elastin-based materials offer in cardiac tissue engineering, either alone or in combination with other biomaterials, in order to illustrate the wide range of options that are being explored. Moreover, although tremendous advances have been achieved with such elastin-based materials, there is still room for new approaches that could trigger advances in cardiac tissue regeneration.

Clinical risk factors associated with recurrence of ischemic stroke within two years: A cohort study.

To identify the clinical risk factors and investigate the efficacy of a classification model based on the identified factors for predicting 2-year recurrence after ischemic stroke.From June 2017 to January 2019, 358 patients with first-ever ischemic stroke were enrolled and followed up in Shenzhen Traditional Chinese Medicine Hospital. Demographic and clinical characteristics were recorded by trained medical staff. The outcome was defined as recurrence within 2 years. A multivariate logistic regression model with risk factors and their interaction effects was established and evaluated.The mean (standard deviation) age of the participants was 61.6 (12.1) years, and 101 (28.2%) of the 358 patients were female. The common comorbidities included hypertension (286 patients, 79.9%), diabetes (148 patients, 41.3%), and hyperlipidemia (149 patients, 41.6%). The 2-year recurrence rate was 30.7%. Of the 23 potential risk factors, 10 were significantly different between recurrent and non-recurrent subjects in the univariate analysis. A multivariate logistic regression model was developed based on 10 risk factors. The significant variables include diabetes mellitus, smoking status, peripheral artery disease, hypercoagulable state, depression, 24 h minimum systolic blood pressure, 24 h maximum diastolic blood pressure, age, family history of stroke, NIHSS score status. The area under the receiver operating characteristic curve (ROC) was 0.78 (95% confidence interval: 0.726–0.829) with a sensitivity of 0.61 and a specificity of 0.81, indicating a potential predictive ability.Ten risk factors were identified, and an effective classification model was built. This may aid clinicians in identifying high-risk patients who would benefit most from intensive follow-up and aggressive risk factor reduction.The clinical trial registration number: ChiCTR1800019647

A Novel Extracorporeal Continuous-Flow Ventricular Assist System for Patients With Advanced Heart Failure - Initial Clinical Experience.

Bridge-to-decision (BTD) devices providing temporary mechanical circulatory support should be introduced to patients with advanced heart failure. This study evaluated the effectiveness and safety of a BTD device comprising an innovative extracorporeal continuous-flow temporary ventricular assist device (VAD) driven by a novel hydrodynamically levitated centrifugal flow blood pump.Methods and Results:Nine patients, comprising 3 with dilated cardiomyopathy, 3 with fulminant myocarditis, and 3 with ischemic heart disease, and 6 males, whose mean age was 47.7±8.1 years, were enrolled into the study. Six patients had Interagency Registry for Mechanically Assisted Circulatory Support profile 1, and 3 were profile 2. The primary endpoint was a composite of survival free from device-related serious adverse events and complications during circulatory support. Eight patients received left ventricular support, of whom 3 received concomitant right ventricular support using extracorporeal membrane oxygenation circuits, as a consequence of severe respiratory failure. One patient with fulminant myocarditis received biventricular support using the novel VAD system. After 19.0±13.5 days, 3 patients were weaned from circulatory support, because their native cardiac function recovered, and 6 patients required conversion to a durable device as a bridge-to-transplantation. One patient had non-disabling ischemic stroke episodes, and no patients died. This novel extracorporeal VAD system with a hydrodynamically levitated centrifugal pump can safely and successfully bridge patients with advanced heart failure to subsequent therapeutic stages.

Factors influencing in-hospital death for pediatric patients with isolated methylmalonic acidemia: a nationwide inpatient database analysis

BackgroundPatients with isolated methylmalonic acidemia (MMA) usually experience recurrent episodes of acute metabolic decompensation or metabolic stroke, require frequent hospitalization, and have a relatively high mortality rate. The aim of our study was to assess factors predicting the in-hospital death of pediatric patients with isolated MMA. We performed a retrospective study using data from the Hospital Quality Monitoring System, a national inpatient database in China collected from 2013 to 2017. All patients under 18 years old with a diagnosis of isolated MMA were included. Demographic, hospital-related, and clinical features were collected. Poisson regression was performed to identify potential influencing variables associated with in-hospital death.ResultsFrom 2013 to 2017, among 2317 admissions for pediatric patients diagnosed with isolated MMA, 1.77% had the outcome of death. In the univariate analysis, patients aged under 1 year had a higher risk of death than did those aged 1 year or older (odds ratio [OR] = 2.63, 95% confidence interval [CI]: 1.36–5.07). There was a higher risk of in-hospital death for patients admitted through emergency departments or via referrals than for those admitted through other routes (OR = 3.76, 95% CI: 1.84–7.67). Deaths were higher in hospitals with volumes of less than 50 patients with isolated MMA during the five study years (OR = 2.92, 95% CI: 1.46–5.83). Moreover, the risk of in-hospital death gradually decreased over time (OR = 0.72, 95% CI: 0.57–0.90). In the multivariate analysis, the abovementioned associations with the risk of in-hospital death remained statistically significant. However, no significant associations were observed between specific clinical signs and in-hospital death in either the univariate or the multivariate analysis.ConclusionsYounger age, admission to hospitals with low patient volumes, and admission through emergency departments or referrals are associated with higher risk of in-hospital death. The co-existence of specific clinical signs appears to have no effect on in-hospital death.

İskemik inmeli çocuklarda trombofilik gen mutasyonu ve hiperhomosisteinemi’nin araştırılması

AbstractIntroduction: Although a variety of potential inherited and acquired aetiologies have been defined as a risk factor for ischemic stroke (IS) in paediatric patients, we aimed to revisit the influence of prothrombin G20210A (PT), methylenetetrahydrofolate reductase C677T (MTHFR-C677T) and hyperhomocysteinemia on the initial stroke episode. Materials and Methods: This retrospective cross-sectional survey was conducted between 2003-2004. Paediatric patients who had been admitted and/or followed up with the diagnosis of IS constituted the patient group (Group I). Nineteen children who were followed up in the healthy children policlinics were elected for control group (Group II). Thrombophilic gene mutation analysis was performed through enzymatic polymerase chain reaction. The homocysteine level was quantified through a chemical immunoassay method.Results: There was no significant difference between the groups in terms of age [10 (1-18), p=0.98], gender (p=1.0), and ethnicity (p=0.27). The family history of IS that suggested hereditary thrombophilia was significantly higher in Group I (p<0.001). Additionally, it showed a 2,38 times greater risk of ischemic stroke. The rate of neither PT (p=1.0) nor MTHFR-C677T (p=0.19) were considerably higher in group I. While homocysteine level was higher in group I (12,6 versus 7.5 µmol/L, p=0.014), the rate of hyperhomocysteinemia was near-significant (p=0.09). In multi-variate analysis, none of the variables revealed a significant impact on the IS. Conclusions: Limited number of patient count was the major limitation of the current study. The co-existence of clinical and genetic factors seems to be more determinant than that of a genetic mutation per se.Keywords: Methylenetetrahydrofolate reductase, Prothrombin G20210A thrombophilia, Hyperhomocysteinemia, Cerebral stroke, Hereditary thrombophilia.

Importancia pronóstica de la enfermedad arterial periférica diagnosticada mediante el índice tobillo-brazo en población general española

ObjectiveThe objectives have been to determine the prognostic value of having a low ankle-brachial index (ABI) for different cardiovascular diseases and whether it improves the predictive capacity of the main cardiovascular risk scores proposed for Spain. DesignPopulation-based cohort study LocationA health area of the province of Badajoz (Spain) Participants2,833 subjects, representative of residents, between 25 and 79 years old, MeasurementsThe ABI was measured at baseline and the first episode of ischemic heart disease or stroke, cardiovascular and total mortality, was recorded during 7 years of follow-up. The hazard ratio (HR) adjusted for cardiovascular risk factors and net reclassification index (NRI) by category, clinical and continuous for the risk functions REGICOR, FRESCO coronary heart disease, FRESCO cardiovascular disease and SCORE, were calculated. Results2,665 subjects were analysed after excluding people with cardiovascular history and loss of follow-up. Low ABI was associated with adjusted HR (95% CI): 6.45 (3.00 - 13.86), 2.60 (1.15 - 5.91), 3.43 (1.39 - 8.44), 2.21 (1.27 - 3.86) for stroke, ischemic heart disease, cardiovascular mortality and total mortality respectively. The ABI improved the NRI (95% CI) in the intermediate risk category according to FRESCO cardiovascular equation by 24.1% (10.1 - 38.2). ConclusionsLow ABI is associated with a significant increase in the risk of stroke, ischemic heart disease, cardiovascular mortality and total mortality in our population. The inclusion of ABI improved the reclassification of people at intermediate risk, according to FRESCO cardiovascular, so its use in that risk category would be justified.

Increased Risk of Recurrent Ischemic Stroke in Anemic Patients

Background: Anaemia is a risk factor for various cardiovascular events including stroke.. There is limited data on the association between anaemia and recurrence of ischemic stroke. This study was intended to explore an association between anaemia and recurrent ischemic stroke. Method: A cross sectional study was conducted over 3 years involving patients of ischemic stroke. Data on ischemic stroke acute or chronic, history of comorbid or confounding factors like of hypertension, diabetes, smoking, alcohol, age, gender and haemogram was collected and analysed. Results: Out of 165 patients having acute ischemic stroke, 65 had first episode of stroke and 100 were found to have recurrence of ischemic stroke. Among the patients with first stroke 23 (35.38%) had anemia and 42 had normal hemoglobin. Among the patients with recurrent ischemic stroke 62 (62%) had anemia (P value <0.001) and 38 had normal hemoglobin. Even after adjusting for confounding factors the odds of anaemia being associated with recurrent ischemic stroke was three times higher (p= 0.001). Conclusion: There is a significant association between anaemia and recurrent ischemic stroke. Longitudinal studies can delineate the temporal association between anaemia and recurrent ischemic stroke.

MON-LB59 Radiofrequency Ablation as a Primary Therapy for Benign Functioning Insulinoma

Background Insulinomas are rare life-threatening pancreatic neuroendocrine tumors. Surgical removal continues to be the treatment of choice for such benign cases with a high cure rate. However, surgery is associated with a considerable risk of morbidity and mortality.Here we describe a case of benign solitary insulinoma successfully treated with RFA in a patient who strongly refused surgery. Case Description A 56-year- old non- diabetic, male is known to have hypertension and lymphoma diagnosed at age of 20 years, in remission. He presented with recurrent episodes of transient ischemic attack and stroke over the last three years. A change in his cognitive function, behavior, and memory was noticed. During his hospital stay for the second episode of stroke, he was found to have hypoglycemia which was asymptomatic. Insulinoma was confirmed based on the followings: low plasma glucose level of 2.04 mmol/l (4.0- 5.6), inappropriately elevated plasma f insulin and C-peptide 68.9 mU/l (3-13) and 4.08 ug/l (1.0-3.1); respectively. Sulfonylurea screening test was negative. MRI of the abdomen showed a 3.2x2.5 cm, well-circumscribed hypervascular lesion at the uncinate process of the pancreas, which is compatible with neuroendocrine tumor. Treatment modalities have been explained to the patient who was fully informed about the risk and benefit of each treatment option. However, he strongly refused surgery. Meanwhile, he was admitted with a third attack of stroke with concurrent hypoglycemia. In view of his refusal of the surgical treatment and due to his recent stroke and high-risk status for surgery, the option of radiofrequency ablation was decided. RFA of the pancreatic tumor using 40.75 GY fractions was carried out with a favorable outcome. The patient achieved biochemical normalization and remains euglycemic during his follow up. Reversal of his cognitive, behavioral, and memory changes was recognized. CT abdomen during a follow-up of 2 months after radiation showed a mild regression of the size of the tumor with no evidence of new lesions or distance metastasis. He remained under close follow up at the neuroendocrine clinic. ConclusionThis case shows a treatment challenge which required the use of an alternative treatment option other than the standard of care in managing a case of benign insulinoma. Successful treatment was achieved in our case with the use of RFA rather than surgery. This report highlights the evolving evidence of nonsurgical RFA being a potential safe, feasible therapeutic modality option or even an alternative to surgery in selected cases of benign insulinoma. Because of the rarity of this tumor and low rate of therapeutic application of RFA in similar cases, the role of RFA had not been extensively studied. Large studies are needed to evaluate the long-term outcomes of RFA in this setting.

Predictors of clinical outcome among Thai patients with atrial fibrillation-associated acute ischemic stroke

ObjectiveTo investigate the predictors of 3-month death among an atrial fibrillation-associated acute ischemic stroke (AF-stroke). MethodsThis retrospective cohort study was conducted at a university hospital in Thailand. Patients with AF-stroke admitted between 2012 and 2017 were enrolled into the study. Baseline characteristics, clinical presentations, complications, and outcomes measured by the modified Rankin scale were collected from electronic medical records. Predictors of death outcomes were analyzed by univariate and multivariate logistic regression analysis. ResultsThe mortality rate among 119 AF-stroke patients was 26.89%. The independent predictors of 3-month death were developing AKI during hospitalization (adjusted odds ratio [aOR] = 6.38, 95% CI = 1.96–20.76, p = 0.001) and age above 75 years old (aOR = 3.08, 95% CI = 1.17–8.13, p = 0.019). In contrast, receiving treatment with an oral anticoagulant prior to the stroke episode was a protective factor (aOR = 0.13, 95% CI = 0.03–0.64, p = 0.002). ConclusionDeveloping AKI and older age were the independent predictor of 3- month death among AF-stroke patients.

CORRELATION OF SERUM CORTISOL LEVEL WITH THE PROGNOSIS OF STROKE: A CROSS SECTIONAL STUDY

Introduction: Cortisol is a hormone of immense importance in the hypothalamo-pituitary-adrenal axis & it has got paramount effects on the metabolism of lipid, glucose & protein. With reference to stroke, a stress response implies rise in the levels of catecholamines & cortisol during the 1st week after the acute episode. Such kind of response is evident in infarction of cerebrum & bleeding in the cerebral cortex. There is ample amount of evidence from past studies that raised levels of serum cortisol levels are associated with volume of ischemic lesion.
 Patients and methods: Subjects included were patients who were admitted in the hospital within six hours after the stroke episode. Every patient was monitored for Scandinavian Stroke Scale (SSS) after the admission. This test was conducted per two hours in first twenty four hours, then per four hours in the next 48 hours & then every day up-to seventh day. Blood samples were extracted for the estimation of serum cortisol. Time duration of 01:00 AM to 07:00 AM was excluded for sample extraction.
 Results: Serum cortisol level was significantly higher in subjects with insular involvement (635 nmol/l) as compared to patients without insular involvement.
 Conclusion: It’s quite clear from our study that raised cortisol levels are highly associated with bad outcome & poor response in patients with stroke.
 Keywords: Serum Cortisol, hypothalamo-pituitary-adrenal axis, Stroke.

Sexual Functioning after Stroke among Rehabilitation Medicine Out-Patients and their Sexual Partners: A Cross-Sectional Study

Background. Sexuality remains to be a sensitive issue in the Philippines, but it encompasses real problems that stroke patients and their partners continue to face. Sexual dysfunction, an under-recognized complication poststroke, is caused by an interplay of physical, emotional, cognitive, and language impairments, in combination with psychosocial factors. Objectives. This study aimed to determine changes in sexual functioning (libido, coital frequency, sexual arousal, and sexual satisfaction) among stroke out-patients at the Philippine General Hospital and their sexual partners.Methods. This cross-sectional study involved patients (≥30 years old with 1 stroke episode), and their partners. Through individual interviews and questionnaires, data were gathered on general attitude toward sex, ability to address sexual issues with partner, fear of recurrence of stroke, unwillingness to participate in coitus, risk of depression, and level of happiness. Results. Twenty-nine patients and 23 partners participated. There was a statistically significant decrease in coital frequency post-stroke among patients (p<0.001) and partners (p<0.05). Majority reported lower level of libido, sexual arousal, and sexual satisfaction post-stroke. Participants unable to discuss sexual issues with partner were more likely to report sexual dissatisfaction (p<0.05). Those with higher scores on Zung’s depression scale were likely to be sexually dissatisfied (p<0.05). Level of happiness was moderately correlated with sexual satisfaction (r=0.51). Conclusion. Sexual life of couples affected by stroke is commonly overlooked. There was a decline in libido, coital frequency, arousal, and sexual satisfaction among stroke patients and partners at the Philippine General Hospital.

Association between hypertensive pregnancy disorders and future risk of stroke in Taiwan: a Nationwide population-based retrospective case-control study

BackgroundThe incidence of female stroke has increased gradually and has begun occurring at a younger age in recent years. Given that women live longer than men, stroke would cause more negative and longer-term impacts on the rest of the lives of women. There are few related studies on Asian women. We aimed to evaluate stroke risk in Asian women following hypertensive pregnancy disorders.MethodsUsing the Taiwan National Health Insurance database, we designed a retrospective study that included pregnant women between 2000 and 2013. We selected an age-matched control group of women without hypertensive pregnancy disorders at a 1:3 ratio. The endpoint was any episode of stroke; otherwise, the patients were tracked until December 31, 2013. After the index date until the end of 2013, Cox proportional hazards analysis was used to compare the risk of incident stroke. The risk factors for stroke were determined using Cox proportional regression to calculate the hazard ratio (HR) compared with the control group.ResultsDuring the follow-up period, the Kaplan-Meier analysis indicated that patients with hypertensive pregnancy disorders had a significantly higher risk of developing stroke than did patients without hypertensive pregnancy disorders (log-rank test P < 0.001). Multivariate Cox regression analysis demonstrated that the case group had a 2.134-fold increased risk of stroke (HR = 2.134; 95% CI = 1.817–2.505; P < 0.001).ConclusionOur study provided evidence of an increased risk of stroke in patients with hypertensive pregnancy disorders. Compared with those without such disorders, the patients who had experienced the disorders had a 2.134-fold (P < 0.001) higher risk of developing stroke in the future.

Long-Term Mortality and Medical Burden of Patients with Chronic Obstructive Pulmonary Disease with and without Subsequent Stroke Episodes.

Background: We used the Taiwan National Health Insurance Research Database (NHIRD) to determine the differences in mortality and medical burden between patients with chronic obstructive pulmonary disease (COPD) with and without stroke. Methods: We enrolled participants aged ≥20 years and defined four subgroups in this study, namely patients with COPD (International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9 CM): 491, 492, 494, and 496), patients with COPD with stroke (ICD-9 CM: 430–438), with COPD without stroke, and comparison subgroups. We calculated the hazard ratios and 95% CIs for all-cause mortality risk, average duration of hospitalization, and frequency of medical visits in these subgroups after adjustments were made for age, sex, and comorbidities. All participants were followed until the date of death, the date they were censored, the date they withdrew from the NHIRD, or 31 December, 2013. Results: In total, 9.70% (men vs. women, 11.19% vs. 8.28%) of patients with COPD developed subsequent stroke during the 14 year follow-up. After a stroke, the risk of mortality exhibited a 2.66- to 5.05-fold increase, especially in the younger ones. COPD with stroke was also a leading factor in the increase in the average number of hospitalization days and frequency of medical visits. Conclusion: The mortality risk of patients with COPD is considerably increased by stroke independent of the other effects of COPD. Moreover, the average number of hospitalization days and frequency of medical visits dramatically increased in patients with COPD after stroke.

SERUM-CORTISOL LEVELS IN SEVERITY OF STROKE

Introduction: Cortisol, an important hormone in the hypothalamic pituitary adrenal axis, has important effects on the metabolism of glucose, protein and lipid[i]. A stress response consists of increased levels of cortisol and catecholamines in the 1st weeks after acute stroke. The cortisol response has been observed in cerebral infarction as well as in intracerebral haemorrhage. Change in serum level of cortisol has been reported in patients with ischemic stroke and studies reported that high levels of this hormone are independently associated with increase in ischemic lesion volume. Also it has been observed that cortisol level in patients with ischemic stroke is associated with significantly increased mortality rate. Increase in the circulating levels of catecholamines was shown in insular damage in experimental stroke suggesting this as a mechanism for the cardiac complications associated with stroke.&#x0D; Patients and Methods: All patients were included in the study who was admitted within 6 hours in the hospital after the episode of stroke. Scandinavian Stroke Scale (SSS)[ii] was monitored in all patients from admission. SSS was performed every 2 hours in the first 24 hours, every 4 hours in the next 48 hours and then daily up to day 7. Blood samples were obtained for routine investigation and estimation of serum cortisol. No patients had blood samples drawn for cortisol determination between 01:00 and 07:00 am.&#x0D; Results: Mean age was observed in the current series was 72.8 ± 12.54 years. There were 34 (53.1%) male and 30(46.9%) female. SSS was observed to be 36 (21-47) on admission. History of hypertension, History of stroke, Diabetes mellitus and Atrial fibrillation was observed in 38(59.4%), 12(18.8%), 24(37.5%) and 11(17.2%) respectively. In univariate logistic regression analysis of the relations to 7 days of mortality, s-cortisol, SSS on admission, and pulse rate reached a significance level. Age, atrial fibrillation, blood glucose, body temperature 12 h after stroke onset, and the presence of early infarctions signs did not reach a significance level of 0.1 in univariate testing. S-cortisol level was higher in patients with insular involvement, 635 nmol/l, in comparison to patients without insular involvement, 589 nmol/l.&#x0D; Conclusion: Adrenal glucocorticoid stress response in acute stroke is harmful. High cortisol levels are associated with the poor outcome and mortality of the patients with stroke.&#x0D; Keywords: Cortisol, HPA, Stroke, SSS