Association of glutathione S-transferase T1 and M1 gene polymorphisms with ischemic stroke risk in the Chinese Han population

Atherosclerosis plays an important role in ischemic stroke, and oxidative stress participates in the entire process of atherosclerosis. Glutathione S-transferase （GST） acting with other antioxidant enzymes can eliminate reactive oxygen species and protect cells against oxidative damage. To assess the association of glutathione S-transferase （GSTT1 and GSTM1） gene polymorphisms with ischemic stroke in the Chinese Han population, the present study selected 315 patients with ischemic stroke and 210 healthy controls for comparison. GSTT1 and GSTM1 genotypes were determined using polymerase chain reactions, electrophoresis and imaging analysis. No obvious evidence of GSTTI-nulI, GSTMI-null and GSTTI/GSTMI-double null genotype distribution differences was found between case and control groups or between genders. Subgroup analysis showed that the risk of stroke was increased when hypertension was accompanied by GSTTl-null （odds ratio （OR） = 2.996, P 〈 0.001） and GSTMl-null （OR = 3.680, P 〈 0.001 ） genotypes; diabetes mellitus was accompanied by GSTTI-null （OR = 1.860, P = 0.031） and GSTMI-null （OR = 2.444, P = 0.002） genotypes, and smokers showed a GSTTl-null genotype （OR = 2.276, P = 0.003）. GSTT1- and GSTMl-null genotypes may interact synergistically with hypertension, diabetes mellitus and smoking to increase the incidence risk of ischemic stroke.

Association ofALOX5,LTA4H and LTC4S gene polymorphisms with ischemic stroke risk in a cohort of Chinese in east China

BACKGROUND:Genetic variations of the 5-lipoxygenase activating protein and leukotriene A4 hydrolase genes that confer an increased risk of ischemic stroke have implicated the family of leukotrienes as potential mediators of ischemic stroke.This study aimed to explore the association of ALOX5,LTA4 H and LTC4 S gene polymorphisms with ischemic stroke risk in a cohort of Chinese in east China.METHODS:This case-control study consisted of 690 patients with ischemic stroke and 690 controls.Polymorphisms of ALOX5 rs2029253 A/G,LTA4 H rs6538697 T/C,and LTC4 S rs730012 A/C were genotyped by the polymerase chain reaction and restriction fragment length polymorphism(PCR-RFLP) analysis.The multivariate logistic regression model was used to exclude the effects of conventional risk factors on ischemic stroke.RESULTS:Carriers of C allele in rs730012 were more susceptible to ischemic stroke(OR:1.37;95%CI:1.08-1.73;P=0.009).The rs2029253 GG genotype showed a risk-reducing effect on ischemic stroke(OR:0.72;95%CI:0.55-0.93;P=0.013) while the rs6538697 CC genotype had an increased risk of ischemic stroke(OR:1.77;95%CI:1.09-2.89;P=0.022).The rs730012 variant was not associated with ischemic stroke risk after adjusting confounding factors(P>0.05).CONCLUSION:The present study suggested that gene polymorphisms in the leukotrienes pathway may exert influences,with independent genetic effects,on ischemic stroke susceptibility in a cohort of Chinese in east China.

Trend analysis of stroke risk research based on three-dimensional metrics

This study comprehensively analyzes the status,characteristics,focal points,and evolving trends of global research on“stroke risk analysis”over the past four years(2020–2023),aiming to provide insights for directing future research endeavors.By utilizing the Newcastle-Ottawa Scale,63 high-quality research papers were selected and subjected to a systematic literature review.In terms of research methods,stroke risk analysis research has evolved from clinical trials(e.g.,establishing control groups,using authoritative scales)towards statistical and data analysis methods(e.g.,decision tree analysis).Regarding research factors,early studies primarily focused on pathological factors associated with hemorrhagic and ischemic stroke,such as hypertension,hyperlipidemia,and diabetes.Recent research from the past two years indicates a shift towards emerging factors,including temperature conditions,air quality,and Corona Virus Disease 2019(COVID-19).In terms of application domains,stroke research covers a broad range of fields but mainly focuses on exploring risk factors,interventions during diagnosis and treatment stages,and rehabilitation,with clinical diagnosis,treatment,and drug intervention studies being predominant.While the research landscape is becoming increasingly diversified and comprehensive,there remains a need for more comprehensive and in-depth studies on novel topics,as well as integrated applications of research methods,presenting ample opportunities for exploring dependent variables in future stroke.

Description of Post-Stroke Cognitive Disorders at Abidjan University Hospitals, Côte d’Ivoire

Stroke patients often experience motor deficits and cognitive problems after a stroke. Objective: To improve our understanding of the cognitive consequences of stroke. Method: a descriptive and analytical cross-sectional study was conducted over 12-month period in the neurology departments of the Cocody and Treichville Hospitals in Côte d’Ivoire. Results: Out of 724 patients admitted to the neurology department, 415 (57.32%) were stroke patients, of which 145 (34.94%) were screened. The frequency of global cognitive functioning impairment was 86.21%, significantly higher than the frequency of patients without impairment, which was 13.79%. The study focused on detailing the cognitive status of stroke patients in neurology departments, assessing several cognitive functions during the subacute phase of stroke. These functions included global cognitive functioning, executive functions, language and memory. The frequency of post-stroke cognitive impairment is high among stroke patients in Abidjan. This frequency is comparable to figures found in Subsaharian stroke populations. Demographic and clinical characteristics studied included age, gender, education level, employment status, vascular diseases and cerebral affected area. Among these characteristics, only the education level and the cerebral affected area have been found significant. Conclusion: The incidence of cognitive impairment after a stroke is significantly high among stroke patients in Abidjan.

Sleep Habits Linked to Stroke Risk

国人云,吃得下,睡得着,就没病。这个观点看来有些愚昧。睡觉时打鼾,给人的印象是:睡得真香。看来,也不对。最近的报刊上有大幅广告,称“打鼾是病”,笔者本以为这是商人做生意的把戏。现在看来,也不无道理。

Paper Analysis of the WATCHMAN on the Reduction of Stroke Compared to Anticoagulants: A Systematic Review of the Literature

Objective: Anticoagulants have been approved and used for decades as highly effective blood thinners. The objective of this study is to analyze the clinical trials in order to determine if the Watchman reduces the risk of stroke in patients with atrial fibrillation compared to those prescribed the traditional anticoagulants. This will contribute to the current body of knowledge and possibly provide beneficial clinical guidance with respect to providing an alternative option for those suffering from non-valvular Atrial fibrillation. Methods: A systematic literature search through the Saint James School of Medicine library resources as well as PubMed, Medscape, Google Scholar was conducted. Studies were included if the literature examined the comparison between the Watchman device and four specific anticoagulants (Xarelto, Eliquis, Pradaxa, and Warfarin) in association with reduction of risks of strokes in an atrial fibrillation population. The study includes a qualitative sub-analysis to explore additional clinical aspects that may affect risk of stroke and response of treatment. Results: Outcomes were significant for similar stroke occurrence, when compared to published clinical trials. Alternatively, there was a significant reduction in risk of bleeding and all-cause mortality in the Watchman™ device compared to traditional NOACs and warfarin. While examining the studies and trials, overall, the Watchman™ device offers a better long-term outcome therapy for non-valvular atrial fibrillation populations who are not possibilities for extended anticoagulation. The studies used for analysis examining the dosage found higher fatality with increased use of NOACs and more hospitalizations with decreased use. Conclusion: From the presented data, it is safe to say that the Watchman™ device is a viable and effective alternative for stroke prophylaxis in certain patient populations. Compared to traditional anticoagulant therapies for non-valvular atrial fibrillation, these studies suggest that the Watchman™ device can reduce bleeding time and, in most cases, the risk of stroke is less than or equal to traditional anti-coagulants.

An Interpretable Prediction Model for Stroke Based on XGBoost and SHAP

Objective:To establish a stroke prediction and feature analysis model integrating XGBoost and SHAP to aid the clinical diagnosis and prevention of stroke.Methods:Based on the open data set on Kaggle,with the help of data preprocessing and grid parameter optimization,an interpretable stroke risk prediction model was established by integrating XGBoost and SHAP and an explanatory analysis of risk factors was performed.Results:The XGBoost model’s accuracy,sensitivity,specificity,and area under the receiver operating characteristic(ROC)curve(AUC)were 96.71%,93.83%,99.59%,and 99.19%,respectively.Our explanatory analysis showed that age,type of residence,and history of hypertension were key factors affecting the incidence of stroke.Conclusion:Based on the data set,our analysis showed that the established model can be used to identify stroke,and our explanatory analysis based on SHAP increases the transparency of the model and facilitates medical practitioners to analyze the reliability of the model.

Risk Factors, Clinical Features and Prognosis for Subtypes of Ischemic Stroke in a Chinese Population

It is unanimously accepted that stroke is a highly heterogeneous disorder. Different subtypes of ischemic stroke may have different risk factors, clinical features, and prognoses. The aim of this study was to evaluate the risk factors, clinical characteristics, and prognoses of different subtypes of ischemic stroke defined by the Trial of ORG10172 in Acute Stroke Treatment （TOAST） criteria. We prospectively analyzed the data from 530 consecutive patients who were admitted to our hospital with acute ischemic stroke within 7 days of stroke onset during the study period. Standardized data assessment was used and the cause of ischemic stroke was classified according to the TOAST criteria. Patients were followed up till 30 and 90 days after stroke onset. It was found that large-artery atherosclerosis was the most frequent etiology of stroke （37.4%）, and showed the highest male preponderance, the highest prevalence of previous transient ischemic attack, and the longest hospital stay among all subtypes. Small artery disease （36.4%） was associated with higher body mass index, higher plasma triglycerides, and lower plasma high-density lipoprotein cholesterol than cardioembolism. Cardioembolism （7.7%）, which was particularly common in the elderly （i.e., individuals aged 65 years and older）, showed the highest female preponderance, the highest prevalence of atrial fibrillation, the earliest presentation to hospital after stroke onset, the most severe symptoms on admission, the maximum complications associated with an adverse outcome, and the highest rate of stroke recurrence and mortality. Our results suggest that ischemic stroke should be regarded as a highly heterogeneous disorder. Studies involving risk factors, clinical features, and prognoses of ischemic stroke should differentiate between etiologic stroke subtypes.

Risk factors for progressive ischemic stroke: A retrospective analysis

BACKGROUND： Progressive ischemic stroke has higher fatality rate and disability rate than common cerebral infarction, thus it is very significant to investigate the early predicting factors related to the occurrence of progressive ischemic stroke, the potential pathological mechanism and the risk factors of early intervention for preventing the occurrence of progressive ischemic stroke and ameliorating its outcome. OBJECTIVE： To analyze the possible related risk factors in patients with progressive ishcemic stroke, so as to provide reference for the prevention and treatment of progressive ishcemic stroke. DESIGN： A retrospective analysis. SETTING： Department of Neurology, General Hospital of Beijing Coal Mining Group. PARTICIPANTS： Totally 280 patients with progressive ischemic stroke were selected from the Department of Neurology, General Hospital of Beijing Coal Mining Group from March 2002 to June 2006, including 192 males and 88 females, with a mean age of （62±7） years old. They were all accorded with the diagnostic standards for cerebral infarction set by the Fourth National Academic Meeting for Cerebrovascular Disease in 1995, and confired by CT or MRI, admitted within 24 hours after attack, and the neurological defect progressed gradually or aggravated in gradients within 72 hours after attack, and the aggravation of neurological defect was defined as the neurological deficit score decreased by more than 2 points. Meanwhile, 200 inpatients with non-progressive ischemic stroke （135 males and 65 females） were selected as the control group. METHODS： After admission, a univariate analysis of variance was conducted using the factors of blood pressure, history of diabetes mellitus, fever, leukocytosis, levels of blood lipids, fibrinogen, blood glucose and plasma homocysteine, cerebral arterial stenosis, and CT symptoms of early infarction, and the significant factors were involved in the multivariate non-conditional Logistic regression analysis. MAIN OUTCOME MEASURES： Results of the univariate analysis of variance of the factors related to progressive ischemic stroke; Results of the multivariate regression analysis. RESULTS： All the 480 patients were involved in the analysis of results. ① Results of the univariate analysis variance： There were significantly more patients with fever, leukocytosis, history of diabetes mellitus, cerebral arterial stenosis and CT symptoms of early infarction in the progressive ischemic stroke group than in the control group （P 〈 0.01）; The levels of blood glucose and fibrinogen in the progressive ischemic stroke group were significantly higher than those in the control group, while the level of blood pressure was significantly lower than that in the control group （P 〈 0.05 - 0.01）. ② Results of the multivariate Logistic regression analysis： The independent predicting factors for progressive ischemic stroke were history of diabetes mellitus, fever, leukocytosis, cerebral arterial stenosis, CT symptoms of early infarction, blood glucose and blood pressure （OR =2.61,2.96, 3.79, 1.03, 3.57, 2.68, 95% CI 0.92 - 3.59, P 〈 0.05 - 0.01）. CONCLUSION： History of diabetes mellitus, fever, leukocytosis, levels of blood pressure, blood glucose, cerebral arterial stenosis and CT symptoms of early infarction are the risk factors for progress ischemic stroke

Systematic review of risk factors for progressive ischemic stroke

OBJECTIVE： To determine the risk factors for progressive ischemic stroke, and to prevent onset and make a prognosis of disease, the present study systemically evaluated 19 cohort studies and 10 case-controlled studies of progressive ischemic stroke. SEARCH STRATEGY： A computer-based, online, literature search of PubMed （1966/2007）, China Biological Medicine Database （CBM-disc, 1979/2007） and CNKI （www.cnki.net, 1979/2007） was performed to screen for related studies. DATA SELECTION： Cohort or case-controlled studies that focused on risk factors of progressive ischemic stroke were selected for review. Two reviewers independently extracted data and assessed study quality according to Cochrane Collaboration guidelines. Statistical analysis was performed using RevMan software. MAIN OUTCOME MEASUREMENT： Risk factors for progressive ischemic stroke. RESULTS： Using the inclusion criteria, 29/781 studies published in English and Chinese were initially reviewed, including 19 cohort studies and 10 case-control studies. Despite variations in determination of progressive ischemic stroke and the intervals between 2 evaluations, all studies described the diagnostic criteria for progressive ischemic stroke. Logistic analysis was employed in 20 of the studies. Meta-analysis of primary data in the related studies determined that the following factors that significantly correlated with progressive ischemic stroke： fever [risk ratio （RR） = 2.26, 95% confidence interval （CO： 1.20-4.26, P = 0.01; odds ratio （OR） = 2.85, 95% CI： 1.64-4.98, P 〈 0.01 ）]; diabetes （RR = 1.38, 95% CI： 1.18-1.61, P 〈 0.01 ; OR = 2.48, 95% Ch 1.93-3.19, P 〈 0.01 ）; coronary heart disease （RR = 1.22, 95% CI： 1.08-1.38, P 〈 0.01）; neuroimaging transformation （RR= 1.55, 95%CI： 1.34-1.80, P〈 0.01; OR= 2.29, 95% CI： 1.47-3.58, P〈 0.01）; and hyperglycemia （RR = 2.62, 95% CI： 1.86-3.68, P 〈 0.01 ; OR = 3.49, 95% CI： 1.92-6.35, P 〈 0.01）. CONCLUSION： Fever, diabetes, coronary heart disease, neuroimaging transformation, and hyperglycemia are important risk factors for progressive ischemic stroke. Interventions for these risk factors could effectively prevent occurrence of progressive ischemic stroke.

Apolipoprotein E polymorphisms increase the risk of post-stroke depression

Recent reports have shown that apolipoprotein E （APOE） polymorphisms are involved in neurodegenerative disease. However, it is unclear whether APOE affects post-stroke depression. Accordingly, we hypothesized that APOE polymorphisms modify the risk of post-stroke depression. Here, we performed a hospital-based case-control study （including 76 cerebral infarction cases with post-stroke depression, 88 cerebral infarction cases without post-stroke depression, and 109 controls without any evidence of post-stroke depression or cerebral infarction） to determine possible association between APOE rs429358 and rs7412 polymorphisms and risk of post-stroke depression. Our findings show no difference among the groups with regards genotype distribution of the rs7412 polymorphism. In contrast, APOE genotypes with rs429358-C alleles increased the risk of post-stroke depression. Further, the rs429358 polymorphism was associated with significantly decreased regional cerebral blood flow values in the left temporal lobe of post-stroke depression cases. Additionally, the rs429358 polymorphism was not only associated with depression severity, but with increasing serum levels of total cholesterol. These resuits suggest that the APOE rs429358 polymorphism is associated with increased risk of developing post-stroke depression, and that APOE rs429358-C allele genotypes may be detrimental to recovery of nerve function after stoke. Indeed, these findings provide clinical data for future post-stroke depression gene interventions.

Prognostic risk factors for stroke-associated pneumonia

Stroke impacts patient＇s quality of life,but most stroke patients die of complications,such as pulmonary infections,rather than the original stroke.Stroke-associated pneumonia（SAP）is a common complication of acute stroke,but the risk factors are poorly understood.SAP can significantly affect neurological recovery after stroke and markedly prolong the hospital stay.The present study analyzed the risk factors for SAP to improve prevention and treatment outcomes.Age,diabetes mellitus,states of consciousness,nasal feeding,gastric mucosa protective drugs,and prophylactic use of antibiotics are risk factors for SAP.In addition,smoking,cardiovascular disease,stroke location and properties,and dehydrating agents are associated with SAP,but are not risk factors.

Variants of the arachidonate 5-lipoxygenase-activating protein (ALOX5AP) gene and risk of ischemic stroke in Han Chinese of eastern China

Variants of the arachidonate 5-1ipoxygenase-activating protein （ALOX5AP） gene have been suggested to play an important role in the pathogenesis of atherosclerosis and ischemic stroke. This study was aimed to explore the association of ALOX5AP variants with ischemic stroke risk in Han Chinese of eastern China. A total of 690 ischemic stroke cases and 767 controls were recruited. The subjects were further subtyped according to the Trial of Org 10172 in Acute Stroke Treatment （TOAST） criteria. On the basis of that, two polymorphisms of the ALOX5AP gene （rs10507391 and rs12429692） were determined by TaqMan genotyping assay. In addition, plasma leukotriene B4 （LTB4） levels were analyzed in these subjects. There was no evidence of association between the two variants of ALOX5AP and the risk of ischemic stroke or its TOAST-subtypes. Haplotype analysis and stratification analysis according to sex, age, body mass index, hypertension, and diabetes also showed negative association. Analysis of LTB4 levels in a subset of cases and controls revealed that LTB4 levels were significantly higher in ischemic stroke cases than in the controls （70.06± 14.75 ng/L vs 57.34±10.93 ng/L; P = 0.000） and carriers of the T allele of the rs10507391 variant were associated with higher plasma LTB4 levels （P = 0.000）. The present study suggests there is no association of the two polymorphisms in the ALOX5AP gene with ischemic stroke risk in Han Chinese of eastern China.

ANALYSIS OF RISK FACTORS IN 3901 PATIENTS WITH STROKE

Objective To estimate the frequency of various risk factors for overall stroke and to identify risk factors for cerebral infarction (CI) versus intracerebral hemorrhage (ICH) in a large hospital-based stroke registry. Methods Data from a total of 3901 patients, consisting of 3525 patients with CI and 376 patients with ICH were pros-pectively coded and entered into a computerized data bank. Results Hypertension and smoking were the most prominent factors affecting overall stroke followed by mild internal carotid artery stenosis (< 50%), hypercholesterolemia, transient ischemic attacks (TIAs), diabetes mellitus, and cardiac ischemia. Univariate analysis showed that factors in male significantly associated with CI versus ICH were old age, a family history of stroke, and intermittent claudication; whereas in female the factors were oral contraception and migraine. By multivariate analysis, in all patients, the factors significantly associated with CI as opposed to ICH were smoking, hyperch-olesterolemia, migraine, TIAs, atrial fibrillation, structural heart disease, and arterial disease. Hypertension was the only significant factor related with ICH versus CI.Conclusions The factors for ischemic and hemorrhagic stroke are not exactly the same. Cardiac and arterial disease are the most powerful factors associated with CI rather than ICH.

Use of the Tinetti Index to Assess Fall Risk in Patients with Sequelae of Stroke

Background and Objective: The knowledge about risk of falls in patients with sequelae of stroke by applying a scale constitutes an important factor fort nurses since it allows planning for quality care and consequently improves the quality of life of such patients. The present study aimed to assess the risk of falls of patients with sequelae of stroke using Tinetti Index. Methods: Transversal descriptive study with 61 hospitalized patients. The data were collected through the application of Tinetti Index, the total score of which is 28 points. Results: The index evaluation shows que 47.9% had 19 points under the ideal score, indicating a high risk of falls, 41.7% from 24 to 28, indicating moderate risk and 10.4% from 19 to 23 points, indicating low risk of falls. The final average was (15.23), the median (16.50) and standard deviation (±11.034). Conclusions: There is a high risk of falls in this population, a quantification of impaired balance and gait anticipate the future risk of falls. The use of assessment instruments has important implications for improving the quality of life in patients with symptomatic stroke.

Risk Factors and Prediction of Stroke in a Population with High Prevalence of Diabetes: The Strong Heart Study

Background and Objective: American Indians have a high prevalence of diabetes and higher incidence of stroke than that of whites and blacks in the U.S. Stroke risk prediction models based on data from American Indians would be of clinical and public health value. Methods and Results: A total of 3483 (2043 women) Strong Heart Study participants free of stroke at baseline were followed from 1989 to 2010 for incident stroke. Overall, 297 stroke cases (179 women) were identified. Cox models with stroke-free time and risk factors recorded at baseline were used to develop stroke risk prediction models. Assessment of the developed stroke risk prediction models regarding discrimination and calibration was performed by an analogous C-statistic (C) and a version of the Hosmer-Lemeshow statistic (HL), respectively, and validated internally through use of Bootstrapping methods. Results: Age, smoking status, alcohol consumption, waist circumference, hypertension status, antihypertensive therapy, fasting plasma glucose, diabetes medications, high/low density lipoproteins, urinary albumin/creatinine ratio, history of coronary heart disease/heart failure, atrial fibrillation, or Left ventricular hypertrophy, and parental history of stroke were identified as the significant optimal risk factors for incident stroke. Discussion: The models produced a C = 0.761 and HL = 4.668 (p = 0.792) for women, and a C = 0.765 and HL = 9.171 (p = 0.328) for men, showing good discrimination and calibration. Conclusions: Our stroke risk prediction models provide a mechanism for stroke risk assessment designed for American Indians. The models may be also useful to other populations with high prevalence of obesity and/or diabetes for screening individuals for risk of incident stroke and designing prevention programs.

<i>NOS</i>3 894G >T Gene Polymorphism: A Potential Risk Factor of Stroke in Bahraini Patients

The endothelial nitric oxide synthase (eNOS) encoded by the NOS3 gene is responsible for the synthesis of a vasoactive endothelium-derived nitric oxide (NO). The genetic polymorphism of this gene explains, in part, why some people are prone to develop stroke than others. In this study we conducted a case control study in Bahrainis to investigate “for the first time” the relationship between NOS3 894G > T (rs1799983) and 786T > C (rs2070744) polymorphisms with the stroke predisposition in Bahraini population. Detection of NOS3 polymorphism was performed by PCR RFLP genotyping method. The level of NO among cases and controls was measured using ELISA. A total of 93 unrelated stroke patients and 86 controls were included in the study. The three types of stroke;Ischemic, hemorrhagic and transient ischemic attack were reported (91.4%, 7.5% and 1.1% respectively). No significant gender difference was observed (P = 0.74). Having previous stroke was a highly significant risk factor of the disease (P = 0.001, OR = 1.4), where as a family history of stroke was not (OR = 0.11). The analysis provides evidence that the mutant 894GT + TT genotypes of NOS3 894G > T polymorphism were positively associated with stroke predisposition and it increased the risk of stroke nearly two folds (P = 0.037, OR = 1.936). Although we found an association between the mutant genotype786 TC + CC of the NOS3 786T > C polymorphism with the susceptibility to stroke (P = 0.023) suggesting that the mutant C allele might have a protective effect against stroke in this population, the strength of this association was rather low (OR = 0.484). The level of NO in stroke patients was significantly low compared to healthy controls (P 0.005). Diabetes, hypertension, heart diseases were reported in stroke patients (67%, 71.4% and 52.1% respectively). More over 50% of the cases with previous stroke are both diabetic and hypertensive. This indicates that these diseases could be considered as a significant factor in the development of stroke in this population. We concluded that the NOS3-894 G > T polymorphism is a potential risk factor of stroke in Bahraini population, whereas as the NOS3 786T > C polymorphism might have a possible protective role against the disease in this population.

Risk assessment of ischemic stroke associated pneumonia

BACKGROUND:Cerebral stroke is a disease with a high disability rate and a high fatality rate.This study was undertaken to assess the risk of stroke associated pneumonia(SAP) in patients with ischemic stroke using A2DS2 score.METHODS:Altogether 1 279 patients with ischemic stroke who were treated in our department from 2009 to 2011 were retrospectively analyzed with A2DS2 score. A2DS2 score was calculated as follows:age ≥75 years=1,atrial fi brillation=1,dysphagia=2,male sex=1; stroke severity:NIHSS score 0–4=0,5–15=3,≥16=5. The patients were divided into three groups according to A2DS2 score:620 in score 0 group,383 in score 1–9 group,and 276 in score ≥10 group. The three groups were comparatively analyzed. The diagnostic criteria for SAP were as follows:newly emerging lesions or progressively infiltrating lesions on post-stroke chest images combined with more than two of the following clinical symptoms of infection:(1) fever ≥38 °C;(2) newly occurred cough,productive cough or exacerbation of preexisting respiratory tract symptoms with or without chest pain;(3) signs of pulmonary consolidation and/or wet rales;(4) peripheral white blood cell count ≥10×109/L or ≤4×109/L with or without nuclear shift to left,while excluding some diseases with clinical manifestations similar to pneumonia,such as tuberculosis,pulmonary tumors,non-infectious interstitial lung disease,pulmonary edema,pulmonary embolism and atelectasis. The incidence and mortality of SAP as well as the correlation with ischemic stroke site were analyzed in the three groups respectively. Mean± standard deviation was used to represent measurement data with normal distribution and Student's t test was used. The chi-square test was used to calculate the percentage for enumeration data.RESULTS:The incidence of SAP was significantly higher in the A2DS2 score≥10 group than that in the score 1–9 and score 0 groups(71.7% vs. 22.7%,71.7% vs. 3.7%,respectively),whereas the mortality in the score≥10 group was significantly higher than that in the score 1–9 and score 0 groups(16.7% vs. 4.96%,16.7% vs. 0.3%,respectively). The incidences of cerebral infarction in posterior circulation and cross-MCA,ACA distribution areas were signif icantly higher than those in the SAP group and in the non-SAP group(35.1% vs.10.1%,11.4% vs. 7.5%,respectively). The incidence of non-fermentative bacteria infection was signifi cantly increased in the score≥10 group.CONCLUSIONS:A2DS2 score provides a basis for risk stratifi cation of SAP. The prevention of SAP needs to be strengthened in acute ischemic stroke patients with a A2DS2 score≥10.

Profile of Cardiovascular Risk Factors in Nigerians with Stroke

Background: There is paucity of data on cardiovascular disease (CVD) risk factors among stroke patients in our population. This study aimed at assessing CVD risk factors amongst stroke patients compared with apparently healthy controls. Methods: This was a case-control study conducted at Aminu Kano Teaching Hospital Kano. One hundred stroke subjects were consecutively recruited and compared with 100 age and sex matched controls. The CVD risk factors assessed were hypertension, diabetes mellitus, dyslipidemia, obesity, cigarette smoking, alcohol consumption, socioeconomic status (SES), increased age, male gender and Human Immunodeficiency Virus (HIV) status. Results: Mean age was 56.4 ± 15.8 years for cases and 54.5 ± 15.4 years for controls (p = 0.39), and 53% of the former and 52% of the latter were males (p = 0.887). The most prevalent CVD risk factor was hypertension, found in 71% of cases and 42% of the controls, (p = 0.01). All heart diseases were found in 70% of cases and 21% of controls (p < 0.001), and hypertensive heart disease (HHD) was the commonest, found in 55% of cases and 18% of controls (p < 0.001). Dyslipidemia was found in 53% of cases and 37% of the controls (p = 0.023), diabetes mellitus/hyperglycemia in 23% of the cases and 6% of the controls (p = 0.01), history of transient ischemic attack (TIA) in 19% of cases and 1% of the controls (p = 0.01), while atrial fibrillation was found in 9% of cases only. Other risk factors were uncommon. Conclusion: The most frequent CVD risk factors among Nigerians with stroke were systemic hypertension, heart diseases, male sex and dyslipidemia, while HIV and other risk factors were uncommon. Thus medical attention and public enlightenment should focus on the common ones as detected in this study.

Ischemic Stroke:Therapy of Risk and Benefit

Therapeutic thrombolysis is an immense opportunity in acute stroke care. For the first time, there is a treatment that has a high probability of being effective if given early enough to patients with acute ischemic stroke. However, the risks of intracranial hemorrhage are substantial and as yet the exact indications and contraindications have not been worked out. And indeed how to deliver this treatment in routine clinical practice.