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Hyperglycemia in stroke

Jun Mo, Lei Huang, Jianhua Peng, Umut Ocak, Jianmin Zhang, John H Zhang
Autonomic disturbances often occur in patients with acute cerebrovascular disease due to damage of the central autonomic network. We summarize the structures of the central autonomic network and the clinical tests used to evaluate the functions of the autonomic nervous system. We review the clinical and experimental findings as well as management strategies of post-stroke autonomic disturbances including electrocardiographic changes, cardiac arrhythmias, myocardial damage, thermoregulatory dysfunction, gastrointestinal dysfunction, urinary incontinence, sexual disorders, and hyperglycemia...
October 11, 2018: Neuroscience Bulletin
Ming Li Yee, Rosemary Wong, Mineesh Datta, Timothy Nicholas Fazlo, Mina Mohammad Ebrahim, Elissa Claire Mcnamara, Gerard De Jong, Christopher Gilfillan
Mitochondrial diseases are rare, heterogeneous conditions affecting organs dependent on high aerobic metabolism. Presenting symptoms and signs vary depending on the mutation and mutant protein load. Diabetes mellitus is the most common endocrinopathy, and recognition of these patients is important due to its impact on management and screening of family members. In particular, glycemic management differs in these patients: the use of metformin is avoided because of the risk of lactic acidosis. We describe a patient who presented with gradual weight loss and an acute presentation of hyperglycemia complicated by the superior mesenteric artery syndrome...
September 25, 2018: Endocrinology, Diabetes & Metabolism Case Reports
Cynthia Rajani, Wei Jia
Diabetes is a widespread, rapidly increasing metabolic disease that is driven by hyperglycemia. Early glycemic control is of primary importance to avoid vascular complications including development of retinal disorders leading to blindness, end-stage renal disease, and accelerated atherosclerosis with a higher risk of myocardial infarction, stroke and limb amputations. Even after hyperglycemia has been brought under control, "metabolic memory," a cluster of irreversible metabolic changes that allow diabetes to progress, may persist depending on the duration of hyperglycemia...
October 10, 2018: Frontiers of Medicine
Lin Yang, Tsun Kit Chu, Jinxiao Lian, Cheuk Wai Lo, Pak Ki Lau, Hairong Nan, Jun Liang
In this study we conducted a cross sectional study to comprehensively evaluated the risk factors of chronic kidney disease (CKD) in a large sample of Chinese adults under primary care for type 2 diabetes mellitus (T2DM). We investigated the risk factors associated with the prevalence of CKD in adults with T2DM, who were enrolled in the Risk Factor Assessment and Management Programme for Patients with Diabetes Mellitus (RAMP-DM) of Hong Kong from July 2014 to June 2017. We collected the individual data of 31,574 subjects, with mean age of 63...
October 2, 2018: Scientific Reports
Devin W McBride, Eric C K Gren, Wayne Kelln, William K Hayes, John H Zhang
Hemorrhagic transformation after ischemic stroke is an independent predictor for poor outcome and is characterized by blood vessel rupture leading to brain edema. To date, no therapies for preventing hemorrhagic transformation exist. Disintegrins from the venom of Crotalus atrox have targets within the coagulation cascade, including receptors on platelets. We hypothesized that disintegrins from C. atrox venom can attenuate hemorrhagic transformation by preventing activation of matrix metalloproteinase after middle cerebral artery occlusion (MCAO) in hyperglycemic rats...
September 22, 2018: Journal of Neuroscience Research
L H Lau, J Lew, K Borschmann, V Thijs, E I Ekinci
BACKGROUND: Diabetes Mellitus is an established risk factor for stroke and maybe associated with poorer outcomes following stroke. OBJECTIVE: The aims of this literature review were to determine (i) the prevalence of diabetes in acute stroke patients through a meta-analysis, (ii) the association between diabetes and outcomes after ischemic and hemorrhagic stroke and (iii) to review the value of HbA1c and admission glucose based tests in predicting stroke outcomes...
September 16, 2018: Journal of Diabetes Investigation
Lakshman I Kongwad, Ajay Hegde, Girish Menon, Rajesh Nair
Background and Aims: Hyperglycemia or elevated blood glucose levels have been associated with poor outcomes in patients with ischemic stroke yet control of hyperglycemia has not resulted in good outcomes. High admission blood glucose (ABG) values have been mitigated by other poor prognosticators like large hematoma volume, intraventricular extension (IVE) of hematoma and poor GCS. The aim of this study was to evaluate the effects of blood glucose levels at admission, on mortality and functional outcomes at discharge and 3 months follow up...
2018: Frontiers in Neurology
Jin Hao, Lin Hua, Xinxing Fu, Xuelian Zhang, Qijuan Zou, Yongxin Li
Diabetes-related hearing loss (DRHL) is a complication of diabetes mellitus that is drawing more attention currently. DNA methylation has a critical role in the pathogenesis of type 2 diabetes mellitus (T2DM) and its complications. Therefore, we investigated the genome-wide DNA methylation of peripheral blood of T2DM patients with/without hearing loss in order to explore the susceptibility loci of DRHL. Between DRHL group and control group, 113 gene sites were identified to be differentially methylated regions (DMRs)...
September 12, 2018: Journal of Human Genetics
Malgorzata Pawelczyk, Andrzej Glabiński, Beata Kaczorowska, Zbigniew Baj
BACKGROUND: Activation of platelets and endothelial cells plays an important role in the pathogenesis of atherosclerosis and thrombotic disorders. The aim of our study was to assess the relationship between the metabolic disorders and markers of platelet activity and vascular injury in patient with acute ischemic stroke. MATERIAL AND METHODS: The study group consisted of 84 patients with acute non-lacunar ischemic stroke divided into four subgroups with: (1) normolipidemia and normoglycemia, (2) normolipidemia and hyperglycemia, (3) hyperlipidemia and normoglycemia, (4) hyperlipidemia and hyperglycemia...
September 2018: Neurologia i Neurochirurgia Polska
Alejandro A Rabinstein, Gregory W Albers, Waleed Brinjikji, Sebastian Koch
Endovascular therapy with mechanical thrombectomy is a formidable treatment for severe acute ischemic stroke caused by occlusion of a proximal intracranial artery. Its strong beneficial effect is explained by the high rates of very good and excellent reperfusion achieved with current endovascular techniques. However, there is a sizable proportion of patients who do not experience clinical improvement despite successful recanalization of the occluded artery and reperfusion of the ischemic territory. Factors such as baseline reserve, collateral flow, anesthesia and systemic factors have been identified as potential culprits for lack of improvement in the setting of timely and successful revascularization...
September 6, 2018: International Journal of Stroke: Official Journal of the International Stroke Society
Ga Eun Nam, Seon Mee Kim, Kyungdo Han, Nan Hee Kim, Hye Soo Chung, Jin Wook Kim, Byoungduck Han, Sung Jung Cho, Ji Hee Yu, Yong Gyu Park, Kyung Mook Choi
BACKGROUND: The association of metabolic syndrome (MetS) with the development of Parkinson disease (PD) is currently unclear. We sought to determine whether MetS and its components are associated with the risk of incident PD using large-scale cohort data for the whole South Korean population. METHODS AND FINDINGS: Health checkup data of 17,163,560 individuals aged ≥40 years provided by the National Health Insurance Service (NHIS) of South Korea between January 1, 2009, and December 31, 2012, were included, and participants were followed up until December 31, 2015...
August 2018: PLoS Medicine
Jan Borggrefe, Berit Glück, Volker Maus, Oezgur Onur, Nuran Abdullayev, Utako Barnikol, Christoph Kabbasch, Gereon Rudolf Fink, Anastasios Mpotsaris
BACKGROUND: Among patients with acute ischemic stroke (AIS) treated with mechanical thrombectomy (MT), diabetic patients (DP) show a poorer outcome compared to non-diabetic patients (NDP). This study aims to provide a comprehensive analysis of factors associated with unfavorable outcome in DP receiving MT for stroke of the anterior circulation. METHODS: This study includes 317 out of 498 consecutive patients who received interventional treatment for AIS in the terminal internal carotid artery and/or middle cerebral artery, including 46 DP...
August 16, 2018: World Neurosurgery
Shih-Chieh Chang, Jiun-I Lai, Mei-Chin Lu, Kuan-Hung Lin, Wei-Shu Wang, Su-Shun Lo, Yi-Chun Lai
Hip fracture is an important health care issue in the elderly. Postoperative pulmonary complications occur in 4% of patients after hip fracture surgery. However, previous research is limited regarding pulmonary rehabilitation in this group. In this study, we present clinical evidence regarding the impact of a comprehensive pulmonary rehabilitation program in elderly hip fracture patients after hip surgery.We designed a nonrandomized, Quasi-experimental study, comparing 2 sequential time periods in the same center...
August 2018: Medicine (Baltimore)
Longling Li, Changqing Li
Objective This study was performed to evaluate the potential predictors of poor outcomes associated with diabetes-specific microvascular pathologies and to analyze their influence on clinical outcomes by adjusting for other well-known prognostic factors in patients with acute ischemic stroke. Methods We analyzed 1389 consecutive adult patients with acute ischemic stroke and explored the relationship among clinical characteristics, laboratory measurements, imaging findings, and 6-month functional outcomes. Results The final study population comprised 216 patients with both acute ischemic stroke and diabetes mellitus who were followed up for 6 months...
August 2018: Journal of International Medical Research
Jaya Prasad Tripathy
Background: Diabetes, hyperglycemia, and their complications are a growing problem in India. However, no comprehensive picture of this disease burden has yet been presented to date. Methods: I used aggregate data from the Global Burden of Disease 2016 to describe the burden of diabetes and its risk factors, chronic kidney disease (CKD) due to diabetes, and diseases caused by high fasting plasma glucose from 1990 to 2016 in India. Results: Deaths due to diabetes accounted for 3...
2018: Diabetes, Metabolic Syndrome and Obesity: Targets and Therapy
Zhi-Xin Huang, Qi-Zhang Wang, Ying-Yi Dai, Hai-Ke Lu, Xiao-Yu Liang, Huan Hu, Xin-Tong Liu
BACKGROUND: To investigate whether endovascular therapy (EVT) was one of the factors influencing the incidence of early neurological deterioration (END) in patients with acute ischemic stroke (AIS) as compared with intravenous thrombolysis alone. METHODS: This study was based on our single-center's database that included information on stroke patients hospitalised between January 2012 and September 2015. A total of 220 patients who underwent EVT after IV rt-PA, EVT or IV rt-PA alone...
August 7, 2018: Journal of the Chinese Medical Association: JCMA
Manuel Navarro-Oviedo, Carmen Roncal, Agustina Salicio, Miriam Belzunce, Obdulia Rabal, Estefanía Toledo, Beatriz Zandio, Jose A Rodríguez, Jose A Páramo, Roberto Muñoz, Josune Orbe
Diabetes is an important risk factor for ischemic stroke (IS). Tissue-type plasminogen activator (tPA) has been associated with less successful revascularization and poor functional outcome in diabetes. We assessed whether a new thrombolytic strategy based on MMP10 was more effective than tPA in a murine IS model of streptozotocin (STZ)-induced diabetes. Wild-type mice were administered a single dose of streptozotocin (STZ) (180 mg/kg) to develop STZ-induced diabetes mellitus. Two weeks later, IS was induced by thrombin injection into the middle cerebral artery and the effect of recombinant MMP10 (6...
July 27, 2018: Translational Stroke Research
S Lattanzi, M Silvestrini
No abstract text is available yet for this article.
July 20, 2018: European Journal of Neurology: the Official Journal of the European Federation of Neurological Societies
Mayada Issa, Fahad Alqahtani, Chalak Berzingi, Mohammad Al-Hajji, Tatiana Busu, Mohamad Alkhouli
Background: Acute hyperglycemia is associated with worse outcomes in diabetic patients admitted with ST-elevation myocardial infarction (STEMI). However, the impact of full-scale decompensated diabetes on STEMI outcomes has not been investigated. Methods: We utilized the national inpatient sample (2003-2014) to identify adult diabetic patients admitted with STEMI. We defined decompensated diabetes as the presence of diabetic ketoacidosis (DKA) or hyperglycemic hyperosmolar state (HHS)...
2018: Diabetology & Metabolic Syndrome
Claire Muller, N Wah Cheung, Helen Dewey, Leonid Churilov, Sandy Middleton, Vincent Thijs, Elif I Ekinci, Chris Levi, Richard Lindley, Geoffrey Donnan, Mark Parsons, Christopher Bladin
Rationale Post-stroke hyperglycemia occurs in up to 50% of patients presenting with acute ischemic stroke. It reduces the efficacy of thrombolysis, increases infarct size, and worsens clinical outcomes. Insulin-based therapies have generally not been beneficial in treating post-stroke hyperglycemia as they are difficult to implement, may cause hypoglycaemia, possibly increase mortality and worsen clinical outcomes. Exenatide may be a safer, simpler, and more effective alternative to insulin in acute ischemic stroke...
January 1, 2018: International Journal of Stroke: Official Journal of the International Stroke Society
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