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https://www.readbyqxmd.com/read/28106485/management-strategies-for-atrial-fibrillation
#1
Peysh A Patel, Noman Ali, Andrew Hogarth, Muzahir H Tayebjee
Atrial fibrillation is the most prevalent cardiac arrhythmia, affecting 10% of those aged over 80 years. Despite multiple treatment options, it remains an independent prognostic marker of mortality due to its association with clinical sequelae, particularly cerebrovascular events. Management can be broadly divided into treatment of the arrhythmia, via rhythm or rate control, and stroke thromboprophylaxis via anticoagulation. Traditional options for pharmacotherapy include negatively chronotropic drugs such as β-blockers, and/or arrhythmia-modifying drugs such as amiodarone...
January 2017: Journal of the Royal Society of Medicine
https://www.readbyqxmd.com/read/28106051/hepatic-alterations-are-accompanied-by-changes-to-bile-acid-transporter-expressing-neurons-in-the-hypothalamus-after-traumatic-brain-injury
#2
Damir Nizamutdinov, Sharon DeMorrow, Matthew McMillin, Jessica Kain, Sanjib Mukherjee, Suzanne Zeitouni, Gabriel Frampton, Paul Clint S Bricker, Jacob Hurst, Lee A Shapiro
Annually, there are over 2 million incidents of traumatic brain injury (TBI) and treatment options are non-existent. While many TBI studies have focused on the brain, peripheral contributions involving the digestive and immune systems are emerging as factors involved in the various symptomology associated with TBI. We hypothesized that TBI would alter hepatic function, including bile acid system machinery in the liver and brain. The results show activation of the hepatic acute phase response by 2 hours after TBI, hepatic inflammation by 6 hours after TBI and a decrease in hepatic transcription factors, Gli 1, Gli 2, Gli 3 at 2 and 24 hrs after TBI...
January 20, 2017: Scientific Reports
https://www.readbyqxmd.com/read/28106020/renin-angiotensin-aldosterone-system-blockers-and-cardiovascular-outcomes-a-meta-analysis-of-randomized-clinical-trials
#3
Pınar Kızılırmak, Yağız Üresin, Oktay Özdemir, Burçak Kılıçkıran Avcı, Lale Tokgözoğlu, Zeki Öngen
OBJECTIVE: Hypertension is the most prevalent modifiable risk factor for cardiovascular (CV) and cerebrovascular morbidity and mortality. This study aimed to assess the effects of renin-angiotensin-aldosterone system (RAAS) blockade on CV outcomes. METHODS: This study was designed according to the Preferred Reporting Items for Systemic reviews and Meta-Analyses statement. Databases were searched for articles published as of December 2014. Two sets of studies were selected...
January 2017: Türk Kardiyoloji Derneği Arşivi: Türk Kardiyoloji Derneğinin Yayın Organıdır
https://www.readbyqxmd.com/read/28105697/association-of-hematocrit-with-blood-pressure-and-hypertension
#4
Marzieh Emamian, Seyed Mahdi Hasanian, Maryam Tayefi, Moniba Bijari, Faeze Movahedian Far, Mojtaba Shafiee, Amir Avan, Alireza Heidari-Bakavoli, Mohsen Moohebati, Mahmoud Ebrahimi, Sousan Darroudi, Parvin Zamani, Mahmoud Reza Azarpazhooh, Mohsen Nematy, Mohammad Safarian, Gordon A Ferns, Habibollah Esmaeili, Mohammad Reza Parizadeh, Majid Ghayour-Mobarhan
BACKGROUND: Hypertension (HTN) is a risk factor for stroke, renal failure, and cardiovascular disease. The association between biochemical and hematological parameters with high blood pressure may provide a more precise approach to risk prediction conferred by HTN in these patients. OBJECTIVE: The aim of current study was to explore whether biochemical and hematological parameters are associated with HTN in a cohort study with a 7-year follow-up. MATERIALS AND METHODS: A total of 9808 individuals were enrolled and recruited as part of the Mashhad Stroke and Heart Atherosclerotic Disorders (MASHAD) cohort study, and biochemical and hematological factors were measured in all subjects...
January 20, 2017: Journal of Clinical Laboratory Analysis
https://www.readbyqxmd.com/read/28104359/todd-s-paralysis-a-crucial-entity-masquerading-stroke-in-the-emergency-department
#5
Halil Onder
No abstract text is available yet for this article.
January 16, 2017: Journal of Emergency Medicine
https://www.readbyqxmd.com/read/28103931/developing-a-framework-to-guide-the-de-adoption-of-low-value-clinical-practices-in-acute-care-medicine-a-study-protocol
#6
Jeanna Parsons Leigh, Daniel J Niven, Jamie M Boyd, Henry T Stelfox
BACKGROUND: Healthcare systems have difficulty incorporating scientific evidence into clinical practice, especially when science suggests that existing clinical practices are of low-value (e.g. ineffective or harmful to patients). While a number of lists outlining low-value practices in acute care medicine currently exist, less is known about how best to initiate and sustain the removal of low-value clinical practices (i.e. de-adoption). This study will develop a comprehensive list of barriers and facilitators to the de-adoption of low-value clinical practices in acute care facilities to inform the development of a framework to guide the de-adoption process...
January 19, 2017: BMC Health Services Research
https://www.readbyqxmd.com/read/28102150/ultra-rare-genetic-variation-in-common-epilepsies-a-case-control-sequencing-study
#7
(no author information available yet)
BACKGROUND: Despite progress in understanding the genetics of rare epilepsies, the more common epilepsies have proven less amenable to traditional gene-discovery analyses. We aimed to assess the contribution of ultra-rare genetic variation to common epilepsies. METHODS: We did a case-control sequencing study with exome sequence data from unrelated individuals clinically evaluated for one of the two most common epilepsy syndromes: familial genetic generalised epilepsy, or familial or sporadic non-acquired focal epilepsy...
February 2017: Lancet Neurology
https://www.readbyqxmd.com/read/28101763/mir-126-affects-brain-heart-interaction-after-cerebral-ischemic-stroke
#8
Jieli Chen, Chengcheng Cui, Xiaoping Yang, Jiang Xu, Poornima Venkat, Alex Zacharek, Peng Yu, Michael Chopp
Cardiovascular diseases are approximately three times higher in patients with neurological deficits than in patients without neurological deficits. MicroRNA-126 (MiR-126) facilitates vascular remodeling and decreases fibrosis and is emerging as an important factor in the pathogenesis of cardiovascular diseases and cerebral stroke. In this study, we tested the hypothesis that decreased miR-126 after ischemic stroke may play an important role in regulating cardiac function. Wild-type (WT), specific conditional-knockout endothelial cell miR-126 (miR-126(EC-/-)), and miR-126 knockout control (miR-126(fl/fl)) mice were subjected to distal middle cerebral artery occlusion (dMCAo) (n = 10/group)...
January 19, 2017: Translational Stroke Research
https://www.readbyqxmd.com/read/28100765/acute-transient-vestibular-syndrome-prevalence-of-stroke-and-efficacy-of-bedside-evaluation
#9
Jae-Hwan Choi, Min-Gyu Park, Seo Young Choi, Kyung-Pil Park, Seung Kug Baik, Ji-Soo Kim, Kwang-Dong Choi
BACKGROUND AND PURPOSE: The aim of this study was to determine the prevalence of stroke and efficacy of bedside evaluation in diagnosing stroke in acute transient vestibular syndrome (ATVS). METHODS: We performed a prospective, single-center, observational study that had consecutively recruited 86 patients presenting with ATVS to the emergency department of Pusan National University Yangsan Hospital from January to December 2014. All patients received a constructed evaluation, including HINTS plus (head impulse, nystagmus patterns, test of skew, and finger rubbing) and brain magnetic resonance imagings...
January 18, 2017: Stroke; a Journal of Cerebral Circulation
https://www.readbyqxmd.com/read/28100764/drip-n-ship-versus-mothership-for-endovascular-treatment-modeling-the-best-transportation-options-for-optimal-outcomes
#10
Matthew S W Milne, Jessalyn K Holodinsky, Michael D Hill, Anders Nygren, Chao Qiu, Mayank Goyal, Noreen Kamal
BACKGROUND AND PURPOSE: There is uncertainty regarding the best way for patients outside of endovascular-capable or Comprehensive Stroke Centers (CSC) to access endovascular treatment for acute ischemic stroke. The role of the nonendovascular-capable Primary Stroke Centers (PSC) that can offer thrombolysis with alteplase but not endovascular treatment is unclear. A key question is whether average benefit is greater with early thrombolysis at the closest PSC before transportation to the CSC (Drip 'n Ship) or with PSC bypass and direct transport to the CSC (Mothership)...
January 18, 2017: Stroke; a Journal of Cerebral Circulation
https://www.readbyqxmd.com/read/28100208/access-to-primary-health-care-for-acute-vascular-events-in-rural-low-income-settings-a-mixed-methods-study
#11
Shyfuddin Ahmed, Muhammad Ashique Haider Chowdhury, Md Alfazal Khan, Nafisa Lira Huq, Aliya Naheed
BACKGROUND: Cardiovascular diseases (CVDs) are the leading cause of global mortality. Among the CVDs, acute vascular events (AVE) mainly ischemic heart diseases and stroke are the largest contributors. To achieve 25% reduction in preventable deaths from CVDs by 2025, health systems need to be equipped with extended service coverage in order to provide person-centered care. The overall goal of this proposed study is to assess access to health care in-terms of service availability, care seeking patterns and barriers to access care after AVE in rural Bangladesh...
January 18, 2017: BMC Health Services Research
https://www.readbyqxmd.com/read/28098559/lattice-boltzmann-simulations-of-the-bead-spring-microswimmer-with-a-responsive-stroke-from-an-individual-to-swarms
#12
Kristina Pickl, Jayant Pande, Harald Köstler, Ulrich Rüde, Ana-Suncana Smith
Propulsion at low Reynolds numbers is often studied by defining artificial microswimmers which exhibit a particular stroke. The disadvantage of such an approach is that the stroke does not adjust to the environment, in particular the fluid flow, which can diminish the effect of hydrodynamic interactions. To overcome this limitation, we simulate a microswimmer consisting of three beads connected by springs and dampers, using the self-developed waLBerla and <i>pe</i> framework based on the lattice Boltzmann method and the discrete element method...
January 18, 2017: Journal of Physics. Condensed Matter: An Institute of Physics Journal
https://www.readbyqxmd.com/read/28098112/autosomal-dominant-polycystic-kidney-disease-study-of-clinical-characteristics-in-an-indian-population
#13
Sanjay Vikrant, Anupam Parashar
Autosomal dominant polycystic kidney disease (ADPKD) is the most common hereditary form of kidney disease. Clinical data on this multisystem disorder are scarce from developing countries. We conducted a prospective observational study of the clinical profile of ADPKD patients at a single center over a period of six years. A total of 208 patients were studied. Majority were male (60.6%) and the mean age was 45.8 ± 14.5 years. About 61.5% had early stage (Stages 1-3) of chronic kidney disease (CKD) and 38.5% had advanced CKD (Stages 4 and 5)...
January 2017: Saudi Journal of Kidney Diseases and Transplantation
https://www.readbyqxmd.com/read/28097193/axillary-versus-femoral-arterial-cannulation-during-repair-of-type-a-aortic-dissection-an-old-problem-seeking-new-solutions
#14
Sotiris C Stamou, Derek Gartner, Nicholas T Kouchoukos, Kevin W Lobdell, Kamal Khabbaz, Edward Murphy, Robert C Hagberg
BACKGROUND: The goal of this study was to compare early postoperative outcomes and actuarial-free survival between patients who underwent repair of acute Type A aortic dissection with axillary or femoral artery cannulation. METHODS: A total of 305 patients from five academic medical centers underwent acute Type A aortic dissection repair via axillary (n = 107) or femoral (n = 198) artery cannulation between January 2000 and December 2010. Major morbidity, operative mortality, and 5-year actuarial survival were compared between groups...
August 2016: Aorta (Stamford, Conn.)
https://www.readbyqxmd.com/read/28096208/improving-door-to-needle-times-for-acute-ischemic-stroke-effect-of-rapid-patient-registration-moving-directly-to-computed-tomography-and-giving-alteplase-at-the-computed-tomography-scanner
#15
Noreen Kamal, Jessalyn K Holodinsky, Caroline Stephenson, Devika Kashayp, Andrew M Demchuk, Michael D Hill, Renee L Vilneff, Erin Bugbee, Charlotte Zerna, Nancy Newcommon, Eddy Lang, Darren Knox, Eric E Smith
BACKGROUND: The effectiveness of specific systems changes to reduce DTN (door-to-needle) time has not been fully evaluated. We analyzed the impact of 4 specific DTN time reduction strategies implemented prospectively in a staggered fashion. METHODS AND RESULTS: The HASTE (Hurry Acute Stroke Treatment and Evaluation) project was implemented in 3 phases at a single academic medical center. In HASTE I (June 6, 2012 to June 5, 2013), baseline performance was analyzed...
January 2017: Circulation. Cardiovascular Quality and Outcomes
https://www.readbyqxmd.com/read/28096207/use-of-strategies-to-improve-door-to-needle-times-with-tissue-type-plasminogen-activator-in-acute-ischemic-stroke-in-clinical-practice-findings-from-target-stroke
#16
Ying Xian, Haolin Xu, Barbara Lytle, Jason Blevins, Eric D Peterson, Adrian F Hernandez, Eric E Smith, Jeffrey L Saver, Steven R Messé, Mary Paulsen, Robert E Suter, Mathew J Reeves, Edward C Jauch, Lee H Schwamm, Gregg C Fonarow
BACKGROUND: The implementation of Target: Stroke Phase I, the first stage of the American Heart Association's national quality improvement initiative to accelerate door-to-needle (DTN) times, was associated with an average 15-minute reduction in DTN times. TARGET: Stroke phase II was launched in April 2014 with a goal of promoting further reduction in treatment times for tissue-type plasminogen activator (tPA) administration. METHODS AND RESULTS: We conducted a second survey of Get With The Guidelines-Stroke hospitals regarding strategies used to reduce delays after Target: Stroke and quantify their association with DTN times...
January 2017: Circulation. Cardiovascular Quality and Outcomes
https://www.readbyqxmd.com/read/28096032/creation-of-an-intensive-care-unit-and-organizational-changes-in-an-adult-emergency-department-impact-on-acute-stroke-management
#17
Laurent Puy, Chantal Lamy, Sandrine Canaple, Audrey Arnoux, Nicolas Laine, Ella Iacob, Jean-Marc Constans, Olivier Godefroy
BACKGROUND AND PURPOSE: Following the reorganization of a University Medical Center onto a single campus, an Intensive Care Unit was created within the adult Emergency Department (ED ICU). We assessed the effects of these organizational changes on acute stroke management and the intravenous administration of recombinant tissue plasminogen activator (IV rtPA), as characterized by the thrombolysis rate, door-to-needle time (DNT) and outcome at 3months. METHODS: Between October 2013 and September 2015, we performed a retrospective, observational, single-center, comparative study of patients admitted for ischemic stroke and treated with IV rtPA during two 321-day periods (before and after the creation of the ED ICU)...
January 10, 2017: American Journal of Emergency Medicine
https://www.readbyqxmd.com/read/28094188/prosthetic-valve-thrombosis-in-the-acute-phase-of-the-stroke-relevance-of-detection-and-follow-up
#18
Jacint Sala-Padro, Jorge Pagola, Maria Teresa Gonzalez-Alujas, Laia Sero, Jesus Juega, Noelia Rodriguez-Villatoro, Sandra Boned, David Rodriguez-Luna, Marian Muchada, Ruben Fernandez-Galera, Marta Rubiera, Marc Ribo, Arturo Evangelista, Carlos Molina
BACKGROUND: Stroke may be the first symptom of prosthetic valve thrombosis (PVT); therefore, rapid diagnosis and therapy are crucial. We aimed to evaluate the prevalence, main predictors, and long-term clinical evolution of patients with PVT in the acute phase of stroke. METHODS: We studied consecutive acute ischemic stroke patients with prosthetic heart valves who underwent emergent transesophageal echocardiography (TEE) during a 5-year period. Two groups were defined depending on the presence of PVT (PVT or non-PVT groups)...
January 13, 2017: Journal of Stroke and Cerebrovascular Diseases: the Official Journal of National Stroke Association
https://www.readbyqxmd.com/read/28094089/use-of-emergency-medical-transport-and-impact-on-time-to-care-in-patients-with-ischaemic-stroke
#19
A Olascoaga Arrate, M M Freijo Guerrero, C Fernández Maiztegi, I Azkune Calle, R Silvariño Fernández, M Fernández Rodríguez, P Vazquez Naveira, A Anievas Elena, I Iturraspe González, Y Pérez Díez, R Ruiz Fernández
INTRODUCTION: According to numerous studies, using emergency medical services (EMS) to transport stroke patients to hospitals decreases diagnostic and treatment delays. OBJECTIVES: To determine the frequency of use of EMS by stroke patients in Bizkaia (Spain), analyse the factors associated with using EMS, and study the impact of EMS on time to care. METHODS: We gathered data from 545 patients hospitalised for acute ischaemic stroke and recruited consecutively...
January 13, 2017: Neurología: Publicación Oficial de la Sociedad Española de Neurología
https://www.readbyqxmd.com/read/28094079/a-stroke-mimic-methotrexate-induced-neurotoxicity-in-the-emergency-department
#20
Patrick Rogers, Wilbur J Pan, Richard A Drachtman, Christopher Haines
BACKGROUND: Acute lymphoblastic leukemia (ALL) is the most common form of childhood leukemia. The treatment of ALL involves multimodality therapy, and methotrexate (MTX) remains a mainstay of treatment. A complication of MTX therapy includes acute, subacute, and chronic neurotoxocity. Signs and symptoms may range from headaches, dizziness, and mood disorders to seizures and stroke-like symptoms. CASE REPORT: An 18-year-old woman with a history of ALL presented to the emergency department with acute onset of right-sided facial paralysis, right upper extremity flaccid paralysis, and right lower extremity weakness after receiving MTX therapy 3 days earlier...
January 13, 2017: Journal of Emergency Medicine
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