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stroke unknown reason

Rakhi P Naik, Marguerite R Irvin, Suzanne Judd, Orlando M Gutiérrez, Neil A Zakai, Vimal K Derebail, Carmen Peralta, Michael R Lewis, Degui Zhi, Donna Arnett, William McClellan, James G Wilson, Alexander P Reiner, Jeffrey B Kopp, Cheryl A Winkler, Mary Cushman
Blacks, compared with whites, have an increased risk of progression to end-stage renal disease (ESRD). Emerging evidence suggests that, in addition to APOL1 high-risk genotypes, hemoglobin variants, including sickle cell trait (SCT) and hemoglobin C trait, have a role in kidney disease in blacks. However, the association between these hemoglobin traits and ESRD remains unknown. In a large population-based cohort, the REasons for Geographic and Racial Differences in Stroke (REGARDS) study, we evaluated 9909 self-reported blacks (739 with SCT and 243 with hemoglobin C trait)...
March 9, 2017: Journal of the American Society of Nephrology: JASN
Rajeshwari S Punekar, Kathleen M Fox, Carly J Paoli, Akshara Richhariya, Mark J Cziraky, Shravanthi R Gandra, Peter P Toth
BACKGROUND: Numerous studies demonstrate that, even with use of statins, many patients are unable to meet their LDL-C goals. This study examined modifications to statin and/or ezetimibe therapy among patients with hyperlipidemia and prior history of cardiovascular (CV) events in a US commercially insured population. METHODS: Adults (age ≥18 years) initiating statins and/or ezetimibe between 1 January 2007 and 31 December 2008 were identified from HealthCore Integrated Research Database...
May 2017: Current Medical Research and Opinion
John P Donnelly, Monika M Safford, Nathan I Shapiro, John W Baddley, Henry E Wang
BACKGROUND: The Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3) present clinical criteria for the classification of patients with sepsis. We investigated incidence and long-term outcomes of patients diagnosed with these classifications, which are currently unknown. METHODS: We did a retrospective analysis using data from 30 239 participants from the USA who were aged at least 45 years and enrolled in the Reasons for Geographic and Racial Differences in Stroke (REGARDS) cohort...
March 3, 2017: Lancet Infectious Diseases
Gina Bravo, Modou Sene, Marcel Arcand
BACKGROUND: Older adults are encouraged by many organizations to engage in advance care planning in the event of decisional incapacity. Planning for future health care often involves anticipating health-related quality of life (HRQoL) in states of reduced cognitive functioning. No study has yet examined whether anticipated HRQoL is stable over time. The accuracy with which significant others can predict how an older adult envisions HRQoL in a future state of cognitive impairment is also unknown...
January 7, 2017: Health and Quality of Life Outcomes
Wesley T O'Neal, Elsayed Z Soliman, Jimmy T Efird, Virginia J Howard, George Howard, Leslie A McClure
BACKGROUND: It is unknown if higher levels of ambient particulate matter (PM) exposure increase the risk for premature ventricular contractions (PVC) in a population-based study of men and women, and if this relationship varies by race or sex. METHODS: We examined the association of PM <2.5µm in diameter (PM2.5) concentration with PVCs in 26,121 (mean age=64±9.3 years; 55% female; 41% black) participants from the REasons for Geographic And Racial Differences in Stroke (REGARDS) study...
April 2017: Environmental Research
Stefan Aschauer, Caroline Zotter-Tufaro, Franz Duca, Andreas Kammerlander, Daniel Dalos, Julia Mascherbauer, Diana Bonderman
BACKGROUND: Recent studies suggest that reduced right ventricular function is an important predictor of outcome in patients with heart failure and preserved ejection fraction (HFpEF). Because affected patients suffer from a broad spectrum of non-cardiac co-morbidities, it remains unclear, whether they actually die from right heart failure (RHF) or as a consequence of other conditions. METHODS: Consecutive patients with a confirmed diagnosis of HFpEF were enrolled in this prospective registry...
February 1, 2017: International Journal of Cardiology
Anke Wouters, Patrick Dupont, Bo Norrving, Rico Laage, Götz Thomalla, Gregory W Albers, Vincent Thijs, Robin Lemmens
BACKGROUND AND PURPOSE: Acute stroke patients with unknown time of symptom onset are ineligible for thrombolysis. The diffusion-weighted imaging and fluid-attenuated inversion recovery (FLAIR) mismatch is a reasonable predictor of stroke within 4.5 hours of symptom onset, and its clinical usefulness in selecting patients for thrombolysis is currently being investigated. The accuracy of the visual mismatch rating is moderate, and we hypothesized that the predictive value of stroke onset within 4...
October 2016: Stroke; a Journal of Cerebral Circulation
Wesley T O'Neal, Hooman Kamel, Dawn Kleindorfer, Suzanne E Judd, George Howard, Virginia J Howard, Elsayed Z Soliman
BACKGROUND: It is currently unknown if premature atrial contractions (PACs) detected on the routine screening electrocardiogram are associated with an increased risk of ischemic stroke. METHODS: We examined the association between PACs and ischemic stroke in 22,975 (mean age 64 ± 9.2; 56% women; 40% black) participants from the Reasons for Geographic and Racial Differences in Stroke study. Participants who were free of stroke at baseline were included. PACs were detected from centrally read electrocardiograms at baseline...
2016: Neuroepidemiology
Manuel Cappellari, Mariachiara Bosco, Stefano Forlivesi, Giampaolo Tomelleri, Nicola Micheletti, Monica Carletti, Paolo Bovi
Intravenous (IV) thrombolysis is the treatment in ischemic stroke, but only the minority of patients receive this medication. The primary objective of this study was to explore the reasons associated with the decision not to offer IV thrombolysis to stroke patients admitted to the Stroke Unit (SU). We conducted a retrospective analysis based on data collected from 876 consecutive stroke patients admitted to the SU <12 h of symptoms onset, treated or not with IV thrombolysis at the discretion of the treating neurologist...
November 2016: Journal of Thrombosis and Thrombolysis
Athanasios Lourbopoulos, Uta Mamrak, Stefan Roth, Matilde Balbi, Joshua Shrouder, Arthur Liesz, Farida Hellal, Nikolaus Plesnila
Experimental stroke models producing clinically relevant functional deficits are often associated with high mortality. Because the mechanisms that underlie post-stroke mortality are largely unknown, results obtained using these models are often difficult to interpret, thereby limiting their translational potential. Given that specific forms of post-stroke care reduce mortality in patients, we hypothesized that inadequate food and water intake may underlie mortality following experimental stroke. C57BL/6 mice were subjected to 1 h of intraluminal filament middle cerebral artery occlusion...
January 1, 2016: Journal of Cerebral Blood Flow and Metabolism
T Jared Bunch, Heidi T May, Tami L Bair, Brian G Crandall, Michael J Cutler, John D Day, Victoria Jacobs, Charles Mallender, Jeffrey S Osborn, Scott M Stevens, J Peter Weiss, Scott C Woller
BACKGROUND: The mechanisms behind the association of atrial fibrillation (AF) and dementia are unknown. We previously found a significantly increased risk of dementia in AF patients taking warfarin with a low percentage of time in therapeutic range. The purpose of this study was to determine the extent to which AF itself increases dementia risk, in addition to long-term anticoagulation exposure. METHODS AND RESULTS: A total of 10 537 patients anticoagulated with warfarin (target INR 2-3), managed by the Clinical Pharmacist Anticoagulation Service with no history of dementia were included...
July 2016: Journal of the American Heart Association
Stina Jakobsson, Daniel Huber, Fredrik Björklund, Thomas Mooe
BACKGROUND: Cardiovascular secondary preventive recommendations are often not reached. We investigated whether a nurse-led telephone-based follow-up could improve the implementation of a new guideline within a year after its release. METHODS: In February 2013, a new secondary preventive guideline for diabetic patients was released in the county of Jämtland, Sweden. It included a changed of the low-density lipoprotein cholesterol (LDL-C) target value from <2...
April 30, 2016: BMC Cardiovascular Disorders
Maria Garoff, Jan Ahlqvist, Eva Levring Jäghagen, Elias Johansson, Per Wester
OBJECTIVES: Approximately 7% of patients examined with panoramic radiographs (PRs) for odontological reasons, and with incidental findings of carotid artery calcification (CAC), have significant (≥50%) carotid stenosis (SCS). The aim of this study was to determine if the radiographic appearance of CACs in PRs could be categorized such that we could improve the positive-predictive value (PPV) for SCS detection. METHODS: This cross-sectional study included 278 patients with CACs identified by PRs, 127 with SCS and 151 without SCS...
May 10, 2016: Dento Maxillo Facial Radiology
Esther S H Kim, Maya Serhal
Fibromuscular dysplasia (FMD) is an arteriopathy of unknown etiology which has traditionally been associated with secondary hypertension; however, it has garnered increased attention in the cardiology field in the recent years because of its potential association with spontaneous coronary artery dissection. Cardiologists should be aware that FMD is a polyvascular disease which can affect any arterial bed and can result in morbid conditions such as chronic headaches, pulsatile tinnitus, stroke from cervical artery dissection, and renal infarction from renal artery dissection and has also been associated with increased prevalence of arterial aneurysm, including brain aneurysm...
June 2016: Current Treatment Options in Cardiovascular Medicine
Per Andersson, Magnus Löndahl
BACKGROUND: Atrial fibrillation (AF) affects about 3.2% of the adult population in the western world and incurs an annual stroke risk of 4.5%. The use of oral anticoagulant (OAC) drugs significantly reduces this risk. OAC drugs seem to be under-utilized, but little is known about why their use is restrained in routine clinical management. The aim of this study was to assess this issue and, from these data, to estimate the proportion of patients with AF in a general population who were eligible for treatment with OAC drugs...
September 2016: European Journal of Preventive Cardiology
Lester Y Leung, Louis R Caplan
OBJECTIVES: Young adults with ischemic stroke may present late to medical care, but the reasons for these delays are unknown. We sought to identify factors that predict delay in presentation. METHODS: We performed a retrospective cohort study of adults aged 18-50 admitted to a single academic medical center between 2007 and 2012. RESULTS: Eighty six of 141 (61%) young adults with ischemic stroke presented at the health center more than 4.5 h after stroke onset...
2016: Cerebrovascular Diseases
Vikas Pathak, Joseph M Stavas, Hubert J Ford, Charles A Austin, Robert M Aris
BACKGROUND: Bronchial artery embolization (BAE) is an established, safe, and effective procedure for the treatment of hemoptysis but long-term outcomes of the BAE have never been investigated before. OBJECTIVES: To retrospectively analyze long-term outcomes of the BAE. MATERIALS AND METHODS: A retrospective chart analysis was done from the hospital central database for all patients undergoing the BAE over a consecutive 14-year period (January 2000-February 2014)...
January 2016: Lung India: Official Organ of Indian Chest Society
Anna Lucia Maria Ferri, Anna Bersano, Daniela Lisini, Giorgio Boncoraglio, Simona Frigerio, Eugenio Parati
Stroke is the most common neurological cause of morbidity and mortality in industrialized countries, afflicting 15 million people every year. The numbers are expected to increase, mostly due to aging populations. One in five stroke patients dies, and one in three are left with permanent disabilities. Although some acute phase therapies such as intravenous recombinant tissue plasminogen activator (rt-PA) andendovascular treatment have been shown to improve ischemic stroke outcome, these therapies are available only for a small proportion of patients...
May 27, 2016: Current Medicinal Chemistry
Monica L Wagner, Jane C Khoury, Kathleen Alwell, Eric Rademacher, Daniel Woo, Matthew L Flaherty, Aaron M Anderson, Opeolu Adeoye, Simona Ferioli, Brett M Kissela, Dawn Kleindorfer, Joseph P Broderick
BACKGROUND AND PURPOSE: Antithrombotic medications are effective for ischemic stroke prevention, but stoppage of these medications is associated with an increased risk of thromboembolism. The frequency of antithrombotic withdrawal in the general population is unknown. METHODS: We conducted a random phone sample of 2036 households in the Greater Cincinnati metropolitan area, representative of the stroke population by age, sex, and race, to determine the frequency of antithrombotic medication use and stoppage by physicians for medically indicated procedures...
April 2016: Journal of Stroke and Cerebrovascular Diseases: the Official Journal of National Stroke Association
Philip M C Choi, Jamsheed A Desai, Devika Kashyap, Caroline Stephenson, Noreen Kamal, Sheldon Vogt, Victoria Bohm, Michael Suddes, Erin Bugbee, Michael D Hill, Andrew M Demchuk, Eric E Smith
OBJECTIVES: The National Quality Forum recently endorsed a performance measure for time to intravenous thrombolytic therapy which allows exclusions for circumstances in which fast alteplase treatment may not be possible. However, the frequency and impact of unavoidable patient reasons for long door-to-needle time (DNT), such as need for medical stabilization, are largely unknown in clinical practice. As part of the Hurry Acute Stroke Treatment and Evaluation-2 (HASTE-2) project, we sought to identify patient and systems reasons associated with longer DNT...
April 2016: Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine
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