scholarly journals The Impact of Pregnancy on Hemorrhagic Stroke in Young Women

2018 ◽  
Vol 46 (1-2) ◽  
pp. 10-15 ◽  
Author(s):  
Eliza C. Miller ◽  
Kathryn M. Sundheim ◽  
Joshua Z. Willey ◽  
Amelia K. Boehme ◽  
Dritan Agalliu ◽  
...  

Background: Pregnancy is a sex-specific risk factor for causing hemorrhagic stroke (HS) in young adults. Unique physiological characteristics during pregnancy may alter the relative risk for HS in pregnant/postpartum (PP) women compared to HS in other young women. We compared patient characteristics and HS subtypes between young non-pregnant and PP women. Methods: We reviewed the medical records of all women 18–45 years old admitted to our center with HS from October 15, 2008 through March 31, 2015, and compared patient characteristics and stroke mechanisms using logistic regression. Results: Of the 130 young women with HS during the study period, 111 were non-PP women, and 19 PP women. PP women had lower proportions of vascular risk factors such as hypertension, prior stroke, and smoking, and a higher proportion of migraine (36.8 vs. 14.4%, p = 0.01). After adjusting for hypertension, smoking, migraine, prior stroke and prior myocardial infarction, PP women had lower odds of having an underlying vascular lesion (OR 0.14, 95% CI 0.04–0.44, p = 0.0009) and a higher proportion of the reversible cerebral vasoconstriction syndrome (RCVS) as cause of their HS. Conclusions: Women with pregnancy-associated HS had fewer cerebrovascular risk factors, lower odds of having ­underlying vascular lesions, and higher proportion of ­migraine and RCVS compared with similar-aged non-­pregnant women. Pregnancy-associated HS appears to represent a unique pathophysiological process, requiring targeted study.

2016 ◽  
pp. 65-68
Author(s):  
Oksana Mikitey

Stroke is an important medical and social problem, and stroke risk assessment tools have difficulty on the interaction of risk factors and the effects of certain risk factors with analysis by age, gender, race, because this information fully available to global risk assessment tools. In addition, these tools tend to be focused and usually do not include the entire range of possible factors contributing. The aim of the study was to conduct a comparison of brain vascular lesions pool with ischemic stroke (II) based predictive analysis and assessment of the main risk factors in patients with primary and recurrent ischemic stroke. Prognostically significant risk factors for recurrent ischemic stroke is not effective antihypertensive therapy, multiple stenoses any one pool vascular brain, duration of hypertension (AH) over 5 years and regular smoking patients (p<0.001). In the initial localization in the second vertebrobasilar recurrent stroke was significantly (p<0.05) more developed in the same pool in women than in men; and the localization of the primary carotid AI in the pool, re-developed stroke often unreliable in the same pool in women than in men.


Stroke ◽  
2017 ◽  
Vol 48 (suppl_1) ◽  
Author(s):  
Eliza C Miller ◽  
Kathryn M Sundheim ◽  
Joshua Z Willey ◽  
Amelia K Boehme ◽  
Randolph S Marshall

Background: Pregnancy-associated hemorrhagic stroke (HS), while rare, is a significant cause of maternal mortality. Prior studies have suggested that the pathophysiology of HS may differ in pregnant/postpartum women when compared with HS in other young adults. Methods: We conducted a single-center retrospective analysis of a prospectively collected stroke registry, for patients aged 18-45, admitted with HS of any type from 01/2008-03/2015. We reviewed charts for study variables, including patient characteristics, risk factors, stroke mechanisms, and outcomes. Good outcome was defined as modified Rankin score of 0-2 at time of discharge. We compared study variables between three groups: pregnant/postpartum women, non-pregnant/postpartum women, and men. Results: Of 219 young adults with HS during the study period, 93 (42%) were men and 126 (58%) were women, of whom 19 (15.1%) were pregnant/postpartum. Among men, 58 (62.4%) had ICH and 41 (33.3%) had SAH, 31 (75.6%) of which were aneurysmal. Among non-pregnant women, 49 (45.8%) had ICH and 61 (57%) had SAH, 53 (87%) of which were aneurysmal. Among pregnant/postpartum women, 10 had ICH (52.6%) and 11 (57.9%) had SAH, 1 of which was aneurysmal. Compared with men and with non-pregnant women, pregnant/postpartum women had fewer vascular risk factors, were more likely to have history of migraine, and were more likely to have the reversible cerebral vasoconstriction syndrome as stroke mechanism (11/19, 57.9% versus 0/93 men and 2/107 non-pregnant women, p=0.0001). While there were no deaths in the pregnant/postpartum group, there were no significant differences between groups in good outcome (Table). Conclusions: In our analysis, pregnancy-associated hemorrhages were uniquely non-aneurysmal and associated with fewer cerebrovascular risk factors than age-matched men and non-pregnant women, suggesting there is a pregnancy-specific pathophysiology for HS that requires special consideration.


BMJ Open ◽  
2020 ◽  
Vol 10 (9) ◽  
pp. e041776
Author(s):  
Ryan Daniel Gotesman ◽  
Naomi Niznick ◽  
Brian Dewar ◽  
Dean A Fergusson ◽  
Risa Shorr ◽  
...  

IntroductionReversible cerebral vasoconstriction syndrome (RCVS) is characterised by severe, recurrent thunderclap headaches (TCHs) and vasoconstriction of cerebral arteries that resolve within 3 months. Abnormalities on non-contrast CT (NCCT) such as ischaemic strokes, intracerebral haemorrhage and subarachnoid haemorrhages are frequently observed on brain imaging of patients with RCVS though their prevalence varies considerably between studies. The aim of this systematic review and meta-analysis is to estimate the prevalence of NCCT abnormalities seen on neuroimaging of adult patients with RCVS.Methods and analysisWe will search the Medline, Embase and the Cochrane Library databases for studies on the prevalence of NCCT abnormalities on neuroimaging of patients with RCVS. Search results will be screened for eligibility by title and abstract. Suitable studies will be fully reviewed and relevant data extracted using a data abstraction form. The studies will be assessed for methodological quality, risk of bias and heterogeneity. Prevalence estimates across studies will be pooled using a random-effects model and subgroup analysis will be performed to assess the impact of age, sex, publication year and study design on prevalence of vascular lesions. Sensitivity analysis will be used to investigate the robustness of the findings. This protocol has been devised using the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols 2015 checklist.Ethics and disseminationFormal ethics is not required as primary data will not be collected. The findings of this study will be disseminated through a peer-reviewed publication and conference presentations.Trial registration numberCRD42020190637.


Kidney360 ◽  
2021 ◽  
pp. 10.34067/KID.0001612021
Author(s):  
Dipal M. Patel ◽  
Manali Phadke ◽  
Feng Dai ◽  
Michael Simonov ◽  
Neera K. Dahl ◽  
...  

Background: Acute kidney injury (AKI) is common in patients hospitalized with coronavirus disease 2019 (COVID-19). Risk factors for AKI requiring dialysis (AKI-D) are not fully understood. We aimed to identify risk factors associated with AKI-D and AKI not requiring dialysis (AKI-ND). Methods: We reviewed electronic health records of 3186 patients aged > 18 years old hospitalized with COVID-19 across six hospitals. Patient characteristics, urinalysis findings, and inflammatory markers were analyzed for association with in-hospital AKI status (AKI-D, AKI-ND, or no AKI), and we subsequently evaluated mortality. Results: After adjustment for multiple covariates, higher baseline eGFR was associated with 30% lower odds of AKI-D and 11% lower odds of AKI-ND (OR 0.70, 95% CI 0.64-0.77 for AKI-D; OR 0.89, 95% CI 0.85-0.92 for AKI-ND). Patients with obesity and Latino patients had increased odds of AKI-D, whereas those with congestive heart failure or diabetes with complications had increased odds of AKI-ND. Females had lower odds of in-hospital AKI (OR 0.28, 95% CI 0.17-0.46 for AKI-D; OR 0.83, 95% CI 0.70-0.99 for AKI-ND). After adjustment for covariates and baseline eGFR, 1-4+ protein on initial urinalysis was associated with a 9-fold increase in odds of AKI-D (OR 9.00, 95% CI 2.16-37.38) and > 2-fold higher odds of AKI-ND (OR 2.28, 95% CI 1.66-3.13). 1-3+ blood and trace glucose on initial urinalysis were also associated with increased odds of both AKI-D and AKI-ND. AKI-D and AKI-ND were associated with in-hospital death (OR 2.64, 95% CI 1.13-6.17 for AKI-D; OR 2.44, 95% CI 1.77-3.35 for AKI-ND). Conclusions: Active urine sediments, even after adjustment for baseline kidney function, and reduced baseline eGFR are significantly associated with increased odds of AKI-D and AKI-ND. In-hospital AKI was associated with in-hospital death. These findings may help prognosticate patients hospitalized with COVID-19.


2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S450-S450
Author(s):  
Alexander Milgrom ◽  
Amanda Collins ◽  
J Aaron Grubbs ◽  
Caroline Derrick ◽  
Kristin Logan ◽  
...  

Abstract Background Left ventricular assist devices (LVADs) are a treatment option for end-stage heart failure, traditionally used as a bridge to a transplant. However, LVADs as a destination therapy is an option for individuals with contraindications for transplant. Infections are a common and devastating complication with significant morbidity and mortality. The purpose of this study was to assess the impact of risk factors for LVAD-associated infections in a nontransplant LVAD center. Methods All patients with implanted LVADs from 2013–2018 at Prisma Health were screened for inclusion. LVAD-associated infection was defined using INTERMACS criteria. Patient characteristics and device characteristics were evaluated for infection risk. Time to infection and associated mortality were also analyzed. Results Fifty-four of 138 (39.1%) patients developed an LVAD infection (driveline infection, or bacteremia). Mean time to infection among those who experienced infections was 7.78 months, with a standard deviation of 9.58 months. Table 1 summarizes baseline patient characteristics. HeartWare devices, compared with HeartMate II, were at an increased risk of infections and had a shorter time to infection (Figure 1) (HeartWare vs. HeartMate II, HR 2.12, P = 0.01). Those with a BMI of ≥35 kg/m2 were found on average to have a number of infections 0.729 greater than those with a BMI < 35 kg/m2 (P = 0.01). Prealbumin, A1C, and chronic kidney disease (any stage) were not found to be associated with infection. Staphylococcus aureus (21, 18.26%), Pseudomonas aeruginosa (24, 20.87%), and Staphylococcus epidermidis (22, 19.13%) were the most common organisms identified. Conclusion In an LVAD center where the majority of patients received LVAD as destination therapy, infection rates were similar as those receiving LVAD as a bridge to transplant. Modifiable risk factors for infection are areas for future interventions and prevention efforts. Disclosures All authors: No reported disclosures.


Circulation ◽  
2020 ◽  
Vol 141 (Suppl_1) ◽  
Author(s):  
Nrupen A Bhavsar ◽  
Danying Li ◽  
Miguel Ramos ◽  
Laura Richman

Introduction: Dynamic changes to neighborhoods due to forces such as gentrification impact the health of residents. Much of this research has been conducted within the United States, where racial disparities and access to healthcare impact risk for health outcomes. Internationally, other factors may play a more prominent role in the association between gentrification and cardiovascular risk factors and outcomes. Hypothesis: Residents living in gentrified vs. non-gentrified neighborhoods will have lower odds of diabetes (DM), hypertension (HTN), depression and cardiovascular disease (CVD). Methods: We defined gentrification using changes in domains of the Index of Multiple Deprivation (IMD) at the level of the Lower Layer Super Output Areas (LSOA) in England from 2004-2010. We used all IMD domains (income, employment, education, crime, barriers to housing, and living environment), except the health domain, from 2004 and 2010 to define LSOA deprivation. The IMD for each LSOA was standardized to the mean IMD of England using z-scores. LSOAs were eligible to be gentrified if they had a positive z-score in 2004 and were considered to gentrify if they had a negative change in the transformed IMD from 2004 to 2010. We linked these data to individual participants in the Understanding Society Study (USS). The USS is a nationally representative cohort study of 60,000 United Kingdom residents started in 2009 with follow-up ongoing. We limited the analysis to residents in England who lived in top and bottom 25% deprived LSOAs (n=8782). We used multivariable logistic regression to calculate the odds ratio for self-reported DM, HTN, depression, and CVD in residents in neighborhoods that did and did not gentrify, adjusting for race, sex, length of residence (LOR), baseline IMD score, and baseline prevalence of health conditions. Results were stratified by age (<65 & >=65 years) and median LOR (<13 & >=13 years). Results: At baseline, 8782 participants had a median age of 43 years, 4% were black and 55% were female. There was no significant difference in the prevalence of DM, HTN, depression, or CVD at baseline. At follow-up, overall, there were no significant difference in the odds of DM, HTN, or CVD between residents living in gentrified vs. non-gentrified neighborhoods. Residents in neighborhoods that gentrified had a 39% lower odds of depression as compared to participants living in neighborhoods that did not gentrify (p=0.01). Results were not significantly modified by age or length of residence. Conclusions: Residents living in gentrified neighborhoods did not have differential risk for most CVD risk factors and outcomes as compared to residents living in neighborhoods that did not gentrify. However, the impact of gentrification on health is not uniform across all conditions. The positive health impact seen may suggest gentrification increases access to resources not present prior to gentrification.


Author(s):  
Anni Ylinen ◽  
◽  
Stefanie Hägg-Holmberg ◽  
Marika I. Eriksson ◽  
Carol Forsblom ◽  
...  

Abstract Background Individuals with type 1 diabetes have a markedly increased risk of stroke. In the general population, genetic predisposition has been linked to increased risk of stroke, but this has not been assessed in type 1 diabetes. Our aim was, therefore, to study how parental risk factors affect the risk of stroke in individuals with type 1 diabetes. Methods This study represents an observational follow-up of 4011 individuals from the Finnish Diabetic Nephropathy Study, mean age at baseline 37.6 ± 11.9 years. All strokes during follow-up were verified from medical records or death certificates. The strokes were classified as either ischemic or hemorrhagic. All individuals filled out questionnaires concerning their parents’ medical history of hypertension, diabetes, stroke, and/or myocardial infarction. Results During a median follow-up of 12.4 (10.9–14.2) years, 188 individuals (4.6%) were diagnosed with their first ever stroke; 134 were ischemic and 54 hemorrhagic. In Cox regression analysis, a history of maternal stroke increased the risk of hemorrhagic stroke, hazard ratio 2.86 (95% confidence interval 1.27–6.44, p = 0.011) after adjustment for sex, age, BMI, retinal photocoagulation, and diabetic kidney disease. There was, however, no association between maternal stroke and ischemic stroke. No other associations between parental risk factors and ischemic or hemorrhagic stroke were observed. Conclusion A history of maternal stroke increases the risk of hemorrhagic stroke in individuals with type 1 diabetes. Other parental risk factors seem to have limited impact on the risk of stroke.


2017 ◽  
Vol 131 (20) ◽  
pp. 2549-2560
Author(s):  
Narges Yazdekhasti ◽  
Corinna Brandsch ◽  
Frank Hirche ◽  
Julia Kühn ◽  
Anke Schloesser ◽  
...  

Cocoa polyphenols are thought to reduce the risk of cardiovascular diseases. Thus, cocoa-containing foods may have significant health benefits. Here, we studied the impact of chocolate liquor on vascular lesion development and plaque composition in a mouse model of atherosclerosis. Apolipoprotein E (apoE)-knockout mice were assigned to two groups and fed a Western diet that contained 250 g/kg of either chocolate liquor or a polyphenol-free isoenergetic control paste for 16 weeks. In addition to fat, protein, and fibers, the chocolate liquor contained 2 g/kg of polyphenols. Compared with the control group, mice fed the chocolate liquor had larger plaque areas in the descending aorta and aortic root, which were attributed to a higher mass of vascular smooth muscle cells (VSMCs) and collagen. Vascular lipid deposits and calcification areas did not differ between the two groups. The aortic tissue level of interleukin-6 (IL-6) mRNA was 5-fold higher in the mice fed chocolate liquor than in the control mice. Chocolate-fed mice exhibited an increased hepatic saturated to polyunsaturated fatty acid ratio than the controls. Although the chocolate liquor contained 14 µg/kg of vitamin D2, the chocolate liquor-fed mice did not have measurable 25-hydroxyvitamin D2 in the serum. These mice even showed a 25% reduction in the level of 25-hydroxyvitamin D3 compared with the control mice. Overall, present data may contribute to our understanding how chocolate constituents can impact vascular lesion development.


2021 ◽  
pp. 1-7
Author(s):  
Andrea Luísa Fernandes Afonso ◽  
Bruno Miguel Morais Pires ◽  
Cristina Martins Teixeira ◽  
António José Nogueira

The screening of groups with a high risk for developing tuberculosis (TB) is a priority in order to control this disease. Since there is no gold standard for the diagnosis of latent TB infection (LTBI), both the tuberculin skin test (TST) and the interferon-gamma release assays (IGRA) have been used for this purpose. The aim of this study was to determine the proportion of LTBI by using the TST and the IGRA tests, and to assess the risk factors related with discordant results between tests across several risk groups advised for screening in Northeast Portugal. Data were collected from the database of patients with suspected LTBI and advised for the screening in a public health unit (January 2014 to December 2015). The proportion of LTBI was computed using both tests. Logistic regression models assessed risk factors for a positive test and for discordant results between tests. The adjusted odds ratio (OR) and respective 95% confidence interval (95% CI) were obtained. Out of 367 patients included in the analysis, 79.8% had a positive TST and 46.0% of them had a positive IGRA. In comparison with contacts of active TB cases, healthcare workers and inmates presented higher odds of TST positivity (OR 4.38, 95% CI 1.59–12.09 and OR 4.74, 95% CI 1.45–15.49, respectively), but immunocompromised people presented lower odds of TST positivity (OR 0.14; 95% CI 0.06–0.31). Instead, healthcare workers (OR 0.44, 95% CI 0.24–0.80) and immunocompromised people (OR 0.24, 95% CI 0.10–0.56) presented lower odds of a positive IGRA. There were 42.0% concordant positive results, 16.1% concordant negative results, and 41.9% discordant results, with healthcare workers presenting higher odds of discordant results (OR 3.34, 95% CI 1.84–6.05). The proportion of LTBI estimated by TST and IGRA among people advised for screening in our setting is high, highlighting the need of preventive strategies. Among healthcare workers, TST results should be read with caution as the higher proportion of discordant results with a positive TST suggests the impact of the booster reaction in this group.


Author(s):  
Melisa Guelhan Inci ◽  
Julia Rasch ◽  
Hannah Woopen ◽  
Kristina Mueller ◽  
Rolf Richter ◽  
...  

Abstract Background Accompanying co-morbidities in patients with ovarian cancer are of major relevance for scheduling debulking surgery, especially in the anesthesiological consultations. Aim of this study was to evaluate the impact of co-morbidities and patient characteristics on postoperative complications. Methods Patients undergoing maximal cytoreductive surgery were prospectively enrolled from October 2015 to January 2017. Various variables were recorded, such as the Charlson comorbidity index, Eastern cooperative oncology group scale of performance status (ECOG PS) and the American society of anesthesiologists physical status classification system (ASA PS). Surgical complications were graded using the Clavien–Dindo criteria. Logistic regression models were used to analyze risk factors for severe postoperative complications. Results Of 106 enrolled patients, 19 (17.9%) developed severe postoperative complications grade ≥ IIIb according to Clavien–Dindo criteria. In the multivariable regression analysis impaired (ECOG PS) > 1 (odds ratio OR) 13.34, 95% confidence interval (CI) 1.74–102.30, p = 0.01), body mass index (BMI) > 25 kg/m2 (OR 10.48, 95% CI 2.38–46.02, p = 0.002) along with the use of intraoperative norepinephrine > 0.11 µg/kg/min (OR 4.69, 95% CI 1.13–19.46, p = 0.03) and intraoperative fresh frozen plasma (FFP) > 17 units (OR 4.11, 95% CI 1.12–15.14, p = 0.03) appeared as significant predictors of severe postoperative complications. Conclusion We demonstrated that neither the presence of a certain comorbidity nor the summation of the co-morbidities were associated with adverse outcome. Patient characteristics, such as ECOG PS > 1 and obesity (BMI > 25 kg/m2), are highly predictive factors for severe postoperative complications. The analysis of intraoperative data showed that the need for more than > 0.11 µg/kg/min of norepinephrine and transfusions of FFPs more than 17 units were strongly associated with severe postoperative complications.


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