scholarly journals High Prevalence of Moyamoya Syndrome in Appalachia

2020 ◽  
Vol 49 (5) ◽  
pp. 516-521
Author(s):  
Michael John Nisiewicz ◽  
Jill M. Roberts ◽  
Michael R. Dobbs ◽  
Ebunoluwa A. Ajadi ◽  
Patrick Kitzman ◽  
...  
Keyword(s):  
Risk Factors ◽  
General Population ◽  
Hemorrhagic Stroke ◽  
Autoimmune Disorder ◽  
Autoimmune Disorders ◽  
Moyamoya Syndrome ◽  
Stroke Registry ◽  
Congenital Condition ◽  
Unclear Etiology ◽  
Progressive Occlusion

<b><i>Introduction:</i></b> Moyamoya is a chronic cerebrovascular condition of unclear etiology characterized by progressive occlusion of 1 or both internal carotid arteries with neovascular collateral formation. With both an idiopathic form (moya­moya disease) and congenital condition-associated form (moyamoya syndrome), it can cause ischemic and hemorrhagic stroke. Recent findings in Kentucky have challenged traditional estimates of its incidence in US populations. Using the Kentucky Appalachian Stroke Registry (KApSR), our aim was to further characterize its incidence as a cause of stroke and to understand the patient population in Appalachia. <b><i>Methods:</i></b> A retrospective review of moyamoya patients was performed using the KApSR database. Data collected included demographics, county location, risk factors, comorbidities, and health-care encounters from January 1, 2012, to December 31, 2016. <b><i>Results:</i></b> Sixty-seven patients were identified; 36 (53.7%) resided in Appalachian counties. The cohort accounted for 125 of 6,305 stroke admissions, representing an incidence of 1,983 per 100,000 stroke admissions. Patients presented with ischemic strokes rather than hemorrhagic strokes (odds ratio 5.50, 95% CI: 2.74–11.04, <i>p</i> &#x3c; 0.01). Eleven patients (16.4%) exhibited autoimmune disorders. Compared to the general population with autoimmune disorder prevalence of 4.5%, the presence of autoimmunity within the cohort was significantly higher (<i>p</i> &#x3c; 0.01). Compared to non-Appalachian patients, Appalachian patients tended to present with lower frequencies of tobacco use (<i>p</i> = 0.08), diabetes mellitus (<i>p</i> = 0.13), and hypertension (<i>p</i> = 0.16). <b><i>Conclusions:</i></b> Moyamoya accounts for a substantial number of stroke admissions in Kentucky; these patients were more likely to develop an ischemic stroke rather than a hemorrhagic stroke. Autoimmune disorders were more prevalent in moyamoya patients than in the general population. The reduced frequency of traditional stroke risk factors within the Appalachian group suggests an etiology distinct to the population.

Abstract 162: Clinical and Neuroradiological Characteristics of Moyamoya Syndrome: UT Houston Experience

Stroke ◽  
2012 ◽  
Vol 43 (suppl_1) ◽  
Author(s):  
Preeti sahota ◽  
Peter Sedrak ◽  
Paul S Lee ◽  
Aditya P Lal ◽  
William J Hicks ◽  
...  
Keyword(s):  
Risk Factors ◽  
Hospital Admissions ◽  
Laboratory Data ◽  
Neurological Deficits ◽  
Disease Stage ◽  
Moyamoya Syndrome ◽  
Stroke Registry ◽  
Single Center Experience ◽  
Unilateral Disease ◽  
Low Hdl

Background: Moyamoya (MM) is a rare progressive arteriopathy characterized by progressive stenosis and occlusion of the internal carotid arteries (ICA) and ultimately the arteries of the circle of Willis. It is called moyamoya disease (MMD) when idiopathic and involving bilateral ICA, and moyamoya syndrome (MMS) when associated with well-recognized risk factors, or when idiopathic but unilateral. Given the paucity of literature on MMS, we analyzed the clinical and radiological characteristics of MM patients presenting to our institute. Methods: We retrospectively identified patients admitted with acute neurological deficits and had ‘moyamoya-like’ physiology from our stroke registry (07/04 to 03/11). We collected demographics, clinical and laboratory data, and prior and subsequent hospital admissions. Two clinically blinded neuroradiologists collected radiological data including vessels involved, type of collateralization, and disease stage and progression. Patients were categorized into MMD or MMS based on risk factors and the side of disease. Results: We identified 36 MM patients (mean age 41.3 years), 13 (36.1%) with MMD and 23 (63.9%) with MMS. Both groups had female preponderance and multiracial involvement; hemiparesis was the leading clinical sign, and most patients had low HDL levels (83%). In MMS group, 4 (17.4%) patients had idiopathic unilateral disease, 4 (17.4%) had atherosclerotic disease, 3 (13%) each had vasculitis and intracranial dissection, 2 (8.7%) each had sickle cell disease and APLA syndrome, and 1 (4.3%) each had Down’s syndrome, Lupus, thyrotoxicosis, hypercoagulable disorder and chronic cocaine use. The MMS patients tended to be older, and higher proportion had ischemic stroke (87%) and neurological worsening after acute event (35%). On the other hand, higher proportion of MMD patients had hemorrhagic stroke (38.5%), multiple (>5) hospital admissions (23%) and EEG abnormality (80%) and were discharged home (62%). In MMS group, 2 (8.7%) patients underwent hemicraniectomy. In MMD group, 12.5% had disease progression radiographically. The clinical and radiological characteristics of these patients are summarized in tables 1 and 2 respectively. Conclusion: We present the single-center experience of clinical and neuroradiological characteristics of patients with MMS.

scholarly journals The comparison of traditional vascular risk factor between hemorrhagic and non-hemorrhagic stroke

2017 ◽  
Vol 8 (6) ◽  
pp. 5-8
Author(s):  
Rizaldy Taslim Pinzon ◽  
Rosa De Lima Renita Sanyasi ◽  
Andre Dharmawan Wijono
Keyword(s):  
Risk Factors ◽  
Risk Factor ◽  
Protective Factor ◽  
Hemorrhagic Stroke ◽  
Sample Size Calculation ◽  
Vascular Risk Factor ◽  
Vascular Risk Factors ◽  
Vascular Risk ◽  
Significance Level ◽  
Stroke Registry

Background: Understanding about risk factors of stroke based on its pathology is very important. Previous study about the vascular risk factors in patients with stroke in Indonesia is very limited.Aims and Objective: Measure the comparison between traditional vascular risk factors in patients with hemorrhagic stroke and non-hemorrhagic (ischemic) stroke.Materials and Methods: This was a nested case-control study using secondary data from electronic medical record and electronic stroke registry of Bethesda Hospital Yogyakarta Indonesia. The stroke was diagnosed with standard way by well-trained neurologist and confirmed with CT Scan. The traditional risk factors were defined systematically. We used Dupont Power and Sample Size calculation software and StatCal EpiInfo software with significance level 0,05.Result: The data of 200 subjects consisted of 100 patients with hemorrhagic stroke and 100 patients with non-hemorrhagic stroke. Hypertension was main vascular risk factor in both Group but it was more common in hemorrhagic stroke (OR: 2,528, 95% CI: 0,069 ; 0,316, p < 0,002). Dyslipidemia was a protective factor against hemorrhagic stroke (OR: 0,147, 95% CI: 1,415 ; 4,516, p < 0,001). Diabetes was more common in ischemic stroke compared with hemorrhagic stroke (68% and 32%) respectively.Conclusion: Hypertension, dyslipidemia, and diabetes were modifiable traditional vascular risk factors which significantly had effect on stroke. Asian Journal of Medical Sciences Vol.8(6) 2017 5-8

scholarly journals Interplay of ADHD polygenic liability with birth-related, somatic and psychosocial factors in ADHD - a nationwide study

2021 ◽  
Author(s):  
Isabell Brikell ◽  
Theresa Wimberley ◽  
Clara Albinana ◽  
Bjarni Johann Vilhjalmsson ◽  
Esben Agerbo ◽  
...  
Keyword(s):  
Risk Factors ◽  
Risk Factor ◽  
General Population ◽  
Population Sample ◽  
Autoimmune Disorder ◽  
Psychosocial Risk Factors ◽  
Psychosocial Risk ◽  
Psychiatric History ◽  
Cox Models ◽  
Associated Risk Factors

Background: ADHD is multifactorial, yet the interplay ADHD polygenic risks scores (ADHD-PRS) and other ADHD associated risk-factors remains relatively unexplored. The aim of this study was to investigate associations, confounding and interactions of ADHD-PRS with birth, somatic and psychosocial risk-factors previously associated with ADHD. Methods: Participants came from the Danish iPSYCH2012 case-cohort, including a randomly selected general population sample (N=21,578), and all ADHD cases with an ICD-10 diagnosis F90.0 (N=13,697), born in Denmark 1981-2005. We derived ADHD-PRS and identified 25 ADHD risk-factors in Danish national registers. Logistic regression was used to estimate associations of ADHD-PRS with each risk-factors in the general population. Cox models were applied in the full case-cohort to evaluate confounding of risk-factor associations by ADHD-PRS and family psychiatry history, and interactions between ADHD-PRS and each risk-factor. Results: ADHD-PRS was associated with 14 out of 25 ADHD risk-factors in the general population, e.g., maternal autoimmune disorder, mild traumatic brain injury (TBI), and most psychosocial risk-factors. In the full case-cohort, 21 risk-factors were associated with ADHD diagnosis. Adjusting for ADHD-PRS and parental psychiatric history only led to minor attenuations of these associations. Interactions were observed between ADHD-PRS and sex, maternal autoimmune disease, TBI, paternal employment and age at child-birth. Conclusion: Higher ADHD-PRS is associated with exposure to certain birth and somatic ADHD risk-factors, and broadly to psychosocial adversity. Evidence of gene-environment interactions were weak and ADHD-PRS and/or family psychiatric history have limited confounding effect on ADHD risk-factor associations, suggesting that majority of the investigated risk-factors act largely independently of ADHD-PRS to increase risk of ADHD.

Cancer in agricultural populations

2020 ◽  
pp. 837-837
Author(s):  
K. . Togawa
Keyword(s):  
Risk Factors ◽  
General Population ◽  
Cohort Studies ◽  
Health Effects ◽  
Cancer Incidence ◽  
Lower Prevalence ◽  
International Consortium ◽  
Adverse Health Effects ◽  
Specific Cancer ◽  
Cancer Types

Agricultural workers can be exposed to a wide variety of agents (e.g. pesticides), some of which may have adverse health effects, such as cancer. To study the health effects of agricultural exposures, an international consortium of agricultural cohort studies, AGRICOH, was established. The present analysis compared cancer incidence between the AGRICOH cohorts and the general population and found lower overall cancer incidence in the AGRICOH cohorts, with some variation across cohorts for specific cancer types. The observed lower cancer incidence may be due to healthy worker bias or lower prevalence of risk factors in the agricultural populations. Further analysis is underway.

scholarly journals Premature STEMI in Men and Women: Current Clinical Features and Improvements in Management and Prognosis

2021 ◽  
Vol 10 (6) ◽  
pp. 1314
Author(s):  
Rebeca Lorca ◽  
Isaac Pascual ◽  
Andrea Aparicio ◽  
Alejandro Junco-Vicente ◽  
Rut Alvarez-Velasco ◽  
...  
Keyword(s):  
Risk Factors ◽  
Cardiovascular Risk ◽  
Coronary Artery ◽  
General Population ◽  
Cardiovascular Risk Factors ◽  
Young Women ◽  
Artery Dissection ◽  
Men And Women ◽  
High Prevalence

Background: Coronary artery disease (CAD) is the most frequent cause of ST-segment elevation myocardial infarction (STEMI). Etiopathogenic and prognostic characteristics in young patients may differ from older patients and young women may present worse outcomes than men. We aimed to evaluate the clinical characteristics and prognosis of men and women with premature STEMI. Methods: A total 1404 consecutive patients were referred to our institution for emergency cardiac catheterization due to STEMI suspicion (1 January 2014–31 December 2018). Patients with confirmed premature (<55 years old in men and <60 in women) STEMI (366 patients, 83% men and 17% women) were included (359 atherothrombotic and 7 spontaneous coronary artery dissection (SCAD)). Results: Premature STEMI patients had a high prevalence of classical cardiovascular risk factors. Mean follow-up was 4.1 years (±1.75 SD). Mortality rates, re-hospitalization, and hospital stay showed no significant differences between sexes. More than 10% of women with premature STEMI suffered SCAD. There were no significant differences between sexes, neither among cholesterol levels nor in hypolipemiant therapy. The global survival rates were similar to that expected in the general population of the same sex and age in our region with a significantly higher excess of mortality at 6 years among men compared with the general population. Conclusion: Our results showed a high incidence of cardiovascular risk factors, a high prevalence of SCAD among young women, and a generally good prognosis after standardized treatment. During follow-up, 23% suffered a major cardiovascular event (MACE), without significant differences between sexes and observed survival at 1, 3, and 6 years of follow-up was 96.57% (95% CI 94.04–98.04), 95.64% (95% CI 92.87–97.35), and 94.5% (95% CI 91.12–97.66). An extra effort to prevent/delay STEMI should be invested focusing on smoking avoidance and optimal hypolipemiant treatment both in primary and secondary prevention.

scholarly journals Cardiovascular disease risk factors of ultra-Orthodox Jewish women in Israel: a comparison study

2020 ◽  
Vol 30 (Supplement_5) ◽  
Author(s):  
E Leiter ◽  
K L Greenberg ◽  
M Donchin ◽  
O Keidar ◽  
S Siemiatycki ◽  
...  
Keyword(s):  
Risk Factors ◽  
Cardiovascular Disease ◽  
General Population ◽  
Secondhand Smoke ◽  
Smoke Exposure ◽  
Orthodox Jewish ◽  
Minority Population ◽  
Secondhand Smoke Exposure ◽  
Community Based ◽  
Increased Risk

Abstract Background Women from low socio-economic, culturally insular populations are at increased risk for cardiovascular disease (CVD). The ultra-Orthodox Jewish (UOJ) community in Israel is a difficult to access, rapidly growing low socio-economic, insular minority with numerous obstacles to health. The current study investigates CVD-related risk factors (RF) in a sample of OUJ women, comparing sample characteristics with the general population. Addressing the questions, 'Are UOJ women at increased risk for CVD?', 'Which RFs should be addressed beyond the general population's?', this study can inform public health initiatives (PHI) for this and similar populations. Methods Self-administered questionnaires completed by a cluster randomized sample of 239 women from a UOJ community included demographics, fruit, vegetables, and sweetened drink consumption, secondhand smoke exposure, physical activity (PA) engagement, and BMI. Population statistics utilized for comparison of demographic and cardiovascular risk factors were obtained from government-sponsored national surveys. Results Compared with the general population, UOJ women were less likely to consume 5 fruits and vegetables a day (12.7% vs. 24.3%, p&lt;.001) and more likely to consume &gt; 5 cups of sweetened beverages a day (18.6% vs. 12.6%, p=.019). UOJ women also reported less secondhand smoke exposure (7.2% vs. 51.4%, p&lt;.001) and higher rates of PA recommendation adherence (60.1% vs. 25.6%, p&lt;.0001) than the general population. Obesity was higher in UOJ women (24.3% vs. 16.1%, p&lt;.0001). Conclusions This study suggests that PHIs in this population target healthy weight maintenance, nutrition, and PA. As a consequence of this study, the first CVD prevention intervention has been implemented in this population, targeting the identified RFs. Utilizing a mixed methods and community-based participatory approach, this innovative 3-year intervention reached over 2,000 individuals. Key messages This study identified nutrition risk behaviors and high levels of obesity in a difficult to access, minority population. This study informed the planning and implementation of a community-based PHI.

The physiopathology of spontaneous hemorrhagic stroke: a systematic review

2021 ◽  
Vol 0 (0) ◽  
Author(s):  
Alcivan Batista de Morais Filho ◽  
Thiago Luis de Holanda Rego ◽  
Letícia de Lima Mendonça ◽  
Sulyanne Saraiva de Almeida ◽  
Mariana Lima da Nóbrega ◽  
...  
Keyword(s):  
Risk Factors ◽  
Systematic Review ◽  
Ischemic Stroke ◽  
Subarachnoid Hemorrhage ◽  
Natural History ◽  
Hemorrhagic Stroke ◽  
Recent Literature ◽  
Clinical Manifestations ◽  
The Road ◽  
History Of

Abstract Hemorrhagic stroke (HS) is a major cause of death and disability worldwide, despite being less common, it presents more aggressively and leads to more severe sequelae than ischemic stroke. There are two types of HS: Intracerebral Hemorrhage (ICH) and Subarachnoid Hemorrhage (SAH), differing not only in the site of bleeding, but also in the mechanisms responsible for acute and subacute symptoms. This is a systematic review of databases in search of works of the last five years relating to the comprehension of both kinds of HS. Sixty two articles composed the direct findings of the recent literature and were further characterized to construct the pathophysiology in the order of events. The road to the understanding of the spontaneous HS pathophysiology is far from complete. Our findings show specific and individual results relating to the natural history of the disease of ICH and SAH, presenting common and different risk factors, distinct and similar clinical manifestations at onset or later days to weeks, and possible complications for both.

Sign in / Sign up

Export Citation Format

Share Document