scholarly journals Cerebrovascular Accident and SARS-CoV-19 (COVID-19): A Systematic Review

2021 ◽  
pp. 1-8
Author(s):  
Amira Athanasios ◽  
Ivy Daley ◽  
Anjali Patel ◽  
Olu Oyesanmi ◽  
Parth Desai ◽  
...  
Keyword(s):  
Risk Factor ◽  
Cerebrovascular Accident ◽  
Case Series ◽  
Severity Of Illness ◽  
Epidemiologic Factors ◽  
Search Terms ◽  
Increased Risk ◽  
Comparable Control ◽  
Novel Coronavirus ◽  
Preexisting Conditions

<b><i>Background:</i></b> While the most common neurologic symptoms reported in patients affected by SARS-CoV-2 are headache, dizziness, myalgia, mental fog, and anosmia, there is a growing basis of published peer-reviewed cases reporting stroke in the setting of SARS-CoV-2 infection. The peer-reviewed literature suggests an increased risk of cerebrovascular accident (CVA) in the setting of COVID-19 infection. <b><i>Methods:</i></b> We searched 3 databases (PubMed, MEDLINE, and CINAHL) with search terms COVID-19, novel coronavirus, stroke, and cerebrovascular accident. Case series and case studies presenting patients positive for both COVID-19 and CVA published from January 1 through September 1, 2020, were included. Data collection and analysis was completed and risk of bias assessed. <b><i>Results:</i></b> The search identified 28 studies across 7 counties comprising 73 patients. Amongst patients hospitalized for COVID-19 infection and CVA, the average age was 60; the most common preexisting conditions were hypertension and diabetes mellitus, and those without preexisting conditions were significantly younger with an average age of 47. Amongst hospitalized patients with COVID-19 and CVA, there was a bimodal association with COVID-19 infection severity with majority of patients classified with mild or critical COVID-19 infection. <b><i>Discussion:</i></b> The data suggest SARS-CoV-2 is a risk factor for developing stroke, particularly in patients with hypertension and diabetes. Furthermore, the younger average age of stroke in patients with SARS-CoV-2, particularly those patients with zero identifiable preexisting conditions, creates high suspicion that SARS-CoV-2 is an independent risk factor for development of stroke; however, this cannot yet be proven without comparable control population. The data suggest the risk of developing CVA in the setting of COVID-19 infection is not dependent upon severity of illness. Continued studies must be done to understand the epidemiologic factors of COVID-19 infection and stroke and the pathophysiology of the COVID-associated hypercoagulable state.

scholarly journals Type II Odontoid Fractures Case Series: History of Seizures a Risk Factor for Failure of Non-operative Treatment of Type II Odontoid Fractures

2021 ◽  
Vol 11 (9) ◽  
Author(s):  
Matthew A. Prevost ◽  
John G. DeVine ◽  
Uzondu F. Agochukwu ◽  
Jacob C. Rumley
Keyword(s):  
Risk Factor ◽  
Case Series ◽  
Odontoid Fracture ◽  
Type Ii ◽  
Odontoid Fractures ◽  
Non Union ◽  
Fracture Displacement ◽  
Increased Risk ◽  
Cervical Orthosis ◽  
History Of

Introduction:Odontoid fractures are one of the most common injuries to the cervical spine. Type II odontoid fracture treatment varies depending on age, co-morbidities, and fracture morphology. Treatment ranges from cervical orthosis to surgical intervention. Currently fractures with high non-union rates are considered for operative management which includes displacement of >6 mm, increasing age (>40-60 years), fracture gap >1 mm, delay in treatment >4 days, posterior re-displacement >2 mm, increased angulation, and history of smoking. While re-displacement of >2 mm has been associated with increased risk of non-union;, to the best of our knowledge, no studies have looked at the risk factors for re-displacement. Case Report:We present two 26-year-old male patients who were found to have minimally displaced type II odontoid fractures initially treated in a cervical collar. These two patients were subsequently found to have displaced their odontoid fracture after having a documented seizure. Conclusion:We suggest that a history of seizures be considered a risk factor for re-displacement of non-displaced type II odontoid fractures. Keywords:Operative indications odontoid case report, Type II odontoid fracture, Displacement, Seizure, Odontoid fracture displacement, Nondisplaced type ? odontoid fracture.

scholarly journals AstraZeneca COVID-19 vaccine: A possible risk factor for Stroke, Case Series

2021 ◽  
Author(s):  
Amira Siddig Omer ◽  
Abbasher Hussien Mohamed Ahmed ◽  
Khabab Mohamed Ahmed ◽  
Abdallah M. Abdallah ◽  
Mohamed Malekaldar ◽  
...  
Keyword(s):  
Risk Factor ◽  
Cerebrovascular Accident ◽  
Case Series ◽  
Neurological Deficits ◽  
Stroke Case

Cerebrovascular accident (CVA) is one of the commonest neurological deficits. There is a well-known association between COVID-19 and stroke. We present a case series of Sudanese patients who developed CVA after receiving the AstraZeneca COVID-19 vaccine suggesting a relationship between the vaccine and CVA.

scholarly journals Risk factors for illness severity in patients with COVID-19 pneumonia: a prospective cohort study

2020 ◽  
Author(s):  
Nannan Zhang ◽  
Hairong Zhang ◽  
Yanhua Tang ◽  
Hao Zhang ◽  
Aiying Ma ◽  
...  
Keyword(s):  
Risk Factors ◽  
Disease Severity ◽  
Case Series ◽  
Severity Of Illness ◽  
Illness Severity ◽  
Laboratory Findings ◽  
Factors Associated ◽  
Detection And Identification ◽  
Disease Hospital ◽  
Novel Coronavirus

Abstract Background Although COVID-19 pneumonia is spreading internationally, knowledge regarding the factors associated with the illness severity of patients remains limited. We aimed to identify the factors associated with the disease severity of patients with COVID-19 pneumonia induced by a novel coronavirus, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Methods We prospectively enrolled a single-center case series of adult patients with COVID-19 admitted to the Infectious Disease Hospital of Jining, Jining City, Shandong Province, China, from January 24 to March 1, 2020. Demographics, clinical characteristics, and laboratory findings were compared to investigate the risk factors related with the disease severity of COVID-19 pneumonia patients. Results We included a total of 78 patients with COVID-19 pneumonia, of whom 6 had the severe type. As compared to a moderately ill cohort, our analysis showed that shortness of breath, fatigue, neutrophil percentages > 70%, neutrophil counts > 6.3 × 10 9 /L, lymphocyte percentages < 20%, lymphocyte counts < 1.0 × 10 9 /L, platelet < 100 × 10 9 /L, C-reactive protein (CRP) > 10 mg/L, neutrophil to platelet ratio (NPR) > 2.3, neutrophil to lymphocyte ratio (NLR) > 3.9, aspartate aminotransferase (AST) > 40 U/L, albumin < 40 g/L, lactate dehydrogenase (LDH) > 245 U/L, and glucose > 6.1 mmol/L were predictors of disease severity in COVID-19 pneumonia. In the sex-, age-, and comorbid illness-matched case-control study, neutrophil percentages > 70%, neutrophil counts > 6.3 × 10 9 /L, lymphocyte percentages < 20%, NPR > 2.3, NLR > 3.9, albumin < 40 g/L, and LDH > 245 U/L remained associated with the early detection and identification of severe patients. Conclusion We demonstrated that neutrophil percentages > 70%, neutrophil counts > 6.3×10 9 /L, lymphocyte percentages < 20%, NPR > 2.3, NLR > 3.9, albumin < 40 g/L, and LDH > 245 U/L might predict the severity of illness in patients with COVID-19 pneumonia.

scholarly journals Unilateral Levator Aponeurosis Excision for Marcus Gunn Syndrome and Risk Factors of Residual Jaw Winking

2019 ◽  
Vol 2019 ◽  
pp. 1-9
Author(s):  
Qingyao Ning ◽  
Jing Cao ◽  
Jiajun Xie ◽  
Qi Gao ◽  
Changjun Wang ◽  
...  
Keyword(s):  
Risk Factors ◽  
Risk Factor ◽  
Strong Association ◽  
Case Series ◽  
Increased Risk ◽  
Frontalis Suspension ◽  
Silicone Rod ◽  
Independent Risk Factors ◽  
Levator Aponeurosis

Purpose. To investigate the association of ptosis, levator, and jaw winking in Marcus Gunn jaw-winking synkinesis (MGJWS), and the risk factor of preservation and outcomes of the unilateral levator excision and frontalis suspension.Methods. Clinical features of MGJWS case series from 2011 to 2018 were retrospectively reviewed. Association between jaw winking and ptosis/levator function was statistically analyzed. The patients underwent unilateral levator excision and frontalis suspension using silicone rod or autogenous fascia lata. Clinical outcomes were evaluated in operated patients and the independent risk factors of residual jaw winking were investigated after a long follow-up.Results. There were 42 MGJWS patients in 2011 to 2018, accounting for 2.87% of all congenital blepharoptosis. 80% of mild jaw winking was accompanied with mild ptosis and fair levator function, and moderate-to-severe jaw winking was often accompanied with moderate-to-severe ptosis and poor levator function (P<0.05). Ptosis showed a strong association with excursion of jaw winking (R = 0.785,P<0.01). Jaw winking was resolved in all 34 operated patients with good correction of ptosis. Severity of jaw winking is an independent risk factor for the residual synkinesis after surgery. Severe preoperative jaw winking had an 18.05 times increased risk of postoperative residual synkinesis compared with moderate jaw winking (P<0.05).Conclusions. In MGJWS eyelid excursion of jaw winking has a direct correlation with ptosis and dysfunction of levator muscle. Unilateral levator aponeurosis excision and frontalis suspension is an efficient approach for MGJWS. Severe jaw winking is a risk factor of residual eyelid synkinesis after surgery.

scholarly journals 2430. Comorbidity and Severity of Illness Risk Adjustment for Hospital-Onset Clostridioides difficile Infection

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S840-S840
Author(s):  
Stephanie Cabral ◽  
Gita Nadimpalli ◽  
Kerri Thom ◽  
Surbhi Leekha ◽  
Lisa Harris ◽  
...  
Keyword(s):  
Risk Factors ◽  
Risk Factor ◽  
Risk Adjustment ◽  
Eligible Patient ◽  
Significant Risk ◽  
Severity Of Illness ◽  
Significant Risk Factor ◽  
Patient Admissions ◽  
Increased Risk ◽  
Binomial Regression

Abstract Background Hospital-onset C. difficile infection (HO-CDI) rates are publicly reported. However, patient-level risk factors are not included in the current risk adjustment methodology, and the knowledge as to which risk factors to include is incomplete. This study aimed to determine whether electronically-available comorbidities and laboratory indicators of severity of illness are risk factors for HO-CDI. Methods We performed a retrospective cohort study of all adult patients admitted to three hospitals (one academic, two community) in Baltimore, Maryland between January 1, 2016 and January 1, 2018. Information extracted from electronic medical records included demographics, ICD-10 codes, laboratory results within 24 hours of admission (i.e., hematocrit, hemoglobin, platelet count, leukocytes, BUN, CO2, creatinine, glucose, sodium, and potassium), medication administration (i.e., antibiotic and antacid use), and C. difficile test result. Comorbid conditions were assessed by the Elixhauser Comorbidity Index components. HO-CDI was defined by positive laboratory test > 3 days after admission. Potential risk factors for HO-CDI were assessed using bivariate log binomial regression. Multivariable log binomial regression was conducted using significant (P < 0.1) covariates. Results At hospital 1 (academic), 314 of the 48,057 (0.65%) eligible patient admissions had HO- CDI; 41 of the 8,791 (0.47%) and 75 of the 29,211 (0.26%) of patient admissions at community hospitals 2 and 3, respectively, had HO-CDI. In multivariable analysis, Elixhauser Score was a significant risk factor for HO-CDI at all hospitals when controlling for antibiotic and antacid use; for every one-point increase in Elixhauser Score, there was an increased risk of HO-CDI of 1.27 (95% CI: 1.21, 1.32) at hospital 1, 1.38 (95% CI: 1.24, 1.54) at hospital 2, and 1.28 (95% CI: 1.10, 1.31) at hospital 3. Table 1 shows significant risk factors for HO-CDI for each hospital. When individual comorbidities were assessed in the regression analysis, fluid and electrolyte disorders were a significant risk factor for HO-CDI for all hospitals. Conclusion Laboratory values upon admission and electronically available patient comorbidities are important risk factors for HO-CDI and should be considered for future risk adjustment. Disclosures All authors: No reported disclosures.

scholarly journals Lipoprotein(a) as a Risk Factor for Venous Thromboembolism: A Systematic Review and Meta-analysis of the Literature

2017 ◽  
Vol 43 (06) ◽  
pp. 614-620 ◽  
Author(s):  
Vera Gessi ◽  
Rossella Marcucci ◽  
Monica Gianni ◽  
Anna Grandi ◽  
Massimo Franchini ◽  
...  
Keyword(s):  
Systematic Review ◽  
Risk Factor ◽  
Venous Thromboembolism ◽  
Case Reports ◽  
Random Effect ◽  
Random Effect Model ◽  
Case Series ◽  
Lipoprotein A ◽  
Increased Risk ◽  
Venous Thromboembolic Events

AbstractElevated plasma levels of lipoprotein(a) (Lp(a)) are associated with increased cardiovascular risk in several clinical studies. However, there is a lack of data supporting a positive association between elevated Lp(a) levels and venous thromboembolism (VTE). Thus, we conducted a systematic review of the literature to better clarify its role as a risk factor for VTE. Medline and the Embase (up to May 2015) electronic databases were used to identify potentially eligible studies. Studies measuring Lp(a) values in adult patients with deep vein thrombosis and/or pulmonary embolism and in a population of patients without a VTE were selected. Studies on patients with major venous thromboembolic events occurring at other unusual site, case reports, and case series were excluded. The odds ratios (ORs) of the association between high values of Lp(a) and VTE and the weighted mean difference (WMD) in Lp(a) levels in cases and in controls were calculated using a random-effect model. Results were presented with 95% confidence interval (CI). Fourteen studies for a total of more than 14,000 patients were finally included in our analysis. Lp(a) was slightly but significantly associated with an increased risk of VTE (OR: 1.56, 95% CI: 1.36, 1.79; 10 studies, 13,541 patients). VTE patients had significantly higher Lp(a) values compared with controls (WMD: 14.46 mg/L, 95% CI: 12.14, 16.78; 4 studies, 470 patients). Lp(a) appeared to be significantly associated with increased risk of VTE. However, Lp(a) levels were only slightly increased in VTE patients compared with controls.

Increased risk of infective endocarditis after traumatic skin wound

Heart ◽  
2021 ◽  
pp. heartjnl-2020-318632
Author(s):  
Hiroyuki Ohbe ◽  
Masao Iwagami ◽  
Yusuke Sasabuchi ◽  
Hideo Yasunaga
Keyword(s):  
Risk Factor ◽  
Infective Endocarditis ◽  
Case Series ◽  
Baseline Period ◽  
Skin Wound ◽  
Current Data ◽  
Infectious Endocarditis ◽  
Skin Wounds ◽  
Increased Risk ◽  
Rate Ratios

ObjectiveCurrent data suggest that a history of traumatic open skin wounds may be a risk factor for infectious endocarditis, with limited evidence. We tested the hypothesis that traumatic skin wound is a risk factor for infectious endocarditis.MethodsUsing the Japan Medical Data Center (JMDC) database (4 650 927 people aged 20–64 years, 2012–2018) and the Kumamoto database (493 414 people aged ≥65 years, 2012–2017), we conducted nested case–control and self-controlled case series (SCCS) analyses.ResultsIn the JMDC database, 544 cases hospitalised for infective endocarditis (IE) were matched with 2091 controls; 2.8% of cases and 0.5% of controls were exposed to traumatic skin wounds in the previous 1–4 weeks, with an adjusted OR of 4.31 (95% CI 1.74 to 10.7). In the Kumamoto database, 4.0% (27/670) of cases and 1.1% (29/2581) of controls were exposed to traumatic skin wounds in the previous 1–4 weeks, with an adjusted OR of 4.15 (95% CI 2.04 to 8.46). In the SCCS, the incidence rate ratios for IE were 2.61 (95% CI 1.67 to 4.09), 1.73 (95% CI 1.01 to 2.94), 1.19 (95% CI 0.63 to 2.27) and 1.52 (95% CI 0.82 to 2.74) for the Kumamoto database and 3.78 (95% CI 2.07 to 6.92), 1.58 (95% CI 0.64 to 3.89), 1.60 (95% CI 0.65 to 3.94) and 1.29 (95% CI 0.47 to 3.53) for the JMDC database at 1–4, 5–8, 9–12 and 13–16 weeks after traumatic skin wound, respectively, compared with the baseline period.ConclusionsThis study suggests that traumatic skin wound is a risk factor for IE 1–4 weeks after the wound.

scholarly journals AstraZeneca COVID-19 vaccine: A possible risk factor for Stroke, Case Series from Sudan

2021 ◽  
Author(s):  
Amira Siddig Omer ◽  
Abbasher Hussien Mohamed Ahmed ◽  
Khabab Mohamed Ahmed ◽  
Abdallah M. Abdallah ◽  
Mohamed Malekaldar ◽  
...  
Keyword(s):  
Risk Factor ◽  
Cerebrovascular Accident ◽  
Case Series ◽  
Neurological Deficits ◽  
Stroke Case

Cerebrovascular accident (CVA) is one of the commonest neurological deficits. There is a well-known association between COVID-19 and stroke. We present a case series of Sudanese patients who developed CVA after receiving the AstraZeneca COVID-19 vaccine suggesting a relationship between the vaccine and CVA.

scholarly journals AstraZeneca COVID-19 vaccine: A possible risk factor for Stroke, Case Series from Sudan

2021 ◽  
Author(s):  
Amira Siddig ◽  
Abbasher Hussien ◽  
Khabab Abbasher Hussien Mohamed Ahmed ◽  
Mazin S. Hassan Haroun ◽  
Mustafa Mohamed Ibrahim Ali ◽  
...  
Keyword(s):  
Risk Factor ◽  
Cerebrovascular Accident ◽  
Case Series ◽  
Neurological Deficits ◽  
Stroke Case

Abstract Cerebrovascular accident (CVA) is one of the commonest neurological deficits. There is a well-known association between COVID-19 and stroke. We present a case series of Sudanese patients who developed CVA after receiving the AstraZeneca COVID-19 vaccine suggesting a relationship between the vaccine and CVA.

scholarly journals Signal for a Different Risk of Thrombosis Between Eltrombopag and Romiplostim

Blood ◽  
2014 ◽  
Vol 124 (21) ◽  
pp. 2170-2170
Author(s):  
Thi Thanh Loan N'Guyen ◽  
Maryse Lapeyre-Mestre ◽  
François Montastruc ◽  
Jean-Louis Montastruc ◽  
Guillaume Moulis
Keyword(s):  
Adverse Drug Reaction ◽  
Drug Reaction ◽  
Risk Factor ◽  
Oral Contraceptive ◽  
Venous Thrombosis ◽  
Cerebrovascular Accident ◽  
Arterial Thrombosis ◽  
Increased Risk ◽  
Pharmacovigilance Database ◽  
Venous Thromboses

Abstract Introduction:Eltrombopag and romiplostim are two thrombopoietin receptor agonists (TPO-RAs) marketed for the treatment of immune thrombocytopenia (ITP). Thrombotic events have been reported with both drugs. Whether there exists a differential risk of thrombosis between the two TPO-RAs is unknown. Indeed, there exist pharmacological arguments to sustain a differential risk: i) the two drugs have different structures and different sites of action: romiplostim is an Fc-peptide fusion protein binding to the extracellular TPO receptor domain, while eltrombopag is a small non-peptide molecule that binds to a transmembrane site of the TPO receptor; ii) consequently the intracellular signaling pathways activated by TPO-RAs are not strictly identical in vitro; iii) in clinical practice, a patient who stops a given TPO-RA due to inefficacy, adverse drug reaction (ADR) or important platelet fluctuations can be efficiently rechallenged with the other TPO-RA; and iv) a disproportionality study carried out in the French PharmacoVigilance Database suggested a signal for a different pattern of ADRs between the two drugs. The aim of this study was to assess whether there exists a signal for a different risk of thrombosis, arterial thrombosis, venous thrombosis, ischemic stroke (IS) and myocardial infarction (MI) between romiplostim and eltrombopag. Methods:We carried out a disproportionality analysis (case/non-case method) in the World Health Organization PharmacoVigilance Database (VigiBase®). We selected all the adverse drug reaction (ADR) reports with exposure to eltrombopag or romiplostim between 01 January 2011 and 31 December 2013. Cases were all reports of thrombosis, identified thanks to validated standardized queries and checked by two independent investigators. Non-cases were all other reports. We searched an exposure to eltrombopag (versus romiplostim) in cases and in non-cases, allowing the calculation of Reporting Odds Ratios (RORs). All analyses were adjusted on thrombotic risk factors recorded in the database: age, gender, indication, exposure to oral contraceptive, danazol, polyvalent immunoglobulins, and other pro-thrombotic drugs. We conducted two sensitivity analyses: one restricted to cases and non-cases reported by physicians, and one including the reports of "cerebrovascular accident" among the cases. Results: Out of 2 733 224 ADR reports colligated in VigiBase®during the study period, 4714 were included in the study. TPO-RA indication was ITP in 96.6% of the reports. We found 598 cases of thrombosis: 203 arterial thromboses (94 IS and 110 MI) and 324 venous thrombosis. Among the 324 venous thromboses, 131 (40.4%) were pulmonary embolisms, 45 (13.9%) portal thromboses, and 17 (5.2%) cerebral venous thromboses were found. In multivariate analyses, there was an increased risk of thrombosis (ROR=1.46; 95% CI [1.18-1.82]) and venous thrombosis (ROR=1.46; 95% CI [1.10-1.94]) with eltrombopag. There was no statistically significant difference between the two TPO-RAs regarding arterial thrombosis (ROR=1.29; 95% CI [0.89-1.87]), IS (ROR=1.28; 95% CI [0.79-2.05]) and MI (ROR=1.53; 95% CI [0.96-2.43]). Age was independently associated with the risk of thrombosis. Female gender was a risk factor for venous thrombosis (ROR=1.55; 95% CI [1.16-2.06]); in contrast, it was a protective factor for arterial thrombosis (ROR=0.65; 95% CI [0.44-0.94]) and MI (ROR=0.55; 95% CI [0.34-0.90]). Exposure to oral contraceptive was also an independent risk factor for venous thrombosis (ROR=3.45; 95% CI [1.20-9.90]). Exposure to IVIg was associated with MI (ROR=2.13; 95% CI [1.23-3.68]). When we restricted to ADRs reported by physicians, all ROR measures were slightly increased (overall thrombosis: ROR=2.07; 95% CI [1.60-2.69]; venous thrombosis: ROR=2.02; 95% CI [1.44-2.83]), reaching significance for arterial thrombosis (ROR=1.58; 95% CI [1.01-2.48]) and IS (ROR=2.00; 95% CI [1.16-3.44]). Inclusion of the 45 reports of "cerebrovascular accident" did not influence the results (data not shown). Conclusions: This study suggests a signal for an increased risk of thrombosis with eltrombopag compared to romiplostim, that must be confirmed by population-based pharmacoepidemiological studies. Disclosures No relevant conflicts of interest to declare.

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