This study analyzed the causes of stroke in 50 young patients aged 15-35 years at a tertiary hospital in Pakistan. The most common cause of stroke was infective meningitis (34%), primarily tuberculosis meningitis. The second most common cause was cardioembolism (20%), mainly due to valvular heart disease. Other major causes included hypertension (14%), pregnancy-related conditions (12%), and systemic lupus erythematosus (4%). Overall, infectious diseases were the leading cause of stroke in this young patient population.
This document summarizes a study comparing clinical characteristics of hypertensive intracerebral hemorrhage (ICH) in young patients versus older patients. The study found that young patients had higher blood pressures, smaller hemorrhage volumes, lower rates of ventricular extensions, and a different distribution pattern of ICH locations. Mortality was lower in young patients but they had more disabling outcomes. The findings suggest there are age-related differences in the pathogenesis of hypertensive ICH.
This document summarizes a study comparing characteristics of hypertensive intracerebral hemorrhage (ICH) in very elderly patients (age 80-99 years) versus younger controls (under age 80). Some key differences were found: very elderly patients had fewer cases of obesity and diabetes, and lower blood pressure measures. They also had more cases of hematoma extension into ventricles. Thalamic hemorrhage was more common in very elderly patients. Factors like age, Glasgow Coma Scale score, ICH volume, and infratentorial location independently predicted in-hospital mortality for all patients.
This document summarizes a study comparing characteristics of hypertensive intracerebral hemorrhage (ICH) in very elderly patients (age 80-99 years) versus younger controls (under age 80). Some key differences were found: very elderly patients had fewer cases of obesity and diabetes, and lower blood pressure measures. They also had more cases of hematoma extension into ventricles. Thalamic hemorrhage was more common in very elderly patients. Factors like age, Glasgow Coma Scale score, ICH volume, and infratentorial location independently predicted in-hospital mortality for all patients.
PVCs are common, occurring in 40-75% of the general population on Holter monitoring. While traditionally thought to be benign without structural heart disease, they represent an increased risk of sudden death in patients with conditions like ischemic heart disease. The frequency and complexity of PVCs is associated with increased mortality in these patients. Implantable cardioverter defibrillators are indicated for those with nonsustained ventricular tachycardia due to prior myocardial infarction and left ventricular ejection fraction ≤40% who are inducible for sustained ventricular arrhythmias on electrophysiological study. However, for patients with congestive heart failure, PVCs do not provide significant prognostic value beyond clinical variables. The concept of PVC-induced
This study analyzed 231 patients with aneurysmal subarachnoid hemorrhage (SAH) from 25 Mexican hospitals to describe clinical characteristics, risk factors, and outcomes. Hypertension was the main risk factor associated with SAH. Most aneurysms (92%) were located in the anterior circulation and 15% of patients had multiple aneurysms. The median hospital stay was 23 days. Invasive treatments like clipping or coiling were performed in 69% of patients. The in-hospital mortality rate was 20% due to neurological causes. 25% of patients were discharged with significant neurological impairment.
This document summarizes a research article that proposes a new hypothesis for studying sudden heart pathology. The authors suggest developing a new diagnostic test that can stress the heart's metabolic processes under normal and abnormal conditions locally within the heart tissue, rather than examining blood plasma. This could help prevent events like heart attacks, arrhythmias, and transplant failure by better understanding the heart's metabolic response under stress. Currently about 20% of sudden cardiac deaths are not explained by autopsy findings, so new testing of the heart's metabolic response directly may provide more insights into these cases. The authors believe translating diagnostic approaches from other medical fields could offer a novel perspective on phenomena in cardiology.
This literature review summarizes the clinical characteristics of myocardial stunning (neurogenic stunned myocardium or NSM) seen in patients after acute ischemic stroke. The review identified 7 case reports/series describing a total of 13 patients with NSM following stroke. Key findings include that NSM after stroke was more common in older females, with involvement of the left ventricle apex. Less than half of cases involved the insular cortex. Troponin levels and left ventricular dysfunction were typically mild. Most patients showed significant left ventricular recovery within 4 weeks, indicating a generally favorable prognosis. However, larger prospective studies are still needed.
Ischaemic Stroke in the Very Elderly PatientsAde Wijaya
Stroke is common in the very elderly population and presents unique challenges. Risk factors like atrial fibrillation and hypertension are more prevalent. Outcomes are generally poorer with higher mortality rates over 80 and 90 years of age. While intravenous thrombolysis can improve outcomes in those 81-90, it does not for those over 90. Endovascular therapy can allow over a quarter of those over 80 to regain independence, though outcomes are inferior to younger patients. Guidelines support oral anticoagulation for atrial fibrillation in the very elderly, and direct oral anticoagulants are recommended over warfarin with a better safety profile. Treatment is otherwise similar but requires more careful assessment.
This document summarizes a study comparing clinical characteristics of hypertensive intracerebral hemorrhage (ICH) in young patients versus older patients. The study found that young patients had higher blood pressures, smaller hemorrhage volumes, lower rates of ventricular extensions, and a different distribution pattern of ICH locations. Mortality was lower in young patients but they had more disabling outcomes. The findings suggest there are age-related differences in the pathogenesis of hypertensive ICH.
This document summarizes a study comparing characteristics of hypertensive intracerebral hemorrhage (ICH) in very elderly patients (age 80-99 years) versus younger controls (under age 80). Some key differences were found: very elderly patients had fewer cases of obesity and diabetes, and lower blood pressure measures. They also had more cases of hematoma extension into ventricles. Thalamic hemorrhage was more common in very elderly patients. Factors like age, Glasgow Coma Scale score, ICH volume, and infratentorial location independently predicted in-hospital mortality for all patients.
This document summarizes a study comparing characteristics of hypertensive intracerebral hemorrhage (ICH) in very elderly patients (age 80-99 years) versus younger controls (under age 80). Some key differences were found: very elderly patients had fewer cases of obesity and diabetes, and lower blood pressure measures. They also had more cases of hematoma extension into ventricles. Thalamic hemorrhage was more common in very elderly patients. Factors like age, Glasgow Coma Scale score, ICH volume, and infratentorial location independently predicted in-hospital mortality for all patients.
PVCs are common, occurring in 40-75% of the general population on Holter monitoring. While traditionally thought to be benign without structural heart disease, they represent an increased risk of sudden death in patients with conditions like ischemic heart disease. The frequency and complexity of PVCs is associated with increased mortality in these patients. Implantable cardioverter defibrillators are indicated for those with nonsustained ventricular tachycardia due to prior myocardial infarction and left ventricular ejection fraction ≤40% who are inducible for sustained ventricular arrhythmias on electrophysiological study. However, for patients with congestive heart failure, PVCs do not provide significant prognostic value beyond clinical variables. The concept of PVC-induced
This study analyzed 231 patients with aneurysmal subarachnoid hemorrhage (SAH) from 25 Mexican hospitals to describe clinical characteristics, risk factors, and outcomes. Hypertension was the main risk factor associated with SAH. Most aneurysms (92%) were located in the anterior circulation and 15% of patients had multiple aneurysms. The median hospital stay was 23 days. Invasive treatments like clipping or coiling were performed in 69% of patients. The in-hospital mortality rate was 20% due to neurological causes. 25% of patients were discharged with significant neurological impairment.
This document summarizes a research article that proposes a new hypothesis for studying sudden heart pathology. The authors suggest developing a new diagnostic test that can stress the heart's metabolic processes under normal and abnormal conditions locally within the heart tissue, rather than examining blood plasma. This could help prevent events like heart attacks, arrhythmias, and transplant failure by better understanding the heart's metabolic response under stress. Currently about 20% of sudden cardiac deaths are not explained by autopsy findings, so new testing of the heart's metabolic response directly may provide more insights into these cases. The authors believe translating diagnostic approaches from other medical fields could offer a novel perspective on phenomena in cardiology.
This literature review summarizes the clinical characteristics of myocardial stunning (neurogenic stunned myocardium or NSM) seen in patients after acute ischemic stroke. The review identified 7 case reports/series describing a total of 13 patients with NSM following stroke. Key findings include that NSM after stroke was more common in older females, with involvement of the left ventricle apex. Less than half of cases involved the insular cortex. Troponin levels and left ventricular dysfunction were typically mild. Most patients showed significant left ventricular recovery within 4 weeks, indicating a generally favorable prognosis. However, larger prospective studies are still needed.
Ischaemic Stroke in the Very Elderly PatientsAde Wijaya
Stroke is common in the very elderly population and presents unique challenges. Risk factors like atrial fibrillation and hypertension are more prevalent. Outcomes are generally poorer with higher mortality rates over 80 and 90 years of age. While intravenous thrombolysis can improve outcomes in those 81-90, it does not for those over 90. Endovascular therapy can allow over a quarter of those over 80 to regain independence, though outcomes are inferior to younger patients. Guidelines support oral anticoagulation for atrial fibrillation in the very elderly, and direct oral anticoagulants are recommended over warfarin with a better safety profile. Treatment is otherwise similar but requires more careful assessment.
This document discusses deep vein thrombosis (DVT) surveillance in patients with traumatic brain injury (TBI) or spinal cord injury (SCI). It outlines several challenges with diagnosing DVT in these patients, as clinical signs may be absent or difficult to assess due to their injuries. The Wells clinical prediction rule and D-dimer testing can help estimate DVT risk, though D-dimer may be elevated due to non-thrombotic factors as well. Ultrasound is the test of choice to diagnose DVT when suspected, while imaging like CT angiography or pulmonary angiography can identify pulmonary embolisms. More research is needed to develop optimal screening algorithms for this high-risk population.
05 acs and stemi treatment gender related issuesNPSAIC
1) Women often experience delays in diagnosis and treatment for acute coronary syndromes (ACS) due to atypical symptoms and a lack of awareness about heart risks in women.
2) Studies show that women with ACS are less likely to receive guideline recommended medical therapies and invasive procedures such as cardiac catheterization and PCI.
3) For both non-ST elevation myocardial infarction (NSTEMI) and ST elevation myocardial infarction (STEMI), delays in diagnosis and treatment contribute to higher mortality rates observed in women compared to men.
1) This study investigated the effect of the antiplatelet drug cilostazol on preventing worsening of symptoms (progressing stroke) in patients with acute ischemic stroke.
2) 510 patients with non-cardioembolic stroke within 24 hours of onset were randomized to receive either cilostazol 200 mg/day or no additional medication (control group) along with standard treatments.
3) The rate of progressing stroke, defined as a 4-point or greater increase in stroke severity scores on days 3 and/or 5, was lower in the cilostazol group (3.2%) compared to the control group (6.3%), but the difference was not statistically significant. Functional outcomes
This document describes a study examining acute care and one-year outcomes of patients experiencing first-ever acute ischemic stroke in Mexico. The study analyzed data from 1,040 patients enrolled in the PREMIER registry from 59 hospitals across Mexico. Key findings include:
- The most common risk factors were hypertension (64%), obesity (51%), and diabetes (35%).
- Diagnostic procedures and acute treatments like IV thrombolysis were underutilized, with only 0.5% receiving thrombolysis despite 17% arriving within 3 hours of onset.
- The 30-day case fatality rate was 15% and the one-year mortality rate was 29%. At one year, 47% had low or no
Ischaemic Stroke and Patent Foramen OvaleAde Wijaya
A patent foramen ovale (PFO) is present in 20-25% of the adult population. In patients who suffer from cryptogenic stroke, which is stroke with no identifiable cause, 40-50% are found to have a PFO. An esophageal echocardiography with bubble study is the standard non-invasive method to diagnose a PFO. The presence of an atrial septal aneurysm or Eustachian valve along with a PFO increases the risk of initial and recurrent strokes by allowing blood clots to pass from the veins to the arteries. Transcatheter closure of a PFO significantly reduces the risk of recurrent strokes in cryptogenic stroke patients compared to medical therapy alone, without increasing
Journal of Stem Cell Research and Transplantation is an international, open access, peer reviewed, scholarly journal committed to publish articles in diversified fields of transplantations and applications of stem cell research. The aim of the academic journal is to provide a platform for researchers, scientists, physicians, and other health professionals to find latest research information in the areas of stem cell research, transplantations such as stem cell transplantation, transplantation immunology, kidney transplantation and its treatment. It is a wide-ranging Open Access peer reviewed scientific journal that covers multidisciplinary fields.
Journal of Stem Cell Research and Transplantation accepts original research articles, letter to editor, review articles, mini reviews, case reports, editorials, scientific data, technical reports, rapid communication, and short communications, etc. on all the aspects of stem cells. The Journal of Stem Cell Research and Transplantation publishes latest scientific information, and is generously accessible across the world through internet to go halves the innovations of the researchers for intellectual advancement in this field. Austin also brings universally peer reviewed scientific journals under one roof thereby promoting knowledge sharing, collaborative and promotion of multidisciplinary science.
Risk Stratification in Arrhythmic Right
Ventricular Cardiomyopathy Without
Implantable Cardioverter-Defibrillators trial published in JACC, Clinical electrophysiology on 5/11/2016, published by ELSEVIER
This document discusses sudden cardiac death and proposes a new research hypothesis for drug design strategies. It summarizes current understanding of sudden cardiac death pathology from medical literature, which finds various etiologies including ventricular arrhythmias, coronary artery disease, and genetic channelopathies in about 20% of cases. The authors propose developing new diagnostic tests that can evaluate the heart's biochemical and metabolic status under normal and stressed conditions locally in the heart tissue, rather than just plasma, to help prevent unexpected cardiac events and better understand sudden cardiac death pathology. This could involve applying diagnostic strategies from other medical disciplines to cardiology.
Reversal of warfarin associated coagulopathy prothrombin complex concentratesTÀI LIỆU NGÀNH MAY
Để xem full tài liệu Xin vui long liên hệ page để được hỗ trợ
: https://www.facebook.com/thuvienluanvan01
HOẶC
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https://www.facebook.com/thuvienluanvan01
https://www.facebook.com/thuvienluanvan01
tai lieu tong hop, thu vien luan van, luan van tong hop, do an chuyen nganh
Cardioembolic cerebral infarction accounts for 14-30% of ischemic strokes. It has a high mortality rate compared to other stroke subtypes. Certain clinical features support a diagnosis of cardioembolic stroke, including sudden onset to maximal deficit within 5 minutes, decreased consciousness, Wernicke's or global aphasia without hemiparesis, onset during a Valsalva maneuver, and hemorrhagic transformation of the infarct. Lacunar presentations and multiple lacunar infarcts make a cardioembolic origin less likely. Echocardiography can identify potential cardiac sources of embolism.
Traumatic versus Non-Traumatic Intracerebral (Intracranial) BleedsAmit Agrawal
The document discusses traumatic intracerebral hemorrhage (TICH) versus spontaneous intracerebral hemorrhage (SICH). It notes that while they share some similarities in management, distinguishing between the two is important as it impacts treatment approach and prognosis. The diagnosis is made initially through clinical assessment and investigating for risk factors or trauma history, then confirmed with imaging studies. Key differences include SICH patients tend to have worse prognosis if bleeding is severe, cortical, or spreads to ventricles, while prognosis for TICH depends more on associated injuries and resuscitation.
natural history of brain arteriovenous malformations a systematic reviewPerla Islas Romero
This document summarizes a systematic review of the literature on the natural history of brain arteriovenous malformations (BAVMs). It finds that the incidence of BAVMs is between 1.12-1.42 cases per 100,000 person-years, with 38-68% of new cases presenting with first-ever hemorrhage. The overall annual risk of hemorrhage for untreated BAVMs ranges from 2.10-4.12%. Factors that increase the risk of subsequent hemorrhage include initial hemorrhagic presentation, exclusively deep venous drainage, and deep or infratentorial brain location. The review aims to clarify the natural history of BAVMs to help clinicians counsel patients.
Bosche, Molcanyi et al. - Occurence and recurrence of spont. cSDH ... FXIII d...Dr. Bert Bosche
This document summarizes a study investigating the role of coagulation factor XIII (FXIII) in spontaneous chronic subdural haematoma (cSDH). The study found that among 117 cSDH patients, 18 had spontaneous cSDH. These patients had significantly lower FXIII activity than controls. Within these 18 patients, 6 developed re-bleeding events after haematoma evacuation, and these patients had significantly lower FXIII activity than the other 12 patients. A FXIII cutoff of 68.5% accurately predicted re-bleeding events, with 100% sensitivity and 75% specificity. The study suggests that FXIII deficiency may play a pathophysiological role in spontaneous cSDH and FXIII activity could help
Computerized scan findings and their correlation with outcome in patients wit...Amit Agrawal
CT scan has become the investigation of choice in traumatic brain injury patients . Because of its wide spread availability and ability to precisely detect and locate intracranial lesions
This document discusses potential new diagnostic methods for studying sudden cardiac death. It notes that in about 20% of cases, no abnormality is found at autopsy to explain the cause of death. It proposes stressing the heart under normal and abnormal conditions to better understand its metabolic responses. This could help clarify pathological causes and allow for improved drug design strategies. The document advocates translating diagnostic approaches across medical disciplines to gain new insights. Overall, it presents the idea of developing innovative tests to evaluate the heart's local biochemical status under varying conditions in order to help prevent unexpected cardiac events, especially in young people.
A randomized study assigned 465 patients undergoing emergency PCI for acute STEMI to either preventive PCI of stenoses in non-infarct arteries or PCI of the infarct artery only. At a mean follow up of 23 months, the preventive PCI group had lower rates of the primary composite outcome of death from cardiac causes, non-fatal heart attack, or refractory angina (9% vs 23%). Preventive PCI also reduced the risk of subsequent cardiovascular events within the first 6 months after the procedure. Procedure times and contrast usage were increased with preventive PCI, but complication rates were similar between the groups.
Neurocardiogenic syncope, also known as vasovagal syncope, is characterized by sudden drops in heart rate and blood pressure causing fainting. The exact pathophysiology is unknown, but theories include miscommunication between neurological and cardiovascular pathways leading to inappropriate baroreceptor sensitivity, sympathetic withdrawal, and parasympathetic activation. Symptoms include hypotension, dizziness, blurred vision, and brief loss of consciousness. Diagnosis can be difficult due to sporadic nature, but tilt table tests can help recreate orthostatic pressure changes to induce syncope response for analysis. Vasovagal syncope has a high lifetime incidence rate and individuals have an increased risk of death from stroke compared to other syncope types
1. A 55-year-old man presented with left eye ptosis and diplopia, symptoms of third cranial nerve palsy. Laboratory tests found elevated white blood cell count. Bone marrow biopsy revealed granulocytic hyperplasia and a positive test for the Philadelphia chromosome, confirming a diagnosis of chronic myelogenous leukemia (CML).
2. This is the first reported case of CML initially presenting solely as third cranial nerve palsy. While cranial neuropathies have been reported in other types of leukemia and lymphoma, this nerve palsy manifestation has not previously been associated with CML.
3. CML may present atypically with isolated cranial nerve pals
This study examined 24 patients with Wilson's disease who presented with hepatic and/or neurological manifestations. The average age was 11.8 years. Most common presentations were jaundice (29.2%) and movement disorders like Parkinsonism (29.3%). Laboratory findings found low serum ceruloplasmin (<20 g/l) in 79.2% of patients and high urinary copper excretion (>100 ug/24hrs) in 62.5% of patients. Based on clinical and laboratory criteria, the diagnosis of Wilson's disease was made in 70.8% of patients. The study concludes that Wilson's disease can present with diverse symptoms involving the liver or nervous system and requires a high index of suspicion for
Validation of three non invasive markers in assessing the severity of liver f...Samiullah Shaikh
This study aimed to compare three non-invasive markers (APRI, AST/ALT ratio, FIB-4) to liver biopsy for assessing liver fibrosis severity in hepatitis C patients. The study analyzed data from 158 hepatitis C patients who underwent liver biopsy and had their APRI, AST/ALT ratio, and FIB-4 calculated based on routine blood tests. Results found that APRI and FIB-4 were better than AST/ALT ratio at excluding or predicting advanced liver fibrosis, with APRI <1 excluding advanced fibrosis in 70% of patients and FIB-4 <1.45 in 74% of patients. APRI >1 predicted advanced fibrosis in 87% of patients and FIB-4 >1.
This document discusses deep vein thrombosis (DVT) surveillance in patients with traumatic brain injury (TBI) or spinal cord injury (SCI). It outlines several challenges with diagnosing DVT in these patients, as clinical signs may be absent or difficult to assess due to their injuries. The Wells clinical prediction rule and D-dimer testing can help estimate DVT risk, though D-dimer may be elevated due to non-thrombotic factors as well. Ultrasound is the test of choice to diagnose DVT when suspected, while imaging like CT angiography or pulmonary angiography can identify pulmonary embolisms. More research is needed to develop optimal screening algorithms for this high-risk population.
05 acs and stemi treatment gender related issuesNPSAIC
1) Women often experience delays in diagnosis and treatment for acute coronary syndromes (ACS) due to atypical symptoms and a lack of awareness about heart risks in women.
2) Studies show that women with ACS are less likely to receive guideline recommended medical therapies and invasive procedures such as cardiac catheterization and PCI.
3) For both non-ST elevation myocardial infarction (NSTEMI) and ST elevation myocardial infarction (STEMI), delays in diagnosis and treatment contribute to higher mortality rates observed in women compared to men.
1) This study investigated the effect of the antiplatelet drug cilostazol on preventing worsening of symptoms (progressing stroke) in patients with acute ischemic stroke.
2) 510 patients with non-cardioembolic stroke within 24 hours of onset were randomized to receive either cilostazol 200 mg/day or no additional medication (control group) along with standard treatments.
3) The rate of progressing stroke, defined as a 4-point or greater increase in stroke severity scores on days 3 and/or 5, was lower in the cilostazol group (3.2%) compared to the control group (6.3%), but the difference was not statistically significant. Functional outcomes
This document describes a study examining acute care and one-year outcomes of patients experiencing first-ever acute ischemic stroke in Mexico. The study analyzed data from 1,040 patients enrolled in the PREMIER registry from 59 hospitals across Mexico. Key findings include:
- The most common risk factors were hypertension (64%), obesity (51%), and diabetes (35%).
- Diagnostic procedures and acute treatments like IV thrombolysis were underutilized, with only 0.5% receiving thrombolysis despite 17% arriving within 3 hours of onset.
- The 30-day case fatality rate was 15% and the one-year mortality rate was 29%. At one year, 47% had low or no
Ischaemic Stroke and Patent Foramen OvaleAde Wijaya
A patent foramen ovale (PFO) is present in 20-25% of the adult population. In patients who suffer from cryptogenic stroke, which is stroke with no identifiable cause, 40-50% are found to have a PFO. An esophageal echocardiography with bubble study is the standard non-invasive method to diagnose a PFO. The presence of an atrial septal aneurysm or Eustachian valve along with a PFO increases the risk of initial and recurrent strokes by allowing blood clots to pass from the veins to the arteries. Transcatheter closure of a PFO significantly reduces the risk of recurrent strokes in cryptogenic stroke patients compared to medical therapy alone, without increasing
Journal of Stem Cell Research and Transplantation is an international, open access, peer reviewed, scholarly journal committed to publish articles in diversified fields of transplantations and applications of stem cell research. The aim of the academic journal is to provide a platform for researchers, scientists, physicians, and other health professionals to find latest research information in the areas of stem cell research, transplantations such as stem cell transplantation, transplantation immunology, kidney transplantation and its treatment. It is a wide-ranging Open Access peer reviewed scientific journal that covers multidisciplinary fields.
Journal of Stem Cell Research and Transplantation accepts original research articles, letter to editor, review articles, mini reviews, case reports, editorials, scientific data, technical reports, rapid communication, and short communications, etc. on all the aspects of stem cells. The Journal of Stem Cell Research and Transplantation publishes latest scientific information, and is generously accessible across the world through internet to go halves the innovations of the researchers for intellectual advancement in this field. Austin also brings universally peer reviewed scientific journals under one roof thereby promoting knowledge sharing, collaborative and promotion of multidisciplinary science.
Risk Stratification in Arrhythmic Right
Ventricular Cardiomyopathy Without
Implantable Cardioverter-Defibrillators trial published in JACC, Clinical electrophysiology on 5/11/2016, published by ELSEVIER
This document discusses sudden cardiac death and proposes a new research hypothesis for drug design strategies. It summarizes current understanding of sudden cardiac death pathology from medical literature, which finds various etiologies including ventricular arrhythmias, coronary artery disease, and genetic channelopathies in about 20% of cases. The authors propose developing new diagnostic tests that can evaluate the heart's biochemical and metabolic status under normal and stressed conditions locally in the heart tissue, rather than just plasma, to help prevent unexpected cardiac events and better understand sudden cardiac death pathology. This could involve applying diagnostic strategies from other medical disciplines to cardiology.
Reversal of warfarin associated coagulopathy prothrombin complex concentratesTÀI LIỆU NGÀNH MAY
Để xem full tài liệu Xin vui long liên hệ page để được hỗ trợ
: https://www.facebook.com/thuvienluanvan01
HOẶC
https://www.facebook.com/garmentspace/
https://www.facebook.com/thuvienluanvan01
https://www.facebook.com/thuvienluanvan01
tai lieu tong hop, thu vien luan van, luan van tong hop, do an chuyen nganh
Cardioembolic cerebral infarction accounts for 14-30% of ischemic strokes. It has a high mortality rate compared to other stroke subtypes. Certain clinical features support a diagnosis of cardioembolic stroke, including sudden onset to maximal deficit within 5 minutes, decreased consciousness, Wernicke's or global aphasia without hemiparesis, onset during a Valsalva maneuver, and hemorrhagic transformation of the infarct. Lacunar presentations and multiple lacunar infarcts make a cardioembolic origin less likely. Echocardiography can identify potential cardiac sources of embolism.
Traumatic versus Non-Traumatic Intracerebral (Intracranial) BleedsAmit Agrawal
The document discusses traumatic intracerebral hemorrhage (TICH) versus spontaneous intracerebral hemorrhage (SICH). It notes that while they share some similarities in management, distinguishing between the two is important as it impacts treatment approach and prognosis. The diagnosis is made initially through clinical assessment and investigating for risk factors or trauma history, then confirmed with imaging studies. Key differences include SICH patients tend to have worse prognosis if bleeding is severe, cortical, or spreads to ventricles, while prognosis for TICH depends more on associated injuries and resuscitation.
natural history of brain arteriovenous malformations a systematic reviewPerla Islas Romero
This document summarizes a systematic review of the literature on the natural history of brain arteriovenous malformations (BAVMs). It finds that the incidence of BAVMs is between 1.12-1.42 cases per 100,000 person-years, with 38-68% of new cases presenting with first-ever hemorrhage. The overall annual risk of hemorrhage for untreated BAVMs ranges from 2.10-4.12%. Factors that increase the risk of subsequent hemorrhage include initial hemorrhagic presentation, exclusively deep venous drainage, and deep or infratentorial brain location. The review aims to clarify the natural history of BAVMs to help clinicians counsel patients.
Bosche, Molcanyi et al. - Occurence and recurrence of spont. cSDH ... FXIII d...Dr. Bert Bosche
This document summarizes a study investigating the role of coagulation factor XIII (FXIII) in spontaneous chronic subdural haematoma (cSDH). The study found that among 117 cSDH patients, 18 had spontaneous cSDH. These patients had significantly lower FXIII activity than controls. Within these 18 patients, 6 developed re-bleeding events after haematoma evacuation, and these patients had significantly lower FXIII activity than the other 12 patients. A FXIII cutoff of 68.5% accurately predicted re-bleeding events, with 100% sensitivity and 75% specificity. The study suggests that FXIII deficiency may play a pathophysiological role in spontaneous cSDH and FXIII activity could help
Computerized scan findings and their correlation with outcome in patients wit...Amit Agrawal
CT scan has become the investigation of choice in traumatic brain injury patients . Because of its wide spread availability and ability to precisely detect and locate intracranial lesions
This document discusses potential new diagnostic methods for studying sudden cardiac death. It notes that in about 20% of cases, no abnormality is found at autopsy to explain the cause of death. It proposes stressing the heart under normal and abnormal conditions to better understand its metabolic responses. This could help clarify pathological causes and allow for improved drug design strategies. The document advocates translating diagnostic approaches across medical disciplines to gain new insights. Overall, it presents the idea of developing innovative tests to evaluate the heart's local biochemical status under varying conditions in order to help prevent unexpected cardiac events, especially in young people.
A randomized study assigned 465 patients undergoing emergency PCI for acute STEMI to either preventive PCI of stenoses in non-infarct arteries or PCI of the infarct artery only. At a mean follow up of 23 months, the preventive PCI group had lower rates of the primary composite outcome of death from cardiac causes, non-fatal heart attack, or refractory angina (9% vs 23%). Preventive PCI also reduced the risk of subsequent cardiovascular events within the first 6 months after the procedure. Procedure times and contrast usage were increased with preventive PCI, but complication rates were similar between the groups.
Neurocardiogenic syncope, also known as vasovagal syncope, is characterized by sudden drops in heart rate and blood pressure causing fainting. The exact pathophysiology is unknown, but theories include miscommunication between neurological and cardiovascular pathways leading to inappropriate baroreceptor sensitivity, sympathetic withdrawal, and parasympathetic activation. Symptoms include hypotension, dizziness, blurred vision, and brief loss of consciousness. Diagnosis can be difficult due to sporadic nature, but tilt table tests can help recreate orthostatic pressure changes to induce syncope response for analysis. Vasovagal syncope has a high lifetime incidence rate and individuals have an increased risk of death from stroke compared to other syncope types
1. A 55-year-old man presented with left eye ptosis and diplopia, symptoms of third cranial nerve palsy. Laboratory tests found elevated white blood cell count. Bone marrow biopsy revealed granulocytic hyperplasia and a positive test for the Philadelphia chromosome, confirming a diagnosis of chronic myelogenous leukemia (CML).
2. This is the first reported case of CML initially presenting solely as third cranial nerve palsy. While cranial neuropathies have been reported in other types of leukemia and lymphoma, this nerve palsy manifestation has not previously been associated with CML.
3. CML may present atypically with isolated cranial nerve pals
This study examined 24 patients with Wilson's disease who presented with hepatic and/or neurological manifestations. The average age was 11.8 years. Most common presentations were jaundice (29.2%) and movement disorders like Parkinsonism (29.3%). Laboratory findings found low serum ceruloplasmin (<20 g/l) in 79.2% of patients and high urinary copper excretion (>100 ug/24hrs) in 62.5% of patients. Based on clinical and laboratory criteria, the diagnosis of Wilson's disease was made in 70.8% of patients. The study concludes that Wilson's disease can present with diverse symptoms involving the liver or nervous system and requires a high index of suspicion for
Validation of three non invasive markers in assessing the severity of liver f...Samiullah Shaikh
This study aimed to compare three non-invasive markers (APRI, AST/ALT ratio, FIB-4) to liver biopsy for assessing liver fibrosis severity in hepatitis C patients. The study analyzed data from 158 hepatitis C patients who underwent liver biopsy and had their APRI, AST/ALT ratio, and FIB-4 calculated based on routine blood tests. Results found that APRI and FIB-4 were better than AST/ALT ratio at excluding or predicting advanced liver fibrosis, with APRI <1 excluding advanced fibrosis in 70% of patients and FIB-4 <1.45 in 74% of patients. APRI >1 predicted advanced fibrosis in 87% of patients and FIB-4 >1.
This study analyzed the causes of stroke in 50 young patients aged 15-35 years at a tertiary hospital in Pakistan. The most common cause of stroke was infective meningitis (34%), predominantly tuberculosis meningitis. The second most common cause was cardioembolism (20%), mainly due to valvular heart disease. Other major causes included hypertension (14%), pregnancy-related conditions (12%), and systemic lupus erythematosus (4%). Infective meningitis, particularly tuberculosis, was found to be the leading cause of stroke in young patients in this study.
This study aimed to compare clinical diagnoses of stroke localization to CT scan findings in 110 patients. Clinically, 80.9% were diagnosed with cerebral infarction and 19.1% with cerebral hemorrhage. CT scans confirmed infarction in 83% and hemorrhage in 47.6%. Left parietal/temporo parietal infarction was the most common clinical diagnosis (43 patients) and CT scans confirmed this in 41 patients. Middle cerebral artery territory involvement was most frequent. The study concluded that clinical localization of stroke is not always accurate but CT scans help provide confident diagnoses and inform prognosis and treatment.
This study examined 24 patients with Wilson's disease who presented with hepatic and/or neurological manifestations. The average age was 11.8 years. Most common presentations were jaundice (29.2%) and movement disorders like Parkinsonism (29.3%). Laboratory findings found low serum ceruloplasmin in 79.2% and high urinary copper in 62.5%. Based on criteria involving Kayser-Fleischer rings and ceruloplasmin levels, 70.8% were diagnosed with Wilson's disease. The study concludes that Wilson's disease causes diverse clinical presentations and requires a high index of suspicion for diagnosis.
This study aimed to compare serum zinc and copper levels in patients with chronic hepatitis C and healthy individuals. The researchers found:
1) Serum zinc levels were significantly lower in patients with chronic hepatitis C compared to healthy controls.
2) Serum copper levels were significantly higher in patients with chronic hepatitis C compared to healthy controls.
3) The increased copper levels in chronic hepatitis C patients may contribute to hepatic injury, while lower zinc levels indicate zinc deficiency which can impact liver function.
This study examined 158 hepatitis C patients to determine the frequency of liver fat (steatosis) and its relationship to fibrosis severity. The results showed:
1) Steatosis was present in 45% of patients and ranged from mild to severe.
2) A strong correlation was found between increasing steatosis severity and worsening fibrosis stage.
3) No significant relationships were found between steatosis and either patient age or BMI. This suggests steatosis may play a role in accelerating liver disease progression in hepatitis C.
This study evaluated the predictive ability of the original Child-Pugh score and a creatinine-modified Child-Pugh score for patients with decompensated cirrhosis. The creatinine-modified score showed marginally better prediction of encephalopathy and similar prediction of other complications compared to the original score. Both scores showed similar accuracy in predicting in-hospital mortality and length of stay, with the creatinine-modified score performing slightly better. The creatinine-modified Child-Pugh score may help better stratify patients, especially those in class B of the original score.
Frequency of metabolic syndrome and its’ variousSamiullah Shaikh
This study examined the frequency of metabolic syndrome and its components in 357 patients with ischemic stroke in Pakistan. The researchers found that metabolic syndrome was present in 46.2% of patients, with the three most common components being high waist circumference (34.5%), high fasting blood sugar (35.3%), and low HDL cholesterol (26.5-73.5%). Female patients accounted for 75.2% of those with metabolic syndrome. The results suggest metabolic syndrome is a frequent occurrence in patients with ischemic stroke and its components are strongly associated with increased risk of the condition.
This study examined 162 patients with cirrhosis who underwent endoscopic variceal band ligation to treat esophageal varices. The study aimed to determine the frequency and risk factors associated with the development of secondary gastric varices after eradicating esophageal varices. The results found that secondary gastric varices developed in 38 patients (23.5%) after eradicating their esophageal varices. Factors associated with an increased risk of developing secondary gastric varices included having more advanced liver disease (based on Child-Pugh class), larger esophageal varices at initial presentation, requiring more sessions of band ligation to eradicate the esophageal varices, and already having gastric varices present at initial presentation.
Frequency Of Hyponatraemia And Its Influence On Liver Cirrhosis Related Compl...Samiullah Shaikh
This study evaluated the frequency and impact of hyponatremia (sodium levels below 130 mEq/L) in 217 patients with liver cirrhosis and ascites. Hyponatremia was found in 26.7% of patients and was associated with more severe liver disease and ascites. Patients with hyponatremia also experienced more frequent hepatic encephalopathy and cirrhosis complications like hepatorenal syndrome and spontaneous bacterial peritonitis during their hospital stay compared to patients with normal sodium levels. The study concluded that hyponatremia is common in cirrhotic patients and negatively influences the development of cirrhosis complications.
This study aimed to compare serum zinc and copper levels in patients with chronic hepatitis C and healthy individuals. The researchers found:
1) Serum zinc levels were significantly lower in patients with chronic hepatitis C compared to healthy controls.
2) Serum copper levels were significantly higher in patients with chronic hepatitis C compared to healthy controls.
3) The increased copper levels in chronic hepatitis C patients may contribute to hepatic injury, while lower zinc levels indicate zinc deficiency which can impact liver function.
Frequency of hyponatraemia and its influence on liver cirrhosis related compl...Samiullah Shaikh
This study evaluated the frequency and impact of hyponatremia (sodium levels below 130 mEq/L) in 217 patients with liver cirrhosis and ascites. Hyponatremia was found in 26.7% of patients and was associated with more severe liver disease and ascites. Patients with hyponatremia also experienced more frequent hepatic encephalopathy and cirrhosis complications like hepatorenal syndrome and spontaneous bacterial peritonitis during their hospital stay compared to patients with normal sodium levels. The study concluded that hyponatremia is common in cirrhotic patients and negatively influences the development of cirrhosis complications.
Frequency of prediabetes and influence of various riskSamiullah Shaikh
This study aimed to determine the frequency of prediabetes and observe the influence of various risk factors on the development of prediabetes. The study found that 29.4% of subjects had prediabetes. Several risk factors were strongly correlated with prediabetes, including high BMI, family history of diabetes, history of gestational diabetes, history of delivering a high birth weight baby, low HDL cholesterol, and high triglycerides. The results suggest screening those with risk factors can help identify individuals at high risk of developing diabetes.
This study evaluated 222 patients with decompensated cirrhosis of the liver to compare the accuracy of the original Child-Pugh score and a creatinine-modified Child-Pugh score in predicting short-term outcomes. The creatinine-modified score added points based on serum creatinine levels to the original score. The creatinine-modified score more accurately predicted the development of complications like hepatic encephalopathy and ascites. It also better predicted in-hospital mortality and length of stay compared to the original Child-Pugh score. The creatinine-modified score showed marginally better prognostic accuracy than the original score, suggesting inclusion of serum creatinine can improve the predictive ability of the Child-
This study evaluated 222 patients with decompensated cirrhosis of the liver to compare the accuracy of the original Child-Pugh score and a creatinine-modified Child-Pugh score in predicting short-term outcomes. The creatinine-modified score added points based on serum creatinine levels to the original score. The creatinine-modified score more accurately predicted the development of complications like encephalopathy and ascites. It also better predicted in-hospital mortality and length of stay compared to the original Child-Pugh score. The creatinine-modified score showed marginally better prognostic accuracy than the original score, suggesting inclusion of serum creatinine can improve the predictive ability of the Child-P
Validation Of Three Non Invasive Markers In Assessing The Severity Of Liver F...Samiullah Shaikh
The document evaluated three non-invasive markers - APRI (AST to platelet ratio index), AST/ALT ratio, and FIB-4 - for assessing the severity of liver fibrosis in patients with hepatitis C and compared them to liver biopsy results. The study found that APRI and FIB-4 were able to exclude minimal fibrosis in 70% and 74% of patients respectively, and predict advanced fibrosis in 87% and 98% of patients respectively. Both markers performed better than AST/ALT ratio. The study concluded that APRI and FIB-4 can reliably predict the stage of liver fibrosis in most hepatitis C patients and could help reduce the need for liver biopsies.
This study investigated hypocalcemia in patients with acute gastroenteritis at Liaquat University Hospital in Hyderabad, Pakistan. The study included 66 patients with acute gastroenteritis and 66 healthy control subjects. The mean serum calcium level was significantly lower in patients with acute gastroenteritis (6.8455 ± 1.8266 mg/dL) compared to the control group (9.2167 ± 0.4534 mg/dL). Hypocalcemia was observed in 62 (94%) of gastroenteritis patients but only 13 (20%) of controls. The results demonstrated that low serum calcium or hypocalcemia is common in patients with acute gastroenteritis.
This study aimed to compare clinical diagnoses of stroke localization to CT scan findings in 110 patients. Clinically, 80.9% were diagnosed with cerebral infarction and 19.1% with cerebral hemorrhage. CT scans confirmed infarction in 83% and hemorrhage in 47.6%. Left parietal/temporo parietal infarction was the most common clinical diagnosis (43 patients) and CT scans confirmed in 41 patients. Middle cerebral artery territory involvement was most frequent. The study concluded that clinical localization of stroke is not always accurate but CT scans help provide confident diagnoses and inform prognosis and treatment.
Introduction: Chronic Kidney Disease (CKD) is a worldwide public health problem and it is increasing over time. Cardiovascular disease is a major concern for patients with end stage renal disease, especially those on hemodialysis. It is the leading cause of death among patients with chronic kidney
disease, particularly in dialysis population.
This document provides information about the 7th International Conference on Biotechnology, Bioinformatics, Bio Medical Sciences and Stem Cell Applications that was held from November 11-12, 2016 at the Nanyang Technological University in Singapore. It lists the conference venue and contact information. It also provides details about the plenary speaker, Yoshiko Yamaguchi, and includes the abstract of a study presented on hypertension in Sohag City, Egypt.
This study reviewed data on 215 young adults aged 18-45 admitted with ischemic stroke or transient ischemic attack (TIA) to a university hospital stroke center between 2005-2010.
The results showed:
- High rates of traditional vascular risk factors like hypertension (20%), diabetes (11%), dyslipidemia (38%), and smoking (34%).
- Extensive diagnostic testing including blood tests, echocardiograms, vessel imaging found relevant abnormalities in 136 of 203 patients on angiography and detected the likely stroke cause in nearly 90% of patients.
- Common causes were cardioembolism (47%), including 17% with patent foramen ovale, and arterial lesions in the middle cerebral artery (23%),
Introduction: Stroke is an even more dramatic major public health problem in young people. Goal of the study: Contribute to the knowledge of strokes in young people. Methodology: This was a retrospective study carried out over a period of 02 years (January 2017 to December 2018) including the files of patients aged 18 to 49 years hospitalized for any suspected case of stroke in the Neurology department of the University Hospital
Center of the Sino-Central African Friendship (CHUSCA) of Bangui.
This study summarizes a case series of 394 young stroke patients aged 14-47 years who were admitted to a hospital in Rome, Italy between 1992-2001. The annual incidence of young stroke was found to be 8.8 per 100,000 people. Common risk factors included smoking (56%), hypertension (23%), and oral contraceptive use (38% of women). The most common causes of stroke were determined to be cardioembolism (34%), atherothrombosis (12%), and non-atherosclerotic vasculopathies like arterial dissection (14%). Despite limitations, the study highlights the importance of thorough diagnostic evaluation for determining the cause of young ischemic strokes.
Clinical profile of paediatric patients with rheumatic heart disease at moi t...Alexander Decker
This document summarizes a study on the clinical profile of pediatric patients with rheumatic heart disease at Moi Teaching and Referral Hospital in Eldoret, Kenya. The study found that the most common symptoms in new patients were dyspnea, easy fatigability, palpitations, cough and orthopnea. The most common signs were systolic murmurs, thrills and tachycardia. Most new patients presented with severe disease in NYHA class 3 or 4. Mitral regurgitation alone or combined with aortic regurgitation were the most common valve lesions. The results suggest that most new patients have advanced valvular disease and complications due to late presentation, highlighting the need for early detection
Clinical profile of paediatric patients with rheumatic heart disease at moi t...Alexander Decker
This document summarizes a study on the clinical profile of pediatric patients with rheumatic heart disease at Moi Teaching and Referral Hospital in Eldoret, Kenya. The study found that 84 pediatric patients had rheumatic heart disease, with more female patients than male. New patients most commonly presented with dyspnea, easy fatigability, and palpitations. Signs like systolic murmurs and tachycardia were also common in new patients. Most new patients were in NYHA classes 3 and 4, indicating severe valvular disease and late presentation. The study recommends emphasis on early detection and prevention of rheumatic heart disease.
A less-invasive-approach-of-medial-meniscectomy-in-rat-a-model-to-target-earl...science journals
In order for insulin to exert its biological actions on target cells in peripheral tissues like muscle and adipose tissues, Insulin must pass through the endothelial barrier into the interstitium.
This document provides an overview of pediatric stroke, including:
- Historical accounts of pediatric stroke dating back to the 17th century.
- The main types of pediatric stroke are arterial ischemic stroke (AIS), intracerebral hemorrhage (ICH), and cerebral venous thrombosis (CVT), with a focus on AIS.
- Risk factors for childhood AIS include cardiac disorders, hematological disorders like sickle cell disease, thrombophilias, arteriopathies, neurofibromatosis, transient cerebral arteriopathy, and primary angiitis of the central nervous system.
- Treatment recommendations are based on small trials and expert consensus, with no guidelines recommending acute thrombolysis for pediatric stroke currently
Clinical Profile of Acute Coronary Syndrome among Young AdultsPremier Publishers
Acute Coronary Syndrome accounts for 30% of hospital admissions with cardiovascular diseases. The risk of this syndrome is increasing among the younger adults, and a deep insight into the clinical profile among these patients will help in devising a preventive strategy, in order to alleviate the morbidity and mortality due to the syndrome. A cross sectional study was done among 125 subjects admitted to our tertiary care hospital with Acute Coronary Syndrome. Their risk factors were assessed and a 12 Lead electrocardiogram and 2D Echocardiogram were taken. Cardio III panel which consists of Troponin I, CK MB, BNP by COBAS meter machine was also measured. STEMI was present in 73.6% of the patients, while unstable angina was present in 16%. About 90% of STEMI patients were males and 62% of them were hypertensives. LV Ejection Fraction <30% was found in 9% of STEMI patients. This study elucidates the need for a preventive strategy for primordial prevention of cardiovascular events among young adults. The study envisaged the male, urban preponderance towards these events.
Central Nervous System Histoplasmosis Related to Bioprosthetic Endocarditisasclepiuspdfs
Endocarditis caused by Histoplasma capsulatum is a rare occurrence. Involvement of the central nervous system by Histoplasma is also relatively uncommon. This paper reports a case of a 62-year-old woman with a past medical history significant for a myocardial infarct 5 years prior which necessitated coronary artery bypass graft surgery, prosthetic aortic valve replacement 4 years prior, and sarcoidosis, diagnosed 1 year prior, which was treated with methotrexate. She presented with fevers, generalized weakness, night sweats, and chest and throat pain. An echocardiogram done as part of her evaluation showed a vegetation on her prosthetic aortic valve. H. capsulatum was identified on blood cultures, and she was started on antibiotics. She expired shortly thereafter. At autopsy, a diagnosis of Histoplasma endocarditis was confirmed with evidence of embolic disease involving kidneys and digits of the hand. Hilar lymph nodes showed evidence of the fungus. Examination of the brain showed multiple widespread microscopic foci of macrophages, lymphocytes, and microglial cells with associated Histoplasma organisms, highlighted on Gomori methenamine silver staining. This paper will discuss central nervous system involvement by Histoplasma.
This study examined 2,112 patients admitted to the National Institute of Cardiovascular Diseases in Dhaka with heart failure. The average age was 46 years old, most were male. Common presenting symptoms were shortness of breath, leg edema, and orthopnea. Hypertension and diabetes were common comorbidities. The leading causes of heart failure were ischemic cardiomyopathy and chronic ischemic heart disease. The study aims to identify clinical presentations of heart failure patients to help determine best treatment approaches.
CVST central venous sinus thrombosis.pptxajitjagtap13
Ppt covers extensively about CEREBRAL VENOUS SINUS THROMBOSIS.
Topics of scope include
Introduction
Epidemiology
Risk factors
Clinical features
Diagnosis
And treatment of cvt.
Author is medicine resident at LTMGH, SION Mumbai.
Study of Congenital Heart Diseases in Pediatric Patientinventionjournals
Introduction: Congenital heart disease is important cause of morbidity and mortality in pediatric practice. Objectives: - 1) To establish the diagnosis and find out incidence of CHD in various age group. 2) To study various mode of presentation of various CHDs. 3) To study morbidity and mortality in various CHDs in children. Methodology:- Total 60 cases of congenital heart diseases coming to K.T. Children hospital, Rajkot from July 2016 to November 2016 were studied. Informed consent and detailed history was taken followed by thorough clinical examination as per Performa attached. Echocardiography of all patients was done. School health cards were prepared for the patients having abnormal echocardiography and referred to higher centre for cardiologist opinion. Conclusion:- Correct diagnosis can be made with help of thorough history and clinical examination especially in acyanotic congenital heart diseases. Early diagnosis and timely referral of patient can greatly improve outcome of patients with CHDs.
INTRACEREBRAL HEMORRHAGE IN YOUNG ADULTS.pptxNeurologyKota
1) The document discusses intracerebral hemorrhage (ICH) in young adults aged 18-50 years.
2) Risk factors for ICH in this age group include hypertension, smoking, alcohol, medications like anticoagulants and cocaine use.
3) Common causes of ICH in young adults are structural abnormalities like arteriovenous malformations, aneurysms, and cavernomas. Other causes include hypertension, coagulopathies, vasculitis and reversible cerebral vasoconstriction syndrome.
Cerebral Venous Thrombosis in a Mexican Multicenter Registry of Acute Cerebro...Erwin Chiquete, MD, PhD
Background: Cerebral venous thrombosis (CVT) is a rare form of cerebrovascular
disease that is usually not mentioned in multicenter registries on all-type acute
stroke. We aimed to describe the experience on hospitalized patients with CVT in
a Mexican multicenter registry on acute cerebrovascular disease. Methods: CVT
patients were selected from the RENAMEVASC registry, which was conducted
between 2002 and 2004 in 25 Mexican hospitals. Risk factors, neuroimaging,
and 30-day outcome as assessed by the modified Rankin scale (mRS) were analyzed.
Results: Among 2000 all-type acute stroke patients, 59 (3%; 95% CI, 2.3-3.8%) had
CVT (50 women; female:male ratio, 5:1; median age, 31 years). Puerperium (42%),
contraceptive use (18%), and pregnancy (12%) were the main risk factors in women.
In 67% of men, CVTwas registered as idiopathic, but thrombophilia assessment was
suboptimal. Longitudinal superior sinus was the most frequent thrombosis location
(78%). Extensive (.5 cm) venous infarction occurred in 36% of patients. Only 81% of
patients received anticoagulation since the acute phase, and 3% needed decompressive
craniectomy. Mechanical ventilation (13.6%), pneumonia (10.2%) and systemic
thromboembolism (8.5%) were the main in-hospital complications. The 30-day case
fatality rate was 3% (2 patients; 95% CI, 0.23-12.2%). In a Cox proportional hazards
model, only age ,40 years was associated with a mRS score of 0 to 2 (functional independence;
rate ratio, 3.46; 95% CI, 1.34-8.92). Conclusions: The relative frequency
of CVT and the associated in-hospital complications were higher than in other registries.
Thrombophilia assessment and acute treatment was suboptimal. Young age
is the main determinant of a good short-term outcome.
10-15% of stroke patients are young adults between 15-44 years old. Stroke risk factors for young adults include conditions like heart defects, recent pregnancy, smoking, drug use, and hypertension. The causes of stroke in young adults are more varied than in older adults and can include cardioembolic, atherosclerotic, and non-atherosclerotic vasculopathies as well as subarachnoid and intraparenchymal hemorrhages. Thorough investigations including imaging, blood work, and cardiac/vascular testing are important for determining the underlying cause, which often remains unknown in 20-30% of young stroke cases. Prognosis is generally better for young stroke patients compared to older patients
Stroke can occur in young adults, accounting for 10-12% of total stroke patients. Risk factors for young adult stroke include diabetes, smoking, chronic renal disease, and hypertension. An analysis of 2004-2015 New York state hospital data found higher rates of ischemic stroke and subarachnoid hemorrhage among young African Americans and women compared to other groups. Both conditions increased in prevalence over time. Ischemic stroke was strongly associated with diabetes, hypertension, and smoking, while subarachnoid hemorrhage was only associated with hypertension. Prevention and treatment of risk factors is important to reduce morbidity and mortality from stroke in young adults.
1) The study assessed the relationship between sudden sensorineural hearing loss (SSNHL) and white matter lesions visible on brain MRI, known as cerebral small vessel disease (CSVD).
2) Results showed that individuals with SSNHL aged 48-60 years have a 26% higher probability of having a Fazekas score indicating CSVD compared to the general population. Those under 28 years showed a statistically significant negative correlation.
3) Higher Fazekas scores, indicating more severe CSVD, were related to a decreased probability of hearing recovery in patients with SSNHL. The probability of recovery decreased from 80% in those under 48 with no lesions, to 14% in those with the most
Frequency of cirrhotic cardiomyopathy in patientsSamiullah Shaikh
This study aimed to determine the frequency of cirrhotic cardiomyopathy in patients with liver cirrhosis. The study included 74 patients with liver cirrhosis. Various tests were performed including ECG, echocardiogram, and proBNP levels. Cirrhotic cardiomyopathy was diagnosed if abnormalities were found on tests. The results found cirrhotic cardiomyopathy present in 44.6% of patients. A strong relationship was seen between cardiomyopathy and severity of cirrhosis, prolonged QT interval, reduced ejection fraction, and elevated proBNP levels. The study concluded that cirrhotic cardiomyopathy was present in a sizable proportion of patients, and increased with later stages of cirrhosis.
Validation of three non invasive markers in assessing the severity of liver f...Samiullah Shaikh
This study aimed to compare three non-invasive markers (APRI, AST/ALT ratio, FIB-4) to liver biopsy for assessing liver fibrosis severity in hepatitis C patients. The study analyzed data from 158 hepatitis C patients who underwent liver biopsy and had their APRI, AST/ALT ratio, and FIB-4 calculated based on routine blood tests. Results found that APRI and FIB-4 were better than AST/ALT ratio at excluding or predicting advanced liver fibrosis, with APRI <1 excluding advanced fibrosis in 70% of patients and FIB-4 <1.45 in 74% of patients. APRI >1 predicted advanced fibrosis in 87% of patients and FIB-4 >1.
This study examined 158 hepatitis C patients to determine the frequency of liver fat (steatosis) and its relationship to fibrosis severity. The results showed:
1) Steatosis was present in 45% of patients and ranged from mild to severe.
2) A strong correlation was found between increasing steatosis severity and worsening fibrosis stage.
3) No significant relationships were found between steatosis and either patient age or BMI. This suggests steatosis may play a role in accelerating liver disease progression in hepatitis C.
This study investigated hypocalcemia in patients with acute gastroenteritis at Liaquat University Hospital in Hyderabad, Pakistan. The study included 66 patients with acute gastroenteritis and 66 healthy control subjects. The mean serum calcium level was significantly lower in patients with acute gastroenteritis (6.8455 ± 1.8266 mg/dL) compared to the control group (9.2167 ± 0.4534 mg/dL). Hypocalcemia was observed in 62 (94%) of gastroenteritis patients but only 13 (20%) of controls. The results demonstrate that low serum calcium is common in patients with acute gastroenteritis.
This study compared serum copper and zinc levels in 100 patients with chronic hepatitis C and 50 healthy controls. Serum zinc levels were significantly lower in patients (mean 3.2357 μmol/L) than controls (mean 4.246 μmol/L). Serum copper levels were significantly higher in patients (mean 2.210 μmol/L) than controls (mean 2.073 μmol/L). The authors conclude that increased copper and decreased zinc in patients may contribute to hepatic injury caused by chronic hepatitis C.
This study investigated hypocalcemia in patients with acute gastroenteritis at Liaquat University Hospital in Hyderabad, Pakistan. The study included 66 patients with acute gastroenteritis and 66 healthy control subjects. The mean serum calcium level was significantly lower in patients with acute gastroenteritis (6.8455 ± 1.8266 mg/dL) compared to the control group (9.2167 ± 0.5534 mg/dL). Hypocalcemia was observed in 62 (94%) of gastroenteritis patients but only 13 (20%) of controls. The results indicate that low serum calcium is common in patients with acute gastroenteritis.
Frequency of hyponatraemia and its influence on liver cirrhosis related compl...Samiullah Shaikh
This study evaluated the frequency and impact of hyponatremia (sodium levels below 130 mEq/L) in 217 patients with liver cirrhosis and ascites. Hyponatremia was found in 26.7% of patients and was associated with more severe liver disease and ascites. Patients with hyponatremia also experienced more complications like hepatic encephalopathy. Even mild hyponatremia with sodium levels between 131-135 mEq/L increased the risk of cirrhosis complications compared to patients with normal sodium levels. The study concludes that hyponatremia is common in cirrhotic patients and negatively influences the development of cirrhosis complications.
This study aimed to determine the frequency of steatosis in 158 hepatitis C patients and examine its relationship to fibrosis. The key findings were:
1) Steatosis was present in 45% of liver biopsies. A strong correlation was observed between increasing steatosis and worsening fibrosis.
2) No significant relationship was found between steatosis and either BMI or age.
3) The results suggest steatosis may play a role in accelerating liver disease progression in hepatitis C by fueling free radical production, amplifying the virus's cytopathic effect. Efforts to control steatosis may help slow disease progression.
STUDIES IN SUPPORT OF SPECIAL POPULATIONS: GERIATRICS E7shruti jagirdar
Unit 4: MRA 103T Regulatory affairs
This guideline is directed principally toward new Molecular Entities that are
likely to have significant use in the elderly, either because the disease intended
to be treated is characteristically a disease of aging ( e.g., Alzheimer's disease) or
because the population to be treated is known to include substantial numbers of
geriatric patients (e.g., hypertension).
Giloy in Ayurveda - Classical Categorization and SynonymsPlanet Ayurveda
Giloy, also known as Guduchi or Amrita in classical Ayurvedic texts, is a revered herb renowned for its myriad health benefits. It is categorized as a Rasayana, meaning it has rejuvenating properties that enhance vitality and longevity. Giloy is celebrated for its ability to boost the immune system, detoxify the body, and promote overall wellness. Its anti-inflammatory, antipyretic, and antioxidant properties make it a staple in managing conditions like fever, diabetes, and stress. The versatility and efficacy of Giloy in supporting health naturally highlight its importance in Ayurveda. At Planet Ayurveda, we provide a comprehensive range of health services and 100% herbal supplements that harness the power of natural ingredients like Giloy. Our products are globally available and affordable, ensuring that everyone can benefit from the ancient wisdom of Ayurveda. If you or your loved ones are dealing with health issues, contact Planet Ayurveda at 01725214040 to book an online video consultation with our professional doctors. Let us help you achieve optimal health and wellness naturally.
Computer in pharmaceutical research and development-Mpharm(Pharmaceutics)MuskanShingari
Statistics- Statistics is the science of collecting, organizing, presenting, analyzing and interpreting numerical data to assist in making more effective decisions.
A statistics is a measure which is used to estimate the population parameter
Parameters-It is used to describe the properties of an entire population.
Examples-Measures of central tendency Dispersion, Variance, Standard Deviation (SD), Absolute Error, Mean Absolute Error (MAE), Eigen Value
CLASSIFICATION OF H1 ANTIHISTAMINICS-
FIRST GENERATION ANTIHISTAMINICS-
1)HIGHLY SEDATIVE-DIPHENHYDRAMINE,DIMENHYDRINATE,PROMETHAZINE,HYDROXYZINE 2)MODERATELY SEDATIVE- PHENARIMINE,CYPROHEPTADINE, MECLIZINE,CINNARIZINE
3)MILD SEDATIVE-CHLORPHENIRAMINE,DEXCHLORPHENIRAMINE
TRIPROLIDINE,CLEMASTINE
SECOND GENERATION ANTIHISTAMINICS-FEXOFENADINE,
LORATADINE,DESLORATADINE,CETIRIZINE,LEVOCETIRIZINE,
AZELASTINE,MIZOLASTINE,EBASTINE,RUPATADINE. Mechanism of action of 2nd generation antihistaminics-
These drugs competitively antagonize actions of
histamine at the H1 receptors.
Pharmacological actions-
Antagonism of histamine-The H1 antagonists effectively block histamine induced bronchoconstriction, contraction of intestinal and other smooth muscle and triple response especially wheal, flare and itch. Constriction of larger blood vessel by histamine is also antagonized.
2) Antiallergic actions-Many manifestations of immediate hypersensitivity (type I reactions)are suppressed. Urticaria, itching and angioedema are well controlled.3) CNS action-The older antihistamines produce variable degree of CNS depression.But in case of 2nd gen antihistaminics there is less CNS depressant property as these cross BBB to significantly lesser extent.
4) Anticholinergic action- many H1 blockers
in addition antagonize muscarinic actions of ACh. BUT IN 2ND gen histaminics there is Higher H1 selectivitiy : no anticholinergic side effects
TEST BANK For Brunner and Suddarth's Textbook of Medical-Surgical Nursing, 14...Donc Test
TEST BANK For Brunner and Suddarth's Textbook of Medical-Surgical Nursing, 14th Edition (Hinkle, 2017) Verified Chapter's 1 - 73 Complete.pdf
TEST BANK For Brunner and Suddarth's Textbook of Medical-Surgical Nursing, 14th Edition (Hinkle, 2017) Verified Chapter's 1 - 73 Complete.pdf
TEST BANK For Brunner and Suddarth's Textbook of Medical-Surgical Nursing, 14th Edition (Hinkle, 2017) Verified Chapter's 1 - 73 Complete.pdf
The biomechanics of running involves the study of the mechanical principles underlying running movements. It includes the analysis of the running gait cycle, which consists of the stance phase (foot contact to push-off) and the swing phase (foot lift-off to next contact). Key aspects include kinematics (joint angles and movements, stride length and frequency) and kinetics (forces involved in running, including ground reaction and muscle forces). Understanding these factors helps in improving running performance, optimizing technique, and preventing injuries.
Nano-gold for Cancer Therapy chemistry investigatory projectSIVAVINAYAKPK
chemistry investigatory project
The development of nanogold-based cancer therapy could revolutionize oncology by providing a more targeted, less invasive treatment option. This project contributes to the growing body of research aimed at harnessing nanotechnology for medical applications, paving the way for future clinical trials and potential commercial applications.
Cancer remains one of the leading causes of death worldwide, prompting the need for innovative treatment methods. Nanotechnology offers promising new approaches, including the use of gold nanoparticles (nanogold) for targeted cancer therapy. Nanogold particles possess unique physical and chemical properties that make them suitable for drug delivery, imaging, and photothermal therapy.
Can Traditional Chinese Medicine Treat Blocked Fallopian Tubes.pptxFFragrant
There are many traditional Chinese medicine therapies to treat blocked fallopian tubes. And herbal medicine Fuyan Pill is one of the more effective choices.
- Video recording of this lecture in English language: https://youtu.be/RvdYsTzgQq8
- Video recording of this lecture in Arabic language: https://youtu.be/ECILGWtgZko
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
Selective alpha1 blockers are Prazosin, Terazosin, Doxazosin, Tamsulosin and Silodosin majorly used to treat BPH, also hypertension, PTSD, Raynaud's phenomenon, CHF
Congestive Heart failure is caused by low cardiac output and high sympathetic discharge. Diuretics reduce preload, ACE inhibitors lower afterload, beta blockers reduce sympathetic activity, and digitalis has inotropic effects. Newer medications target vasodilation and myosin activation to improve heart efficiency while lowering energy requirements. Combination therapy, following an assessment of cardiac function and volume status, is the most effective strategy to heart failure care.
Discover the benefits of homeopathic medicine for irregular periods with our guide on 5 common remedies. Learn how these natural treatments can help regulate menstrual cycles and improve overall menstrual health.
Visit Us: https://drdeepikashomeopathy.com/service/irregular-periods-treatment/
Breast cancer: Post menopausal endocrine therapyDr. Sumit KUMAR
Breast cancer in postmenopausal women with hormone receptor-positive (HR+) status is a common and complex condition that necessitates a multifaceted approach to management. HR+ breast cancer means that the cancer cells grow in response to hormones such as estrogen and progesterone. This subtype is prevalent among postmenopausal women and typically exhibits a more indolent course compared to other forms of breast cancer, which allows for a variety of treatment options.
Diagnosis and Staging
The diagnosis of HR+ breast cancer begins with clinical evaluation, imaging, and biopsy. Imaging modalities such as mammography, ultrasound, and MRI help in assessing the extent of the disease. Histopathological examination and immunohistochemical staining of the biopsy sample confirm the diagnosis and hormone receptor status by identifying the presence of estrogen receptors (ER) and progesterone receptors (PR) on the tumor cells.
Staging involves determining the size of the tumor (T), the involvement of regional lymph nodes (N), and the presence of distant metastasis (M). The American Joint Committee on Cancer (AJCC) staging system is commonly used. Accurate staging is critical as it guides treatment decisions.
Treatment Options
Endocrine Therapy
Endocrine therapy is the cornerstone of treatment for HR+ breast cancer in postmenopausal women. The primary goal is to reduce the levels of estrogen or block its effects on cancer cells. Commonly used agents include:
Selective Estrogen Receptor Modulators (SERMs): Tamoxifen is a SERM that binds to estrogen receptors, blocking estrogen from stimulating breast cancer cells. It is effective but may have side effects such as increased risk of endometrial cancer and thromboembolic events.
Aromatase Inhibitors (AIs): These drugs, including anastrozole, letrozole, and exemestane, lower estrogen levels by inhibiting the aromatase enzyme, which converts androgens to estrogen in peripheral tissues. AIs are generally preferred in postmenopausal women due to their efficacy and safety profile compared to tamoxifen.
Selective Estrogen Receptor Downregulators (SERDs): Fulvestrant is a SERD that degrades estrogen receptors and is used in cases where resistance to other endocrine therapies develops.
Combination Therapies
Combining endocrine therapy with other treatments enhances efficacy. Examples include:
Endocrine Therapy with CDK4/6 Inhibitors: Palbociclib, ribociclib, and abemaciclib are CDK4/6 inhibitors that, when combined with endocrine therapy, significantly improve progression-free survival in advanced HR+ breast cancer.
Endocrine Therapy with mTOR Inhibitors: Everolimus, an mTOR inhibitor, can be added to endocrine therapy for patients who have developed resistance to aromatase inhibitors.
Chemotherapy
Chemotherapy is generally reserved for patients with high-risk features, such as large tumor size, high-grade histology, or extensive lymph node involvement. Regimens often include anthracyclines and taxanes.
1. Original Article
Etiological patterns of stroke in young patients at a tertiary care hospital
Shaikh Samiullah, Mona Humaira, Ghani Hanif, Aslam Aziz Ghouri, Khalid Shaikh
Department of Medicine, Liaquat University of Medical and Health Sciences, Jamshoro, Hyderabad Sindh.
Abstract
Objective: To observe frequency of various causes of stroke in patients of young (15-35 years) age.
Methods: This Descriptive case series study was conducted in all Medical Units of Liaquat University Hospital
(LUH) Jamshoro, Hyderabad, from August 2006 to February 2008 and included 50 patients of stroke aged 15-
35 years, irrespective of sex and community. Data of these patients was collected through a pre-designed
proforma by completing a comprehensive history, detailed examination and carrying out basic and relevant
investigations. Patients suffering from hypoglycaemia, space occupying lesions, transient ischaemic attack or
psychosis were excluded from the study. The collected data was analyzed on SPSS version 16.0.
Results: Out of total number of 113 acute strokes, 50 patients fulfilling inclusion criteria were selected,
comprising 30 males and 20 females. Forty-three (86%) patients suffered from ischaemic strokes while seven
(14%) had haemorrhagic strokes. Infective meningitis including Tuberculosis meningitis and Bacterial meningitis
was the leading cause of stroke (34%). The second most common cause was cardio-embolism (20%) comprising
Valvular heart diseases (14%), Cardiomyopathies (4%) and atrial myxoma (2%).Hypertension was found in 14%
cases. Pregnancy related causes (including Pregnancy induced hypertension and puerperal sepsis) were 12%.
Systemic lupus erythematous and nephritic syndrome was 4% each. Various causes which constitute 4% or less
were grouped together as miscellaneous and they include hyperhomocysteinaemia, and hyperlipidaemias.
Conclusions: Common cause of stroke detected was infective meningitis (Tuberculosis and Bacterial).
Predominant cause of haemorrhagic stroke was Hypertension. Stroke in young age occurred
predominantly in males. Cardio embolism, pregnancy induced hypertension and puerperal sepsis were
other major causes (JPMA 60:201; 2010).
Introduction substances and head trauma have been described.4
Diseases of the cerebral blood vessels are the third In patients with 15-35 years of age dissection, cardio
most common cause of death in the world and are responsible embolism, non-atherosclerotic vasculopathies and
for a large proportion of Physical disability.1 prothrombotic states cause significant percentage of strokes.5
Stroke signifies the abrupt impairment of the brain Young patients usually require more extensive
function caused by a variety of Pathological changes investigations in order to determine the primary cause. It is
involving one (Focal) or several (Multifocal) intracranial or important that a comprehensive search be made since many of
extra cranial blood vessels.2 Ischaemic strokes occurring the under lying disorders are treatable.6
between 15 and 45 years of age, account for approximately The data on young stroke in Pakistan is fragmentary
1% of all strokes in the community and for 4 to 12% in and there are very few local studies on strokes carried out on
specialized tertiary centres.3 a small number of young patients.7 Hence, it is essential to
Approximately 80% of strokes are caused by too little investigate stroke in young and determine the exact cause
blood flow (Ischaemic stroke) and the remaining 20% are and take appropriate measures accordingly. The aim of this
nearly equally divided between haemorrhage into brain tissue study was to determine the etiological pattern of patients
(parenchymatous haemorrhage) and haemorrhage into the presenting with stroke at the young ages between 15 to 35
surrounding sub-arachnoid space (sub-arachnoid years of age.
haemorrhage).3
Patients and Methods
Stroke in young adults has been related to mechanisms
different to those found in older individuals. Cardio- This descriptive case series study included 50
embolism, arteritis, atherosclerosis, fibro muscular dysplasia, consecutive patients admitted from August 2006 to February
and pregnancy related angiopathy, migrainous arteriopathy, 2008 at Liaquat University Hospital, Jamshoro Hyderabad.
anaemia, antiphospholipid syndrome, arterial dissection, Patients included were those with stroke and age
arterio-venous malformations, the consumption of toxic between 15 to 35 years. All patients were received either from
Vol. 60, No. 3, March 2010 201
2. the emergency department or outpatient department of the
hospital. Patients who were suffering from transient ischaemic
stroke, hypoglycaemia, space occupying lesion or psychosis
were excluded.
Proforma was made consisting of Questionnaire
which included demographic data, detailed history and
clinical examination of every patient. It was focused for
clinical assessment and for the evaluation of risk factors.
Investigations such as Complete blood count, Urine DR, X-
ray chest, lipid profile and blood sugar were sent to Liaquat
university research laboratory. ECG, and Echocardiography
was done from the cardiology department and CT Scan
Brain from the radiology department of Liaquat university
hospital. Lumbar puncture was done in 17 patients who
presented with history of fever, neck stiffness and positive
Kernigs'sign. Cerebrospinal fluid (CSF) was sent for
detailed report and culture. Patients were diagnosed as
tuberculosis meningitis if CSF contained predominant
lymphocyte and pyogenic meningitis if CSF contained
predominant polymorph leucocytes along with protein
content > 40mg/dl and CSF sugar < 40mg/dl. Special
investigations like Protein C and S levels, Anti ds DNA,
ANA profile, VDRL, anti cardiolipin antibodies, MRI Brain
Figure: Causes of stroke in young patients at a tertiary care hospital.
and MRA were done where necessary.
Qualitative variables such as sex, type of stroke, risk
factors, cause of stroke was expressed as percentage, tuberculous meningitis. The second most common cause
frequency and quantitative data such as age was expressed was cardio-embolism, 10 (20%) comprising Valvular heart
as mean ± SD. The collected data was analyzed on SPSS diseases 7 (14%), Cardiomyopathies 2 (4%) and atrial
version 16.0. myxoma 1 (2%). Hypertension was found in 7 (14%) cases.
Pregnancy related causes (including Pregnancy induced
Results hypertension and puerperal sepsis) were 6 (12%). Systemic
This study included 50 patients with mean age 0f 25 lupus erythematosus and nephritic syndrome were 2 (4%)
± 7 years. There were 30(60%) males and 20(40%) females. each. Various causes which constituted 2 (4%) or less were
Forty three (86%) patients suffered from ischaemic strokes grouped together as miscellaneous and they included
while 7 (14 %) had Haemorrhagic strokes. The Table shows Hyperhomocysteinaemia, and hyperlipidaemias. The
the baseline characteristics of the patients. causes of stroke are summarized in Figure.
Infective meningitis including Tuberculosis Discussion
meningitis and Bacterial meningitis was the leading cause
Stroke is a frequently encountered neurological
of stroke being present in 17 (34%) cases of which 12 were
disease.3 This study focused on causes of stroke in young
patients and it was carried out in a tertiary care hospital. A
Table: Baseline characteristics of young patients with large number of patients presented with stroke but less than
stroke at a tertiary care hospital.
one fourth of them were under the age of 35 years. Fifty
Quantitative N Mean Std. patients of stroke under the age of 35 years were selected
Variables Deviation irrespective of sex, religion or geographical belonging.
Thirty patients were male while 20 were female. The higher
Age 50 25.7200 6.5622
Qualitative Variables Frequency Percentage frequency of males has also been shown in other studies.7,8
Sex There are two major types of stroke i.e. Ischaemic
Male 30 60
Female 20 40
and haemorrhagic. Ischaemic stroke was the predominant
Type of Stroke type in the present study as 86% suffered from Ischaemic
Ischemic 43 86 while 14% from Haemorrhagic stroke. This finding is
Haemorrhagic 7 14 comparable with other studies.2,7
202 J Pak Med Assoc
3. The highest percentage of ischaemic stroke was seen regurgitation while in 30% of patients mitral stenosis
in 17 patients (34%) due to infective meningitis. This is an alone and in 12% mitral regurgitation alone was the cause.
unusual finding because although infection is a recognized Rheumatic heart disease was the main culprit of these
cause of stroke7 it has not been reported as the prime valvular lesions. Another cause which leads to
dominant cause of this ailment in studies conducted earlier. cardioembolism was cardiomyopathies. Both of our
This may be due to more increased prevalence of infectious patients were female and were diagnosed as the case of
diseases in Pakistan. postpartum dilated cardiomyopathy. One of our patients
Infective meningitis includes tuberculous as well was a case of left Atrial Myxoma.This is the most common
as bacterial meningitis. Nine out of 17 patients (53%) cardiac tumour and is believed to cause 1% of stroke in
suffered from tuberculoses meningitis (TBM) while young individuals.16
remaining 8 (47%) from bacterial meningitis. TB is the Hypertension (HTN) is the most common and most
most common infectious disease in developing countries important risk factor for stroke whether primary or
of the world.9 This may be the reason why TBM related secondary.17 One recommendation is that a long term (5
stroke outnumbered the Bacterial meningitis related years) 5 to 6 mmHg decrease in the usual diastolic blood
stroke. The reported incidence of cerebral infarction in pressure was associated with a 35-40% reduction in
TBM is between 6-41% and is usually related to a stroke.8 In this study 7 (14%) patients had hypertension as
necrotizing arteritis of vessels of circle of Willis, involved a cause of stroke. Four (8%) of them suffered from
in the basal meningitis.10 TBM develops most commonly haemorrhagic stroke while 3 (6%) had ischaemic stroke. In
shortly after a primary infection in childhood or as a part 3 patients, no cause of hypertension was found though
of miliary TB.11 In our study organisms found responsible family history of hypertension was present two. HTN
for bacterial meningitis were meningococci and occurring in teenagers and young adults is uncommon,
haemophilus influenza. Meningococcal meningitis has a though the most common form is still essential
well defined relationship with stroke in young patients. In hypertension. Secondary causes are more commonly
one large study 28% of the patients of bacterial meningitis found here than in older adults.18 In this study nephritic
were found to suffer from one or more of neurological syndrome and pregnancy induced hypertension are
complications.12 In another study 21% out of 277 patients discussed separately, however, together over all there were
of bacterial meningitis had cerebrovascular 24% of patients suffering from hypertensive
complications. 13
complications, hence this suggests that HTN is one of the
In our study the second most frequent cause was major culprits leading to stroke not only in elderly people
cardioembolism i.e. 10 (20%) patients. It comprises 7 but also in young ones.14
(14%) patients of valvular heart disease (VHD), 2 (4%)
Stroke is a recognized complication of pregnancy
patients of dilated cardiomyopathy and 1 (2%) patient of
contributing to more than 12% of all maternal deaths.19 Our
cardiac myxoma. Cardioembolism was the leading cause
6 patients (12%) suffered from stroke due to pregnancy
of stroke in young in most of the studies nationally and
related complications. These results correlate with various
internationally.4,7,13,14 In our study VHD was the most
earlier studies.20-22 Among them 3 patients suffered from
frequent cause of cardioembolism. This is also the finding
pregnancy induced hypertension while remaining 3 from
of studies conducted in Iran.14,15 Findings of a local study
puerperal sepsis.
indicate that rheumatic heart disease (RHD) was the most
common cause followed by prosthetic valves infective Among less frequent causes, 2 patients (4%)
endocarditis and Ischaemic heart diseases.7 This may be suffered from systemic lupus erythematosis (SLE), 2
attributed to higher prevalence of RHD in the population patients from nephritic syndrome while other causes
of underdeveloped countries.14 It highlighted the fact that included thrombocytosis (4%), hyperlipidaemia (2%) and
although cardioembolism is a leading cause of stroke in hyperhomocystinaemia (4%). Stroke is a well defined
young people, its etiology is different in Asians compared complication of SLE.23 It is shown in different studies
to the developed world or other countries. In developed that hyper-homocystinaemia, thrombocytosis and
countries paradoxical embolism is now diagnosed as a dyslipidaemias are associated with stroke in young
leading cause of stroke in young adults.14 In Europe and patients.24,25
America RHD is much less common, mitral value prolapse MRI and MRA of brain could have given better
(MVP) and patent foramen ovale (PFO) have been information about the vascularity and extension of
considered as most common cardiac causes associated lesion as CT scan brain can only locate the lesion above
with stroke in young adults.7 In this study 58% of patients posterior fossa. Most of times CT scan brain can give the
of VHD suffered from combined mitral stenosis and mitral required information as MRI and MRA are costly
Vol. 60, No. 3, March 2010 203
4. investigations. 11. Pulsinelli WA. Ischemic cerebrovascular disease In: Goldman L, Bennett JC,
Drazen JM, Gill GN , Griggs RC, Kokko JP, et al. Cecil textbook of medicine
Conclusion 12.
21st ed. Philadelphia: WB sanders 2000; 2099- 105.
Pfister HW, Borasio GP, Dirnagl U, Einhaupl KM. Cerebrovascular
In young patients (15-35 years predominantly male) complications of bacterial meningitis in adults. Neurology 1992; 42: 1497-
504.
the major type of stroke encountered is due to cerebral 13. Ghori RA, Memon MA, Asghar P, Memon H. 100 cases of Meningococeal
Ischaemia, while common cause of Ischaemic stroke is Meningitis. Biomedica 1998; 14: 92- 7.
infective meningitis including both Tuberculous Meningitis 14. Harirchan MH, Ghaffarpoun M, Doratataji D, Akhavirad MB. Stroke in
young adults: a retrospective study of 68 cases. Acta Medica Iranica 2006;
and Bacterial Meningitis. The ratio of TBM was higher than 44: 119-24.
Bacterial Meningitis. Predominant cause of Haemorrhagic 15. Sadreddini SA. The Investigation of the Underlying Causes of Cerebral
stroke was Hypertension whether primary or secondary. Embolism, Common Site of Involvement, Cardiogenic and Neurogenic Signs
and Symptoms in Patients, Hospitalized in Imam Khomeini and Razi
References Hospitals in 9 months, September 1998-June 1999 Tabriz-Iran. Pak J Neurol
1999; 5: 41-4.
1. Bonita R, Mendis S, Truelsen T, Bagousslavsky J, Toole J, Yatsu F. The global 16. Bashore TM, Granger CB, Hranitzky P. Heart Disease. In: Tiernecy Jr. LM,
stroke initiative. Lancet Neurol 2004; 3: 391-3. Mcphee SJ, Papadakis MA. Current Medical Diagnosis and Treatment. 47th
2. Pulsinell WA. Cerebrovascular diseases Principles. In: Goldman L. Benett JC, ed. USA: McGraw-Hill 2008; pp 351-7.
Drazen JM, Gill GN, Griggs RC, Kokko JP, etal.Cecil text book of medicine. 17. Hsu LF, SinFaiLam KN, Rajasoorya C, Chew LS. Hypertension in the young
21st ed. Philadelphia: WB Sanders 2000; pp 2092-3. adult, come feel the pulse. Singapore Med J 2000; 41: 235-8.
3. Qureshi AI, Safdar K, Patel M, Janssen RS, Frankel MR. Stroke in young 18. Khan J, Rehman A, Shah AA, Jielani A. Frequency of hypertension in stroke
black patients. Risk factors, subtypes, and prognosis. Stroke 1995; 26: 1995- patients presenting at Ayub Teaching Hospital. J Ayub Med Coll Abbottabad
8. 2006; 18: 59-61.
4. Gonzalez- Martinez F, Navarro- Gutierrez S, Oliete- Ramirez E, Sanchez- 19. Treadwell SD, Thanvi B, Robinson TG. Stroke in pregnancy and the
Yepez J, Ballester-Vidal Mr Estevez, Rovira E. Stroke in young patients a puerperium. Postgrad Med J 2008; 84: 238-45.
diagnostic challenge in the emergency room. Eur J Emerg Med 2004; 11: 178- 20. Lamy C, Sharshar T, Mas JL. Cerebrovascular diseases in pregnancy and
80. puerperium. Rev Neurol (Paris) 1996; 52: 422-40.
5. Bendixen BH, Posner J, Lango R. Stroke in young adults and children. Curr 21. Mas JL, Lamy C. Stroke in Pregnancy and the puerperium. J Neurol 1998;
Neurol Neurosci Rep 2001; 1: 54-66. 245: 305-13.
6. Martin PJ, Enevoldson TP, Humphrey PR. Causes of ischaemic stroke in the 22. Lamy C, Hamon JB, Coste J, MasJL. Ischemic stroke in young women: risk
young. Postgrad Med J 1997; 73: 8-16. of recurrence during subsequent pregnancies. French Study Group on Stroke
7. Khan AJ, Shah MA. Young Stroke Clinical aspects. J Coll Physicians Surg in Pregnancy. Neurology 2000; 55: 269-74.
Pak 2000; 10: 461-2. 23. Hellmann DB, Imboden jr JB. Arthritis and musculoskeletal disorders. In:
8. Overview of the evaluation of stroke: 2003 uptodate [computer program] Tiernery Jr LM, Mcphee SJ, Papadakis MA. Current Medical diagnosis and
version 11.3. (Online) 2000. Available from URL: www.uptodate.com (800) treatment 47th ed. USA: Mc Graw Hill companies 2008; pp 727.
998- 6374 (781) 237- 4788. 24. Kristensen B, Malm J, Nilsson TK, Hultdin J, Carlberg B, Dahlen, G, et al.
9. Haslett C, Chilvers ER, Corris PA. Respiratory disease. In: Haslett C, Chilvers Hyperhomocysteinaemia and hypofibrinolysis in young adults with ischemic
ER, Boon NA, Colledge NR. Davidson's principles and practice of medicine. stroke. Stroke 1999; 30: 974-80.
19th ed. Edinburgh: Churchill Livingstone 2002; pp 532. 25. Allen CMC, Lueck CJ, Dennis M. Neurological disease In: Boon NA,
10. Chan KH, Cheung RTF, Lee R, Mak W, Ho SL. Cerebral Infarcts Colledge NR Walker BR,Hunter JAA. Davidson's principles and practice of
Complicating Tuberculosis Meningitis. Cerebrovasc Dis 2005; 19: 391-5. medicine 20th ed. Edinburgh: Churchill Livingstone 2006; pp 1204.
204 J Pak Med Assoc