Cerebral infarcts associated with migraine: Clinical features, risk factors and follow-up

Objective: To describe the clinical features of stroke patients from rural and urban areas and to identify possible associations with clinical outcomes. Introduction: There is little information in Latin America about risk factors, treatments, and outcomes in stroke patients from rural areas and urban people. The rural population faces multiple healthcare access barriers that might influence stroke outcomes. This paper describes and analyzes clinical features in stroke patients according to their location. Methods: Prospective cohort study of Colombian stroke patients using demographic and clinical data collected between 2018 and 2020 in a high complexity hospital from southwestern Colombia, as part of a pilot stroke network consisting of rural primary centers and a mothership center. Mode of transport to the stroke center, timing, clinical characteristics, interventions, and modified Rankin scale (mRS) at discharge and 3 months were assessed. Results: We included 579 stroke patients (66.14% ischemic), with a median age of 70 years (60-81). Urban subjects showed higher prevalence of dyslipidemia (p=0.009), previous hemorrhagic stroke (p=0.036), and TIA (p=0.002). Approximately 35% of cases were initially evaluated at a rural primary care center. These subjects exhibited a higher NIHSS scores (10 IQR 5-19 vs. 5 IQR 2-13; p=0.000) with a longer window (p<0.001) and were mainly transferred by ambulance (89.80%, p=0.000). Due to the severity, door-to-imaging time was shorter (p=0.001). Rural patients receive thrombolysis in 27.36% and underwent thrombectomy in 14.43%. Higher mRs at discharge (3 IQR 2-5 vs. 2 IQR 1-4; p=0.000) and three-months follow-up (3 IQR 1-6 vs. 1 IQR 0-4; p<0.001) were observed. Conclusions: Rural patients from southwestern Colombia were more likely to present with severe strokes even though they had lower rates of cardiovascular risk factors. They arrived later to the stroke center, but the final diagnosis was reached faster. Nonetheless, disability was higher at discharge and 3-months follow-up.

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Clinical features, risk factors, and prognosis in transient global amnesia: a follow-up study

European Journal of Neurology ◽

10.1111/j.1468-1331.2004.00982.x ◽

2005 ◽

Vol 12 (5) ◽

pp. 350-356 ◽

Cited By ~ 55

Author(s):

L. Pantoni ◽

E. Bertini ◽

M. Lamassa ◽

G. Pracucci ◽

D. Inzitari

Keyword(s):

Risk Factors ◽

Clinical Features ◽

Transient Global Amnesia ◽

Follow Up Study ◽

Global Amnesia

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Clinical Features, Prothrombotic Risk Factors, and Long-Term Follow-Up of Eight Pediatric Moyamoya Patients

Journal of Clinical Neurology ◽

10.3988/jcn.2012.8.2.100 ◽

2012 ◽

Vol 8 (2) ◽

pp. 100 ◽

Cited By ~ 4

Author(s):

Burak Tatlı ◽

Barış Ekici ◽

Altay Sencer ◽

Serra Sencer ◽

Kubilay Aydın ◽

...

Keyword(s):

Risk Factors ◽

Clinical Features ◽

Prothrombotic Risk Factors ◽

Long Term Follow Up

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Clinical and Prognostic Features of Essential Thrombocythemia: Comparison of Who 2001 Versus Who 2008/2016 Criteria in a Large Single Center Cohort

Blood ◽

10.1182/blood-2018-99-117905 ◽

2018 ◽

Vol 132 (Supplement 1) ◽

pp. 5464-5464

Author(s):

Sofia Chiatamone Ricci ◽

Maria Antonietta Arleo ◽

Stefania Trasarti ◽

Cristina Santoro ◽

Massimo Breccia ◽

...

Keyword(s):

Risk Factors ◽

Clinical Features ◽

Essential Thrombocythemia ◽

Advisory Board ◽

World Health ◽

Thrombotic Risk ◽

Entire Cohort ◽

Prognostic Features ◽

Who 2008

Abstract According to the World Health Organization (WHO) 2008/2016 criteria for classification of myeloid neoplasms, a platelet (PLT) count ≥ 450X109/l, thus reduced from the previous WHO 2001 level ≥ 600 x 109/l, was considered the new PLT threshold for the diagnosis of Essential Thrombocythemia (ET). Aim of the study was to validate in a setting of current clinical practice this important diagnostic change and compare clinical and hematological features at diagnosis and during follow-up of patients with PLT ≥600 x 109/l versus patients with PLT < 600 x 109/l. We retrospectively analyzed data from 264 patients with ET according to WHO 2008/2016 criteria, enrolled in our center from 1/2008 to 12/2017. Patients were divided into Group A (G-A) (PLT ≥600 x 109/l at diagnosis) (199 patients - 75.4%) and Group B (G-B) (PLT ≥ 450 x 109/l < 600 x 109/l at diagnosis) (65 patients - 24.6%) and compared for clinical features at the onset, clinical course and follow-up. Main features and commonly recognized pro-thrombotic risk factors at diagnosis of the entire cohort as well as of G-A and G-B are reported in the Table 1. Among clinical features, only the median value of leukocytes was significantly higher in G- A [9.1 x 109/l, interquartile range (IQR) 7.8-10.3 vs 7.4 x 109/l, IQR 6.0-9.6; p = 0.001]. Among pro-thrombotic risk factors, only the median cholesterol value was significantly lower in the G-A [187 mg/dl (IQR 164-220) vs 204 mg/dl (RIQ 177-238); p = 0.048]. Cytostatic treatment was administered in 175 patients (71.1%) of entire cohort at different intervals from diagnosis, with a significantly higher rate in patients of G-A (76.9% versus 49.2%, p <0.001). After a median follow-up of 37.5 months (IQR 19.8 - 60.7), 13 thrombotic events (4.9%) were recorded in the entire cohort (7 episodes in the G-A and 6 episodes in the G-B), with a 5-year Cumulative Incidence of Thrombosis (CIT) significantly higher in the G-B [79.6% (95%CI 59.6 - 99.6) versus 95.4% (95%CI 91.8 - 99.0); p=0.047] (Figure 1). No patient evolved in myelofibrotic phase, 2 patients evolved in blastic phase (BP) after 42 and 58 months, respectively [1 patient (0.5%) in the G-A and 1 patient (1.3%) in the G-B; p=0.40). At the last follow-up, 4 patients (1.5%) died (1 from BP, 1 from cerebral hemorrhage, 2 from unavailable cause), 15 (5.7%) were lost to follow-up and 245 (92.8%) are still alive and currently followed at our Institute. The 5-year Overall Survival (OS) of the entire cohort was 96.2% (IC95% 92.2 - 100), without differences between the two groups [96.3% (95% CI 92.0 - 100) in the G-A versus 96.7% (IC95% 91.7 - 100) in the G-B; p=0.898]. Our data indicate a substantial homogeneity among ET patients regardless of the PLT number at diagnosis, thus confirming the usefulness of 2008/2016 WHO diagnostic criteria. Furthermore, the counterintuitive lower CIT observed in G-A, due to a larger use of cytostatic treatments and/or to an acquired Von Willebrand phenomenon when PLT levels > 1.000 x 109/l, highlights how thrombotic risk is unrelated to PLT value and leads to consider the administration of adequate cytostatic therapy even in patients with relatively lower PLT count at diagnosis. Disclosures Breccia: Novartis: Honoraria; Pfizer: Honoraria; Incyte: Honoraria; BMS: Honoraria. Foà:INCYTE: Other: ADVISORY BOARD; JANSSEN: Other: ADVISORY BOARD, Speakers Bureau; GILEAD: Speakers Bureau; CELTRION: Other: ADVISORY BOARD; ABBVIE: Other: ADVISORY BOARD, Speakers Bureau; CELGENE: Other: ADVISORY BOARD, Speakers Bureau; AMGEN: Other: ADVISORY BOARD; ROCHE: Other: ADVISORY BOARD, Speakers Bureau; NOVARTIS: Speakers Bureau.

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Chronic lymphedema in patients with kaposiform hemangioendothelioma: incidence, clinical features, risk factors and management

Orphanet Journal of Rare Diseases ◽

10.1186/s13023-020-01595-2 ◽

2020 ◽

Vol 15 (1) ◽

Author(s):

Yi Ji ◽

Siyuan Chen ◽

Chuncao Xia ◽

Jiangyuan Zhou ◽

Xian Jiang ◽

...

Keyword(s):

Risk Factors ◽

Cohort Studies ◽

Clinical Features ◽

Management Strategies ◽

Compression Therapy ◽

Kaposiform Hemangioendothelioma ◽

History Of ◽

Chronic Lymphedema ◽

Possible Cause

Abstract Objectives There are no cohort studies of chronic lymphedema in patients with kaposiform hemangioendothelioma (KHE). We sought to characterize the incidence, clinical features, risk factors and management of chronic lymphedema in patients with KHE. Methods We conducted a multicenter retrospective analysis of patients who had a minimum of 3 years of follow-up after the onset of KHE and/or Kasabach–Merritt phenomenon (KMP). Clinical features were reviewed to determine the possible cause of chronic lymphedema. The degree of lymphedema, risk factors and management strategies were analyzed. Results Among the 118 patients, chronic lymphedema was confirmed by lymphoscintigraphy 1 year after the onset of KHE and/or KMP in 13 patients. In 8 patients with lymphedema, extremity swelling was evident in the presence of KHE and/or KMP. In all patients with lymphedema, a unilateral extremity was affected, along with ipsilateral KHE. Most (84.6%) patients reported moderate lymphedema. Lymphedema was more common in patients with larger (≥ 10 cm) and mixed lesions involving the extremities (P < 0.01). A history of KMP and sirolimus treatment were not predictors of lymphedema (P > 0.05). Overall, 76.9% of patients received sirolimus treatment after referral, including 53.8% who presented extremity swelling before referral. Seven (53.8%) patients received compression therapy. Five (38.5%) patients reported lymphedema-associated decreased range of motion at the last follow-up. Conclusions Chronic lymphedema is a common sequela of KHE and can occur independently of KMP and sirolimus treatment. Patients with large and mixed KHE involving extremities should be closely monitored for this disabling complication.

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Lambl's Excrescences: Association with Cerebrovascular Disease and Pathogenesis

Cerebrovascular Diseases ◽

10.1159/000381906 ◽

2015 ◽

Vol 40 (1-2) ◽

pp. 18-27 ◽

Cited By ~ 6

Author(s):

Carlos A. Roldan ◽

Oleksandr Schevchuck ◽

Kirsten Tolstrup ◽

Paola C. Roldan ◽

Leonardo Macias ◽

...

Keyword(s):

Risk Factors ◽

Cerebrovascular Disease ◽

Lupus Erythematosus ◽

Transcranial Doppler ◽

Heart Valves ◽

Brain Mri ◽

Healthy Controls ◽

Cerebral Infarcts ◽

Platelet Activity

Background: Lambl's excrescences (LEx) are detected by transesophageal echocardiography (TEE) and are characterized as thin, elongated, and hypermobile structures located at the leaflets' coaptation point of the heart valves. The association of LEx with cerebrovascular disease (CVD) is still undefined and yet patients with LEx and suspected CVD receive unproven effective antiplatelet or anticoagulant therapy or even undergo valve surgery. Also, the association of LEx with aging and atherogenic, inflammatory, or thrombogenic parameters has not been reported. Methods: Seventy-seven patients with systemic lupus erythematosus (SLE) (71 women, age 37 ± 12 years) and 26 age- and sex-matched healthy controls (22 women, age 34 ± 11 years) prospectively underwent routine history and physical exam, transcranial Doppler, brain MRI, TEE, carotid duplex, and clinical and laboratory evaluations of atherogenesis, inflammation, platelet activity, coagulation, and fibrinolysis. Subjects without stroke/TIA on enrollment (with and without LEx) had a median follow-up of 57 months. Results: On enrollment, 33 (43%) of 77 patients had CVD manifested as acute stroke/TIA (23 patients), cerebromicroembolism by transcranial Doppler (17 patients), or cerebral infarcts by MRI (14 patients). Mitral or aortic valve LEx were equally frequent in healthy controls (46%) as in patients with and without any CVD (39 and 43%), stroke/TIA (35 and 43%), cerebromicroembolism (41 and 42%), or cerebral infarcts (36 and 43%) (all p ≥ 0.72). Also, other mechanisms for CVD other than LEx such as Libman-Sacks vegetations, patent foramen ovale or interatrial septal aneurysm, aortic or carotid atherosclerosis, or thrombogenesis were found in ≥94% of patients with CVD. In addition, 36 subjects with and 44 without LEx had similar low incidence of stroke/TIA (1 (1.3%) and 2 (2.5%), respectively, p = 1.0) during follow-up. Finally, LEx were not associated with aging, atherogenic risk factors, atherosclerosis, inflammation, or thrombogenesis. Conclusions: In this study, LEx are similarly prevalent in healthy controls and SLE patients, are not associated with CVD, and are not associated with pathogenic risk factors. Therefore, the study findings suggest that LEx may not be cardioembolic substrates, may not represent pathologic valve structures, and may not require therapy.

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Investigating phenotypes of pulmonary COVID-19 recovery: a longitudinal observational prospective multicenter trial

10.1101/2021.06.22.21259316 ◽

2021 ◽

Author(s):

Thomas Sonnweber ◽

Piotr Tymoszuk ◽

Sabina Sachanic ◽

Anna Boehm ◽

Alex Pizzini ◽

...

Keyword(s):

Risk Factors ◽

Clinical Features ◽

Research Question ◽

Acute Infection ◽

Machine Learning Algorithms ◽

Individual Risk ◽

Clinical Trial Registration ◽

Risk Class ◽

Persistent Symptoms

Background: COVID-19 is associated with long-term pulmonary symptoms and may result in chronic pulmonary impairment. The optimal procedures to prevent, identify, monitor, and treat these pulmonary sequelae are elusive. Research question: To characterize the kinetics of pulmonary recovery, risk factors and constellations of clinical features linked to persisting radiological lung findings after COVID-19. Study design and methods: A longitudinal, prospective, multicenter, observational cohort study including COVID-19 patients (n = 108). Longitudinal pulmonary imaging and functional readouts, symptom prevalence, clinical and laboratory parameters were collected during acute COVID-19 and at 60-, 100- and 180-days follow-up visits. Recovery kinetics and risk factors were investigated by logistic regression. Classification of clinical features and study participants was accomplished by k-means clustering, the k-nearest neighbors (kNN), and naive Bayes algorithms. Results: At the six-month follow-up, 51.9% of participants reported persistent symptoms with physical performance impairment (27.8%) and dyspnea (24.1%) being the most frequent. Structural lung abnormalities were still present in 45.4% of the collective, ranging from 12% in the outpatients to 78% in the subjects treated at the ICU during acute infection. The strongest risk factors of persisting lung findings were elevated interleukin-6 (IL6) and C-reactive protein (CRP) during recovery and hospitalization during acute COVID-19. Clustering analysis revealed association of the lung lesions with increased anti-S1/S2 antibody, IL6, CRP, and D-dimer levels at the early follow-up suggesting non-resolving inflammation as a mechanism of the perturbed recovery. Finally, we demonstrate the robustness of risk class assignment and prediction of individual risk of delayed lung recovery employing clustering and machine learning algorithms. Interpretation: Severity of acute infection, and systemic inflammation is strongly linked to persistent post-COVID-19 lung abnormality. Automated screening of multi-parameter health record data may assist the identification of patients at risk of delayed pulmonary recovery and optimize COVID-19 follow-up management. Clinical Trial Registration: ClinicalTrials.gov: NCT04416100

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Complementary Effects of Multivitamin and Omega-3 Fatty Acid Supplementation on Indices of Cardiovascular Health in Individuals with Elevated Homocysteine

International Journal for Vitamin and Nutrition Research ◽

10.1024/0300-9831/a000093 ◽

2012 ◽

Vol 82 (1) ◽

pp. 41-52 ◽

Cited By ~ 5

Author(s):

P. Earnest ◽

S. Kupper ◽

M. Thompson ◽

Guo ◽

S. Church

Keyword(s):

Risk Factors ◽

Cardiovascular Health ◽

Omega 3 Fatty Acids ◽

Omega 3 ◽

C Reactive Protein ◽

Fatty Acid Supplementation ◽

Omega 3 Fatty Acid ◽

Reactive Protein ◽

Daily Ingestion

Homocysteine (HCY), C-reactive protein (hsCRP), and triglycerides (TG) are risk factors for cardiovascular disease (CVD). While multivitamins (MVit) may reduce HCY and hsCRP, omega-3 fatty acids (N3) reduce TG; yet, they are seldom studied simultaneously. We randomly assigned 100 participants with baseline HCY (> 8.0 umol/L) to the daily ingestion of: (1) placebo, (2) MVit (VitC: 200 mg; VitE: 400 IU; VitB6: 25 mg; Folic Acid: 400 ug; VitB12: 400 ug) + placebo, (3) N3 (2 g N3, 760 mg EPA, 440 mg DHA)+placebo, or (4) MVit + N3 for 12 weeks. At follow-up, we observed significant reductions in HCY (umol/L) for the MVit (- 1.43, 95 %CI, - 2.39, - 0.47) and MVit + N3 groups (- 1.01, 95 %CI, - 1.98, - 0.04) groups, both being significant (p < 0.05) vs. placebo (- 0.57, 95 %CI, - 1.49, 0.35) and N3 (1.11, 95 % CI, 0.07, 2.17). hsCRP (nmol/L) was significantly reduced in the MVit (- 6.00, 95 %CI, - 1.04, - 0.15) and MVit + N3 (- 0.98, 95 %CI, - 1.51, - 0.46) groups, but not vs. placebo (- 0.15, 95 %CI, - 0.74, 0.43) or N3 (- 0.53, 95 %CI, - 1.18, 0.12). Lastly, we observed significant reductions in TG for the N3 (- 0.41, 95 %CI, - 0.69, - 0.13) and MVit + N3 (- 0.71, 95 %CI, - 0.93, - 0.46) groups, both significant vs. placebo (- 0.10, 95 %CI, - 0.36, 0.17) and MVit groups (0.15, 95 %CI, - 12, 0.42). The co-ingestion of MVit + N3 provides synergistic affects on HCY, hsCRP, and plasma TG.

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Psychological Resilience Provides No Independent Protection From Suicidal Risk

Crisis ◽

10.1027/0227-5910/a000364 ◽

2016 ◽

Vol 37 (2) ◽

pp. 130-139 ◽

Cited By ~ 9

Author(s):

Danica W. Y. Liu ◽

A. Kate Fairweather-Schmidt ◽

Richard Burns ◽

Rachel M. Roberts ◽

Kaarin J. Anstey

Keyword(s):

Risk Factors ◽

Well Being ◽

Current Status ◽

Psychological Resilience ◽

Cross Sectional ◽

Life Project ◽

Resilience Factors ◽

First Time

Abstract. Background: Little is known about the role of resilience in the likelihood of suicidal ideation (SI) over time. Aims: We examined the association between resilience and SI in a young-adult cohort over 4 years. Our objectives were to determine whether resilience was associated with SI at follow-up or, conversely, whether SI was associated with lowered resilience at follow-up. Method: Participants were selected from the Personality and Total Health (PATH) Through Life Project from Canberra and Queanbeyan, Australia, aged 28–32 years at the first time point and 32–36 at the second. Multinomial, linear, and binary regression analyses explored the association between resilience and SI over two time points. Models were adjusted for suicidality risk factors. Results: While unadjusted analyses identified associations between resilience and SI, these effects were fully explained by the inclusion of other suicidality risk factors. Conclusion: Despite strong cross-sectional associations, resilience and SI appear to be unrelated in a longitudinal context, once risk/resilience factors are controlled for. As independent indicators of psychological well-being, suicidality and resilience are essential if current status is to be captured. However, the addition of other factors (e.g., support, mastery) makes this association tenuous. Consequently, resilience per se may not be protective of SI.

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