P5345Association and prevalence of post-stroke erectile dysfunction with cardiovascular risk factors and co-morbidities

Abstract Objectives The aim of this study was to establish a correlation between prevalence and severity of erectile dysfunction (ED) and cardiovascular (CV) co-morbidities and ongoing medication and other risk factors associated with post-stroke ED. Materials and methods For 153 patients (57.04±6.54 years) with ischemic stroke, we evaluated the pre- and post-stroke prevalence of ED using the five-item International Index of Erectile Function questionnaire (IIEF5). Erectile Function questionnaire (IIEF5). Within 5 days of admission we determined the stroke site location and severity using the National Institute of Health Stroke Scale (NIHSS). The pre- and post-stroke data obtained were compared with those of 30 control non-stroke patients (52.27±8.35). Additional cardiovascular co-morbidities, medication and risk factors were asset and analyzed. Results The IIEF5 scores were much lower [median 17 interquartile range (IQR) 10–20] post stroke than pre-stroke (median 22 IQR 12–23) and lower than in control group (median 22.5 IQR 21–24). From the analysis of comorbidities and risk factors for stroke of post- stroke group and the control group, we infer that diabetes (p=0.003), hypercholesterolemia (p<0.001), and hypertension (p<0.001) were more common in patients with stroke than those in the control group. (Table 1). From the statistical analysis of data on medication use by patients, results that more patients have used ACE inhibitors, calcium antagonists, beta blocking agents, diuretics, statins, oral agents, antiplatelet and oral anticoagulants after the stoke than before, and in terms of consumption of drugs before stroke compared with the control group, differences were not significant. Lot 1 Lot 2 Lot 3 P values P values P values post-stoke patients pre-stroke patients control group [1 vs 3] [2 vs 3] [1 vs 2] No. of Patients 153 153 30 Age, mean ± SD 57.04±6.54 57.04±6.54 52.27±8.35 Pacient with ED, N (%) 127 (83%) 76 (49.67%) 9 (30%) <0.001 0.048 <0.001 Severity of ED, N (%) Mild 74 (48.37%) 29 (18.95%) 7 (23.33%) 0.015 0.581 <0.001 Mild to moderate 1 (0.01%) 11 (7.19%) 1 (3.33%) 0.302* 0.694* 0.127* Moderate 28 (18.30%) 21 (13.73%) 1 (3.33%) 0.052* 0.134* <0.001* Severe 24 (15.69%) 15 (9.80%) 0 0.016* 0.136* <0.001* IIEF5 (Erectile function) Mean ± SD 15.53±5.89 17.83±6.18 21.83±3.31 <0.001 <0.001 <0.001 Median (Q1–Q3) 17 (10–20) 22 (12–23) 22.5 (21–24) Hamilton Score Normal 91 (59.4%) 144 (94.1%) 23 (76.6%) Mild depression 40 (26.1%) 1 (0.6%) 5 (16.6%) Moderate depression 11 (7.1%) 0 (0.0%) 1 (3.3%) Severe depression 9 (5.8%) 6 (3.9%) 1 (3.3%) Very severe depression 2 (1.3%) 2 (1.3%) 0 (0.0%) Comorbidities Diabetes mellitus 59 (38.5%) 3 (10.0%) 0.003* Hypercholesterolemia 104 (67.9%) 6 (20.0%) <0.001 Hypertension 121 (79.0%) 8 (26.6%) <0.001 Obesity 36 (23.5%) 6 (20.0%) 0.674 Smoking 53 (34.6%) 5 (16.6%) 0.056* Atrial fibrillation 22 (14.3%) 2 (6.6%) 0.377* Carotid artery stenosis 18 (11.7%) 1 (3.3%) 0.321* Coronary hearth disease 26 (16.9%) 1 (3.3%) 0.086* Medication ACE inhibitors 72 (47.0%) 32 (20.9%) 2 (6.6%) <0.001* 0.075* <0.001 Calcium Antagonists 49 (32.0%) 17 (11.1%) 4 (13.3%) 0.047* 0.755* <0.001 Beta-Blokers 65 (42.4%) 36 (23.5%) 3 (10.0%) 0.001* 0.142* <0.001 Diuretics 43 (28.1%) 14 (9.1%) 3 (10.0%) 0.039* >0.999* <0.001 Statins 99 (64.7%) 25 (16.3%) 4 (13.3%) <0.001* 0.791* <0.001 Oral antidiabetics 39 (25.4%) 25 (16.3%) 1 (10.0%) 0.007* 0.084* 0.442 Insulin 20 (13.0%) 15 (9.8%) 0 (0.0%) 0.048* 0.136* 0.369 Antiplatelet drugs 131 (85.6%) 14 (9.1%) 2 (6.6%) <0.001* >0.999* <0.001 Oral anticoagulants 22 (14.3%) 8 (5.2%) 0 (0.0%) 0.028* 0.357* 0.007 Antidepressants 28 (18.3%) 12 (7.84%) 2 (6.6%) 0.176* >0.999* 0.007 Conclusions The prevalence and severity of ED increase after stroke due to disruption of autonomous central structures. The depression, functional impairment, CV co-morbidities and medication used after stroke may contribute to ED.

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A prospective study of erectile dysfunction in men after pelvic surgical procedures and its association with non - modifiable risk factors

10.21203/rs.2.16681/v3 ◽

2019 ◽

Author(s):

Sofia Artemi ◽

Panteleimon Vassiliu ◽

Nikolaos Arkadopoulos ◽

Maria - Eleni Smyrnioti ◽

Pavlos Sarafis ◽

...

Keyword(s):

Risk Factors ◽

Erectile Dysfunction ◽

Prospective Study ◽

Erectile Function ◽

Pelvic Surgery ◽

Control Group ◽

Modifiable Risk Factors ◽

Analysis Model ◽

Male Patients ◽

A Prospective Study

Abstract Objective: A pelvic surgery can cause erectile dysfunction. The purpose of this study was to evaluate erectile function at various times after pelvic surgery in male patients; to search the non-modifiable risk factors associated with the presence and intensity of sexuality in these patients. This prospective study used the erectile dysfunction IIEF scale. Results: The study population comprised of 106 male patients who had undergone minor pelvic surgery at least 9 months before and during the 2010–2016 period in the 4th Surgical Clinic. A control group of healthy males (N=106) who underwent no pelvic surgery matched for age was also used for reference values. The main age of the participants was 66.16 ±13.07 years old. A history of colectomy was present in 36.8%, 18.9% had undergone sigmoidectomy, and 33% inguinal hernia repair. The percentage of severe erectile function increased from 38.7% before surgery to 48.1% (25% increase) after surgery, at the end of the follow-up period (p<0.05). In the multivariate analysis model, age emerged as an independent predictor of erectile function (p<0.001). Age was the most important determinant of the IIEF score, which was aggravated by 25% from the first to the last assessment of patients.

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A prospective study of erectile dysfunction in men after pelvic surgical procedures and its association with non - modifiable risk factors

10.21203/rs.2.16681/v2 ◽

2019 ◽

Author(s):

Sofia Artemi ◽

Panteleimon Vassiliu ◽

Nikolaos Arkadopoulos ◽

Maria - Eleni Smyrnioti ◽

Pavlos Sarafis ◽

...

Keyword(s):

Risk Factors ◽

Erectile Dysfunction ◽

Prospective Study ◽

Erectile Function ◽

Pelvic Surgery ◽

Control Group ◽

Modifiable Risk Factors ◽

Analysis Model ◽

Male Patients ◽

A Prospective Study

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A prospective study of erectile dysfunction in men after pelvic surgical procedures and its association with non-modifiable risk factors

BMC Research Notes ◽

10.1186/s13104-019-4839-2 ◽

2019 ◽

Vol 12 (1) ◽

Cited By ~ 1

Author(s):

S. Artemi ◽

P. Vassiliu ◽

N. Arkadopoulos ◽

Maria-Eleni Smyrnioti ◽

P. Sarafis ◽

...

Keyword(s):

Risk Factors ◽

Erectile Dysfunction ◽

Prospective Study ◽

Erectile Function ◽

Pelvic Surgery ◽

Control Group ◽

Modifiable Risk Factors ◽

Analysis Model ◽

Male Patients ◽

A Prospective Study

Abstract Objective A pelvic surgery can cause erectile dysfunction. The purpose of this study was to evaluate erectile function at various times after pelvic surgery in male patients; to search the non-modifiable risk factors associated with the presence and intensity of sexuality in these patients. This prospective study used the erectile dysfunction IIEF scale. Results The study population comprised of 106 male patients who had undergone minor pelvic surgery at least 9 months before and during the 2010–2016 period in the 4th Surgical Clinic. A control group of healthy males (N = 106) who underwent no pelvic surgery matched for age was also used for reference values. The main age of the participants was 66.16 ± 13.07 years old. A history of colectomy was present in 36.8%, 18.9% had undergone sigmoidectomy, and 33% inguinal hernia repair. The percentage of severe erectile function increased from 38.7% before surgery to 48.1% (25% increase) after surgery, at the end of the follow-up period (p < 0.05). In the multivariate analysis model, age emerged as an independent predictor of erectile function (p < 0.001). Age was the most important determinant of the IIEF score, which was aggravated by 25% from the first to the last assessment of patients.

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Significant Increase of Erectile Dysfunction in Men With Post-stroke: A Comprehensive Review

Frontiers in Neurology ◽

10.3389/fneur.2021.671738 ◽

2021 ◽

Vol 12 ◽

Author(s):

Shankun Zhao ◽

Weizhou Wu ◽

Panxing Wu ◽

Chao Ding ◽

Bingxiang Xiao ◽

...

Keyword(s):

Erectile Dysfunction ◽

General Population ◽

Erectile Function ◽

Meta Analysis ◽

Quantitative Result ◽

Stroke Patients ◽

Comprehensive Review ◽

Post Stroke ◽

High Prevalence ◽

Mean Differences

Men with erectile dysfunction (ED) are considered to be at risk from stroke events. Conversely, post-stroke patients are also at high risk of ED, whereas a quantitative result from all the relevant studies has not been previously addressed. Therefore, we have performed a comprehensive review and meta-analysis on this issue. This study was registered on PROSPERO (ID No. CRD42021226618). Twenty studies with a total of 3,382 stroke events were included, of which six studies were included for quantitative analysis, and the remaining 14 studies were calculated for the ratio of ED. Synthetic results from four eligible studies providing the ED cases showed that stroke patients were associated with a significantly higher risk of ED than the general population [pooled relative risk (RR) = 3.32, 95% confidence interval (CI): 1.25–8.82, P = 0.016]. Men with stroke were also found to be associated with a significant decline in International Index of Erectile Function −5 (IIEF-5) score as compared with the healthy controls [three studies, standard mean differences (SMD) = −1.8, 95% CI: −2.94 to −0.67, P = 0.002]. The prevalence of ED in post-stroke patients among 14 studies ranged from 32.1 to 77.8%, which was dramatically higher than that of the general population. The result of the GRADE-pro revealed that the quality of the evidence in this study was moderate. The present study has confirmed the high prevalence of ED in men with stroke. ED in stroke patients is a result of both neurological and psychological factors. Rehabilitative interventions rather than phosphodiesterase-5 (PDE-5) inhibitors are recommended to improve the erectile function for those survivors with ED.

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Risk Factors of Recurrent Ischemic Events after Acute Noncardiogenic Ischemic Stroke

Current Pharmaceutical Design ◽

10.2174/1381612825666191029103756 ◽

2020 ◽

Vol 25 (45) ◽

pp. 4827-4834 ◽

Cited By ~ 1

Author(s):

Limin Zhang ◽

Xingang Li ◽

Dongzhi Wang ◽

Hong Lv ◽

Xuezhong Si ◽

...

Keyword(s):

Risk Factors ◽

Logistic Regression ◽

Regression Analysis ◽

Ischemic Stroke ◽

Operating Characteristic ◽

Control Group ◽

Case Group ◽

Stroke Patients ◽

Clopidogrel Therapy ◽

Ischemic Events

Background: A considerable proportion of acute noncardiogenic ischemic stroke patients continue to experience recurrent ischemic events after standard therapy. Aim: We aimed to identify risk factors for recurrent ischemic event prediction at an early stage. Methods : 286 non-cardioembolic ischemic stroke patients with the onset of symptoms within 24 hours were enrolled. Vascular risk factors, routine laboratory data on admission, thromboelastography test seven days after clopidogrel therapy and any recurrent events within one year were assessed. Patients were divided into case group (patients with clinical adverse events, including ischemic stokes, transient ischemic attack, myocardial infarction and vascular related mortality) and control group (events-free patients). The risk of the recurrent ischemic events was determined by the receiver operating characteristic curve and multivariable logistic regression analysis. Results: Clinical adverse events were observed in 43 patients (case group). The mean levels of Mean Platelet Volume (MPV), Platelet/Lymphocyte Ratio (PLR), Lymphocyte Count (LY) and Fibrinogen (Fib) on admission were significantly higher in the case group as compared to the control group (P<0.001). Seven days after clopidogrel therapy, the ADP-induced platelet inhibition rate (ADP%) level was lower in the case group, while the Maximum Amplitude (MA) level was higher in the case group as compared to the control group (P<0.01). The Area Under the Curve (AUC) of receiver operating characteristic(ROC) curve of LY, PLR, , Fib, MA, ADP% and MPV were 0.602, 0.614, 0.629, 0.770, 0.800 and 0.808, respectively. The logistic regression analysis showed that MPV, ADP% and MA were indeed predictive factors. Conclusion: MPV, ADP% and MA were risk factors of recurrent ischemic events after acute noncardiogenic ischemic stroke. Urgent assessment and individual drug therapy should be offered to these patients as soon as possible.

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Abstract TP224: Interleukin-37 Level is Elevated in Acute Ischemic Stroke

Stroke ◽

10.1161/str.48.suppl_1.tp224 ◽

2017 ◽

Vol 48 (suppl_1) ◽

Author(s):

Saif Bushnaq ◽

Atif Zafar ◽

Kempuraj Duraisamy ◽

Nudrat Tasneem ◽

Mohammad M Khan ◽

...

Keyword(s):

Ischemic Stroke ◽

Acute Ischemic Stroke ◽

Inflammatory Responses ◽

Enzyme Linked Immunosorbent Assay ◽

Control Group ◽

Delayed Presentation ◽

Stroke Patients ◽

Post Stroke ◽

Urine And Serum ◽

Serum And Urine

Background: Interleukin-37 (IL-37) is a new member of IL-1 cytokine family with a defined role as a negative feedback inhibitor of pro-inflammatory responses. IL-37 has yet to be evaluated in non-immune neurological diseases like ischemic or hemorrhagic stroke. This study aimed to measure the urine and serum IL-37 levels in patients with acute ischemic stroke. Method: Twelve patients consented for the study. Two sets of serum and urine samples were obtained and analyzed; one upon admission to the hospital, and the second the next morning after overnight fasting. The trends in serum level of IL-37 in 5 stroke patients, while trends in urine level of 6 patients were available, measured by real-time polymerase chain reaction (RT-PCR) and enzyme-linked immunosorbent assay (ELISA). Prior studies with healthy volunteers as control group have consistently showed IL-37 plasma level around or less than 65 pg/ml with maximum normal levels on ELISA approximated at 130 pg/ml. Results: IL-37 level in urine in stroke patients ranged from 297 - 4467. IL-37 levels were in the range of 300s to 1000s in patients with ischemic stroke compared with reported healthy controls in literature where the level was always less than 90. Three of these 10 patients presented within 3 hours of stroke onset with IL-37 serum levels being 2655 pg/ml, 3517 pg/ml and 5235 pg/ml. In all others, it ranged much less than that, with the trend of delayed presentation giving less IL-37 levels, both in urine and serum. There were no clear differences found in patients with or without tPA, diabetes, hyperlipidemia and high blood pressure in our small study. Conclusion: The study shows a rather stable elevation of IL-37 levels post-ischemic stroke, which if compared to available data from other studies, is 3-10 times elevated after acute ischemic stroke with an uptrend in the first few days. IL-37 plays some role in mediating post-stroke inflammation with significant rise in serum and urine IL-37 levels suggesting a key role of this novel cytokine in post-stroke pathology. This is the first ever reported study measuring and trending IL-37 levels in human plasma after an acute ischemic stroke.

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Abstract TP319: Risk Factors of Post-stroke Epilepsy

Stroke ◽

10.1161/str.51.suppl_1.tp319 ◽

2020 ◽

Vol 51 (Suppl_1) ◽

Author(s):

Tatyana Danilova ◽

Dina Khasanova

Keyword(s):

Risk Factors ◽

Ischemic Stroke ◽

Functional Neuroimaging ◽

Cerebral Arteries ◽

Transcranial Doppler Sonography ◽

Epileptic Seizures ◽

Brain Lesions ◽

Control Group ◽

Ischemic Brain ◽

Post Stroke

Purpose: The aim of the study was to identify the risk factors for seizures in patients with ischemic stroke using clinical, functional, neuroimaging research methods. Materials and methods: The results of the complex survey of 468 patients suffering from ischemic stroke (256 patients experienced epileptic seizures and 203 experienced no epileptic seizures) are presented. The diagnostic procedures included clinical evaluation, magnetic resonance imaging, electroencephalography, extracranial and transcranial Doppler sonography. In addition the assessment of the rate of sodium lithium countertransport (the marker of genetically determined on transport mechanisms of cell membranes) in patients with c ischemic stroke with the development of epileptic seizures and no seizures was carried out. Results: The focal seizures are the most common (92,5%). Cortical ischemic brain lesions prevailed in patients with seizures (81,1%), whereas in the control group cortex was affected in 38,9% patients (χ2=89.2, <0,001). Stenosis of cerebral arteries was more common in patients with epilepsy (82.3%) compared to patients without seizures (74.4%, <0.05). Reduced cerebrovascular reactivity (CVR) in vertebro-basilar basin was more frequently detected in patients with seizures (85.9%, p<0.001) compared to controls (71.6%). CVR < 10% was registered in 33.8% patients with seizures versus 13.4% controls (p<0.001). Patients with epileptic seizures showed cerebral perfusion reduction mostly in vertebro-basilar basin (85.9%) rather than in carotid basin (61.2%, p<0.001). Patients experienced epileptic seizures had high rates of sodium-lithium antitransport (> 346 μmol/liter cells x hour) more often than patients without epileptic seizures (52,6% and 35,5%, respectively, <0,05). Patients experienced epileptic seizures with high rates of sodium-lithium antitransport had a higher seizure frequency than patients with low rates of sodium-lithium antitransport. Conclusion: Thus, cortical ischemic brain lesions, significant stenosis of cerebral arteries, predominant perfusion reserve reduction in the posterior cerebral circulation, as well as a high rate of sodium lithium countertransport may be considered as risk factors for post-stroke epilepsy.

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Factors Affecting Quality of Life among Post-Stroke Patients in the Sub-Himalayan Region

Journal of Neurosciences in Rural Practice ◽

10.1055/s-0040-1716927 ◽

2020 ◽

Vol 11 (04) ◽

pp. 616-622

Author(s):

Tarannum Ahmed ◽

Rajesh Kumar ◽

Yogesh Bahurupi ◽

Keyword(s):

Quality Of Life ◽

Risk Factors ◽

Functional Dependence ◽

Himalayan Region ◽

World Health ◽

Rank Test ◽

Poststroke Depression ◽

Stroke Patients ◽

Post Stroke

Abstract Background Stroke is one of the most debilitating conditions contributing to significant disability and death globally. Identifying risk factors for quality of life (QoL) will enable to improve home-based rehabilitation in post-stroke phase. Objective This study was aimed to identify the risk factors of QoL in stroke patients in the sub-Himalayan region. Materials and Methods A cross-sectional hospital-based study assessed the QoL among stroke patients within a week after the onset of acute stroke and then re-evaluated at 3 months. World Health Organization QoL-BREF, Beck Depression Inventory, the Barthel Index, and Montreal Cognitive Assessment (MOCA) were used to seek data on QoL, depression, cognitive, and functional dependence status, respectively. Appropriate statistics were used to compute the results. Results In total, 129 stroke patients recruited, out of which 102 returned to a 3-month follow-up. QoL, MOCA, disability index, and depression score were compared using Wilcoxon Singed-rank test. In multivariate analysis, depression and disability together predicted 60% of the variance for physical QoL (p < 0.0001). Similarly, poststroke depression and disability together predicted 61% of the variance for psychological QoL (p < 0.0001) in stroke patients. Conclusion Findings indicated that depression and disability are leading risk factors of QoL in stroke patients. Early identification of poststroke depression and functional dependence status is, therefore, essential to devise screening procedure and to develop targeted intervention to improve rehabilitation outcomes.

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Gothenburg Very Early Supported Discharge study (GOTVED): a randomised controlled trial investigating anxiety and overall disability in the first year after stroke

BMC Neurology ◽

10.1186/s12883-019-1503-3 ◽

2019 ◽

Vol 19 (1) ◽

Cited By ~ 2

Author(s):

Lena Rafsten ◽

Anna Danielsson ◽

Asa Nordin ◽

Ann Björkdahl ◽

Asa Lundgren-Nilsson ◽

...

Keyword(s):

Multidisciplinary Team ◽

Controlled Trial ◽

Stroke Care ◽

Secondary Outcome ◽

Outpatient Rehabilitation ◽

Control Group ◽

Stroke Patients ◽

Post Stroke ◽

Early Supported Discharge ◽

Significant Difference

Abstract Background and purpose Early supported discharge (ESD) has been shown to be efficient and safe as part of the stroke care pathway. The best results have been seen with a multidisciplinary team and after mild to moderate stroke. However, how very early supported discharge (VESD) works has not been studied. The aim of this study was to investigate whether VESD for stroke patients in need of ongoing individualized rehabilitation affects the level of anxiety and overall disability for the patient compared with ordinary discharge routine. Methods A randomized controlled trial was performed with intention to treat analyses comparing VESD and ordinary discharge from hospital. All patients admitted at the stroke care unit at Sahlgrenska University Hospital of Gothenburg between August 2011 and April 2016 were screened. Inclusion occurred on day 4 using a block randomization of 20 and with a blinded assessor. Assessments were made 5 days post-stroke and 3 and 12 months post-stroke. Patients in the VESD group underwent continued rehabilitation in their homes with a multidisciplinary team from the stroke care unit for a maximum of 1 month. The patients in the control group had support as usual after discharge when needed such as home care service and outpatient rehabilitation. The primary outcome was anxiety as assessed by the Hospital Anxiety and Depression Scale-Anxiety subscale (HADS-A). The secondary outcome was the patients’ degree of overall disability, measured by the modified Rankin Scale (mRS). Results No significant differences were found between the groups regarding anxiety at three or 12 months post-stroke (p = 0.811). The overall disability was significantly lower in the VESD group 3 months post-stroke (p = 0.004), compared to the control group. However, there was no significant difference between the groups 1 year post-stroke. Conclusions The VESD does not affects the level of anxiety compared to ordinary rehabilitation. The VESD leads to a faster improvement of overall disability compared to ordinary rehabilitation. We suggest considering coordinated VESD for patients with mild to moderate stroke in addition to ordinary rehabilitation as part of the service from a stroke unit. Trial registration Clinical Trials.gov: NCT01622205. Registered 19 June 2012 (retrospectively registered).

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