P0586ACUTE KIDNEY INJURY IN PATIENTS UNDERGOING CARDIAC SURGERY: A PROSPECTIVE, OBSERVATIONAL STUDY TO ASSESS INCIDENCE, SEVERITY, RISK FACTORS AND MORTALITY IN TERTIARY CARE HOSPITAL IN INDIA

2020 ◽  
Vol 35 (Supplement_3) ◽  
Author(s):  
Reetesh Sharma ◽  
Salil Jain ◽  
Naresh Trehan
Keyword(s):  
Risk Factors ◽  
Myocardial Infarction ◽  
Cardiac Surgery ◽  
Risk Factor ◽  
Hospital Stay ◽  
Tertiary Care ◽  
Kidney Injury ◽  
Care Hospital ◽  
Ckd Stage ◽  
Prolonged Ventilation

Abstract Background and Aims Acute kidney injury (AKI) occurs in up to 30% of patients undergoing cardiac surgeries and is associated with increased morbidity and mortality. There is paucity of such data in our country. Hence this study was done to assess the incidence of AKI following cardiac surgery and its associated risk factors along with outcomes, in the Indian context. The incidence and severity of AKI in patients with normal renal parameters vs those with underlying CKD was studied. We also compared incidence and severity of AKI in patients undergoing surgery off pump vs on pump. Method All patients age>25yrs of either gender undergoing cardiac surgeries were enrolled prospectively from July to October 2018. Patients undergoing aortic surgeries or on dialysis, renal transplants or with pre-existing AKI were excluded. Incidence and severity of AKI was defined by the AKIN criteria. NKF/DOQI definition was used to define CKD. Prevalence of risk factors such as age, sex, BMI, diabetes mellitus, hypertension, dyslipidemia, CKD, CVA, peripheral vascular disease (PVD), prior myocardial infarction (MI), peri-operative acute myocardial infarction (AMI), use of cardiopulmonary bypass (CPB) and prolonged ventilation were assessed. Results 1,040 patients were enrolled with these baseline characteristics: 83.5% were males, mean age 58.2±10.4 years, mean BMI 25.6±4.3, diabetes in 48.2%, hypertension in 57.5%,dyslipidemia in 70%,CVA in 36%,CKD in 6.3%,PVD in 0.9%,peri-operative AMI in 0.6%,use of CPB in 24%. Overall incidence of AKI was 23.3% and was 71.2% in patients with underlying CKD. AKI was more severe in patients with higher CKD stages. Stage3 AKI occurred only in patients with CKD stage 3 and 4. Overall the need for dialysis was 1.1% and it was 4.9% in AKI group. 8.5% of patients with CKD needed dialysis as compared to 4.1% without CKD.In multivariate risk factor analysis hypertension (p=0.01),peri-operative AMI (p=0.03), prolonged ventilation (p=0.01), CVA (p=0.01) and CKD (p<0.001) were found to be significantly associated with AKI whereas diabetes (p =0.12), PVD (p=0.13), use of CPB (p=0.4), prior AMI (p=0.07) were not significant. Mean hospital stay was prolonged in those with AKI (8.33±4.06 vs 7.16±3.01 days (p<0.001)). Overall the mortality was 0.67% and it was 2.9% in AKI group. All mortalities were associated with AKI. Conclusion Incidence of AKI (23.3%) and mortality (0.67%) in cardiac surgery patients at our centre in India is similar to other reported studies. We found that underlying CKD is the most significant risk factor for AKI in these patients in addition to hypertension, CVA, prolonged ventilation and pre-operative AMI. Use of CPB did not increase the incidence of AKI. AKI significantly increases mean hospital stay and is also associated with increased in-hospital mortality.

scholarly journals Risk factors for ventricular tachycardia in acute ST-elevated myocardial infarction patients of a tertiary care hospital of Peshawar

2021 ◽  
Vol 6 (4) ◽  
pp. 12-15
Author(s):  
Inam Ullah ◽  
Ashfaq Ahmad Shah Bukhari ◽  
Mehwish Durrani ◽  
Zulfania Khan ◽  
Saman Tauqir ◽  
...  
Keyword(s):  
Risk Factors ◽  
Myocardial Infarction ◽  
Risk Factor ◽  
Ventricular Tachycardia ◽  
Tertiary Care Hospital ◽  
Tertiary Care ◽  
Anterior Wall ◽  
Care Hospital ◽  
Common Risk Factor ◽  
Common Location

Introduction: Ventricular arrhythmias are the most common cause of death in various ST-Elevated Myocardial Infarction (STEMI) patients and can be prevented if diagnosed and managed in time. Objectives: To document the occurrence of ventricular tachycardia in patients with acute ST-segment elevated myocardial infarction (STEMI) admitted to a tertiary care hospital of Peshawar and to identify associated risk factors. Materials & Methods: A descriptive cross-sectional study consisting of 252 MI patients of 51-60 years of age, were observed for the presence of ventricular tachycardia at Lady Reading Hospital, Peshawar from September 2017 to January 2018. Results: Hypertension was found to be the most common risk factor for ventricular tachycardia observed in 180 patients. Diabetes mellitus was the 2nd most common risk factor present in 104 patients while smoking was found in 56 patients. The most common location of ST-Elevation MI was anterior wall myocardial infarction (30.2%) occurring in 76 patients. Conclusion: Ventricular tachycardia occurred in a quarter of the patients presenting with acute ST-elevated myocardial infarction, and was more common in anterior wall MI followed by extensive anterior wall MI.  

scholarly journals Tracheostomy in Postoperative Pediatric Cardiac Surgical Patients—The Earlier, the Better

2021 ◽  
Author(s):  
Chalattil Bipin ◽  
Manoj K. Sahu ◽  
Sarvesh P. Singh ◽  
Velayoudam Devagourou ◽  
Palleti Rajashekar ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Cardiac Surgery ◽  
Hospital Stay ◽  
Pediatric Patients ◽  
Tertiary Care ◽  
Surgical Patients ◽  
Surgical Intensive Care Unit ◽  
Care Hospital ◽  
Surgical Intensive Care ◽  
Nutrition Supplementation

Abstract Objectives This study was aimed to assess the benefits of early tracheostomy (ET) compared with late tracheostomy (LT) on postoperative outcomes in pediatric cardiac surgical patients. Design Present one is a prospective, observational study. Setting The study was conducted at a cardiac surgical intensive care unit (ICU) of a tertiary care hospital. Participants All pediatric patients below 10 years of age, who underwent tracheostomy after cardiac surgery from January2019 to december2019, were subdivided into two groups according to the timing of tracheostomy: “early” if done before 7 days or “late” if done after 7 days postcardiac surgery. Interventions ET versus LT was measured in the study. Results Out of all 1,084 pediatric patients who underwent cardiac surgery over the study period, 41 (3.7%) received tracheostomy. Sixteen (39%) patients underwent ET and 25 (61%) underwent LT. ET had advantages by having reduced risk associations with the following variables: preoperative hospital stay (p = 0.0016), sepsis (p = 0.03), high risk surgery (p = 0.04), postoperative sepsis (p = 0.001), C-reactive protein (p = 0.04), ventilator-associated pneumonia (VAP; p = 0.006), antibiotic escalation (p = 0.006), and antifungal therapy (p = 0.01) requirement. Furthermore, ET was associated with lesser duration of mechanical ventilation (p = 0.0027), length of ICU stay (LOICUS; p = 0.01), length of hospital stay (LOHS; p = 0.001), lesser days of feed interruption (p = 0.0017), and tracheostomy tube change (p = 0.02). ET group of children, who had higher total ventilation-free days (p = 0.02), were decannulated earlier (p = 0.03) and discharged earlier (p = 0.0089). Conclusion ET had significant benefits in reduction of postoperative morbidities with overall shorter mechanical ventilation, LOICUS, and LOHS, better nutrition supplementation, lesser infection, etc. These benefits may promote faster patient convalescence and rehabilitation with reduced hospital costs.

scholarly journals Cross-sectional Study on MyocardialInfarction in Young Adults in an EmergencyDepartment of a Rural Tertiary Care Hospital, Davanagere,Karnataka, India

2021 ◽  
Author(s):  
CH Karthik Reddy ◽  
Mahesh Krishnamurthy ◽  
Ashray Vasanthapuram ◽  
Girish Narayan ◽  
SS Narendra
Keyword(s):  
Risk Factors ◽  
Myocardial Infarction ◽  
Young Adults ◽  
Tertiary Care Hospital ◽  
Tertiary Care ◽  
Cross Sectional Study ◽  
Care Hospital ◽  
Sectional Study ◽  
Cross Sectional ◽  
Vessel Disease

Introduction: The incidence of Acute Coronary Syndrome (ACS) in the young has been increasing globally. Research in this population has been limited in developed countries or urban areas in developing countries. Identifying the various epidemiologic features in this age group is crucial to understand the disease. Aim: To describe the clinical characteristics of young adults presenting with ACS in a rural tertiary care hospital. Materials and Methods: This cross-sectional study included 50 patients diagnosed with ACS. Data were collected from consecutive patients between the ages of 18 to 45 years diagnosed with ACS between January 2014 to January 2015 in the Emergency Medicine Department of a tertiary care hospital in Davanagere, India. Data were collected on demographic characteristics, risk factors, laboratory tests, and angiographic findings. Range, mean and percentages were calculated for continuous and categorical variables, respectively. A 95% confidence intervals were calculated for all variables. Results: The mean age was 38.1±5.8 years with male preponderance 46 (92%). Risk factors were smoking 36 (72%), diabetes 17 (34%), hypertension 6 (12%) and Body Mass Index (BMI) >23 kg/m2, 36 (72%). Anterior Wall Myocardial Infarction (AWMI) was observed in 35 (70%) of subjects with angiography revealing Single Vessel Disease (SVD) 28 (56%), Double Vessel Disease (DVD) 5 (10%), Triple Vessel Disease (TVD) 3 (6%) and Myocardial Infarction with Non-Obstructive Coronary Artery Disease (MINOCA) 11 (22%). Three patients died during their course of treatment before initiating an interventional procedure. Conclusion: Smoking, diabetes mellitus and elevated BMI are associated with ACS among young patients. Interventions targeting these risk factors among younger individuals should be developed.

scholarly journals Clinical presentation, risk factors, complications and outcome of acute myocardial infarction in elderly patients

2017 ◽  
Vol 5 (11) ◽  
pp. 4765 ◽  
Author(s):  
Sandhya S. ◽  
Mohanraj P.
Keyword(s):  
Risk Factors ◽  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Chest Pain ◽  
Elderly Patients ◽  
Epigastric Pain ◽  
Tertiary Care ◽  
Care Hospital ◽  
Wide Range ◽  
Atypical Presentations

Background: Myocardial Infarction is one of the most common causes of mortality and morbidity among the elderly patients. Also, it is known for wide range of clinical presentations other than chest pain. This article enlightens the clinical features, risk factors, complications, prognosis and outcome of Acute myocardial infarction in elderly patients. The objective of this study was to assess the risk factors, various symptoms, complications, prognosis and outcome of elderly patients with Acute myocardial Infarction (AMI).  Methods: This is a prospective study done over a period of two years in a tertiary care hospital in South India. 80 elderly patients who were diagnosed as AMI were included in the study.Results: Among the eighty patients the majority of the patients belonged to the age group 60-69 years. Twenty percent of the patients presented without chest pain. The atypical presentations included dyspnoea, giddiness, vomiting, sweating and epigastric pain. Mortality rate was 20%.Conclusions: This study showed that even though chest pain was the most common presentation in elderly AMI patients, they were also found to have atypical presentations like shortness of breath, giddiness, vomiting, sweating and epigastric pain. This signifies the need of examining physicians to meticulously identify acute myocardial infarction in elderly though they may not present typically.  

scholarly journals Acute kidney injury in renal transplant recipients undergoing cardiac surgery

2020 ◽  
Vol 36 (1) ◽  
pp. 185-196
Author(s):  
Gregory L Hundemer ◽  
Anand Srivastava ◽  
Kirolos A Jacob ◽  
Neeraja Krishnasamudram ◽  
Salman Ahmed ◽  
...  
Keyword(s):  
Risk Factors ◽  
Acute Kidney Injury ◽  
Cardiac Surgery ◽  
Risk Factor ◽  
Renal Transplant ◽  
Kidney Disease ◽  
Kidney Injury ◽  
Renal Transplant Recipients ◽  
Transplant Recipients ◽  
Trough Levels

Abstract Background Acute kidney injury (AKI) is a key risk factor for chronic kidney disease in the general population, but has not been investigated in detail among renal transplant recipients (RTRs). We investigated the incidence, severity and risk factors for AKI following cardiac surgery among RTRs compared with non-RTRs with otherwise similar clinical characteristics. Methods We conducted a retrospective cohort study of RTRs (n = 83) and non-RTRs (n = 83) who underwent cardiac surgery at two major academic medical centers. Non-RTRs were matched 1:1 to RTRs by age, preoperative (preop) estimated glomerular filtration rate and type of cardiac surgery. We defined AKI according to Kidney Disease: Improving Global Outcomes criteria. Results RTRs had a higher rate of AKI following cardiac surgery compared with non-RTRs [46% versus 28%; adjusted odds ratio 2.77 (95% confidence interval 1.36–5.64)]. Among RTRs, deceased donor (DD) versus living donor (LD) status, as well as higher versus lower preop calcineurin inhibitor (CNI) trough levels, were associated with higher rates of AKI (57% versus 33% among DD-RTRs versus LD-RTRs; P = 0.047; 73% versus 36% among RTRs with higher versus lower CNI trough levels, P = 0.02). The combination of both risk factors (DD status and higher CNI trough level) had an additive effect (88% AKI incidence among patients with both risk factors versus 25% incidence among RTRs with neither risk factor, P = 0.004). Conclusions RTRs have a higher risk of AKI following cardiac surgery compared with non-RTRs with otherwise similar characteristics. Among RTRs, DD-RTRs and those with higher preop CNI trough levels are at the highest risk.

scholarly journals A Hospital based cross sectional study to find out factors associated with disease severity and length of hospital stay in COVID-19 patients in Tertiary Care Hospital of Ahmedabad city

2021 ◽  
Vol 33 (2) ◽  
pp. 256-259
Author(s):  
Arpit Chelabhai Prajapati ◽  
Mansi Maulik Patel ◽  
Hardika Jamanadas Khanpara ◽  
Rujul Pankajbhai Shukla ◽  
Donald Shailendra Christian ◽  
...  
Keyword(s):  
Risk Factors ◽  
Hospital Stay ◽  
Disease Severity ◽  
Tertiary Care Hospital ◽  
Heart Diseases ◽  
Tertiary Care ◽  
Length Of Hospital Stay ◽  
Care Hospital ◽  
Factors Associated ◽  
High Dependency

Background: Tertiary hospital care may vary from isolation bed ward care to high dependency units (HDUs) with oxygen support to intensive care unit (ICU) where patients may be intubated for mechanical ventilation The major risk factors for severe disease are age more than 60 years and underlying diseases like diabetes, hypertension. COVID-19 patients present at varying levels of severity. Understanding how long patients hospitalized with COVID-19 remain in hospital is critical for planning. Objectives: 1. To determine risk factors associated with disease severity 2. To determine risk factors associated with length of hospital stay in COVID-19 patients 3. To study the disease outcome Material & Methods: This was retrospective record-based study of inpatients with COVID-19 at Tertiary Care Hospital of Ahmedabad City. All patients admitted at tertiary care hospital diagnosed with COVID-19 between April 2020 to June, 2020, were included in present study. Inclusion criteria were all COVID-19 patients admitted at tertiary care hospital during the duration of April 2020 to June 2020. Results: A total of 916 COVID-19 patients were included in the study. Out of 916 total admitted patients 526 (57.4%) were male. 174 (19%) patients having one or more comorbidities like diabetes, hypertension, tuberculosis, heart diseases etc. Total 769 discharged (83.9%), 115 deaths (12.6%) and 32 transferred to other COVID-19 hospital (3.5%) out of total 916 patients admitted during study period. Conclusion: Severity of disease and deaths were associated with age and comorbidities. COVID-19 patients with comorbidities have more deteriorating outcomes compared with patients without.

scholarly journals Prevalence of gestational diabetes mellitus and its relationship with various risk factors in a tertiary care hospital in West Bengal with special reference to tribal population, India

2019 ◽  
Vol 7 (4) ◽  
pp. 1098
Author(s):  
Narenrda Kumar Sharma ◽  
Subodh Kumar Mahto ◽  
Rahul Sharma ◽  
Ankita Sheoran ◽  
Sumit Kumar Suman ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Risk Factors ◽  
Risk Factor ◽  
Gestational Diabetes ◽  
Gestational Diabetes Mellitus ◽  
West Bengal ◽  
Tertiary Care Hospital ◽  
Tertiary Care ◽  
Care Hospital ◽  
Tribal Population

Background: Gestational diabetes mellitus (GDM) is the most common medical complication and metabolic disorder of pregnancy. The aim and objective of this study was to determine the prevalence of GDM and its relationship with various risk factors with special reference to tribal population.Methods: The study was done in 200 patients between 24 and 28 weeks of gestation, attending antenatal outdoor in a tertiary care hospital of West Bengal.  These patients were given 75gm oral glucose irrespective of the last meal and their plasma glucose was estimated at 2hours. Patients with plasma glucose values ≥140 mg/dl were labelled as GDM. Patients who were diabetic before pregnancy or whose pre pregnancy body mass index was not known or was in labour or had chronic disease, were not included in the study.Results: Prevalence of GDM was 11% in whole population while it was 14.63% and 10.06% in tribal and non-tribal population respectively.  Prevalence of GDM and its correlation with most of risk factors in previous pregnancies was found to be significant in both non-tribal and tribal population. Family history of diabetes mellitus was the most prevalent risk factor in both non-tribal (9.4%) and tribal population (14.63%). There was no single most common risk factor among GDM patients found as there were multiple risk factors present with same frequency in both tribal and non-tribal population.Conclusions: The prevalence of GDM is 14.63% in the tribal population and 10.06% in non-tribal population which is not statically significant (P<0.407). The relation between the prevalence of GDM and risk factors was found to be significant for most of the risk factors.

scholarly journals Risk Factors Associated With Sino-Nasal Polyposis And Its Relationship With The Occupational Inhalants

2019 ◽  
Vol 09 (04) ◽  
pp. 290-293
Author(s):  
Qaisar Sajad ◽  
Ayub Musani ◽  
Faheem Ahmed Khan
Keyword(s):  
Risk Factors ◽  
Risk Factor ◽  
Nasal Polyposis ◽  
Local Population ◽  
Tertiary Care ◽  
Nasal Allergy ◽  
Care Hospital ◽  
Common Risk Factor ◽  
Factors Associated ◽  
Number Of Patients

Objective: To determine the risk factors associated with sino-nasal polyposis and its relationship with the exposure of occupational inhalants in patients presenting in a tertiary care hospital of Karachi. Study design and Settings: Cross-sectional study conducted at department of otorhino-laryngology Karachi Medical & Dental College and Abbasi Shaheed Hospital Karachi for a period of two and a half years from October 2015 to April 2018. Methodology: Total number of patients included for this study were 221 patients with diagnosis of bilateral and multiple nasal polyposis with age greater than 10 years. Specifically, designed proforma was used for data collection specially in relation with occupation and exposure to different occupational inhalants and entered in SPSS version 23 for analysis. Results: There were 133 male and 88 female patient with a mean age was 36.16 ± 12.33 years. Mostly patients belonged to poor socio-economic status i.e. 133 (60.70%). Allergic rhinitis or nasal allergy was the most common risk factor present in 114 patients (51.6%) while aspirin hypersensitivity was the least common risk factor present in only 19 patients (8.5%). Most of the patients (76 or 34.4%) were related with one or the other form of agriculture and were exposed to different occupational inhalants like mud, pollens, animals and plants. Conclusions: Nasal allergy is the most common risk factor and occupational inhalant specially related with agriculture, poultry and pets are the common agents responsible for nasal polyposis in our local population.

Frequency of Modifiable and Non-Modifiable Risk Factors of ST elevation Myocardial Infarction at Tertiary Care Hospital

2021 ◽  
Vol 15 (9) ◽  
pp. 3040-3042
Author(s):  
Mubashir Kolachi ◽  
Zahid Naseeb Ansari ◽  
Tahir Hussain ◽  
Imran Karim ◽  
Muhammad Khan Soomro ◽  
...  
Keyword(s):  
Risk Factors ◽  
Myocardial Infarction ◽  
Tertiary Care Hospital ◽  
Tertiary Care ◽  
Male Gender ◽  
St Elevation Myocardial Infarction ◽  
Modifiable Risk Factors ◽  
Care Hospital ◽  
Type Ii ◽  
St Elevation

Objective: To determine the frequency of modifiable and non-modifiable risk factors of acute ST elevation myocardial infarction at tertiary care Hospital. Methods: This study was conducted in the department of Cardiology, Liaquat University Hospital Jamshoro, from July 2019 to January 2020. All the patients those presented with myocardial infarction and either of gender were included in the study. After taking complete clinical examination and diagnosis, patients were interviewed regarding family history, hypertension, diabetes, smoking, alcohol consumption, dietary habits and life style activities. Non modifiable predisposing risk factors were defined as age, gender and family history. Modifiable risk factors were defined as elevated serum cholesterol, presence of type II DM, cigarette smoking, obesity, a sedentary lifestyle and hypertension. All the data was recorded in self-made proforma. Data analysis was done by SPSS version 21 Results: Total 100 patients were studied; most common age group was 41-50 years (45.0%), and 51-60 years (35.0%). According to the types of myocardial infarction, Acute anterior wall MI was in 25.0%, Acute inferior MI was in 20.0%, EXT ANT WALL MI was in 16.0% and Acute inferior +RV MI was in 15.0% of patients. Elevated age in 70.0% and male gender in 69% of cases were found to be most common non-modifiable risk factors, while frequently seen Modifiable risk factors were smoking, type II diabetes, hypercholesteremia, hypertension, and physical activities. Conclusion: It was observed that elevated age, male gender, smoking, diabetes and hypertension are frequent risk factors for ST elevation myocardial infarction. Keywords: Modifiable, non-modifiable, risk factors, MI

Abstract T P377: Vitamin B12 Deficiency - A Poorly Recognised and Treatable Childhood Stroke Risk Factor

Stroke ◽  
2015 ◽  
Vol 46 (suppl_1) ◽  
Author(s):  
Zarah Yusuf ◽  
Jayanthi Alamelu ◽  
Ming Lim ◽  
Nomazulu Dlamini
Keyword(s):  
Risk Factors ◽  
Risk Factor ◽  
Vitamin B12 ◽  
Tertiary Care ◽  
Vitamin B12 Deficiency ◽  
Care Hospital ◽  
Childhood Stroke ◽  
Stroke Risk Factor ◽  
B12 Deficiency ◽  
Age Range

Introduction: Risk factors in childhood stroke are multiple and causality hard to determine. Current guidelines recommend prothrombotic workup, yet yield is variable, often without therapeutic consequence. Raised homocysteine is associated with vitamin B12 deficiency (B12), which is not routinely measured. Hypothesis: We hypothesised that B12 deficiency is a treatable risk factor for stroke in children not reliably identified by analysis of homocysteine only. Method: We retrospectively reviewed paediatric stroke patients admitted to a tertiary care hospital from 2010-2014. All patients with plasma homocysteine measured as part of their prothrombotic workup were selected. All clinical data closest to stroke diagnosis were reviewed. B12 deficiency was defined as low total and/or holo (functional) vitamin B12 with/without raised methylmalonic acid (MMA). Parental prothrombotic workup and B12 status was analysed where available. Results: Of 134 patients, 61 had homocysteine levels, 20 were tested for vitamin B12 (age range 0-14.8 years), 14/20 for MMA. B12 deficiency was found in 7/20 with median age of acute stroke presentation of 1 day (25th percentile= 0; 75th percentile= 51days). Median age of stroke presentation in B12 replete group was 3.5 years (25th percentile=2.0;75th percentile=7.0years). There was a statistical difference in age of stroke presentation between the B12 deficient and replete groups (Kruskal-Wallis, p=0.001). Raised homocysteine (10/20) was not sensitive in detecting B12 deficiency (sensitivity 42.8%, 95% CI 15.82-74.95). Two of seven had additional risk factors (1/7 iron deficiency, 1/7 MTHFR 667 homozygous). Seizures were the most common stroke presentation regardless of B12 status. Vitamin B12 (im) was given in 4/7 children and 3/9 parents (2 mothers, 1 father). Five of seven were breast fed. All treated parents were vegetarian. Conclusion: Our study suggests vitamin B12 deficiency is associated with early childhood stroke. Homocysteine alone is not a sensitive screen for this. Investigation with functional biomarkers such as holo B12 and MMA would allow for improved detection of a treatable risk factor in childhood stroke. Further studies may support this recommendation being added to guidelines.

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