scholarly journals Current Incidence and Risk Factors of Fecal Incontinence After Acute Stroke Affecting Functionally Independent People

2021 ◽  
Vol 12 ◽  
Author(s):  
Giuseppe Lucente ◽  
Javier Corral ◽  
Luis Rodríguez-Esparragoza ◽  
Sara Castañer ◽  
Hector Ortiz ◽  
...  
Keyword(s):  
Risk Factors ◽  
Fecal Incontinence ◽  
Acute Stroke ◽  
Chronic Phase ◽  
Fold Increase ◽  
Functional Dependency ◽  
First Episode ◽  
Inclusion Criteria ◽  
Stroke Patients ◽  
Current Incidence

Background: Previously published retrospective series show a high prevalence of fecal incontinence (FI) in stroke patients. We aimed to analyze in a prospective series the current incidence of FI in acute stroke in functionally independent patients and its evolution over time and the patient characteristics associated with the appearance of FI in acute stroke.Methods: We included consecutive patients with acute stroke admitted in our stroke unit who fulfilled the following inclusion criteria: a first episode of stroke, aged >18 years, with no previous functional dependency [modified Rankin Scale (mRS) ≤ 2] and without previous known FI. FI was assessed by a multidisciplinary trained team using dedicated questionnaires at 72 ± 24 h (acute phase) and at 90 ± 15 days (chronic phase). Demographic, medical history, clinical and stroke features, mortality, and mRS at 7 days were collected.Results: Three hundred fifty-nine (48.3%) of 749 patients (mean age 65.9 ± 10, 64% male, 84.1% ischemic) fulfilled the inclusion criteria and were prospectively included during a 20-month period. FI was identified in 23 patients (6.4%) at 72 ± 24 h and in 7 (1.9%) at 90 days ± 15 days after stroke onset. FI was more frequent in hemorrhagic strokes (18 vs. 5%, p 0.007) and in more severe strokes [median National Institute of Health Stroke Scale (NIHSS) 18 (14–22) vs. 5 (3–13), p < 0.0001]. No differences were found regarding age, sex, vascular risk factors, or other comorbidities, or affected hemisphere. Patients with NIHSS ≥12 (AUC 0.81, 95% CI 0.71 to 0.89) had a 17-fold increase for the risk of FI (OR 16.9, IC 95% 4.7–60.1) adjusted for covariates.Conclusions: At present, the incidence of FI in acute stroke patients without previous functional dependency is lower than expected, with an association of a more severe and hemorrhagic stroke. Due to its impact on the quality of life, it is necessary to deepen the knowledge of the underlying mechanisms to address therapeutic strategies.

Abstract TP208: Sleep Disordered Breathing (SDB) - An Overlooked Modifiable Risk Factor in Acute Stroke Care

Stroke ◽  
2017 ◽  
Vol 48 (suppl_1) ◽  
Author(s):  
Vishal Shah ◽  
Ashrai Gudlavalleti ◽  
Julius G Latorre
Keyword(s):  
Risk Factors ◽  
Risk Factor ◽  
Ischemic Stroke ◽  
Acute Stroke ◽  
Acute Ischemic Stroke ◽  
Sleep Disordered Breathing ◽  
Modifiable Risk Factor ◽  
Inclusion Criteria ◽  
Risk Of Death ◽  
Disordered Breathing

Introduction: In patients with acute stroke, part of the acute management entails identifying the risk factors; modifiable or non modifiable. Early recognition of these factors is essential for optimizing therapeutic procedures, especially those with a known effective treatment. In this sense, Sleep Disordered Breathing (SDB) has also been suggested as a modifiable and independent risk factor for stroke as defined by international guidelines and some studies have demonstrated that patients with stroke and particularly Obstructive Sleep Apnea (OSA) have an increased risk of death or new vascular events. Pathogenesis of ischemic stroke in SDB is probably related to worsening of existing cardiovascular risk factors such as hypertension and hypoxia driven cardiac arrhythmia leading to higher prevalence of ischemic stroke in patients with sleep disordered breathing disease. Despite strong evidence linking SDB to ischemic stroke, evaluation for SDB is rarely performed in patients presenting with an acute ischemic stroke. Hypothesis: Evaluation of SDB is rarely performed in patients presenting with acute ischemic stroke. Methods: We performed a retrospective review of all patients above the age of 18 who were admitted to the acute stroke service at University Hospital July 2014 to December 2014. Demographic data, etiology of stroke as identified per TOAST criteria, modifiable risk factors, presenting NIHSS and frequency of testing for SDB and their results were collected. The data was consolidated and tabulated by using STATA version 14. Results: Total of 240 patients satisfied our inclusion criteria. Only 24 patients ie 10% of those who satisfied our inclusion criteria received evaluation for SDB. Out of those evaluated, 62.5% ie 15 patients out of 24 patients had findings concerning for significant desaturation. Only 2 providers out of 8 stroke physicians ie 25% tested for SDB in more than 5 patients. Conclusions: Our observations highlight the paucity in evaluation for SDB in acute ischemic stroke in a tertiary care setting. Being a modifiable risk factor, greater emphasis must be placed on evaluation for SDB in patients in patients with acute stroke. Education must be provided to all patients and providers regarding identification of these factors.

Abstract 3259: Leukocyte Subset Specific Gene Expression In Acute Stroke Patients

Stroke ◽  
2012 ◽  
Vol 43 (suppl_1) ◽  
Author(s):  
Mateusz G Adamski ◽  
Yan Li ◽  
Hua Yu ◽  
Erin Wagner ◽  
Sareen Amarjeet ◽  
...  
Keyword(s):  
Gene Expression ◽  
Acute Stroke ◽  
Whole Blood ◽  
Peripheral Blood ◽  
Fold Increase ◽  
Specific Gene ◽  
Related Gene ◽  
Stroke Patients ◽  
Leukocyte Subset ◽  
Control Subjects

Background: Alterations in gene expression in the peripheral blood of patients with acute stroke have been demonstrated using microarray technology. Whole blood and peripheral blood mononuclear cells (PBMCs) were used in prior studies in which panels of genes diagnostic for stroke were developed. We aimed to determine the cellular sources of alterations in gene expression by studying individual leukocyte subsets. Methods: The expression of four genes previously found to be upregulated in ischemic and hemorrhagic stroke (IL1R2, S100A9, ETS2 and F5) was measured in four leukocyte subsets: CD14+ monocytes, CD4+ T cell lymphocytes, CD20+ B cell lymphocytes and PBMCs. These four genes had been reported in at least two of the previously published stroke-related gene panels. Peripheral blood was obtained from six acute stroke patients (all <48 hours from symptom onset) and 6 age, race and sex matched control subjects. Leukocytes were separated from whole blood using density gradient centrifugation and column magnetic bead cell sorting. The purity of separated leukocyte subsets exceeded 90% and was verified with flow cytometry. Messenger RNA was isolated from each leukocyte subset and analyzed by two step RT PCR and qPCR. The expression of the four stroke-related genes was compared to the expression of a housekeeping gene (GAPDH). The relative expression of individual genes and of the 4 gene panel within cellular subsets was compared between stroke patients and control subjects. Results: Individually, IL1R2 and S100A9 were significantly over-expressed in stroke patients with a 10 fold increase for IL1R2 in PBMCs (p<0.05) and a 3 fold increase for S100A9 in the CD4+ T and CD20+ B lymphocyte subsets (p<0.05). When analyzed as a panel of four genes the expression of IL1R2, S100A9, ETS2 and F5 was significantly higher in both the CD4+ T lymphocytes (p<0.05) and CD20+ B lymphocytes (p<0.05) of stroke patients but not in the monocytes or the PBMCs. Conclusion: These results show the potential diagnostic value of selected genes from panels previously found in microarray studies in stroke patients. They also emphasize the value of panel analysis over that of single gene expression and the potential cellular specificity of alterations in gene expression. Analysis of whole blood and PBMCs alone may not reflect important dynamic changes in stroke-related gene expression.

Abstract 2903: Nutritional Access of Dysphagic Patients 3 Months after Onset of Acute Stroke -From Database of 5,000 Patients in a Single Stroke Center-

Stroke ◽  
2012 ◽  
Vol 43 (suppl_1) ◽  
Author(s):  
Makoto Nakajima ◽  
Yuichiro Inatomi ◽  
Toshiro Yonehara ◽  
Yoichiro Hashimoto ◽  
Teruyuki Hirano
Keyword(s):  
Acute Stroke ◽  
Chronic Phase ◽  
Oral Intake ◽  
Continuous Variables ◽  
Operating Characteristics ◽  
Stroke Patients ◽  
Nihss Score ◽  
Swallowing Dysfunction ◽  
Stroke Center ◽  
Dysphagic Patients

Background and purpose: Prediction of swallowing function in dysphagic patients with acute stroke is indispensable for discussing percutaneous endoscopic gastrostomy (PEG) placement. We performed a retrospective study using database of a large number of acute ischemic stroke patients to clarify predictors for acquisition of oral intake in chronic phase. Methods: A total 4,972 consecutive acute stroke patients were admitted to our stroke center during 8.5 years; a questionnaire was sent to all the survivors after 3 months of onset. We investigated nutritional access after 3 months of onset in 588 patients who could not eat orally 10 days after admission, and analyzed predictive factors for their acquisition of oral intake. Continuous variables were dichotomized to identify the most sensitive predictors; the cutoff values were investigated by receiver operating characteristics curve analysis. Results: Out of 588 dysphagic patients, 75 died during the 3 months, and 143 (28%) of the residual 513 achieved oral intake after 3 months. In logistic-regression models, age ≤80 years, absence of hyperlipidemia, absence of atrial fibrillation, modified Rankin Scale score 0 before onset, and low National Institutes of Health Stroke Scale (NIHSS) score independently predicted oral intake 3 months after onset. From two different model analyses, NIHSS score ≤17 on day 10 (OR 3.63, 95% CI 2.37-5.56) was found to be a stronger predictor for oral intake than NIHSS score ≤17 on admission (OR 2.34, 95% CI 1.52-3.59). At 3 months, 17/143 (12%) patients with oral intake were living at home, while only 1/370 (0.3%) patients without oral intake were. Conclusion: A quarter of dysphagic patients with acute stroke obtained oral intake 3 months after onset. Clinicians should be cautious about PEG placement for stroke patients with severe dysphagia who were independent prior to the stroke, aged ≤80 years, and show NIHSS score ≤17 on day 10, because their swallowing dysfunction may improve in a few months.

scholarly journals Frequency and Risk Factors of Pneumonia and Urinary Tract Infection during Hospitalization in Acute Stroke Patients.

2016 ◽  
Vol 32 (2) ◽  
pp. 74-84
Author(s):  
Shahed Ahmad ◽  
Matiur Rahman ◽  
Mostafa Hosen ◽  
Abul Kalam ◽  
Mohammed Shoab ◽  
...  
Keyword(s):  
Risk Factors ◽  
Urinary Tract Infection ◽  
Urinary Tract ◽  
Tract Infection ◽  
Acute Stroke ◽  
Female Gender ◽  
Older Age ◽  
Stroke Patients ◽  
Severe Stroke ◽  
Wide Range

Background: Acute stroke Patients are at risk of developing a wide range of complications. Among these medical complications the most common are infections, including pneumonia and urinary tract infection (UTI). This study was designed to see the frequency and risk factors of pneumonia and UTI after acute stroke in hospitalized patients. Methods : This prospective observational study was done in the Department of Neurology and Department of Medicine, Sylhet M.A.G Osmani Medical College Hospital, from May 2014 to November 2014. After hospitalization, a total number of 80 acute stroke patients were enrolled in this study. All patients of both sexes, presented with acute stroke, were confirmed by CT scan of head; vascular risk factors were recorded and relevant investigations were done. Results: Among the study subjects Urinary tract infection was found in 23 (28.8%) patients. Statistically significant risk factors for UTI were : > 65 years age (OR=2.926; 95% of CI=1.044-8.202; p=0.037). Female gender (OR=0.327; 95% of CI=0.120-0.889; p=0.026), diabetes (OR=2.015; 95% of CI=1.019-7.780; p=0.042), Severe stroke (OR=3.331; 95% of CI=1.217-9.116; p=0.017), Foley tube catheterization (OR=4.229; 95% of CI=1.492-11.982; p=0.005). Pneumonia developed in 17 (21.2%) patients and no pneumonia in 63 (78.8%) patients. Conclusion : UTI and pneumonia are common occurrence after acute stroke during stroke hospitalization. Older age, female gender, diabetes mellitus, severe stroke at presentation and urinary catheterization were found the risk factors of UTI; whereas older age, severe stroke at presentation, nasogastric tube feeding, oropharyngeal suction and difficulty in swallowing were found the risk factors of pneumonia in acute stroke. Bangladesh Journal of Neuroscience 2016; Vol. 32 (2): 74-84

scholarly journals Risk Factors and Characteristics of Falls Among Hospitalized Stroke Patients

2019 ◽  
Vol 0 (0) ◽  
Author(s):  
Olivera Djurovic ◽  
Snezana Radovanovic ◽  
Nela Djonovic ◽  
Ivana Simic Vukomanovic ◽  
Gordana Gajovic ◽  
...  
Keyword(s):  
Risk Factors ◽  
Acute Stroke ◽  
The Body ◽  
Stroke Patients ◽  
Levels Of Care ◽  
Hospitalization Period ◽  
Neurological Patients ◽  
Fall Risks ◽  
Risk Factors For Falls ◽  
Healthcare Expenses

Abstract Falls and fall-related injuries during hospitalization may cause serious problems and consequences for patients, their quality of life as well as increased healthcare expenses. The aim of the paper were to assess fall risks and identify risk factors, related to falls among stroke patients. This was a retrospective cohort study that included 217 neurological patients with acute stroke who have experienced fall during hospitalization. Morse Fall Scale was used to estimate a likelihood of falling for hospitalized patients. In total, 1.4% patients with acute stroke experienced a fall during hospitalization. According to the fall risk assessment, 77% of the patients presented a high risk for falls. Women, older respondents and those who were hospitalized for period longer than 22 days and who had higher levels of care, had higher values of Morse score. The most common risk factors for falls are: the presence of other medical diagnosis, the use of disability aids while walking, the use of intravenous therapy, disorientation in time and space, and the largest contribution to Morse score comes from using disability aids while walking and transferring patients. Greater risk of falling was observed in older neurological patients with ischemic type of stroke and weakness on the left side of the body, patients with longer hospitalization period and those with higher level of care.

scholarly journals Faktor Faktor Risiko terjadinya Pneumonia pada Stroke Akut di RSUP Dr Hasan Sadikin Bandung

2021 ◽  
Vol 10 (3) ◽  
pp. 151-161
Author(s):  
Novi Fatni Muhafidzah ◽  
◽  
Sobaryati Mansur ◽  
Emmy Hermiyanti Pranggono ◽  
Yusuf Wibisono ◽  
...  
Keyword(s):  
Risk Factors ◽  
Infarct Size ◽  
Acute Stroke ◽  
Primary Data ◽  
Neurogenic Pulmonary Edema ◽  
Stroke Severity ◽  
Stroke Patients ◽  
Anterior Circulation ◽  
Stroke Treatment ◽  
Large Infarct

Risk Factors of Pneumonia in Acute Stroke at Hasan Sadikin Hospital Bandung Abstract Background and Objective:Pneumonia is the most common non neurological complications in acute stroke (22%) that increase mortality rate, length of stay and hospitalization cost. It is necessary to identified risk factors for pneumonia including neurogenic pulmonary edema (NPE) for better prevention and early intervention. The purpose of this study is to determine risk factors of pneumonia (including NPE) in acute stroke patients at Hasan Sadikin General Hospital Bandung. Subject and Methods: Prospective observational descriptive study, consecutive sampling method, during September – October 2019. Primary data collected from acute stroke patients such as stroke severity, type, location and size of stroke, treatment during hospitalizataion, comorbidities (including NPE). Pneumonia was diagnosed based on Central for Disease Control Prevention (CDC) criteria, NPE based on Davison criteria. Results: 30 patients (28.3%) with pneumonia in acute stroke patients. Pneumonia were commonly found in NGT insertion (90%), dysphagia (64,71%), total anterior circulation infarct (TACI) (61,54%), large infarct size (61,54%), GCS 9-12 (50%) and NIHSS 16-20 (50%). NPE only found in 6,60% acute stroke patients, 57,14% of them developed pneumonia. Conclusions: Pneumonia in acute stroke patients is more often found in NGT insertion, dysphagia, TACI location, large infarct size, lower GCS and more severe stroke degree.

Abstract 2395: Respiratory Muscle Weakness in Acute Stroke Patients

Stroke ◽  
2012 ◽  
Vol 43 (suppl_1) ◽  
Author(s):  
Ross Pollock ◽  
Ged Rafferty ◽  
John Moxham ◽  
Lalit Kalra
Keyword(s):  
Systematic Review ◽  
Muscle Strength ◽  
Acute Stroke ◽  
Muscle Weakness ◽  
Respiratory Muscle ◽  
Mean Difference ◽  
Respiratory Muscle Strength ◽  
Inclusion Criteria ◽  
Stroke Patients ◽  
Respiratory Muscle Weakness

Background: Increased frequency of chest infections in acute stroke patients may be the result of respiratory muscle weakness contributing to a weak cough and poor airway clearance. We undertook a systematic review of studies comparing respiratory muscle strength in acute stroke patients with age-matched controls. Method: A systematic review of literature was performed using the electronic databases Medline, EMBASE, ISI web of knowledge and the Scopus. The key words searched were stroke or cerebrovascular accident in combination with cough, inspiratory, expiratory or respiratory and strength or weakness. Studies were included if they compared stroke patients with age matched controls and measured maximum inspiratory or expiratory mouth pressure (PImax and PEmax) for inspiratory and expiratory muscle strength respectively. Results: The initial search identified 136 articles, 14 of which remained after screening for pre-defined inclusion criteria and removal of duplicates. Eleven were excluded after reviewing abstracts (5 did not assess muscle strength, 5 did not include healthy control group, 1 absolute values could not be obtained). A further study was identified from the reference lists of screened articles. The 4 studies that met inclusion criteria included 121 subjects. Mean PImax ranged from 75-99 cmH 2 O in controls and 37-74 cmH 2 O in stroke patients. (mean difference 41 cmH 2 O, 95% CI 54 to 29 cm H 2 O; P<0.0001). Mean PEmax ranged from 52-89 cm H 2 O in stroke patients and was also reduced compared with age matched controls (mean difference 55 cmH 2 O, 95% CI 61 to 48 cmH 2 O; P<0.0001). ( Fig 1 ). Conclusion: Individual studies and pooled data suggest that respiratory muscle strength is impaired in acute stroke patients. However, these studies are limited by small samples and design heterogeneity. Larger studies are needed to assess the relationship of respiratory muscle weakness with chest infections and clinical outcomes in the acute phase.

scholarly journals Socio-demographic Status & Associated Risk Factors of the Stroke Patient's in a Tertiary Care Hospital of Bangladesh

2013 ◽  
Vol 4 (2) ◽  
pp. 18-22 ◽  
Author(s):  
Mahmudur Rahman Siddiqui ◽  
Quazi Tarikul Islam ◽  
Md. Jabed Iqbal ◽  
Sumaiya Sultana Binte-Mosharraf
Keyword(s):  
Risk Factors ◽  
Acute Stroke ◽  
Low Income ◽  
Demographic Data ◽  
Tertiary Care ◽  
Income Group ◽  
Care Hospital ◽  
Stroke Patients ◽  
College Hospital ◽  
Medical College

Stroke is the most common neurological emergency. A total number of 100 randomly selected, clinically and CT proven acute stroke patients were studied at medicine units of Dhaka Medical College Hospital. Socio-demographic data and major risk factors or co-morbid conditions among acute stroke patient were identified and correlated. Out of 100 patients 29% were in between 51- 60 years age group & 72% were male and 28% were female patients. In this series 24% were illiterate. Of the literate group 39% went to primary school, 20% completed SSC, 8% completed HSC, 5% completed graduation and only 4% completed post-graduation. Majority of the patients were unemployed (22%). Other was businessman (20%), housewife (19%) and cultivator (16%). 63% percentage of the patients from low income group, which was followed by middle income group (33%). Majority 53% patients had Ischaemic stroke, 45% Intracerebral haemorrhage (ICH) and only 2% had Subarachnoid haemorrhage (SAH). 77% of patient had history of hypertension, 22% Diabetes mellitus, 20% Dyslipidaemia, 13% Previous Stroke, 27% Ischaemic heart disease. Out of 77 hypertensive stroke patients 37(48.05%) had haemorrhagic stroke & 40(51.94%) had ischemic stroke. Anwer Khan Modern Medical College Journal Vol. 4, No. 2: July 2013, Pages 18-22 DOI: http://dx.doi.org/10.3329/akmmcj.v4i2.16920

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