scholarly journals The significant gap between international standards and stroke management practices at Queen Elizabeth Central Hospital (Malawi): An audit report

2019 ◽  
Vol 31 (4) ◽  
pp. 249-255 ◽  
Author(s):  
Yohane Gadama
Keyword(s):  
Risk Factors ◽  
Cardiovascular Risk ◽  
Acute Stroke ◽  
Cardiovascular Risk Factors ◽  
Management Practices ◽  
Vital Signs ◽  
Central Hospital ◽  
Stroke Management ◽  
The Mean ◽  
Queen Elizabeth Central Hospital

BackgroundThe Queen Elizabeth Central Hospital (QECH) is preparing to set up the first stroke unit in Blantyre, Malawi. We conducted this audit to assess current stroke management practices and outcomes at QECH and identify priority areas for intervention.MethodsFrom April to June 2018, we prospectively enrolled patients with acute stroke and collected data on clinical presentation, cardiovascular risk factors, investigations and interventions, in-hospital outcomes, and follow-up plans after discharge. The American Heart Association/American Stroke Association (AHA/ASA) guidelines were used as the standard of care for comparison.ResultsFifty patients with acute stroke were enrolled (46% women, 54% men). The mean age was 63.1 years (95% CI: 59.7–66.6). The diagnosis of stroke was based on the World Health Organization criteria. The diagnosis was made within 24 hours of admission in 19 patients (38%). Acute revascularisation therapy was not available. Forty-eight patients (96%) had their vital signs checked at baseline and <10% had their vital signs checked more than three times within the first 24 hours. Essential blood tests including random blood sugar (RBS), full blood count (FBC), urea/creatinine, and lipid profiles were performed in 72%, 68%, 48%, and 4%, respectively. An electrocardiogram was performed on 34 patients (68%). Blood pressure on admission was >140/90 mmHg in 34 patients (68%), including 4 with values >220/120 mmHg. Nine patients had an RBS >10 mmol/L and four received insulin. Prophylaxis for deep venous thrombosis was offered to 12 patients (24%). Aspiration pneumonia was reported in 16 patients (32%) and was the most common hospital complication. The mean duration of hospitalisation was 10.4 days (95% CI: 5.6–15.2), and case fatality was 18%. The modified Rankin scale at discharge was ≤2 in 32% of patients. Only four patients (8%) were transferred to a rehabilitation centre. At the time of discharge, only 32% of patients received education on stroke.ConclusionAcute stroke care is less than optimal in this setting. Simple interventions such as reducing the delay in making a stroke diagnosis, early swallow assessments, and closer monitoring of vital signs could make a significant difference in stroke outcome. Furthermore, treating cardiovascular risk factors and setting up health education programmes to improve secondary prevention represent key priorities.

scholarly journals High prevalence of obesity in rheumatoid arthritis patients: association with disease activity, hypertension, dyslipidemia and diabetes, a multi-center study

2019 ◽  
Vol 59 (1) ◽  
Author(s):  
Maria Fernanda Brandão de Resende Guimarães ◽  
Carlos Ewerton Maia Rodrigues ◽  
Kirla Wagner Poti Gomes ◽  
Carla Jorge Machado ◽  
Claiton Viegas Brenol ◽  
...  
Keyword(s):  
Rheumatoid Arthritis ◽  
Risk Factors ◽  
Cardiovascular Disease ◽  
Cardiovascular Risk ◽  
Disease Activity ◽  
Cardiovascular Risk Factors ◽  
Laboratory Data ◽  
Premature Cardiovascular Disease ◽  
Prevalence Of Obesity ◽  
The Mean

Abstract Introduction Rheumatoid arthritis (RA) is a well-documented independent risk factor for cardiovascular disease. Obesity may provide an additional link between inflammation and accelerated atherosclerosis in RA. Objective To evaluate the association between obesity and disease parameters and cardiovascular risk factors in RA patients. Method Cross-sectional study of a cohort of RA patients from three Brazilian teaching hospitals. Information on demographics, clinical parameters and the presence of cardiovascular risk factors was collected. Blood pressure, weight, height and waist circumference (WC) were measured during the first consultation. Laboratory data were retrieved from medical records. Obesity was defined according to the NCEP/ATPIII and IDF guidelines. The prevalence of obesity was determined cross-sectionally. Disease activity was evaluated using the DAS28 system (remission < 2.6; low 2.6–3.1; moderate 3.2–5.0; high > 5.1). Results The sample consisted of 791 RA patients aged 54.7 ± 12.0 years, of whom 86.9% were women and 59.9% were Caucasian. The mean disease duration was 12.8 ± 8.9 years. Three quarters were rheumatoid factor-positive, the mean body mass index (BMI) was 27.1 ± 4.9, and the mean WC was 93.5 ± 12.5 cm. The observed risk factors included dyslipidemia (34.3%), type-2 diabetes (15%), hypertension (49.2%) and family history of premature cardiovascular disease (16.5%). BMI-defined obesity was highly prevalent (26.9%) and associated with age, hypertension and dyslipidemia. Increased WC was associated with diabetes, hypertension, dyslipidemia and disease activity. Conclusion: Obesity was highly prevalent in RA patients and associated with disease activity.

scholarly journals Feasibility of Aerobic Interval Training in Nonambulant Persons after Stroke

2019 ◽  
Vol 8 (3) ◽  
pp. 97-101
Author(s):  
Sarah R. Valkenborghs ◽  
Kirk I. Erickson ◽  
Michael Nilsson ◽  
Paulette van Vliet ◽  
Robin Callister
Keyword(s):  
Risk Factors ◽  
Heart Rate ◽  
Cardiovascular Risk ◽  
Aerobic Exercise ◽  
Cardiovascular Risk Factors ◽  
Interval Training ◽  
Cycle Ergometer ◽  
Recovery Interval ◽  
Aerobic Interval Training ◽  
The Mean

ABSTRACT Background: Modifiable cardiovascular risk factors are prevalent and poorly managed in people after stroke. Aerobic exercise is effective in reducing many modifiable cardiovascular risk factors after stroke but is challenging and under-researched in nonambulant persons. This pilot study aimed to investigate the feasibility of aerobic interval training in nonambulant persons after stroke. Methods: Aerobic exercise was performed on an upright or semi-recumbent cycle ergometer. Participants were prescribed 4 × 4-min intervals of exercise at 85% maximum age-predicted heart rate (APHRmax) with a 3-min active recovery at 70%APHRmax per 30-min session, 3 times per week for 10 weeks. Heart rate, rating of perceived exertion, workload, cadence, and duration of exercise achieved were recorded for each interval. Results: Nine participants (mean ± SD; age 62 ± 12 y; 5 males) unable to walk without assistance after stroke (2.9 ± 3.9 y) were recruited. There were no adverse events reported, but there was one dropout (due to bronchitis). Attendance for the remaining participants was 93 ± 6%. The mean training %APHRmax was 72 ± 14% for the higher intensity interval and 57 ± 21% for the recovery interval. The mean increase in training workload between weeks 1 and 10 was 11.2 ± 11.6 W (27 ± 28%) for the higher intensity interval and 4.0 ± 7.7W (17 ± 33%) for the recovery interval. The mean increase in VO2peak was 2.3 ± 2.9 mL·kg−1·min−1 (18 ± 22%) over the 10-week intervention. Conclusion: Aerobic interval training at a moderate-vigorous intensity on an upright or recumbent cycle ergometer is feasible for nonambulant persons after stroke. Aerobic interval training should be further investigated to determine its potential to improve cardiorespiratory fitness after stroke and risk factors for recurrent stroke.

scholarly journals Meta-regression analysis of the effect of lifestyle interventions on mediators of inflammation in postmenopausal breast cancer women with cardiovascular risk factors

2019 ◽  
Author(s):  
Jean Paul Muambngu Milambo ◽  
Maritha Kotze ◽  
Erasmus Rajiv ◽  
John Akudugu ◽  
Tamuzi Lukenze Jacques
Keyword(s):  
Breast Cancer ◽  
Risk Factors ◽  
Cardiovascular Risk ◽  
Cardiovascular Risk Factors ◽  
Cochrane Library ◽  
Lifestyle Interventions ◽  
Mediators Of Inflammation ◽  
The Mean ◽  
Meta Regression ◽  
Shared Risk

Abstract Background: Chronic inflammation is associated with obesity, dyslipidemia, and different types of malignancies that may play a complex role in the risk of breast cancer (BC) recurrence and therapy related side effects. The purpose of this review was to determine the effects of lifestyle interventions on mediators of inflammation (C-reactive protein (CRP), interleukin 6 (IL-6) and tumor necrosis factor α (TNF-α)) and other therapy related adverse events in postmenopausal BCS with cardiovascular related risk factors. Methods: A systematic search for relevant articles was performed according to the Preferred Reporting Items for Systematic Review and Meta-Analysis criteria using available databases (PubMed, Scopus, The Cochrane Library, OpenGrey, Google Scholar and CENTRAL). Results: Twelve eligible randomized controlled trials (RCT) met the inclusion criteria. The mean ages of postmenopausal BC women ranged from 49 to 56 years. The meta-regression revealed that there was moderate evidence that MSE decreased the mean difference (MD) of inflammatory markers in BCS, with CVD risk factors (MD: 0.31; 95% CI: 0.05 to 0.57, P=0.02; heterogeneity: Tau² = 0. 12; Chi² = 106.30, df = 19, I² = 0. 50.4%). Conclusion: There is a moderate level of evidence on the effects of MSE on mediators of inflammation in postmenopausal BCS with cardiovascular risk factors. A number of shared risk factors between postmenopausal status and CVD should be considered, while treating postmenopausal BCS.

Abstract WP241: Prevalence of Subclinical Extracranial Carotid Atherosclerosis Detected by Ultrasound Among Amerindians: A Population Study in Rural Ecuador

Stroke ◽  
2020 ◽  
Vol 51 (Suppl_1) ◽  
Author(s):  
Victor J Del Brutto ◽  
Jose G Romano ◽  
Robertino M Mera ◽  
Jonathan P Amodio ◽  
Tatjana Rundek ◽  
...  
Keyword(s):  
Risk Factors ◽  
Blood Pressure ◽  
Cardiovascular Risk ◽  
Cardiovascular Risk Factors ◽  
High Blood Pressure ◽  
Carotid Atherosclerosis ◽  
Male Gender ◽  
Rural Setting ◽  
Carotid Plaques ◽  
The Mean

Background: Epidemiological information on extracranial carotid atherosclerosis (ECA) among Amerindians is limited. We aim to determine the prevalence of subclinical ECA and its correlation with cardiovascular risk factors in community-dwelling adults of Amerindian ancestry living in a rural Ecuadorian village. Methods: Utilizing a population-based design, stroke-free individuals aged ≥40 years were invited to undergo carotid ultrasound. Subclinical ECA was defined as an intima-media thickness (cIMT) >1mm and/or the presence of carotid plaques (focal intima thickening >1.5mm that protrudes into the lumen). Degree of luminal stenosis was calculated and considered significant if >50%. We investigated the association between these biomarkers and cardiovascular risk factors. Results: Of 728 candidates, 559 (77%) stroke-free individuals underwent carotid sonographic evaluation and were included. The mean age was 62.3 ±12.5 and 238 (43%) were men. The mean value of the cIMT was 0.85 ± 0.17mm (median cIMT: 0.83mm; IQ range: 0.74-0.92 mm). The prevalence of increased cIMT, carotid plaques, and increased cIMT and/or carotid plaques were 14%, 23.8%, and 26.1%, respectively. Table depicts the association of these biomarkers with cardiovascular risk factors. A multinomial logistic regression model, using individuals with normal carotids as the referent category, showed significant associations of ECA with increasing age, male gender, smoking and high blood pressure. Significant carotid stenosis was found in 19 subjects (3.4%). Conclusions: About one-fourth of Amerindians living in a rural setting have subclinical ECA. Increasing age, male gender, smoking and high blood pressure were independent determinants of the burden of ECA, while elevated glucose and total cholesterol showed no significant association. Obesity was inversely associated with ECA in univariate analysis, but such association disappeared in the multivariate model.

scholarly journals General health of patients with diabetic macular edema—The LIPSIA study

PLoS ONE ◽  
2021 ◽  
Vol 16 (6) ◽  
pp. e0252321
Author(s):  
Catharina Busch ◽  
Julius L. Katzmann ◽  
Claudia Jochmann ◽  
Jan Darius Unterlauft ◽  
Daniela Vollhardt ◽  
...  
Keyword(s):  
Risk Factors ◽  
Blood Pressure ◽  
Cardiovascular Risk ◽  
Macular Edema ◽  
Cardiovascular Risk Factors ◽  
Diabetic Macular Edema ◽  
Lipid Lowering ◽  
Lipid Lowering Therapy ◽  
Target Values ◽  
The Mean

Purpose Cardiovascular risk factors such as hypertension or dyslipidemia can influence the incidence and progression of diabetic retinopathy (DR) and diabetic macular edema (DME). The aim of this study is to describe the comorbidities in patients with DME. Methods Prospective, monocentric observational study. Patients presenting for the treatment of DME received laboratory and clinical examinations including 24-hour blood pressure measurement. Results Seventy-five consecutive patients were included in the study. The mean age was 61.0 ± 14.5 years, and 83% had type 2 diabetes. The mean body mass index (BMI) was 32.8 ± 6.0 kg/m2. Overweight (BMI ≥ 25 kg/m2) was present in 92% of all patients. HbA1c values were > 7.0% in 57%. Although 87% of the patients already received antihypertensive therapy, the blood pressure (BP) of 82% was still above the recommended target values of systolic < 140 mmHg and diastolic < 80 mmHg. An insufficient nocturnal fall of the systolic BP (< 10%, non-dipping or reverse dipping) was observed in 62%. In 83% of the patients the glomerular filtration rate was ≤ 90 ml/min/1.73m2. Despite 65% of the cohort already receiving lipid-lowering therapy, LDL cholesterol was above the target value of 1.4 mmol/l in 93%. All patients had at least one cardiovascular risk factor in addition to diabetes (overweight, hypertension, insufficient nocturnal BP fall, dyslipidemia, or renal dysfunction) and 86% had ≥ 3 risk factors. Conclusion DME patients are characterized by highly prevalent cardiovascular risk factors that are poorly controlled. These comorbidities reduce the prognosis and negatively influence existing DR and DME. The data reveal an important opportunity for improving patient care by interaction of the ophthalmologist with the general practitioner and internal specialists for the detection and treatment of these conditions.

scholarly journals Circadian Blood Pressure Profile and Associated Cardiovascular Risk Factors in Non-Dippers

2020 ◽  
Vol 12 (2) ◽  
Author(s):  
Siti Suhaila MY ◽  
Juwita S ◽  
Harmy MY ◽  
Tengku Alina T
Keyword(s):  
Risk Factors ◽  
Blood Pressure ◽  
Cardiovascular Risk ◽  
Cardiovascular Risk Factors ◽  
Pressure Profile ◽  
Night Time ◽  
Hypertensive Patients ◽  
Blood Pressure Profile ◽  
The Mean ◽  
Circadian Blood Pressure Profile

Introduction: Ambulatory blood pressure accurately reflects a patient's actual blood pressure than casual or office blood pressure. This study aims to describe the circadian blood pressure profile of hypertensive patients and to identify the associated cardiovascular risk factors in non-dippers. Methods: A cross-sectional study was conducted from 1st January 2008 to 30th June 2008 among hypertensive patients attending Family Medicine Clinic HUSM. Schiller BR-102 plus was used to get 24 hours blood pressure (BP) reading. Mean of two offices BP were also taken. Non-dippers are defined as a systolic or diastolic nocturnal drop of less than 10%. Analysis was done using SPSS Version 12. Results: 105 patients were recruited with mean (SD) age of 51.8 (9.34) year old. The mean (SD) 24-hour systolic and diastolic BP was 128.4 (12.7) mmHg and 79.7 (8.74) mmHg respectively. Mean (SD) daytime systolic and diastolic BP was 132.1 (11.72) mmHg and 82.4 (9.41) mmHg while for the night time were 123.3 (12.78) mmHg and 76.2 (9.01) mmHg. Mean (SD) systolic and diastolic office BP was 144.2(15.16) mmHg and 90.2(9.71) mmHg. Percentage of non dippers were 68.6% for systolic and 61.9% for diastolic. Conclusion: Mean 24 hours and daytime ambulatory BP was normal but the mean night time diastolic and office BP was above-normal value. Majority of the patients were categorized as non dippers. Therefore, using ambulatory BP is clinically important to get a better understanding of blood pressure fluctuations over 24-hour periods compared to simple clinical measurements.

scholarly journals CONTROL OF GLYCEMIA AND CARDIOVASCULAR RISK FACTORS IN PATIENTS WITH TYPE 2 DIABETES IN PRIMARY CARE IN MONTENEGRO

2018 ◽  
pp. 016
Author(s):  
Milena M. Cojić ◽  
Ljiljana Cvejanov-Kezunović ◽  
Jelena Stanković ◽  
Nebojša Kavarić ◽  
Maja Koraćević ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Risk Factors ◽  
Blood Pressure ◽  
Type 2 Diabetes ◽  
Type 2 Diabetes Mellitus ◽  
Cardiovascular Risk ◽  
Cardiovascular Risk Factors ◽  
Diabetic Patients ◽  
The Mean

Some observational studies have shown that only a small number of diabetic patients achieve optimum control of glycaemia and cardiovascular risk factors. The aim of this study was to analyze whether patients with type 2 diabetes mellitus treated in primary care achieve adequate control of glycemic levels and cardiovascular risk factors. This was a retrospective, record-based, cross-sectional study that included eligible patients from 35 to 90 years old with type 2 diabetes mellitus treated in Primary Health Care Center in Podgorica. We investigated electronic records of 531 diabetic patients. The observed prevalence of type 2 diabetes mellitus among individuals between ages 35 and 90 years, was 11,84 %. Half of the patients were female. The mean age was 65,88±9,86 years. The mean value of HbA1c was 7,56±1,71. Fifty-nine percents of patients achieved optimal levels of HbA1c ≤ 7 %. Also, more than half of patients achieved target levels of blood pressure while 27.9% achieved LDL ≤ 2.6 mmol/L. Fifty percent of patients were non-smokers and 45.1 % were obese. Among patients on primary prevention only 5.7 % had met all target levels while on secondary prevention that number was even smaller 3.7 %. Our study showed that control of HbA1c and blood pressure was similar to other studies but reaching target levels of LDL was challenging for our patients. Further analysis are needed in order to discover the reasons for poor control of certain CVRF and to develop strategies for its optimal management.

Prevalence of cardiovascular risk factors among 28,000 employees

VASA ◽  
2017 ◽  
Vol 46 (3) ◽  
pp. 203-210 ◽  
Author(s):  
Martin Scheerbaum ◽  
Constantin Langenbach ◽  
Petra Scheerbaum ◽  
Franziska Heidemann ◽  
Henrik C. Rieß ◽  
...  
Keyword(s):  
Risk Factors ◽  
Regression Analysis ◽  
Cardiovascular Risk ◽  
Cardiovascular Risk Factors ◽  
Vascular Diseases ◽  
Lipid Lowering ◽  
Anthropometric Measures ◽  
Cross Sectional ◽  
Screening Programs ◽  
The Mean

Abstract. Background: Cardiovascular diseases are the leading cause of death in Germany. The knowledge of causal risk factors and their distribution is of utmost importance to design screening programs. Probands and methods: In this cross-sectional study design we used STROBE criteria to achieve the highest comparability possible. Anthropometric measures (height and weight), total cholesterol, glucose level, and blood pressure were measured. Probands’ history was collected by using a standardized questionnaire. The data was age- and gender-adjusted for the working population 16 to 70 years of age, derived from the micro census, the 1 %-sample census of the German statistical office. For each study year weight factors were calculated. Logistic regression analysis was conducted regarding the cardiovascular risk factors: smoking, arterial hypertension, diabetes, hypercholesterolemia, and obesity. Results: Between 2006 and 2015 a total of 28,293 employees took part in the ongoing company screenings. The mean age was 42.3 years for both sexes (median: 43 years). The mean body mass index (BMI) was 25.6 kg/m2 (men: 26.5 kg/m2, women: 24.7 kg/m2). A history of hypertension was present in 16 % of the employees (men: 17.8 %, women: 13.8 %). Of the respondents 2 % suffered from diabetes (men: 2.4 %, women: 1.6 %). Lipid-lowering drugs were taken by 2.8 % of all employees (3.6 % men and 1.9 % women). 23.3 % of the men and women indicated to be active smokers. In the regression analysis obesity was associated with a four times higher risk of hypertension and a three times higher risk of elevated glucose levels, thus manifesting as main contributor for vascular diseases. Meanwhile the risk for obesity was 140 % higher in probands who are former smokers. Conclusions: We regard obesity as the number one cardiovascular risk which should be assessed by various medical, legislative, and socio-economic actions to limit future mortality and health-care costs in Germany.

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