Stroke Research & Therapy

Description        

Between January 2011 and September 2018, we looked back at the stroke registry data of TIA patients. An electrocardiogram (ECG), medication history, and imaging findings were gathered. An integer point system was created using stepwise logistic regression analyses that were both unavailable and multivariable. Discrimination and calibration were examined with the help of the Hosmer-Lemeshow (HL) test and the area under the receiver operating characteristic curve (AUC). The best cutoff value was also determined using Youden's Index. 557 patients were included, with a 5.03 percent incidence of acute ischemic stroke within 90 days of a TIA. A new integer point system, the MESH (Medication Electrocardiogram Stenosis Hypodense) score, was developed following multivariable analysis. The MESH score included the medication history (antiplatelet medication taken prior to admission, 1 point), right bundle branch block on the electrocardiogram, intracranial stenosis  50%, 1 point, and the size of the hypodense area on computed tomography, 2 points). The MESH score demonstrated adequate calibration and discrimination (HL test = 0.78; AUC=0.78). With a sensitivity of 60.71 percent and a specificity of 81.66 percent, the best cutoff value was 2 points. We retrospectively identified patients with obesity and a medical history of TIA and divided them into two groups using the NIS database from 2010 to 2015: a control group of obese people and a treatment group of people who had bariatric surgery. Using a multivariate regression model and a univariate analysis, we compared the incidence of new AIS in both groups. Lifestyle factors like smoking, drinking, and cocaine use, as well as a family history of stroke, co-morbidities like diabetes, hypertension, hyperlipidemia, and atrial fibrillation, and long-term medical treatment (antiplatelet/antithrombotic therapy) were included in the covariates. We conclude that bariatric surgery lowers the risk of AIS in patients with a history of TIA after analyzing data from across the country. However, the database's nature restricts this comparison. To better comprehend these outcomes, additional research is required. Patients with a history of TIA who underwent bariatric surgery had a lower risk of AIS, as well as a shorter hospital stay and lower costs overall, according to our research.

Distinct Risk Factor for Brain Ischemia

This is the first study of its kind to look into how bariatric surgery affects TIA and how it gets worse. Bariatric surgery and its effect on other cardiovascular diseases like stroke and acute myocardial infarction was the subject of previous research. Since the majority of asterixis with metabolic causes is asymptomatic, it has not been included in the stroke differential diagnosis. On the other hand, there are times when an asterixis resembles a transient ischemic attack (TIA). On the other hand, anemia has been reported to be a distinct risk factor for brain ischemia. As a result, the diagnosis of stroke must take into account both asterixis and anemia. Aspirin was immediately prescribed to a 79-year-old man with frequent leg palsy who was initially diagnosed with recurrent TIA at the anterior cerebral artery (ACA) with a small callosal infarction. However, an in-depth physical examination that followed revealed asterixis at the knee and wrist joints. As a result of colon cancer, severe anemia was discovered through colonoscopy and laboratory testing. The asterixis and gait were immediately improved after a blood transfusion, indicating that anemia was a factor in the patient's symptoms. Magnetic resonance imaging (MRI)-detected anemia-induced brain ischemic lesions may accompany this novel asterixis etiology. To avoid complications that could result in patients with anemia receiving an excessive amount of stroke treatment, anemia-induced asterixis should be considered a novel stroke differential diagnosis.

Stroke and Transient Ischemic Attacks

When it comes to secondary prevention following a stroke or transient ischemic attack, quitting smoking is essential. There is a lack of data on the use of smoking cessation interventions following stroke and transient ischemic attacks. We investigated these patients' use of prescribed smoking cessation medications. This is a retrospective cohort study using data from the Insight Clinical Research Network from 2013 to 2016 on patients receiving care at five health care institutions in New York City. The Medicare prescription claims data was combined with the electronic health record data. The presence of an electronic health record active smoking indicator or a validated ICD-9-CM diagnosis code, reflecting data entered by the clinician, was used to determine active smoking. A claim for any prescribed smoking-cessation medication within a year of hospital discharge was the primary outcome. Because statins are a standard component of stroke secondary prevention, we evaluated claims for any statin medication as a comparator. At the time of their event, 3,153 patients who had a stroke or transient ischemic attack were active smokers. 3.1% of these patients were discharged from the hospital after a year. Statin medication claims, on the other hand, were 67.5 percent at six months and 74.6 percent at twelve months. After a stroke or transient ischemic attack, prescription medications for quitting smoking were rarely used. Mexican children and adolescents have a high rate of obesity and overweight, and their lifestyle choices are far from meeting health recommendations. In Mexico, Salud Escolar is a multi-level, complex, cross-sectoral policy program with the goal of encouraging healthy behaviour in schoolchildren. During the initial implementation phase of Salud Escolar, we explain the rationale, design, and methods for the comprehensive evaluation. A comprehensive evaluation that included three different types of evaluations was created employing a mixed-methods approach and the logic model of Salud Escolar as a guide. An evaluation of the design before the program is implemented to see if the design of Salud Escolar is consistent with the problem that needs to be addressed namely, childhood obesity; an evaluation of the implementation to see if there are any potential execution bottlenecks; and an evaluation of the outcomes to measure short-term and intermediate outcomes. For solid conclusions regarding the program's efficacy, this evaluation will provide crucial information about the program's design and implementation processes. This comprehensive evaluation's findings and lessons learned will help the Salud Escolar program be improved and scaled up, as well as provide useful information for school-based programs in other locations with similar socio-contextual conditions.