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  1. Aziz ZA, Lee YY, Ngah BA, Sidek NN, Looi I, Hanip MR, et al.
    J Stroke Cerebrovasc Dis, 2015 Dec;24(12):2701-9.
    PMID: 26338106 DOI: 10.1016/j.jstrokecerebrovasdis.2015.07.025
    Stroke remains a major health burden worldwide. The incidence and prevalence rates of stroke are decreasing in developed countries, an opposite trend is taking place in the Asia Pacific, where an increasing number of patients are being diagnosed with acute stroke. The results of the present study on acute stroke in multi-ethnic Malaysia will significantly contribute to the global stroke epidemiological data. We aimed to present epidemiological data of stroke including incidence and prevalence rates as well as associated risk factors from a prospective nationwide hospital-based registry from 2010 to 2014.
  2. Wei LK, Au A, Menon S, Gan SH, Griffiths LR
    J Stroke Cerebrovasc Dis, 2015 Sep;24(9):2017-25.
    PMID: 26187788 DOI: 10.1016/j.jstrokecerebrovasdis.2015.04.011
    The purpose of this study was threefold. First, it was to determine the relationship between serum vitamin profiles and ischemic stroke. The second purpose was to investigate the association of methylenetetrahydrofolate reductase (MTHFR), endothelial nitric oxide synthase (eNOS), angiotensin converting enzyme (ACE), and apolipoprotein-E (ApoE) gene polymorphisms with ischemic stroke and further correlate with serum vitamin profiles among ischemic stroke patients. The third purpose of the study was to highlight the interaction of MTHFR and eNOS haplotypes with serum vitamin profiles and ischemic stroke risks.
  3. Ramaiah SS, Mitchell P, Dowling R, Yan B
    J Stroke Cerebrovasc Dis, 2014 Mar;23(3):399-407.
    PMID: 23601372 DOI: 10.1016/j.jstrokecerebrovasdis.2013.03.012
    Evidence from recent randomized controlled studies comparing intra-arterial (IA) therapy with intravenous tissue plasminogen activator highlighted the mismatch between recanalization success and clinical outcomes in patients presenting with acute ischemic stroke. There is emerging interest in the impact of arterial collateralization, as determined by leptomeningeal anastomoses (LMAs), on the treatment outcomes of IA therapy. The system of LMA constitutes the secondary network of cerebral collateral circulation apart from the Circle of Willis. Both anatomic and angiographic studies confirmed significant interindividual variability in LMA. This review aims to outline the current understanding of arterial collateralization and its impact on outcomes after IA therapy for acute ischemic stroke, underpinning the possible role of arterial collateralization assessment as a selection tool for patients most likely to benefit from IA therapy.
  4. Wei LK, Au A, Menon S, Griffiths LR, Kooi CW, Irene L, et al.
    J Stroke Cerebrovasc Dis, 2017 Nov;26(11):2482-2493.
    PMID: 28760411 DOI: 10.1016/j.jstrokecerebrovasdis.2017.05.048
    INTRODUCTION: The association between ischemic stroke and genetic polymorphisms of methylenetetrahydrofolate reductase (MTHFR; 677C>T and 1298A>C), endothelial nitric oxide synthase (eNOS; -786T>C, +894G>T, and variable number tandem repeat [VNTR]), phosphodiesterase 4D (PDE4D; SNPs 83 and 87), angiotensin-converting enzyme (ACE) I/D, angiotensinogen (AGT) 235M>T, paraoxonase 1 (PON1) 192Q>R, and apolipoprotein E (ApoE) ε2ε3ε4 remains inconclusive. Therefore, this updated meta-analysis aimed to clarify the presumed influence of genetic polymorphisms on ischemic stroke by meta-analyzing the comprehensive coverage of all individual association studies.

    METHODS: All case-control studies published in different languages such as English, Japanese, Korean, Spanish, Chinese, Hungarian, Ukrainian, or Russian were identified from databases. The pooled odds ratios (ORs) and 95% confidence intervals (CIs) were calculated via fixed- and random-effect models. Sensitivity analysis, heterogeneity test, Hardy Weinberg Equilibrium, and Egger's regression analyses were performed in this study.

    RESULTS: A total of 490 case-control studies with 138,592 cases and 159,314 controls were included in this meta-analysis. Pooled ORs from all the genetic models indicated that MTHFR 677TT and 1298CC, eNOS +894TT and VNTR, PDE4D SNP 83, ACE DD, AGT 235TT, PON1 192RR, and ApoE ε4 polymorphisms were increasing the risks of ischemic stroke. Nevertheless, PDE4D SNP 87 and eNOS -786T>C polymorphisms are not associated with ischemic stroke risks.

    CONCLUSIONS: Hence, the evidence from this meta-analysis concluded that MTHFR (677C>T and 1298A>C), eNOS (+894G>T and VNTR), PDE4D SNP 83, ACE I/D, AGT 235M>T, PON1 192Q>R, and ApoE ε2ε3ε4 polymorphisms predispose individuals to ischemic stroke.

  5. Glamcevski MT, Pierson J
    J Stroke Cerebrovasc Dis, 2005 Jul-Aug;14(4):157-61.
    PMID: 17904018 DOI: 10.1016/j.jstrokecerebrovasdis.2005.03.006
    This study investigated the prevalence of depression 3-6 months poststroke and examined specific factors associated with depression in a stroke population of the University Malaya Medical Centre, Kuala Lumpur, Malaysia. It was hypothesised that poststroke depression (PSD) is prevalent in the poststroke population of University Hospital Malaysia and that PSD is significantly correlated with demographics, educational background, medical history, rehabilitation attendance, traditional medicine use, prestroke and poststroke activities, religiousness, activities of daily living, and social support. The study group comprised 80 patients admitted to the hospital with stroke of any etiology. Mean patient age was 56.8 years (standard deviation +/- 12.5 years). The results were derived by comparing the 80 stroke patients with 80 controls matched for age, sex, race, and medication use. Results were also derived from comparisons between depressed and nondepressed members of the stroke population (n = 80). The diagnosis of depression was based on the Zung Self-Rating Scale and confirmed by a psychiatrist, based on DSM-IV criteria. Interviews were conducted based on a 26-item questionnaire, modified Barthel Index, and Social Resources Scale were used to assess which factors correlated with depression. Depression was found to be common among Malaysians 3-6 months after stroke. A total of 66% of the patients were depressed, with depression considered mild in 51% and moderate to severe in 15%. It was demonstrated that the occurrence of depression was significantly correlated with age, ethnicity, noncontinuance of prestroke lifestyles, and poor performance in the activities of daily living rating.
  6. Seow SC, How AK, Chan SP, Teoh HL, Lim TW, Singh D, et al.
    J Stroke Cerebrovasc Dis, 2018 Aug;27(8):2182-2186.
    PMID: 29678635 DOI: 10.1016/j.jstrokecerebrovasdis.2018.03.019
    BACKGROUND: Occult atrial fibrillation (AF) is not uncommon in patients with stroke. In western cohorts, insertable loop recorders (ILRs) have been shown to be the gold-standard and are cost-effective for AF detection. Anticoagulation for secondary stroke prevention is indicated if AF is detected. The incidence of occult AF among Asian patients with cryptogenic stroke is unclear.

    METHODS: Patients with cryptogenic stroke referred between August 2014 and February 2017 had ILRs implanted. Episodes of AF >2 minutes duration were recorded using proprietary algorithms within the ILRs, whereupon clinicians and patients were alerted via remote monitoring. All AF episodes were adjudicated using recorded electrograms. Once AF was detected, patients were counseled for anticoagulation.

    RESULTS: Seventy-one patients with cryptogenic stroke, (age 61.9 ± 13.5 years, 77.5% male, mean CHA2DS2VASc score of 4.2 ± 1.3) had ILRs implanted. Time from stroke to the ILR implant was a median of 66 days. Duration of ILR monitoring was 345 ± 229 days. The primary endpoint of AF detection at 6 months was 12.9%; and at 12 months it was 15.2%. Median time to detection of AF was 50 days. The AF episodes were all asymptomatic and lasted a mean of 77 minutes (± 118.9). Anticoagulation was initiated in all but 1 patient found to have AF.

    CONCLUSIONS: The incidence of occult AF is high in Asian patients with cryptogenic stroke and comparable to western cohorts. The combination of ILR and remote monitoring is a highly automated, technologically driven, and clinically effective technique to screen for AF.

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