Iron deficiency in middle age is linked with higher risk of developing heart disease

You'll have to ask your doctor what deficiency levels are. To donate blood you have to have these levels:  

To help ensure that it is safe for you to donate, females must have a minimum hemoglobin level of 12.5g/dL and males must have a minimum level of 13.0g/dL. A donor's hemoglobin level cannot be higher than 20.0g/dL to donate.

I once fell below that so I now take a daily 65 mg tablet. 

Iron deficiency in middle age is linked with higher risk of developing heart disease

European Society of Cardiology Press Releases|October 6, 2021

Approximately 10% of new coronary heart disease cases occurring within a decade of middle age could be avoided by preventing iron deficiency, suggests a study published today in ESC Heart Failure, a journal of the European Society of Cardiology (ESC).

“This was an observational study and we cannot conclude that iron deficiency causes heart disease,” said study author Dr. Benedikt Schrage of the University Heart and Vasculature Centre Hamburg, Germany. “However, evidence is growing that there is a link and these findings provide the basis for further research to confirm the results.”

Previous studies have shown that in patients with cardiovascular diseases such as heart failure, iron deficiency was linked to worse outcomes including hospitalisations and death. Treatment with intravenous iron improved symptoms, functional capacity, and quality of life in patients with heart failure and iron deficiency enrolled in the FAIR-HF trial.Based on these results, the FAIR-HF 2 trial is investigating the impact of intravenous iron supplementation on the risk of death in patients with heart failure.

The current study aimed to examine whether the association between iron deficiency and outcomes was also observed in the general population.

The study included 12,164 individuals from three European population-based cohorts. The median age was 59 years and 55% were women. During the baseline study visit, cardiovascular risk factors and comorbidities such as smoking, obesity, diabetes and cholesterol were assessed via a thorough clinical assessment including blood samples.

Participants were classified as iron deficient or not according to two definitions: 1) absolute iron deficiency, which only includes stored iron (ferritin); and 2) functional iron deficiency, which includes iron in storage (ferritin) and iron in circulation for use by the body (transferrin).

Dr. Schrage explained: “Absolute iron deficiency is the traditional way of assessing iron status but it misses circulating iron. The functional definition is more accurate as it includes both measures and picks up those with sufficient stores but not enough in circulation for the body to work properly.”

Participants were followed up for incident coronary heart disease and stroke, death due to cardiovascular disease, and all-cause death. The researchers analysed the association between iron deficiency and incident coronary heart disease, stroke, cardiovascular mortality, and all-cause mortality after adjustments for age, sex, smoking, cholesterol, blood pressure, diabetes, body mass index, and inflammation. Participants with a history of coronary heart disease or stroke at baseline were excluded from the incident disease analyses.

At baseline, 60% of participants had absolute iron deficiency and 64% had functional iron deficiency. During a median follow-up of 13.3 years there were 2,212 (18.2%) deaths. Of these, a total of 573 individuals (4.7%) died from a cardiovascular cause. Incidence coronary heart disease and stroke were diagnosed in 1,033 (8.5%) and 766 (6.3%) participants, respectively.

Functional iron deficiency was associated with a 24% higher risk of coronary heart disease, 26% raised risk of cardiovascular mortality, and 12% increased risk of all-cause mortality compared with no functional iron deficiency. Absolute iron deficiency was associated with a 20% raised risk of coronary heart disease compared with no absolute iron deficiency, but was not linked with mortality. There were no associations between iron status and incident stroke.

The researchers calculated the population attributable fraction, which estimates the proportion of events in 10 years that would have been avoided if all individuals had the risk of those without iron deficiency at baseline. The models were adjusted for age, sex, smoking, cholesterol, blood pressure, diabetes, body mass index, and inflammation. Within a 10-year period, 5.4% of all deaths, 11.7% of cardiovascular deaths, and 10.7% of new coronary heart disease diagnoses were attributable to functional iron deficiency.

“This analysis suggests that if iron deficiency had been absent at baseline, about 5% of deaths, 12% of cardiovascular deaths, and 11% of new coronary heart disease diagnoses would not have occurred in the following decade,” said Dr. Schrage.

“The study showed that iron deficiency was highly prevalent in this middle-aged population, with nearly two-thirds having functional iron deficiency,” said Dr. Schrage. “These individuals were more likely to develop heart disease and were also more likely to die during the next 13 years.”

Dr. Schrage noted that future studies should examine these associations in younger and non-European cohorts. He said: “If the relationships are confirmed, the next step would be a randomised trial investigating the effect of treating iron deficiency in the general population.”

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Constipation drug shows promise for memory enhancement

Some safety stuff already done, so get your hospital to test this out in stroke survivors to see if it solves our memory problems.

Identification and Validation of Major Cardiovascular Events in the United Kingdom Data Sources Included in a Multi-database Post-authorization Safety Study of Prucalopride

The latest here:

Constipation drug shows promise for memory enhancement

 

Reuters Health Medical News|October 6, 2021

Prucalopride, a selective serotonin-4 (5-HT4)-receptor agonist primarily used for constipation, may help with memory and thinking, according to new research.

In a small study of healthy young adults, those who took prucalopride for six days performed better on a memory test that than peers taking placebo, with the prucalopride group identifying 81% of previously viewed images versus 76% of the placebo group (P=0.029).

"Statistical tests indicate that this was a fairly large effect - such an obvious cognitive improvement with the drug was a surprise to us," Dr. Angharad de Cates of the University of Oxford, in the U.K., said in a news release.

She presented the study at the European College of Neuropsychopharmacology (ECNP) conference in Lisbon, Portugal, with simultaneous publication in Translational Psychiatry.

Drugs that target the 5-HT4 receptor have shown promise in improving cognitive function in animal studies. In an earlier study, Dr. de Cates and colleagues showed that a single 1-mg dose of prucalopride has pro-cognitive effects across three different tasks of learning and memory.

To investigate further, they studied 44 adults aged 18 to 36 years; 23 took prucalopride (1-mg daily) and 21 took a placebo.

After six days, all participants had a functional MRI brain scan. Before the scan, they were shown a series of images of animals and landscapes. During the scan, they were shown the same images plus similar images. Following the scan, they took a memory test where they were asked to distinguish the images they had seen before and during the scan from a set of completely new images.

"We found that participants who had received six days of prucalopride treatment were significantly better at recalling previously seen neutral images and distinguishing them from new images," the study team reports in their paper.

"At a neural level, prucalopride bilaterally increased hippocampal activity and activity in the right angular gyrus compared with placebo," they add.

"Taken together, these findings demonstrate the potential of 5-HT4-receptor activation for cognitive enhancement in humans, and support the potential of this receptor as a treatment target for cognitive impairment," they conclude.

"This is a proof-of-concept study, and so a starting point for further investigation," Dr. de Cates cautioned in the news release.

"We are currently planning and undertaking further studies looking at prucalopride and other 5-HT4 agonists in patient and clinically vulnerable populations, to see if our findings in healthy volunteers can be replicated and have clinical importance," she added.

—Reuters Staff

To read more, click here

Why hospital design matters: A narrative review of built environments research relevant to stroke care

 I disagree, with only 10% that almost fully recover  the design of the hospital has almost nothing to do with recovery.  With 'care' in the title you're not even trying to get survivors recovered.  You blithering idiots need to focus on stopping the 5 causes of the neuronal cascade of death in the first week saving billions of neurons. Then your rehab just might work.

Oops, I'm not playing by the polite rules of Dale Carnegie,  'How to Win Friends and Influence People'. 

Telling stroke medical persons they know nothing about stroke is a no-no even if it is true. 

Politeness will never solve anything in stroke. Yes, I'm a bomb thrower and proud of it. Someday a stroke 'leader' will try to ream me out for making them look bad by being truthful , I look forward to that day.

Why hospital design matters: A narrative review of built environments research relevant to stroke care

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Julie Bernhardt, Ruby Lipson-Smith, Aaron Davis, ...

First Published October 5, 2021 Review Article Find in PubMed 

https://doi.org/10.1177/17474930211042485

Article information

Abstract

Healthcare facilities are among the most expensive buildings to construct, maintain, and operate. How building design can best support healthcare services, staff, and patients is important to consider. In this narrative review, we outline why the healthcare environment matters and describe areas of research focus and current built environment evidence that supports healthcare in general and stroke care in particular. Ward configuration, corridor design, and staff station placements can all impact care provision, staff and patient behavior. Contrary to many new ward design approaches, single-bed rooms are neither uniformly favored, nor strongly evidence-based, for people with stroke. Green spaces are important both for staff (helping to reduce stress and errors), patients and relatives, although access to, and awareness of, these and other communal spaces is often poor. Built environment research specific to stroke is limited but increasing, and we highlight emerging collaborative multistakeholder partnerships (Living Labs) contributing to this evidence base. We believe that involving engaged and informed clinicians in design and research will help shape better hospitals of the future.

Keywords

Stroke, stroke rehabilitation, hospital design and construction, evidence-based design

Introduction

Imagine (re-)designing the very hospital you work in. What would you design differently? What would you change, to benefit you, your patients, and their families? What evidence might help guide those design decisions?

Healthcare facilities are among the most expensive buildings to construct, maintain, and operate.¹ Once built, hospitals remain in service for decades and are difficult to modify. With stakes this high, considering how building design best supports healthcare services is important. In this narrative review, we outline why the built environment matters, with particular focus on stroke care. We also discuss challenges inherent in designing healthcare environments, undertaking research and evaluating completed architecture.

The planning and design process for new healthcare environments is incredibly complex, but, in general, it occurs in three overlapping stages: (1) the planning stage in which the healthcare provider describes the users’ needs, model of care, and clinical program in a functional brief that summarizes the requirements for the new hospital; (2) the design stage in which these requirements are interpreted by architects to develop an initial concept which is then refined to a more detailed design; and (3) the delivery stage in which the building is constructed. The extent to which hospital staff and patients are included at each stage of this process can vary significantly between projects.²

Healthcare professionals have long advocated for design features thought to benefit health and well-being, such as natural light, ventilation, and space between patients—for example, the circular hospital design proposed by the physician Antoine Petit³ and long “Nightingale wards” proposed by Florence Nightingale.⁴ Hospital design is now informed by a process termed “evidence-based design” (EBD), in which research evidence is used alongside other considerations such as the healthcare context, budget, and architects’ experience, to inform the design of the healthcare built environment.^5,6 In this context, the “healthcare built environment” encompasses: (1) the physical construction (layout, room dimensions, doors and window placement, outdoor and community access, etc.), (2) ambient features (noise, air quality, light, temperature, etc.), and (3) interior design (furniture, signage, equipment, artwork, etc.).⁷ Analogous to evidence-based clinical practice, hospitals designed following best research evidence garnered from EBD processes have better safety, patient outcomes, staff retention, and operation costs.^8,9 The Center for Health Design, established in 1993 to advance EBD, now maintains a repository of over 5,000 articles on healthcare design (https://www.healthdesign.org).

The field is growing; however, many healthcare contexts, including stroke, have a limited built environment evidence base.¹⁰ Establishing geographically organized stroke units has been an important focus¹¹; however, these studies rarely address specifics of the built environment, and we know little about optimal stroke unit design. Stroke clinical guidelines rarely mention the built environment nor provide guidance on how the environment might best support care. There are currently no stroke care-specific building standards, nor standardized checklists to evaluate the quality of these environments.¹²

Why is the built environment neglected? Clinicians may identify as knowing less about how the environment might influence patient care or staff well-being. They may also feel uninformed about the design process and how to contribute their clinical expertise to influence decision-making. To begin to address these gaps, our objectives for this review were: (1) to introduce readers to healthcare built environment research and (2) to highlight evidence that underpins acute, subacute, or rehabilitation stroke care facility design. This review is in three parts:

1. Overview of healthcare built environment research;

2. Stroke care built environment evidence; and

3. Planning and design of new healthcare environments: Challenges and opportunities.

We include research from recent, relevant systematic reviews, other evidence summaries, and selected qualitative and mixed-methods research focusing on healthcare environments and design. Healthcare environments are complex and context-specific, with many interdependent variables that can rarely be isolated. This complex system does not readily lend itself to highly controlled experimental research designs in real-life settings.¹³ Qualitative methods, such as case studies and pre- and post-occupancy evaluations (before and after a redesign or redevelopment), are common. With research still developing, heterogeneity exists in research designs, outcomes, environments, populations, and theoretical frameworks employed.¹⁴ Hence, robust summary evidence derived from meta-analyses is lacking.

 

 

Timing and Dose of Upper Limb Motor Intervention After Stroke: A Systematic Review

 Are you surprised that after decades of research there is still NOTHING on upper limb recovery? I'm not, we have NO leadership and NO strategy. Nothing will get done until survivors are in charge. I'd suggest waiting at least 50 years before you have your stroke, maybe then something will be known about recovery

Timing and Dose of Upper Limb Motor Intervention After Stroke: A Systematic Review

Kathryn S. Hayward

,

Sharon F. Kramer

,

Emily J. Dalton

,

Gemma R. Hughes

,

Amy Brodtmann

,

Leonid Churilov

,

Geoffrey Cloud

,

Dale Corbett

,

Laura Jolliffe

,

Tina Kaffenberger

,

Venesha Rethnam

,

Vincent Thijs

,

Nick Ward

… See all authors

Originally published4 Oct 2021https://doi.org/10.1161/STROKEAHA.121.034348Stroke. ;0:STROKEAHA.121.034348

Abstract

This systematic review aimed to investigate timing, dose, and efficacy of upper limb intervention during the first 6 months poststroke. Three online databases were searched up to July 2020. Titles/abstracts/full-text were reviewed independently by 2 authors. Randomized and nonrandomized studies that enrolled people within the first 6 months poststroke, aimed to improve upper limb recovery, and completed preintervention and postintervention assessments were included. Risk of bias was assessed using Cochrane reporting tools. Studies were examined by timing (recovery epoch), dose, and intervention type. Two hundred and sixty-one studies were included, representing 228 (n=9704 participants) unique data sets. The number of studies completed increased from one (n=37 participants) between 1980 and 1984 to 91 (n=4417 participants) between 2015 and 2019. Timing of intervention start has not changed (median 38 days, interquartile range [IQR], 22–66) and study sample size remains small (median n=30, IQR 20–48). Most studies were rated high risk of bias (62%). Study participants were enrolled at different recovery epochs: 1 hyperacute (<24 hours), 13 acute (1–7 days), 176 early subacute (8–90 days), 34 late subacute (91–180 days), and 4 were unable to be classified to an epoch. For both the intervention and control groups, the median dose was 45 (IQR, 600–1430) min/session, 1 (IQR, 1–1) session/d, 5 (IQR, 5–5) d/wk for 4 (IQR, 3–5) weeks. The most common interventions tested were electromechanical (n=55 studies), electrical stimulation (n=38 studies), and constraint-induced movement (n=28 studies) therapies. Despite a large and growing body of research, intervention dose and sample size of included studies were often too small to detect clinically important effects. Furthermore, interventions remain focused on subacute stroke recovery with little change in recent decades. A united research agenda that establishes a clear biological understanding of timing, dose, and intervention type is needed to progress stroke recovery research. Prospective Register of Systematic Reviews ID: CRD42018019367/CRD42018111629.

 

 

Risk of Aneurysm Rupture After Thrombolysis in Patients With Acute Ischemic Stroke and Unruptured Intracranial Aneurysms

It is your responsibility not to have these problems until your stroke hospital has protocols in place to prevent these deaths and disability.  YOUR RESPONSIBILITY! Obviously you can't expect your hospital to be competent in all types of strokes.

Risk of Aneurysm Rupture After Thrombolysis in Patients With Acute Ischemic Stroke and Unruptured Intracranial Aneurysms

View ORCID ProfileJyri Juhani Virta, Daniel Strbian, View ORCID ProfileJukka Putaala, View ORCID ProfileMiikka Korja

First published October 6, 2021, DOI: https://doi.org/10.1212/WNL.0000000000012771

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Abstract

Background and Objectives: Unruptured intracranial aneurysms (UIAs) are considered to be a relative contraindication for intravenous thrombolysis (IVT) in acute ischemic stroke (AIS). However, there is currently limited data on the risk of UIA rupture following IVT. Our objective was to assess whether IVT for AIS can lead to a UIA rupture and intracranial hemorrhages (ICHs) in patients with unruptured UIAs.

Methods: Prospective cohort study of consecutive patients treated in a comprehensive stroke center between 2005 and 2019. We assessed radiology reports and records at the Finnish Care Register for Health Care to identify patients with UIAs among all AIS patients treated with IVT at the center. We analyzed patient angiograms for aneurysm characteristics and other brain imaging studies for ICHs after IVT. The main outcome was in-hospital ICHs attributable to an UIA rupture after IVT. Secondary outcomes were in-hospital symptomatic ICHs (ECASS-2 criteria, i.e., NIH Stroke Scale score increase of ≥4 points) and any in-hospital ICHs.

Results: A total of 3 953 patients were treated with IVT during the 15-year study period. One hundred thirty-two (3.3 %) of the 3 953 AIS patients had a total of 155 UIAs (141 saccular and 14 fusiform). The mean diameter of UIAs was 4.7 ± 3.8 mm, with 18.7% being ≥7 mm and 9.7% ≥10 mm in diameter. None of the 141 saccular UIAs ruptured following IVT. Three patients [2.3%, 95% confidence interval (CI) 0.6-5.8%] with large fusiform basilar artery UIAs suffered from a fatal rupture at 27 hours, 43 hours, and 19 days after IVT. All three were administered anticoagulation treatments following IVT and anticoagulation took effect during the UIA rupture. Any ICHs and symptomatic ICHs were detected in 18.9 % (95% CI 12.9-26.2%) and 8.3% (95% CI 4.4-13.8%) of all AIS patients, respectively.

Discussion: IVT appears to be safe in AIS patients with saccular UIAs, including larges UIAs (≥10 mm). Anticoagulation after AIS in patients with large fusiform posterior circulation UIAs may increase the risk of aneurysm rupture.

• Received May 17, 2021.
• Accepted in final form August 12, 2021.

• © 2021 American Academy of Neurology

 

You're invited to the National Stroke Quality Improvement Virtual Workshop 2021 4th, 5th and 11th November 2021

Go and keep asking about 100% recovery until they kick you out. I'll be in California visiting national parks that aren't closed and hopefully drinking wine in Sonoma valley.

You're invited to the National Stroke Quality Improvement Virtual Workshop 2021

4th, 5th and 11th November 2021

The Florey Institute of Neuroscience and Mental Health, the Stroke Foundation, and Monash University are proud to present the 9th annual National Stroke Quality Improvement Workshop. Due to the ongoing restrictions currently in place in Melbourne, this year’s workshop will be held as a virtual meeting across three days Thursday 4th, Friday 5th, and Thursday 11th of November, 2021.

This is a FREE event that will feature presentations from a range of stroke clinicians, academics, and government representatives from across Australia.

In 2021, the program will include sessions on:

• Health care improvement initiatives;
• The National Stroke Data Linkage Interest Group; 
• Post-stroke care including the use of e-health; and
• Innovations in pre-hospital, emergency, and hospital care.

The 2021 Workshop Agenda Overview can be viewed here.
Please note: The presenters and time slots depicted in the Agenda Overview are provisional and may be subject to change.
 

When someone has a stroke, every second delayed is critical

Well in one second 31,666 neurons will die. ABSOLUTELY NOTHING COMPARED TO THE BILLIONS THAT WILL DIE THE FIRST WEEK, because your doctor and hospital have nothing for stopping the 5 causes of the neuronal cascade of death in the first week. I lost 5.4 billion neurons that first week. If I'd only lost 177 million neurons in the 90 minutes it took to get tPA I'd easily be recovered by now. They are not even focusing on the humongous elephant in the room, just swatting mites on the gnats.

When someone has a stroke, every second delayed is critical

Where does the Indian government stand on its statement made by Prime Minister Narendra Modi in his speech at the UN Sustainable Development Summit in September 2015? stroke Sentinel Digital DeskBy : Sentinel Digital Desk | 10 Oct 2021 12:54 AM Follow Us on Google News Dr Praveen Aggarwal & Dr Manorama Bakshi (The authors, Dr Praveen Aggarwal is co-founder and Director of Consocia Advisor, while Dr Manorama Bakshi is Public Health Expert, Head Health care and Advocacy of Consocia Advisory.) Where does the Indian government stand on its statement made by Prime Minister Narendra Modi in his speech at the UN Sustainable Development Summit in September 2015? To quote him: "Much of India's development agenda is mirrored in the Sustainable Development Goals (SDGs). Our national plans are ambitious and purposeful, sustainable development of one-sixth of humanity will be of great consequence to the world and our beautiful planet." Also Read - Securing land from 'land-hungry' migrants India along with many other countries is tumbling behind on global commitments to tackle premature deaths from chronic diseases, such as strokes, diabetes, lung cancer and heart disease. The NCD Countdown to 2030 report states that the pace of change is too slow to achieve SDG 3.4 in most countries. It may be noted that non-communicable diseases (NCDs) kill 41 million people each year, equivalent to 71 per cent of all deaths globally. Each year, more than 15 million people die from NCD between the ages of 30 and 69 years; 85 per cent of these "premature" deaths occur in low- and middle-income countries.

https://www.sentinelassam.com/editorial/when-someone-has-a-stroke-every-second-delayed-is-critical-558437

 

Where does the Indian government stand on its statement made by Prime Minister Narendra Modi in his speech at the UN Sustainable Development Summit in September 2015? stroke Sentinel Digital DeskBy : Sentinel Digital Desk | 10 Oct 2021 12:54 AM Follow Us on Google News Dr Praveen Aggarwal & Dr Manorama Bakshi (The authors, Dr Praveen Aggarwal is co-founder and Director of Consocia Advisor, while Dr Manorama Bakshi is Public Health Expert, Head Health care and Advocacy of Consocia Advisory.) Where does the Indian government stand on its statement made by Prime Minister Narendra Modi in his speech at the UN Sustainable Development Summit in September 2015? To quote him: "Much of India's development agenda is mirrored in the Sustainable Development Goals (SDGs). Our national plans are ambitious and purposeful, sustainable development of one-sixth of humanity will be of great consequence to the world and our beautiful planet." Also Read - Securing land from 'land-hungry' migrants India along with many other countries is tumbling behind on global commitments to tackle premature deaths from chronic diseases, such as strokes, diabetes, lung cancer and heart disease. The NCD Countdown to 2030 report states that the pace of change is too slow to achieve SDG 3.4 in most countries. It may be noted that non-communicable diseases (NCDs) kill 41 million people each year, equivalent to 71 per cent of all deaths globally. Each year, more than 15 million people die from NCD between the ages of 30 and 69 years; 85 per cent of these "premature" deaths occur in low- and middle-income countries.

https://www.sentinelassam.com/editorial/when-someone-has-a-stroke-every-second-delayed-is-critical-558437

 Where does the Indian government stand on its statement made by Prime Minister Narendra Modi in his speech at the UN Sustainable Development Summit in September 2015? stroke Sentinel Digital DeskBy : Sentinel Digital Desk | 10 Oct 2021 12:54 AM Follow Us on Google News Dr Praveen Aggarwal & Dr Manorama Bakshi (The authors, Dr Praveen Aggarwal is co-founder and Director of Consocia Advisor, while Dr Manorama Bakshi is Public Health Expert, Head Health care and Advocacy of Consocia Advisory.) Where does the Indian government stand on its statement made by Prime Minister Narendra Modi in his speech at the UN Sustainable Development Summit in September 2015? To quote him: "Much of India's development agenda is mirrored in the Sustainable Development Goals (SDGs). Our national plans are ambitious and purposeful, sustainable development of one-sixth of humanity will be of great consequence to the world and our beautiful planet."

https://www.sentinelassam.com/editorial/when-someone-has-a-stroke-every-second-delayed-is-critical-558437

Where does the Indian government stand on its statement made by Prime Minister Narendra Modi in his speech at the UN Sustainable Development Summit in September 2015? stroke Sentinel Digital DeskBy : Sentinel Digital Desk | 10 Oct 2021 12:54 AM Follow Us on Google News Dr Praveen Aggarwal & Dr Manorama Bakshi (The authors, Dr Praveen Aggarwal is co-founder and Director of Consocia Advisor, while Dr Manorama Bakshi is Public Health Expert, Head Health care and Advocacy of Consocia Advisory.) Where does the Indian government stand on its statement made by Prime Minister Narendra Modi in his speech at the UN Sustainable Development Summit in September 2015? To quote him: "Much of India's development agenda is mirrored in the Sustainable Development Goals (SDGs). Our national plans are ambitious and purposeful, sustainable development of one-sixth of humanity will be of great consequence to the world and our beautiful planet."

https://www.sentinelassam.com/editorial/when-someone-has-a-stroke-every-second-delayed-is-critical-558437

Where does the Indian government stand on its statement made by Prime Minister Narendra Modi in his speech at the UN Sustainable Development Summit in September 2015? stroke Sentinel Digital DeskBy : Sentinel Digital Desk | 10 Oct 2021 12:54 AM Follow Us on Google News Dr Praveen Aggarwal & Dr Manorama Bakshi (The authors, Dr Praveen Aggarwal is co-founder and Director of Consocia Advisor, while Dr Manorama Bakshi is Public Health Expert, Head Health care and Advocacy of Consocia Advisory.) Where does the Indian government stand on its statement made by Prime Minister Narendra Modi in his speech at the UN Sustainable Development Summit in September 2015? To quote him: "Much of India's development agenda is mirrored in the Sustainable Development Goals (SDGs). Our national plans are ambitious and purposeful, sustainable development of one-sixth of humanity will be of great consequence to the world and our beautiful planet."

https://www.sentinelassam.com/editorial/when-someone-has-a-stroke-every-second-delayed-is-critical-558437

Where does the Indian government stand on its statement made by Prime Minister Narendra Modi in his speech at the UN Sustainable Development Summit in September 2015? stroke Sentinel Digital DeskBy : Sentinel Digital Desk | 10 Oct 2021 12:54 AM Follow Us on Google News Dr Praveen Aggarwal & Dr Manorama Bakshi (The authors, Dr Praveen Aggarwal is co-founder and Director of Consocia Advisor, while Dr Manorama Bakshi is Public Health Expert, Head Health care and Advocacy of Consocia Advisory.) Where does the Indian government stand on its statement made by Prime Minister Narendra Modi in his speech at the UN Sustainable Development Summit in September 2015? To quote him: "Much of India's development agenda is mirrored in the Sustainable Development Goals (SDGs). Our national plans are ambitious and purposeful, sustainable development of one-sixth of humanity will be of great consequence to the world and our beautiful planet." Also Read - Securing land from 'land-hungry' migrants India along with many other countries is tumbling behind on global commitments to tackle premature deaths from chronic diseases, such as strokes, diabetes, lung cancer and heart disease. The NCD Countdown to 2030 report states that the pace of change is too slow to achieve SDG 3.4 in most countries. It may be noted that non-communicable diseases (NCDs) kill 41 million people each year, equivalent to 71 per cent of all deaths globally. Each year, more than 15 million people die from NCD between the ages of 30 and 69 years; 85 per cent of these "premature" deaths occur in low- and middle-income countries.

https://www.sentinelassam.com/editorial/when-someone-has-a-stroke-every-second-delayed-is-critical-558437

When someone has a stroke, every second delayed is critical

https://www.sentinelassam.com/editorial/when-someone-has-a-stroke-every-second-delayed-is-critical-558437

Large-Scale Multivariate Analysis to Interrogate an Animal Model of Stroke: Novel Insights Into Poststroke Pathology

 No clue how this is going to help your recovery, so ask your doctor very very specifically how this will help.  NO KNOWLEDGE OF THE RESEARCH, CALL THE PRESIDENT AND ASK WHEN COMPETENT PEOPLE WILL BE HIRED!

Large-Scale Multivariate Analysis to Interrogate an Animal Model of Stroke: Novel Insights Into Poststroke Pathology

 

Shenpeng R. Zhang

,

Hyun Ah Kim

,

Hannah X. Chu

,

Seyoung Lee

,

Megan A. Evans

,

Xia Li

,

Henry Ma

,

Grant R. Drummond

,

Christopher G. Sobey

,

Thanh G. Phan

Originally published8 Oct 2021https://doi.org/10.1161/STROKEAHA.121.036500Stroke. ;0:STROKEAHA.121.036500

Abstract

Background and Purpose:

Preclinical stroke studies endeavor to model the pathophysiology of clinical stroke, assessing a range of parameters of injury and impairment. However, poststroke pathology is complex and variable, and associations between diverse parameters may be difficult to identify within the usual small study designs that focus on infarct size.

Methods:

We have performed a retrospective large-scale big data analysis of records from 631 C57BL/6 mice of either sex in which the middle cerebral artery was occluded by 1 of 5 surgeons either transiently for 1 hour followed by 23-hour reperfusion (transient middle cerebral artery occlusion [MCAO]; n=435) or permanently for 24 hours without reperfusion (permanent MCAO; n=196). Analyses included a multivariate linear mixed model with random intercept for different surgeons as a random effect to reduce type I and type II errors and a generalized ordinal regression model for ordinal data when random effects are low.

Results:

Analyses indicated that brain edema volume was associated with infarct volume at 24 hours (β, 0.52 [95% CI, 0.45–0.59]) and was higher after permanent MCAO than after transient MCAO (P<0.05). A more severe clinical score was associated with a greater infarct volume but not with the animal’s age or edema volume. Further, a more severe clinical score was observed for a given brain infarct volume after transient MCAO versus permanent MCAO. Remarkably the animal’s age, which corresponded with the period of young adulthood (6–40 weeks; equivalent to ≈18–35 years in humans), was positively associated with severity of lung infection (β, 0.65 [95% CI, 0.42–0.88]) and negatively with spleen weight (β, −0.36 [95% CI, −0.63 to −0.09]).

Conclusions:

Large-scale analysis of preclinical stroke data can provide researchers in our field with insight into relationships between variables not possible if individual studies are analyzed in isolation and has identified hypotheses for future study.

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Translational Interdisciplinary Science—Immune Cell Niches: Possible Targets for Stroke Therapy?

Your doctor better be able to tell you what they are doing to get further research on this going. NO RESEARCH. FIRE THE BOARD OF DIRECTORS FOR INCOMPETENCE!

Translational Interdisciplinary Science—Immune Cell Niches: Possible Targets for Stroke Therapy?

Louise D. McCullough

,

María A. Moro

Originally published8 Oct 2021https://doi.org/10.1161/STROKEAHA.121.033969Stroke. ;0:STROKEAHA.121.033969

Footnotes

 

Reclassifications of ischemic stroke patterns due to variants of the Circle of Willis

 Reclassification does absolutely nothing for stroke survivors. We need exact protocols delivering recovery based on these differences.  Useless research.

Reclassifications of ischemic stroke patterns due to variants of the Circle of Willis

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Ida Rangus, Lennart S Milles, Ivana Galinovic, ...

First Published October 5, 2021 Research Article Find in PubMed 

https://doi.org/10.1177/17474930211048381

Article information

Abstract

Background

Variants of the Circle of Willis (vCoW) may impede correct identification of ischemic lesion patterns and stroke etiology. We assessed reclassifications of ischemic lesion patterns due to vCoW.

Methods

We analyzed vCoW in patients with acute ischemic stroke from the 1000+ study using time-of-flight magnetic resonance angiography (TOF MRA) of intracranial arteries. We assessed A1 segment agenesis or hypoplasia in the anterior circulation and fetal posterior cerebral artery in the posterior circulation. Stroke patterns were classified as one or more-than-one territory stroke pattern. We examined associations between vCoW and stroke patterns and the frequency of reclassifications of stroke patterns due to vCoW.

Results

Of 1000 patients, 991 had evaluable magnetic resonance angiography. At least one vCoW was present in 37.1%. VCoW were more common in the posterior than in the anterior circulation (33.3% vs. 6.7%). Of 238 patients initially thought to have a more-than-one territory stroke pattern, 20 (8.4%) had to be reclassified to a one territory stroke pattern after considering vCoW. All these patients had fetal posterior cerebral artery and six (30%) additionally had carotid artery disease. Of 753 patients initially presumed to have a one-territory stroke pattern, four (0.5%) were reclassified as having more-than-one territory pattern.

Conclusions

VCoW are present in about one in three stroke patients and more common in the posterior circulation. Reclassifications of stroke lesion patterns due to vCoW occurred predominantly in the posterior circulation with fetal posterior cerebral artery mimicking multiple territory stroke pattern. Considering vCoW in these cases may uncover symptomatic carotid disease.

Keywords

Circle of Willis, stroke patterns, neuroanatomy

Introduction

Identifying stroke lesion patterns and affected territories supplied by neck arteries is an essential component in determining ischemic stroke etiology. More-than-one territory stroke patterns suggest a proximal embolic source, e.g. of cardiac or aortal origin, whereas single territory stroke patterns point to large or small vessel disease.¹ Assigning stroke lesions to the corresponding arterial territories is usually carried out using pre-set brain maps due to practicality.² However, since the Circle of Willis (CoW) connects all three major cerebral territories (left anterior, right anterior, and posterior), classifying stroke lesion patterns based solely on brain maps without considering variants of the Circle of Willis (vCoW) may lead to false assignment of affected arterial territories.³ Taking vCoW into account may lead to clinically relevant reclassifications of stroke patterns.

Aims

Establishing the frequency of different vCoW could help to distinguish stroke locations that are more prone to misclassifications. Here, we analyzed the frequency of two vCoW in patients with ischemic stroke using time-of-flight magnetic resonance angiography (TOF MRA): (a) agenesis or hypoplastic A1 segment of the ACA in the anterior circulation (anterior vCoW) and (b) fetal posterior cerebral artery (fPCA) in the posterior circulation. Furthermore, we examined stroke lesion patterns (classified as one and more-than-one territory stroke pattern) in patients with complete Circle of Willis (cCoW) and vCoW. Finally, we examined the rate of reclassifications from more-than-one territory to one territory and vice versa, following reattributions of stroke lesions to the corresponding cerebral artery after identifying vCoW.

 

Treatment-Associated Stroke in Patients Undergoing Endovascular Therapy in the ARUBA Trial

If you have an upruptured AVM you'll have to ask your doctor EXACTLY WHAT IS BEING DONE TO PREVENT THAT 16% RISK OF STROKE. This is your doctor's responsibility, don't let her pooh pooh the risk, it's your life, not hers that is on the line. Ask about the efficacy of the protocol she is using.

Treatment-Associated Stroke in Patients Undergoing Endovascular Therapy in the ARUBA Trial

Joshua D. Burks

,

Evan M. Luther

,

Vaidya Govindarajan

,

Stephanie H. Chen

,

Robert M. Starke

Originally published8 Oct 2021https://doi.org/10.1161/STROKEAHA.120.033743Stroke. ;0:STROKEAHA.120.033743

Abstract

Background and Purpose:

Since the publication of ARUBA trial (A Randomized Trial of Unruptured Brain Arteriovenous Malformations), outcomes in treated and untreated patients with unruptured arteriovenous malformation have been thoroughly compared. However, no prior analysis of ARUBA patients has sought to identify risk factors for perioperative stroke. Improved understanding of risks within the ARUBA cohort will help clinicians apply the study’s findings in a broader context.

Methods:

The National Institute of Neurological Disorders and Stroke database was queried for all data relating to ARUBA patients, including demographics, interventions undertaken, and timing of stroke. Retrospective cohort analysis was performed with the primary outcome of perioperative stroke in patients who underwent endovascular intervention, and stroke risk was modeled with multivariate analysis.

Results:

A total of 64 ARUBA patients were included in the analysis. One hundred and fifty-ninth interventions were performed, and 26 (16%) procedures resulted in stroke within 48 hours of treatment.(Way too high.) Posterior cerebral artery supply (adjusted odds ratio, 4.42 [95% CI, 1.23–15.9], P=0.02) and Spetzler-Martin grades 2 and 3 arteriovenous malformation (adjusted odds ratio, 7.76 [95% CI, 1.20–50.3], P=0.03; 9.64 [95% CI, 1.36–68.4], P=0.04, respectively) were associated with increased perioperative stroke risk in patients who underwent endovascular intervention. Patients treated in the United States or Germany had a significantly lower stroke risk than patients treated in other countries (adjusted odds ratio, 0.18 [95% CI, 0.04–0.82], P=0.02).

Conclusions:

Knowing patient and lesion characteristics that increase risk during endovascular treatment can better guide clinicians managing unruptured brain arteriovenous malformation. Our analysis suggests risk of perioperative stroke is dependent on Spetzler-Martin grade and posterior-circulation arterial supply. Differences in regional treatment paradigms may also affect stroke risk.

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Timing and Dose of Upper Limb Motor Intervention After Stroke: A Systematic Review

So your doctors and stroke researchers know absolutely nothing on getting your upper limb recovered.  Just lousy guidelines, NOT PROTOCOLS!  You better wait on having your stroke until better interventions exist.

Timing and Dose of Upper Limb Motor Intervention After Stroke: A Systematic Review

 

Kathryn S. Hayward

,

Sharon F. Kramer

,

Emily J. Dalton

,

Gemma R. Hughes

,

Amy Brodtmann

,

Leonid Churilov

,

Geoffrey Cloud

,

Dale Corbett

,

Laura Jolliffe

,

Tina Kaffenberger

,

Venesha Rethnam

,

Vincent Thijs

,

Nick Ward

… See all authors

Originally published4 Oct 2021https://doi.org/10.1161/STROKEAHA.121.034348Stroke. ;0:STROKEAHA.121.034348

Abstract

This systematic review aimed to investigate timing, dose, and efficacy of upper limb intervention during the first 6 months poststroke. Three online databases were searched up to July 2020. Titles/abstracts/full-text were reviewed independently by 2 authors. Randomized and nonrandomized studies that enrolled people within the first 6 months poststroke, aimed to improve(NOT RECOVER! The tyranny pf low expectations in full view.)g 228 (n=9704 participants) unique data sets. The number of studies completed increased from one (n=37 participants) between 1980 and 1984 to 91 (n=4417 participants) between 2015 and 2019. Timing of intervention start has not changed (median 38 days, interquartile range [IQR], 22–66) and study sample size remains small (median n=30, IQR 20–48). Most studies were rated high risk of bias (62%). Study participants were enrolled at different recovery epochs: 1 hyperacute (<24 hours), 13 acute (1–7 days), 176 early subacute (8–90 days), 34 late subacute (91–180 days), and 4 were unable to be classified to an epoch. For both the intervention and control groups, the median dose was 45 (IQR, 600–1430) min/session, 1 (IQR, 1–1) session/d, 5 (IQR, 5–5) d/wk for 4 (IQR, 3–5) weeks. The most common interventions tested were electromechanical (n=55 studies), electrical stimulation (n=38 studies), and constraint-induced movement (n=28 studies) therapies. Despite a large and growing body of research, intervention dose and sample size of included studies were often too small to detect clinically important effects. Furthermore, interventions remain focused on subacute stroke recovery with little change in recent decades. A united research agenda that establishes a clear biological understanding of timing, dose, and intervention type is needed to progress stroke recovery research. Prospective Register of Systematic Reviews ID: CRD42018019367/CRD42018111629.

Footnotes

The Data Supplement is available with this article at https://www.ahajournals.org/doi/suppl/10.1161/STROKEAHA.121.034348.

For Sources of Funding and Disclosures, see page xxx.

Correspondence to: Kathryn S. Hayward, PhD, Departments of Physiotherapy and Medicine, Florey Institute of Neuroscience and Mental Health, University of Melbourne, Level 5 Harold Stokes Bldg, Austin Hospital, Heidelberg, VIC Australia. Email kate.hayward@unimelb.edu.au