Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0010200 (cough)
 23,843 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

We aimed to describe and classify headaches associated with acute stroke, by interviewing patients consecutively admitted to a stroke unit using a validated headache questionnaire and the International Classification of Headache Disorders of the International Headache Society (IHS). One hundred and twenty-four patients (61% ischaemic and 39% haemorrhagic stroke) reported headache. Headaches started mostly on the day of stroke, were more often continuous, pressure-type, bilateral and located in the anterior region, were increased by movement and by cough and lasted for a mean of 3.8 days. Tension-type was the most frequent type of headache. Eleven per cent of headaches could not be classified using the criteria of the IHS. Previous primary headache was documented in 71 patients. The presence of nausea/vomiting due to acute stroke can confound headache classification using the IHS criteria. In up to half of the patients, headache seems to be a reactivation of previous primary headache.
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PMID:Headache in acute stroke. A prospective study in the first 8 days. 1824 Dec 22

ONTARGET ("ONgoing Telmisartan Alone and in combination with Ramipril Global Endpoint Trial") compared the angiotensin converting enzyme inhibitor ramipril (10 mg/day), the angiotensin-receptor blocker telmisartan 80 mg/day, and the combination of the two drugs in 25,620 patients with vascular disease or high-risk diabetes. After a median follow up of 56 months, no significant differences were observed between the three groups neither in the primary composite outcome (death from cardiovascular causes, myocardial infarction, stroke, or hospitalization for heart failure), nor in each of its components, total mortality and other secondary outcomes. Telmisartan was equivalent to ramipril (non inferiority criterion), but was better tolerated (less cough and angioedema). The combination of the two drugs in this population (without congestive heart failure and proteinuric nephropathy) did not bring increased benefit (no superiority), but was associated with more adverse events (hypotension, syncope and renal dysfunction). In this population, the choice of the molecule in monotherapy remains optional and the use of a dual blockade is not justified in order to have a better cardiovascular protection.
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PMID:[ONTARGET: similar protection of telmisartan and ramipril and lack of benefit of combined therapy in patients at high risk for vascular events]. 1857 77

The aim of the study was to estimate the frequency of pneumonia and to determine the risk factors for this complication in poststroke patients with oropharyngeal dysphagia (OD). We prospectively followed up 67 patients (mean age 72.9+/-12.2 years) in the first 6 months after stroke, during which time we recorded gender, stroke side, type of lesion, diabetes, history of chronic obstructive pulmonary disease (COPD), smoking, level of consciousness, functional outcome, dietary history, occurrence of chest infection, and death. Degree of OD and presence/absence of reflex cough was assessed by Fiberoptic Endoscopic Evaluation of Swallowing. Sixty patients showed complete recovery of prestroke swallowing; 9 (13.4% IC 95%=5-20%) developed pneumonia, two of whom died. The first episode of pneumonia occurred in all nine patients within the first month after stroke onset. The pneumonia was associated with absence of reflex cough after swallow, COPD, and severe impairment of consciousness and poor functional outcome.
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PMID:Pneumonia in stroke patients with oropharyngeal dysphagia: a six-month follow-up study. 1861 60

Paradoxical embolism (EP) occurs when a venous thrombus passes into the arterial circulation, most commonly through an intracardiac shunt. A patent foramen ovale (FOP) is present in 25-35%of people at all ages. It is now possible to detect FOP by contrast echocardiography and it has been shown that there exists quite frequently a spontaneous transient right-to-left shunt during systole and, moreover, a right-to-left shunt during Valsalva maneuver and coughing. Acute or chronic pulmonary hypertension are also causes of shunt. This phenomenon has been associated with catastrophic outcomes such as stroke, visceral infarction and ischemic limb. We report the case of a 31-year old man with multiple paradoxical thromboemboli into his right kidney, spleen, small bowel and left brachial artery. Paradoxical embolism was suspected and confirmed by transoesophageal contrast echocardiography, disclosing FOP with right-to-left shunt. Successful percutaneous closure of patent foramen ovale with Amplatzer(R) PFO occluder 18 mm allowed subsequent oral antiaggregation with acetilsalicilic acid 150 mg/day and clopidogrel 75 mg/day. A new case gives the opportunity to review mechanisms, diagnosis and therapeutic issues. Treatment strategies for FOP in recurrent PE include antiplatelet agents, anticoagulants, surgical closure, or percutaneous closure devices. The completion of ongoing, randomized clinical trials comparing percutaneous closure devices with medical management is urgently needed to clarify if the risks of invasive endovascular device placement are outweighed by a long-term reduction in recurrent vascular events.
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PMID:[Recurrent systemic paradoxical embolism: a clinical report]. 1892 82

An 80-year-old woman presenting with fever and cough was given a diagnosis of community-acquired pneumonia. She was hospitalized and treated with ampicillin/sulbactam (ABPC/SBT) and clarithromycin (CAM). Gram stain images and sputum culture results led us to believe that the causative agent was Haemophilus influenzae. Drug sensitivity testing indicated that the H. influenzae was a beta-lactamase-positive, ABPC-resistant (BLPAR) strain. Treatment with ABPC/SBT was not clinically effective. We considered the possibility of beta-lactamase-positive amoxicillin/clavulanate-resistant (BLPACR) strains. Further testing revealed that the MIC of ABPC was 128 microg/ml, that of SBT/ABPC was 8 microg/ml, and that of AMPC/CVA was 4 microg/ml. Furthermore, genetic analysis indicated the H. influenzae to be a BLPACR-I strain. The poor clinical course eventually led to a diagnosis of BLPACR. When beta-lactamase-producing H. influenzae is cultured, the possibility of a BLPACR strain resistant to ABPC/SBT and AMPC/CVA must be considered.
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PMID:[Case of pneumonia caused by beta-lactamase-producing and amoxicillin/clavulanate resistant strains of H. influenzae]. 1893 21

The Authors describe a non-demented patient who, after a left subthalamic haemorrhage causing hemiballism, was completely unaware of both neurological (i.e., dyskinesias) and non-neurological (i.e., cough) symptoms occurring after the stroke. In contrast, he was perfectly able to acknowledge pathological conditions affecting him before the brain damage. Neuropsychological assessment showed no cognitive defects, but revealed the presence of frontal behaviours (e.g., perseverations and utilization behaviours). This unusual clinical picture was ascribed to damage of frontal-subcortical circuits involved in conscious representation of current bodily states.
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PMID:Unawareness of "illnesses": a case of right-sided hemiballism. 1894 38

Evidence-based guidelines suggest that stroke patients should be screened for dysphagia before oral intake. The purpose of this study was to validate a dysphagia screening tool comparing registered nurses (RNs) with speech therapists (STs). All stroke unit patients who received predetermined scores on specific items of the National Institutes of Health Stroke Scale were eligible for screening. The trial consisted of three parts (with swallow, cough, and vocal quality observed during each part): 1 teaspoon lemon ice, 1 teaspoon applesauce, and 1 teaspoon water RNs performed five screenings that were compared with independent screenings performed on the same patient within 1 hour by a speech therapist (ST). Eighty-three paired screenings were completed, with 94% agreement between the RNs and the STs. This screening identifies patients who are able to swallow and can eat from a safe menu until formally evaluated by an ST while maintaining nothing by mouth (NPO) status for those at risk for aspiration.
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PMID:Accuracy of a bedside dysphagia screening: a comparison of registered nurses and speech therapists. 1902 39

Cardiovascular risk is subject to circadian variation, with peak morning incidence of myocardial infarction and stroke correlating with the early morning blood pressure (BP) surge (EMBPS). Ideally, antihypertensive therapy should maintain control of BP throughout the 24-h dosing cycle. In two sister studies, Prospective, Randomized Investigation of the Safety and efficacy of Micardis vs Ramipril Using ABPM (ambulatory BP monitoring) (PRISMA) I and II, BP control was compared in patients with essential hypertension (24-h mean baseline ambulatory BP approximately 148/93 mm Hg) randomized to the angiotensin receptor blocker, telmisartan (80 mg; n=802), or the angiotensin-converting enzyme inhibitor, ramipril (5 or 10 mg; n=811), both dosed in the morning. The primary end point was the change from baseline in mean ambulatory systolic BP (SBP) and diastolic BP (DBP) during the final 6 h of the 24-h dosing cycle. The adjusted mean treatment differences in the last 6-h mean ambulatory SBP/DBP were -5.8/-4.2 mm Hg after 8 weeks and -4.1/-3.0 mm Hg after 14 weeks, in favour of telmisartan (P<0.0001 for all four comparisons). Secondary end point results, including the mean 24-h ambulatory BP monitoring, day- and night-time BP and 24-h BP load, also significantly favoured telmisartan (P<0.0001). Both treatments were well tolerated; adverse events, including cough, were less common with telmisartan. These findings suggest that telmisartan is more effective than ramipril throughout the 24-h period and during the EMBPS; this may be attributable to telmisartan's long duration of effect, which is sustained throughout the 24-h dosing period.
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PMID:Antihypertensive efficacy of telmisartan vs ramipril over the 24-h dosing period, including the critical early morning hours: a pooled analysis of the PRISMA I and II randomized trials. 1922 30

Although dysphagia in stroke may result in lethal chest infection, it can be prevented by coughing. We report on a patient with dysphagia and aspiration who regained oral ingestion by swallowing with voluntary cough. A 54-year-old man with subarachnoidal hemorrhage underwent endovascular coiling and developed brain stem infarction. Scintigraphy showed pulmonary aspiration just after swallowing, but no radioactivity was detected in the lungs 10 min after swallowing with voluntary cough. Swallowing exercise with voluntary cough resulted in a safe swallow without enteral feeding. Even if laryngeal penetration and pulmonary aspiration are observed, chest infection could be prevented by swallowing exercise combined with voluntary cough.
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PMID:Successful treatment of pulmonary aspiration due to brain stem infarction by using cough exercise based on swallowing scintigraphy: preliminary observations. 1938 37

Angiotensin-converting enzyme (ACE) inhibitors are useful drugs for preventing cardiovascular disease and death in patients at risk. However, a significant proportion of patients experience side effects, mainly cough or less frequently angioedema, when treated with ACE inhibitors. Angiotensin receptor blockers (ARBs) are also useful drugs for treatment of hypertension, diabetic nephropathy and patients with left ventricular dysfunction or cardiac failure who are intolerant to ACE inhibitors. The Telmisartan Randomised AssessmeNt Study in ACE iNtolerant subjects with cardiovascular Disease (TRANSCEND) study examined the effect of a long-acting ARB, telmisartan, on cardiovascular events in a group of patients at high-risk for cardiovascular disease who were intolerant to ACE inhibitors. Five thousand nine hundred twenty-six patients with known intolerance to ACE inhibitors were randomized to telmisartan or placebo added to current treatments. The primary composite endpoint, a sum of cardiovascular death, nonfatal myocardial infarction, nonfatal stroke and hospitalization due to heart failure was nonsignificantly reduced in telmisartan-treated patients with respect to placebo (15.7 vs. 17%; relative risk reduction 8%). The key secondary endpoint (the primary endpoint excluding heart failure hospitalization) was reduced in telmisartan-treated patients by 13% (13 vs. 14.8%; P = 0.046). In conclusion, telmisartan reduces cardiovascular events in high-risk patients with the exception of heart failure hospitalization and can be considered as the first-line therapy in those intolerant to ACE inhibitors.
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PMID:Main results and clinical interpretations from the TRANSCEND study. 1949 18


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