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Query: UMLS:C0038454 (stroke)
 147,016 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

A long-term decline in death rates from cerebrovascular diseases in the United States accelerated in 1969, with a further increase in the rate of decline after 1972. This break in the pattern of the mortality curve for stroke was observed in all 4 major sex-color groups, and affected all age groups in which a significant number of stroke deaths occur. The decline for non-whites was relatively and absolutely greater than for the comparable white sex. If the 1960 rates had persisted in 1975, 87,600 more lives would have been lost to cerebrovascular diseases. Although there are no data documenting a declining prevalence of hypertension in the population, detection, treatment and control of hypertension have improved markedly over recent years. A concomitant decrease in the severity of epidemic respiratory infection may have contributed to the improvement in recorded death rates from stroke. Mortality from all major cardiovascular diseases has demonstrated a parallel downward trend. Continued emphasis on public health efforts to detect and treat hypertension and other known cardiovascular risk factors can be expected to result in further improvement in cardiovascular mortality.
Stroke
PMID:Trends in mortality from cerebrovascular diseases in the United States, 1960 to 1975. 74 84

A growing amount of clinical and experimental evidence suggests a link between infection and atherosclerotic diseases including both myocardial and cerebral infarction. A prime example is a greatly increased risk of stroke in septicaemic patients with and without endocarditis. Controlled clinical studies have recently shown, however, that certain other milder bacterial infections are also a risk factor for infarction. A preceding febrile respiratory infection was a major risk factor for stroke in young and middle aged patients. In patients with acute myocardial infarction Chlamydia pneumoniae and dental infections seem to be risk factors according to one controlled clinical study. Several possible mechanisms could explain the observed association of infection and infarction. For instance, infection causes a hypercoagulable state which increases the risk of thrombosis. In addition, infection has profound and harmful effects on prostaglandin and lipid metabolism. Infection may also have some role in the atherosclerotic process itself by inducing damage and inflammation in vascular endothelium in the presence of hypercholesterolemia. So far, however, little clinical evidence is available to suggest that by controlling infection the risk of infarction or development of atherosclerotic lesions might be reduced except in patients with endocarditis, where the risk of thromboembolic complications rapidly diminished when the infection is controlled with antimicrobial therapy.
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PMID:Infection as a risk factor for infarction and atherosclerosis. 175 23

This study carried out at a type "C" hospital, analyses the actual pathology of 1,052 patients attended to at the internal medicine department during a period of one year. The sex distribution did not show any differences. The median age (64 years) was significantly superior in women. The more frequent diseases were from group VII (cardiovascular: 512 cases) and group VIII (respiratory: 471 cases) according to the 9th edition of the who international diseases classification. The most frequent causes for admission were: respiratory infection (19.5%), cardiac insufficiency (13.8%) and CVA (10.6%). The most frequent baseline diseases were cardiomyopathy (20.4%), chronic obstructive airways syndrome (16%), malignant neoplasia (8.5%) and hepatopathy (7.6%). The risk factors and toxic habits observed were: Chronic bronchitis (19.6%), blood hypertension (15.5%), diabetes (13.5%) and high alcohol intake (10%).
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PMID:[A morbidity study in a general internal medicine service in a third-level hospital]. 195 89

The role of preceding infection as a risk factor for ischaemic stroke was investigated in a case-control study of 54 consecutive patients under 50 years of age with brain infarction and 54 randomly selected controls from the community matched for sex and age. Information about previous illnesses, smoking, consumption of alcohol, and use of drugs was taken. A blood sample was analysed for standard biochemical variables and serum cholesterol, high density lipoprotein cholesterol, triglyceride, and fasting blood glucose concentrations determined. Titres of antimicrobial antibodies against various bacteria, including Staphylococcus, Streptococcus, Yersinia, and Salmonella and several viruses were determined. Febrile infection was found in patients during the month before the brain infarction significantly more often than in controls one month before their examination (19 patients v three controls; estimated relative risk 9.0 (95% confidence interval 2.2 to 80.0)). The most common preceding febrile infection was respiratory infection (80%). Infections preceding brain infarction were mostly of bacterial origin based on cultural, serological, and clinical data. In conditional logistic regression analysis for matched pairs the effect of preceding febrile infection remained significant (estimated relative risk 14.5 (95% confidence interval 1.9 to 112.3)) when tested with triglyceride concentration, hypertension, smoking, and preceding intoxication with alcohol. Although causality cannot be inferred from these data and plausible underlying mechanisms remain undetermined, preceding febrile infection may play an important part in the development of brain infarction in young and middle aged patients.
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PMID:Preceding infection as an important risk factor for ischaemic brain infarction in young and middle aged patients. 313 45

Age-related changes, for example reduced elasticity and earlier airways collapse, predispose the elderly to respiratory infection. Other factors such as a lifetime of smoking, the use of hypnotics, or the development of stroke also predispose. Pneumonia becomes increasingly common with advancing age, and both morbidity and mortality increase with associated disease burden. Diagnosis of pneumonia may be more difficult in the aged because of physiological changes. However, careful physical examination with accurate, regular recording of body temperature will usually reveal the characteristic features of pneumonia, which should be confirmed by chest radiograph. In the frail elderly, the onset of impaired function, such as confusion, immobility, falling or incontinence, should raise suspicion of infection. Pneumonia is classified as community-acquired, nursing home-acquired or nosocomial, which helps in the empirical choice of antibiotics. Streptococcus pneumoniae is the most common organism in the community, then Haemophilus influenzae and Branhamella catarrhalis. Gram-negative organisms like Klebsiella and Escherichia coli are more common in nosocomial infections. Nursing home patients with pneumonia tend to be more frail than those in the community. Treatment is directed at eradication of the organism with the appropriate antibiotic, maintaining hydration and oxygenation, as well as managing impaired mobility, faecal loading, urinary incontinence and confusion. Influenza vaccination is strongly recommended for the frail elderly. Tuberculosis remains an important diagnosis in the frail elderly and should always be considered, especially in patients with respiratory infection who fail to respond to conventional therapy.
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PMID:Treatment recommendations for respiratory tract infections associated with aging. 845 84

Cerebrovascular ischemia can be caused by infectious diseases which involve cerebral arteries or the heart, including infectious endocarditis, bacterial and fungal meningitis, neurosyphilis, neuroborreliosis, herpes zoster, the acquired immunodeficiency syndrome, cat scratch disease and other rare infectious diseases. Presently, there is increasing evidence that infection in general and mainly respiratory infection is a risk factor for ischemic stroke. Case reports and smaller case series reported an association of cerebrovascular ischemia and recent infection in children and younger adults. Two case control studies from Helsinki (54 patients under the age of 50) and from Heidelberg (197 patients aged 80 or less) identified recent infection as an important risk factor for ischemic stroke. Febrile, bacterial and respiratory infections were most important in this respect. In the study from Heidelberg, the neurological deficit was more severe and cardioembolism was more frequent in infection-associated stroke than in stroke without preceding infection. This review summarizes the association of infectious diseases and cerebrovascular ischemia and discusses potential pathogenetic mechanisms linking both diseases.
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PMID:[Infectious diseases as a cause and risk factor for cerebrovascular ischemia]. 880 9

The established risk factors for ischemic stroke do not sufficiently explain all clinical and epidemiological features of the disease, such as the winter peak of stroke incidence, the decline of stroke during this century and the time point of cerebral ischemia. A role of infectious disease as stroke risk factor may partly explain above features. Several case-control studies with both hospital and population control groups showed that acute infection within the preceding week and mainly respiratory infection of both viral and bacterial origin increase the risk of cerebral ischemia independent from other risk factors (odds ratio 2.9-14.5). Infection as a risk factor appears to be most important in young age groups. Infection may cause a procoagulant state and thus, trigger thrombosis and cerebral ischemia. There is increasing evidence for chronic infection as stroke risk factor. A case-control study indicated chronic and recurrent bronchitis to increase stroke risk. Two case-control and one cohort study showed that chronic dental infection, mainly parodontitis, is a risk factor for stroke. There are conflicting results on chronic infection with cytomegalovirus and insufficient evidence for a role of Helicobacter pylorii infection in pathogenesis of stroke. Seroepidemiological studies and analyses of carotid plaques indicate a role of Chlamydia pneumoniae in ischemic stroke. However, causality can not yet be inferred from present results. Acute and chronic infectious diseases are treatable and partly preventable conditions. Their recognition as stroke risk factors could therefore be important for stroke prevention.
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PMID:[Infection, atherosclerosis and acute ischemic cerebrovascular disease]. 1069 60

From May 91 to March 99 a consecutive series of 100 acute obstructions or perforations of the left colon or rectum were treated by primary resection with mechanical anastomosis using a double or triple stapling technique without proximal colostomy. There were 8 postoperative deaths (8%) due to sepsis, acute respiratory distress syndrome, pulmonary embolism, stroke, and cachexy. Complications occurred in 29% of surviving patients. Clinical anastomotic leaks were observed in 7%, respiratory infection in 8%, wound infection in 8% and major cardiovascular problems in 4% of patients. The median hospital stay was 19 days. The morbidity and mortality of this series did not exceed the cumulative morbidity and mortality that can be expected after staged surgery. Compared with staged surgery, immediate resection and anastomosis using an entirely mechanical suture, thereby avoiding the problems of colostomy and reducing the length of hospital stay, has significant advantages for patients.
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PMID:Primary mechanical stapled anastomosis in surgery for colorectal emergencies. 1192 36

Stroke in children is a relatively uncommon condition and frequently associated with other diseases like cardiopathies, sickle cell disease and chronic smoking. In contrast to stroke in adults, it is rarely caused by atherosclerosis, hypertension or diabetes mellitus. Childhood stroke of unknown causes is called idiopathic stroke. The etiology of idiopathic stroke is unknown. However, several so-called idiopathic diseases develop on the basis of a genetic predisposition. As an approach to investigate this possibility in idiopathic childhood ischemic stroke, we studied the relationship between clinical and immunogenetic features in this disease. We demonstrate that the gene frequencies and relative risk of HLA-B51 were markedly increased in our patients compared with controls (p < 0.001). Thirteen of seventeen HLA-B51-positive patients had had a preceding respiratory infection, which was a higher proportion than in the control group (p < 0.05). In the patient group, the alleles HLA-DRB1*0802, -DRAI*0401 and -DQBI*0402 were also significantly increased, defining the haplotype DRB1*0802-DRA1*0401-DQB1*0402 as a high-risk haplotype for idiopathic childhood ischemic stroke. Transient viral or bacterial infections, which involve vasculitis and vascular occlusion in the brain, can trigger idiopathic childhood ischemic stroke on the basis of an genetic predisposition.
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PMID:Evidence for human leukocyte antigen-related susceptibility in idiopathic childhood ischemic stroke. 1237 32

Providing quality oral health care for the growing elderly population is a major challenge, particularly for those residing in long-term care institutions. The Surgeon General's report on oral health in America (2000) noted that elders are at particularly high risk for oral health problems, and poor oral health in seniors has been linked to general systemic health risks such as cardiovascular disease, stroke, poor nutrition, and respiratory infection. This article outlines the need for greater attention to oral health care for the elderly in both nursing education and practice, and describes opportunities for effective inter-professional collaboration between nursing and oral health professionals. It also provides specific recommendations for fostering such collaboration. Working together, nurses and dental professionals can raise awareness of this issue, promote higher standards for oral care, and improve oral health and quality of life for elderly Americans.
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PMID:Opportunities for nursing-dental collaboration: addressing oral health needs among the elderly. 1576 98


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