UMLS:C0038454 - FACTA Search

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

This article presents the results of a prospective multivariable study of elderly patients aged over 70 years, hospitalized in an Internal Medicine Department of a Central Lisbon Hospital. The study aimed to identify, at the beginning of hospital admission (HA), predictive factors of hospital mortality (HM) and mortality at 6 months, of duration of HA, of admission to a nursing home at the time of discharge and during a period of 6 months thereafter and of hospital readmission during the 6 months following discharge. The study included 158 patients with a mean hospital stay of 15 days and a hospital mortality of 12%. The main pathologies responsible for hospital admission were cerebrovascular accident (22%), heart failure (20%) and pneumonia (16%). Mortality at 6 months was 29% and hospital readmission in the 6 months thereafter was 24%. When the patient was cared for by the spouse there was a statistically significant correlation with a shorter duration of admission (p = 0.006). Mean hospital stay was not significantly associated with any other variable. A subjective medical evaluation (SME) at the start of HA (p = 0.001), a low Barthel score prior to and at the time of HA, low serum albumin (p = 0.001) and a high leucocyte count (p = 0.005) were correlated with a higher HM. Nursing home admission was only positively correlated with cerebrovascular pathology. Mortality at 6 months was significantly correlated with the SME (p = 0.001), a low Barthel score prior to admission (p < 0.008) and at the time of HA (p < 0.001), nursing home residency (p < 0.005) and a low mental test score (p < 0.01). Hospital readmission at 6 months was influenced by the SME (p < 0.04) and by the reduction in the Barthel score caused by the illness and HA (p = 0.004). These correlations enabled the development of mathematical models that predict HM and mortality at 6 months and admission to a nursing home at the time of discharge and during a period of 6 months thereafter. They could be important in identifying elderly patients' needs early in the hospital admission and in the improvement of the strategy necessary for a successful and dignified hospital discharge.
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PMID:[Predictive factors of hospital and 6-month morbidity and mortality in hospitalized elderly patients]. 1237 94

Pyrroloquinoline quinone (PQQ) is a redox active essential nutrient that can generate or scavenge superoxide depending on its microenvironment. PQQ has been shown previously to be neuroprotective in a rodent stroke model. Here we test whether PQQ interacts with reactive nitrogen species, known to be involved in the pathogenesis of stroke. Using rat forebrain neurons in culture, we determined that the toxicity of SIN-1 was mediated by peroxynitrite and that PQQ could block this toxic action. However, PQQ could not block the toxicity of peroxynitrite itself. Both SIN-1 and peroxynitrite caused ATP depletion, but only SIN-1 evoked ATP depletion was blocked by PQQ. In a cell-free system, PQQ blocked nitration of bovine serum albumin produced by SIN-1, but potentiated peroxynitrite-induced nitration. PQQ was unable to block ATP depletion and cell death induced by NO. donors (DEA/NO, DPT/NO and DETA/NO), indicating that it does not directly interact with nitric oxide, and suggesting that it acts as a superoxide scavenger. PQQ significantly potentiated cGMP accumulation evoked by SIN-1, similar to the effect of superoxide dismutase (SOD). However, unlike SOD, which potentiated neurotoxicity induced by SIN-1, PQQ blocked its toxicity, arguing against the possibility that PQQ functions simply as a SOD mimetic. Indeed, substantially less H2O2 was produced by the incubation of SIN-1 with PQQ, when compared to SOD. These results suggest that PQQ scavenges superoxide without forming toxic levels of H2O2. Therefore, the protective effect of PQQ on stroke might be due, at least in part, to the suppression of peroxynitrite formation.
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PMID:The essential nutrient pyrroloquinoline quinone may act as a neuroprotectant by suppressing peroxynitrite formation. 1238 30

The optimal time to start renal replacement therapy remains controversial. Residual renal function (RRF) and nutrition status being important prognostic factors, the present study evaluates the impact of timely start of peritoneal dialysis (PD) on their evolution. Our study used a prospective database on pre-end-stage renal disease patients at a tertiary care center. We included 18 patients who were planned to start PD at a GFR > 8 mL/min between 1 January and 31 December 1999. At the start of PD (month 0), creatinine clearance (CCr) was 11.3 +/- 3.9 mL/min, actual glomerular filtration rate (GFR) was 8.6 +/- 3.3 mL/min, and Kt/V was 1.56 +/- 0.65. The monthly declines of GFR and CCr before and after the start of PD were -0.47 +/- 0.64 mL/min (GFR) and -0.59 +/- 0.46 mL/min (CCr), and -0.06 +/- 0.30 mL/min (GFR) and -0.05 +/- 0.39 mL/min (CCr) respectively (p = 0.034 and 0.001, respectively). Before the start of PD, CCr was 21.9 +/- 4.6 mL/min (month -12) and 18.1 +/- 4.8 mL/min (month -6, p < 0.001). After the start of PD, CCr was 12.0 +/- 4.3 mL/min (month 3), 11.5 +/- 4.9 mL/min (month 6), and 13.1 +/- 5.4 mL/min (month 12, p = 0.9). Serum albumin dropped until just before the start of PD: 3.89 +/- 0.59 g/dL (month -6) and 3.78 +/- 0.51 g/dL (month -3) versus 2.56 +/- 1.60 g/dL (month 0, p = 0.04). Serum albumin then increased to 3.42 +/- 0.95 mg/dL (month 3 after the start of PD) and 3.35 +/- 0.86 mg/dL (month 6 after the start of PD, p = 0.04). In the months preceding the start of PD, the normalized protein catabolic rate (nPCR) dropped from 1.41 +/- 0.36 g/kg daily (month -6) and 1.34 +/- 0.46 g/kg daily (month -3) to 1.12 +/- 0.25 g/kg daily (month 0). It then stabilized at 1.17 +/- 0.25 g/kg daily (month 3) and 1.18 +/- 0.17 g/kg daily (months 6). One patient died owing to a cerebrovascular accident after 18 months of PD, and one was transferred to hemodialysis because of ultrafiltration failure after 19 months of PD. During 264 patient-months, 14 peritonitis episodes occurred. Of the 14 episodes, 12 resolved without complication, and the catheter was replaced in 2 episodes. After timely start of PD, the rate of RRF decline decreases. Already, at a GFR > 8 mL/min, uremia has a negative impact on nutrition parameters. Timely initiation of PD could reverse the negative evolution of albumin and stop the decline of nPCR. No severe complications related to PD were seen. In view of the important impact of RRF and nutrition on patient outcome, our data may favor an early start of PD.
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PMID:The impact of healthy start peritoneal dialysis on the evolution of residual renal function and nutrition parameters. 1240 85

To determine the incidence rate of cardiovascular disease (CVD) and its association with conventional and less well-established risk factors in African Americans with diabetes, we studied 741 African Americans aged 45 to 64 years with diabetes, in the Atherosclerosis Risk in Communities (ARIC) study. Risk factors were measured from 1987 to 1989, and incident CVD (n = 143 coronary heart disease (CHD) or stroke events) was ascertained through 1998. The crude incidence rate (per 1000 person-years) of CVD was 22.5 (11.9 for CHD and 12.0 for stroke). After multivariate adjustments, total cholesterol, prevalent hypertension and current smoking were significantly and positively associated with incident CVD among these African Americans with diabetes. Among the non-conventional risk factors, serum creatinine, factor VIII, von Willebrand factor, and white blood cell count were positively and serum albumin negatively and independently associated with CVD incidence. Adjusted relative risks for highest versus lowest tertiles of these risk factors ranged from 1.77 to 2.13. This study confirms that the major risk factors (hypercholesterolemia, hypertension and smoking) are important determinants of CVD in African Americans with diabetes. In addition, several blood markers of hemostasis or inflammatory response and elevated serum creatinine also proved to be CVD risk factors in African Americans with diabetes.
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PMID:Incidence and risk factors for cardiovascular disease in African Americans with diabetes: the Atherosclerosis Risk in Communities (ARIC) study. 1251 Jul 2

Although patients with ESRD experience markedly higher rates of stroke, no studies in the US have identified risk factors associated with stroke in this population. It was hypothesized that black race, malnutrition, and elevated BP would be associated with the risk of stroke among patients with ESRD. Data from the United States Renal Data Systems were used. Adult Medicare-insured hemodialysis and peritoneal dialysis patients without a history of stroke or transient ischemic attack (TIA) were considered for analysis. The primary outcome was hospitalized or fatal stroke. Cox proportional hazards models were used to determine the associations between the primary predictor variables and stroke. The rate of incident stroke was 33/1,000 person-years in the study sample. After adjustment for age and other patient characteristics, three markers of malnutrition were associated with the risk of stroke-serum albumin (per 1 g/dl decrease, hazard ratio [HR] = 1.43), height-adjusted body weight (per 25% decrease, HR = 1.09), and a subjective assessment of undernourishment (HR = 1.27)-as was higher mean BP (per 10 mmHg, HR = 1.11). The association between black race varied by cardiac disease status, with blacks estimated to be at lower risk than whites among individuals with cardiac disease (HR = 0.74), but at higher risk among individuals without cardiac disease (HR = 1.24). This study confirms the extraordinarily high rates of stroke in ESRD patients on dialysis and identifies high mean BP and malnutrition as potentially modifiable risk factors. The association between black race and stroke differs by cardiac disease status; the reasons for this differing effect of race deserve further investigation.
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PMID:Risk factors for incident stroke among patients with end-stage renal disease. 1451 41

Cigarette smoking may adversely influence patient and graft survival. In Europe and the United States the prevalence of cigarette smoking in dialysis patients is 35% to 40% and 25%, respectively. In Turkey, the estimated prevalence of cigarette smoking rate in the normal population is 26%. This study evaluated the rate of smoking in 63 cadaveric, and 158 living-related renal transplant recipients including (150 men, and 76 women of 38 +/- 12 years; range, 8 to 70) who were operated between 1986 and 2001. Demographic data were collected with a questionnaire delivered to patients during their routine outpatient visits. During this time period, 8 patients had died, 4 from hemophagocytic syndrome, 2 from cardiovascular disease, 1 from Kaposi sarcoma and 1 from a cerebrovascular accident. Twenty-three patients have lost their grafts. While at the time of transplantation 97 (42%) were smoking cigarettes, only 29 (12%) continued smoke after transplantation. Male gender significantly correlated with cigarette smoking (P =.000). Twelve smokers were single but 85 out of 97 were married, a statistically significant difference (P =.010). In contrast there was no significant relationship between pretransplant smoking and educational status (P =.354); graft loss and smoking (P =.129); or mortality and smoking (P =.224). There was a significant relationship between pretransplant and posttransplant smoking (P =.000). There was no relationship between pre- and post-transplant smoking and development of diabetes mellitus or hypertension. Interestingly the posttransplant serum albumin level was lower among smokers than nonsmokers (4.44 +/- 0.02 g/dL vs 4.30 +/- 0.02 g/dL; P =.019). There was a close relationship between transplantation duration and smoking.
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PMID:Cigarette smoking in renal transplant recipients. 1501 15

Most drugs with central nervous system (CNS) activity enter the brain either by diffusing across the membranes which comprise the blood-brain barrier (BBB) or by being transported by carrier systems across those membranes. Substances which cannot cross the BBB by one of these mechanisms, like serum albumin, are virtually excluded from the CNS. However, this exclusion is not absolute. Cerebrospinal fluid (CSF) levels of albumin, for example, are about 0.5% those of serum levels. Albumin enters the CNS through a variety of pathways collectively termed the extracellular pathways. Any circulating substance can, in theory, use these pathways to enter the CNS. But, traditional drug development has ignored this pathway. To approach even the CSF/serum ratio of 0.5%, a candidate therapeutic would need to meet several criterion: long half-life in blood, small volume of distribution, high potency in the CNS, and absence of brain-to-blood efflux. Two emerging therapeutics which are likely exerting their CNS effects by way of the extracellular pathways are antibodies directed against amyloid beta protein (ABP) and erythropoietin (Epo) used in the treatment of stroke. These examples suggest that the extracellular pathways are an option for the delivery of certain therapeutics to the brain.
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PMID:Are the extracellular [correction of extracelluar] pathways a conduit for the delivery of therapeutics to the brain? 1513 87

The present paper explores predictors of all-cause mortality based on a longitudinal multidisciplinary study of 422 community residents (197 men, 225 women) aged 69-71 years at baseline examination. The 422 subjects were followed up for 10 years (1976-1986), during which time 102 (59 men, 43 women) died. The Cox proportional hazards model was used to examine the effects of baseline variables on a time-dependent 10-year mortality. Body mass showed a U-shaped relationship to mortality in both sexes. Ex-drinking, current-smoking, history of stroke, history of diabetes mellitus, low ADL and ST and/or T changes in ECG had significant and direct effects on mortality in both sexes or either sex. Whereas, level of education, current-drinking, grip strength, visual retention, and serum albumin revealed significantly inverse relationships to mortality.
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PMID:Predictors of all-cause mortality between ages 70 and 80: the Koganei study. 1537 92

Peroxynitrite (ONOO-) is a reactive oxidant formed from superoxide (*O2(-)) and nitric oxide (*NO), that can oxidize several cellular components, including essential protein, non-protein thiols, DNA, low-density lipoproteins (LDL), and membrane phospholipids. ONOO- has contributed to the pathogenesis of diseases such as stroke, heart disease, Alzheimer's disease, and atherosclerosis. Because of the lack of endogenous enzymes to thwart ONOO- activation, developing a specific ONOO- scavenger is remarkably important. In this study, the ability of hesperetin (3',5,7-trihydroxy-4-methoxyflavanone) to scavenge ONOO- and to protect cells against ONOO- and ROS was investigated. The data gained show that hesperetin can efficiently scavenge authentic ONOO- . In spectrophotometric analysis, the data revealed that hesperetin led to declined ONOO- -mediated nitration of tyrosine through electron donation. Hesperetin exhibited significant inhibition on the nitration of bovine serum albumin (BSA) by ONOO- in a dose-dependent manner. Hesperetin also manifested cytoprotection from cell damage induced by ONOO- and ROS. The present study suggests that hesperetin is a powerful ONOO- scavenger and promotes cellular defense activity in the protection against ONOO- involved diseases.
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PMID:Hesperetin: a potent antioxidant against peroxynitrite. 1545 41

Individuals with type 2 diabetes and nephropathy represent a particularly high-risk group for both adverse cardiac as well as renal events. Using the Irbesartan in Diabetic Nephropathy Trial (IDNT) cohort, our objective was to determine baseline characteristics of individuals with type 2 diabetic nephropathy and hypertension predictive for cardiac events. IDNT identified 1715 individuals with type 2 diabetic nephropathy and hypertension having serum creatinine of 1.0 to 3.0 mg/dL and urinary albumin excretion rates > or = 900 mg/day. A cardiovascular (CV) composite was used consisting of CV death, nonfatal MI, hospitalization for heart failure, stroke, amputation, and coronary and peripheral revascularization. Using multivariable Cox regression analysis, 41 baseline characteristics determined a priori were analyzed for their potential relationship to risk of experiencing a CV event. Of the 1715 individuals, 518 (30.2%) had at least one of the CV composite end points. Older age, male gender, longer duration of diabetes, history of cardiovascular disease, history of CHF, high urinary albumin:creatinine ratio, and low serum albumin were strong predictors for CV events; of these, prior history of CVD (RR 2.00, 95% CI 1.63-2.45; P < 0.0001) and high urinary albumin:creatinine ratio (RR 1.29 per natural log unit, 95% CI 1.13-1.48; P = 0.0002) at baseline were highly predictive for cardiovascular events. In conclusion, among individuals with hypertension and diabetic nephropathy, both the degree of albuminuria and lower serum albumin levels provide additional prognostic information concerning cardiovascular risk, in addition to traditional coronary risk factors.
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PMID:Predictors of cardiovascular events in patients with type 2 diabetic nephropathy and hypertension: a case for albuminuria. 1548 18

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