35 research outputs found
Polymorphisms of MTHFR, eNOS, ACE, AGT, ApoE, PON1, PDE4D, and ischemic stroke: Meta-analysis
No full text<b>Introduction</b>\ud
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The association between ischemic stroke and genetic polymorphisms of methylenetetrahydrofolate reductase (<i>MTHFR</i>; 677C>T and 1298A>C), endothelial nitric oxide synthase (<i>eNOS</i>; -786T>C, +894G>T, and variable number tandem repeat [VNTR]), phosphodiesterase 4D (<i>PDE4D</i>; SNPs 83 and 87), angiotensin-converting enzyme (<i>ACE</i>) I/D, angiotensinogen (<i>AGT</i>) 235M>T, paraoxonase 1 (<i>PON1</i>) 192Q>R, and apolipoprotein E (<i>ApoE</i>) ε2ε3ε4 remains inconclusive. Therefore, this updated meta-analysis aimed to clarify the presumed influence of genetic polymorphisms on ischemic stroke by meta-analyzing the comprehensive coverage of all individual association studies.\ud
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<b>Methods</b>\ud
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All case-control studies published in different languages such as English, Japanese, Korean, Spanish, Chinese, Hungarian, Ukrainian, or Russian were identified from databases. The pooled odds ratios (ORs) and 95% confidence intervals (CIs) were calculated via fixed- and random-effect models. Sensitivity analysis, heterogeneity test, Hardy Weinberg Equilibrium, and Egger's regression analyses were performed in this study.\ud
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<b>Results</b>\ud
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A total of 490 case-control studies with 138,592 cases and 159,314 controls were included in this meta-analysis. Pooled ORs from all the genetic models indicated that <i>MTHFR</i> 677TT and 1298CC, <i>eNOS</i> +894TT and VNTR, <i>PDE4D</i> SNP 83, <i>ACE</i> DD, <i>AGT</i> 235TT, <i>PON1</i> 192RR, and <i>ApoE</i> ε4 polymorphisms were increasing the risks of ischemic stroke. Nevertheless, <i>PDE4D</i> SNP 87 and eNOS -786T>C polymorphisms are not associated with ischemic stroke risks.\ud
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<b>Conclusions</b>\ud
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Hence, the evidence from this meta-analysis concluded that <i>MTHFR</i> (677C>T and 1298A>C), <i>eNOS</i> (+894G>T and VNTR), <i>PDE4D</i> SNP 83, <i>ACE</i> I/D, <i>AGT</i> 235M>T, <i>PON1</i> 192Q>R, and <i>ApoE</i> ε2ε3ε4 polymorphisms predispose individuals to ischemic stroke
The needs and problems in epilepsy caregiving: A gualitive exploration
No full textObjective: Living with epilepsy imposes great challenges on both patients and
their family caregivers but most researchers only explored the impact on
patients, with less attention given to family caregivers. Our study intended to
explore the needs and problems of epilepsy family caregivers of epilepsy patients
encountered during the caregiving process. Methods: Respondents were
recruited from the Neurology Clinic of Hospital Sultanah Nur Zahirah (HSNZ),
Kuala Terengganu. A semi-structured interview was conducted using openended and broad questions asking about their general experience in caregiving,
daily routine activities, caregiving effects, caregiving difficulties and caregivers’
needs. The interviewed data were later transcribed into verbatim before further
analysis using the QSR International’s NVivo10 software. Results: Fifteen Malay
Muslim family caregivers between the age of 19 and 66 years participated. Most
were females (53%), married (67%), with education level at secondary school or
equivalent (73%) and were homemakers (40%). In particular, respondents
expressed the need for extra support from their family members and experts in
terms of physical (care relief), mental, and financial aspects. In addition, the
major caregiving problems identified included: (i) emotional disturbances (sad,
angry, depressed, and anxious); (ii) care giving challenges (family adjustments,
physical burden, psychological burden, and time management); and (iii)
financial issues (not working and limited family income). Some advantages in
caregiving were also reported. Conclusion: In conclusion, their experiences while
taking care of their loved ones in terms of feelings, beliefs and needs exposed the
difficulties in caregiving, causing substantial emotional pressure which could
later lead to poor quality of caregiving. ASEAN Journal of Psychiatry, Vol. 16 (1):
Januray – June 2015: XX XX
Amelioration of Dystonic Opisthotonus in Pantothenate Kinase‐Associated Neurodegeneration Syndrome with Absent “Eye‐of‐the‐Tiger” Sign Following Bilateral Pallidal Deep Brain Stimulation
No full textAssociated Factors of Stroke Severity Among Young Adult Stroke Patients in Malaysia from National Neurology Registry 2014 - 2018
No full textIntroduction Incidence of stroke in Malaysian young adult is rising. The aims of this study were to estimate the proportion of stroke severity and to determine the factors associated with the stroke severity among young adult stroke patients.
Method This was a cross-sectional study of young stroke patients aged between 18-49 years old. Data of patients registered from January 2014 to December 2018 with the first stroke event including socio demographic characteristics, stroke subtype classification, comorbidities characteristics, and other risk factors were retrieved from the National Neurology Registry (NNeur). The stroke severity outcome was measured with NIH stroke scale (NIHSS) and categorized as mild, moderate, or severe. Ordinal logistic regression was used to analyze and quantify the odds ratio and 95% confidence interval.
Results A total of 1,421 patients with a mean age of 41±7.64 years old were analysed. The overall proportion of young adult stroke patients was 6.22% and predominantly by male with a ratio of 1.7 to 1. The proportion of mild, moderate and severe were 50.4% (95% CI:0.48,0.54), 41.2% (95% CI:0.38,0.44) and 8.7% (95% CI:0.07,0.10), respectively. In multivariable analysis, ischaemic stroke (OR=2.15, 95% CI:1.43,3.23), atrial fibrillation (OR=3.94, 95% CI:2.08,7.47) and alcohol drinking (OR=1.93, 95% CI:1.06,3.50) were factors that influenced higher odds of having a more severe stroke.
Conclusion Of total, about 50% of young adult patient was categorized as mild stroke. Stroke classification, atrial fibrillation and alcohol drinking were factors that influenced in having a more severe stroke.Following are the links for the poster on Zenodo Repository:
Poster: https://zenodo.org/record/5348580
The presentation slides are also available on Slideshare:
Presentation Slides: https://www.slideshare.net/ICRInstituteForClini/associated-factors-of-stroke-severity-among-young-adult-stroke-patients-in-malaysia-from-national-neurology-registry-2014-201
Modelling the prognostic effect of glucose and lipid profiles on stroke recurrence in Malaysia: an event-history analysis
No full textBackground Diabetes and dyslipidemia are significantly associated with stroke recurrence, yet the evidence for this relationship is conflicting. Consequently, the parameters in the glucose and lipid profiles may inform us regarding their relationship with stroke recurrence, thus enhancing the physicians’ clinical decision-making. Aim This study sought to investigate whether glucose and lipid profiles could prognosticate stroke recurrence in Malaysia. Methods We conducted a retrospective hospital-based study where we analyzed the first-ever stroke cases regarding about which the Malaysia National Stroke Registry was informed between 2009 and 2017, that fulfilled this study’s criteria, and that were followed for stroke recurrence. Using the Cox proportional hazard regression analysis, we estimated the adjusted hazard ratios (HRs), which reflected the prognostic effect of the primary variables (i.e., glucose and lipid profiles on the first-stroke admission) on stroke recurrence. Results Among the 8,576 first-ever stroke patients, 394 (4.6%) experienced a subsequent first stroke recurrence event. The prognostic effect measured by univariable Cox regression showed that, when unadjusted, ten variables have prognostic value with regards to stroke recurrence. A multivariable regression analysis revealed that glucose was not a significant prognostic factor (adjusted HR 1.28; 95% CI [1.00–1.65]), while triglyceride level was the only parameter in the lipid profile found to have an independent prognostication concerning stroke recurrence (adjusted HR: 1.28 to 1.36). Conclusions Triglyceride could independently prognosticate stroke recurrence, which suggests the role of physicians in intervening hypertriglyceridemia. In line with previous recommendations, we call for further investigations in first-ever stroke patients with impaired glucose and lipid profiles and suggest a need for interventions in these patients
The Malay version of the attitudes and beliefs about cardiovascular disease (ABCD-M) risk questionnaire: a translation, reliability and validation study
No full textBACKGROUND: Cardiovascular disease (CVD) and stroke are global public health problems and cause high mortality, especially in low- and middle-income countries. Knowledge and awareness are critical points in managing the risk in the general population. The Attitudes and Beliefs about Cardiovascular Disease (ABCD) risk questionnaire was developed to evaluate the awareness of stroke and CVD risk. Thus, the government can set up a practical risk assessment and management programme. The initiative will encourage people to seek healthcare timely and reduce the possibilities of developing complications. OBJECTIVE: This study aimed to translate and validate the ABCD risk questionnaire into the Malay language and evaluate the psychometric properties of the Malay version in the general population in Malaysia. METHODS: The questionnaire was translated using a standard forward–backwards translation method. The validation was perfomed by both expert panels and a potential user group. Next, the exploratory factor analysis was conducted to examine factorial validity. The respondents were selected from the government health clinics and according to the study criteria irrespective of the CVD risk. We used Cronbach’s alpha and Raykov’s rho to explore the internal consistency and composite reliability of the 18 items from three domains. Finally, the confirmatory factor analysis (CFA) was conducted using a robust maximum likelihood estimator. RESULTS: The content and face validity indices were determined to be 0.94 and 0.99 respectively. Data were obtained from 179 respondents (mean age, 36.8 years; female, 68.2%; secondary level education, 51.1%). The internal consistency and composite reliability of the domains showed good results ranging from 0.643 to 0.885. The factor loadings of each item were acceptable (> 0.3), and the fit indices from the CFA resulted in a good model fit [χ(2) (p-value = 0.16), SRMR = 0.054, RMSEA = 0.029, CFI = 0.99, TLI = 0.99)]. CONCLUSIONS: The Malay version of the ABCD risk questionnaire is a valid and reliable tool to assess the awareness of stroke and CVD risk in the general population in Malaysia. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s12889-022-13811-8
A post hoc analysis of the long‐term safety and efficacy of perampanel in Asian patients with epilepsy
No full textGender disparities and thrombolysis use among patient with first-ever ischemic stroke in Malaysia
No full textObjective: Gender as an independent predictor in stroke has been well documented. However, data on gender differences among first-ever ischemic stroke in developing country are limited. We aim to describe gender effects on clinical characteristics, thrombolysis treatment received, and outcomes of patients with first-ever ischemic stroke. Methods: Data were extracted from the prospective multiethnic stroke registry, National Neurology Registry (NNEUR). Descriptive analysis and logistic regression were performed. Results: A total of 4762 first-ever ischemic stroke patients admitted to 13 government hospitals from July 2009 to June 2015 were available for this study. Slightly over half were male (55.1%), and they were 1.7 years younger than female (mean age, 63.6 versus 61.9 years, p < 0.001). Gender–age-adjusted incidence was observed to be higher in females (66.7 per 100,000) compared to males (57.4 per 100,000). First-ever ischemic stroke incidence increased by 24.3 and 11.2% among female and male annually. Female experienced significantly poorer functional outcome and greater 30-day in-hospital mortality compared to male. In subgroup analysis, only 31 (0.65%) patients were treated with thrombolysis. Discussion: First-ever ischemic stroke incidence increased by 24.3 and 11.2% among female and male annually. There were distinct symptoms at hospital presentation between genders. All our patients discharged home regardless of genders. In summary, Malaysian female first-ever ischemic stroke was older, present with severe stroke, greater number of risk factors and poorer functional outcome and 30-day in-hospital mortality compared to male
Direct medical cost of first-ever acute ischemic stroke in Malaysia: a retrospective cohort study
No full textUnderstanding the economic impact of first-ever stroke in a multiethnic population like Malaysia is essential for informed resource allocation. This study aimed to evaluate the direct medical costs associated with first-ever ischemic stroke in Malaysia. The study was a retrospective cohort study that estimated the inpatient direct medical costs of first-ever ischemic stroke in Malaysia. The study involved 122 adult patients managed at Hospital Sultanah Nur Zahirah, Terengganu (HSNZ), enrolled in the Malaysian National Stroke Registry (NSR) from 2009 to 2020. The mean ± standard deviation (SD) for the patients’ age was 61.0 ± 10.9 years, the length of stay (LOS) was 4.5 ± 3.5 days, and the modified Rankin scale (mRS) score was 3.0 ± 1.1. Most patients experienced functional disability (poor functional status, mRS ≥ 3) and incurred an average (SD) treatment cost of MYR 1,970.7 ± 1,385.8, primarily attributed to hospital admissions and radiology expenses. The medical costs were significantly lower in patients with good functional status [mRS < 3 (p = 0.002)] and shorter LOS (p < 0.001), but higher in patients with the partial anterior circulation infarct (PACI) stroke subtype (p < 0.001). Additionally, patients with good functional status incurred significantly lower costs for admission and medications (p < 0.001). In conclusion, the inpatient direct medical cost of first-ever ischemic stroke in Malaysia is substantial and is influenced by stroke subtypes, length of stay, risk factors, and functional status. Strategies to reduce the length of stay, comorbidities, and functional status can potentially reduce the economic burden of the first-ever acute ischemic stroke. These findings are crucial for guiding the optimal allocation of resources for stroke care
