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1.
Work ; 68(1): 77-80, 2021.
Article in English | MEDLINE | ID: covidwho-2198518

ABSTRACT

BACKGROUND: Due to the coronavirus disease 2019 (COVID-19) pandemic, rehabilitation facilities have become less accessible for patients with a stroke. Lack of early, intensive rehabilitation misses the opportunity for recovery during the critical time window of endogenous plasticity and improvement post-stroke. OBJECTIVES: The purpose of this commentary was to highlighting the benefits of telework and telerehabilitation programs for workers with a stroke during the COVID-19 pandemic. METHODS: Relevant publications regarding the management of individuals with a stroke, telerehabilitation and teleworking in the setting of COVID-19 were reviewed. RESULTS: Previous studies showed that telerehabilitation can effectively provide an alternate method of promoting recovery for patients with a stroke. With the physical distancing precautions in place for mitigating viral spread, teleworking can also provide a method for long term recovery and improvements in quality of life after a stroke. CONCLUSIONS: Overall, this commentary addresses the benefits of physically distant, safe and effective alternatives to support individuals who live with a stroke during COVID-19 pandemic.


Subject(s)
Disabled Persons/rehabilitation , Stroke/complications , Telerehabilitation/methods , Teleworking , Work/statistics & numerical data , Adult , COVID-19/prevention & control , Disabled Persons/statistics & numerical data , Female , Humans , Male , Middle Aged , Pandemics/prevention & control , Pandemics/statistics & numerical data , Telerehabilitation/trends , Work/trends
2.
Acta Clin Croat ; 60(Suppl 3): 50-56, 2021 Dec.
Article in English | MEDLINE | ID: covidwho-2145889

ABSTRACT

The most common neurological symptoms in patients with SARS-CoV-2 infection are headache, myalgia, encephalopathy, dizziness, dysgeusia and anosmia, making more than 90 percent of neurological manifestations of COVID-19. Other neurological manifestations such as stroke, movement disorder symptoms or epileptic seizures are rare but rather devastating, with possible lethal outcome. The primary aim of this study was to estimate the prevalence of acute symptomatic seizures among COVID-19 patients, while secondary aim was to determine their possible etiology. Out of 5382 patients with COVID-19 admitted to Dubrava University Hospital from November 1, 2020 until June 1, 2021, 38 (seizure rate 0.7%) of them had acute symptomatic seizures. Of these 38 patients, 29 (76.3%) had new-onset epileptic seizures and nine (23.7%) patients with previous epilepsy history had breakthrough seizures during COVID-19. Although acute symptomatic seizures are an infrequent complication of COVID-19, seizure risk must be considered in these patients, particularly in the group of patients with a severe course of the disease. Accumulation of proinflammatory cytokines may contribute to the occurrence of seizures in patients with COVID-19, but seizures may also be secondary to primary brain pathology related to COVID-19, such as stroke or encephalitis.


Subject(s)
COVID-19 , Epilepsy , Stroke , Humans , Incidence , COVID-19/complications , COVID-19/epidemiology , SARS-CoV-2 , Seizures/epidemiology , Seizures/etiology , Seizures/diagnosis , Epilepsy/epidemiology , Epilepsy/etiology , Stroke/complications , Stroke/epidemiology
3.
Oxid Med Cell Longev ; 2022: 7692215, 2022.
Article in English | MEDLINE | ID: covidwho-2138248

ABSTRACT

Stroke is the most common cause of epilepsy and ultimately leads to a decrease in the quality of life of those affected. Ischemic and hemorrhagic strokes can both lead to poststroke epilepsy (PSE). Significant risk factors for PSE include age < 65age less than 65 years, stroke severity measured by the National Institutes of Health Stroke Scale (NIHSS), cortical involvement, and genetic factors such as TRPM6 polymorphism. The diagnosis of PSE is made by using imaging modalities, blood biomarkers, and prognostic criteria. Electroencephalography (EEG) is currently the gold standard to diagnose PSE, while new combinations of modalities are being tested to increase diagnostic specificity. This literature review uncovers a newly found mechanism for the pathology of poststroke epilepsy. The pathogenesis of early-onset and late-onset is characterized by sequelae of neuronal cellular hypoxia and disruption of the blood-brain barrier, respectively. Interleukin-6 is responsible for increasing the activity of glial cells, causing gliosis and hyperexcitability of neurons. Epinephrine, high-mobility group protein B1, downregulation of CD32, and upregulation of HLA-DR impact the pathology of poststroke epilepsy by inhibiting the normal neuronal immune response. Decreased levels of neuropeptide Y, a neurotransmitter, act through multiple unique mechanisms, such as inhibiting intracellular Ca2+ accumulation and acting as an anti-inflammatory, also implemented in the worsening progression of poststroke epilepsy. Additionally, CA1 hippocampal resonant neurons that increase theta oscillation are associated with poststroke epilepsy. Hypertensive small vessel disease may also have an implication in the temporal lobe epilepsy by causing occult microinfarctions. Furthermore, this review highlights the potential use of statins as primary prophylaxis against PSE, with multiple studies demonstrating a reduction in incidence using statins alone, statins in combination with antiepileptic drugs (AEDs), and statins with aspirin. The evidence strongly suggests that the second generation AEDs are a superior treatment method for PSE. Data from numerous studies demonstrate their relative lack of significant drug interactions, increased tolerability, and potential superiority in maintaining seizure-free status.


Subject(s)
Epilepsy , Hydroxymethylglutaryl-CoA Reductase Inhibitors , Stroke , Humans , Aged , Incidence , Quality of Life , Epilepsy/drug therapy , Seizures/drug therapy , Anticonvulsants/therapeutic use , Stroke/complications , Stroke/drug therapy , Stroke/epidemiology , Risk Factors
4.
Arq Neuropsiquiatr ; 80(7): 741-758, 2022 07.
Article in English | MEDLINE | ID: covidwho-2096903

ABSTRACT

The Brazilian Practice Guidelines for Stroke Rehabilitation - Part II, developed by the Scientific Department of Neurological Rehabilitation of the Brazilian Academy of Neurology (Academia Brasileira de Neurologia, in Portuguese), focuses on specific rehabilitation techniques to aid recovery from impairment and disability after stroke. As in Part I, Part II is also based on recently available evidence from randomized controlled trials, systematic reviews, meta-analyses, and other guidelines. Part II covers disorders of communication, dysphagia, postural control and balance, ataxias, spasticity, upper limb rehabilitation, gait, cognition, unilateral spatial neglect, sensory impairments, home rehabilitation, medication adherence, palliative care, cerebrovascular events related to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, the future of stroke rehabilitation, and stroke websites to support patients and caregivers. Our goal is to provide health professionals with more recent knowledge and recommendations for better rehabilitation care after stroke.


As Diretrizes Brasileiras de Reabilitação do Acidente Vascular Cerebral (AVC) - Parte II, desenvolvida pelo Departamento Científico de Reabilitação Neurológica da Academia Brasileira de Neurologia é voltada para intervenções específicas de técnicas de reabilitação de déficits neurológicos e incapacidades. Seguindo o mesmo modelo da Parte I, a Parte II também se baseia em estudos randomizados, revisões sistemáticas, metanálises e outras diretrizes sobre o mesmo tema. A segunda parte aborda os distúrbios da comunicação, disfagia, controle postural e equilíbrio, ataxias, espasticidade, reabilitação do membro superior, marcha, cognição, negligência espacial unilateral, déficits sensoriais, reabilitação domiciliar, aderência ao uso de medicamentos, cuidados paliativos, o futuro da reabilitação no AVC, e websites de orientação sobre AVC para pacientes e cuidadores. Nosso objetivo é fornecer aos profissionais envolvidos na reabilitação conhecimento atualizado e recomendações para um melhor cuidado no pós-AVC.


Subject(s)
Stroke Rehabilitation , Stroke , Humans , Brazil , COVID-19 , Stroke/complications , Stroke/drug therapy , Stroke Rehabilitation/methods , Randomized Controlled Trials as Topic , Meta-Analysis as Topic , Systematic Reviews as Topic
5.
Zh Nevrol Psikhiatr Im S S Korsakova ; 122(10): 133-137, 2022.
Article in Russian | MEDLINE | ID: covidwho-2091096

ABSTRACT

A case of the development of multifocal leukoencephalopathy and hemorrhage after infection with SARS-CoV-2 in a female patient with Alzheimer's disease, aged 67 years, is described. The patient was hospitalized by an ambulance. Computed tomography (CT) of the brain showed the signs of cerebral infarction in the basin of the left middle cerebral artery with hemorrhagic transformation, multiple low-density foci that do not accumulate contrast in the white matter of the brain, the presence of sickle-shaped lesions in the cerebellum. CT of the chest revealed bilateral diffuse COVID-associated pneumonitis, alveolitis. The percentage of lesion was 75%. A smear express test for a new coronavirus infection was positive. Treatment was started, and a sudden death occurred. A sectional study in the brain revealed signs of ischemic cerebral infarction and multifocal leukoencephalomalacia - foci of demyelination (from 1 mm to 1 cm) had a multifocal lesion located in different parts of the white matter. Fibrinoid necrosis of vessel walls, destructive-productive vasculitis, ischemic small-focal perivascular necrosis, ischemic lesions of neurons and glial cells, neuronal and glial spongiosis were noted. In conclusion, the cause of death of the patient was a new coronavirus infection COVID-19, which caused diffuse viral COVID-associated pneumonitis, alveolitis with the development of acute respiratory distress syndrome in adults, respiratory failure and COVID-associated ischemic infarction, multifocal leukoencephalopathy (or malacia), cerebral edema complicated by neuromorphological changes in the brain.


Subject(s)
COVID-19 , Leukoencephalopathy, Progressive Multifocal , Pneumonia, Viral , Stroke , Adult , Female , Humans , COVID-19/complications , SARS-CoV-2 , Pneumonia, Viral/complications , Pneumonia, Viral/diagnosis , Pneumonia, Viral/pathology , Stroke/etiology , Stroke/complications , Cerebral Infarction/complications
6.
Int J Environ Res Public Health ; 19(21)2022 Oct 25.
Article in English | MEDLINE | ID: covidwho-2090128

ABSTRACT

BACKGROUND: People who have experienced a stroke or transient ischaemic attack (TIA) have greater risks of complications from COVID-19. Therefore, vaccine uptake in this vulnerable population is important. To prevent vaccine hesitancy and maximise compliance, we need to better understand individuals' views on the vaccine. OBJECTIVES: We aimed to explore perspectives of the COVID-19 vaccine and influences on its uptake from people who have experienced a stroke or TIA. METHOD: A cross-sectional, electronic survey comprising multiple choice and free text questions. Convenience sampling was used to recruit people who have experienced a stroke/TIA in the UK/Ireland. RESULTS: The survey was completed by 377 stroke/TIA survivors. 87% (328/377) had either received the first vaccine dose or were booked to have it. The vaccine was declined by 2% (7/377) and 3% (11/377) had been offered the vaccine but not yet taken it up. 8% (30/377) had not been offered the vaccine despite being eligible. Some people expressed concerns around the safety of the vaccine (particularly risk of blood clots and stroke) and some were hesitant to have the second vaccine. Societal and personal benefits were motivations for vaccine uptake. There was uncertainty and lack of information about risk of COVID-19 related complications specifically for people who have experienced a stroke or TIA. CONCLUSION: Despite high uptake of the first vaccine, some people with stroke and TIA have legitimate concerns and information needs that should be addressed. Our findings can be used to identify targets for behaviour change to improve vaccine uptake specific to stroke/TIA patients.


Subject(s)
COVID-19 , Ischemic Attack, Transient , Stroke , Humans , Ischemic Attack, Transient/epidemiology , Cross-Sectional Studies , COVID-19 Vaccines/therapeutic use , COVID-19/prevention & control , Stroke/epidemiology , Stroke/prevention & control , Stroke/complications , Survivors
7.
Clin Neurol Neurosurg ; 222: 107467, 2022 Nov.
Article in English | MEDLINE | ID: covidwho-2061005

ABSTRACT

OBJECTIVE: We explored the relationship between markers of infection and inflammation and mortality in patients with acute ischemic stroke who underwent thrombectomy. METHODS: We performed retrospective chart review of stroke patients who underwent thrombectomy at two tertiary academic centers between December 2018 and November 2020. Associations between discharge mortality, WBC count, neutrophil percentage, fever, culture data, and antibiotic treatment were analyzed using the Wilcoxon rank sum test, Student's t-test, and Fisher's exact test. Independent predictors of mortality were identified with multivariable analysis. Analyses were repeated excluding COVID-positive patients. RESULTS: Of 248 patients who underwent thrombectomy, 41 (17 %) died prior to discharge. Mortality was associated with admission WBC count (11 [8-14] vs. 9 [7-12], p = 0.0093), admission neutrophil percentage (78 % ± 11 vs. 71 % ± 14, p = 0.0003), peak WBC count (17 [13-22] vs. 12 [9-15], p < 0.0001), fever (71 % vs. 27 %, p < 0.0001), positive culture (44 % vs. 15 %, p < 0.0001), and days treated with antibiotics (3 [1-7] vs. 1 [0-4], p < 0.0001). After controlling for age, admission NIHSS and post-thrombectomy ASPECTS score, mortality was associated with admission WBC count (OR 13, CI 1.32-142, p = 0.027), neutrophil percentage (OR 1.03, CI 1.0-1.07, p = 0.045), peak WBC count (OR 301, CI 24-5008, p < 0.0001), fever (OR 24.2, CI 1.77-332, p < 0.0001), and positive cultures (OR 4.24, CI 1.87-9.62, p = 0.0006). After excluding COVID-positive patients (n = 14), peak WBC count, fever and positive culture remained independent predictors of mortality. CONCLUSION: Markers of infection and inflammation are associated with discharge mortality after thrombectomy. Further study is warranted to investigate the causal relationship of these markers with clinical outcome.


Subject(s)
Brain Ischemia , COVID-19 , Ischemic Stroke , Stroke , Humans , Retrospective Studies , Treatment Outcome , Thrombectomy , Stroke/complications , Biomarkers , Inflammation , Anti-Bacterial Agents , Brain Ischemia/complications
8.
Dis Markers ; 2022: 7099908, 2022.
Article in English | MEDLINE | ID: covidwho-2053426

ABSTRACT

Objective: This research sets out to elucidate the influence of evidence-based nursing (EBN) on psychological status (PSY), neurological function, and quality of life (QoL) of patients with acute poststroke depression (PSD). Methods: One hundred and fifty stroke patients who received treatment in the Characteristic Medical Center of PLA Rocket Force between December 2019 and December 2021 were enrolled, including 100 cases (Group A) treated with comprehensive EBN and 50 patients (Group B) with routine nursing. Anxiety and depression (Self-Rating Anxiety Scale [SAS] and Self-Rating Depression Scale [SDS] scores), neurological function (National Institutes of Health Stroke Scale [NIHSS] and Scandinavian Stroke Scale [SSS] scores), QoL (Generic Quality Of Life Inventory-74 [GQOLI-74] score), and complication rate of both groups were evaluated, as well as total effective rate and nursing satisfaction. Results: Group A outperformed Group B with lower scores of NIHSS, SSS, SAS, and SDS and higher GOOLI-74 scores. Besides, lower complication rate and higher total effective rate and nursing satisfaction were determined in Group A. Conclusions: EBN can better improve the PSY of patients with acute PSD, restore their neurological function, and effectively improve their QoL.


Subject(s)
Depression , Stroke , Depression/etiology , Evidence-Based Nursing , Humans , Polyesters , Quality of Life/psychology , Stroke/complications
9.
Medicine (Baltimore) ; 101(26): e29834, 2022 Jul 01.
Article in English | MEDLINE | ID: covidwho-2051694

ABSTRACT

We assessed whether stroke severity, functional outcome, and mortality in patients with ischemic stroke differed between patients with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and those without. We conducted a prospective, single-center cohort study in Irbid, North Jordan. All patients diagnosed with ischemic stroke and SARS-CoV-2 infection were consecutively recruited from October 15, 2020, to October 16, 2021. We recorded demographic data, vascular risk factors, National Institutes of Health Stroke Scale (NIHSS) score, stroke subtype according to the Trial of ORG 10172 in Acute Stroke Treatment Criteria (TOAST), treatments at admission, and laboratory variables for all patients. The primary endpoint was the functional outcome at 3 months assessed using the modified Rankin Score. Secondary outcomes involved in-hospital mortality and mortality at 3 months. We included 178 patients with a mean (standard deviation) age of 67.3 (12), and more than half of the cases were males (96/178; 53.9%). Thirty-six cases were coronavirus disease 2019 (COVID-19) related and had a mean (standard deviation) age of 70 (11.5). When compared with COVID-19-negative patients, COVID-19-positive patients were more likely to have a higher median NIHSS score at baseline (6 vs 11; P = .043), after 72 hours (6 vs 12; P = .006), and at discharge (4 vs 16; P < .001). They were also more likely to have a higher median modified Rankin Score after 3 months of follow-up (P < .001). NIHSS score at admission (odds ratio = 1.387, 95% confidence interval = 1.238-1.553]; P < .001) predicted having an unfavorable outcome after 3 months. On the other hand, having a concomitant SARS-CoV-2 infection did not significantly impact the likelihood of unfavorable outcomes (odds ratio = 1.098, 95% confidence interval = 0.270-4.473; P = .896). The finding conclude that SARS-CoV-2 infection led to an increase in both stroke severity and in-hospital mortality but had no significant impact on the likelihood of developing unfavorable outcomes.


Subject(s)
Brain Ischemia , COVID-19 , Ischemic Stroke , Stroke , Brain Ischemia/complications , COVID-19/complications , COVID-19/epidemiology , Cohort Studies , Female , Humans , Ischemic Stroke/epidemiology , Jordan/epidemiology , Male , Prospective Studies , SARS-CoV-2 , Stroke/complications
10.
J Stroke Cerebrovasc Dis ; 31(11): 106716, 2022 Nov.
Article in English | MEDLINE | ID: covidwho-2036331

ABSTRACT

OBJECTIVES: To assess whether COVID-19 could be a concurrent factor in the genesis and/or worsening of stroke and to provide data on COVID-19 -associated stroke patients during the first pandemic wave and comparative data on COVID-19 negative stroke patients in the same period. MATERIALS AND METHODS: This is a retrospective, observational, case-control, single centre study, carried out in a General Hospital in northern Italy. Sixty-three consecutive stroke patients were included, COVID-19-associated stroke was classified as cases and non COVID-19-associated stroke as controls. RESULTS: A total of 19/63 (28.8%) had a COVID-19-associated stroke, 11 /63 (17.5%) were haemorrhagic and 52/63 (82.5%) ischaemic. COVID-19-associated strokes were more severe (p-value 0.019) and had a higher risk of severe disability and/or death (OR 3.79, CI 95%: 1.21-11.93, p-value 0.19). The COVID-19-associated stroke patients with onset during hospitalization for COVID-19 had a more severe stroke than patients with COVID-19 onset during hospitalization for stroke (p-value 0.019). CONCLUSION: Although no relationship was observed between the stroke aetiology and COVID-19, intriguingly, COVID-associated stroke turned out to be more severe and disabling. Hopefully, further studies will provide more data and help in the management of this emerging population.


Subject(s)
COVID-19 , Communicable Diseases , Stroke , Humans , COVID-19/complications , COVID-19/diagnosis , SARS-CoV-2 , Case-Control Studies , Pandemics , Stroke/diagnosis , Stroke/therapy , Stroke/complications , Retrospective Studies , Communicable Diseases/complications
13.
Pediatr Neurol ; 135: 52-55, 2022 10.
Article in English | MEDLINE | ID: covidwho-2015913

ABSTRACT

BACKGROUND: Children with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection can experience neurological symptoms, but limited data are available on neurological symptoms associated with other respiratory infections. We compared proportions of neurological symptoms in children hospitalized with seizures and respiratory infections, including SARS-CoV-2, influenza, and endemic coronaviruses. METHODS: A retrospective cohort study was performed on children admitted for seizures who had positive respiratory polymerase chain reactions for SARS-CoV-2, coronavirus NL63, coronavirus OC34, influenza (A and B), adenovirus, Mycoplasma pneumoniae, or parainfluenza 3 or 4. Primary outcomes were rates of new neurological diagnoses and mortality. RESULTS: A total of 883 children were included. Mortality rates ranged from 0% with M. pneumoniae to 4.9% with parainfluenza 4. Strokes were observed with all infections except for coronavirus OC43 and M. pneumoniae, with the highest rates in parainfluenza 4 (4.9%) and SARS-CoV-2 (5.9%). Compared with other infections, children with SARS-CoV-2 were older, had higher rates of stroke, and lower rates of intubation. The most common brain magnetic resonance imaging (MRI) abnormality was diffusion restriction. Abnormal MRI rates were lower in SARS-CoV-2, compared with patients with other coronavirus (OC). However, rates of stroke, encephalopathy, hypoxic-ischemic encephalopathy, and meningoencephalitis were similar between SARS-CoV-2 and influenza cohorts. CONCLUSIONS: In children hospitalized with seizures, higher rates of stroke were observed in SARS-CoV-2 versus OC. Similar rates of neurological symptoms were observed in patients with SARS-CoV-2 and those with influenza. Strokes can occur in children with these viral infections, particularly SARS-CoV-2.


Subject(s)
COVID-19 , Influenza, Human , Paramyxoviridae Infections , Respiratory Tract Infections , Stroke , COVID-19/complications , Child , Humans , Influenza, Human/complications , Influenza, Human/epidemiology , Paramyxoviridae Infections/complications , Respiratory Tract Infections/complications , Respiratory Tract Infections/epidemiology , Retrospective Studies , SARS-CoV-2 , Seizures/epidemiology , Seizures/etiology , Stroke/complications
14.
J Stroke Cerebrovasc Dis ; 31(11): 106776, 2022 Nov.
Article in English | MEDLINE | ID: covidwho-2007885

ABSTRACT

BACKGROUND: While most large studies on the possible association of COVID-19 and stroke were done in high-income countries, only a few studies consisting of small sample populations have been done in low- to middle-income countries like the Philippines. OBJECTIVES: To determine the risk factors of stroke among hospitalized COVID19 patients in the Philippines; to determine the possible association between these risk factors and stroke among the same cohort; and to determine if there is an association between mortality and stroke in this same group. METHODOLOGY: We obtained relevant clinical and neurological, including stroke data from the Philippine CORONA study, an observational study involving 10,881 patients with COVID-19 admitted in 37 referral hospitals from all over the Philippines. RESULTS: The incidence of stroke among patients with COVID-19 was 3.4% (n = 367). There were more deaths among patients with stroke and COVID-19 than those without stroke and COVID-19 (42.2% vs 14.7%, p < 0.01). In addition, more patients with stroke were admitted in the ICU (43.3% vs 15.0%, p < 0.01) regardless of cause. Smoking (OR: 1.5, 95% CI: 1.3 to 1.7, p < 0.0001), hypertension (OR:1.75, 95% CI:1.53 to 1.97, p < 0.0001), presence of heart failure (OR: 1.4, 95% CI: 1.07 to 1.86, p = 0.01), presence of any neurologic co-morbidities (OR: 1.4, 95% CI:1.11 to 1.46, p = 0.004), and history of stroke (OR:2.3, 95% CI:1.82 to 2.97, p < 0.0001) had direct significant correlation with stroke; while being a health care worker (OR: 0.5, 95% CI: 0.33 to 0.70, p < 0.0004) had an inverse significant association with stroke. CONCLUSION: COVID-19 stroke patients in the Philippines have a higher mortality and ICU admission rates than patients with COVID-19 alone or COVID-19 stroke patients from developed countries. Our cohort has similar cardiovascular and metabolic risk factors to western patients with stroke, highlighting that COVID-19 may only have a small contribution to stroke incidence.


Subject(s)
COVID-19 , Stroke , Humans , Incidence , Philippines/epidemiology , Stroke/diagnosis , Stroke/epidemiology , Stroke/complications , Risk Factors , Retrospective Studies
16.
J Affect Disord ; 308: 155-159, 2022 07 01.
Article in English | MEDLINE | ID: covidwho-1972145

ABSTRACT

BACKGROUND: Physical disability is a cause of depression among acute stroke patients. Although previous studies have shown that physical disability, perceived social support, mental resilience, and post-stroke depression are significantly related, the interaction mechanism remains unclear. METHODS: Convenience sampling was used to recruit participants from a tertiary hospital in Daqing City, Heilongjiang Province, China from October 2020 to May 2021. Participants completed the Barthel Index Rating Scale, Multidimensional Scale of Perceived Social Support, Connor-Davidson Resilience Scale and Zung Self-Rating Depression Scale. We used the PROCESS macro for SPSS to determine the mediating effect of perceived social support and resilience between disability and depression. RESULT: A total of 259 acute stroke patients participated in this study and completed the questionnaire survey. Stroke patients' BI scores was positively correlated with perceived social support (r = 0.26, P < 0.01) and resilience (r = 0.25, P < 0.01), and negatively correlated with depression (r = -0.47, P < 0.01). Perceived social support was positively correlated with resilience (r = 0.55, P < 0.01) and negatively correlated with depression (r = -0.41, P < 0.01). Resilience was negatively correlated with depression (r = -0.43, P < 0.01). Perceived social support and resilience played a mediating role of 10.27% and 5.74% of the total effects of disability and post-stroke depression, respectively. Meanwhile, the chain mediating effect of perceived social support and resilience (7%) was also significant. LIMITATIONS: The cross-sectional study design limited the inference of causal relationships between variables. This study used convenience sampling to select research participants from a single hospital, they were all acute stroke patients from the same region of China. Participants in our study were in high BI status, and thirty of them had a low level of education, which may contribute to the possibility of selection bias. Meanwhile, the low level of education and the poor eye-sight of old people prevents them from completing the questionnaire by themselves. So we collected data in the form of "researcher reading questionnaire items and recording participant responses" for the majority of participants (257 subjects), and only 2 participants completed it independently. Furthermore, the findings of this study may not apply to stroke survivors from other backgrounds. CONCLUSION: This study found that disability can directly predict post-stroke depression, and indirectly predict post-stroke depression through the mediating effect of perceived social support and resilience, and the chain mediating effect of perceived social support-resilience. Therefore, reducing the degree of disability of acute stroke patients and improving their perceived social support and resilience may help prevent post-stroke depression.


Subject(s)
Resilience, Psychological , Stroke , China , Cross-Sectional Studies , Depression/epidemiology , Depression/etiology , Humans , Social Support , Stroke/complications , Surveys and Questionnaires
17.
Health Technol Assess ; 26(31): 1-88, 2022 07.
Article in English | MEDLINE | ID: covidwho-1963373

ABSTRACT

BACKGROUND: Urinary incontinence affects around half of stroke survivors in the acute phase, and it often presents as a new problem after stroke or, if pre-existing, worsens significantly, adding to the disability and helplessness caused by neurological deficits. New management programmes after stroke are needed to address urinary incontinence early and effectively. OBJECTIVE: The Identifying Continence OptioNs after Stroke (ICONS)-II trial aimed to evaluate the clinical effectiveness and cost-effectiveness of a systematic voiding programme for urinary incontinence after stroke in hospital. DESIGN: This was a pragmatic, multicentre, individual-patient-randomised (1 : 1), parallel-group trial with an internal pilot. SETTING: Eighteen NHS stroke services with stroke units took part. PARTICIPANTS: Participants were adult men and women with acute stroke and urinary incontinence, including those with cognitive impairment. INTERVENTION: Participants were randomised to the intervention, a systematic voiding programme, or to usual care. The systematic voiding programme comprised assessment, behavioural interventions (bladder training or prompted voiding) and review. The assessment included evaluation of the need for and possible removal of an indwelling urinary catheter. The intervention began within 24 hours of recruitment and continued until discharge from the stroke unit. MAIN OUTCOME MEASURES: The primary outcome measure was severity of urinary incontinence (measured using the International Consultation on Incontinence Questionnaire) at 3 months post randomisation. Secondary outcome measures were taken at 3 and 6 months after randomisation and on discharge from the stroke unit. They included severity of urinary incontinence (at discharge and at 6 months), urinary symptoms, number of urinary tract infections, number of days indwelling urinary catheter was in situ, functional independence, quality of life, falls, mortality rate and costs. The trial statistician remained blinded until clinical effectiveness analysis was complete. RESULTS: The planned sample size was 1024 participants, with 512 allocated to each of the intervention and the usual-care groups. The internal pilot did not meet the target for recruitment and was extended to March 2020, with changes made to address low recruitment. The trial was paused in March 2020 because of COVID-19, and was later stopped, at which point 157 participants had been randomised (intervention, n = 79; usual care, n = 78). There were major issues with attrition, with 45% of the primary outcome data missing: 56% of the intervention group data and 35% of the usual-care group data. In terms of the primary outcome, patients allocated to the intervention group had a lower score for severity of urinary incontinence (higher scores indicate greater severity in urinary incontinence) than those allocated to the usual-care group, with means (standard deviations) of 8.1 (7.4) and 9.1 (7.8), respectively. LIMITATIONS: The trial was unable to recruit sufficient participants and had very high attrition, which resulted in seriously underpowered results. CONCLUSIONS: The internal pilot did not meet its target for recruitment and, despite recruitment subsequently being more promising, it was concluded that the trial was not feasible owing to the combined problems of poor recruitment, poor retention and COVID-19. The intervention group had a slightly lower score for severity of urinary incontinence at 3 months post randomisation, but this result should be interpreted with caution. FUTURE WORK: Further studies to assess the effectiveness of an intervention starting in or continuing into the community are required. TRIAL REGISTRATION: This trial is registered as ISRCTN14005026. FUNDING: This project was funded by the National Institute for Health and Care Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 26, No. 31. See the NIHR Journals Library website for further project information.


Urinary incontinence affects around half of stroke survivors. It causes embarrassment and distress, affecting patients' ability to take part in rehabilitation. It also has a major impact on families and may determine whether or not patients are able to return home. Finding the underlying cause and addressing it can prevent, cure or reduce problems. Doing this in a systematic way for everyone with incontinence problems as early as possible after the stroke, while they are still in hospital, may work best. We also wanted to avoid using catheters in the bladder to drain the urine away, as these are often unnecessary and can cause urinary tract infections. This study aimed to test whether or not continence problems and the use of urinary catheters could be reduced if everyone with incontinence was fully assessed and given the right management and support early after hospital admission. We also wanted to find out if the benefits outweighed the costs. We planned to involve 1024 men and women with incontinence from 18 stroke units in the study, with 512 people receiving the intervention and 512 receiving usual care. However, the trial was paused because of COVID-19, at which time only 157 participants had been recruited. When we were thinking about restarting the study and looked at its progress, we found that not enough people had agreed to take part and, of those who had agreed, many had not returned their outcome questionnaires. This indicated that the trial was not feasible and should not restart. We could not make any firm conclusions about whether or not the intervention worked, as not enough people were involved. We found that stays in hospital after stroke are shorter than they were in the past. This suggests that future studies investigating ways of treating incontinence should consider interventions with management and support for incontinence that continue after patients leave the hospital.


Subject(s)
Stroke , Urinary Incontinence , Adult , COVID-19 , Cost-Benefit Analysis , Female , Humans , Male , Program Evaluation , Quality of Life , Stroke/complications , Surveys and Questionnaires , Urinary Incontinence/etiology , Urinary Incontinence/therapy
18.
J Med Internet Res ; 24(7): e36135, 2022 Jul 20.
Article in English | MEDLINE | ID: covidwho-1952033

ABSTRACT

BACKGROUND: Although the efficacy of high-dose speech-language therapy (SLT) for individuals with poststroke aphasia has been established in the literature, there is a gap in translating these research findings to clinical practice. Therefore, patients continue to receive suboptimal amounts of SLT, with negative consequences for their functional communication recovery. Recent research has identified self-managed digital health technology as one way to close the dosage gap by enabling high-intensity therapy unrestricted by clinician availability or other practical constraints. However, there is limited empirical evidence available to rehabilitation professionals to guide dose prescriptions for self-managed SLT despite their increasing use in the COVID-19 era and likely beyond. OBJECTIVE: This study aims to leverage real-world mobile health data to investigate the effects of varied dosage frequency on performance outcomes for individuals with poststroke speech, language, and cognitive deficits following a 10-week period of self-managed treatment via a commercially available digital health platform. METHODS: Anonymized data from 2249 poststroke survivors who used the Constant Therapy app between late 2016 and 2019 were analyzed. The data included therapy tasks spanning 13 different language and cognitive skill domains. For each patient, the weekly therapy dosage was calculated based on the median number of days per week of app use over the 10-week therapy period, binned into groups of 1, 2, 3, 4, or ≥5 days per week. Linear mixed-effects models were run to examine change in performance over time as a function of dosage group, with post hoc comparisons of slopes to evaluate the performance gain associated with each additional day of practice. RESULTS: Across all skill domains, linear mixed-effects model results showed that performance improvement was significantly greater for patients who practiced 2 (ß=.001; t15,355=2.37; P=.02), 3 (ß=.003; t9738=5.21; P<.001), 4 (ß=.005; t9289=7.82; P<.001), or ≥5 (ß=.005; t6343=8.14; P<.001) days per week compared with those who only practiced for 1 day per week. Post hoc comparisons confirmed an incremental dosage effect accumulating with each day of practice (ie, 1 day vs 2 days, 2 days vs 3 days, and 3 days vs 4 days), apart from 4 days versus ≥5 days of practice per week. The result of greater improvement for higher versus lower dosage frequency groups was true not only across all domains but also within a majority of individual subdomains. CONCLUSIONS: The findings from this study demonstrated that increased dosage frequency is associated with greater therapy gains over a 10-week treatment period of self-managed digital therapy. The use of real-world data maximizes the ecological validity of study results and makes the findings more generalizable to clinical settings. This study represents an important step toward the development of optimal dose recommendations for self-managed SLT.


Subject(s)
COVID-19 , Self-Management , Stroke , Humans , Language Therapy/methods , Retrospective Studies , Stroke/complications , Stroke/therapy , Treatment Outcome
19.
Eur Rev Med Pharmacol Sci ; 26(13): 4884-4892, 2022 07.
Article in English | MEDLINE | ID: covidwho-1955406

ABSTRACT

OBJECTIVE: We aimed at determining the effectiveness of mechanical thrombectomy (MT) in patients with major vessel occlusion and infected with COVID-19, evaluating its clinical outcome and comparing it with non-COVID patients. PATIENTS AND METHODS: During the pandemic, 729 patients who underwent MT in stroke centers due to Acute Ischemic Stroke (AIS) with large vessel occlusion were evaluated. This study included 40 patients with a confirmed COVID-19 diagnosis by a positive PCR test between March 11, 2020, and December 31, 2020. These patients were compared to 409 patients who underwent MT due to major vessel occlusion between March 11, 2019, and December 31, 2019. RESULTS: Of the patients with AIS who are infected with COVID-19, 62.5% were males, and all patients have a median age of 63.5 ± 14.4 years. The median NIHSS score of the COVID-19 group was significantly higher than that of the non-COVID-19 groups. Dissection was significantly more in the COVID-19 group. The mortality rates at 3 months were higher in the COVID-19 groups compared to non-COVID-19 groups. CONCLUSIONS: This study revealed an increased frequency of dissection in patients with COVID-19. COVID-19-related ischemic strokes are associated with worse functional outcomes and higher mortality rates than non-COVID-19 ischemic strokes.


Subject(s)
Brain Ischemia , COVID-19 , Ischemic Stroke , Stroke , Aged , Brain Ischemia/complications , COVID-19 Testing , Female , Humans , Ischemic Stroke/epidemiology , Ischemic Stroke/surgery , Male , Middle Aged , Pandemics , Prognosis , Retrospective Studies , Stroke/complications , Thrombectomy/adverse effects , Treatment Outcome
20.
Brain Nerve ; 74(7): 853-859, 2022 Jul.
Article in Japanese | MEDLINE | ID: covidwho-1954938

ABSTRACT

As the number of COVID-19 cases continues to rapidly increase worldwide, a corresponding increase in COVID-19-induced neurological complications is being observed in clinical practice. COVID-19 is shown to trigger a pro-thrombotic state, which increases the risk of ischemic stroke. However, the incidence of COVID-19-induced ischemic stroke in 2022 was lower than that observed during the early stages of the pandemic. In this chapter, we describe the association between COVID-19 and stroke and the pathophysiology and prognosis of stroke in patients with COVID-19, together with a review of the latest literature.


Subject(s)
Brain Ischemia , COVID-19 , Cerebrovascular Disorders , Ischemic Stroke , Stroke , COVID-19/complications , Cerebrovascular Disorders/complications , Humans , SARS-CoV-2 , Stroke/complications
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