Does Vitamin D Deficiency Predispose to Post Stroke Fatigue?

Aim This study is aimed at assessing the prevalence and associates of vitamin D deficiency amongst stroke survivors with fatigue and the impact of vitamin D supplementation on fatigue symptoms. Methods This was a retrospective observational study in which records of 58 consecutive stroke survivors with fatigue who had their vitamin D levels checked at presentation were reviewed and analysed. Comparison between groups was assessed using Pearson Chi Square and Fishers Exact tests. Results A total of 58 survivors (mean age 75.8, range 37-94 years) were included, the majority of which were females (56.9%), aged over 75 years (65.5%), lived with a partner (72.4%), were ambulant at presentation (53.4%) and had modified rankin scores (MRS) of <4(79.3%). The over-all prevalence of vitamin D insufficiency was 74.5% while the prevalence amongst ambulant survivors was 77.4%. There was significant improvement in fatigue symptoms in 100%of those treated. Conclusion Our results indicate a high prevalence of vitamin D deficiency especially amongst ambulant survivors where such deficiencies are unexpected; as well as improvement in symptoms following correction. If replicated in a longitudinal randomised study, this can open treatment options and possibly improve the quality of life of stroke survivors with fatigue. Keywords: Stroke, fatigue, survivors, vitamin D deficiency.

Homocysteine, migration and early vascular impairment in people of African descent.

OBJECTIVES: A gradient of increased vascular risk with migration exists across the African diaspora. We investigated the hypothesis that differences in homocysteine/folic acid status contribute to this increased risk. DESIGN: Community cohort study of 73 Afro-Caribbeans in the United Kingdom and 151 matched Afro-Caribbeans in Jamaica with no conventional vascular risk factors. METHODS: Subjects were compared for baseline characteristics, vascular risk profile, homocysteine (tHcy), folate and B(12) concentrations. Endothelium-dependent vasodilatation was assessed by measuring the absolute change from baseline in the reflection index (RI) of the digital volume pulse during intravenous infusion of albuterol (5 microg/min, Delta RI(ALB)) and glyceryltrinitrate (GTN) (5 microg/min, Delta RI(GTN)). Carotid intima media thickness (CIMT) was measured ultrasonographically in the distal 1 cm of the common carotid artery. RESULTS: UK Afro-Caribbeans had higher tHcy (mean difference 2.3 (95% confidence interval 1.3 to 3.4) micromol/l) and lower folate (mean difference 3.2 (95% CI 1.8 to 4.7) microg/l) levels. Delta RI(ALB) was 5.1 (95% CI 2.5 to 7.6) percentage points lower and CIMT 0.124 (95% CI 0.075 to 0.173) mm greater in UK Afro-Caribbeans. Higher tHcy and lower folate concentrations correlated with impaired Delta RI(ALB) and increased CIMT. A 1 microg/l increase in folate concentration was associated with 0.3 (95% CI 0.1 to 0.5) percentage point increase in Delta RI(ALB) and 0.002 (95% CI 0.001 to 0.006) mm decrease in CIMT, independent of blood pressure, smoking and vascular risk profile. CONCLUSIONS: Lower folate concentrations in UK compared with West Indian African-Caribbeans may contribute to the higher stroke risk seen in UK African-Caribbean people.

The under use of thromboprophylaxis in older medical in-patients: a regional audit.

BACKGROUND: The risk of venous thromboembolism (VTE) among medical in-patients increases with age. Thromboprophylaxis using low-molecular-weight heparin can reduce the incidence by 50%, but anecdotally is under-used in medical patients, particularly the elderly. AIM: To examine prescribing practice for thromboprophylaxis in elderly in-patients in the Yorkshire region. DESIGN: Regional audit of medical records and drug charts. METHODS: A simultaneous audit was done of all medical in-patients >75 years on 30 wards in 10 hospitals. Guidelines published by the Scottish Intercollegiate Guidelines Network (SIGN) on the use of thromboprophylaxis were used as the standard. Data were collected on contraindications and/or indications for thromboprophylaxis and the type of prophylaxis used. RESULTS: Of 601 patients studied (mean age 84.6 years), 117 (19.5%) had indications for thromboprophylaxis with no contraindications. Of these 117, 34 (29%) were receiving prophylaxis as per guidelines. There was more than one indication for thromboprophylaxis in 17% of those left untreated. The mean age of those receiving therapy was similar to those not receiving it (84.0 vs. 84.5 years, p = 0.66, t-test). Elderly in-patients on medical wards were more likely to receive appropriate treatment than those on geriatric wards (43% vs. 23%, p = 0.03, chi(2) test). DISCUSSION: Thromboprophylaxis is under-used in older medical in-patients, despite their increased risk of VTE, particularly on geriatric wards. Greater consideration by doctors attending to older medical patients is needed if VTE is to be prevented.