RESUMO
BACKGROUND: Longitudinal studies on cognitive outcomes after stroke revealed heterogeneous results and the underlying pathology and risk factors for so-called post-stroke dementia are unclear. OBJECTIVE: To assess long-term cognitive performance changes in patients after the first ischemic stroke and to evaluate possible risk factors for post-stroke dementia. MATERIAL AND METHODS: In this study 66 clinically mildly affected patients aged 54-87 years without a history of dementia underwent extensive neuropsychological assessment after first ever ischemic stroke and again 6 months after the event (follow-up assessment). Demographic, clinical and paraclinical parameters were assessed as potential predictors for long-term cognitive outcome. RESULTS: At the group level significant performance improvements were found for most of the neurocognitive domains at the follow-up assessment. The greatest cognitive improvement was found in visuospatial processing. Immediately after stroke 54.5% of patients were considered cognitively impaired (z-scoresâ¯< -2 in at least 2 neurocognitive domains). At follow-up only 16.7% were considered cognitively impaired according to this criterion and among these only 2 patients (3%) had developed a new, clinically relevant cognitive impairment (i.e. post-stroke dementia). Patients with inferior cognitive performance improvements at follow-up had on average larger brain lesions caused by the stroke as well as a prediabetic metabolic status. DISCUSSION: The probability of developing a post-stroke dementia syndrome is lower than previously assumed in patients with first ever stroke, with only mild clinical disability and without premorbid cognitive impairment. Long-term cognitive impairment could primarily be determined by the size of the lesioned brain area as well as the premorbid (pre)diabetic status.
Assuntos
Transtornos Cognitivos , Disfunção Cognitiva , Demência , Acidente Vascular Cerebral , Idoso , Idoso de 80 Anos ou mais , Transtornos Cognitivos/etiologia , Disfunção Cognitiva/etiologia , Demência/etiologia , Humanos , Pessoa de Meia-Idade , Testes Neuropsicológicos , Fatores de Risco , Acidente Vascular Cerebral/complicaçõesAssuntos
Antimetabólitos Antineoplásicos/farmacologia , Citarabina/farmacologia , Desoxicitidina Quinase/metabolismo , Regulação para Baixo , Leucemia Mieloide Aguda/enzimologia , Animais , Linhagem Celular Tumoral , Resistencia a Medicamentos Antineoplásicos , Leucemia Mieloide Aguda/patologia , CamundongosAssuntos
Antimetabólitos Antineoplásicos/uso terapêutico , Citarabina/uso terapêutico , Perfilação da Expressão Gênica , Leucemia Mieloide Aguda/tratamento farmacológico , Leucemia Mieloide Aguda/genética , Análise de Sequência com Séries de Oligonucleotídeos/métodos , Precursor de Proteína beta-Amiloide/genética , Reparo de Erro de Pareamento de DNA , Resistencia a Medicamentos Antineoplásicos , Humanos , Proteínas Proto-Oncogênicas c-bcl-2/genéticaRESUMO
BACKGROUND: Little is known about the prevalence of sexually transmitted infections (STIs) and about sexual and reproductive health in Central and Eastern Europe. However, it is clear that major epidemics of STIs currently exist. GOAL: To provide baseline information for the development of national guidelines on the management of STIs in Azerbaijan. STUDY DESIGN: A prevalence study on STIs, including a questionnaire on sexual and reproductive health, in two regions of Azerbaijan targeted three groups: (1) pregnant women, (2) gynecology patients, and (3) men attending a dermatovenereology clinic. RESULTS: The 407 pregnant women in this study had a mean of 1.47 abortions and 1.40 births per woman. Of these women, 12% reported condom use and 41% previous symptoms of a sexually transmitted infection. Active syphilis was found in 1.7% of the women. The 326 gynecology patients had a mean of 2.54 abortions and 2.63 births per woman. Of these patients, 11% reported use of modern contraceptives, 18.3% previous condom use, and 63% previous symptoms of an STI. The prevalence of active syphilis was 2.2%, Chlamydia trachomatis 3.1%, Neisseria gonorrhoeae 2.8%, Trichomonas vaginalis 7.1%, Candida 33.1%, and bacterial vaginosis 32.5%. Of the 197 male patients, 67% reported multiple partners in the past 3 months, 62% money exchanged for sex, 37% condom use ever, and 40% a history of STIs. Active syphilis was found in 9.5% of the men, C trachomatis in 5.9%, N gonorrhoeae in 17%, and T vaginalis in 4.4%. CONCLUSIONS: The data show high-risk behavior in the men attending STI clinics, poor sexual and reproductive health status in the women, and underreporting of official data.