Background
The relationship between anticardiolipin (aCL) antibodies and cardiovascular events is uncertain and may vary according to arterial location.
Materials and methods
FRENA is an ongoing ...registry of stable outpatients with symptomatic coronary artery disease (CAD), cerebrovascular disease (CVD) or peripheral artery disease (PAD). The rate of subsequent ischaemic events was cross‐referenced with the presence of aCL antibodies (any isotype, IgG or IgM).
Results
As of June 2017, 1387 stable outpatients were recruited. Of these, 120 (8.7%) showed positive levels of aCL antibodies. Over an average follow‐up of 18 months, 250 patients developed subsequent events: 101 myocardial infarction, 57 ischaemic stroke and 92 critical leg events. Patients with positive aCL antibodies had a higher risk of distal artery events (a composite of ischaemic stroke or critical leg events) than patients with undetectable or low levels (rate ratio: 1.66; 95% CI: 1.07‐2.60). However, an association with central coronary events was not found. The multivariate Cox analysis after adjustment for relevant clinical covariates showed that positivity of aCL antibodies is an independent risk factor for distal events (hazard ratio: 1.60; 95% CI: 1.01‐2.55; P < .05).
Conclusions
Positivity of aCL antibodies is associated with an increased risk of subsequent distal artery ischaemic events (cerebral or leg arteries) but not coronary artery events. Anticardiolipin antibodies appear to have a different relationship on the localisation of ischaemic events in patients with symptomatic artery disease.
Background Teledermoscopy involves the use of dermoscopic images for remote consultation and decision-making in skin cancer screening. Objective We sought to analyze the potential benefits gained ...from the addition of dermoscopic images to an internet-based skin cancer screening system. Methods A randomized clinical trial assessed the diagnostic performance and cost-effectiveness of clinical teleconsultations (CTC) and clinical with dermoscopic teleconsultations. Results A total of 454 patients were enrolled in the trial (nCTC = 226, nclinical with dermoscopic teleconsultation = 228). Teledermoscopy improved sensitivity and specificity (92.86% and 96.24%, respectively) compared with CTC (86.57% and 72.33%, respectively). Correct decisions were made in 94.30% of patients through clinical with dermoscopic teleconsultations and in 79.20% in CTC ( P < .001). The only variable associated with an increased likelihood of correct diagnosis was management using teledermoscopy (odds ratio 4.04; 95% confidence interval 2.02-8.09; P < .0001). The cost-effectiveness analysis showed teledermoscopy as the dominant strategy, with a lower cost-effectiveness ratio (65.13 vs 80.84). Limitations Potentially, a limitation is the establishment of an experienced dermatologist as the gold standard for the in-person evaluation. Conclusions The addition of dermoscopic images significantly improves the results of an internet-based skin cancer screening system, compared with screening systems based on clinical images alone.
The aim of the HISPANIAS (HyperperfusIon Syndrome Post-carotid ANgIoplasty And Stenting) study was to define CHS rates and develop a clinical predictive model for cerebral hyperperfusion syndrome ...(CHS) after carotid artery stenting (CAS).
CHS is a severe complication following CAS. The presence of clinical manifestations is estimated on the basis of retrospective reviews and is still uncertain.
The HISPANIAS study was a national prospective multicenter study with 14 recruiting hospitals. CHS was classified as mild (headache only) and moderate-severe (seizure, impaired level of consciousness, or development of focal neurological signs).
A total of 757 CAS procedures were performed. CHS occurred in 22 (2.9%) patients, in which 16 (2.1%) had moderate-severe CHS and 6 (0.8%) had mild CHS (only headache). The rate of hemorrhages was 0.7% and was associated with high mortality (20%). Pre-operative predictors of moderate-severe CHS in multivariate analysis were female sex (odds ratio OR: 3.24; 95% confidence interval CI: 1.11 to 9.47; p = 0.03), older patients (OR: 1.09; 95% CI: 1.01 to 1.17; p = 0.02), left carotid artery treated (OR: 4.13; 95% CI: 1.11 to 15.40; p = 0.03), and chronic renal failure (OR: 6.29; 95% CI: 1.75 to 22.57; p = 0.005). The area under the curve of this clinical and radiological model was 0.86 (95% CI: 0.81 to 0.92; p = 0.001).
The rate of CHS in the HISPANIAS study was 2.9%, with moderate-severe CHS of 2.1%. CHS was independently associated with female sex, older age, history of chronic kidney disease, and a treated left carotid artery. Although further investigations are needed, the authors propose a model to identify high-risk patients and develop strategies to decrease CHS morbidity and mortality in the future.
Many guidelines recommend urgent intervention for patients with two or more transient ischaemic attacks (TIAs) within 7 days (multiple TIAs) to reduce the early risk of stroke.
To determine whether ...all patients with multiple TIAs have the same high early risk of stroke.
Between April 2008 and December 2009, we included 1255 consecutive patients with a TIA from 30 Spanish stroke centres (PROMAPA study). We prospectively recorded clinical characteristics. We also determined the short-term risk of stroke (at 7 and 90 days). Aetiology was categorised using the TOAST (Trial of Org 10172 in Acute Stroke Treatment) classification.
Clinical variables and extracranial vascular imaging were available and assessed in 1137/1255 (90.6%) patients. 7-Day and 90-day stroke risk were 2.6% and 3.8%, respectively. Large-artery atherosclerosis (LAA) was confirmed in 190 (16.7%) patients. Multiple TIAs were seen in 274 (24.1%) patients. Duration <1 h (OR=2.97, 95% CI 2.20 to 4.01, p<0.001), LAA (OR=1.92, 95% CI 1.35 to 2.72, p<0.001) and motor weakness (OR=1.37, 95% CI 1.03 to 1.81, p=0.031) were independent predictors of multiple TIAs. The subsequent risk of stroke in these patients at 7 and 90 days was significantly higher than the risk after a single TIA (5.9% vs 1.5%, p<0.001 and 6.8% vs 3.0%, respectively). In the logistic regression model, among patients with multiple TIAs, no variables remained as independent predictors of stroke recurrence.
According to our results, multiple TIAs within 7 days are associated with a greater subsequent risk of stroke than after a single TIA. Nevertheless, we found no independent predictor of stroke recurrence among these patients.
Background The Charlson Comorbidity Index (CCI) is commonly used in outcome and mortality studies. Our aim was to investigate the association between CCI score and the functional outcome and ...mortality 6 months after ischemic stroke (IS) or intracerebral hemorrhage. Methods This was a prospective observational cohort of patients with spontaneous intracerebral hemorrhage and IS admitted to the stroke unit during 18 months. The modified Rankin scale (mRS) score was obtained for subjects 6 months after event. The CCI score was dichotomized (low comorbidity 0 or 1 versus high ≥2) for analysis. The mRS score was also dichotomized (good outcome, mRS score 0 or 1 versus poor outcome, mRS score ≥2). Results In all, 175 patients were enrolled in the study. Logistic regression showed that those with a high CCI score (≥2) had 37.3% increased odds of having a poor outcome (≥2) at 6 months and 68.4% greater odds of death at 6 months. Conclusions Comorbid medical conditions independently influence outcome after IS or intracerebral hemorrhage.
Public health is increasingly concerned with recognising factors that lead to sex differences in stroke. We conducted a study to determine the effect of sex on knowledge of stroke risk factors and ...warning signs, and how both are perceived, in a representative sample of adults.
A representative sample of the population of Extremadura, Spain was selected using a double randomisation technique. Previously trained medical students carried out face-to-face interviews using a structured questionnaire.
2409 subjects were interviewed 59.9 % women; mean age (SD) 49.0 (18.7) years. Seventy-three percent of all subjects reported at least one correct warning sign of stroke (OR: 1.01; 95 % CI: 0.84-1.21). The most frequently mentioned warning signs were sudden weakness, dizziness, and headache. There were no sex differences regarding the types of warning symptoms that respondents listed. Women displayed better knowledge of risk factors than men (OR: 1.23; 95 % CI: 1.05-1.46). Women were more likely to name hypertension as a risk factor for stroke whereas men more frequently listed smoking, alcohol consumption and a sedentary lifestyle as risk factors. In response to stroke, women were significantly less likely than men to choose to call an ambulance or to go immediately to hospital (OR: 0.69; 95 % CI: 0.60-0.85).
Stroke knowledge is suboptimal in both men and women. We detected better knowledge of stroke risk factors in women, as well as differences in the type of risk factors listed by men and women. There were significant sex differences regarding response to stroke or to its warning signs.
Background The prognostic benefit of health care service provision and delivery policies for patients with malignant melanoma (MM) is not yet clear. Objective To analyze the role of health care ...provision determinants in the initial prognosis of MM. Methods A multicenter cross-sectional study was conducted at 14 public hospitals and recruited 3550 patients with MM between 2000 and 2009. The study variables were analyzed using univariate and multivariate models to identify their role in the variations observed. Results In a 10-year period, the number of patients with MM increased by 78.54%, with primary in situ MM (Tis) or MMs with a Breslow thickness <1 mm (T1) representing 51.72% of the total number of MMs in 2000, increasing to 62.23% by the end of the study period ( P = .005). Among the variables that explained the variation in MM frequency the year of diagnosis after 2004 (univariate odds ratio OR, 1.43 P < .001; multivariate OR, 1.36 P = .005) and diagnosis in centers with specific fast-track referral systems (univariate OR, 1.24 P = .01; multivariate OR, 1.59 P = .025) were shown to explain the increasing frequency of Tis-T1 MM. Limitations The primary potential limitation of this study is its retrospective nature. Conclusion Health care provision policies and interventions aimed at improving accessibility to specialized care appear to explain the increasing frequency of Tis-T1 MM.
Background This article surveys a representative sample of adults to assess their knowledge of stroke, its vascular risk factors and warning symptoms, illness perception, and attitude toward strokes. ...Methods A representative sample of the region population was selected using a double randomization design. Previously trained medical students carried out face-to-face interviews using a structured questionnaire with open- and closed-ended questions. Results In all, 2411 subjects were interviewed. Seventy-three percent reported at least 1 correct warning sign of stroke, whereas only 12.2% reported 3. The most frequently mentioned were sudden weakness, dizziness, and headache. Only 59.2% named at least 1 correct risk factor for stroke. Smoking and hypertension were mainly named. Forty percent of the respondents demonstrated adequate knowledge of stroke. Tellingly, prevalence of adequate knowledge was significantly lower in subjects with previous stroke (29.3% 95% confidence interval {CI}, 19.7-40.3, P = .049), hypertension (35.0% 95% CI, 31.1-39.1, P = .009), diabetes (31.9% 95% CI, 25.9-38.3, P = .011), hypercholesterolemia (35.8% 95% CI, 31.8-39.9, P = .03), and obesity (28.2% 95% CI, 23.8-33.0, P < .001). Illness perception was generally correct. In the final logistic regression model, younger age, urban area of residence, higher educational level, higher family income, normal pressure, normal weight, and family history of stroke were associated with adequate knowledge of stroke. Conclusions Basic knowledge of stroke is insufficient among the general population of Extremadura. There is a discrepancy between theoretical stroke knowledge and illness perception. These findings have implications for public health initiatives for stroke.
PDF
