Search Results (1,491)

Introduction: Antiphospholipid syndrome (APS) is an autoimmune prothrombotic disorder associated with both venous and arterial thrombosis, most notably ischemic stroke. Patients face a high risk of recurrence, and yet optimal strategies for secondary prevention remain uncertain. Methods: We conducted a narrative review of the literature on secondary prevention of ischemic stroke in APS. We performed a comprehensive literature search of PubMed for English-language articles on secondary stroke prevention in APS. Studies were included if they were original human research (e.g., randomized trials, cohort, or case–control studies) or relevant reviews addressing APS-related stroke prevention. Results: Vitamin K antagonists (VKAs) remain the standard of care for high-risk patients with arterial events. Several randomized controlled trials demonstrated higher recurrence rates, particularly of stroke, among APS patients treated with direct oral anticoagulants (DOACs). The optimal target INR remains debated; pooled analyses suggest no clear advantage of high-intensity anticoagulation (INR 3–4) over standard-intensity (INR 2–3), but individualized adjustment is warranted in select cases. In patients with recurrence despite adequate anticoagulation, adding an antiplatelet agent may be beneficial, although supporting evidence is limited. Adjunctive statin therapy shows promise in reducing endothelial dysfunction and prothrombotic markers, with observational data suggesting a possible protective effect, although randomized evidence is lacking. In addition, patent foramen ovale (PFO) closure has been proposed in selected APS patients with paradoxical embolisms, particularly when combined with anticoagulation. Non-pharmacological strategies, including structured lifestyle modification and rigorous vascular risk-factor management, are strongly recommended, as traditional cardiovascular risk factors synergistically increase recurrence risk. Conclusions: Secondary prevention of ischemic stroke in APS requires an individualized approach. VKAs remain first-line, with consideration of antiplatelet add-on, statins, lifestyle interventions, and PFO closure in appropriate settings. Future well-designed clinical trials are needed to refine INR targets, validate combination strategies, and clarify the role of adjunctive therapies in this complex patient population. Full article

Hospital readmission among stroke survivors is frequent, especially in contexts of social vulnerability, compromising recovery and overburdening health services. This study aimed to develop a predictive model of hospital readmission among socially vulnerable stroke survivors, based on the Chronic Conditions Care Model (CCCM). Machine learning algorithms were applied, specifically decision tree and logistic regression, with data split into training (70% and 80%) and testing (30% and 20%) sets. Analyses were conducted using Python, with accuracy evaluated through ROC curves, AUC, and the confusion matrix in Analyse-it^®, adopting a 5% significance level. The decision tree with an 80/20 partition achieved an accuracy of 92.45%. The variables most associated with readmission were falls, time since the first stroke, presence of a caregiver, and difficulty sleeping. In logistic regression, falls increased the risk by 235%, ischemic stroke by 155%, complications by 153.53%, COVID-19 by 132%, and time since stroke by 11.5% per year. The model proved to be feasible and robust, with the decision tree standing out, highlighting its potential to support preventive strategies and enhance care management. Full article

Background/Objectives: The aim of this study was a video-based observational assessment of movement strategies during supine position transfers in patients with hemiparesis following a first-ever ischemic stroke. Methods: The study included 51 participants (n = 51), covering 20 healthy individuals (n = 20) and 31 patients (n = 31) after their first ischemic stroke with hemiparesis. All participants underwent observational kinematic analysis of supine mobility using video recording and time-lapse analysis. The assessment focused on the time required to complete the task, the number of pelvic movements, the presence of trunk translation, spinal flexion, and pelvic mobility across three planes. Results: In the control group, transfers followed a consistent and repetitive sequence in both directions, typically involving trunk translation, spinal flexion, pelvic elevation, and symmetrical movement of both upper and lower limbs. In contrast, post-stroke patients demonstrated altered, asymmetrical, and less efficient movement patterns. These movement strategies were consistent across the hemiparetic group and characterized typical motor responses following stroke. The average transfer time in the study group was approximately three times longer than in the control group. The average number of pelvic movements was 7.2 ± 2.44 in healthy individuals and 16.71 ± 13.52 in post-stroke patients. Conclusions: Supine transfers should be routinely assessed in patients after stroke and included as a key focus in physiotherapy goals. The movement patterns required for such transfers represent a distinct component of complex motor function. Both qualitative and quantitative aspects of their execution may have a significant impact on functional independence in individuals with hemiparesis. Identifying typical transfer patterns in hemiparetic patients may offer valuable guidance for early post-stroke rehabilitation planning, particularly in preventing maladaptive compensatory strategies. Full article

Background/Objectives: One of the neurotoxic components from the sea trumpet polyps, Protopalythoa variabilis (Cnidaria, Anthozoa), is a 26-residue, V-shape helical peptide (PpVα). Its synthetic versions, i.e., the linear, the single-disulfide-bonded analog, and the chimeric peptide with a 6-residue stretch of the N-terminal native homologous peptide covalently linked to the linear sequence, were investigated for their activity on ion channels responsible for cellular excitability and synaptic transmission. Methods: Molecular docking analyses and dynamic simulations focused on the ability of PpVα peptides to bind ion channels selectively through interaction with critical residues at their binding sites. Results: Electrophysiological studies using the patch clamp technique with sympathetic bovine chromaffin cells from the adrenal medulla confirmed that PpVα analogs can block both sodium and calcium currents, which are responsible for initiating and propagating action potentials, respectively, and for neurotransmitter release. Additionally, the peptides displayed neuroprotective effects, attenuating cellular damage induced by veratridine, which interferes with sodium channel activity, and by oligomycin and rotenone (O/R), which affect mitochondrial function. Conclusions: The block of calcium and sodium channels and the neuroprotective effects against oxidative stress make the PpVα peptide scaffold an attractive template for developing agents that has significant clinical potential in several areas, such as the treatment of neurological diseases (epilepsy, multiple sclerosis, and neurodegenerative diseases), neuroprotection in acute events (stroke and traumatic brain or spinal cord injuries), the management of neuropathic pain, the prevention of ischemic damage, and psychiatric disorders (anxiety and bipolar disorder). Full article

Gerstmann syndrome (GS) is characterised by the tetrad of agraphia, acalculia, finger agnosia, and right-left disorientation, which was first described by Josef Gerstmann in 1924 and is conventionally linked to lesions of the dominant angular gyrus. Contemporary neuroimaging and lesion mapping research indicates that a more dispersed parietal and occipito-temporal network may be involved. Bilateral parietal lobe infarcts are uncommon and usually arise from embolic events or small artery pathology, frequently resulting in multifocal cognitive and perceptual impairments. A 52-year-old male presented with acute confusion, perseverative speech, and an inability to follow commands. The neurological examination indicated the presence of the complete Gerstmann tetrad. The Magnetic Resonance Imaging (MRI brain) revealed bilateral parieto-occipital infarcts, with greater severity on the left, indicative of ischaemia in the territory of the posterior cerebral artery (PCA). The medical team provided supportive care and implemented secondary stroke prevention, leading to partial neurocognitive recovery over a period of three weeks. This case highlights a rare presentation of Gerstmann syndrome due to bilateral parieto-occipital infarcts and emphasises that the syndrome can arise from bilateral or widespread parietal injury rather than lesions limited to the angular gyrus. The prompt identification of the Gerstmann constellation helps localise the lesion, enhances diagnostic accuracy, and aids in rehabilitation planning. Full article

Background: Direct oral anticoagulants (DOACs) have become the standard of care for preventing venous thromboembolism (VTE) and cardioembolic stroke in patients with atrial fibrillation, due to their predictable pharmacokinetics and reduced need for frequent laboratory monitoring. However, long-term DOAC use still carries a risk of complications such as gastrointestinal or occult bleeding and progressive renal decline, particularly in elderly and frail patients. Objective: This study proposes a remote monitoring model integrated with AI supports designed to enhance the safety and personalization of chronic DOAC therapy in both inpatient and outpatient settings. Methods: Building on existing national frameworks in which DOAC prescriptions are regulated by experienced physicians through regional digital platforms, we developed a structured model that integrates automatic alerts for abnormal laboratory trends, potential drug interactions, and changes in clinical status. The system uses artificial intelligence to identify high-risk patterns, such as declining hemoglobin or glomerular filtration rate, before symptoms appear, enabling early intervention. Results: The proposed model is presented as an integrated workflow supported by structured components. This conceptual framework facilitates real-time surveillance of patient data, supports clinical decision-making, and is expected to reduce preventable complications. Anticipated benefits include improved clinical appropriateness, better resource allocation, and reduced avoidable emergency visits. Conclusions: remote monitoring system integrated with AI supports for predefinite items for long term treatment with DOACs can significantly improve safety and continuity of care. By replacing passive surveillance with predictive, automated alerts, this model exemplifies how digitalization can enhance the efficiency and responsiveness of the National Health System. Full article

Background/Objectives: The demand for Emergency Medical Services (EMS) has increased over the past few years, increasing the EMS burden. Public utilization of EMS for non-emergency cases is a major global issue contributing to this burden. This study explores the public’s ability to accurately recognize emergency situations and appropriately request ambulance services. Methods: This cross-sectional study utilized a survey to explore public awareness among residents of Riyadh, Saudi Arabia. The survey was developed from the relevant literature and panel discussions, followed by validation through a pilot study. Recruitment was conducted in different publicly accessible places to capture the diverse demographics of the residents. The sample size was statistically calculated using the Raosoft sample size calculator to identify significant differences. Results: This study included 522 respondents, predominantly females (79%) aged 18–34 (42%) and 35–54 (41%) years. Both males and females correctly identified around two-thirds of the total emergency cases, with means of 6.49 (SD = 1.27) and 6.55 (SD = 1.32), respectively. Appropriate ambulance requests were made in less than one-third of the emergencies by both males and females, with means of 2.29 (SD = 1.29) and 2.38 (SD = 1.32), respectively. Stroke and older adults with hip pain were the most accurately recognized emergency cases at 92.5% and 90%, respectively, while mild chest pain and child head hematoma were the least accurately recognized at 36.6% and 38.5%. Women in labor and objects in the ear canal were the most misidentified as emergencies at 97.3% and 87.7%, respectively. Conclusions: This study highlights the prevalence of unrecognized emergency situations and the underutilization of EMS for real emergency cases. The findings recommend the need for national training programs and provide valuable insights for EMS dispatcher training programs regarding public perceptions of emergency and non-emergency situations. While the findings provide insights into targeted preventive measures to alleviate the EMS burden, they also demonstrate the critical role of public awareness in enhancing public health safety concerning emergency situations. Full article

Background/Objectives: India has experienced a sharp increase in stroke burden over the last half-century. The diverse geographical conditions and developing health infrastructure warrant an investigation into changes in mortality and morbidity due to ischemic stroke. This research aims to estimate the impact of attributable risk factors, providing comprehensive insights into the temporal trends of ischemic stroke in India. Methods: Data regarding ischemic stroke in India were queried from the 2019 Global Burden of Disease (GBD) study. Age-standardized deaths, disability-adjusted life years (DALYs), years lived with disability (YLDs), years of life lost (YLLs), prevalence, and incidence were collected and analyzed. Descriptive statistics and 95% uncertainty intervals (UI) were utilized to ensure reliability. Results: In 2019, there were 535,700 incident stroke cases in India (95% CI 453,200–631,800), marking a 118.8% increase from 1990. Females saw a higher incidence rise (131.1%) than males (107.5%). The incidence rate reached 38.5 per 100,000 (95% CI 32.6–45.4), a 34.6% increase, while the age-standardized incidence rate declined by 4.2%. Stroke deaths rose by 148.5%, totaling 271,200 (95% CI 227,800–320,700). Females experienced a higher increase (183.5%) than males (123.0%). Prevalence increased by 130.4%, reaching 6,465,700 cases (95% CI 5,541,000–7,378,000), while age-standardized prevalence rose by 5.7%. Disability-adjusted life years (DALYs) increased by 121.0% to 5,689,300 (95% CI 4,821,100–6,649,500), but the age-standardized DALY rate fell by 23.1%. Years lived with disability (YLD) increased by 135.5% to 907,000 (95% CI 640,300–1,172,900). Years of life lost (YLL) rose by 118.4% to 4,782,300 (95% CI 3,945,500–5,743,700), but the age-standardized YLL rate fell by 26.3%. Metabolic risks, ambient particulate matter pollution, and tobacco smoking were significant risk factors contributing to stroke burden. Conclusions: This study highlights contrasting trends in ischemic stroke indicators in India from 1990 to 2019. While prevalence and YLDs have increased, the overall decline in mortality, YLLs, DALYs, and stroke incidence points to improvements in healthcare access and treatment. There is a need for targeted public health interventions to address the growing stroke burden, mainly focusing on preventive measures and addressing sex-based disparities. Full article

Diabetes mellitus increases the risk of developing coronary artery disease, stroke, aortic disease, heart failure, atrial fibrillation, and peripheral arterial disease. This condition negatively impacts prognosis by increasing the risk of future cardiovascular (CV) events. Patients with type 2 diabetes mellitus need a comprehensive and personalized assessment and definition of the CV risk profile. In very high-risk individuals, special attention is required due to the high risk of adverse events despite appropriate management and treatment. Key interventions to reduce this risk include CV prevention and cardiac rehabilitation. Traditional and non-traditional CV risk factor management, dietary modifications, regular physical activity, aerobic and resistance exercise training, psychosocial and frailty management, optimal pharmacological therapy, and investigation of comorbidities are recommended to reduce the development of CV disease and mortality. Therefore, our manuscript provides updated and critical evidence on the comprehensive management of patients with type 2 diabetes mellitus in clinical practice from the perspective of CV prevention and cardiac rehabilitation, with a focus on individuals at very high risk. Further, practical guidance on individualizing exercise prescriptions based on patient-specific risk profiles and comorbid conditions is provided. Full article

Background: Ischemic stroke (IS) remains a leading global cause of mortality, recurrence, and long-term disability, with survivors also at risk of post-stroke dementia (PSD) and cognitive impairment (PSCI). The precise impact of statin therapy across different IS populations, including those with cardioembolic/atrial fibrillation (CE/AF) strokes and patients with low-baseline low-density lipoprotein (LDL) cholesterol, remains unclear, as does the influence of statin timing, intensity, type, and solubility. Methods: We conducted the Impact of Statin Therapy on the Risk of Stroke Recurrence, Mortality, and Dementia After Ischemic Stroke (ISMARDD) meta-analysis, synthesizing evidence from 51 studies (n = 521,126), to evaluate the association between post-stroke statin therapy and key outcomes: all-cause mortality, stroke recurrence, cognition, and C-reactive protein (CRP). PSD was defined as new, persistent cognitive decline meeting standard diagnostic criteria, and PSCI as measurable but sub-threshold cognitive deficits. Random-effects models were used, and certainty was assessed with the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) framework. Results: Statin therapy significantly reduced all-cause mortality within 3 months (OR 0.32), at 1 year (OR 0.35), and beyond 1 year (OR 0.56). Stroke recurrence was modestly reduced both within 1 year (OR 0.77) and after 1 year (OR 0.76). Statin use was associated with a lower risk of PSD (OR 0.74) but not PSCI overall. Benefits extended to CE/AF-related strokes and patients with low-baseline LDL cholesterol, both showing significantly lower mortality with statin use. Early initiation (<24 h) was linked with reduced recurrence, though effects of statin intensity, type, and solubility were inconsistent. Statins also significantly reduced CRP levels, underscoring anti-inflammatory and pleiotropic mechanisms. Conclusions: The ISMARDD study demonstrates that statins confer survival benefit and selective cognitive protection (notably reduced PSD risk) after ischemic stroke, with modest recurrence benefit, supporting their broad use in secondary prevention. These findings highlight the need for precision-guided approaches tailored to stroke subtype, pharmacogenomics, and treatment timing to optimize therapeutic outcomes. Full article

Background: Brazil’s dietary patterns and significant socioeconomic and geographic diversity present unique challenges for the prevention of cardiometabolic diseases. Methods: In this cross-sectional study, we analyzed data from a nationwide representative survey to understand how dietary patterns related to cardiometabolic diseases. We classified the dietary pattern of participants as whole plant-based, processed plant-based, and animal-based. Then, they were categorized into high, intermediate, and low consumption. Logistic regression analysis was used to test the prevalence of obesity, hypertension, hypercholesterolemia, diabetes, stroke, and heart diseases according to the level of intake of each of the three dietary patterns. Results: Compared to the low intake of a whole plant-based dietary pattern, a high intake was associated with a lower prevalence of obesity (OR 0.64; 95% CI 0.54, 0.75) and hypercholesterolemia (OR 0.69, 95% CI 0.56, 0.85). A processed plant-based dietary pattern (including items such as soda and sweets) was inversely associated with the prevalence of obesity (OR 0.90; 95% CI 0.83, 0.97), hypertension (OR 0.82; 95% CI 0.76, 0.88), hypercholesterolemia (OR 0.81; 95% CI 0.74, 0.88), and diabetes (OR 0.53; 95% CI 0.48, 0.59). A high intake of animal-based dietary patterns was associated with a lower prevalence of heart diseases (OR: 0.60; 95% CI 0.40, 0.90). Conclusions: In this cross-sectional analysis, greater adherence to specific dietary patterns was associated with differences in the prevalence of cardiometabolic conditions. However, causality cannot be established, and longitudinal studies are warranted to confirm these findings. Full article

Introduction/Aim: As the prevalence of atrial fibrillation (AF) increases with the aging population, the challenge of enhancing the detection rate of AF in embolic stroke of undetermined source (ESUS) has intensified. AF is often detected only after a debilitating or fatal cardioembolic stroke, underscoring the crucial need for early identification to prevent further ischemic stroke (IS). This study aims to assess the efficacy of AF detection in patients with ESUS using a single-lead patch (mobiCARE™; Seers Tech, Inc.) over a period of at least 72 h and up to 5 days, in comparison with standard 24 h Holter monitoring. Design: This multicenter, prospective, consecutive observational trial involves patients aged 18 years and older who have experienced an IS within the past six months. Study outcomes: The primary outcome is the initial detection of AF using either a single-lead wearable patch or 24 h Holter monitoring at both baseline and at a 6-month follow-up among patients diagnosed with ESUS stroke. Secondary outcomes include the first detection of AF among stroke patients with large-artery atherosclerosis or small-vessel occlusion, particularly those whose transthoracic echocardiography reveals a left atrial size of ≥44 mm, an echocardiographic marker of AF. Discussion: Prolonged cardiac monitoring increases the detection rate of paroxysmal AF, but the optimal method should be non-invasive, patient-friendly, and accurate. This new technology may reduce patient burden and socioeconomic impact by facilitating AF detection and preventing cardioembolic stroke, even in patients with non-cardiogenic stroke. Full article

This study presents a soft exoskeleton system designed to enhance the safety of electrical maintenance personnel during tower climbing by augmenting the hand grip and providing fall prevention assistance. Inspired by biological principles, a compact, stroke-amplified, and fast-response actuator based on a spring energy storage–release mechanism was developed and evaluated through tensile and speed tests, demonstrating sufficient locking force and a fast response time of 37.5 ms. A dual-sensing module integrating pressure and flexible bending sensors was designed to detect grasping states in real time. System effectiveness was further validated through functional electrical stimulation (FES) and simulated climbing experiments. FES tests confirmed the system’s ability to maintain grasp posture under involuntary hand extension, while climbing experiments verified consistent and reliable transitions between locking and unlocking during movement. Although preliminary, these results suggest that integrating soft exoskeletons with rapid-response actuators offers a promising solution for improving grip stability and operational safety in high-risk vertical environments. Full article

Background/Objectives: Dynapenia, characterized by an age-related decline in muscle strength, has recently gained attention as a major public health concern. While prior studies identified individual risk factors, little is known about how these factors cluster differently by sex. This study investigated sex-specific risk factors and their combinations associated with dynapenia among Korean middle-aged and older adults. Methods: We analyzed 22,850 participants aged ≥ 40 years from the 2014–2019 Korea National Health and Nutrition Examination Survey. Dynapenia was defined as handgrip strength < 28 kg in men and <18 kg in women. Sex-stratified multivariable logistic regression identified independent predictors, and association rule mining (ARM) detected synergistic risk factor combinations. Results: Dynapenia was more prevalent in women (13.9%) than in men (8.5%). Advancing age, physical inactivity, lack of resistance exercise, and a high incidence of diabetes and stroke were consistent risk factors in both sexes. However, ARM revealed distinct clustering patterns: behavioral factors predominated in men, whereas socioeconomic disadvantage and metabolic comorbidities were more relevant in women with dynapenia. Conclusions: These findings emphasize the need for sex-specific prevention strategies for dynapenia, promoting resistance exercise among men and addressing both inactivity and socioeconomic barriers in women. Full article

High concentrations of NO₂ in the air have a negative impact on human health, increasing the risk of cardiovascular diseases such as heart attacks and strokes, as well as causing pulmonary oedema and weak heartbeat. The aim of this study was to develop a mathematical model describing the cyclical variability of NO₂ concentrations, which is crucial for risk assessment and preventive action planning. Based on long-term data from 47 measuring stations located throughout Poland, the sum of sines model was fitted, which reflected seasonal and cyclical fluctuations in NO₂ concentrations and allowed the identification of periods with the highest NO₂ values, especially in winter months and during traffic peaks. The results can be used to support environmental policy and decision-making on preventive measures, for example, related to traffic restrictions, as well as in sustainable urban planning and in the protection of public health and the environment, thereby contributing to the achievement of global sustainable development goals. Full article