Introduction: It is well known that in the first 24 h after stroke onset, plasma glucose concentrations are elevated in 20–43% of patients, of whom more than half are not known to have diabetes mellitus. Glucose levels >8 mmol/l have been found to be predictive of a poor prognosis in ischemic stroke patients. It is thought that the clinical use of insulin infusions has a beneficial effect on hyperglycemia. Indeed, insulin therapy in critically ill patients, including acute stroke patients, is safe and results in lower mortality and complication rates. Unfortunately, the impact of intensive insulin therapy in non-critically ill patients with hyperglycemia is poorly understood. Objectives: It was the aim of this study to determine the clinical efficacy and safety of early-onset therapy with human recombinant insulin: glycemic control measured by reduction in plasma glucose concentrations, vital activity measured by the Barthel index (no significant disability was defined as ≤50, moderate disability was defined as 51–75, and severe disability was defined as ≧75), and neurological deficit measured by the National Institutes of Health Stroke Scale (NIHSS; values ranging from 0 = normal to 42 = worst case) in non-critically ill ischemic stroke diabetic and non-diabetic patients. Design: We used a randomized prospec- tive open trial of insulin-potassium-saline-magnesium (IPSM) infusions in patients after acute ischemic stroke presenting with mild to moderate hyperglycemia. Acute (<24 h) ischemic stroke patients (n = 128) with hyperglycemia on admission between 7.0 and 16 mmol/l with and without type 2 diabetes mellitus (T2DM) were randomly divided into four groups: (1) hyperglycemia associated with T2DM and treated with IPSM (n = 36), (2) hyperglycemia associated with T2DM without IPSM administration (n = 40), (3) hyperglycemia without confirmed T2DM and treated with IPSM (n = 25), and (4) hyperglycemia without confirmed T2DM and without IPSM administration (n = 27). Results: Treatment with the IPSM regimen permitted to normalize blood glucose levels. The neurological deficit according to the NIHSS in stroke patients with hyperglycemia treated with insulin did not worsen in the first 3 days. Results were expressed as means ± SD of NIHSS scores at admission and at day 30. At the same time, the clinical status of patients not treated with insulin worsened. Three weeks after admission, the neurological deficit improved in treated stroke patients (13.5 ± 1.5 and 8.6 ± 1.1, respectively; p < 0.05) and untreated patients with T2DM (13.2 ± 1.7 and 8.9 ± 1.3; p < 0.05). However, the neurological deficit in stroke patients without T2DM, but with hyperglycemia not treated with insulin did not improve significantly (14.4 ± 1.5 and 10.1 ± 1.0, respectively; p > 0.05). Administration of IPSM led to a significant improvement in the neurological status (14.6 ± 1.5 and 8.9 ± 1.3; p < 0.05). Conclusions: Insulin therapy (IPSM infusion) is a safe and effective approach to normalize blood glucose levels after ischemic stroke. Administrati...
Objective: We determined the plasma protein C and coagulation factor X activities, prothrombin, fibrinogen and soluble fibrin monomer complex (SFMC) content and performed the haemostatic screening coagulation time tests under acute ischemic stroke patients with or without type 2 diabetes mellitus, as well as evaluated the significance of biochemical haemostatic markers as predictors of mortality in stroke regardless of diabetes presence. Methods: The baseline data were collected from 87 patients during the admission. Neurological disturbances were assessed using the NIH stroke scale. The functional outcome was estimated using Barthel index. All patients underwent fibrinogen and SFMC (gravimetric methods), prothrombin level (ELISA), plasma protein C and coagulation factor X activity assessment, haemostatic screening coagulation time tests with coagulation analyzer, glucose and glycosylated hemoglobin content and BMI (body mass index) measurements. Results: The conducted research had established the changes of fibrinogen and SFMC levels in both investigated patient groups comparing to the control. The protein C activity was found to be significantly decreased in blood of patients with ischemic stroke with and without diabetes. There were differences in factor X activity change in patients with stroke only comparing with patients with diabetes and stroke and high level of this parameter as well as the increase in SFMC can be regarded as death predictors of stroke independently of diabetes mellitus presence. Conclusion: Among ischemic stroke patients with type 2 diabetes mellitus the differences were more significant for all Time tests of the coagulation cascade, but deviations of haemostatic biochemical markers were more pronounced in ischemic stroke patients without diabetes mellitus.
Introduction: The research of biological properties of enteroviruses associated with ischemic stroke (IS) allows us to identify their intratypic differences. The aim: to identify genetic markers of strains of enteroviruses associated with IS. Materials and methods: 11 strains of enteroviruses isolated from the serum of patients with IS were identified in the virus neutralization test. Genetic markers of isolated strains (Abent, marker S, marker rct40) were determined. Results: Eleven strains of enteroviruses were isolated from the serum of patients with IS. Eight viruses: Coxsackie B viruses (serotypes 2, 3, 4) and ECHO viruses (serotypes 6, 9, 27 (two strains), 29) were identified in these strains. Other three strains of enteroviruses were unidentified. Different combinations of genetic markers were found. Seven strains of enteroviruses (Coxsackie B2, B3, ECHO 6, ECHO 9, ECHO 27 (two strains) and one unidentified virus) had virulence markers: Abent–, rct40+ and S−. Three strains (Coxsackie B4, ECHO 29, one unidentified virus) had markers: Abent–, rct40+, S+. Another one unidentified virus had markers: Abent+, rct40+, S –. Conclusions: All 11 isolates of enteroviruses associated with IS had rct40+ marker, 10 of the 11 isolates had marker Abent– and 8 of 11 isolates had marker S–. The research of genetic markers allows to perform typic and intratypic differentiation of strains of enteroviruses associated with the IS.
Background: Immunoglobulin G (IgG) is a major immunoglobulin (Ig) in blood that accumulates to a greater extent in the bloodstream of patients impacted by neuroimmunological disorders such as multiple sclerosis (MS). The aim of this study was to determine the effect of IgG obtained from MS patients on the amidolytic activity of coagulation and on anticoagulation factors, and to compare those effects to the effects of IgG from healthy donors. Methods: Spectrophotometric hydrolysis of specific chromogenic substrate by key haemostasis factors was examined. Results: Our study shows that unlike healthy individuals, patients suffering from MS express IgG which enhances the amidolytic activity of thrombin and protein C, but inhibits the activity of factor Xa. Conclusion: Our study shows that IgG and coagulation factors, indeed, interact with each other. IgG may be key mediators of neuroinflammation and, therefore, may serve as a potential target for therapeutic strategies for MS and other neuroimmunological diseases.
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