The Time Course and Determinants of Temperature within the First 48 h after Ischaemic Stroke

Wong, Andrew; Davis, James P.; Schluter, Philip J.; Henderson, Robert D.; O’Sullivan, John D.; Read, Stephen

doi:10.1159/000103124

Cited by 24 publications

(28 citation statements)

References 38 publications

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“…The individual outcome depends on age, gender, stroke severity and comorbidity [1,2,3,4,5,6,7,8,9,10,11]. Infections such as urinary tract infection and especially pneumonia are serious complications after stroke [1, 6, 7, 9,12,13,14,15,16,17,18,19]. They have been reported to occur in 5–65% of patients after acute stroke, but in these studies, the length of follow-up, baseline risk and clinical definitions vary widely [1, 2, 4,6,7,8,9,10, 12,20,21,22,23,24,25,26,27].…”

Section: Introductionmentioning

confidence: 99%

Stroke-Associated Infection Is an Independent Risk Factor for Poor Outcome after Acute Ischemic Stroke: Data from the Netherlands Stroke Survey

et al. 2009

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Background: Infections are a common and serious threat to patients with acute ischemic stroke. The aim of this study was to assess the effect of infection on mortality and functional outcome at discharge and at 1 year. Methods: From a consecutive cohort study in 11 centers, the Netherlands Stroke Survey, we selected 521 patients with ischemic stroke admitted to hospital within 48 h of onset. Stroke-associated infection was defined as infection occurring within 7 days after admission. Poor outcome (modified Rankin score >2) was recorded at discharge and at 1 year. Results: Stroke-associated infection occurred in 78 patients (15%); 39 of these (7.5%) had pneumonia and 23 (4.4%) had urinary tract infection. Overall, 276 patients (53%) had a poor outcome at 1 year. Poor outcome was recorded in 69 patients with stroke-associated infection (88%), and 37 of the 78 patients with stroke-associated infection (47%) had died at 1 year. After adjustment for confounders, stroke-associated infection was associated with poor outcome at discharge [odds ratio (OR) 2.6, 95% confidence interval (CI) 1.0–6.7] and at 1 year (OR 3.8, 95% CI 1.8–8.9). Pneumonia had a stronger association with poor outcome at 1 year (OR 10, 95% CI 2.2–46). Conclusions: This study suggests that stroke-associated infection, in particular pneumonia, is independently associated with poor functional outcome after ischemic stroke.

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Section: Introductionmentioning

confidence: 99%

Stroke-Associated Infection Is an Independent Risk Factor for Poor Outcome after Acute Ischemic Stroke: Data from the Netherlands Stroke Survey

et al. 2009

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“…Both linear and quadratic relationship between time and blood glucose was investigated to allow for nonlinear relationships suggested previously. 16,17 The appropriateness of variables within each model were determined by type III F-tests.…”

Section: Discussionmentioning

confidence: 99%

“…Other aspects of this cohort have been analyzed and published in the past. [17][18][19] Informed consent was obtained from the participant or next of kin when the participant was unable to provide consent due to premorbid or stroke-related impairments.…”

Section: Discussionmentioning

confidence: 99%

Natural history of blood glucose within the first 48 hours after ischemic stroke

Wong¹,

Schluter²,

Henderson³

et al. 2008

Neurology

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Background: Despite suggestions that glucose levels rise after stroke before falling within a few hours, the natural history and determinants of this phenomenon remain unclear. We aimed to better characterise the time course of changes in glucose levels after ischemic stroke and to identify factors that affect post-stroke glycemia. Methods: Ischemic stroke patients without previously diagnosed diabetes had blood glucose measured at least 4-hourly until 48 hours post-stroke. The relationship between baseline factors, such as the NIHSS, and blood glucose was assessed with mixed-effect models. The behaviour of glucose over time was modelled in the whole cohort, and for the cohort partitioned into two around an admission glucose of 6.0 mmol/L. Results: In the cohort of 124 patients the mean glucose was 5.7 mmol/L throughout the period of monitoring, with no change over time. Mixed-effects models identified more severe stroke and glucose-lowering therapy to be associated with higher post-stroke glucose levels. When the cohort was partitioned, the mean glucose of those below 6.0 mmol/L at admission increased and the mean glucose of those above 6.0 mmol/L at admission decreased to the overall mean. Conclusions: Mean glucose levels remain static in ischemic stroke patients without diabetes until at least 48 hours post-stroke. Serial glucose levels are higher in patients with more severe stroke. Initially high or low mean glucose recordings exhibit regression to the mean over time, a change which may merely be a statistical phenomenon without necessarily indicating resolution of abnormal glycemia. Background: The role of elevated blood pressure (BP) in determining prognosis after spontaneous intracerebral haemorrhage (ICH) is highly controversial , with arguments both for and against early BP lowering. Aims: We undertook an exploratory preliminary analysis of blinded data in the vanguard (initial) phase of the INTERACT study, an open label, multi-centre, randomised controlled trial of early intensive BP lowering in 404 patients with ICH. Our aim was to determine the role of initial BP and other baseline factors associated with early haematoma growth. Methods: Complete data were available in 280 patients with baseline (<6 hours) and 24 hour follow-up CT in order to develop a logistic regression model that included various potential baseline variables as predictors of 'significant' (>33% of total ICH volume) haematoma growth. Age, sex and time to presentation were included in the model as potential confounders. Results: Baseline systolic BP was significantly associated with haematoma growth (higher systolic BP with increased growth). The odds of increased growth with a 10 mmHg increase in systolic BP were 1.27 (P < 0.05). Other significant predictors included high NIHSS scores (high scores with increased growth), time from onset to baseline CT (early baseline CT with increased growth), haematoma volume (smaller volumes with increased growth) and oedema volume (larger volumes with increased growth). Conclusion: We report, f...

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“…Paracetamol is currently undergoing phase II clinical trial for the acute treatment of stroke [39]. This is because of the anti-febrile effects of paracetamol [40], which can counter act post-stroke hyperthermia [41]. The ability of hypothermia to protect the brain during oxidative stress is well known [42].…”

Section: The Future Of Pro-drug Indirect Cannabimi-metics?mentioning

confidence: 99%

Pro-Drugs for Indirect Cannabinoids as Therapeutic Agents

Ashton

2008

CDD

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Medicinal cannabis, cannabis extracts, and other cannabinoids are currently in use or under clinical trial investigation for the control of nausea, emesis and wasting in patients undergoing chemotherapy, the control of neuropathic pain and arthritic pain, and the control of the symptoms of multiple sclerosis. The further development of medicinal cannabinoids has been challenged with problems. These include the psychoactivity of cannabinoid CB1 receptor agonists and the lack of availability of highly selective cannabinoid receptor full agonists (for the CB1 or CB2 receptor), as well as problems of pharmacokinetics. Global activation of cannabinoid receptors is usually undesirable, and so enhancement of local endocannabinoid receptor activity with indirect cannabimimetics is an attractive strategy for therapeutic modulation of the endocannabinoid system. However, existing drugs of this type tend to be metabolized by the same enzymes as their target endocannabinoids and are not yet available in a form that is clinically useful. A potential solution to these problems may now have been suggested by the discovery that paracetamol (acetaminophen) exerts its analgesic (and probably anti-pyretic) effects by its degradation into an anandamide (an endocannabinoid) reuptake inhibitor (AM404) within the body, thus classifying it as pro-drug for an indirect cannabimimetic. Given the proven efficacy and safety of paracetamol, the challenge now is to develop related drugs, or entirely different substrates, into pro-drug indirect cannabimimetics with a similar safety profile to paracetamol but at high effective dose titrations.

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The Time Course and Determinants of Temperature within the First 48 h after Ischaemic Stroke

Cited by 24 publications

References 38 publications

Stroke-Associated Infection Is an Independent Risk Factor for Poor Outcome after Acute Ischemic Stroke: Data from the Netherlands Stroke Survey

Stroke-Associated Infection Is an Independent Risk Factor for Poor Outcome after Acute Ischemic Stroke: Data from the Netherlands Stroke Survey

Natural history of blood glucose within the first 48 hours after ischemic stroke

Pro-Drugs for Indirect Cannabinoids as Therapeutic Agents

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