Minor stroke needs quick medical attention, too

Agencies
July 4, 2018

Jul 4: Minor strokes and “mini-strokes,” or transient ischemic attacks (TIAs), need early medical attention, just like major strokes, but a public education campaign in the UK had little success convincing the public to act fast after these events.

“Although the campaign worked well for behavior after more major stroke, patients were still slow to act on, or ignored completely, the symptoms of minor events,” said Dr. Peter M. Rothwell from John Radcliffe Hospital, University of Oxford.

“It was almost as though the messages from the campaign about major stroke had falsely reassured them that the more minor event that they had experienced was probably nothing to worry about,” said Rothwell, senior author of a study on the campaign´s impact.

“If you have a minor ‘warning’ event, the risk of a more major stroke over the next week is about 10 percent if you are not treated,” he said in an email. “However, that risk is reduced by 80 percent if simple medical treatments are started urgently.”

If you have sudden, temporary neurological symptoms that you haven’t had before, he advises, “Don’t delay. . . get checked.”

Also, he said, “The most important immediate thing that you can do yourself if you have a ‘TIA’ is to take an aspirin (same as is advised after a suspected heart attack). Take an aspirin and seek medical attention.”

Rothwell’s team looked at the impact of the Face, Arm, Speech, Time (FAST) public education campaign on the likelihood that patients would seek medical attention within three hours of their symptoms.

The campaign warned, “When stroke strikes, act FAST. Face: has it fallen on one side? Arms: can they raise them? Speech: is it slurred? Time: if you notice any of these signs, it’s time to call (for an ambulance).”

Facial weakness, arm symptoms and speech disturbance were less common among people with minor stroke or TIA than among those with major stroke, and only about 35 percent of patients with TIAs who didn’t seek medical attention had any of these signs.

Before the campaign, about 68 percent of people with major stroke obtained medical attention within three hours; after the FAST campaign this increased to 81 percent, according to the report in JAMA Neurology.

In contrast, only about 40 percent of patients with TIA and minor stroke obtained medical attention within three hours both before and after the FAST campaign.

Surprisingly, fewer patients correctly attributed their symptoms to TIA or minor stroke after the FAST campaign (28 percent) than before it (37 percent), and 5 percent of patients did not even report their symptoms until the next routine appointment with their doctor.

“Campaigns rightly stress the need to seek emergency medical attention if you have signs of a major stroke,” Rothwell said. “The symptoms of TIA and minor stroke are very similar - but just less severe and more transient (often lasting only minutes). Current campaigns would really only need to add that message at the end of the TV advertisement or poster – ‘and don’t ignore symptoms that might be a small ‘warning stroke’ either - that is an emergency, too.’”

“For any of the stroke symptoms, major, minor, or transitory, time remains of the essence,” said Dr. Victor Loh from National University Health System, Singapore, who recently detailed the outpatient management of TIA, but was not involved in the study.

“Perhaps after the primary message of needing to head to hospital within the time window for patients with major stroke, the secondary message needs to be emphasized: that even if symptoms are mild or transitory, early review and intervention can drastically reduce the risk of a major stroke,” he said by email.

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Agencies
January 25,2020

Washington D.C., Jan 25: A new study conducted by a team of researchers reveals why individuals who have a history of early life adversity (ELA) are disproportionately prone to opioid addiction.

The study conducted examined how early adversities interact with factors such as increased access to opioids to directly influence brain development and function, causing a higher potential for opioid addiction.

The study was lead by UCI researchers and was published in Molecular Psychiatry.

Tallie Z. Baram, MD, PhD, the Danette Shepard Chair in Neurological Sciences at the UCI School of Medicine and one of the senior researchers for the study, was on the take that the widely known factor genetics that plays major role in addiction vulnerability, cannot be solely held responsible for the recent rise in opioid abuse.

To further clarify, the researchers simulated ELA in rats by limiting bedding and nesting materials during a short, postnatal period of time.

In female rats, this led to striking opioid addiction-like characteristics including an increased relapse- behaviour, for example.

As observed in addicted humans, the rats were willing to work very hard (pay a very high price) to obtain the drug.

Baram said: "Ultimately, we found that conditions during sensitive developmental periods can lead to vulnerability to the addictive effects of opioid drugs, especially in females, which is consistent with the prevalence of ELA in heroin-addicted women."

These findings can be used to highlight the importance given to sex differences in future ELA-related studies on opioid addiction, and in future prevention or intervention strategies being developed to address the growing opioid crisis.

The study conducted examined how early adversities interact with factors such as increased access to opioids to directly influence brain development and function, causing a higher potential for opioid addiction.

The study was lead by UCI researchers and was published in Molecular Psychiatry.

The study found that unpredictable, fragmented early life environments may lead to abnormal maturation of certain brain circuits, which profoundly impacts brain function and persists into adolescence and adulthood.

Tallie Z. Baram, MD, PhD, the Danette Shepard Chair in Neurological Sciences at the UCI School of Medicine and one of the senior researchers for the study, was on the take that the widely known factor genetics that plays major role in addiction vulnerability, cannot be solely held responsible for the recent rise in opioid abuse.

To further clarify, the researchers implanted ELA in rats by limiting bedding and nesting materials during a short, postnatal period of time.

In female rats, this led to striking opioid addiction-like characteristics including an increased relapse- behaviour, for example.

As observed in addicted humans, the rats were willing to work very hard (pay a very high price) to obtain the drug.

Baram said: "Ultimately, we found that conditions during sensitive developmental periods can lead to vulnerability to the addictive effects of opioid drugs, especially in females, which is consistent with the prevalence of ELA in heroin-addicted women."

These findings can be used to highlight the importance given to sex differences in future ELA-related studies on opioid addiction, and in future prevention or intervention strategies being developed to address the growing opioid crisis.

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Agencies
June 11,2020

The World Health Organisation (WHO) Director-General Tedros Adhanom Ghebreyesus said that more research needs to be done to better understand the extent to which COVID-19 is being spread by people who don't show symptoms.

"Since early February, we have said that asymptomatic people can transmit COVID-19, but that we need more research to establish the extent of asymptomatic transmission," the WHO chief said at a virtual press conference from Geneva on Wednesday, Xinhua news agency reported.

"That research is ongoing, and we're seeing more and more research being done," he added.

Saying that the world has been achieving a lot in knowing the new virus, the WHO chief told reporters that "there's still a lot we don't

"WHO's advice will continue to evolve as new information becomes available," he said.

Tedros stressed that the most critical way to stop transmission is to find, isolate and test people with symptoms, and trace and quarantine their contacts.

"Many countries have succeeded in suppressing transmission and controlling the virus doing exactly this," Tedros said.

Meanwhile, Michael Ryan, executive director of WHO Health Emergencies Program, said Wednesday that the COVID-19 pandemic is still evolving.

"If we look at the numbers... this pandemic is still evolving. It is growing in many parts of the world," he said. "We have deep concerns that health systems of some countries are struggling, under a huge strain and require our support, our help and our solidarity."

He said "each and every country has a different combination of risks and opportunities, and it's really down to national authorities to carefully consider where they are in the pandemic."

In Europe, the risk issue now are about travels and the opening of the schools, around risk management, mass gathering, surveillance and contact tracing, said the WHO official.

In Southeast Asian countries, where to a great extent transmissions have been under control, governments are more concerned about the re-emergence of clusters, while in South America, the issue of PPE for health workers has not gone away, said Ryan.

As regards Africa, Ryan said the death rates have been very low in the past week, but the health system can be overwhelmed, as it would have to cope with other diseases such as malaria.

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Agencies
January 26,2020

High-protein diets may help people lose weight and build muscle, but there is a downside to it --a greater heart attack risk. Researchers now report that high-protein diets boost artery-clogging plaque.

The research in mice showed that high-protein diets spur unstable plaque -- the kind most prone to rupturing and causing blocked arteries.

More plaque buildup in the arteries, particularly if it's unstable, increases the risk of heart attack.

"There are clear weight-loss benefits to high-protein diets, which has boosted their popularity in recent years," said senior author Babak Razani, associate professor at Washington University School of Medicine in St. Louis, Missouri.

"But animal studies and some large epidemiological studies in people have linked high dietary protein to cardiovascular problems. We decided to take a look at whether there is truly a causal link between high dietary protein and poorer cardiovascular health," Razani added.

The researchers studied mice who were fed a high-fat diet to deliberately induce atherosclerosis, or plaque buildup in the arteries.

Some of the mice received a high-fat diet that was also high in protein. And others were fed a high-fat, low-protein diet for comparison.

The mice on the high-fat, high-protein diet developed worse atherosclerosis -- about 30 per cent more plaque in the arteries -- than mice on the high-fat, normal-protein diet, despite the fact that the mice eating more protein did not gain weight, unlike the mice on the high-fat, normal-protein diet.

"A couple of a scoop of protein powder in a milkshake or smoothie adds something like 40 grams of protein -- almost equivalent to the daily recommended intake," Razani said.

"To see if protein has an effect on cardiovascular health, we tripled the amount of protein that the mice receive in the high-fat, high-protein diet -- keeping the fat constant. Protein went from 15 per cent to 46 per cent of calories for these mice".

Plaque contains a mix of fat, cholesterol, calcium deposits and dead cells. Past work by Razani's team and other groups has shown that immune cells called macrophages work to clean up plaque in the arteries.

But the environment inside plaque can overwhelm these cells, and when such cells die, they make the problem worse, contributing to plaque buildup and increasing plaque complexity.

"In mice on the high-protein diet, their plaques were a macrophage graveyard," Razani informed.

To understand how high dietary protein might increase plaque complexity, Razani and his colleagues also studied the path protein takes after it has been digested -- broken down into its original building blocks, called amino acids.

"This study is not the first to show a telltale increase in plaque with high-protein diets, but it offers a deeper understanding of the impact of high protein with the detailed analysis of the plaques," said Razani.

"This work not only defines the critical processes underlying the cardiovascular risks of dietary protein but also lays the groundwork for targeting these pathways in treating heart disease," he added.

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