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Search Results (179)

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Keywords = stroke-epidemiology

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39 pages, 1388 KiB  
Review
Neuroprotective Effects of Metformin Through the Modulation of Neuroinflammation and Oxidative Stress
by Sarah Reed, Equar Taka, Selina Darling-Reed and Karam F. A. Soliman
Cells 2025, 14(14), 1064; https://doi.org/10.3390/cells14141064 - 11 Jul 2025
Viewed by 804
Abstract
Epidemiological studies have shown that individuals with type 2 diabetes have an increased risk of developing neurodegenerative diseases. These diseases and type 2 diabetes share several risk factors. Meanwhile, the antidiabetic drug metformin offers promising neuroprotective effects by reducing oxidative stress and neuroinflammation, [...] Read more.
Epidemiological studies have shown that individuals with type 2 diabetes have an increased risk of developing neurodegenerative diseases. These diseases and type 2 diabetes share several risk factors. Meanwhile, the antidiabetic drug metformin offers promising neuroprotective effects by reducing oxidative stress and neuroinflammation, two significant factors in neurodegenerative diseases. This review examines the mechanisms by which metformin mitigates neuronal damage. Metformin reduces neuroinflammation by inhibiting microglial activation and suppressing proinflammatory cytokines. It also triggers the nuclear factor erythroid-2-related factor-2 (Nrf2) pathway to combat oxidative stress, an essential regulator of antioxidant defenses. These outcomes support the possible neuroprotective roles of metformin in type 2 diabetes-related cognitive decline and conditions like Alzheimer’s disease. Metformin’s therapeutic potential is further supported by its capacity to strengthen the blood–brain barrier’s (BBB’s) integrity and increase autophagic flux. Metformin also offers several neuroprotective effects by targeting multiple pathological pathways. Moreover, metformin is being studied for its potential benefits beyond glycemic control, particularly in the areas of cognition, Alzheimer’s disease, aging, and stroke management. Evidence from both clinical and preclinical studies indicates a complex and multifaceted impact, with benefits varying among populations and depending on underlying disease conditions, making it an appealing candidate for managing several neurodegenerative diseases. Full article
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14 pages, 1250 KiB  
Article
Stroke Risk Stratification in Incident Atrial Fibrillation: A Sex-Specific Evaluation of CHA2DS2-VA and CHA2DS2-VASc
by Jose L. Clua-Espuny, Anna Panisello-Tafalla, Jorgina Lucas-Noll, Eulàlia Muria-Subirats, Teresa Forcadell-Arenas, Juan M. Carrera-Ortiz, Pedro Molto-Balado, Josep Clua-Queralt, Immaculada Fusté-Anguera and Silvia Reverte-Vilarroya
J. Cardiovasc. Dev. Dis. 2025, 12(7), 259; https://doi.org/10.3390/jcdd12070259 - 5 Jul 2025
Viewed by 516
Abstract
(1) Background: In the absence of locally validated tools, the CHA2DS2-VA score has been suggested as a substitute for the CHA2DS2-VASc score. This study compared the potential discrepancies between these scores. (2) Methods: The observational, retrospective, and community-based study included a cohort of [...] Read more.
(1) Background: In the absence of locally validated tools, the CHA2DS2-VA score has been suggested as a substitute for the CHA2DS2-VASc score. This study compared the potential discrepancies between these scores. (2) Methods: The observational, retrospective, and community-based study included a cohort of 3370 patients with a new diagnosis of atrial fibrillation (AF) between 1 January 2015 and 31 December 2024. (3) Results: AF prevalence was 8.4%, which was significantly higher in men. The mean age was 80.1 (SD ± 6.24) years. Women (42.8%) were older (80.9 SD ± 6.1 vs. 79.5 SD ± 6.23; p < 0.001). Men had more instances of diabetes mellitus, peripheral vascular disease, coronary artery disease, and chronic obstructive pulmonary disease, as well as a higher Charlson Comorbidity Index. Conversely, women exhibited a higher proportion ≥75 years, including cognitive impairment, dyslipidemia, and higher stroke risk, as assessed by the CHA2DS2-VASc score (p < 0.001) but not by the CHA2DS2-VA score (p = 0.071). The CHA2DS2-VA score reduced the sex-based risk stratification differences, and only 3.2% of women were reclassified as being at very low risk (CHA2DS2-VA < 2). (4) Conclusions: The CHA2DS2-VA score notably redefined sex-based thromboembolic risk stratification profiles, with no sex-based disparities in the selection of OAC treatment modality. The clinical utility of CHA2DS2-VA remains a subject of ongoing debate. Full article
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11 pages, 379 KiB  
Article
Proportional Stroke Mortality in Espírito Santo, Brazil: A 20-Year Joinpoint Regression Study
by Casanova André Motopa Mpuhua, Orivaldo Florencio de Souza, Blanca Elena Guerrero Daboin, Italla Maria Pinheiro Bezerra, Marcelino Na Blei, Thiago Dias Sarti, Vithor Ely Bortolin da Silva and Luiz Carlos de Abreu
Epidemiologia 2025, 6(2), 28; https://doi.org/10.3390/epidemiologia6020028 - 19 Jun 2025
Viewed by 840
Abstract
Introduction: Stroke is one of the leading causes of death and disability worldwide. In Brazil, it remains the primary cause of mortality among adults. Although overall stroke mortality rates have declined, the absolute number of stroke incidents, deaths, and years of life loss [...] Read more.
Introduction: Stroke is one of the leading causes of death and disability worldwide. In Brazil, it remains the primary cause of mortality among adults. Although overall stroke mortality rates have declined, the absolute number of stroke incidents, deaths, and years of life loss continues to rise, particularly in developing and underdeveloped countries. Objective: The aim of this study was to analyze trends in stroke mortality across different age groups and both sexes in Espírito Santo, Brazil, from 2000 to 2021. Methods: This ecological time series study utilized secondary data from Espírito Santo, Brazil, from 2000 to 2021. Mortality data, categorized by sex and age group, were obtained from the Department of Informatics of the Unified Health System (DATASUS) database. Stroke-related mortality included deaths recorded under the International Classification of Diseases, 10th Revision (ICD-10) codes for subarachnoid hemorrhage (I60), intracerebral hemorrhage (I61), cerebral infarction (I63), and stroke not specified as hemorrhagic or ischemic (I64). Temporal trends in stroke mortality were assessed using joinpoint regression analysis. Results: From 2000 to 2021, there was a significant reduction in proportional mortality from stroke, with an overall decrease of −3.7% (p < 0.001). When analyzed by sex, the decline was −3.0% (p < 0.001) for males and −3.9% (p < 0.001) for females. The most significant decrease in proportional mortality was observed in the 50 to 59 age group, with an average annual percentage change of −4.9% (p < 0.001). The 30 to 39 age group exhibited the smallest decline, with an average annual percentage change of −2.4% (p < 0.001). No significant segments were observed in the 40 to 49, 60 to 69, and 70 to 79 age groups during the study period. Conclusions: This study identified a notable decline in stroke-related proportional mortality in the adult population of Espírito Santo between 2000 and 2021. While males had a higher absolute number of deaths, females exhibited a higher proportional mortality rate, underscoring the need for targeted preventive measures and effective acute stroke treatment, particularly among men. Full article
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19 pages, 266 KiB  
Article
Characteristics of Neonates with Sepsis Associated with Antimicrobial Resistance and Mortality in a Tertiary Hospital in Mexico: A Retrospective Observational Study
by Uriel A. Angulo-Zamudio, Maria Luisa Velazquez-Meza, Jesus J. Martinez-Garcia, Nidia Leon-Sicairos, Jorge Velazquez-Roman, Hector Flores-Villaseñor, Claudia Leon-Sicairos, Francisco A. Martínez-Villa and Adrian Canizalez-Roman
Pathogens 2025, 14(6), 588; https://doi.org/10.3390/pathogens14060588 - 14 Jun 2025
Viewed by 921
Abstract
The objective of this study was to determine the epidemiological, clinical, and laboratory characteristics of newborns with sepsis in northwestern Mexico, identify the microorganisms causing early- and late-onset sepsis, and assess antimicrobial resistance. Additionally, it sought to associate neonatal characteristics with antimicrobial resistance [...] Read more.
The objective of this study was to determine the epidemiological, clinical, and laboratory characteristics of newborns with sepsis in northwestern Mexico, identify the microorganisms causing early- and late-onset sepsis, and assess antimicrobial resistance. Additionally, it sought to associate neonatal characteristics with antimicrobial resistance or mortality. A retrospective study was conducted from August 2021 to April 2023, during which 8382 neonatal clinical records were analyzed to collect epidemiological, clinical, and laboratory characteristics, as well as microorganisms isolated from neonates and their antimicrobial resistance profiles. Of these, 314 neonates with sepsis were included. The incidence of neonatal sepsis was 4% (314/8382), and the mortality was 12.7% (40/314); late-onset sepsis (65.3%) was more frequent than early-onset sepsis (34.7%). Staphylococcus epidermidis was the most frequently isolated bacterium in neonates with sepsis (both early- and late-onset). Gram-positive bacteria, such as Staphylococcus hominis and Enterococcus faecium, were associated with early-onset sepsis, whereas fungi, particularly Candida albicans, were associated with late-onset sepsis. Of the microorganisms, 52.6% were multidrug resistant (MDR), 10.8% were extensively drug resistant (XDR), and 5.5% were pan-drug resistant (PDR). Low birth weight, prematurity, cesarean section, mechanical ventilation, tachycardia, and low hemoglobin and platelet levels, among others, were associated with XDR or MDR microorganisms. In contrast, low birth weight, mechanical ventilation, stroke, unexpected delivery, respiratory distress, tachycardia, convulsive crisis, high procalcitonin, urea, and AST/TGO levels, among others, were associated with mortality. The incidence, types of sepsis, antimicrobial resistance, and associations identified in this study will aid in diagnosing neonatal sepsis earlier and may reduce mortality in our region. Full article
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11 pages, 501 KiB  
Article
Association of Sarcopenia and Visceral Obesity with Clinical Outcomes Among Older Adults with Cardiovascular Disease: A Retrospective Cohort Study
by Hye-Jin Yoon, Keon-Woo Park and Young-Hoon Seo
J. Clin. Med. 2025, 14(12), 4191; https://doi.org/10.3390/jcm14124191 - 12 Jun 2025
Viewed by 930
Abstract
Background/Objectives: The clinical implications of sarcopenia and visceral obesity in patients with cardiovascular disease (CVD) are poorly understood. We evaluated the impact of sarcopenia and visceral obesity on clinical outcomes among older adults with CVD. Methods: This retrospective cohort study included patients aged [...] Read more.
Background/Objectives: The clinical implications of sarcopenia and visceral obesity in patients with cardiovascular disease (CVD) are poorly understood. We evaluated the impact of sarcopenia and visceral obesity on clinical outcomes among older adults with CVD. Methods: This retrospective cohort study included patients aged 65 years and older who had cardiovascular disease and had undergone body composition analysis using dual-energy X-ray absorptiometry (DXA) between November 2021 and October 2022 and been followed through February 2024. Sarcopenia was defined using the 2019 Asian Working Group for Sarcopenia criteria, and visceral obesity was defined using Korean sex-specific visceral adipose tissue area. The primary outcome was a composite of all-cause mortality and major cardiovascular events, including myocardial infarction, stroke, hospitalization for heart failure, and coronary revascularization. This study followed the Strengthening the Reporting of Observational Studies in Epidemiology reporting guidelines. Results: A total of 317 patients were included, of whom 118 patients (37.2%) had sarcopenia, 184 (58.0%) had visceral obesity, and 55 (17.4%) had sarcopenic obesity. The prevalence of sarcopenia or visceral obesity was 93.8% in patients with obesity and 69.3% in those without obesity. Sarcopenic obesity showed a mixture of characteristics of two metabolic conditions in terms of demographics and body mass index. Sarcopenia was associated with an increased risk of primary outcomes (hazard ratio [HR], 1.93; 95% CI, 1.02–3.66), with the highest risk observed in patients with sarcopenic obesity (HR, 6.74; 95% CI, 1.81–25.16). Conclusions: Sarcopenia was associated with 1.9-fold increased risk of cardiovascular events among older adults with CVD, with a greater than 6-fold increased risk when combined with visceral obesity. Full article
(This article belongs to the Special Issue Cardiovascular Disease in the Elderly: Prevention and Diagnosis)
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8 pages, 351 KiB  
Brief Report
Screening for Post-Stroke Cognitive Impairment in Sub-Saharan Africa: A Good IDEA?
by Fode Abass Cissé, Yannick Fogoum Fogang, Male Dore and Gilles Naeije
Brain Sci. 2025, 15(6), 543; https://doi.org/10.3390/brainsci15060543 - 22 May 2025
Viewed by 471
Abstract
Background: Post-stroke cognitive impairment (PSCI) remains under-recognized in Sub-Saharan Africa (SSA), in part due to the lack of validated cognitive screening tools adapted to low-literacy populations. We aimed to validate the Identification of Dementia in Elderly Africans (IDEA) cognitive screen in SSA and [...] Read more.
Background: Post-stroke cognitive impairment (PSCI) remains under-recognized in Sub-Saharan Africa (SSA), in part due to the lack of validated cognitive screening tools adapted to low-literacy populations. We aimed to validate the Identification of Dementia in Elderly Africans (IDEA) cognitive screen in SSA and assess its utility for detecting PSCI in Guinea and Cameroon. Methods: Normative IDEA scores were derived from a control cohort of healthy older adults in Conakry (Guinea) and Bafoussam (Cameroon). The tool was then applied to consecutive stroke patients from the same hospitals within one month of stroke onset. Demographic, clinical, and vascular risk profiles were collected. Between-group comparisons were performed using Welch’s t-tests and chi-square tests. Results: Among 91 healthy controls (median age: 64), the mean IDEA score was 12 ± 2.4. A cut-off of ≤7 (2 standard deviations below the mean) was defined for cognitive impairment. Among 111 stroke patients (median age: 65; mean NIHSS: 9.9 ± 5.8), the mean IDEA score was 9.6 ± 3.2, and 31 patients (28%) had scores ≤ 7. Stroke patients had significantly higher rates of hypertension and diabetes compared to controls. Conclusions: The IDEA screen appears to be a feasible and effective tool for detecting PSCI in SSA clinical settings. The 28% prevalence of cognitive impairment aligns with data from high-income countries, supporting the broader use of the IDEA to strengthen cognitive care pathways in SSA stroke populations. Full article
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22 pages, 1375 KiB  
Article
Network Approach to Evaluate the Effect of Diet on Stroke or Myocardial Infarction Using Gaussian Graphical Model
by Jaca Maison Lailo, Jiae Shin, Giulia Menichetti and Sang-Ah Lee
Nutrients 2025, 17(10), 1605; https://doi.org/10.3390/nu17101605 - 8 May 2025
Viewed by 719
Abstract
Background/Objectives/Methods: Current research on the link between diet and stroke or myocardial infarction primarily focuses on individual food items. However, people’s eating habits involve complex combinations of various foods. By employing an innovative approach known as the Gaussian graphical model to identify dietary [...] Read more.
Background/Objectives/Methods: Current research on the link between diet and stroke or myocardial infarction primarily focuses on individual food items. However, people’s eating habits involve complex combinations of various foods. By employing an innovative approach known as the Gaussian graphical model to identify dietary patterns along with the Cox proportional model, the study aimed to identify dietary networks and explore their relationship with the incidence of stroke and/or myocardial infarction in the Korean population. The research utilized data from 84,729 participants in the Korean Genome and Epidemiological Study (KoGES), including the HEXA cohort (61,140 participants), CAVAS cohort (15,419 participants), and Ansan-Ansung cohort (8170 participants). Results: The network identified five dietary patterns or communities consisting of different food groups, while nine food groups did not belong to any community. The High-Protein and Green Tea Community consistently reduced the risk of stroke and myocardial infarction (MI), particularly among females. In most communities, no significant associations with stroke risk were noted in males, and the Rice and High-Calorie Beverages Community was linked to an increased risk of MI in both the total population and females. Conclusions: Dietary patterns derived from network analysis revealed distinct dietary habits in the Korean population, offering new insights into the relationship between diet and the risk of stroke and MI. Full article
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13 pages, 265 KiB  
Review
COVID-19 and Diabetes: Persistent Cardiovascular and Renal Risks in the Post-Pandemic Landscape
by Tzu-Shan Huang, Jo-Yen Chao, Ho-Hsiang Chang, Wei-Ren Lin and Wei-Hung Lin
Life 2025, 15(5), 726; https://doi.org/10.3390/life15050726 - 30 Apr 2025
Cited by 1 | Viewed by 1064
Abstract
The Coronavirus Disease 2019 (COVID-19) pandemic, caused by Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2), disproportionately affects individuals with diabetes mellitus (DM) by exacerbating cardiovascular and renal complications. This increased risk is mediated through immune dysfunction, chronic inflammation, hyperglycemia, dysregulation of renin-angiotensin system [...] Read more.
The Coronavirus Disease 2019 (COVID-19) pandemic, caused by Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2), disproportionately affects individuals with diabetes mellitus (DM) by exacerbating cardiovascular and renal complications. This increased risk is mediated through immune dysfunction, chronic inflammation, hyperglycemia, dysregulation of renin-angiotensin system dysregulation, endothelial dysfunction, and hypercoagulability. Epidemiological studies indicate a two-fold increased risk of stroke and end-stage renal disease in SARS-CoV-2-infected individuals with diabetes, along with a 60% higher risk of cardiovascular disease. While antidiabetic therapies like sodium-glucose cotransporter-2 inhibitors and glucagon-like peptide-1 receptor agonists show potential protective effects, insulin use in hospitalized patients is linked to higher mortality. Vaccination is crucial in reducing severe COVID-19 outcomes and mitigating post-infection complications, including new-onset diabetes. While concerns exist regarding vaccine-associated nephropathy and thromboembolic events, these risks are thought to be minimal compared to the benefits. As COVID-19 shifts to an endemic phase, the long-term renal and cardiovascular outcomes in patients with DM remain uncertain, highlighting the urgent need for continued research and targeted management strategies. Full article
(This article belongs to the Special Issue Human Health Before, During, and After COVID-19)
14 pages, 1269 KiB  
Article
Impact of the Recanalization Level and the First-Pass Effect on Functional Outcomes in Patients After M2 MCA Occlusion Thrombectomy
by Stefan Pataky, Jakub Fedorko, Piotr Pedowski, Matej Skorvanek and Zuzana Gdovinova
J. Clin. Med. 2025, 14(8), 2563; https://doi.org/10.3390/jcm14082563 - 8 Apr 2025
Viewed by 702
Abstract
Objective: Acute ischemic stroke (AIS) remains one of the most common causes of death and disability in the world. Mechanical thrombectomy (MT) is the modality of choice in the treatment of AIS and large vessel occlusion (LVO). The endovascular treatment of medium [...] Read more.
Objective: Acute ischemic stroke (AIS) remains one of the most common causes of death and disability in the world. Mechanical thrombectomy (MT) is the modality of choice in the treatment of AIS and large vessel occlusion (LVO). The endovascular treatment of medium and distal vessel occlusions (DMVO) is currently under intensive scientific investigation. The aim of our study was to prove the feasibility, effectiveness and safety of MT in patients with a primary, isolated occlusion of the M2 segment of the middle cerebral artery (MCA), with a focus on the recanalization level and the first-pass effect (FPE) as predictors. Methods: We prospectively assessed patients after MT for primary isolated occlusion of the M2 MCA segment that were treated at our center during a three-year period between July 2021 and June 2024. Our final cohort included 137 patients who met the inclusion criteria. Epidemiological, clinical and technical data, as well as the clinical and safety outcomes of MT procedures, were recorded and analyzed. The primary outcome was defined as a modified Rankin scale (mRS) score of 0–2. Secondary outcomes included excellent functional independence (mRS 0–1) and successful recanalization, defined by a modified thrombolysis in cerebral infarction (mTICI) score of 2c–3. Safety outcomes included symptomatic intracerebral hemorrhage (sICH), any intracerebral (IC) hemorrhage and 90-day mortality. Results: The mean age of our cohort was 71.8 ± 12.5 years; 59 were men (43.1%). The primary outcome (mRS 0–2) was achieved in 89 (65%) patients. An excellent functional outcome (mRS 0–1) was reached in 58 (42.3%) and successful recanalization (mTICI 2c–3) in 118 (86.1%) patients. sICH was present in 5 cases (3.7%), any IC hemorrhage in 42 (30.7%) and 90-day mortality in 28 (20.4%). We found a statistically significant correlation between the primary outcome (mRS 0–2) and a successful recanalization mTICI of 2c–3 (p—0.024). This correlation was even stronger between excellent functional outcomes and a recanalization mTICI of 2c-3 (p < 0.001). The study did not confirm the importance of the first-pass effect (FPE) during MT of the M2 segment (p—0.489). We also noticed a significant 31.3% mortality increase in the group of patients in which recanalization of the occluded M2 branch was insufficient. Conclusions: MT is a powerful and effective treatment method for AIS caused by an occlusion of the M2 segment in real-life conditions. Patients have a higher probability of a long-term good functional outcome when complete or near-complete reperfusion is achieved. Full article
(This article belongs to the Special Issue Acute Ischemic Stroke: Current Status and Future Challenges)
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19 pages, 669 KiB  
Review
The Role of the Intrauterine Environment in Shaping Childhood and Adolescence Metabolic Outcomes
by Asli Derya Kardelen and Feyza Darendeliler
Metabolites 2025, 15(4), 252; https://doi.org/10.3390/metabo15040252 - 6 Apr 2025
Cited by 1 | Viewed by 809
Abstract
Emerging research suggests that the intrauterine environment plays a critical role in predisposing individuals to metabolic syndrome (MetS), a constellation of conditions that heightens the risk for heart disease, stroke, and diabetes. Traditionally linked to lifestyle, the risk for MetS is now understood [...] Read more.
Emerging research suggests that the intrauterine environment plays a critical role in predisposing individuals to metabolic syndrome (MetS), a constellation of conditions that heightens the risk for heart disease, stroke, and diabetes. Traditionally linked to lifestyle, the risk for MetS is now understood to be also influenced by fetal exposures. The environment in which a child lives offers abundant potential sources that can contribute to an increased risk of developing various diseases, and in some cases, these factors can be avoided. This review integrates findings from both epidemiological and experimental research to underscore the impact of prenatal factors, including maternal nutrition, obesity, gestational diabetes (GDM), and birth size, on the subsequent development of metabolic derangements in offspring, particularly during puberty. The progression of genetic and epigenetic studies has enlightened the pathophysiology of these conditions starting in the intrauterine period and continuing into early life. By examining data and studies, this article elucidates the prenatal influences and underlying mechanisms that contribute to the pathogenesis of MetS. The updated understanding of the link between the intrauterine environment and future health comorbidities will draw attention to intrauterine care and maternal health and contribute to the prevention of serious diseases in adulthood. Full article
(This article belongs to the Special Issue Puberty and the Metabolic Syndrome)
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47 pages, 488 KiB  
Review
Autism Spectrum Disorder and Epilepsy: Pathogenetic Mechanisms and Therapeutic Implications
by Alessandra Giliberti, Adele Maria Frisina, Stefania Giustiniano, Ylenia Carbonaro, Michele Roccella and Rosaria Nardello
J. Clin. Med. 2025, 14(7), 2431; https://doi.org/10.3390/jcm14072431 - 2 Apr 2025
Viewed by 2887
Abstract
The co-occurrence of autism spectrum disorder (ASD) and epilepsy is a complex neurological condition that presents significant challenges for both patients and clinicians. ASD is a group of complex developmental disorders characterized by the following: (1) Social communication difficulties: challenges in understanding and [...] Read more.
The co-occurrence of autism spectrum disorder (ASD) and epilepsy is a complex neurological condition that presents significant challenges for both patients and clinicians. ASD is a group of complex developmental disorders characterized by the following: (1) Social communication difficulties: challenges in understanding and responding to social cues, initiating and maintaining conversations, and developing and maintaining relationships. (2) Repetitive behaviors: engaging in repetitive actions, such as hand-flapping, rocking, or lining up objects. (3) Restricted interests: focusing intensely on specific topics or activities, often to the exclusion of other interests. (4) Sensory sensitivities: over- or under-sensitivity to sensory input, such as sounds, touch, tastes, smells, or sights. These challenges can significantly impact individuals’ daily lives and require specialized support and interventions. Early diagnosis and intervention can significantly improve the quality of life for individuals with ASD and their families. Epilepsy is a chronic brain disorder characterized by recurrent unprovoked (≥2) seizures that occur >24 h apart. Single seizures are not considered epileptic seizures. Epilepsy is often idiopathic, but various brain disorders, such as malformations, strokes, and tumors, can cause symptomatic epilepsy. While these two conditions were once considered distinct, growing evidence suggests a substantial overlap in their underlying neurobiology. The prevalence of epilepsy in individuals with ASD is significantly higher than in the general population. This review will explore the epidemiology of this comorbidity, delve into the potential mechanisms linking ASD and epilepsy, and discuss the implications for diagnosis, treatment, and management. Full article
(This article belongs to the Special Issue Advances in Child Neurology)
12 pages, 412 KiB  
Article
Risk of Cardiovascular Disease According to the Precedence Relationship Between Hypertension and Diabetes Mellitus
by Junhee Park, Kyungdo Han, Kyuna Lee, Yoosoo Chang and Dong Wook Shin
Healthcare 2025, 13(7), 796; https://doi.org/10.3390/healthcare13070796 - 2 Apr 2025
Viewed by 854
Abstract
Background/Objectives: Cardiovascular disease (CVD) risk may be based on the sequence of hypertension (HTN) and diabetes mellitus (DM) occurrence since the pathophysiological mechanisms might not be the same. The present study examined the risk of CVD according to the precedent relationship between HTN [...] Read more.
Background/Objectives: Cardiovascular disease (CVD) risk may be based on the sequence of hypertension (HTN) and diabetes mellitus (DM) occurrence since the pathophysiological mechanisms might not be the same. The present study examined the risk of CVD according to the precedent relationship between HTN and DM. Methods: Participants with both HTN and DM in a national health screening program in 2015–2016 were divided into two groups based on the order of HTN and DM occurrence: ‘HTN → DM’ and ‘DM → HTN’. The primary outcomes were newly diagnosed myocardial infarction (MI) and ischemic stroke based on the International Classification of Diseases, 10th revision code. Results: Among 914,338 participants, there were 28,368 MI events and 35,632 ischemic stroke events during the follow-up period. The DM → HTN group showed a higher risk of MI (adjusted hazard ratio [aHR]: 1.13 [95% CI: 1.10–1.15]) and ischemic stroke (aHR: 1.06 [95% CI: 1.04–1.09]) than the HTN → DM group. The increased risk of MI in the DM → HTN group was more prominent in females than in males and in those without dyslipidemia than in those with dyslipidemia. A higher risk of MI and ischemic stroke in the DM-HTN group was found in patients with chronic kidney disease (CKD) than in patients without CKD. Conclusions: MI and ischemic stroke were more frequent in patients in the DM → HTN group than in those of the HTN → DM group. When approaching HTN and DM clinically and epidemiologically, two phenotypes based on the order of occurrence should be considered. Given the generalization limitations of Asian patients, who develop DM at an early age compared to other groups, future studies are needed to reveal the underlying mechanism in the precedence relationship between HTN and DM. Full article
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13 pages, 618 KiB  
Article
Mediation Role of Behavioral Decision-Making Between Self-Efficacy and Self-Management Among Elderly Stroke Survivors in China: Cross-Sectional Study
by Xiaoxuan Wang, Hu Jiang, Zhixin Zhao, Noubessi Tchekwagep Kevine, Baoxia An, Zhiguang Ping, Beilei Lin and Zhenxiang Zhang
Healthcare 2025, 13(7), 704; https://doi.org/10.3390/healthcare13070704 - 23 Mar 2025
Viewed by 556
Abstract
Background: Identifying the factors that impact self-management is crucial, as elderly stroke survivors frequently face challenges in self-management. Self-efficacy and behavioral decision-making are reported as influencing factors of self-management, but their relationship within the elderly population remains unconfirmed. This study aimed to explore [...] Read more.
Background: Identifying the factors that impact self-management is crucial, as elderly stroke survivors frequently face challenges in self-management. Self-efficacy and behavioral decision-making are reported as influencing factors of self-management, but their relationship within the elderly population remains unconfirmed. This study aimed to explore whether self-efficacy impacts self-management through the mediating role of behavioral decision-making among elderly stroke survivors. Methods: A cross-sectional design and convenience sampling method were used in this study. A total of 291 elderly stroke survivors were recruited from a tertiary hospital in Henan Province, China, between March and July of 2024. Questionnaires were distributed to collect sociodemographic, self-efficacy, behavioral decision-making, and self-management data. A path analysis and correlation analysis were used to analyze the data. This study adhered to the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) guidelines. Results: Elderly stroke survivors reported having a moderate level of self-management. There was a positive correlation between self-efficacy, behavioral decision-making, and self-management (all p < 0.01). The mediation model indicated that behavioral decision-making mediated the association of self-efficacy and self-management in the regression model (95% CI 0.03 to 0.14), and the effect value was 0.08. It was also confirmed that behavioral decision-making mediated the impact of self-efficacy and self-management, accounting for 25.81% of the total effect. Conclusion: Self-efficacy is not solely a key factor influencing self-management in elderly stroke survivors, but it also improves their self-management behaviors by facilitating behavioral decision-making. As a result, healthcare professionals should consider self-efficacy and behavioral decision-making as crucial elements for assessing elderly stroke survivors during discharge and follow-up. Full article
(This article belongs to the Special Issue Stroke and Ageing)
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13 pages, 859 KiB  
Article
Description of the Risk Factors for Ischemic Stroke in the Lebanese Population: Their Association with Age at First Stroke Incidence and the Predictors of Recurrence
by Jad El Masri, Diala El Masri, Maya Ghazi, Ahmad Afyouni, Hani Finge, Jad El Ahdab, Maryam Tlayss, Soltan Al Chaar, Wassim Abou-Kheir, Pascale Salameh and Hassan Hosseini
J. Clin. Med. 2025, 14(6), 2034; https://doi.org/10.3390/jcm14062034 - 17 Mar 2025
Cited by 1 | Viewed by 765
Abstract
Background: Stroke is the third most common cause of death in Lebanon. With many preventive strategies identified, stroke remains a national burden, especially in developing countries, where risk factors and epidemiological states are understudied. This study aims to investigate the association of [...] Read more.
Background: Stroke is the third most common cause of death in Lebanon. With many preventive strategies identified, stroke remains a national burden, especially in developing countries, where risk factors and epidemiological states are understudied. This study aims to investigate the association of sociodemographic factors and health-related risk factors with age at first ischemic stroke and its recurrence in the Lebanese population. Methods: A retrospective study including 214 ischemic stroke cases was carried out. Sociodemographic characteristics and health-related risk factors were assessed, in addition to disability levels (modified Rankin score (mRS)), age at first ischemic stroke incidence, and number of ischemic strokes. Data were analyzed using SPSS software version 25, including descriptive, bivariate, and multivariate analyses. Results: This study showed that stressful factors were significantly associated with a younger age at first ischemic stroke, such as having no partner (p < 0.001), having employment (p < 0.001), and having migraines (p < 0.001). However, metabolic risk factors were associated with an older age of ischemic stroke, such as hypertension (p < 0.001) and hyperlipidemia (p < 0.001). Moreover, having a partner (OR: 2.136), having a family history of stroke (OR: 2.873), having hyperlipidemia (OR: 3.71), and having atrial fibrillation (OR: 2.521) were associated with ischemic stroke recurrence. Conclusions: Many modifiable factors are associated with age at first ischemic stroke and its recurrence. This study sheds light on the necessity of increasing knowledge and awareness of well-known risk factors in the Lebanese population. These results suggest implementing targeted preventive strategies and highlight the importance of complying with early detection and follow-up measures. Full article
(This article belongs to the Section Clinical Neurology)
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Article
Gene–Diet Interactions in High-Density Lipoprotein Cholesterol-Related Polymorphisms and Cardiovascular Disease Risk: Insights from the Korean Genome and Epidemiology Study
by Jong-Hee Lee, Kyung-Won Hong, Byoung-Jin Park, Ja-Eun Choi and Dong-Hyuk Jung
Nutrients 2025, 17(5), 778; https://doi.org/10.3390/nu17050778 - 24 Feb 2025
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Abstract
Background: Understanding gene–diet interactions is crucial for establishing dietary guidelines for cardiovascular diseases (CVD). This study analyzed the interaction between dietary intake and six genome-wide association study (GWAS)-identified single nucleotide polymorphisms (SNP) associated with high-density lipoprotein (HDL) cholesterol levels and their impact [...] Read more.
Background: Understanding gene–diet interactions is crucial for establishing dietary guidelines for cardiovascular diseases (CVD). This study analyzed the interaction between dietary intake and six genome-wide association study (GWAS)-identified single nucleotide polymorphisms (SNP) associated with high-density lipoprotein (HDL) cholesterol levels and their impact on CVD risk. Methods: A total of 68,806 participants in the Korean Genome and Epidemiology Study (KoGES) were analyzed. Six target SNPs (LPL: rs17482753; ABCA1: rs1883025; APOA5: rs651821; LIPC: rs1077835; CETP: rs17231506; and LIPG: rs9953437) were extracted from genome-wide SNP genotype data. Dietary intake was assessed using a food frequency questionnaire. SNP genotyping was conducted using the Korea Biobank Array (Korean Chip), a specialized genotyping platform designed for GWAS of blood biochemical traits in the Korean population. SNP–diet interactions on CVD risk were analyzed using generalized linear models (GLM). Results: Among the six SNPs, ABCA1: rs1883025 and APOA5: rs651821 showed significant gene–diet interactions. For rs1883025 (ABCA1), carriers of the T allele exhibited reduced HDL cholesterol levels. However, in the high-protein intake group, individuals with the T/T genotype had a significantly lower risk of ischemic stroke compared to those in the low-protein intake group (interaction p-value = 0.044). For rs651821 (APOA5), carriers of the T allele also had lower HDL cholesterol levels, but individuals with the C/C genotype (wild-type homozygotes) in the low-fat intake group showed a significantly reduced risk of coronary artery disease (interaction p-value = 0.0155). Conclusions: This study suggests potential interactions between polymorphisms associated with low HDL cholesterol and dietary patterns, particularly high-protein and low-fat diets, in relation to CVD risk. These findings highlight the importance of personalized dietary recommendations based on genetic profiles to reduce CVD risk. They provide a basis for future research aimed at developing precision nutrition guidelines and targeted interventions to manage hypo-HDL cholesterolemia and nutrition-related CVD risks. Full article
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