مجال التميز | تميز دراسي و بحثي |
البحوث المنشورة |
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البحث (1): | |
عنوان البحث: |
Can we prevent poststroke cognitive impairment? An umbrella review of risk factors and treatments |
رابط إلى البحث: | |
تاريخ النشر: |
09/09/2020 |
موجز عن البحث: |
Objectives Cognitive impairment poststroke is progressive. We aimed to synthesise the existing evidence evaluating risk factors and the effects of treatments to prevent/improve cognitive function in patients who had a stroke with cognitive impairment. Design Umbrella review. Data source Medline, PsycINFO, EMBASE, Cochrane and PROSPERO were searched from inception until 11 June 2019. Eligibility criteria Published systematic review (SR) that incorporated randomised controlled trials to investigate an intervention to improve poststroke cognitive impairment, or SR of longitudinal observational studies that evaluated the risk factors of this condition. No restrictions were applied. Data extraction and synthesis From each eligible study, details were recorded by one reviewer in a validated form. Grading of Recommendations, Assessment, Development and Evaluations criteria were used to assess our certainty level of each outcome, and A Measurement Tool to Assess Systematic Reviews 2 to assess quality. Results Altogether, 3464 abstracts were retrieved, 135 full texts were evaluated and 22 SRs were included in the final analysis. From four SRs of observational studies, we found 19 significant associations with postulated risk factors, and those which we determined to be confident about were: atrial fibrillation (3 SRs, 25 original studies); relative risk 3.01 (1.96–4.61), ORs 2.4 (1.7–3.5) and 2.0 (1.4–2.8), leukoaraiosis, multiple and recurrent strokes, ORs 2.5 (1.9–3.4), 2.5 (1.9–3.1) and 2.3 (1.5–3.5), respectively. From 18 SRs of interventional trials, we found that interventions including physical activity or cognitive rehabilitation were enhancing cognitive function, while the certainty of the other interventions was rated low, due to limited methodological quality. Conclusions This review represents common risk factors related to poststroke cognitive impairment, in particular atrial fibrillation, and points to different interventions that warrant attention in the development of treatment strategies. Physical activity and cognitive rehabilitation interventions showed evidence of enhancing cognitive function; however, we could not recommend a change in practice yet, due to lack of strong evidence. |
البحث (2): | |
عنوان البحث: |
Long-Term Outcomes in Stroke Patients with Cognitive Impairment: A Population-Based Study |
رابط إلى البحث: | |
تاريخ النشر: |
18/05/2020 |
موجز عن البحث: |
This study assesses five year outcomes of patients with cognitive deficits within the first three months after stroke. Population-based data from the South London Stroke Register between 1995 and 2018 were studied. Cognitive function was assessed using the Abbreviated-Mental-Test or Mini-Mental-State-Examination. Multivariable Poisson regression models with robust standard errors were constructed, to evaluate relative risks (RRs) and associations between post-stroke deterioration in cognitive function during the first three months on dependency, mortality, depression and institutionalisation. A total of 6504 patients with first-ever strokes were registered with a mean age of 73 (SD: 13.2). During the first three months post-stoke, approximately one-third of these stroke survivors either cognitively improved (37%), deteriorated (30%) or remained unchanged (33%). Post-stroke cognitive impairment was associated with increases, in five years, of the risks of mortality, dependency, depression and being institutionalised by RRs 30% (95% confidence interval: 1.1–1.5), 90% (1.3–2.6), 60% (1.1–2.4) and 50% (1.1–2.3), respectively. Deterioration in cognitive function by 10% or more between seven days and three months was associated with an approximate two-fold increased risk in mortality, dependency, and being institutionalised after one year, compared to stable cognitive function; RRs 80% (1.1–3.0), 70% (1.2–2.4) and two-fold (1.3–3.2), respectively. Monitoring further change to maintain cognitive abilities should be a focus to improve outcomes |
البحث (3): | |
عنوان البحث: |
The association between medical diseases and orofacial abscess: A retrospective, hospital-based study |
رابط إلى البحث: | |
تاريخ النشر: |
30/03/2020 |
موجز عن البحث: |
Objective: This study aimed to identify the most commonly reported medical diseases among dental patients and to assess its association with the development of the orofacial abscess. Methods:The medical records (n = 3164) of dental patients who visited the dental hospital at Umm-Al-Qura University (Makkah, Saudi Arabia) were reviewed. Demographic characteristics of eligible patients were collected. Medical diseases were collected as reported by the patients in the medical records. The International Classification of Diseases (ICD-10) was used to classify the reported medical diseases. Simple descriptive statistics were used to define the characteristics of the study variables through a form of counts and percentages. Multivariable logistic regression analysis was carried out to find out the significant predictors of orofacial abscess. Results: Upon reviewing 3164 medical records, almost half of the patients had medical diseases(n = 1543, 49%). The mean age of the cohort was 30.3 (SD = 16.43). Diabetes mellitus (n = 316,20%) and hypertension (n = 210, 14%) were the most common reported medical diseases. Male patients reported having more medical diseases compared to the female. Hypertension was found to be significantly high among female patients (X2= 3.167, P-value < 0.001). Multivariable logistic regression analysis indicated that the female gender is significantly associated with the development of orofacial abscess after adjustment for age and vascular risk factors (i.e., hypertension) (B = 1.26,S.E. = 0.57, OR = 3.54, 95%CI = 1.13 to 11.40, P-value = 0.028).Conclusion: Dentists should be aware that diabetes mellitus and hypertension are prevalent among patients visiting dental services. The female gender has a higher association of developing orofacial abscess than male. Within the limitation of this study in a single study centre with few patients having orofacial abscess, this study found no association between medical diseases and the development of orofacial abscess |
المؤتمرات العلمية |
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المؤتمر (1): | |
عنوان المؤتمر: |
Joint European Stroke Organisation and World Stroke Organization (ESO-WSO 2020) Virtual Conference |
تاريخ الإنعقاد: |
07/11/2020 |
مكان الإنعقاد: |
Vienna, Austria (virtual) |
طبيعة المشاركة: |
Oral presentation |
عنوان المشاركة: |
Preventive treatments of poststroke cognitive function: A population-based study |
ملخص المشاركة: |
Background: Limited data exist on the impact of stroke management strategies on cognitive function after stroke. This study aims to determine whether preventive or acute stroke care strategies protect global cognitive function in stroke survivors. Methods: Data were collected between 1995 and 2018 from the population-based South London Stroke Register (SLSR). Multivariable Poisson regression models with robust standard errors were constructed to evaluate relative risks (RRs) between cognitive impairment and treatment strategies; before, at acute phase or after stroke, up to ten years of follow-up. Models were adjusted for demographic characteristics, baseline vascular risk factors, treatments, stroke severity, disability and pathological stroke subtypes. Results: Overall, 6504 patients with a first-ever stroke were registered in the SLSR, of them 3411 and 2514 patients had cognitive function measured at seven-days and three-months post-stroke respectively. The prevalence of cognitive impairment was 28.9 (confidence interval (CI) 25.7-32.4). The mean age was 72.9 years (SD 12.9) and (52%) were female. At stroke onset, in participants with no history of atrial fibrillation (AF) who were on primary preventive treatments, there was a reduced risk of cognitive impairment associated with antihypertensive (RR 0.9, CI 0.77-1.05), lipid-lowering (RR 0.87, CI 0.72-1.04) and antiplatelet (RR 0.94, CI 0.79-1.11). Follow-up at five years after stroke, in ischemic stroke patients with a history of AF, there was a reduced risk of cognitive impairment associated with antihypertensive (relative risks (RR) 0.5, CI 0.27-0.91), lipid-lowering (RR 0.23, CI 0.06-0.91) and anticoagulant (RR 0.18, CI 0.05-0.64),while no significant association observed on antidiabetic medications (RR 0.74 CI 0.13-1.76). There was also reduced risk across ischemic stroke patients with no history of AF with the following: antihypertensive (RR 0.74, CI 0.57-0.95) and lipid-lowering (RR 0.81, CI 0.64-1.03), while no significant association observed on antiplatelet (RR 1.17 CI 0.87-1.58). All of these positive associations tend to diminish with time as observed in ten years after stroke. When clinically indicated, a combined treatment prescribed before or after stroke was strongly associated with a reduced risk of cognitive impairment. There were no significant associations identified on preventive medications among hemorrhagic stroke patients. Small protective associations were also observed between cognitive impairment and thrombolysis or admission to an acute stroke unit during the acute phase (RR 0.96, CI 0.91-1.01) and (RR 0.96, CI 0.93-0.98), respectively. Conclusions: Preventive treatments and acute stroke care strategies are associated with improved post-stroke cognitive function. Combined treatments strategy should be supported. |
الرابط: | |
المؤتمر (2): | |
عنوان المؤتمر: |
Joint European Stroke Organisation and World Stroke Organization (ESO-WSO 2020) Virtual Conference |
تاريخ الإنعقاد: |
08/11/2020 |
مكان الإنعقاد: |
Vienna, Austria (virtual) |
طبيعة المشاركة: |
Oral presentation |
عنوان المشاركة: |
Stroke recovery at one year in patients with cognitive impairment: a population-based study |
ملخص المشاركة: |
Background: Cognitive impairment is common and progressive after stroke. This study assesses 5-years outcome of patients with cognitive deficits in the first 3-months after stroke. Methods: Data were collected between 1995 and 2018 from the community-based South London Stroke Register (SLSR), covering a multi-ethnic population. Cognitive function was assessed using the Abbreviated-Mental-Test or Mini-Mental-State-Examination. Multivariable Poisson regression models with robust standard errors were constructed, to evaluate relative risks and associations between post-stroke deterioration in cognitive function at first three-months, on dependency, mortality, depression and institutionalisation up to five-years post-stroke. Models were adjusted for sociodemographic factors, case-mix, vascular risk factors and their treatment prior to stroke. Results: Overall, 6,504 individuals with first-ever stroke were registered in the SLSR, mean age was 73 years (SD: 13.2) and (52%) were female. In the first three-months after stroke approximately one third of cognitively impaired patients either improved (37%), deteriorated (30%) or stayed the same (33%). Post-stroke cognitive impairment was associated with an increase in 5-years risk of mortality, dependency, depression and being institutionalised, by; 30% (95% Confidence Interval: 1.1-1.5), 90% (1.3-2.6), 60% (1.1-2.4) and 50% (1.1-2.3), respectively. Early decline in cognitive function by (10%) or more, between seven-days and three-months was associated with approximately 2-fold increased risk in mortality, dependency and being institutionalised at one-year compared to stable cognition; 80% (1.1-3.0), 70% (1.2-2.4), and 2-fold (1.3-3.2), respectively. Conclusions: Declines in cognitive function at the first three-months of stroke index were associated with an important increased risk of worsening of stroke outcomes. Therefore, monitoring further change to maintain cognitive abilities should be a focus to improve outcomes. |
الرابط: | |
المؤتمر (3): | |
عنوان المؤتمر: |
Joint European Stroke Organisation and World Stroke Organization (ESO-WSO 2020) Virtual Conference |
تاريخ الإنعقاد: |
09/11/2020 |
مكان الإنعقاد: |
Vienna, Austria (virtual) |
طبيعة المشاركة: |
Poster presentation |
عنوان المشاركة: |
Can we prevent post-stroke cognitive impairment? An umbrella systematic review of risk factors and preventative treatment |
ملخص المشاركة: |
Objectives: Cognitive impairment post-stroke is progressive. We aimed to synthesise the existing evidence evaluating risk factors and the effects of treatments to prevent/improve cognitive function in stroke patients with cognitive impairment. Design: Umbrella review. Data source: Medline, PsycINFO, EMBASE, Cochrane, and PROSPERO were searched from inception until the 11th of June 2019. Eligibility criteria: Systematic review (SR) published that incorporated randomised controlled trials, to investigate an intervention to improve post-stroke cognitive impairment or systematic review of longitudinal observational studies that evaluated risk factors of this condition. No restrictions were applied. Data extraction and synthesis: From each eligible study, details were recorded by one reviewer in a validated form. GRADE criteria were used to assess our certainty level of each outcome, and AMSTAR2 to assess quality. Results: Altogether, 3464 abstracts were retrieved, 135 full texts were evaluated, and 22 SRs were included in the final analysis. From four SRs of observational studies, we found 19 significant associations with postulated risk factors, and those, which we determined to be confident about were: atrial fibrillation (3 SRs, 25 original studies); relative risk 3.01 (1.96–4.61), odds ratios (ORs) 2.4 (1.7–3.5) and 2·0 (1.4–2.8), leukoaraiosis, multiple, and recurrent strokes ORs 2.5 (1.9–3.4), 2.5 (1.9–3.1), and 2.3 (1.5–3.5), respectively. From 18 SRs of interventional trials, we found that interventions included physical activity or cognitive rehabilitation were enhancing cognitive function, while the certainty of the other interventions was rated low, due to limited methodological quality. Conclusions: This review represents common risk factors related to post-stroke cognitive impairment, in particular atrial fibrillation, and points to different interventions that warrant attention in the development of treatment strategies. Physical activity and cognitive rehabilitation interventions showed evidence of enhancing cognitive function; however, we could not recommend a change in practice yet, due to lack of strong evidence. Protocol registration (PROSPERO): CRD42018096667. |
الرابط: |