RESUMEN
OBJECTIVE: To evaluate the safety and efficacy of enteral nutritional suspension (TPF-FOS) JEVITY in acute stroke patients. METHODS: A multicenter, prospective, post-marketing observational study was conducted. A total of 103 acute stroke patients with dysphagia received a 10-day regimen of enteral nutritional suspension (TPF-FOS) JEVITY via nasal gastric tube feeding. The parameters of serum prealbumin, serum albumin and percentage of abnormal blood glucose were evaluated and compared. The incidence of adverse events was recorded. The data were analyzed by paired t-test. RESULTS: At the end of the study in comparison with the baselines, the serum prealbumin increased significantly (213 mg/L ± 56 mg/L vs 219 mg/L ± 66 mg/L) and serum albumin decreased markedly (38 g/L ± 5 g/L vs 36 g/L ± 5 g/L) but stayed stable during tube feeding. No significant changes were found in percentage of abnormal blood glucose (40.78% vs 38.76%), body mass index (23.1 kg/m(2) ± 3.0 kg/m(2) vs 22.8 kg/m(2) ± 2.9 kg/m(2)) and C-reactive protein (13 mg vs 14 mg). Only 18 adverse events were related with the study product. And most of them were gastrointestinal reactions. CONCLUSION: Enteral nutritional suspension (TPF-FOS) JEVITY may increase the level of serum prealbumin in acute stroke patients and improve the patient nutritional status. With a low incidence of adverse events, it is a preferred option for enteral nutrition formulas in stroke.
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Nutrición Enteral/efectos adversos , Nutrición Enteral/métodos , Accidente Cerebrovascular/terapia , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estudios ProspectivosRESUMEN
OBJECTIVE: To understand the nature of subjective memory complaints through comparative study of depression status of patients with subjective memory complaints and mild cognitive impairment. METHODS: A total of 214 patients were assessed with the Center for Epidemiologic Studies Depression (CES-D) scale, the Geriatric Depression Scale and some neuropsychological tests. Among them, 76 were of subjective memory complaints (SMC), 74 amnestic mild cognitive impairment-single domain (aMCI-s) and 64 amnestic mild cognitive impairment-multiple domain (aMCI-m). RESULTS: According to CESD, 31% of the patients had symptoms of depression. The ratios were 30%, 24% and 39% in SMC, aMCI-s and aMCI-m groups respectively. GDS study showed that 43% of the patients had symptoms of depression. The ratios were 47%, 30% and 53% in SMC, aMCI-s and aMCI-m groups respectively. The ratio in SMC group fell between the other two groups. The total score of CESD (12 +/- 10) or GDS (11 +/- 6) of the SMC group, reflecting the severity of depression, fell between aMCI-s (CESD: 11 +/- 8, GDS: 9 +/- 5) and (CESD: 15 +/- 11, GDS: 12 +/- 7) groups. There was no significant difference between them in comparison with either aMCI-s or aMCI-m group (P > 0.05). But the total score of CESD or GDS was significantly different between aMCI-m and aMCI-s groups (P < 0.05). The depression status was worse in aMCI-m group than that in aMCI-s group. CONCLUSION: There is no significant discrepancy in the incidence and severity of depression between SMC and aMCI groups. It indicates that depressive mood is not the specific cause of SMC.
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Trastornos del Conocimiento , Trastorno Depresivo/psicología , Trastornos de la Memoria , Anciano , Anciano de 80 o más Años , Trastornos del Conocimiento/diagnóstico , Trastorno Depresivo/diagnóstico , Femenino , Humanos , Masculino , Trastornos de la Memoria/diagnóstico , Persona de Mediana EdadRESUMEN
Intravenous tissue plasminogen activator (tPA) at 0.9mg/kg improves outcome in acute ischemic stroke. The dose response to tPA may be different in Chinese patients compared with Western populations, but this has not been systematically examined. We aimed to compare the efficacy and safety of different doses of tPA in Chinese stroke patients. We included all acute ischemic stroke patients treated with tPA within 4.5 hours of onset. Patients were treated with three dose regimens of tPA (0.6-0.7mg/kg, 0.8mg/kg, 0.9mg/kg). The following data were collected: patient demographics; vascular risk factors; neuroimaging results; time of tPA administration; clinical assessment before treatment, at 24 hours and 3months; and modified Rankin Scale (mRS) score at 3months. A total of 105 patients with stroke of Han Chinese origin were included in the study. The baseline characteristics of the three dose groups were well matched. In the 0.9mg/kg group (n=51), 51.1% had favorable outcome at 3months, compared with 38.7% of patients in the 0.8mg/kg group (n=31) (odds ratio [OR] to 0.9mg/kg group, 0.57; 95% CI, 0.19-1.73; p=0.32) and 34.8% in the 0.6-0.7mg/kg group (n=23) (OR to 0.9mg/kg group, 0.31; 95% CI, 0.08-1.16; p=0.08). There were no statistically significant differences in the incidence of symptomatic intracerebral hemorrhage and mortality rate. There was a higher proportion of patients with good functional outcomes in the 0.9mg/kg group. Although not significant, these results strongly support the feasibility and urgent need for a dose ranging trial to establish an optimal tPA dose in Chinese stroke patients.
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Isquemia Encefálica/tratamiento farmacológico , Accidente Cerebrovascular/tratamiento farmacológico , Activador de Tejido Plasminógeno/administración & dosificación , Activador de Tejido Plasminógeno/efectos adversos , Anciano , Anciano de 80 o más Años , Análisis de Varianza , Pueblo Asiatico , Relación Dosis-Respuesta a Droga , Femenino , Fibrinolíticos/administración & dosificación , Fibrinolíticos/efectos adversos , Humanos , Infusiones Intravenosas , Masculino , Persona de Mediana Edad , Oportunidad Relativa , Estudios Retrospectivos , Terapia Trombolítica , Factores de Tiempo , Resultado del TratamientoRESUMEN
OBJECTIVE: To investigate the detection rate of malnutrition among post-stroke patients in community hospitals and unravel the relevant factors that precipitate malnutrition after stroke. METHODS: Based on 438 post-stroke patients who were admitted in community hospitals, we examined the demographic characteristics, the nutritional indices and the possible malnutrition related factors through a cross-sectional study. RESULTS: The detection rate of malnutrition among post-stroke patients was 52.7%. Group comparison through multivariate logistic regression analysis showed that there was a higher malnutrition detection rate in the post-stroke patients with multiple stroke attacks (three stroke attackes and above, OR = 11.00, 95%CI 1.14 - 106.34), higher NIHSS scores (group with NIHSS >/= 15, OR = 7.09, 95%CI 2.90 - 17.36), higher modified Rankin scales (group mRS 4 - 5, OR = 15.77, 95%CI 6.61 - 37.59) (trend test P < 0.0001). The risk of malnutrition was also correlated with the post-stroke depression, poorer family care, no early-stage rehabilitation, history of malignant tumors and severe alcoholism. CONCLUSIONS: There is a high detection rate of malnutrition among post-stroke patients in community hospitals. There are many factors related to malnutrition among post-stroke patients in the community. More attention to controllable influencing factors would improve the prognosis of post-stroke patients.
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Desnutrición , Accidente Cerebrovascular , Estudios Transversales , Humanos , Pronóstico , Factores de Riesgo , Accidente Cerebrovascular/diagnósticoRESUMEN
OBJECTIVE: To discuss the short-term effects of early naso-gastric nutrition after acute stroke. METHODS: In a prospective non-randomized controlled design, 146 stroke patients with dysphagia were included. 75 patients in the intervention group received standard naso-gastric nutrition and 71 patients in the control group and received feeding supervised by family members. We observed the nutrition status, infective complications and mortality between the two groups for 21 days. Neurological deficit was evaluated with NIH stroke scale, Barthel index and the modified of Rankin Scale, the latter scale being calculated for 90 days. RESULTS: After 21 days, the nutritional parameters (triceps skin thickness, arm muscle circumference, haemoglobin, serum albumin, and triglycerides) in the intervention group were significantly better than those in the control group. Malnutrition was observed in 27.1% of the intervention group and 48.3% of the control group (P = 0.014). The incidence of infective complications was 33.3% in the intervention group and 52.1% in the control group (P = 0.022). Mortality rate was 6.7% in the intervention group and 18.1% in the control group (P = 0.032). The score of NIH stroke scale on the 21st day in the intervention group was also significantly better than that in the control group (P = 0.008). However, the Barthel index on the 21st day and the score of the modified Rankin Scale on the 90th day of follow-up were not statistically different between the two groups. CONCLUSIONS: It is suggested that standardized naso-gastric nutrition is helpful for improving short-term neurological function following acute stroke. However, improvement of Barthel index and the score of the modified Rankin Scale needs more therapeutic measures besides nutritional support.