18 results on '"Pervez MA"'
Search Results
2. Differential response of pea ('Pisum sativum' l.) Genotypes to salt stress in relation to the growth, physiological attributes antioxidant activity and organic solutes
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Shahid, MA, Balal, RM, Pervez, MA, Abbas, T, Ashfaq, M, Ghazanfar, U, Afzal, M, Rashid, A, Garcia-Sanchez, F, and Mattson, NS
- Published
- 2012
3. Brassinosteroid (24-Epibrassinolide) Enhances Growth and Alleviates the Deleterious Effects Induced by Salt Stress in Pea ('Pisum sativum' L.)
- Author
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Shahid, MA, Pervez, MA, Balal, RM, Mattson, NS, Rashid, A, Ahmad, R, Ayyub, CM, and Abbas, T
- Published
- 2011
4. Treatment of fluoride contaminated water using mango (Mangifera indica) leaves powder as an adsorbent
- Author
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Fazli Aziz, Islamud Din, Fawad Khan, Pervez Manan, Aroosa Sher, and Said Hakim
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Fluoride ,Mango leaves ,Water treatment ,Adsorbent ,Adsorption ,Chemistry ,QD1-999 - Abstract
Excessive levels of Fluoride in water is detrimental to human health as it can cause many health problems including both dental and skeletal fluorosis etc. The aims of the current research work were to prepare a novel check the efficiency of Mango (Mangifera indica) leaves powder (MLP) for fluoride removal as well as to observe the effect of various factors over fluoride adsorption from water. The experiments were performed under batch mode and the results indicated that maximum adsorption efficiency was noticed in the acidic range. The Scanning Electron Microscopy (SEM) and Fourier Transform Infrared Spectroscopy (FTIR) techniques were applied for adsorbent characterization. Data modeling declared that pseudo second order kinetic model and Langmuir isotherm models were in best fitting. The study concluded that the investigated adsorbent material is suitable for reducing the high fluoride concentration in water to the WHO established level and is suggested as an ecofriendly material for water purification. Conclusively, future research prospects and further modification of mango leaves materials for fluoride adsorption are recommended.
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- 2023
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5. Phalaris minor control, resistance development and strategies for integrated management of resistance to fenoxaprop-ethyl
- Author
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Yasin, M, Iqbal, Z, Safdar, ME, Rehman, A, Ali, A, Asif, M, Aziz, M, Tanveer, A, and Pervez, MA
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Control, fenoxaprop-ethyl, management, Phalaris minor, resistance, wheat - Abstract
Phalaris minor (Littleseed canary grass) is a very important and annual weed of winter cereal crops. It is a very competitive weed of wheat, oat and barley crops in Pakistan. Usually, three aryloxyphenoxypropionate herbicides, fenoxaprop-P-ethyl, diclofop-methyl and clodinafop-propargyl are used as chemical weed control against different grassy weeds like P. minor, Avena sativa and Cyperus rotundus L. This review describes fenoxaprop-ethyl, a selective chemical herbicide used to control P. minor in wheat crop. High production of wheat is associated with its continuous use. But this practice enhances the development of resistant biotypes of P. minor. Different management approaches like preference of mechanical weeding over chemical weed control, integration of competitive varietal selection, crop rotation and herbicide rotation can be long duration strategies of resistance management in P. minor. However, tillage method, planting time, method of herbicide application, optimum dose, higher seed rate, early sowing, bed planting, stale seed bed and zero tillage are short duration resistance management strategies. Use of water extracts of herbicidal potential (allelopathic) plants can be effective integrated management of herbicide resistant against P. minor in wheat and for eco-friendly and sustainable weed management.Key words: Control, fenoxaprop-ethyl, management, Phalaris minor, resistance, wheat.
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- 2013
6. Unsuspected coagulopathy rarely prevents IV thrombolysis in acute ischemic stroke.
- Author
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Rost NS, Masrur S, Pervez MA, Viswanathan A, Schwamm LH, Rost, N S, Masrur, S, Pervez, M A, Viswanathan, A, and Schwamm, L H
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- 2009
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7. Remote supervision of IV-tPA for acute ischemic stroke by telemedicine or telephone before transfer to a regional stroke center is feasible and safe.
- Author
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Pervez MA, Silva G, Masrur S, Betensky RA, Furie KL, Hidalgo R, Lima F, Rosenthal ES, Rost N, Viswanathan A, Schwamm LH, Pervez, Muhammad A, Silva, Gisele, Masrur, Shihab, Betensky, Rebecca A, Furie, Karen L, Hidalgo, Renzo, Lima, Fabricio, Rosenthal, Eric S, and Rost, Natalia
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- 2010
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8. δ-Tocotrienol in Combination with Resveratrol Improves the Cardiometabolic Risk Factors and Biomarkers in Patients with Metabolic Syndrome: A Randomized Controlled Trial.
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Fatima S, Khan DA, Aamir M, Pervez MA, and Fatima F
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- Humans, Resveratrol therapeutic use, Cardiometabolic Risk Factors, Double-Blind Method, Antioxidants therapeutic use, Biomarkers, Blood Glucose metabolism, Dietary Supplements adverse effects, Metabolic Syndrome
- Abstract
Background: Metabolic syndrome (MetS) is a cluster of central obesity, hypertension, hyperglycemia, and dyslipidemia. It is a global health issue with an increased risk of cardiovascular disease. Recently, a few natural products have been reported with promising anti-inflammatory and antioxidative effects. We aimed to evaluate the impact of δ-tocotrienol and resveratrol mixture (TRM) supplementation on cardiometabolic risk factors and biomarkers in patients with MetS. Methods: A randomized controlled trial was conducted at the hospitals of National University of Medical Sciences Rawalpindi, Pakistan. A total of 82 patients with MetS aged 18-60 years were enrolled based on International Diabetes Federation-2005 diagnostic criteria and randomly grouped into TRM ( n = 41) and placebo ( n = 41). Patients in the TRM group were given a 400 mg capsule (δ-tocotrienol 250 mg; resveratrol 150 mg), and a placebo (cellulose 400 mg) twice daily for 24 weeks. The biochemical tests were analyzed on ADVIA 1800 Chemistry
® analyzer and inflammatory biomarkers by ELISA methods. Results: In the TRM group, a significant reduction in waist circumference, blood pressure, mean (95% confidence interval) of fasting plasma glucose -0.15 mmol/L (-0.22 to -0.08), serum triglyceride -0.32 mmol/L (-0.47 to -0.17), and increment in high-density lipoprotein cholesterol were observed as compared with placebo. TRM supplementation also improved biomarkers: high-sensitive C-reactive protein -0.61 mg/L (-0.89 to -0.33), interleukin-6-1.99 pg/mL (-2.50 to -1.48), tumor necrosis factor-α -2.19 pg/mL (-2.55 to -1.83), malondialdehyde -0.48 μmol/L (-0.65 to -0.30), and total antioxidant capacity 1.71 U/mL (1.29 to 2.13). Conclusion: TRM supplementations improved cardiometabolic risk factors and biomarkers of inflammation and oxidative stress without any significant side effects in the patients with MetS. Clinical Trials Registry: The clinical trial was registered in Sri Lanka Clinical Trials Registry (https://slctr.lk/trials/slctr-2019-021).- Published
- 2023
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9. Hepato-Protective Effects of Delta-Tocotrienol and Alpha-Tocopherol in Patients with Non-Alcoholic Fatty Liver Disease: Regulation of Circulating MicroRNA Expression.
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Pervez MA, Khan DA, Gilani STA, Fatima S, Ijaz A, and Nida S
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- Humans, alpha-Tocopherol pharmacology, alpha-Tocopherol metabolism, Liver metabolism, Inflammation metabolism, Biomarkers metabolism, Non-alcoholic Fatty Liver Disease drug therapy, Non-alcoholic Fatty Liver Disease genetics, Circulating MicroRNA metabolism, MicroRNAs metabolism, Insulin Resistance
- Abstract
MicroRNAs (miRNAs) play a key role in the regulation of genes for normal metabolism in the liver. Dysregulation of miRNAs is involved in the development and progression of non-alcoholic fatty liver disease (NAFLD). We aimed to explore changes in circulating miRNA expression in response to delta-tocotrienol (δT3) and alpha-tocopherol (αTF) supplementation and correlate them with relevant biochemical markers in patients with NAFLD. In total, 100 patients with NAFLD were randomized to either receive δT3 ( n = 50) 300 mg or αTF ( n = 50) 268 mg twice/day for 48 weeks. Plasma expression of miRNA-122, -21, -103a-2, -421, -375 and -34a were determined at baseline, 24 and 48 weeks of intervention using RT-qPCR. Both δT3 and αTF significantly downregulated expression of miRNA-122, -21, -103a-2, -421, -375 and -34a. Moreover, δT3 was more effective than αTF in reducing expression of miRNA-375 and -34a. A significant correlation was observed between miRNA expression and biochemical markers of hepatic steatosis, insulin resistance (IR), oxidative stress (OS), inflammation and apoptosis. δT3 and αTF exert hepato-protective effects by downregulating miRNAs involved in hepatic steatosis, IR, OS, inflammation and apoptosis in patients with NAFLD. Furthermore, δT3 has more pronounced effects than αTF in reducing miR-375 and miR-34a, which are linked to regulation of inflammation and apoptosis.
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- 2022
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10. Comparison of delta-tocotrienol and alpha-tocopherol effects on hepatic steatosis and inflammatory biomarkers in patients with non-alcoholic fatty liver disease: A randomized double-blind active-controlled trial.
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Pervez MA, Khan DA, Mirza SA, Slehria AUR, Nisar U, and Aamir M
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- Biomarkers, Body Weight, Double-Blind Method, Humans, Inflammation, Liver, Vitamin E analogs & derivatives, alpha-Tocopherol, Insulin Resistance, Non-alcoholic Fatty Liver Disease
- Abstract
Objective: We aimed to compare the efficacy of δ-tocotrienol with α-tocopherol in the treatment of patients with non-alcoholic fatty liver disease (NAFLD)., Design and Interventions: This study was a double-blinded, active-controlled trial. The patients with NAFLD were randomly assigned to receive either δ-tocotrienol 300 mg or α-tocopherol 268 mg twice daily for 48 weeks., Endpoints: The primary endpoints were change from baseline in fatty liver index (FLI), liver-to-spleen attenuation ratio (L/S ratio), and homeostatic model assessment for insulin resistance (HOMA-IR) at 48 weeks. Key secondary endpoints were change in markers of inflammation, oxidative stress, and hepatocyte apoptosis. Clinical assessment, biochemical analysis, and computed tomography scan of the liver were conducted at baseline, 24 and 48 weeks., Results: A total of 100 patients (δ-tocotrienol = 50, α-tocopherol = 50) were randomized and included in the intention to treat analysis. Compared with baseline, there was a significant improvement (p < .001) in FLI, L/S ratio, HOMA-IR, and serum malondialdehyde in both groups at 48 weeks that was not significant between the two groups. However, there was a significantly greater decrease in body weight, serum interleukin-6, tumor necrosis factor-alpha, leptin, cytokeratin-18, and increase in adiponectin in the δ-tocotrienol group compared to the α-tocopherol group at 48 weeks (p < .05). No adverse events were reported., Conclusion: δ-tocotrienol and α-tocopherol exerted equally beneficial effects in terms of improvement in hepatic steatosis, oxidative stress, and insulin resistance in patients with NAFLD. However, δ-tocotrienol was more potent than α-tocopherol in reducing body weight, inflammation, and apoptosis associated with NAFLD. TRIAL REGISTRATION: Sri Lankan Clinical Trials Registry (https://slctr.lk/SLCTR/2019/038)., (Copyright © 2022 The Authors. Published by Elsevier Ltd.. All rights reserved.)
- Published
- 2022
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11. Effects of delta-tocotrienol supplementation on glycaemic control in individuals with prediabetes: A randomized controlled study.
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Suleman F, Khan DA, Pervez MA, and Aamir M
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- Blood Glucose, Dietary Supplements, Glycemic Control, Humans, Vitamin E analogs & derivatives, Prediabetic State drug therapy
- Abstract
Objective: To study the effects of delta-tocotrienol on glycaemic control parameters in individuals with pre-diabetes., Methods: The randomised control trial was conducted at the Armed Forces Institute of Pathology, Rawalpindi, Pakistan, from July 15 to November 15, 2019, and comprised individuals aged 18-60 years having fasting plasma glucose of 5.6 to 6.9 mmol/L or glycosylated haemoglobin of 5.7 to 6.4%. They were randomised into group A receiving 300mg delta-tocotrienol and group B receiving a placebo once daily for 12 weeks. Weight, height, waist circumference, fasting plasma glucose, insulin and glycosylated haemoglobin were measured at the beginning and end of the trial to assess any change. Body mass index and homeostatic model assessment-insulin resistance were also calculated. Data was analysed using SPSS 21., Results: Of the 77participants, 40(52%) were in group A and 37(48%) in group B. Group A showed significantly greater reduction in terms of fasting plasma glucose, glycosylated haemoglobin, insulin and homeostatic model assessment-insulin resistance index (p≤0.001) post-intervention., Conclusions: Delta-tocotrienol supplementation was found to have a significant effect in improving glycaemic control parameters in persons with pre-diabetes. Futures larger scale clinical trials are needed to confirm these findings., Clinical Trial Number: SLCTR/2019/024.
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- 2022
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12. Effects of delta-tocotrienol supplementation on Glycemic Control, oxidative stress, inflammatory biomarkers and miRNA expression in type 2 diabetes mellitus: A randomized control trial.
- Author
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Mahjabeen W, Khan DA, Mirza SA, and Pervez MA
- Subjects
- Biomarkers, Blood Glucose, Dietary Supplements, Double-Blind Method, Humans, Vitamin E therapeutic use, Diabetes Mellitus, Type 2 drug therapy, Glycemic Control, MicroRNAs genetics, Oxidative Stress, Vitamin E analogs & derivatives
- Abstract
The study aimed to ascertain the effects of delta-tocotrienol (δT3) supplementation on glycemic control, oxidative stress, inflammation and related micro-ribonucleic acid (miRNA) expression in patients with type 2 diabetes mellitus (T2DM). Total 110 patients of T2DM on oral hypoglycemic agents, were randomly divided into tocotrienol and placebo groups and given 250 mg δT3 or cellulose soft gel capsule once daily respectively for 24 weeks. Glycemic control, oxidative stress, inflammatory biomarkers, and miRNAs expression were measured in serum at baseline and end of the intervention by using standard laboratory methods. Compared to the placebo, δT3 supplementation resulted in a significant (p ≤ .05) reduction [mean difference (95% confidence interval)] in plasma glucose [-0.48 (-0.65, -0.30)], insulin [-1.19 (-1.51, -0.87)], homeostatic model assessment of insulin resistance [-0.67 (-0.86, -0.49)], glycosylated hemoglobin [-0.53 (-0.79, -0.28)], malondialdehyde [-0.34 (-0.45, -0.22)], high sensitive-C-reactive protein[-0.35 (-0.54, -0.16)], tumor necrosis factor-alpha [-1.22 (-1.62, -0.83)], and interleukin-6[-2.30 (-2.91, -1.68)]. More than twofold downregulation in miRNA-375, miRNA-34a, miRNA-21, and upregulation in miRNA-126, miRNA-132 expression was observed in the δT3 group compared to the placebo. The study demonstrated that δT3 supplementation in addition to oral hypoglycemic agents, improved glycemic control, inflammation, oxidative stress, and miRNA expression in T2DM without any adverse effect. Thus, δT3 might be considered as an effective dietary supplement to prevent long-term diabetic complications., (© 2021 John Wiley & Sons Ltd.)
- Published
- 2021
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13. Delta-tocotrienol supplementation improves biochemical markers of hepatocellular injury and steatosis in patients with nonalcoholic fatty liver disease: A randomized, placebo-controlled trial.
- Author
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Pervez MA, Khan DA, Slehria AUR, and Ijaz A
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- Adult, Aged, Biomarkers blood, Double-Blind Method, Female, Humans, Male, Middle Aged, Vitamin E therapeutic use, Young Adult, Non-alcoholic Fatty Liver Disease drug therapy, Vitamin E analogs & derivatives
- Abstract
Objective: The aim of this study was to examine the effects of delta-tocotrienol (δ-tocotrienol) supplementation on biochemical markers of hepatocellular injury and steatosis in patients with nonalcoholic fatty liver disease (NAFLD)., Design: The study design was a two-group, randomized, double-blind, placebo-controlled trial. The patients with NAFLD were randomly assigned to receive δ-tocotrienol 300 mg twice daily or placebo for 24 weeks., Endpoints: The primary endpoints were change from baseline in fatty liver index (FLI) and homeostasis model of insulin resistance (HOMA-IR) after 24 weeks. Secondary endpoints included change from baseline in high sensitivity C-reactive protein (hs-CRP), malondialdehyde (MDA), alanine transaminase (ALT), aspartate transaminase (AST) and grading of hepatic steatosis on ultrasound. Between-group differences were tested for significance using ANCOVA. Mean differences (MD) with 95 % CIs are reported., Results: A total of 71 patients (tocotrienol=35, placebo=36) were randomized and included in the intention to treat analysis. Compared with placebo, δ-tocotrienol significantly reduced (MD [95 % CI]) FLI (-8.52 [-10.7, -6.3]; p < 0.001); HOMA-IR (-0.37 [-0.53, -0.21]; p < 0.001), hs-CRP (-0.61[-0.81, -0.42]; p < 0.001), MDA (-0.91 [-1.20, -0.63]; p < 0.001), ALT (-8.86 [-11.5, -6.2]; p < 0.001) and AST (-6.6 [-10.0, -3.08]; p < 0.001). Hepatic steatosis was also reduced by a significantly greater extent with tocotrienol than with placebo (p =0.047). No adverse events were reported., Conclusion: δ-tocotrienol effectively improved biochemical markers of hepatocellular injury and steatosis in patients with NAFLD. δ-tocotrienol supplementation might be considered as a therapeutic option in the management of patients with NAFLD., Trial Registration: Sri Lankan Clinical Trials Registry (SLCTR/2015/023, 2015-10-03)., (Copyright © 2020 Elsevier Ltd. All rights reserved.)
- Published
- 2020
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14. Effects of Delta-tocotrienol Supplementation on Liver Enzymes, Inflammation, Oxidative stress and Hepatic Steatosis in Patients with Nonalcoholic Fatty Liver Disease.
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Pervez MA, Khan DA, Ijaz A, and Khan S
- Subjects
- Adult, Alanine Transaminase blood, Anti-Inflammatory Agents therapeutic use, Antioxidants therapeutic use, Aspartate Aminotransferases blood, Biomarkers blood, Double-Blind Method, Female, Humans, Inflammation, Liver enzymology, Male, Middle Aged, Non-alcoholic Fatty Liver Disease blood, Non-alcoholic Fatty Liver Disease complications, Oxidative Stress, Pilot Projects, Treatment Outcome, Vitamin E therapeutic use, Dietary Supplements, Fatty Liver etiology, Non-alcoholic Fatty Liver Disease therapy, Vitamin E analogs & derivatives
- Abstract
Background/aims: Non-alcoholic fatty liver disease (NAFLD) is a growing public health problem worldwide and is associated with increased morbidity and mortality. Currently, there is no definitive treatment for this disease. δ-Tocotrienol has potent anti-inflammatory and antioxidant properties and may reduce liver injury in NAFLD. The present study aims to evaluate the efficacy and safety of δ-tocotrienol in the treatment of NAFLD., Materials and Methods: The present study was a randomized, double-blind, placebo-controlled pilot study conducted in patients aged > 20 years, belonging to both sexes, having ultrasound-proven fatty liver disease, having a fatty liver index (FLI) of ≥ 60, and persistent elevation of alanine transaminase. A total of 71 patients were assigned to receive either oral δ-tocotrienol (n=35, 300 mg twice daily) or placebo (n=36) for 12 weeks. At the baseline and at the end of the study, clinical and biochemical parameters, including lipid profile, liver function tests, high-sensitivity C-reactive protein (hs-CRP), and malondialdehyde (MDA) were measured. Body mass index and FLI were calculated, and ultrasound grading of hepatic steatosis was performed., Results: Out of 71 enrolled patients, 64 patients, 31 in the δ-tocotrienol group and 33 in the placebo group, completed the study. After 12 weeks of supplementation, δ-tocotrienol showed greater efficacy than placebo by decreasing serum aminotransferases, hs-CRP, MDA, and FLI score (p<0.001). However, it did not improve hepatic steatosis on ultrasound examination. No adverse effects were reported., Conclusion: δ-Tocotrienol was safe, and it effectively improved aminotransferase levels and inflammatory and oxidative stress markers in patients with NAFLD. Large-scale randomized clinical trials are warranted to further support these findings.
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- 2018
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15. Lipid profile, lipid-lowering medications, and intracerebral hemorrhage after tPA in get with the guidelines-stroke.
- Author
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Messé SR, Pervez MA, Smith EE, Siddique KA, Hellkamp AS, Saver JL, Bhatt DL, Fonarow GC, Peterson ED, and Schwamm LH
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- Aged, Aged, 80 and over, Anticholesteremic Agents therapeutic use, Antihypertensive Agents therapeutic use, Brain Ischemia blood, Brain Ischemia complications, Cerebral Hemorrhage blood, Databases, Factual, Female, Fibrinolytic Agents therapeutic use, Humans, Male, Middle Aged, Risk Factors, Stroke blood, Stroke complications, Tissue Plasminogen Activator therapeutic use, Treatment Outcome, Brain Ischemia drug therapy, Cerebral Hemorrhage etiology, Fibrinolytic Agents adverse effects, Lipids blood, Stroke drug therapy, Thrombolytic Therapy adverse effects, Tissue Plasminogen Activator adverse effects
- Abstract
Background and Purpose: Symptomatic intracerebral hemorrhage (sICH) after tissue plasminogen activator for acute ischemic stroke is associated with poor outcome. There are conflicting data on sICH risk related to lipid levels and use of lipid-lowering medications. We evaluated whether there are associations between lipid levels, lipid-lowering medications, and sICH in Get With the Guidelines-Stroke., Methods: We identified acute ischemic stroke patients in the Get With the Guidelines-Stroke data set who were treated with IV tissue plasminogen activator between April 2003 and September 2009 and had complete data on lipid profiles and complications. Potential predictors of sICH were tested in univariate and multivariate analysis., Results: The analysis included 22 216 IV tissue plasminogen activator-treated acute ischemic stroke patients. Overall, 1104 (4.97%) experienced sICH (National Institute of Neurological Disorders and Stroke definition). In univariate analysis, patients with sICH were more often taking antihypertensive, lipid-lowering, and diabetes mellitus medications. There was no relationship between low density lipoprotein or total cholesterol and sICH in univariate analysis. However, the risk of sICH increased with higher high density lipoprotein, 6.1% in Q4 versus 4.7% in Q1, P=0.0013; and lower triglyceride levels, 5.9% in Q1 versus 4.2% in Q4, P<0.0001. In multivariable models, although the high density lipoprotein and triglyceride levels were modestly associated with sICH, low density lipoprotein and total cholesterol were not. Lipid-lowering medications were not independently associated with sICH., Conclusions: We found that low density lipoprotein and total cholesterol levels are not associated with risk of sICH after tissue plasminogen activator, although higher high density lipoprotein and lower triglyceride levels were modest risk factors. Lipid-lowering medications are not associated with risk of sICH.
- Published
- 2013
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16. Ischemic stroke and transient ischemic attack in young adults: risk factors, diagnostic yield, neuroimaging, and thrombolysis.
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Ji R, Schwamm LH, Pervez MA, and Singhal AB
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- Adolescent, Adult, Cerebral Angiography, Electrocardiography, Electrocardiography, Ambulatory, Female, Hematologic Tests, Humans, Male, Middle Aged, Neuroimaging, Retrospective Studies, Risk Factors, Thrombolytic Therapy statistics & numerical data, Treatment Outcome, Young Adult, Brain Ischemia blood, Brain Ischemia cerebrospinal fluid, Brain Ischemia diagnosis, Brain Ischemia drug therapy, Ischemic Attack, Transient blood, Ischemic Attack, Transient cerebrospinal fluid, Ischemic Attack, Transient diagnosis, Ischemic Attack, Transient drug therapy, Stroke blood, Stroke cerebrospinal fluid, Stroke diagnosis, Stroke drug therapy
- Abstract
Background: Approximately 10% to 14% of ischemic strokes occur in young adults., Objective: To investigate the yield of diagnostic tests, neuroimaging findings, and treatment of ischemic strokes in young adults., Design: We retrospectively reviewed data from our Get with the Guidelines-Stroke database from 2005 through 2010., Setting: University hospital tertiary stroke center., Patients: A total of 215 consecutive inpatients aged 18 to 45 years with ischemic stroke/transient ischemic attack. The mean (SD) age was 37.5 (7) years; 51% were male., Results: There were high incidence rates of hypertension (20%), diabetes mellitus (11%), dyslipidemia (38%), and smoking (34%). Relevant abnormalities were shown on cerebral angiography in 136 of 203 patients, on cardiac ultrasonography in 100 of 195, on Holter monitoring in 2 of 192; and on hypercoagulable panel in 30 of 189 patients. Multiple infarcts were observed in 31% and were more prevalent in individuals younger than age 35 years. Relevant arterial lesions were frequently detected in the middle cerebral artery (23%), internal carotid artery (13%), and vertebrobasilar arteries (13%). Cardioembolic stroke occurred in 47% (including 17% with isolated patent foramen ovale), and 11% had undetermined stroke etiology. The median National Institutes of Health Stroke Scale score was 3 (interquartile range, 0-9) and 81% had good outcome at hospital discharge. Of the 29 patients receiving thrombolysis (median National Institutes of Health Stroke Scale score, 14; interquartile range, 9-17), 55% had good outcome at hospital discharge and none developed symptomatic brain hemorrhage., Conclusions: This study shows the contemporary profile of ischemic stroke in young adults admitted to a tertiary stroke center. Stroke etiology can be determined in nearly 90% of patients with modern diagnostic tests. The causes are heterogeneous; however, young adults have a high rate of traditional vascular risk factors. Thrombolysis appears safe and short-term outcomes are favorable.
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- 2013
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17. Predictors of increased intravenous tissue plasminogen activator use among hospitals participating in the Massachusetts Primary Stroke Service Program.
- Author
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Rost NS, Smith EE, Pervez MA, Mello P, Dreyer P, and Schwamm LH
- Subjects
- Age Factors, Aged, Aged, 80 and over, Female, Healthcare Disparities, Humans, Infusions, Intravenous, Linear Models, Logistic Models, Male, Massachusetts, Middle Aged, Multivariate Analysis, Odds Ratio, Patient Selection, Practice Guidelines as Topic, Retrospective Studies, Risk Assessment, Risk Factors, Time Factors, Treatment Outcome, Emergency Service, Hospital standards, Emergency Service, Hospital statistics & numerical data, Fibrinolytic Agents administration & dosage, Quality Improvement, Regional Medical Programs standards, Regional Medical Programs statistics & numerical data, Stroke drug therapy, Thrombolytic Therapy standards, Thrombolytic Therapy statistics & numerical data, Tissue Plasminogen Activator administration & dosage
- Abstract
Background: We sought to determine if intravenous tissue plasminogen activator (IV tPA) use for acute ischemic stroke increased in Massachusetts in association with the Primary Stroke Service program, a statewide stroke center designation and quality improvement initiative., Methods and Results: We analyzed prospectively acquired data from the Massachusetts Department of Public Health between October 2004 and June 2008, including 10 045 consecutive emergency department-based acute ischemic stroke encounters arriving ≤ 3 hours after stroke onset at 69 participating Massachusetts PSS hospitals. The overall rate of IV tPA use was 854 of 3866 (22.1%) of patients arriving ≤ 2 hours of symptom onset. IV tPA use increased steadily from 2005 (the first full year of the program) to 2008 (18.4%, 21.9%, 22.6%, 25.5%; P=0.001). Patients treated with IV tPA were more likely to be younger (72.3 ± 14.1 versus 74.7 ± 14.0 years, P<0.005) and to have presented after emergency medical services rerouting in July 2005 (96% versus 94%, P=0.009). Patients who arrived at hospitals with a performance achievement award from the Get With The Guidelines-Stroke program were more likely to receive IV tPA after versus before award recognition (28.1% versus 22.3%, P<0.001)., Conclusions: In this nearly complete capture of statewide data, rates of IV tPA improved significantly in Massachusetts from 2005 to 2008 in association with a state Primary Stroke Service designation program. Further studies are needed to confirm that treatment disparities exist for older acute ischemic stroke patients and that the rates of thrombolysis have increased above and beyond secular trends.
- Published
- 2012
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18. Combining acute diffusion-weighted imaging and mean transmit time lesion volumes with National Institutes of Health Stroke Scale Score improves the prediction of acute stroke outcome.
- Author
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Yoo AJ, Barak ER, Copen WA, Kamalian S, Gharai LR, Pervez MA, Schwamm LH, González RG, and Schaefer PW
- Subjects
- Adult, Aged, Aged, 80 and over, Brain physiopathology, Brain Ischemia physiopathology, Diffusion Magnetic Resonance Imaging, Female, Humans, Image Processing, Computer-Assisted, Male, Middle Aged, National Institutes of Health (U.S.), Predictive Value of Tests, Prognosis, ROC Curve, Severity of Illness Index, Statistics, Nonparametric, Stroke physiopathology, Time Factors, Treatment Outcome, United States, Brain pathology, Brain Ischemia pathology, Stroke pathology
- Abstract
Background and Purpose: The purpose of this study was to determine whether acute diffusion-weighted imaging (DWI) and mean transit time (MTT) lesion volumes and presenting National Institutes of Health Stroke Scale (NIHSS) can identify patients with acute ischemic stroke who will have a high probability of good and poor outcomes., Methods: Fifty-four patients with acute ischemic stroke who had MRI within 9 hours of symptom onset and 3-month follow-up with modified Rankin scale were evaluated. Acute DWI and MTT lesion volumes and baseline NIHSS scores were calculated. Clinical outcomes were considered good if the modified Rankin Scale was 0 to 2., Results: The 33 of 54 (61%) patients with good outcomes had significantly smaller DWI lesion volumes (P=0.0001), smaller MTT lesion volumes (P<0.0001), and lower NIHSS scores (P<0.0001) compared with those with poor outcomes. Receiver operating characteristic curves for DWI, MTT, and NIHSS relative to poor outcome had areas under the curve of 0.889, 0.854, and 0.930, respectively, which were not significantly different. DWI and MTT lesion volumes predicted outcome better than mismatch volume or percentage mismatch. All patients with a DWI volume >72 mL (13 of 54) and an NIHSS score >20 (6 of 54) had poor outcomes. All patients with an MTT volume of <47 mL (16 of 54) and an NIHSS score <8 (17 of 54) had good outcomes. Combining clinical and imaging thresholds improved prognostic yield (70%) over clinical (43%) or imaging (54%) thresholds alone (P=0.01)., Conclusions: Combining quantitative DWI and MTT with NIHSS predicts good and poor outcomes with high probability and is superior to NIHSS alone.
- Published
- 2010
- Full Text
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