Katarzyna Snarska

Hyperglycemia and diabetes have different impacts on outcome of ischemic and hemorrhagic stroke

Introduction Stroke is the second leading cause of long-term disability and death worldwide. Diabetes and hyperglycemia may impact the outcome of stroke. We examined the impact of hyperglycemia and diabetes on in-hospital death among ischemic and hemorrhagic stroke patients. Material and methods Data from 766 consecutive patients with ischemic (83.15%) and hemorrhagic stroke were analyzed. Patients were classified into four groups: ischemic and diabetic; ischemic and non-diabetic; hemorrhagic and diabetic; and hemorrhagic and non-diabetic. Serum glucose was measured on admission at the emergency department together with biochemical and clinical parameters. Results Mean admission glucose in ischemic stroke patients with diabetes was higher than in non-diabetic ones (p < 0.001) and in hemorrhagic stroke patients with diabetes than in those without diabetes (p < 0.05). Mean admission glucose in all patients who died was significantly higher than in patients who survived. In multivariate analysis, the risk factors for outcome in patients with ischemic stroke and without diabetes were age, admission glucose level and estimated glomerular filtration rate (eGFR), while in diabetics they were female gender, admission glucose level, and eGFR; in patients with hemorrhagic stroke and without diabetes they were age and admission glucose levels. The cut-off value in predicting death in patients with ischemic stroke and without diabetes was above 113.5 mg/dl, while in diabetics it was above 210.5 mg/dl. Conclusions Hyperglycemia on admission is associated with worsened clinical outcome and increased risk of in-hospital death in ischemic and hemorrhagic stroke patients. Diabetes increased the risk of in-hospital death in hemorrhagic stroke patients, but not in ischemic ones.

Renal Function Predicts Outcomes in Patients with Ischaemic Stroke and Haemorrhagic Stroke.

Background/Aims: We evaluated renal function and the impact of renal function on in-hospital outcomes in patients with ischaemic and haemorrhagic stroke. Methods: We collected data from 766 patients with stroke; 637 (83.2 %) with ischaemic and 129 with haemorrhagic one. Results: The mean serum creatinine on admission in patients with both types of stroke, who died, was significantly higher than in those who survived. Multivariate analysis showed that independent predictors of mortality in patients with ischaemic stroke were: ischemic heart disease or prior myocardial infarction, diabetes, admission glucose and eGFR on admission. Also, multivariate analysis showed that independent predictors of mortality in patients with haemorrhagic stroke were: age and admission glucose. Conclusions: Patients with haemorrhagic stroke, in particular with acute kidney injury during hospitalisation had significantly worse outcomes than patients with ischaemic stroke. Assessment of kidney function is prerequisite to employ the necessary measures to decrease the risk of in-hospital mortality among patients with acute stroke. Appropriate approach to patients with renal dysfunction (adequate hydration, avoidance of nephrotoxic drugs, drug dose adjustment etc) should be considered as preventive and therapeutic strategies in the management of acute stroke.

Prevalence of multiple sclerosis in Poland

OBJECTIVE The prevalence of multiple sclerosis (MS)was previously unknown in Poland. The aim of this study was to determine the prevalence of MS in Poland. METHODS MS prevalence was determined on the basis of data from the Swietokrzyskie (central Poland) and Podlaskie (northeastern Poland) Voivodeships. The area population on the prevalence study day (December 31, 2013) was 1,268,239 (649,007 women; 619,232 men) in central and 1,195,625 (612,979 women; 582,646 men) in northeastern Poland. RESULTS The overall crude prevalence rate of confirmed MS patients was 109.1/100,000 (95% confidence interval[CI]103.5-115.0) in the Swietokrzyskie and 108.7/100,000 (95% CI 103.0-114.7) in the Podlaskie Voivodeships. A significantly higher prevalence was recorded in females (149.8/100,000, 95% CI 140.6-159.3 vs. 142.4/100,000, 95% CI 133.3-152.0) than in males (66.5/100,000, 95% CI 60.4-73.1 vs.57.8/100,000, 95% CI 52.0-64.2)(p < 0.001). Age-adjusted rates for the Polish Standard Population were the same in both regions (110.3/100,000 (95% CI 104.6-116.1) vs.110.9/100,000 (95% CI 105.1-117.1)) and for the European Standard Population did not different statistically between both voivodeships (103.9/100,000 (95% CI 98.6-109.5) vs.108.5/100,000 (95% CI 102.7-114.5)). CONCLUSION This is the first data that obtained the level of MS prevalence in Poland and confirmed that Poland is a high-risk area for multiple sclerosis.

Analiza jakości życia pacjentów po udarze niedokrwiennym mózgu

Introduction . In highly developed countries, apart from heart attack and malignancies, stroke is the third leading cause for death and one of the major causes for disability or worsening of self-reliance, and consequently the quality of life for adults. Aim . To evaluate the quality of life and its conditions in patients who suffered an ischemic stroke. Material and Methods . The study involved 100 patients who suffered an ischemic stroke of the brain at the Department of Neurological Rehabilitation of the Regional Hospital in Bialystok. A cutom-designed self-assessment questionnaire, the WHOQOL BREF Scale for assessing the quality of life, the Barthel Scale, and the Geriatric Depression Scale were used as research tools. Results . 40 (40%) women and 60 (60%) men in the age range between 36 and 86 years old (mean age 69±9.93). The mean level of the overall quality of life in the study group of ischemic stroke of the brain patients was at 3.23±0.81, while self-assessment of health was worse than that. The somatic domain was rated as the worst by the elderly. Patients with diabetes, hypertension, and heart disease have assessed their quality of life to be worse. Patients in a fair functional condition rated their quality of life and self-assessed health as better. Conclusions . The overall quality of life of patients after ischemic stroke of the brain was at an average level, both under objective and subjective assessment, and was correlated with functional fitness, worsening of depressive disorders, risk factors, education, and gender. (JNNN 2017;6(2):44–54)

Jakość życia pacjentów ze stwardnieniem rozsianym

Introduction. Multiple sclerosis is a chronic autoimmune disease of the central nervous system. It changes patients’ lives and their families, makes tough choices, loses hope and desire to fight against the disease, reduces the quality of life. Aim. The aim of the study was assessment of quality of life of patients with multiple sclerosis and the factors which can influence this assessment. Material and methods. The study was conducted using a questionnaire, designed for this study and the standard WHOQOL-BREF and Extended Disability Status Scale (EDSS), among 100 patients with multiple sclerosis. Results. In the study group was 32 men (32%) and 68 women (68%). The mean age of patients was 10.3 ± 41.9 years. The mean disease duration was 11.1 ± 8,9lat. The mean EDSS was 2.7 ± 2.0. Overall quality of life and general health assessment in the questionnaire WHOQOL was 3.4 ± 0.9, and general health assessment was equal to 2.9 ± 0.8. Conclusions. Malfunction of patients increased with age of the patient, duration of illness, number of views, and decreased as a result of hospitalization and the appropriate treatment and affect the operation in all areas. The decrease in the overall quality of life in patients with multiple sclerosis affect of illness, number of throws and the scale of motor failure and did not affect her diagnosis, the treatment and age of onset.

Uwarunkowania wydolności funkcjonalnej chorych z dyskopatią lędźwiowo-krzyżową poddanych leczeniu zachowawczemu

Introduction . Back pain has now become a disease of our civilization. One of the reasons being the herniated nucleus pulposus, which often leads to a restriction in various aspects of the bio-psycho-physical functioning. These disorders intensify the pain discomfort which occurs. Aim . Assessment of functional capacity in the case of patients with lumbar discectomy-cross treated conservatively and the evaluation of the lumbosacral disc disease impact on the quality of life. Material and Methods . The study included 181 patients, two days before discharge from hospital, hospitalized in the Department of Neurological Clinic, at the Medical University of Bialystok in the period from June to December 2013 due to lumbosacral disc disease. The research tools included: our questionnaire, the WHOQOL-BREF Scale assessing the quality of life, as well as the Visual Analogue Scale — VAS. Results . The group of respondents included 102 women (56.4%) and 79 men (43.6%) aged 24–76 years (mean age 48.3±12.7 years). The overall quality of life for the studied group of patients with lumbosacral discopathy ranged at the level of 3.32±0.83, which indicates patients’ average satisfaction with their quality of life. Self-assessment of health condition on scale from 1 to 5 ranged 2.83±0.99, which meant average satisfaction with health condition. The respondents working mentally better assess the physical realm, while those with higher education better evaluated the quality of their lives. Lonely people worse assessed the psychological sphere than those married or not-married. Feeling the pain discomfort of strong and maximum intensity significantly affected patients’ assessment regarding the physical sphere and resulted in the decrease of the quality of life. Conclusions . 1. There is a relationship between the functional capacity of patients with lumbosacral discopathy and the type of work performed, marital status, the level of education, and risk factors. 2. Patients with lumbosacral discopathy of the spine, especially those feeling strong pain, have a reduced quality of life, particularly in the field of physical fitness. (JNNN 2015;4(1):4–12)