Stroke: People at Risk and its Consequences

"Stroke" is a the common term for an "acute cerebral infarction", which means injury with loss of neurons of the brain tissue. There are 2 main causes for stroke: the obstruction of one of the arteries that feeds blood to the brain and bleeding from blood vessels in the brain. Both situations are very serious and can lead to loss of brain cells, loss of physical or intellectual function and death.

The people who are at risk for stroke are diabetics, people with high blood pressure, smokers, obese and patients with high cholesterol. If someone already has had a stroke he or she has a higher risk to have another one. In addition, for an individual who has coronary artery disease or peripheral artery disease, there is an increased risk of stroke. Atrial fibrillation (AF; an irregular heart beat) increases the chances of stroke, that is the reason why many persons with AF have to take an anticoagulant (blood thinner). Finally, there are genetic conditions that can increase the risk of stroke. Examples of this are sickle cell disease and increased coagulation disorders such as Factor V Leyden.

Stroke can be a devastating condition for the individual and it is definitely a major public health problem¹ due to the immense cost it represents. It accounts for approximately 320 billion dollars every year in healthcare direct and indirect expenditures². The patient has to deal with loss of function, which could be physical  (paralysis of arms, legs and/or face), and intellectual deficits like the loss memory and inability to speak. The recovery from stroke is usually slow and involves the use different levels of rehabilitation services.

References

1. Hankey GJ. StrokeHow Large a Public Health Problem, and How Can the Neurologist Help?. Arch Neurol. 1999;56(6):748-754. 

2. Mozaffarian D, Benjamin EJ, Go AS, et al. Heart Disease and Stroke Statistics-2016 Update: A Report From the American Heart Association. Circulation. 2016;133:e38-e360.

Marco A. Ramos MD

Crohn’s Disease and its Complications

Crohn’s disease is an inflammatory disease of the bowel that can affect any part of the intestinal tract, from the mouth to the anus. It symptoms, may include abdominal pain, diarrhea, bloody stools, abdominal distention, and intestinal malabsorption.  It can also cause extra intestinal symptoms, such as fever, joint pain, skin rashes, eye problems and generalized fatigue.  Currently, it affects 0.32 percent of people in Europe and North America and its prevalence has been increasing over the past decades.

This condition is caused by a combination of genetic and environmental factors. There are several genes known to be strongly associated with the presence of Crohn’s disease¹. In addition, an environmental risk factors such as tobacco exposure, seems to be equally important. It is known that tobacco smokers are twice as likely to be affected by this entity than non smokers².

There are various degrees of severity for Crohn’s disease and it can be complicated by intestinal obstruction, fistula formation, gastrointestinal bleeding, intestinal perforation and abscesses. There is a higher risk of cancer in the areas of inflammation caused by Crohn’s disease. Due to the inflammatory nature of the condition, food malabsorption can develop leading to weight loss and malnutrition.

The treatment of Crohn’s disease has to include lifestyle changes such as stopping smoking and following dietary recommendations such as low dietary fiber, low casein and gluten free diet. In addition to this, there are certain medications that may be used for the exacerbations of the disease, such as steroids and some long term medications like methotrexate and biological therapies. At this point, the advise of a gastroenterologist is the most valuable tool.

Marco A. Ramos MD

References

1. Genome-wide association defines more than thirty distinct susceptibility loci for Crohn's disease. Barrett JC, Hansoul S, Dan L. Nicolae DL, et al. Nat Genet. 2008; 40(8): 955–962

2. Tobacco and IBD: Relevance in the understanding of disease mechanisms and clinical practice. Cosnes J. Best Pract Res Clin Gastroenterol. 2004; 8(3):481-96