International journal of stroke : official journal of the International Stroke Society
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The fluoxetine for motor recovery after acute ischemic stroke study was a double blind, placebo-controlled trial examining the effects of fluoxetine in patients five- to 10 days after an ischemic stroke. The study found motor improvement to 90 days poststroke, measured as the change in the Fugl-Meyer score, was significantly greater in the fluoxetine group as compared with the placebo group, and that this finding was significant after adjusting for depression. Patients randomized to fluoxetine also had less disability (modified Rankin Scale 0-2). ⋯ Stroke remains among the leading causes of human disability. Currently, a minority of patients can access approved reperfusion therapies, and among those so treated a substantial fraction derives limited benefit. Therapies that target restorative events have a time window measured in days-weeks and so hold the potential to help many patients with stroke.
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As a leading cause of severe disability and death, stroke places an enormous burden on the health care system in China. There are limited data on the pattern of current medical practice and quality of care delivery for stroke patients at the national level. ⋯ The China National Stroke Registry is a large-scale nationwide registry in China. Rich data collected from this prospective registry may provide the opportunity to evaluate the quality of care for stroke patients in China.
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Diabetes mellitus predicts an increased risk of stroke, and acute hyperglycemia during acute stroke predicts the presence of undiagnosed diabetes mellitus. Based on recent investigations, 28% of previously nondiabetic stroke or transient ischemic attack patients have undetected diabetes mellitus, and 29% have impaired glucose tolerance, while only 43% have normal glycemic control. ⋯ Secondary prevention of stroke is different in patients with diabetes mellitus and the detection of impaired glucose tolerance would ring alarm bells of impending diabetes mellitus and promote lifestyle changes. As screening with inexpensive oral glucose tolerance test would have a hit rate of one in three patients in revealing undetected diabetes mellitus and another one in three in revealing impaired glucose tolerance, it should be implemented in guidelines as an inexpensive test for monitoring stroke and transient ischemic attack patients.