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Clares de Andrade JB, Mohr JP, Lima FO, de Carvalho JJF, Maia Barros LC, Pontes-Neto OM, de Abreu GQ, Silva GS. In-Hospital Aspirin Dose as a Risk Factor for Hemorrhagic Transformation in Patients Not Treated With Thrombolysis. Neurologist 2023; 28:287-294. [PMID: 37027173 DOI: 10.1097/nrl.0000000000000486] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/08/2023]
Abstract
BACKGROUND Aspirin is widely used as secondary prophylaxis for acute ischemic stroke. However, its influence on the risk of spontaneous hemorrhagic transformation (HT) is still unclear. Predictive scores of HT have been proposed. We hypothesized that an increased aspirin dose might be harmful in patients at a high risk of HT. This study aimed to analyze the relationship between in-hospital daily aspirin dose (IAD) and HT in patients with acute ischemic stroke. METHODS We conducted a retrospective cohort study of patients admitted to our comprehensive stroke center between 2015 and 2017. The attending team defined IAD. All included patients underwent either computed tomography or magnetic resonance imaging within 7 days of admission. The risk of HT was assessed using the predictive score of HT in patients not undergoing reperfusion therapies. Regression models were used to evaluate the correlations between HT and IAD. RESULTS A total of 986 patients were included in the final analysis. The prevalence of HT was 19.2%, and parenchymatous hematomas type-2 (PH-2) represented 10% (n=19) of these cases. IAD was not associated with HT ( P =0.09) or PH-2 ( P =0.06) among all patients. However, in patients at a higher risk for HT (patients not undergoing reperfusion therapies ≥3), IAD was associated with PH-2 (odds ratio 1.01,95% CI 1.001-1.023, P =0.03) in an adjusted analysis. Taking 200 versus 300 mg aspirin was protective against PH-2 (odds ratio 0.102, 95% CI 0.018-0.563, P =0.009). CONCLUSION An increased in-hospital aspirin dose is associated with intracerebral hematoma in patients at a high risk of HT. Stratifying the risk of HT may lead to individualized daily aspirin dose choices. However, clinical trials on this topic are required.
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Affiliation(s)
| | - Jay P Mohr
- Columbia University, Doris and Stanley Tananbaum Stroke Center, New York, NY
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de Andrade JBC, Mohr JP, Lima FO, Barros LCM, de Meira GAR, Silva Junior EAB, Robles AC, Silva GS. Predictors of congruency between clinical and radiographic Oxfordshire Community Stroke Project Classification subtypes. J Clin Neurosci 2023; 115:47-52. [PMID: 37487447 DOI: 10.1016/j.jocn.2023.07.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Revised: 07/13/2023] [Accepted: 07/18/2023] [Indexed: 07/26/2023]
Abstract
BACKGROUND The Oxfordshire Community Stroke Project (OCSP) classification has been widely used to assess ischemic stroke patients based on clinical characteristics alone. However, the correlation between the clinical presentation evaluated using OCSP and imaging findings is yet to be determined. Our study aimed to describe the baseline characteristics of the OCSP subtypes of patients admitted with ischemic stroke and evaluate the predictors of the relationship between clinical and neuroimaging findings. METHODS Patients with a confirmed diagnosis of ischemic stroke admitted to a comprehensive stroke center in Brazil between February 2015 and October 2017 were eligible for the study. All participants underwent computed tomography (CT) at admission and follow-up neuroimaging within seven days, per the institutional protocol. Trained staff classified patients according to the OCSP at hospital admission. The radiographic OCSP classification was retrospectively assessed based on the last follow-up neuroimaging by investigators unaware of the clinical classification. RESULTS The overall agreement rates ranged from 65.5% to 88.7%. Lower NIHSS scores, absent hyperdense MCA sign, higher ASPECTS, and absent brainstem symptoms were related to a higher risk of misclassification. Treatment with intravenous tPA was associated with reclassification in patients with total anterior circulation syndrome. For predicting radiographic posterior circulation involvement, vertigo (OR 2.9, 95% CI 1.7-5.1, p < 0.001) and brainstem symptoms (OR 35, 95% CI 20.5-60.2, p < 0.001) were directly associated with correct classification, but motor and higher cerebral function were not correlated. CONCLUSION The clinical OCSP classification presented good congruency rates with the neuroimaging findings. However, patients with lacunar syndromes are often misclassified when radiological criteria are considered.
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Affiliation(s)
- Joao Brainer Clares de Andrade
- Universidade Federal de Sao Paulo, Rua Napoleao de Barros, 715, Sao Paulo, SP, Brazil; Columbia University, Doris and Stanley Tananbaum Stroke Center, Neurological Institute of New York, 710 W 168th St., 6th Floor, NI 614, 10032 New York City, NY, USA; Centro Universitario Sao Camilo, Av Nazare, 1501, São Paulo, São Paulo, Brazil.
| | - Jay P Mohr
- Columbia University, Doris and Stanley Tananbaum Stroke Center, Neurological Institute of New York, 710 W 168th St., 6th Floor, NI 614, 10032 New York City, NY, USA.
| | | | | | | | | | | | - Gisele Sampaio Silva
- Universidade Federal de Sao Paulo, Rua Napoleao de Barros, 715, Sao Paulo, SP, Brazil
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de Andrade JBC, Mohr JP, Costa FFM, Malheiros JEF, Ikeda RK, Barros LCM, Lima FO, Pontes-Neto OM, Merida KLB, Franciscato L, Marques MS, Silva GS. Predicting hemorrhagic transformation in posterior circulation stroke patients not treated with reperfusion therapies. J Clin Neurosci 2022; 103:78-84. [PMID: 35843184 DOI: 10.1016/j.jocn.2022.07.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Revised: 07/02/2022] [Accepted: 07/09/2022] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Posterior Circulation (PC) stroke represents one-fifth of all ischemic strokes, with peculiar physiological characteristics. Hemorrhagic Transformation (HT) is a dreaded complication among stroke patients. Many predictive scores of this complication have been proposed, but none is designed specifically for PC stroke patients - therefore, patients who are not eligible for reperfusion therapies (RT) represent about 80% of hospitalized cases. We propose a scoring system to assess the HT risk in PC stroke patients not submitted to RT. METHODS We retrospectively evaluated data of patients diagnosed with PC stroke not treated with RT from 5 Comprehensive Stroke Centers (four in Brazil, 1 in the US) from 2015 to 2018. All patients underwent CT scan or MRI at admission and a follow-up neuroimaging within seven days. Independent variables identified in a logistic regression analysis were used to produce a predictive grading score. RESULTS We included 952 patients in the final analysis. The overall incidence of HT was 8.7%. Male gender (1 point), NIH Stroke Scale at admission ≥ 5 points (1), blood glucose at admission ≥ 160 mg/dL (1), and cardioembolism (2) were independently associated with HT. The AUC of the grading score (0 to 5 points) was 0.713 (95% CI 0.65-0.78). Subjects with a score ≥ 3 points had an OR of 4.8 (95% CI 2.9-7.9, p < 0.001) for HT. CONCLUSIONS Our score has good accuracy in identifying patients at higher risk of HT. This score may be useful for evaluating secondary prevention and stratifying patients in the context of even clinical trials.
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Affiliation(s)
- Joao Brainer Clares de Andrade
- Universidade Federal de São Paulo, Sao Paulo, Brazil; Columbia University, Doris and Stanley Tananbaum Stroke Center, USA; Centro Universitario São Camilo, São Paulo, Brazil.
| | - Jay P Mohr
- Columbia University, Doris and Stanley Tananbaum Stroke Center, USA
| | | | | | | | | | | | | | | | | | | | - Gisele Sampaio Silva
- Universidade Federal de São Paulo, Sao Paulo, Brazil; Hospital Israelita Brasileiro Albert Einstein, São Paulo, Brazil
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Brainer Clares de Andrade J, Mohr JP, Oliveira Lima F, José de Freitas Carvalho J, Andre Castro de Oliveira R, Coelho Maia Barros L, Sampaio Silva G. Predictors of hemorrhagic transformation differences between patients treated or not with reperfusion therapy. J Clin Neurosci 2022; 101:9-15. [DOI: 10.1016/j.jocn.2022.04.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Revised: 02/08/2022] [Accepted: 04/23/2022] [Indexed: 11/25/2022]
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Andrade JBCD, Mohr JP, Ahmad M, Lima FO, Barros LCM, Silva GS. Accuracy of predictive scores of hemorrhagic transformation in patients with acute ischemic stroke. Arq Neuropsiquiatr 2022; 80:455-461. [PMID: 35293556 DOI: 10.1590/0004-282x-anp-2021-0091] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Accepted: 06/07/2021] [Indexed: 11/22/2022]
Abstract
BACKGROUND Hemorrhagic transformation (HT) is a complication in ischemic strokes, regardless of use of reperfusion therapy (RT). There are many predictive scores for estimating the risk of HT. However, most of them include patients also treated with RT. Therefore, this may lead to a misinterpretation of the risk of HT in patients who did not undergo RT. OBJECTIVE We aimed to review published predictive scores and analyze their accuracy in our dataset. METHODS We analyzed the accuracy of seven scales. Our dataset was derived from a cohort of 1,565 consecutive patients from 2015 to 2017 who were admitted to a comprehensive stroke center. All patients were evaluated with follow-up neuroimaging within seven days. Comparison of area under the curve (AUC) was performed on each scale, to analyze differences between patients treated with recombinant tissue plasminogen activator (tPA) and those without this treatment. RESULTS Our dataset provided enough data to assess seven scales, among which six were used among patients with and without tPA treatment. HAT (AUC 0.76), HTI (0.73) and SEDAN (0.70) were the most accurate scores for patients not treated with tPA. SPAN-100 (0.55) had the worst accuracy in both groups. Three of these scores had different cutoffs between study groups. CONCLUSIONS The predictive scores had moderate to fair accuracy for predicting HT in patients treated with tPA. Three scales were more accurate for predicting HT in patients not treated with tPA. Through standardizing these characteristics and including more patients not treated with RT in a large multicenter series, accurate predictive scores may be created.
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Affiliation(s)
| | | | - Muhammad Ahmad
- CMH Lahore Medical College and Institute of Dentistry, Lahore, Pakistan
| | - Fabricio Oliveira Lima
- Hospital Geral de Fortaleza, Fortaleza CE, Brazil.,Universidade de Fortaleza, Fortaleza CE, Brazil
| | | | - Gisele Sampaio Silva
- Universidade Federal de São Paulo, São Paulo SP, Brazil.,Hospital Israelita Albert Einstein, São Paulo SP, Brazil
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Braga FNHF, das Chagas Medeiros MM, Junior ABV, de Sousa Lima ME, Barros LCM, Pontes MX, de Sousa Lima AW, Fernandes PFCBC. Proteinuria and serum creatinine after 12 months of treatment for lupus nephritis as predictors of long-term renal outcome: a case-control study. Adv Rheumatol 2022; 62:2. [PMID: 34983697 DOI: 10.1186/s42358-021-00232-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2021] [Accepted: 12/21/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Lupus nephritis (LN) is a major source of morbidity and mortality in patients with systemic lupus erythematosus (SLE), with 10-25% of patients progressing to end-stage renal disease (ESRD). OBJECTIVE This study aims to elucidate the predictive capabilities of 24-h proteinuria (24PTU) and serum creatinine (sCr) after 12 months of treatment with respect to long-term renal outcomes in LN in a single-center cohort of LN patients. METHODS A retrospective analysis was performed on 214 patients diagnosed with LN followed in our center. Values of 24PTU and sCr were assessed at baseline and after 3, 6 and 12 months, and after 5 years and/or the last evaluation. Chronic kidney disease (CKD) was defined as an estimated glomerular filtration rate (eGFR) < 60 mL/min/1.73 m2 for 3 months or longer. End-stage renal disease (ESRD) was defined as the need for permanent dialysis. Receiver operating characteristics curves (ROC) were used to test the best cut-off value of 24PTU and sCr at 12 months who predict bad long-term renal outcomes. RESULTS: The mean follow-up period was 11.2 ± 7.2 years. The best cut-off values for 24PTU and sCr as predictor of CKD were, respectively, 0.9 g/24 h and 0.9 mg/dL. ROC curve for 24PTU had a slightly lower performance than ROC curve for sCr as predictor for CKD (PTU AUC = 0.68; sCr AUC = 0.70), but sensitivity and specificity were better for 24PTU (24PTU: sensitivity = 63.5%, specificity = 71.2%; sCr: sensitivity = 54.8%, specificity = 75.3%). When the outcome was ESRD the best cut-off points were 0.9 g/24hs and 1.3 mg/dL for 24PTU and sCr, respectively, and the curve performance was better for 24PTU (PTU AUC = 0.72; sCr AUC = 0.61). CONCLUSIONS In this ethnically diverse population with LN followed for a long time (> 10 years), levels of 24PTU > 0.9/day at 12 months was a good predictor of bad long-term renal outcome. The serum creatinine > 0.9 mg/dL and > 1.3 mg/dL at 12 months were also good predictors of CKD and ESRD, respectively. Patients with 24PTU < 0.9 g/day and sCr < 1.3 mg/dL at 12 months are not likely to develop ESRD because of the high negative predictive values (NPV) (93.2% and 82%). 24PTU and sCr are relevant as components for a treat-to-target strategy for LN treatment, since their high NPV corroborates their importance as good predictors of long-term renal outcome.
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Affiliation(s)
| | - Marta Maria das Chagas Medeiros
- Hospital Universitário Walter Cantídio, Universidade Federal Do Ceará, Rua Capitão Francisco Pedro 1290, Rodolfo Teófilo, Fortaleza, Ceará, Brazil
| | - Antonio Brazil Viana Junior
- Hospital Universitário Walter Cantídio, Universidade Federal Do Ceará, Rua Capitão Francisco Pedro 1290, Rodolfo Teófilo, Fortaleza, Ceará, Brazil
| | - Matheus Eugênio de Sousa Lima
- Centro de Ciências da Saúde, Universidade Estadual Do Ceará, Avenida Dr. Silas Munguba, 1700, Itaperi, Fortaleza, Ceará, Brazil
| | - Levi Coelho Maia Barros
- Centro de Ciências da Saúde, Universidade Estadual Do Ceará, Avenida Dr. Silas Munguba, 1700, Itaperi, Fortaleza, Ceará, Brazil
| | - Marcelo Ximenes Pontes
- Centro de Ciências da Saúde, Universidade Estadual Do Ceará, Avenida Dr. Silas Munguba, 1700, Itaperi, Fortaleza, Ceará, Brazil
| | - Allysson Wosley de Sousa Lima
- Centro de Ciências da Saúde, Universidade Estadual Do Ceará, Avenida Dr. Silas Munguba, 1700, Itaperi, Fortaleza, Ceará, Brazil
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Barros LCM, Lima MEDS, Pereira RMM, Vasconcelos LAA, Rabelo WC. Juvenile lupus, cytomegalovirus infection and cardiac tamponade: case report. ACTA ACUST UNITED AC 2021; 40:e2020291. [PMID: 34495276 PMCID: PMC8431997 DOI: 10.1590/1984-0462/2022/40/2020291] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Accepted: 12/27/2020] [Indexed: 11/21/2022]
Abstract
Objective: To describe a rare case of cardiac tamponade in a pediatric patient with systemic lupus erythematosus (SLE) and cytomegalovirus (CMV) infection, and to discuss the relationship between these morbidities, the diagnostic approach, and the possible treatments. Case description: A 9-year-old girl presented to the emergency department with severe dyspnea, muffled heart sounds, jugular vein distention, hemodynamic instability, and intense pallor. She had previously been followed up at the outpatient clinic for a six-month history of mild respiratory distress, polyarthritis, fever, and various cutaneous manifestations. Doppler echocardiogram revealed pericardial effusion. The patient was submitted to pericardiocentesis followed by water seal pleuropericardial drainage, with no complications. The investigation continued, with fulfillment of clinical and laboratory SLE criteria plus CMV antigenemia of 15/200,000 cells. Medications to control CMV infection and SLE were then initiated, with good clinical and laboratory response. Comments: Pediatric SLE commonly manifests in a more severe form, accounting for high morbimortality. Cardiac tamponade could be one of the first manifestations of SLE, which can also be precipitated by infectious agents, such as CMV, leading to diagnostic confusion and misleading the treatment. Changes in therapeutics must also be considered in the presence of both conditions. This study presents a juvenile SLE case aggravated by a CMV infection with the unusual manifestation of cardiac tamponade.%
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Lima MEDS, Maia MR, Barros LCM, Vale TCB, Meneses Filho LRDS, Aires MAP. Prevalência do lúpus eritematoso cutâneo em centro dermatológico terciário do Brasil. Rev Fac Ciênc Méd Sorocaba 2021. [DOI: 10.23925/1984-4840.2020v22i1a8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
Abstract
Objetivo: Avaliar a situação epidemiológica do lúpus eritematoso sistêmico no estado do Ceará no ano de 2015. Método: Trata-se de um estudo retrospectivo quantitativo no qual foram analisados todos os registros das consultas médicas realizadas no Centro de Referência em Dermatologia Dona Libânia (CDERM), Fortaleza, Ceará, em 2015, por meio das variáveis: nome, sexo, idade, data da consulta, número do prontuário, diagnóstico presuntivo ou confirmado, outras afecções associadas e frequência do paciente no CDERM (se primeira vez ou retorno ao atendimento médico da instituição). Resultados: Dos 19.576 pacientes analisados, 320 foram diagnosticados com lúpus, representando prevalência de 1,63% no serviço, e desse número 185 foram diagnosticados com lúpus discoide. Conclusão: O lúpus cutâneo é uma doença de extrema importância e prevalência significativa em nosso meio, porém ainda carece de consistência de dados epidemiológicos, sendo necessários estudos multicêntricos e epidemiológicos maiores tanto no Ceará quanto no Brasil, para a adequada avaliação da prevalência dessa enfermidade.
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Abstract
The coronavirus SARS-CoV-2 pandemia is infecting millions of people and some studies relate conditions that might increase the risk of developing a fatal course for the disease, such as diabetes, cardiovascular diseases and obesity. In COVID-19 physiopathology, one of the main inflammation mechanisms is the "cytokine storm", causing a pro-inflammatory state, related to cardiac and pulmonary damage. There is also a less effective role of lymphocyte B and T in the humoral immunity due to the reduction of their proliferative response. The physiopathology of ASD (Autism Spectrum Disorder) involves several modifications at the genetic and at the immune level, such as the increase of inflammatory cytokines and abnormal immune response in several levels. We hypothesize that ASD could be a risk-factor as the other conditions are.
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Affiliation(s)
| | - Levi Coelho Maia Barros
- Centro de Ciências da Saúde, Curso de Medicina, Universidade Estadual do Ceará, Fortaleza, Brazil
| | - Gislei Frota Aragão
- Centro de Ciências da Saúde, Curso de Medicina, Universidade Estadual do Ceará, Fortaleza, Brazil; Faculdade de Medicina, Núcleo de Pesquisa e Desenvolvimento de Medicamentos, Universisade Federal do Ceará, Fortaleza, Brazil.
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Andrade JBC, Mohr JP, Lima FO, de Carvalho JJF, Barros LCM, Nepomuceno CR, Ferrer JVCC, Silva GS. The Role of Hemorrhagic Transformation in Acute Ischemic Stroke Upon Clinical Complications and Outcomes. J Stroke Cerebrovasc Dis 2020; 29:104898. [PMID: 32417239 DOI: 10.1016/j.jstrokecerebrovasdis.2020.104898] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Revised: 03/04/2020] [Accepted: 04/19/2020] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND AND PURPOSE Hemorrhagic transformation (HT) is a common neurological complication after ischemic stroke. The influence of symptomatic HT upon clinical outcomes post-stroke is well established, however, the role of asymptomatic HT upon prognosis is still unclear. We aimed to analyze the relationship between HT, clinical complications and outcomes in patients not submitted to reperfusion therapies (RT). METHODS We included 448 randomly selected patients admitted with acute ischemic stroke to a tertiary hospital stroke unit from 2015 to 2017. Patients submitted to RT were excluded. All patients were evaluated with computed tomography (CT) at admission and within 7 days from the initial CT. Patients with HT were divided into two groups: symptomatic and asymptomatic cases based on the ECASS II definition. A good clinical outcome was defined as a modified Rankin Scale (mRS) 0-2 at discharge. RESULTS A total of 95 patients (21.2%) had HT (51 asymptomatic and 44 symptomatic). Age, NIHSS at admission and symptomatic HT were associated with a higher risk of developing pneumonia and seizures during hospitalization. Symptomatic HT was also associated with a prolonged length of hospitalization and death and inversely associated with good clinical outcomes at discharge (OR 0.96, 95% CI 0.94-0.98, p<0.001). In an adjusted analysis, even asymptomatic HT was independently associated with worse clinical outcomes at discharge (mRS 4-6) (OR 5.99, 95% CI 1.83-19.58, p = 0.003). CONCLUSIONS Symptomatic HT is associated with a higher risk of clinical complications, prolonged hospitalization, death and worse clinical outcome at discharge. Furthermore, even patients with asymptomatic HT had a higher chance of worse clinical outcomes at discharge.
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Affiliation(s)
- Joao Brainer Clares Andrade
- Department of Neurology, Universidade Federal de Sao Paulo, Rua Napoleao de Barros, 715, Sao Paulo, SP 04039-001, Brazil; Columbia University, Doris and Stanley Tananbaum Stroke Center, USA.
| | - Jay P Mohr
- Columbia University, Doris and Stanley Tananbaum Stroke Center, USA.
| | | | | | | | | | | | - Gisele Sampaio Silva
- Department of Neurology, Universidade Federal de Sao Paulo, Rua Napoleao de Barros, 715, Sao Paulo, SP 04039-001, Brazil.
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Andrade JBCD, Mohr JP, Lima FO, Barros LCM, Nepomuceno CR, Portela LB, Silva GS. Predictors of hemorrhagic transformation after acute ischemic stroke based on the experts' opinion. Arq Neuropsiquiatr 2020; 78:390-396. [PMID: 32401833 DOI: 10.1590/0004-282x20200008] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Accepted: 01/10/2020] [Indexed: 11/22/2022]
Abstract
BACKGROUND Hemorrhagic transformation (HT) is a common complication after ischemic stroke. It may be associated to poor outcomes. Some predictors of HT have been previously identified, but there remain controversies. OBJECTIVE To describe the risk factors for HT more frequently reported by a panel of experts surveyed for this project. METHODS We sent a standard questionnaire by e-mail to specialists in Vascular Neurology from 2014 to 2018. Forty-five specialists were contacted and 20 of them responded to the invitation. Predictors cited by three or more specialists were included in a table and ranked by the frequency in which they appeared. A review of the literature looking for published predictive scores of HT was performed, comparing to the answers received. RESULTS The 20 responding specialists cited 23 different risk factors for HT. The most frequent factors in the order of citation were the volume of ischemia, previous use of antithrombotic medication, neurological severity, age, hyperglycemia at presentation, hypertension on admission, and cardioembolism. Most variables were also found in previously published predictive scores, but they were reported by the authors with divergences of frequency. CONCLUSION Although many studies have evaluated HT in patients with acute ischemic stroke, the published risk factors were neither uniform nor in agreement with those cited by the stroke specialists. These findings may be helpful to build a score that can be tested with the goal of improving the prediction of HT.
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Affiliation(s)
| | - Jay Preston Mohr
- Doris and Stanley Tananbaum Stroke Center, Columbia University, New York City, USA
| | | | | | | | | | - Gisele Sampaio Silva
- Vascular Neurology Department, Universidade Federal de São Paulo, São Paulo, SP, Brazil
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Barros LCM, Lima MEDS, Lima ASD, Nobre DGDM, Aires MAP. Prevalência da doença de Darier no estado do Ceará. Rev Med UFC 2019. [DOI: 10.20513/2447-6595.2019v59n1p30-33] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Objetivo: averiguar a situação epidemiológica da doença de Darier no estado do Ceará no ano de 2015. Metodologia: trata-se de um estudo retrospectivo quantitativo, no qual foram analisados todos os registros das consultas médicas realizadas no Centro de Referência em Dermatologia Dona Libânia (CDERM), Fortaleza, Ceará, em 2015, através das variáveis: nome, sexo, idade, data da consulta, número do prontuário, diagnóstico presuntivo ou confirmado e a frequência do paciente no CDERM. Resultados: dos 19.576 pacientes analisados, 33 pacientes foram diagnosticados com doença de Darier, representando uma incidência de 0,1685% no serviço, enquanto que na população cearense uma incidência de 1:270.000, aproximadamente. Dentre estes pacientes, 18 eram do sexo feminino e 15 do sexo masculino. A idade média dos pacientes foi de 40,66 anos. Conclusão: a menor prevalência da doença de Darier no estado do Ceará, em discordância com a literatura, no ano de 2015, poderia ser justificada por um subdiagnóstico da doença. O atraso na idade de diagnóstico corrobora para esta hipótese. Entretanto, estudos multicêntricos e epidemiológicos maiores, tanto no Ceará como no Brasil, serão necessários para uma adequada avaliação da prevalência desta doença.
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